Introduction: Excess bodyweight or adiposity is an epidemic health problem that increases the risk of various types of cancer. Adipose tissue produces hormones known as adipocytokines, which participate in carcinogenesis in many solid tumours. Leptin was shown to have mitogenic effects in cancer cell lines thus promoting the malignant behavior of cancer. Adiponectin has a significant anti-inflammatory effect and showed an inverse relation with solid tumours risk. It was hypothesized that adiponectin provides protection against carcinogenesis. However, the knowledge on the relation of adiposity and adipocytokines with haematological malignancies is limited and the findings were not consistent. Materials and Methods: We studied this feature in newly diagnosed haematological malignancy cases in Malaysia. Diagnosis was made according to World Health Organization (WHO) guidelines or the French-American-Britain (FAB) classification. The body mass index (BMI), waist hip ratio, adipocytokines levels (leptin and adiponectin) were measured in subjects (n=29) and healthy control (n=18). Results: There was no significant difference in the mean BMI of control and subjects. However, the mean waist hip ratio in subjects were significantly higher (0.91) compared to control (0.82) with p=0.04. The mean level of leptin was markedly raised in subjects compared to control (1.80 vs 17.41) with p=0.00. The mean adiponectin level was significantly suppressed in subjects (6.54 vs 0.15) with p=0.00. Discussion: This study supports the evidence that adiposity and adipocytokines are related to haematological malignancy similar to that of solid tumours. We also concluded that waist hip ratio is a better index of adiposity compared to BMI.

Introduction: Thrombotic thrombocytopenic purpura (TTP) is characterized by severe thrombocytopenia and microangiopathic hemolytic anemia. Although some patients also have a combination of fever and neurologic and/or renal manifestations, these are not essentially required for diagnosis. Ultra-large von Willebrand factor (vWf) multimers found in the patient's plasma are the basis for the platelet thrombi. Recent evidence has linked the abnormal fragments of vWf with deficiency of a plasma enzyme named vWf-cleaving protease or ADAMTS-13. Our aim is to raise awareness that clinical suspicion is paramount in clinching the diagnosis and highlight the importance of early detection and prompt management to improve patient's chance of survival. Case Report: We present a case of a 41-year-old Malay lady initially diagnosed with Severe Dengue, who subsequently demonstrated clinical and laboratory findings of TTP. When it was thought that she was recovering from the Dengue infection, she developed marked direct hyperbilirubinemia, which was quickly complicated by encephalopathy. Further laboratory investigations strongly pointed towards ongoing haemolysis with evidence of microangiopathic haemolytic anaemia. Despite, a within-range ADAMTS-13 level, three cycles of plasma exchange with fresh frozen plasma were promptly constituted to the patient of which she made a remarkable recovery. Discussion and Conclusion: The absence of severe ADAMTS-13 deficiency, as measured by current static assays, should not be used to argue against the use of plasma exchange, which has been highly effective even several years before the discovery of ADAMTS-13. Thus the determination of ADAMTS-13 activity has only a limited role in the diagnosis of TTP.