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ORIGINAL ARTICLES
Significance of extreme leukocytosis in evaluation of febrile children aged 3-36 months: A single center experience
Sadek H Ghani, Rabab H Baaker, Nabeeha N Akram
July-December 2016, 5(2):167-172
DOI:10.4103/2072-8069.198121  
Background: Emergency department evaluation of young febrile children often includes measurement of white blood cell (WBC) count. Although a high WBC count is associated with an increased likelihood of infection, the clinical significance of extreme leukocytosis (EL) (a WBC count of ≥25,000/mm 3 ), has not been well studied. Objective: The aim of this study is to study the correlation between the level of WBC and the cause of fever in febrile children and to assess if WBC level helpful in predicting the seriousness of febrile illness. Patients and Methods: A cross-sectional case series study conducted over 5 months from August 01 to December 31, 2015, in the emergency department at child central teaching hospital in Baghdad city in Iraq. The study was evaluating children aged 3-36 months admitted to the emergency department for fever. WBC count was done either manually or a complete blood count by automated hematologic analyzer. Results: Of those 129 febrile children were enrolled in this study, 42 patients with EL were identified and compared with 87 patients with moderate leukocytosis (ML). Pneumonia was the only diagnosis found to be significantly higher in EL group 17 cases (40.5%) versus 15 cases (17.2%) in ML group with P value (0.004). Meningitis was higher in patient with ML with P value (0.03). Finally, EL was associated with higher rates of admission to hospital (P < 0.036). Conclusions: The presence of EL indicates a higher risk of having pneumonia. The degree of leukocytosis (extreme or moderate) does not affect the rates of serious bacterial infection.
  2,600 119 -
Evaluation of chronic myeloid leukemia patients and their molecular responses to tyrosine kinase inhibitors in Erbil city, Iraq
Kawa Muhamedamin Hasan
January-June 2018, 7(1):1-7
DOI:10.4103/ijh.ijh_28_17  
Background: Chronic myeloid leukemia (CML) is one of the indolent myeloproliferative neoplasms. It is characterized by the presence of the Philadelphia chromosome, a translocation between chromosomes 9 and 22 or BCR-ABL1 gene. Objectives: The aims of this study were to evaluate characteristics of CML patients and their molecular response to tyrosine kinase inhibitors (TKI) in Erbil city in Iraq. Patients and Methods: Seventy-six patients with CML were recruited in this retrospective and prospective study from February 2014 to March 2016, at Nanakaly Hospital for Blood Diseases in Erbil city – Kurdistan region of Iraq. They were evaluated from clinical point of view and their laboratory data, and molecular responses to TKI based on polymerase chain reaction were analyzed. Results: The median age of participants was 45 years; the male: female ratio was 1:0.9. The main presenting features were abdominal fullness in 66% and splenomegaly in 95% of patients. Nearly 66% of them had low European Treatment and Outcome Study (EUTOS) score; 70% of patient had major or complete molecular responses (MMR/CMR). There was a significant difference between patients who did versus who did not achieve MMR/CMR in hemoglobin level, promyelocyte, and myelocyte percent, EUTOS, and Sokal scores (P = 0.02, 0.006, 0.03, 0.001, and 0.02, respectively). Conclusion: In the current study, CML patients were at a younger age of onset, and more high EUTOS score. The majority of patients achieved MMR with frontline Imatinib or Nilotinib and those who switched from Imatinib to Nilotinib as well.
  1,618 264 -
Comparative behavior of red blood cells indices in iron deficiency anemia and β-thalassemia trait
Abdulbasit Nsief Jassim
July-December 2016, 5(2):183-186
DOI:10.4103/2072-8069.198129  
Background: β-thalassemia trait (β-TT) is an important differential diagnosis of iron deficiency anemia (IDA). It is important to distinguish between the above conditions to avoid unnecessary iron therapy. IDA and β-TT are the two most common causes of microcytic hypochromic anemia. Red blood cells (RBCs) indices are a simple, easy, and cost-effective method to get a primary and valuable information regarding the diagnosis of IDA and β-TT. Objectives: This study was focused on the comparison of RBC indices behavior: hemoglobin (Hb), hematocrit (Hct), RBC count, mean cell volume (MCV), mean cell hemoglobin (MCH), MCH concentration (MCHC), and red cell distribution width (RDW) in IDA and β-TT. Patients and Methods: Fifty subjects with IDA (12 males and 38 females, age range: 18-65 years) and fifty subjects with β-TT (twenty male and thirty females with age range: 17-66 years) were chosen. Both groups were investigated for RBC indices by automated hematology analyzer. Results: RBC count, Hb, and Hct were significantly lower with (P < 0.001) in IDA subjects than in β-TT subjects. MCH and MCHC were significantly lower with (P = 0.01 and 0.001, respectively) in IDA subjects than in β-TT subjects. RDW was significantly higher with (P < 0.001) in IDA subjects than in β-TT subjects. There is no significant difference with (P = 0.2) regarding MCV between IDA subjects and β-TT subjects. Conclusion: The study showed that RBC count, Hb, Hct, MCH, and MCHC were significantly lower in IDA subjects than in β-TT subjects, whereas RDW was significantly higher in IDA subjects than in β-TT subjects. There was no significant difference regarding MCV between IDA subjects and β-TT subjects.
