The hemostatic derangements accompanying liver disease are complex and affect all aspects of hemostasis. Depressed levels of the major natural anticoagulants (NAs): Antithrombin (AT), protein C (PC), protein S (PS), and tissue factor pathway inhibitor (TFPI) were reported in advanced liver disease and this reduction correlated with the severity of liver disease. Recent evidence suggests that changes in the blood levels of NAs particularly, PS and PC, were found to be more sensitive to hepatocyte dysfunction than the conventional coagulation tests prothrombin time and activated partial thromboplastin time. Depressed levels of PS and PC were found even in the mildest forms of liver disease such as chronic viral hepatitis and its carrier state when the other coagulation tests and routine liver function tests were normal. This topic did not receive enough coverage and was not described in many recent publications. The current review provides an overview of the current understanding of the pathophysiology of the major anticoagulants; AT, PC, PS, and TFPI with a particular focus on their fluctuations in different types of liver disease. It also discusses the emerging important roles of these NAs as sensitive markers of liver disease.

Context: Oral anticoagulant therapy (OAT) is one of the most widely used therapies. Being on such regimens requires high degree of compliance and adequate knowledge to avoid serious complications. Aims: This study aims to assess compliance with and awareness about OAT among Saudi patients, and their willingness to use the point-of-care (POC) international normalized ratio (INR) testing devices for self-monitoring. Settings and Design: This cross-sectional study was conducted at a tertiary hospital in Riyadh, Saudi Arabia, over 6 months. Subjects and Methods: A face-to-face interview has been carried out for all patients based on the questionnaire carried out for all patients based on the questionnaire. Results were analyzed according to demographics, adherence, knowledge, and INR control. Statistical Analysis Used: Statistical Package for the Social Sciences version 19 software (SPSS Inc., Chicago, IL, USA) was used. Results: One hundred sixty-two patients were interviewed, of which females (69.1%) exceeded males (30.1%). Most of them were on warfarin (80.2%), received education by their physicians. In general, patients had poor knowledge and medium adherence (53.1%) (scored < 50%). About 24% of the poor knowledge group (PKG) were highly adherent compared to 14.5% of the fine knowledge group (FKG). However, 53.2% of FKG had a controlled INR where this percentage reduces to 27% in PKG. The most incorrect answered question in both groups was related to warfarin-drug-interactions (75.3%). The majority (74.7%) was eager to make use of the POC-INR devices. Conclusions: The participants' knowledge was generally poor but level of knowledge did not play a role in compliance. Regardless, an education program should be accommodated to help patients in improving their medication control and reducing clinical visits. The majority was willing to adopt (POC) INR devices that will certainly help them in managing their treatment and potentially reducing adverse clinical outcomes.

Background and Objectives: Minimal residual disease (MRD) assays for monitoring acute lymphoblastic leukemia (ALL) during treatment are defined as assays with a limit of detection of at least 0.01% leukemic blasts per mononuclear cells or total nucleated cells. Settings and Design: We retrospectively reviewed out experience at Dhahran Health Center in monitoring adult and pediatric ALL patients with a MRD assay based on immunophenotyping by flow cytometry with a level of detection of 0.01% leukemic blasts per mononuclear cells and compute Kaplan–Meier survival analysis for overall survival (OS) and relapse-free survival (RFS). We also demonstrated the incorporation of an estimated measurement uncertainty for the reported MRD values based on metrological principles. Methods: A retrospective review of all cases diagnosed with ALL from 2006 to 2012 was undertaken and after applying exclusion criteria, 26 cases were identified and patient chart review was done. Results: Although the Kaplan–Meier survival analysis for OS and RFS do demonstrate a statistically significant difference between MRD positive and negative patients, none of the pediatric ALL MRD positive cases have relapsed till now. Conclusions: The detection of MRD in ALL opens up the opportunity to intensify or alter treatment for patients with detectable levels by a highly sensitive assay before clinical relapse.

