Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Abstract Introduction: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inher... more Abstract Introduction: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. Methods: Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. Results: Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). Conclusion: Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.
BackgroundIn patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increa... more BackgroundIn patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment‐related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis‐related mortality and morbidity rates in pediatric ALL patients.ProcedurePediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Türkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records w...
of hematological malignancies. Particularly, when ARA-C is given in high doses, it provokes vario... more of hematological malignancies. Particularly, when ARA-C is given in high doses, it provokes various adverse effects, including fever, severe myelosupression, infection and toxic reactions involving the central nervous system, liver, gastrointestinal tract, eyes and skin. Dermatologic side effects of cytosine arabinoside therapy are often described as rare. Nevertheless, there are differences in the observed frequency of toxic skin events ranging from 2% to 53%. Moreover, idarubicine and etoposide are very rarely associated with adverse skin reactions.1,2
OBJECTIVES In children, cancer chemotherapy may impair the functioning of the cardiac autonomic n... more OBJECTIVES In children, cancer chemotherapy may impair the functioning of the cardiac autonomic nervous system. Moreover, it is not known whether there are any differences between intensive and maintenance phases of chemotherapy. Therefore, the aim of the current study was to assess autonomic nervous system activity using heart rate variability, in children receiving intensive or maintenance cancer chemotherapy. METHODS For that purpose, children who were healthy (healthy control, n = 30), receiving intensive chemotherapy (chemotherapy, n = 30), and receiving maintenance chemotherapy (maintenance, n = 25) were included in the study. Autonomic nervous system activity was measured by means of heart rate variability. Electrocardiogram recordings were used to calculate time- and frequency-domain heart rate variability parameters. RESULTS Time-domain parameters such as standard deviation of NN intervals and frequency-domain parameters such as total power were lower during the intensive chemotherapy but not during maintenance phase (standard deviation of NN intervals: 50±5, 33±3, and 48±3 ms, and total power: 2613±504, 1379±296 and 2295±264 ms2, respectively for healthy control, chemotherapy and maintenance groups, P<0.001 for both standard deviation of NN intervals and total power). DISCUSSION The present results indicate that intensive chemotherapy perturbs the function of heart rate variability in children, with recovery during the maintenance phase. This suggests that intensive chemotherapy is likely to affect the autonomic nervous system but this effect does not appear to be permanent.
We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for... more We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.
Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyreti... more Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyretic agent in several countries. In spite of its availability and common usage, it has serious and potentially fatal adverse effects like agranulocytosis and aplastic anemia. Objectives of this study are to evaluate incidence, severity, and clinical significance of metamizole related neutropenia and agranulocytosis, and to study recovery duration of neutropenia and agranulocytosis in children exposed to metamizole. Material and Methods: Thirteen cases of neutropenia and/or agranulocytosis secondary to metamizole usage have been evaluated retrospectively. Duration and cumulative doses of metamizole, degree of neutropenia, recovery from neutropenia, and other complications related to neutropenia were evaluated. Results: Overall, thirteen granulocytopenic patients were recorded for 12 months after metamizol usage. Mean metamizole exposure duration was 4,64 (2-7) days; mean daily total metamizo...
The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in schoo... more The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in school‐aged children by pure‐tone audiometry.
Thalassemia major (TM) is a severe transfusion-dependent anemia. Regular erytrocyte transfusion i... more Thalassemia major (TM) is a severe transfusion-dependent anemia. Regular erytrocyte transfusion is required for the treatment of thalassemia patients. However, repeated transfusion may result in impairements in heart function. In this study, we aimed to investigate short-term effects of erythrocyte transfusion on autonomic control of heart in children with thalassemia major. For that purpose heart rate variability (HRV), which is a non-invasive method used to evaluate the effects of the autonomic nervous system on the heart rhythym, was measured before and after erythrocyte transfusion and compared to the healthy controls. Children diagnosed with TM (n = 17) and sex and age matched healthy children (HC, n = 30) were included in the study. HRV values of TM patients were measured 5 min before erythrocyte transfusion (BET, n = 17) and 5 min after erythrocyte transfusion (AET, n = 17). Parameters of time-domain and frequency-domain of HRV were evaluated in all participants. Heart rate (HR) was higher in the BET than AET (P = 0.002) but there was no difference between AET and HC groups (P > 0.05). HRV parameters were lower in BET than AET (P < 0.05) but there were no statistical difference between AET and HC (P> 0.05). The data suggest that, in thalassemia major patients, erythrocyte transfusion restores HR and HRV parameters to the levels observed in healthy controls and, thus, in short-terms, appears to be beneficial for the autonomic control of the heart.