  1,691 173 -
Expression of CD45, CD34, CD10, and human leukocyte antigen-DR in acute lymphoblastic leukemia
Faris H Jaafar, Areej Emad Kadhom
January-June 2018, 7(1):14-19
DOI:10.4103/ijh.ijh_31_17  
Background: Immunophenotypic analysis of leukemic cells by multicolor flow cytometry using different monoclonal antibodies labeled to various flourochromes, is an important, precise and rapid investigation for diagnosis, classification, prognosis prediction, and minimal residual disease detection in acute lymphoblastic leukemia (ALL). Objectives: The aims of study were to study the expression of CD45, CD34, CD10, human leukocyte antigen-DR (HLA-DR) in B and T-ALL among 114 Iraqi patients and compare findings with other reports worldwide. Patients, Materials and Methods: A retrospective cross-sectional study was conducted on 114 ALL patients of various age groups from different hematology centers in Baghdad who were referred to Flowcytometry Department at the Bone Marrow Transplantation Center/Private Nursing Home Hospital/Medical City for immunophenotypic classification using multi-color flow cytometry from the January 1, 2016, to the August 31, 2016. Results: Out of 114 patients, 71 patients were pediatric patients and 43 were adults. Eighty-three patients were classified as B-cell ALL and 31 patients as T-cell ALL. There was significant association between male gender, high white blood cells count and T-cell ALL subtype. Negative-dim-moderate CD45, positive CD34, and positive HLA-DR expressions were significantly associated with B-cell ALL. Common ALL antigen was seen in 86.7% of the B-cell ALL patients and was accompanied cTdT expression. Aberrant myeloid antigens were observed in 22.9% of B-cell ALL patients and in 35.5% of T-cell ALL. About 4.8% of the patients with B-cell ALL had aberrant T-linage antigens while 6.5% of the patients with T-cell ALL expressed aberrant B-cell lineage antigens. Conclusion: Immunophenotypic expression of ALL cells among Iraqi patients is to somewhat in accordance with various researches worldwide making immunophenotyping flow cytometry a crucial appliance in diagnosis, classification, risk stratification, and minimal residual disease detection in ALL.
  1,347 182 -
The impact of Helicobacter pylori infection on iron deficiency anemia in pregnancy
Miami Abdul Hassan Ali, Eaman Marouf Muhammad, Ban Hadi Hameed, Hala Hashim Hasoobe
July-December 2017, 6(2):60-64
DOI:10.4103/ijh.ijh_19_17  
Background: Anemia in pregnancy has different adverse effects on pregnancy outcome, and iron deficiency anemia (IDA) is the most common cause of anemia during pregnancy. Recent studies have suggested an association between Helicobacter pylori and IDA during pregnancy. Objective: The aim of this study was to evaluate the impact of H. pylori infection on IDA in pregnancy. Patients And Methods: This was a case–control study carried out at Al-Yarmouk Teaching Hospital between January 1 and August 1, 2016. The study included 100 pregnant women divided into two groups: control group with normal hemoglobin (Hb) and a study group with IDA. Both groups were subjected to H. Pylori test. Results: The mean Hb level of the patients was 9.4 ± 0.8 g/dl. Fifty cases had an Hb level <11 g/dl and fifty cases with Hb ≥11 gm/dl. Thirty-two percentage of the study group were seropositive for anti-H. pylori IgA compared to 4% of the control group, and this difference was statistically significant at P < 0.001. Conclusion: There was a positive correlation between IDA during pregnancy and H. pylori-positive cases.
