Introduction: Rituximab, which is widely used in the treatment of B-cell lymphoma, is a chimeric monoclonal antibody directed against the CD20 antigen. Rituximab has many side effects, mainly allergic and neurological. Rituximab may cause thrombocytopenia in the long term after administration. Rare cases with rituximab-induced acute thrombocytopenia have been reported in the literature. Case Report: A 51-year-old female patient who newly diagnosed splenic marginal zone lymphoma recieved rituximab as first line therapy. Petechiae occurred in the lower extremities on the day following rituximab administration. The blood test showed a severe drop in the platelet count from 112,000/μL to 5,000/μL. Blood peripheral smear evaluation confirmed severe thrombocytopenia. Management and outcome: There was no change in hemoglobin or white blood cell levels. After the diagnosis of rituximab-induced acute thrombocytopenia, thrombocyte suspension was administered due to the risk of bleeding. Close clinical and laboratory observations were made. The platelet count began to rise gradually in the following period. Before the second week of rituximab administration, the platelet count was 122,000/μL. No complications developed after premedication and slow rituximab administration, and subsequent treatments were continued in the same way. Discussion: Rituximab has a widespread use, especially in malignancies and autoimmune diseases. Like many monoclonal antibodies, rituximab has several side effects. Thrombocytopenia is a long-term side effect associated with rituximab, and rituximab-induced severe acute thrombocytopenia has been rarely reported. Therefore, it should be kept in mind that severe acute thrombocytopenia may develop after rituximab administration.
This study aims to evaluate the COVID-19 pandemic consultations requested from the division of hematology in the hospital. We recorded the following features of the patients: demographic information, the status of outpatient or inpatient, the clinic requested consultation, the result of the consultation, having a hematological disease, diagnosis and COVID-19 suspicion. In this study, 82 cases were evaluated. The median age of the patients was 49,5. Females were mild higher (56,1% vs. 43,9%). Eight of the patients was suspected with COVID-19. The frequency of suspicion in patients with the previously diagnosed hematological disorder was higher significantly than patients without previously diagnosed (42,9% vs. 6,7% p=0,018). The frequency of suspicion was higher significantly inpatients than outpatients (19,4% vs. 2,2%, p=0,019). Only two of the patients who was suspected with COVID-19 were PCR-positive and these patients were diagnosed with concomitant hematologic malignancy; CLL and MCL. The most common clinic and cause of this consultation of this clinic were gynecology and thrombocytopenia, respectively, and most of the patients were diagnosed with pseudothrombocytopenia. After the consultation for all patients, the diagnosis was drug-related cytopenia; however, detailed evaluation for cytopenia was delayed to period which after the pandemic because any patients had no deep levels of cytopenia. Although our study has some limitations, this study is remarkable because this is the first study that has investigated hematology consultation during the pandemic. We think that more significant results will be achieved as new data become available, as long as the pandemic continues.