Patients with primary immune thrombocytopenia (ITP) from the Asia-Pacific region often exhibit characteristics distinct from those of patients from the West. Moreover, as the region itself is heterogeneous, the ITP landscape among individual Asia-Pacific countries can be diverse. The recently released international consensus report on ITP places new emphasis on ITP, but does not address the unique ITP landscape in the Asia-Pacific region, which is home to 60% of the world's population. In an attempt to characterize how the ITP landscape differs between the West and the Asia-Pacific region, an expert panel with representatives from Northeast Asia, Southeast Asia, and Australia was convened. Important differences were identified between the guidance provided in the international consensus report and experience in the Asia-Pacific region, namely diagnostic practices, incidence and approach to ITP secondary to H. pylori infection, systemic lupus erythematosus-related ITP, the use of bone marrow examination, initial treatment strategies, and the role of splenectomy, rituximab, and thrombopoietin receptor agonists.
Cytomegalovirus infection is ubiquitous but often remains asymptomatic in affected patients. Symptomatic cytomegalovirus infection usually occurs in immunocompromised patients--patients who are infected with the Human Immunodefi ciency Virus, have received organ transplantations, or are on immunosuppressive therapies. Cytomegalovirus colitis can present with abdominal pain, diarrhea and signifi cant per rectal blood loss. It is a rare entity in immunocompetent patients and can often be missed unless one has a high index of suspicion. We describe a case of CMV colitis in a 78-year-old patient with no known risk factors for immunosuppression who was admitted for respiratory diseases and then subsequently developed transfusion dependent lower gastrointestinal bleeding. She ultimately required surgical resection of her colon. A literature review on CMV colitis, its myriad manifestations and therapeutic outcomes was conducted, with particular emphasis on its occurrence in immunocompetent patients.
Stem cell transplants (SCT) are potentially life-saving procedures but the availability of such services is limited in the government sector in Malaysia. The cost and logistics of having SCT abroad are daunting. This paper outlined our experience in setting up a SCT unit in a private hospital and reporting on the first hundred cases done over a 4 and a half year period from 1999 to 2004. All cases of SCT were performed with peripheral blood stem cells and in 5 cases (5%) back- up marrow was necessary as <2X10^6 per kg of CD34 positive PBSC was harvested. Autologous SCT was performed on 66 cases for the following indications i.e. Non Hodgkin’s lymphoma (37), Acute myeloid Leukemia (13), multiple myeloma (10) and Hodgkin’s lymphoma (6). Thirty four allogeneic SCT were performed for AML (16), chronic myeloid leukemia (8), acute lymphoblastic leukemia (4), Non Hodgkin’s lymphoma (4), Myelodysplastic syndrome (1) and aplastic anaemia (1). Twenty of the allografts were conventional SCT while 14 had reduced intensity allografts. Transplant related mortality (TRM) was recorded in 4 cases (13.6%) of allogeneic SCT. Three of the deaths were sepsis related. No TRM was seen in autologous SCT. The direct medical cost (included stem cell harvest and the first 3 months post transplant care) of autologous SCT was a mean of US$ 16000 (ranged from US$ 9000 to US$ 20000) while allogeneic SCT cost a mean of US$ 25000 (ranged from US$ 20000 to US$ 60000). Our experiences indicated that SCT is feasible in a private medical center in a developing nation—the SCT results were comparable with established centers but with substantial cost saving as compared with SCT done abroad.
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