Background/Objectives: Neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios (NLR and PLR) were introduced as cheap and readily assessed biologic markers of subclinical inflammation. There are few studies that have evaluated NLR and PLR as prognostic markers of proteinuria in sickle cell anemia (SCA) patients. This study seeks to evaluate NLR and PLR in SCA patients with proteinuria, impaired kidney function and to ascertain whether there exist relationship between the leukocyte ratios and atherogenic index of plasma. Materials and Methods: The NLR, PLR, and atherogenic index were calculated from full blood count and lipid profile parameters determined from fasting blood specimens collected from 200 confirmed SCA patients and 100 control subjects with normal hemoglobin (Hb). Results: The NLR and PLR values were significantly higher (P < 0.001) in SCA patients compared with control subjects with normal Hb. Similarly, NLR and PLR values were significantly higher (P < 0.001) in SCA patients with proteinuria and those with impaired kidney function than without proteinuria and normal controls. A significantly positive association was observed between NLR and atherogenic index of plasma (AIP) in SCA patients with proteinuria (P < 0.05) and those with impaired kidney function (P < 0.02) while significant association was observed between PLR and AIP in SCA with impaired kidney function (P < 0.05). Conclusion: The leukocyte ratios may be useful as prognostic markers for the presence of proteinuria in SCA patients and impaired kidney function as well as cardiovascular risk event. The need to have reference cut-off values of NLR and PLR is hereby suggested to better identify those patients at risk in the management SCA patients.

Introduction: Hepatitis B virus (HBV) infection is one of the most prominent health threats worldwide. Hepatitis B exacerbation is a significant cause of morbidity and mortality in patients who are the candidates of cytotoxic, immunosuppressive therapy and hematopoietic stem cell transplantation (HSCT) in areas where chronic hepatitis B infection is endemic. Patient and Methods: This retrospective study was conducted in Bone Marrow Transplantation Unit. A total of 64 patients, who underwent autologous HSCT were retrospectively reviewed. Results: A total of 64 patients with median age of 57 (22–79) years and gender distribution of 66% (n = 42) males and 34% (n = 22) females, who underwent autologous HSCT were included in the study. Three patients who were identified as hepatitis B surface antigen (HBsAg) positive prior to the transplantation had autologous HSCT under lamivudine prophylaxis. HBV reactivation had occurred in one of these patients. Hepatitis B infection (reverse seroconversion) was identified in one of the two patients who were HBsAg negative and hepatitis B core antibody (anti-HBc) positive prior to the treatment via serologic tests performed due to transaminase increases observed on day 407 in one case and on day 222 in the other. Conclusion: HBsAg positivity constitutes an independent risk factor for HSCT. In addition, it is necessary to administer prophylaxis and/or be more cautious in HBsAg negative patients prior to the transplantation and those with antibody positivity as they are more likely to develop reverse seroconversion.

Intravenous immunoglobulin (IVIG) is increasingly being used in wide variety of auto-immune and inflammatory disorders. FDA has approved the use of IVIG in primary and secondary immune-deficiencies like Chronic Lymphoid leukemia, HIV infection, prevention of GVHD in bone marrow transplantation, ITP, Polymyositis and Kawasaki's disease, pemphigus vulgaris and Guillain barre syndrome and many other disorders.(1). Although they are generally considered safe however, thrombotic complications are being recognized more often in recent years including arterial and venous thrombosis after being used in wide range and extended spectrum of disorders, (2). We report a case of thrombotic stroke in a young adult patient who received IVIG for acute ITP and had no underlying risk factors for development of stroke.

Spontaneous hemoperitoneum as an initial presentation of chronic myeloid leukemia (CML) is rare and however if that occurs it is usually due to splenic hemorrhage. Corpus luteal hemorrhage which is common in child bearing women is a rare etiology of spontaneous hemoperitoneum in CML and it is rare in adolescent girls. We report an adolescent girl with CML presented with corpus luteal hemorrhage causing hemoperitoneum which to our best knowledge has never been reported before in literature. She was managed conservatively for hemoperitoneum and imatinib for CML. She is well with 1 year of follow-up now.