To the Editor: Adultswith cancer are reported tohave ahigher risk for coronavirus disease (COVID-... more To the Editor: Adultswith cancer are reported tohave ahigher risk for coronavirus disease (COVID-19) infection and more severe disease and mortality than the general population.1,2 Although children seem to be at a lower risk for COVID-19 than adults,3–5 data specifically addressing children with cancer are limited.6–12 Weconducted a retrospective,multicenter, cross-sectional studyon behalf of the Turkish Pediatric Hematology Society (TPHD) and Turkish Pediatric Oncology Group (TPOG) Society to analyze the characteristics of COVID-19 in all patients with cancer and stem cell transplant (SCT) recipients in all centers in Turkey, during March 11-May 31, 2020. Approval for the study was obtained by Turkish Ministry of Health (MoH), Istanbul University COVID Scientific Research Committee, and Istanbul University Ethics Committee. The study was carried out through the analysis of a questionnaire with 62 questions, which was sent to all members of the TPOG and TPHD Societies working in all 66 pediatric hematology/oncology departments in university, state, and private hospitals in Turkey. All replied and 53 patients were reported from the 24 centers. Following the national recommendations and guidelines of the MoH,13,14 centers tested all symptomatic patients or patients with contact history or patients who were planned to undergo transplantation or surgery. All patients and caregivers were questioned at the entrance of the hospital/oncology center and if there were any symptoms or contact history they were sent to the special clinics within the hospital that were allocated for suspected/proven COVID-19 patients. If a patient was suspected of having COVID-19 and found positive while in the oncology clinic, she/hewas transferred to theCOVID clinic and all staff, patients, and accompanying persons with whom she/he was in contact were tested for COVID-19. Samples from the naso-oropharyngeal swabs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction (PCR). Confirmed cases were defined as PCR-positive patients. Probable cases were defined according to guidelines of World Health Organization15 and MoH,13 as those who had typical symptoms and chest CT findings, or who had typical symptoms and contact history but negative PCR. Patients were classified into four groups regarding the severity of infection as asymptomatic/mild, moderate, severe, and critical on the basis of the clinical, laboratory, and radiological features.3,15 Patients were treated according to recommendations of the MoH.13,14 Statistical analyses were performed by IBM SPSS Statistics version 21.0. For comparison of mean of numerical variables Mann-Whitney U test was used. Categorical nominal variableswere comparedwith Fisher’s exact tests. There were 51 children with cancer, six of whom (four leukemia/lymphomas, two solid tumors) had undergone SCT (Table 1). The median age was 6 (0.3-17.8) years and 64.7% of the patients were male. Additional two patients with thalassemia major who underwent SCT were not included in the analyses. Chemotherapy courses were interrupted in 32 (62.7%) patients and delayed with a median of 15 (3-45) days. The most common presenting signs were fever and cough, while 37.25% of patients were asymptomatic. COVID-19 pneumonia was detected in 26 (50.9%) patients. Five of them had hypoxemia. Gastrointestinal system (17.6%) was the second most commonly involved site followed by central nervous, musculoskeletal systems and skin. Twenty-five patients had asymptomatic/mild, 17 patients moderate/severe, and nine patients critical disease. Thirty-eight patients were hospitalized and treated according to the severity of illness, six of whom were already hospitalized for reasons such as surgery or diagnostic workup when diagnosed with COVID-19. Nine patients with critical disease were in the intensive care unit (ICU) and three were intubated. Treatment consisted of hydroxychloroquine, azitromycine, antivirals either as a single agent or in combination (Table 1). Convalescent plasma was used in three patients, one of whom additionally received mesenchymal stem cell, tocizulumab, and granulocyte transfusions and was intubated. At the time of COVID-19 diagnosis, 26 patients had neutropenia and among them 15 had fever. In all patients with febrile neutropenia, broad-spectrum empirical antibiotics were initiated. In addition, 12 patients received antimicrobial therapy due to clinically and/or microbiologically documented infections. All patients, but one, fully recovered and the PCR tests became negative at a median of 7 (2-17) days. The patient who had received allogeneic SCT for relapsed leukemia/lymphoma and had progressive disease and fungal infection died due to COVID-19 infection. The incidence of critical care disease and need for ICU care were found tobehigher inpatientswithhematologicmalignancies (P= .012), patients post SCT (P = .001), patients with other infections (P = .005), and…
Scandinavian Journal of Clinical and Laboratory Investigation, 2021
