Expert review of hematology
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Intravenous (iv.) iron is now the recommended treatment for iron deficiency anemia if oral preparations have failed or in those undergoing hemodialysis. Iron isomaltoside is a new iv. iron preparation, licensed since 2009 in the UK and Europe. The iron is tightly bound within a nonionic isomaltoside carbohydrate matrix, as opposed to most other iv. iron preparations that use branched polymers to form a carbohydrate shell. ⋯ Currently, there remains limited data on efficacy, safety and cost-effectiveness. Although initial data are encouraging, they come from only three published small trials, thus restricting the conclusions that can be made. Future research needs to concentrate on comparative analyses with other iv. iron therapies.
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The introduction of new agents immunomodulatory drugs (IMiDs) and proteasome inhibitors has brought a major shift in therapeutic paradigm in the treatment of newly diagnosed and refractory multiple myeloma (MM). Thalidomide was the first immunomodulatory agent approved for use in myeloma. Although highly active, it is associated with considerable toxicity, particularly in older patients. ⋯ The pleiotropic antitumor effects of lenalidomide have translated into clinical efficacy in diseases other than MM. Pomalidomide is a highly potent third-generation IMiD that shares similar pharmacologic properties as thalidomide, with very promising activity in MM and myelofibrosis. This review summarizes the mechanisms of action and clinical activity of IMiDs in MM.
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Three diagnostic criteria for disseminated intravascular coagulation (DIC) have been established by the Japanese Ministry of Health, Labor and Welfare, the International Society on Thrombosis and Hemostasis (ISTH) and the Japanese Association for Acute Medicine. The diagnostic criteria involving global coagulation tests, such as the Japanese Ministry of Health, Labor and Welfare criteria and the ISTH overt diagnostic criteria, are first-generation DIC diagnostic criteria, those involving global coagulation tests and changes in these tests such as the Japanese Association for Acute Medicine criteria, are second-generation DIC diagnostic criteria, and those including non-overt DIC diagnostic criteria involving global coagulation tests, changes in these tests and hemostatic molecular markers will be the future (third-generation) DIC diagnostic criteria. ⋯ Therefore, the third generation of diagnostic criteria including hemostatic molecular markers is expected to be established. Standardization and the determination of adequate cutoff values should be required for each laboratory test.
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Invasive fungal disease is associated with increased morbidity and mortality in hematologic malignancy patients and hematopoietic stem cell transplant recipients. Timely recognition and treatment of invasive fungal diseases in these patients are essential and decrease mortality. ⋯ While conventional microbiological and histopathological methods are still needed for a definitive diagnosis of invasive fungal disease, new noninvasive diagnostic methods including serologic and molecular biomarkers are now available. These new diagnostic methods facilitate an early diagnosis of invasive fungal disease and allow for utilization of a pre-emptive treatment approach, which may ultimately lead to improved treatment outcomes and reduced toxicity.
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Hemorrhage remains one of the most common causes of early death in severely injured patients. It is also the most common preventable cause of death in this population. More than 80% of deaths in the operating room and nearly 50% in the first 24 h after injury are related to hemorrhagic shock. ⋯ However, the survival benefit of damage-control resuscitation and MT protocols is primarily in the first 24 h and is most impressive when these strategies are employed early. New scoring systems in conjunction with laboratory data have contributed to early objective identification of those patients requiring MT. Activating these protocols early and with an organized team approach is critical to achieving their full benefit.