  1,253 188 1
Utility of simultaneous assessment of bone marrow aspirates and trephine biopsy sections in various haematological disorders
Vandana Puri, Pooja Sharma, Mrinalini Kotru, Meera Sikka, Satendra Sharma
January-June 2018, 7(1):26-32
DOI:10.4103/ijh.ijh_33_17  
Background: Bone marrow examination is crucial diagnostic modality for evaluation of various hematological and nonhematological disorders. However, marrow aspirate smears and biopsy sections, even though performed simultaneously, are often assessed at different points of time due to different processing methods. This sometimes results in discordance in diagnosis which adds to the diagnostic dilemma and delays the treatment. aim: This study aims to compare the diagnostic accuracy and the rate of concordance between the two modalities of bone marrow examination. Materials and Methods: Three hundred simultaneously performed bone marrow aspirates and BM trephine biopsies were retrospectively analyzed over a period of 1 year. The presence or absence of concordance was recorded. The reasons for inconclusive reports were also recorded. The concordance rates for different hematological disorders were calculated and recorded as high for >80%, moderate for 50%–80%, and low for <50%. The findings of discordant cases and reasons for discordance were also tabulated. Results: A high concordance was found in cases of megaloblastic anemia, leukemias, non-Hodgkin's lymphoma, and multiple myeloma; moderate concordance was found in hypoplastic marrow and concordance was low in Hodgkin's lymphoma, chronic myeloid leukemia (CML) in blast phase, metastatic, and granulomatous involvement of bone marrow. Conclusion: Bone marrow aspiration alone is sufficient for the diagnosis of megaloblastic anemia and most of the hematological malignancies. Bone marrow biopsy is more appropriate for detection of disorders with focal marrow involvement such as lymphoproliferative disorders, metastatic cancer, focal blast crisis in CML, granulomatous lesions, and hypoplastic marrow. However, it is strongly recommended that both should be reviewed simultaneously to ensure maximum diagnostic accuracy.
  1,258 171 -
The effect of gamma ray on total leukocytes, lymphocytes and neutrophils on blood samples of smokers compared to non-smoker donors
Baydaa Taher Sih, Alauldeen Mudhafar Zubair Alqasim, Awras Hameed Ajil
January-June 2017, 6(1):1-5
DOI:10.4103/ijh.ijh_1_17  
Background: The immune system depends on white blood cells (WBCs) to fight infections in the human body. Smoking tobacco causes the increasing of WBCs comparing with nonsmokers due to virus infection and bronchitis. Exposing blood samples of smokers and non-smokers donors to gamma-ray (γ-ray) will affect the structure of the WBCs then as a result will cause the declination in the values of total leukocytes, lymphocytes, and neutrophils in the smokers' blood is greater than of nonsmokers and this confirms that these cells are more fragile, weak, and less tolerant to external stimuli. Objectives: The objective of this study is to compare the effects of increasing doses of γ-ray on total leukocyte, neutrophil, and lymphocyte count between smokers and non-smokers. Materials and Methods: Ethylenediaminetetraacetic acid blood samples were collected from healthy donors: Ten smokers and ten nonsmokers. Samples of both groups were exposed to incremental doses of γ-ray (5–40 Gy). Total and differential leukocyte count for each sample was performed by autoanalyzer. Results: Smokers had higher average total leukocyte, lymphocyte, and neutrophil counts than nonsmokers before exposure to radiation. However, they showed more decline than nonsmokers after exposure to increasing doses of γ-ray. Conclusions: By increases the doses of γ-ray, the declining in the values of WBCs, lymphocytes, and neutrophils in the smokers blood is greater than of nonsmokers and this confirms that these cells are more fragile, weak, and less tolerant to external stimuli.
  1,231 141 1
ARTICLE
Cutaneous manifestation among patients with β- thalassemia major
Sayran Izzaddin, Kawa Mohamedamin Hasan
July-December 2014, 3(2):98-107
Background: Dermatological manifestations among β thalassemia major patients including skin changes as well as nail, hair, oral mucosa changes and leg ulcer were reported among these patients, either due to the hemolytic process of the disease itself or as a sequel of therapeutic effect taxes of blood transfusion and iron overload complication. In Kurdistan there is no study has yet investigated the common dermatologic problems that coexist with β-thalassemia major. Objectives : The purpose of this study was to determine the commonly seen dermatologic problems in patients with β-thalassemia major. Patients and Method: A descriptive cross sectional study performed at Erbil Thalassemia center, the study was conducted among 176 patients over a period extended from April, 2013 to January, 2014. They were assessed for cutaneous manifestation with clinical importance of static laboratory tests. Results: All patients enrolled in this study had at least one cutaneous manifestation. The disorders are in decreasing order of frequency was pallor, xerosis, jaundice, bronze skin, hyperpigmentation and the least frequent was vitiligo. Most of the of the findings (31.8%) were between (10-15) years age group. The mean age of patients, the mean duration of blood transfusion and the mean of serum ferritin level among patients with xerosis, pallor, hyperpigmentation and jaunduce was higher and was statistically significant (p<0.05) also there was a significant association between HCV positive and patients with xerosis, hyperpigmentation and jaundice (p<0.05). Conclusion: The cutaneous disorders are common among beta thalasemia patients, pallor ,xerosis and jaundice were the common skin changes, while white streak (leukonychia)and gingivitis are the most common nail and oral mucoasa changes respectivly. Xerosis is common in patients recieving desferoxamine, serum ferritin level was higher in patients with xerosis,hyperpigmentation and jaundice.