Abstract Introduction: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inher... more Abstract Introduction: Inherited factor VII (FVII) deficiency (FVIID) is the most common of inherited rare bleeding disorders. Other determinants of clinical severity apart from FVII level (FVIIL) include genetic and environmental factors. We aimed to identify the cut-off FVIILs for general and severe bleedings in patients with FVIID by using an online national registry system including clinical, laboratory, and demographic characteristics of patients. Methods: Demographic, clinical, and laboratory data of patients with FVIID extracted from the national database, constituted by the Turkish Society of Hematology, were examined. Bleeding phenotypes, general characteristics, and laboratory features were assessed in terms of FVIILs. Bleeding rates and prophylaxis during special procedures/interventions were also recorded. Results: Data from 197 patients showed that 46.2% of patients had FVIIL< 10%. Most bleeds were of mucosal origin (67.7%), and severe bleeds tended to occur in younger patients (median age: 15 (IQR:6-29)). Cut-off FVIILs for all and severe bleeds were 16.5% and 7.5%, respectively. The major reason for long-term prophylaxis was observed as central nervous system bleeding (80%). Conclusion: Our data are consistent with most of the published literature in terms of cut-off FVIIL for bleeding, as well as reasons for prophylaxis, showing both an increased severity of bleeding and younger age at diagnosis with decreasing FVIIL. However, in order to offer a classification similar to that in Hemophilia A or B, data of a larger cohort with information about environmental and genetic factors are required.
BackgroundIn patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increa... more BackgroundIn patients with acute lymphoblastic leukemia (ALL), the risk of thromboembolism increases due to hemostatic changes secondary to the primary disease and due to treatment‐related factors. In this multicenter study, we aimed to research the frequency of central nervous system (CNS) thrombosis occurring during treatment, hereditary and acquired risk factors, clinical and laboratory features of patients with thrombosis, treatment approaches, and thrombosis‐related mortality and morbidity rates in pediatric ALL patients.ProcedurePediatric patients who developed CNS thrombosis during ALL treatment from 2010 to 2021 were analyzed retrospectively in 25 different Pediatric Hematology Oncology centers in Türkiye. The demographic characteristics of the patients, symptoms associated with thrombosis, the stage of the leukemia treatment during thrombosis, the anticoagulant therapy applied for thrombosis, and the final status of the patients recorded through electronic medical records w...
of hematological malignancies. Particularly, when ARA-C is given in high doses, it provokes vario... more of hematological malignancies. Particularly, when ARA-C is given in high doses, it provokes various adverse effects, including fever, severe myelosupression, infection and toxic reactions involving the central nervous system, liver, gastrointestinal tract, eyes and skin. Dermatologic side effects of cytosine arabinoside therapy are often described as rare. Nevertheless, there are differences in the observed frequency of toxic skin events ranging from 2% to 53%. Moreover, idarubicine and etoposide are very rarely associated with adverse skin reactions.1,2
OBJECTIVES In children, cancer chemotherapy may impair the functioning of the cardiac autonomic n... more OBJECTIVES In children, cancer chemotherapy may impair the functioning of the cardiac autonomic nervous system. Moreover, it is not known whether there are any differences between intensive and maintenance phases of chemotherapy. Therefore, the aim of the current study was to assess autonomic nervous system activity using heart rate variability, in children receiving intensive or maintenance cancer chemotherapy. METHODS For that purpose, children who were healthy (healthy control, n = 30), receiving intensive chemotherapy (chemotherapy, n = 30), and receiving maintenance chemotherapy (maintenance, n = 25) were included in the study. Autonomic nervous system activity was measured by means of heart rate variability. Electrocardiogram recordings were used to calculate time- and frequency-domain heart rate variability parameters. RESULTS Time-domain parameters such as standard deviation of NN intervals and frequency-domain parameters such as total power were lower during the intensive chemotherapy but not during maintenance phase (standard deviation of NN intervals: 50±5, 33±3, and 48±3 ms, and total power: 2613±504, 1379±296 and 2295±264 ms2, respectively for healthy control, chemotherapy and maintenance groups, P<0.001 for both standard deviation of NN intervals and total power). DISCUSSION The present results indicate that intensive chemotherapy perturbs the function of heart rate variability in children, with recovery during the maintenance phase. This suggests that intensive chemotherapy is likely to affect the autonomic nervous system but this effect does not appear to be permanent.
