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The following recommendations, which aim at standardising and rationalising the clinical indications for administering polyclonal immunoglobulins in Belgium, were drawn up by a working group of the Superior Health Council. To this end, the Superior Health Council organised an expert meeting devoted to"Guidelines for the use of immunoglobulins". The experts discussed the indications for immunoglobulin use, the'ideal'immunoglobulin preparation, its mechanisms of action, the practical issues involved in administering immunoglobulins and their potential side effects. The recommendations formulated by the experts were validated by the Superior Health Council working group with the purpose of harmonising immunoglobulin use in Belgium

The prognosis of multiple myeloma patients has significantly improved since the introduction of the novel agents thalidomide, bortezomib and lenalidomide. We report the data of a medical need programme with lenalidomide plus dexamethasone, conducted in Belgium between August 2007 and March 2008, and including 98 relapsed refractory multiple myeloma patients. In addition to chemotherapy and steroids, all patients had received prior treatment with bortezomib, and 84% of them had been exposed to thalidomide. In 52 patients response data could be retrieved by post-hoc analysis. A partial remission or better was achieved in 52% (49% partial and 3% complete response) of patients, despite a median of 5 previous anti-myeloma treatment lines. Responses were rapid while the majority of patients received lenalidomide with once weekly (also called low-dose) dexamethasone. Treatment with lenalidomide plus dexamethasone did prolong overall survival by nearly half a year in this population with end-stage myeloma. Overall response and quality of response were independent of previous response to thalidomide and bortezomib, although the time to progression tended to be shorter in thalidomide- and bortezomib-refractory patients. It can be concluded that lenalidomide plus dexamethasone is an effective and safe treatment regimen in highly refractory multiple myeloma patients, and that these responses are irrespective of previous exposure or sensitivity to thalidomide and bortezomib.

New haematopoietic stem cell transplantation procedures make the treatment available to patients who previously did not qualify, such as the elderly. In addition, the spectrum of oral complications associated with haematopoietic stem cell transplantation has altered as a result of the recent developments. This article is a review of the main principles of haematopoietic stem cell transplantation and provides information on oral complications which may develop, such as mucositis, infections, bleeding, graft-versus-host disease, xerostomia, hyposalivation, altered taste, secondary tumors, osteoporosis, osteonecrosis and growing and developing disturbancies. Finally, the role of dental care providers in cases of haematopoietic stem cell transplantation is addressed.

In arterial thrombosis chronic use of acetylsalicylic acid is frequently prescribed. Venous thromboembolism is most often treated with short courses of heparin, followed by oral anticoagulants. All antithrombotic drugs cause hemorrhagic diathesis. Therefore, consultation with the prescribing authority is necessary before proceeding to invasive procedures.

After the formation of a platelet-plug, generation of fibrin is necessary for its stabilization. Both congenital and acquired deficiencies of clotting factors occur, leading to retarded formation of fibrin. In congenital disorders, preoperative correction is possible and necessary. In acquired deficiencies, the type and feasibility of correction depends on the cause of the deficiency.

Haemostasis starts through adhesion of platelets to the subendothelium. Subsequently, ADP and prostaglandins are secreted by the adhered platelets, inducing aggregation of further platelets. The so formed platelet plug stops the bleeding. Congenital disorders of vessel wall and platelets are rare, but acquired abnormalities occur frequently. Usually the consequences of these abnormalities can be handled by local haemostatic action and by the use of antifibrinolytic agents.

In the dental office, adequate functioning of the haemostatic mechanism is essential in surgical procedures, e.g. tooth extractions. Haemostasis is the result of proper interaction between blood platelets, clotting factors and vessel wall. In the laboratory, intensive testing of the mechanism involved may be performed but the ultimate tests are the patient history and the clinical outcome of invasive procedures.

Aspirin is widely used as an antithrombotic drug in the prevention of cardiovascular events. It causes a usually mild bleeding tendency. When used before dental or surgical procedures, aspirin increases the risk of bleeding, contrary to the postoperative administration of aspirin, which has not been associated with increased risk of bleeding. To estimate the risk of bleeding, a history on bleeding tendency and information on the recent use of aspirin is worthwhile. It is recommended to delay procedures for at least one week after the last ingestion of aspirin, if possible. In case of urgent surgical procedures or in patients who suffer from serious bleeding due to the use of aspirin, a single preoperative transfusion of a suspension of platelets is usually sufficient to antagonize the effects of aspirin. Tranexamic acid can be given alternatively. The preferred policy depends on the type of the procedure to be performed, or the nature of the bleeding.

In order to evaluate the Cobas Argos 5 Diff, a five-part differential haematological analyser, we performed a comparative study using our current analyser, the Toa E-5000, and the manual leukocyte differential. Samples (n = 593) were collected from various departments in our hospital and were tested on both Cobas Argos 5 Diff and Toa E-5000. Regression lines were calculated for all standard haematological quantities. A group of 100 samples, including 50 negative (absence of flags) and 50 positive (presence of flags), on the Cobas Argos 5 Diff were randomly selected from the above-mentioned collection. All these samples had been checked under the microscope by two persons counting 200 cells each. The comparison of standard haematological quantities between Cobas Argos 5 Diff and the Toa E-5000 shows good correlation: Red Blood Cells r = 0.993; White Blood Cells r = 0.998; Haemoglobin r = 0.989; Haematocrit r = 0.982; Thrombocytes r = 0.988; Lymphocytes (%) r = 0.983; Neutrophils (%) r = 0.959. The correlation between Cobas Argos 5 Diff and the manual leukocyte differential shows good correlation for lymphocytes and neutrophils, with acceptable correlation for eosinophils. The correlation for basophils and monocytes was less acceptable, especially for normal samples. We conclude that the efficiency of the Cobas Argos 5 Diff is good (93%) and that it is a suitable haematological cell analyser.

Careful scrutiny of relevant thrombosis prevention studies in the light of recent knowledge on the responsiveness to the anticoagulant defect of the various prothrombin time assays used in these studies casts serious doubts on the adequacy of the so-called moderate-intensity warfarin regimens, currently recommended by British and North American experts, in the majority of clinical situations. As long as there is strict laboratory monitoring, more intensive anticoagulation provides satisfactory prevention of thromboembolic events. The Federation of Dutch Thrombosis Centers recommends a target of 3.0 International Normalized Ratio (INR) for the primary and secondary prevention of venous thrombosis and thromboembolism, 3.5 INR in case of recurrence under the former regimen and for patients at risk for a cardiogenic embolism from any source (including tissue heart valve replacement) and those with atherothrombotic disease, and 4.0 INR for patients with a mechanical heart valve prosthesis. The risk of hemorrhage at such levels of anticoagulation remains acceptable.

We report a case of pyoderma gangrenosum in association with chronic myeloid leukemia. The clinical and pathological features are reviewed and the relationship with hematological disorders is discussed.