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  1,267 100 -
ORIGINAL ARTICLES
Prognostic value of myeloid antigens expression in childhood acute lymphoblastic leukemia
Aula Mahmood Ibrahim, Bassam M Hameed
January-June 2017, 6(1):12-16
DOI:10.4103/ijh.ijh_5_17  
Background: Leukemic blasts in acute lymphoblastic leukemia (ALL) may have immunological features of both lymphoid and myeloid lineages known as aberrant myeloid antigens expression in ALL, which are explained as abnormal genetic program of leukemic cells that lead to lineage infidelity. In this study, CD13, CD14, and CD33 (which are the most frequent myeloid antigens associated with aberrant antigens expression in ALL) were investigated. Objectives: To evaluate the occurrence of aberrant myeloid antigens expression in childhood ALL and its effects on complete remission and other parameters. Materials and Methods: This study was conducted on 31 pediatric patients with newly diagnosed de novo ALL (27 B-ALL, 4 T-ALL) in Children Welfare Teaching Hospital/Medical City of Baghdad; diagnosis of ALL based on morphology and cytochemistry, CD13, CD14, CD33 were investigated as myeloid antigens using four-color flow cytometry. Results: Five cases of ALL (16.13%) out of 31 cases were confirmed to have aberrant myeloid antigens expression (CD13 was expressed in all five cases, CD33 was expressed in three cases, and CD14 was not expressed in any of these five cases). Complete remission was achieved in 90.30% (28 patients) and all cases with aberrant myeloid antigens expression achieved complete remission; however, despite this, there was no significant difference in complete remission between myeloid-positive (MY+) and myeloid-negative (MY−) cases, P > 0.05. Regarding other parameters, there were significant statistical differences in lactate dehydrogenase (LDH), hemoglobin value, and bone marrow (B.M.) blasts percent at diagnosis between MY+ and MY− cases, P< 0.05; however, there was no significant differences in leukocytes count, platelets count, peripheral blood blast percent at diagnosis, age, and gender, P > 0.05. Conclusions: The most frequent aberrant myeloid antigens expression in childhood ALL is CD13 and less frequently is CD33 while CD14 showed no expression; myeloid antigens expression in ALL may have better prognosis as they have lower B.M. blast percent and LDH value.
  1,241 116 -
Knowledge of the caregivers of thalassemic children regarding thalassemia: A cross-sectional study in a tertiary care health facility of eastern India
Bijit Biswas, Narendra Nath Naskar, Rivu Basu, Aparajita Dasgupta, Bobby Paul, Keya Basu
July-December 2018, 7(2):49-54
DOI:10.4103/ijh.ijh_1_18  
Background: Caregivers knowledge regarding thalassemia is one of the vital areas in the prevention of the disease. Studies related to caregivers knowledge and its sociodemographic predictors are very few in number which is helpful in designing interventions across different study settings. Objectives: the study aimed to find out the knowledge level of caregivers of thalassemic children and its sociodemographic determinants. Materials and Methods: It was a cross-sectional observational study conducted in a thalassemia day care unit of Eastern India. The study included 328 caregivers of thalassemic children attending thalassemia day care unit during May 2015–April 2016. Data were analyzed using Statistical Package for the Social Sciences (SPSS) (version 16). Results: Out of 328 caregivers only 47.6% knew about genetic etiology of the disease, while only 52.4% and 50.9% knew about premarital counseling and antenatal screening, respectively. Regarding treatment of the disease, 75.9% knew that both blood transfusion and iron chelation are the treatment of thalassemia, while only 19.2% and 2.7% of them had knowledge regarding splenectomy and bone marrow transplantation, respectively. Only 52.7% had satisfactory knowledge regarding the disease. In multivariable model, caregivers educational level (adjusted odds ratio, AOR-3.13 [1.87–5.25]), working status (AOR-2.18 [1.23–3.86]), place of residence (AOR-2.05 [1.19–3.52]), and socioeconomic class (AOR-2.11 [1.25–3.58]) were significant predictors of their knowledge. Conclusion: Caregivers' knowledge regarding thalassemia was not at all satisfactory. Regular counseling of caregivers should be done addressing the knowledge lacunae's among them.