We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for... more We report the national data on the outcomes of hematopoietic stem cell transplantation (HSCT) for thalassemia major (TM) patients in Turkey on behalf of the Turkish Pediatric Stem Cell Transplantation Group. We retrospectively enrolled 1469 patients with TM who underwent their first HSCT between 1988 and 2020 in 25 pediatric centers in Turkey. The median follow-up duration and transplant ages were 62 months and 7 years, respectively; 113 patients had chronic graft versus host disease (cGVHD) and the cGVHD rate was 8.3% in surviving patients. Upon the last visit, 30 patients still had cGvHD (2.2%). The 5-year overall survival (OS), thalassemia-free survival (TFS) and thalassemia-GVHD-free survival (TGFS) rates were 92.3%, 82.1%, and 80.8%, respectively. cGVHD incidence was significantly lower in the mixed chimerism (MC) group compared to the complete chimerism (CC) group (p < 0.001). In survival analysis, OS, TFS, and TGFS rates were significantly higher for transplants after 2010. TFS and TGFS rates were better for patients under 7 years and at centers that had performed over 100 thalassemia transplants. Transplants from matched unrelated donors had significantly higher TFS rates. We recommend HSCT before 7 years old in thalassemia patients who have a matched donor for improved outcomes.
Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyreti... more Objectives: Metamizole sodium (Novalgin ® ) is an effective, widely used analgesic and antipyretic agent in several countries. In spite of its availability and common usage, it has serious and potentially fatal adverse effects like agranulocytosis and aplastic anemia. Objectives of this study are to evaluate incidence, severity, and clinical significance of metamizole related neutropenia and agranulocytosis, and to study recovery duration of neutropenia and agranulocytosis in children exposed to metamizole. Material and Methods: Thirteen cases of neutropenia and/or agranulocytosis secondary to metamizole usage have been evaluated retrospectively. Duration and cumulative doses of metamizole, degree of neutropenia, recovery from neutropenia, and other complications related to neutropenia were evaluated. Results: Overall, thirteen granulocytopenic patients were recorded for 12 months after metamizol usage. Mean metamizole exposure duration was 4,64 (2-7) days; mean daily total metamizo...
The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in schoo... more The aim of this study is to investigate the effects of vitamin B12 deficiency on hearing in school‐aged children by pure‐tone audiometry.
Thalassemia major (TM) is a severe transfusion-dependent anemia. Regular erytrocyte transfusion i... more Thalassemia major (TM) is a severe transfusion-dependent anemia. Regular erytrocyte transfusion is required for the treatment of thalassemia patients. However, repeated transfusion may result in impairements in heart function. In this study, we aimed to investigate short-term effects of erythrocyte transfusion on autonomic control of heart in children with thalassemia major. For that purpose heart rate variability (HRV), which is a non-invasive method used to evaluate the effects of the autonomic nervous system on the heart rhythym, was measured before and after erythrocyte transfusion and compared to the healthy controls. Children diagnosed with TM (n = 17) and sex and age matched healthy children (HC, n = 30) were included in the study. HRV values of TM patients were measured 5 min before erythrocyte transfusion (BET, n = 17) and 5 min after erythrocyte transfusion (AET, n = 17). Parameters of time-domain and frequency-domain of HRV were evaluated in all participants. Heart rate (HR) was higher in the BET than AET (P = 0.002) but there was no difference between AET and HC groups (P > 0.05). HRV parameters were lower in BET than AET (P < 0.05) but there were no statistical difference between AET and HC (P> 0.05). The data suggest that, in thalassemia major patients, erythrocyte transfusion restores HR and HRV parameters to the levels observed in healthy controls and, thus, in short-terms, appears to be beneficial for the autonomic control of the heart.
