Objective: Anthracyclines are widely used in the treatment of acute lymphoblastic leukemia (ALL). However, cardiotoxicity is the most critical side effect that requires dose limitation. It is thought to occur at first exposure, but the clinical presentation may occur years later. Inthisstudy, we aimed to determine thetime of initial damage and cardiotoxicity that develops in children with ALL. Methods: In this prospective study, 13 patients with newly diagnosed intermediate-risk precursor B cell ALL treated with the ALL-IC BFM 2009 protocol were included. Conventional echocardiography, tissue Doppler imaging (TDI), and speckle-tracking echocardiography (STE) were performed in all the patients before chemotherapy, after completing the induction phase, and at the end of the reinduction phase. Results: The mean age of the patients was 7.8 +/- 4.6 (3.1-16.3) years. Myocardial velocity during systole (S-m) determined by TDI at the interventricular septum significantly decreased during the induction phase. Despite a decrease in STE parameters, a statistically significant reduction was determined in the global longitudinal strain rate at both left and right ventricles at the end of the induction. Nevertheless, a statistically significant increase was observed among the conventional echocardiographic findings in the left ventricular end-diastolic diameter at the end of the reinduction. Conclusion: During the treatment of ALL, subclinical anthracycline-associated cardiotoxicity develops in the early stages of treatment. The findings detected by TDI and STE could be missed by conventional echocardiography. We recommend evaluating patients with these newly developedtechniquesto detectsubclinical cardiotoxicity at an early stage and starting appropriate therapy on time.

Background/aimTransfusion of blood products is a life-saving clinical practice in patients with bleeding, hemoglobinopathy and cancer. In this study, we aimed to analyze the frequency and types of blood component-related acute transfusion reactions (ATR) in pediatric patients.Materials and methodsThis retrospective study was conducted at a tertiary care academic pediatric hospital.ResultsDuring the study period, 30,811 transfusions were administered to 25,448 patients. 103 ATRs were detected in 81 patients (0.33%; 3.34 reactions per 1000 transfusions, mean age 8.3±5.98 years, F/M: 36/45). All reactions were observed within an average of 4 hours after the start of the transfusion. The most common ATRs were allergic reactions (79; 76.6%) and febrile non-hemolytic transfusion reactions (12; 11.6%). All allergic transfusion reactions occurred within the first hour after the start of the transfusion. Granulocyte concentrates were the blood component that were associated with the highest ATR rate (2.1%).ConclusionWithin our hospital, pediatric hematology-oncology wards and the stem cell transplantation unit had the most frequent ATR reports, therefore transfusions should be carried out with paying high attention in these units. Education of health staff about the adverse effects of transfusion therapy should increase awareness and reporting of ATRs in children.