  1,150 190 -
Immunohistochemical expression of SOX11 as a diagnostic tool for mantle cell lymphoma
Bassam M Hameed
January-June 2017, 6(1):17-20
DOI:10.4103/ijh.ijh_8_17  
Background: SOX11 is a transcription factor that has role in central nervous system development, it has found that this marker expressed in nuclei of mantle cell lymphoma and may play vital role in diagnosis and pathogenesis of mantle cell lymphoma. AIMS: To evaluate the diagnostic role of SOX11 immunohistochemical expression in mantle cell lymphoma. Materials and Methods: A cross sectional study was designed, a total of 62 left over tissue samples (paraffin block of bone marrow biopsy) were included in the study. All the samples were taken from the Medical city/ teaching laboratories, and presented during the period 2014-2016. Cases diagnosed according to the WHO classification of mature B-cell Neoplasms with 26 cases having CLL/SLL, 17 were mantle cell lymphoma and 19 cases with follicular lymphoma. All the practical steps were carried out in teaching laboratories department of pathology and forensic medicine/ Al-Nahrain University - Collage Of Medicine. From each block, two sections were taken, and one were immunohistochemically stained for SOX11. And other section stained for haemtotoxylin and eosin stain. Results: In MCL, nuclear staining of SOX11 was seen in 16 (94.12%) of 17 patients, SOX11 nuclear staining was also seen in 1 case (3.85%) of 26 CLL/SLL cases, and 0 (0.0%) of 19 patients with FL. Furthermore, compared with CLL/SLL and FL, the positive rate of SOX11 nuclear staining was significantly higher in the MCL samples (P < 0.001). In addition SOX11 nuclear positivity had high sensitivity (94.12%) and specificity (97.78 %) in diagnosis of MCL compared to Cyclin D1. Conclusions: SOX11 is a powerful diagnostic tool for MCL, and may help in distinguishing it from other B-cell lymphoproliferative disoreders.
  1,197 112 -
Application of serum C-reactive protein in comparison with βeta-2-microglobulin in patient with multiple myeloma
Sammer A Najjar, Waseem F Al Tameemi
January-June 2017, 6(1):6-11
DOI:10.4103/ijh.ijh_3_17  
Background: Multiple myeloma (MM) is a clonal proliferation of malignant plasma cells in the bone marrow that produced monoclonal protein, and associated with different organ dysfunction. β2 Microglubulin is a known prognostic marker while CRP is proposed to be of equivalent significance. Objective: To assess the usefulness of C-reactive protein (CRP) as an alternative to β2 Microglobulin in term of MM staging and related organ tissue injury in case of limited resources circumstances. Patients and Methods: A hospital based cross sectional study was conducted from the 1st of Mar 2015 till the 1st of Jan 2016 at the hematology department in Al-Imamain Al-Kadhimain Medical City and Baghdad Medical City. It included 25 patients who were newly diagnosed with Multiple myeloma from both genders. CRP and β2 Microglubulin were estimated using ELISA in relation to diseases stage and manifestation. Results: The mean age was 56.5 ± 12.6 years. Fatigue and bone pain were the predominant presenting features. Mean CRP was 20.87 ± 11.20 μg/ml with a very significant positive correlation with staging (r = 0.779, P = 0.0001) as well as with bone marrow (BM) Plasma Cells % (r = 0.665, P = 0.0001) and β2 Microglubulin (r = 0.816, P = 0.0001). Conclusions: C-reactive protein can be considered as an independent prognostic parameter to replace β2 microglobulin in evaluating patients with MM staging and related tissue organ injury in case of limited resources, with equivalent clinical applications.
  1,186 113 -
CASE REPORT
Pure red cell aplasia in chronic lymphocytic leukemia: Case report and review of literature
Hassanain H Al-Charrakh, Liqaa M Al-Shareefy
July-December 2016, 5(2):187-191
DOI:10.4103/2072-8069.198131  
Despite being immune deficient, chronic lymphocytic leukemia (CLL) patients have an increased incidence of autoimmune cytopenias secondary to autoantibody formation. These are: warm autoimmune hemolytic anemia; idiopathic thrombocytopenia; pure red cell aplasia (PRCA), and In this case report, we describe a patient with CLL who developed severe anemia requiring frequent red cell transfusion after the third cycle of chemotherapy. Blood film showed no evidence of hemolysis and absolute reticulocytopenia. Bone marrow showed erythroid hypoplasia and residual interstitial infiltrate of CLL. The diagnosis of CLL-induced PRCA was made, and the patient showed a prompt and dramatic response to treatment with cyclosporine.