To the Editor: Adultswith cancer are reported tohave ahigher risk for coronavirus disease (COVID-... more To the Editor: Adultswith cancer are reported tohave ahigher risk for coronavirus disease (COVID-19) infection and more severe disease and mortality than the general population.1,2 Although children seem to be at a lower risk for COVID-19 than adults,3–5 data specifically addressing children with cancer are limited.6–12 Weconducted a retrospective,multicenter, cross-sectional studyon behalf of the Turkish Pediatric Hematology Society (TPHD) and Turkish Pediatric Oncology Group (TPOG) Society to analyze the characteristics of COVID-19 in all patients with cancer and stem cell transplant (SCT) recipients in all centers in Turkey, during March 11-May 31, 2020. Approval for the study was obtained by Turkish Ministry of Health (MoH), Istanbul University COVID Scientific Research Committee, and Istanbul University Ethics Committee. The study was carried out through the analysis of a questionnaire with 62 questions, which was sent to all members of the TPOG and TPHD Societies working in all 66 pediatric hematology/oncology departments in university, state, and private hospitals in Turkey. All replied and 53 patients were reported from the 24 centers. Following the national recommendations and guidelines of the MoH,13,14 centers tested all symptomatic patients or patients with contact history or patients who were planned to undergo transplantation or surgery. All patients and caregivers were questioned at the entrance of the hospital/oncology center and if there were any symptoms or contact history they were sent to the special clinics within the hospital that were allocated for suspected/proven COVID-19 patients. If a patient was suspected of having COVID-19 and found positive while in the oncology clinic, she/hewas transferred to theCOVID clinic and all staff, patients, and accompanying persons with whom she/he was in contact were tested for COVID-19. Samples from the naso-oropharyngeal swabs were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by polymerase chain reaction (PCR). Confirmed cases were defined as PCR-positive patients. Probable cases were defined according to guidelines of World Health Organization15 and MoH,13 as those who had typical symptoms and chest CT findings, or who had typical symptoms and contact history but negative PCR. Patients were classified into four groups regarding the severity of infection as asymptomatic/mild, moderate, severe, and critical on the basis of the clinical, laboratory, and radiological features.3,15 Patients were treated according to recommendations of the MoH.13,14 Statistical analyses were performed by IBM SPSS Statistics version 21.0. For comparison of mean of numerical variables Mann-Whitney U test was used. Categorical nominal variableswere comparedwith Fisher’s exact tests. There were 51 children with cancer, six of whom (four leukemia/lymphomas, two solid tumors) had undergone SCT (Table 1). The median age was 6 (0.3-17.8) years and 64.7% of the patients were male. Additional two patients with thalassemia major who underwent SCT were not included in the analyses. Chemotherapy courses were interrupted in 32 (62.7%) patients and delayed with a median of 15 (3-45) days. The most common presenting signs were fever and cough, while 37.25% of patients were asymptomatic. COVID-19 pneumonia was detected in 26 (50.9%) patients. Five of them had hypoxemia. Gastrointestinal system (17.6%) was the second most commonly involved site followed by central nervous, musculoskeletal systems and skin. Twenty-five patients had asymptomatic/mild, 17 patients moderate/severe, and nine patients critical disease. Thirty-eight patients were hospitalized and treated according to the severity of illness, six of whom were already hospitalized for reasons such as surgery or diagnostic workup when diagnosed with COVID-19. Nine patients with critical disease were in the intensive care unit (ICU) and three were intubated. Treatment consisted of hydroxychloroquine, azitromycine, antivirals either as a single agent or in combination (Table 1). Convalescent plasma was used in three patients, one of whom additionally received mesenchymal stem cell, tocizulumab, and granulocyte transfusions and was intubated. At the time of COVID-19 diagnosis, 26 patients had neutropenia and among them 15 had fever. In all patients with febrile neutropenia, broad-spectrum empirical antibiotics were initiated. In addition, 12 patients received antimicrobial therapy due to clinically and/or microbiologically documented infections. All patients, but one, fully recovered and the PCR tests became negative at a median of 7 (2-17) days. The patient who had received allogeneic SCT for relapsed leukemia/lymphoma and had progressive disease and fungal infection died due to COVID-19 infection. The incidence of critical care disease and need for ICU care were found tobehigher inpatientswithhematologicmalignancies (P= .012), patients post SCT (P = .001), patients with other infections (P = .005), and…
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