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The article presents the results of studying the features of the endoscopic picture of acute rhinosinusitis in patients with anemia and neutropenia, who underwent hematopoietic stem cell transplantation (HSCT). The questions of the influence of the level of hemoglobin on the presence of hyperemia of the mucous membrane of the nasal cavity, as well as the influence of the level of neutrophils on the presence of pus in the exudate in rhinosinusitis, are being studied. The study was carried out based on the Clinic of the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology, and Transplantation. The study included 49 episodes of rhinosinusitis in HSCT recipients diagnosed in the period from day –7 to day +30 after transplantation. The control group included 46 patients with rhinosinusitis undergoing treatment at the otorhinolaryngology clinic. In the course of the study, the influence of the level of neutrophils on the presence of purulent discharge in rhinosinusitis was established. The threshold value, below which the chances of having pus in the exudate significantly decreased, was 2.6 x 109/l (sensitivity and specificity of the method – 81.6 and 76.1%, respectively). It was also found that hemoglobin level affects the presence of hyperemia of the nasal mucosa. It was shown that at a hemoglobin level less than 119 g/l, the odds of presence of hyperemia of the nasal mucosa significantly decreased (sensitivity 77.6%, specificity 95.5%). Thus, in patients with anemia and neutropenia, one should remember the likelihood of the absence of pus and hyperemia of the nasal mucosa in the presence of rhinosinusitis. These criteria should not be the main ones in such a group of patients, and the diagnosis should be based on the results of an X-ray examination and the presence of other symptoms.

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Introduction: Sinusitis is one of the most common infectious complications at the stages of hematopoietic stem cell transplantation. Diagnosis and treatment patients whith cytopenia often causes difficulties for otorhinolaryngologists. Objective: To analyze the possibility of puncture of the maxillary sinuses in patients whith cytopenia after hemopoietic stem cells transplantation. Materials and methods. The case histories of 350 patients whith rhinosinusitis, who received treatment at the Raisa Gorbacheva Memorial Research Institute of Children Oncology, Hematology and Transplantation from January 2017 to June 2018 were analyzed. Of these patients, 41 (11%) (11 – 62 y.o.) underwent puncture of the maxillary sinuses. The control group included 59 immunocompetent patients undergoing puncture treatment for sinusitis. Results: The clinical picture of sinusitis in patients with cytopenia was different from the classical one. In cases of severe anemia (<80 g/l), paleness of the mucous membranes of the nasal cavity prevailed; with extremely severe neutropenia (<0.5 x 109/l), and leukopenia (<1.0 x 109/l) in the vast majority of patients, the nasal discharge was mucopurulent. 10% patients with drug immunosuppression and agranulocytosis have pronounced edema and hyperemia of nasal soft tissues. In 19.5% patients, who underwent puncture, severe thrombocytopenia (<25 x 109/l) was observed. In 3 (7%) patients, significant bleeding was observed after puncture. In punctate we observed Str. Viridans (26.8%), Pseudomonas spp. (14.6%), and Klebsiella pneumonia (12.2%) of cases. Conclusion: Sinusitis with cytopenia is prone to atypical course. Symptoms in these conditions can vary from scanty to pronounced. Puncture of the maxillary sinuses in such patients can be performed according to indications.

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The objective: to assess the incidence and influence of platelets level on the hemorrhagic complications during percutaneous dilated tracheotomy (PDT) in patients with thrombocytopenia.Subjects and Methods. The study included 85 consecutive patients with varying degrees of thrombocytopenia at the stages of hematopoietic stem cell transplantation. The control group included 56 patients who underwent classical tracheotomy. The study group included 29 patients who underwent PDT (Griggs method). The operations were performed for prolonged artificial pulmonary ventilation. When the platelets level was below 20 × 109/L, platelet concentrate transfusion was performed before the operation.Results. The incidence of hemorrhagic complications in patients with thrombocytopenia during PDT was 13.8% (95% CI 9.13–18.45%). In open tracheotomy, the bleeding rate was 3.8% (95% CI 2.65–4.49%). These results are comparable to the incidence of hemorrhagic complications in patients with normal platelet counts. The influence of the platelet level on the presence of hemorrhagic complications in both groups was not established.Conclusion. Thrombocytopenia is not a contraindication to performing PDT. However, platelet concentrate transfusion should be performed in patients with platelet counts less than 20 × 109/L. An experienced team of anesthesiologists and endoscopists can reduce the incidence of other complications.

The article presents the results of a study of the prevalence of acute (exacerbation of chronic) otorhinolaryngological pathology at the stages of hematopoietic stem cell transplantation (HSCT). The frequency of the studied pathology was assessed at the stage of pre-transplant screening, at the stage before graft engraftment and at the stage after graft engraftment up to 180 days. The study included 1129 cases of HSCT performed at the Raisa Gorbacheva Memorial Research Institute of Pediatric Oncology, Hematology and Transplantation from January 2017 to December 2019. The median age of the patients was 27 years (min – 0,36, max – 73,22). Allogeneic HSCT was performed in 784 (69,4%) cases, autologous HSCT in 345 (30,6%) cases. The power of the study was 0,95. A comparative analysis using the Pearson χ2 criterion revealed that infectious complications were significantly more frequent with allo-HSCT than with auto-HSCT, both at the stage before engraftment (χ2 = 21.8 at p <0.0001) and at the stage after graft engraftment (χ2 = 224,78 at p < 0.0001). It was also shown that acute symptoms of rhinosinusitis prevailed at all stages of HSCT, reaching 5,3% (95% CI 5.0% – 5,6%) at the stage before transplantation, 3,01% (95% CI 2, 8% – 3,2%) at the stage before engraftment, and 8,13% (95% CI 7,67% – 8,60%) at the stage after engraftment. At the stage before engraftment, rhinosinusitis competed with the diagnosis of acute pharyngitis, with a frequency of 34 (36,17%) and 33 (35,11%), respectively. Acute rhinosinusitis, acute rhinitis, and strep throat were the most common diagnoses at all three stages assessed. The rest of the acute inflammatory otorhinolaryngological diagnoses were observed in less than 2% of cases each. Establishing the frequency of acute otorhinolaryngological pathology at the stages of HSCT; understanding the most relevant nosologies. This allows us to focus on further study of the factors of their development, prevention and treatment.