  1,192 93 -
ORIGINAL ARTICLES
Evaluation of CD96 and CD123 in CD34+ leukemic stem cells in acute myeloid leukemia patients and their relation to response to induction therapy
Haidar H Al-Fatlawi, Raad Jaber Musa
July-December 2016, 5(2):161-166
DOI:10.4103/2072-8069.198119  
Background: Leukemic stem cells (LSCs) are thought to originate either from normal hematopoietic stem cells or from more differentiated progenitor cells. LSCs are capable of self-renewal, proliferation, and differentiation into malignant blasts. Objective: To evaluate the expression of the LSC markers CD96 and CD123 in de novo acute myeloid leukemia (AML) patients, and to explore the relationship between those markers and response to induction therapy and prognostic factors in AML. Materials and Methods: A cross-sectional study was conducted on 30 adults with newly diagnosed AML patients were prospectively tested for the expression of CD96 and CD123 using four-color flow cytometer at the time of diagnosis and re-evaluated at day 28 from the start of chemotherapy for the response to 3 + 7 induction therapy regimen. Results: Eight cases (26.7%) expressed CD96, and 12 cases (40%) expressed CD123; all the CD96 positive cases were also CD123 positive, however, four cases among the CD123 positive patients did not express CD96. CD96 and CD123 were expressed more on blast cells in the cases of M5 French-American-British subtype, whereas the least expression was in M3. Among the eight cases with CD96+ expression, only (37.5%) acquired CR, whereas cases without CD96 expression, (77.3%) acquired CR. Among the 12 cases with CD123+ expression, only (33.3%) acquired CR, while cases without CD123 expression, (88.9%) acquired CR. Conclusion: The expressions of CD96 and CD123 were associated with a higher total white blood cell count and bone marrow blast cells at presentation, and a lower response rate to the induction therapy.
  1,155 126 -
Evaluation of molecular monitoring and response milestone of patients with chronic myeloid leukemia to tyrosine kinase inhibitors in Middle Euphrates of Iraq
Rahem M Rahem, Alaa S Alaawad, Talib H Kamoona
July-December 2016, 5(2):143-148
DOI:10.4103/2072-8069.198080  
Background: In the last decade, tremendous changes occurred in the treatment and follow-up of the patients with chronic myeloid leukemia (CML), with continuous update in the close molecular monitoring of treatment for the presence of minimal residual disease. Objectives: The objective of this study was to evaluate the molecular monitoring of patients with CML on tyrosine kinase inhibitor (TKI) treatment and categorization of those patients according to the European Leukemia Net (ELN) guidelines. Materials and Methods: This observational cross-sectional study was conducted among all patients with CML registered in Oncology and Hematology Centers in Middle Euphrates of Iraq including 244 patients from April 2013 to April 2016. Eligible patients were 199 cases while 45 cases were excluded from the study. Venous blood in ethylenediaminetetraacetic acid was collected with each time of molecular monitoring to assess the level of messenger RNA of breakpoint cluster region-Abelson (BCR-ABL) by quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) (Cepheid, Gene Xpert Diagnostic System). Results: Most of the patients were in young adult age group with disease predominance more in females than males. Majority of the patients (72%) achieved optimal response after 12 months of treatment according to the ELN guidelines and 28% showed primary resistance to TKI. Some patients with optimal response (9%) will develop secondary resistance to treatment. Conclusion: Most of our patients achieved major molecular response after 12 months of treatment with TKI according to the ELN guidelines that reflect proper management and regular follow-up of the patients by quantitative RT-PCR for the detection of BCR-ABL level.
  1,133 147 -
Thyroid dysfunction in chronic myeloid leukemia patients on nilotinib
Khaleed J Khaleel, Ahmed H Matloob, Abdalsalam Hatim
January-June 2018, 7(1):33-38
DOI:10.4103/ijh.ijh_39_17  
Background: The use of tyrosine kinase inhibitors has dramatically improved the prognosis of chronic myeloid leukemia (CML). Nilotinib has been reported to be associated with hypothyroidism and hyperthyroidism. Objectives: The current study aims to evaluate the prevalence of thyroid dysfunction in a sample of Iraqi patients with CML (chronic phase) treated with nilotinib and its possible association with grade of other hematological parameters. Patients and Methods: Thirty-one patients with CML and the same number of healthy controls were enrolled in this cross-sectional study. All the patients were on nilotinib hydrochloride for at least 6 months. Results: Approximately 10% of the patients were having hypothyroidism and 3% were hyperthyroid while the rest (87%) were normal regarding thyroid function. There was a significant difference between the study and control group in thyroid stimulating hormone levels (P < 0.05) with the level being higher in the study group. Conclusion: Thyroid dysfunction, particularly hypothyroidism is a clinically important adverse effect of nilotinib. Monitoring of thyroid function is required for patients taking this drug.
