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Introduction: Abnormal uterine bleeding (AUK) is a term used for changes in menstrual bleeding pattern, duration, or amount. In adolescent girls, it is associated with the immature hypothalamo-pituitary-ovarian axis, bleeding disorders, infections, endocrine disorders, systemic diseases, vagina-cervix-uterus and problems related to the ovary and drugs. There are different approaches between different disciplines in this assessment. In our study, we aimed to share our results and contribute to the hematological approach to these cases by retrospectively evaluating the abnormal uterine bleeding examination and treated cases in Afyon Health Sciences University Department of Pediatric Hematology. Materials and Methods: Between July 2016 and September 2019, patients over 12 years admitted to the Afyonkarahisar University of Health Sciences Department of Pediatric Hematology who had hemoglobin value <12 grams/dL and 60-80 mL bleeding in normal menstrual period (3-6 pads/day or 10-15 pads/cycle), menstrual cycle lasting longer than 8 days, and menstrual cycle repeated more than 21-28 days were included in the study and their records were analyzed retrospectively. The demographic features, admittion complaints, consultations, treatments applied and the results were documented and evaluated. Results: A total of 39 subjects were enrolled in the study. The mean age of the patients was 16.2±1.5 (13.2-21.5), the mean age at menarche was 12.4±1.1 (8-14). Hb <8 g/dL in 53.8% (n=21) of patients, hb 8-10 g/dL in 23% (n=9) and 10-12 g/dL in 23% (n=9) and von Willebrand Type 1 was detected in one patient. Conclusion: Abnormal uterine bleeding is an important cause of anemia in adolescent girls. It is necessary to conduct investigations for etiology and bleeding disorders especially von Willebrand disease, in differential diagnosis. The communication of different disciplines and the knowledge of other disciplines about the approach to the subject for effective treatment of abnormal uterine bleeding plays an important role in decreasing hospital admissions and increasing the success of treatment. [ABSTRACT FROM AUTHOR]

Aims: Long term treatment with lithium has been suggested to cause prominent toxic effects on different organs and systems. We aimed to investigate the effect of lithium on liver, kidney, and thyroid functions and hematopoietic system in euthymic patients with bipolar mood disorder, who have been on lithium monotherapy. Methods: The medical charts of the bipolar patients from January 2009 to January 2011 were screened. Liver, kidney, and thyroid function test results and complete blood count parameters were recorded. The data of patients, who were under lithium monotherapy for three months or longer, were included in the study. Results: A total of sixty five patients were included in this study and 41.5% of the patients (n=27) were male and 58.5% (n=38) were female. All patients were diagnosed with Type I Bipolar Disorder. The mean age of the patients was 40.47±11.41; 41.84±12.49 years for females versus 38.88±9.61 years for males (p=0.313). The mean duration of illness was 16.70±9.86 years and the received mean lithium dose was 1160±274 mg/day. The duration of lithium therapy was 156.29±117.53 weeks (min: 12 max: 410); 139.26±130.20 weeks in males and 168.39±107.80 weeks in females (p=0.207). There were significant differences between genders for creatinine, uric acid, and creatinine levels (p<0.001, p<0.001, and p=0.034, respectively) and for hemoglobin, hematocrit, and MPV values (p<0.001, p<0.001, p=0.019, respectively). Hematocrit values of the 13,8% of women were below the reference range, however hematocrit values of male patients were between reference range (χ2=7.422, p=0.006). There were higher neutrophil levels in 47.7% of patients, thrombocytopenia in the 4.6% of patients, and thrombocytosis in the 4.6% of patients. There were no significant differences between gender according to average values of fT3 (p=0.173), fT4 (p=0.167), and TSH (p=0.170). Conclusion: Kidney and liver functions in patients with bipolar mood disorder, who have been on long term lithium monotherapy generally seemed to be in reference range, however some differences were observed in some patients. The side effects of lithium monotherapy on the different organs or systems were similar to reported findings in the literature. [ABSTRACT FROM AUTHOR]

Spontaneous subcapsular liver hematoma (SLH) is extremely rare. We report here a case of a 74-year-old male, with a rare complication of anticoagulant therapy. The patient was admitted to the emergency unit with complaints of pain in the right upper quadrant and respiratory distress. He had abnormal coagulation parameters with a prolonged prothrombin time and elevated INR value. Computed tomography (CT) scan showed a giant hematoma, measuring more than 18 cm in diameter, in the right lobe of the liver. Despite a two-months conservative treatment, abdominal complaints persisted and the liver hematoma eventually progressed in size. The patient underwent laparotomy, the capsule was opened and approximately 2 liters of hematoma was evacuated. His postoperative course was generally downhill. On the 22nd day of follow-up he died due to respiratory insufficiency and sepsis. Conservative management is the mainstay therapy for the non-ruptured SLH unless the patient's general condition worsens due to enlarging hematoma. SLH should be considered in the differential diagnosis in patients presenting with abdominal pain while receiving oral anticoagulants. [ABSTRACT FROM AUTHOR]

Atypical antipsychotics cause less frequently extrapyramidal system symptoms, neuroleptic malignant syndrome and hyperprolactinemia than typical antipsychotics. However hematological side effects such as leukopenia and neutropenia could occur during treatment with atypical antipsychotics. These side effects could lead to life threatening situations and the mortality rate due to drug related agranulocytosis is about 5-10%. There are several hypothesis describing the mechanisms underlying drug induced leukopenia and/or neutropenia such as direct toxic effects of these drugs upon the bone marrow or myeloid precursors, immunologic destruction of the granulocytes or supression of the granulopoiesis. Clozapine is the antipsychotic agent which has been most commonly associated with agranulocytosis. A nitrenium ion which is formed by the bioactivation of clozapine is thought to have an important role in the pathophysiogy of this adverse effect. Aside from clozapine, there are several case reports reporting an association between olanzapine, quetiapine, risperidone, ziprasidone, aripiprazole and leukopenia. We did not find any study or case report presenting amisulpride or sulpride related hematological side effects in our literature search. Patients who had hematological side effects during their previous antipsychotic drug treatments and who had lower baseline blood leukocyte counts, have higher risk to develop leukopenia or neutropenia during their current antipsychotic treatment. Once leukopenia and neutropenia develops, drugs thought to be responsible for this side effect should be discontinued or dosages should be lowered. In some cases iniatition of lithium or G-CSF (granulocyte colony-stimulating factor) therapy may be helpful in normalizing blood cell counts. Clinicans should avoid any combination of drugs known to cause hematological side effects. Besides during antipsychotic treatment, infection symptoms such as fever, cough, sore throat or fatigue should be evaluated closely and routinely. In this review, all up to date studies including case reports presenting or searching for atypical antipsychotic drugs related hematological side effects have been reviewed and possible mechanisms leading to these adverse effects and suggested treatment modalities have been discussed. [ABSTRACT FROM AUTHOR]