  1,108 102 -
The frequency of aberrant lymphoid antigens expression in 202 Iraqi patients with de novo acute myeloid leukemia
Wafaa Mohammed Al-Anizi, Mohammed Abdul Rassoul Al-Mashta
July-December 2017, 6(2):49-54
DOI:10.4103/ijh.ijh_17_17  
Background: Immunophenotyping improves both accuracy and reproducibility of acute leukemia classification and is considered, particularly useful for identifying acute myeloid leukemia (AML) with lymphoid marker expression. The incidence of the aberrant phenotypes in AML is still controversial; incidences as high as 88% have been reported. Objectives: To evaluate the occurrence of aberrant lymphoid phenotypes and to correlate their presence with various French-American-British classification (FAB subtypes), 202 cases of newly diagnosed AML were analyzed for lymphoid markers CD1a, CD2, CD3, CD4, CD5, CD7, CD8, CD10, CD19, CD20, and CD79a. Materials And Methods: Whole blood or bone marrow aspirate of 202 patients with de novo AML was collected in ethylenediaminetetraacetic acid tube and analyzed by flow cytometry using a large panel of fluorochrome-labeled monoclonal antibodies. Identification of blast cells was performed using forward scatter versus side scatter (SSC) parameters and CD45 intensity versus SSC dot plots. An antigen was considered positively expressed when at least 20% of the gated cells expressed that antigen. Results: Eighty-five patients (42%) with de novo AML expressed lymphoid-associated antigens. All AML subtypes demonstrated lymphoid-associated antigens except M7. T-cell aberrancy was the most common comprising 32.2% of the total aberrancy. The most frequently lymphoid antigen aberrantly expressed was CD7 (25.7%), followed by CD4 (22.4%) and CD19 (7.9%). Conclusion: A large number of AML cases showed aberrant lymphoid phenotypes. These lymphoid phenotypes might be associated with different leukemia subtypes. T-cell markers are more common than B-cell markers. CD7 was the most common lymphoid marker aberrantly expressed in AML.
  1,069 137 -
Plateletpheresis adverse events in relation to donor and plateletpheresis session profile
Rajni Bassi, Kusum K Thakur, Kanchan Bhardwaj
July-December 2017, 6(2):38-42
DOI:10.4103/ijh.ijh_14_17  
Introduction: Increasing demand of platelet transfusions for patients has led to a trend in the increased use of automated blood collections. These share many of the same reactions and injuries seen with pooled platelets obtained from whole blood donation but also have unique complications. Aims And Objectives: To study the adverse events (AEs) of plateletpheresis procedure and their relationship with donor and plateletpheresis procedure session profiles. Materials And Methods: This is a retrospective observational study conducted from January 2016 to December 2016. A two-hundred and thirteen (213) plateletpheresis procedures were performed after taking informed and written consent from the donor. All the donors were male and selected according to the guidelines laid down by Director General of Health Services. The AEs were classified into donor related, kit/equipment related and technique related. Results: A total of 13 AEs were noted; of which, 8 (61.53 %) events were associated with donors, 3 (23.07 %) were owed to fault in kit/equipment and 2 (15.384 %) were due to technical aberrations. Donor related AEs included vascular injuries [n = 3 (1.40%)], vasovagal reactions [n = 2 (0.938%)] and perioral tingling sensation [n = 3 (1.40%)]. Technique related AEs [n = 2 (0.938%)] and kit/equipment related AEs [n = 3 (1.40%)] were due to faulty technique and defective kits respectively. Conclusion: Apheresis donations performed on cell separators are safe. Meticulous donor vigilance, superior technical personnel training and experienced transfusion medicine specialist's supervision will make donor's experience more pleasant.
  1,079 113 -
Platelet parameters: Can they serve as biomarkers of glycemic control or development of complications in evaluation of type 2 diabetes mellitus?
Mukta Pujani, Himani Gahlawat, Charu Agarwal, Varsha Chauhan, Kanika Singh, Shveta Lukhmana
July-December 2018, 7(2):72-78
DOI:10.4103/ijh.ijh_8_18  
Background: Platelet function plays a crucial pathophysiological role in the development of atherothrombosis in patients with type 2 diabetes mellitus (DM). Platelet count (PC) and mean platelet volume (MPV) are simple, effective, and cheap tests that may be used to predict angiopathy in type 2 DM. Objectives: The aims of this study were to analyze various platelet parameters including PC, plateletcrit (total mass of platelets) (PCT), and mean platelet indices that are MPV, platelet distribution width (PDW), and platelet-large cell ratio (PLCR) in the type 2 DM patients, to compare various platelet indices between DM patients (with and without complications) and controls. Materials and Methods: This was a cross-sectional study conducted over a period of 3 months. Complete blood count along with blood glucose and HbA1c was estimated. The study population was divided into three groups: Group 1: Normal controls (n = 30); Group 2: DM patients without complications (n = 30); and Group 3: DM patients with complications (n = 30). Based on HbA1c levels among the diabetic patients, the diabetic groups were also classified as DM with HbA1c <7% and DM with HbA1c >7%. Results: All the platelet parameters were found to be higher among DM with complication as compared to DM without complication, and this was found to be statistically significant. Among the platelet parameters, MPV, PCT, and PDW were found to be higher among DM with HbA1c >7% as compared to DM with HbA1c <7%, and this was found to be statistically significant while there was no significant differences in PC and PLCR between the two groups. Conclusion: Monitoring of DM to prevent the occurrence of vascular complications is the need of the hour. The results of the study suggest a role of various platelet indices as a simple and cost-effective tool to monitor the progression and control of DM.
  991 193 -
Hematological toxic effect and the frequency of micronucleus formation of different doses of cyproheptadine on albino male mice blood picture
Ruqaya M Al-Ezzy, Zainab Yaseen Mohammed Hassan, Farah T. O. Al-Jumaili
July-December 2016, 5(2):149-153
DOI:10.4103/2072-8069.198085  
Background: Synthetic drugs are created using chemicals rather than natural ingredients. One reason that synthetic drugs are extremely dangerous is that buyers do not know what chemicals they are ingesting. Histamine in the body can produce symptoms of sneezing, itching, watery eyes, and runny nose. Cyproheptadine (periactin) an antihistamine is used to treat all these symptoms of allergies by reduces the natural chemical histamine, but it has different side effects which include: confusion, hallucinations, unusual thoughts or behavior, and seizure (convulsions). Objective: The aim of this study is to prove the scope of danger from cyproheptadine abuse on lymphocyte cells of male mice treated with child dose, maximum dose, and adult dose that may affect blood picture and their cytotoxic effect by determination of micronucleus (MN) formation in the cells of mice bone marrow. Materials and Methods: In the current study, a method was used for determination of total and absolute counts of white blood cells and find the frequency of MN formation in three groups of albino male mice treated with three equivalent doses of cyproheptadine: child dose, adult dose, and maximum adult dose (0.065, 0.092, and 0.12 mg/kg) respectively. Results: The study showed that cyproheptadine decreases total leukocyte count in adult and child dose in comparison to mice blank group that had not get the drug; also, the frequency of MN increases significantly after treated mice with cyproheptadine drug in comparison with negative control. Conclusion: More studies are necessary to elucidate the relationship between cytotoxic, genotoxic, and apoptotic effects and to make a possible risk assessment in patients receiving therapy with this drug.
  1,066 88 -
Role of endothelial dysfunction in relation to prothrombogenesis in polycythemia vera
Ibrahim A Mahmood, Farqad B Hamdan, Waseem F Al-Tameemi
January-June 2018, 7(1):8-13
DOI:10.4103/ijh.ijh_32_17  
Background: The morbidity and mortality in polycythemia vera (PV) are closely associated with cardiovascular diseases burden and clonal evolution. These complications were primarily attributed to abnormal rheology consequent to the raised hematocrit, leukocytosis, and thrombocytosis, and in vivo activation of leukocytes, thrombocytes, and endothelial cells. It has been established that damage of endothelium determines the release in circulation of specific markers including thrombomodulin (TM), selectins, and von Willbrand factor (vWF) which are released and favor the formation of cellular aggregates. Objectives: The objective of this study is to evaluate the pathophysiological role of endothelial dysfunction (ED) in relation to increased risk of thrombosis in PV patients. Patients and Methods: In a case–control study, 53 patients enrolled in this study from Al-Imamain Al-Khadimiyan Medical City, and the National Center for Hematology Diseases and Researches. They comprised of thirty patients with PV with mean age of − 54.87 ± 13.44 years-and another twenty-three patients with secondary polycythemia, whose mean age was 40.13 ± 12.21 years. Another thirty aged- and sex-matched, non-smokers healthy volunteers comprised 16 males and 14 females were also studied, their mean age was = 52.1 ± 11.16 years. JAK2 mutation was assessed for PV group while Serum erythropoietin (Epo), vWF and TM were determined for all patient and control group. Results: TM was significantly different among the three studied groups (P < 0.001) as well as vWF was significantly higher (P < 0.001) in patients with PV as compared to the patients with secondary polycythemia and controls. Epo level was significantly lower (P = 0.004) in the newly diagnosed patients with PV when compared to those with a history of thrombosis or longstanding disease. There is positive correlation between JAK2 and TM (r = 0.431, P = 0.017), while negative correlation with vWF (r = −0.565, P = 0.001) in PV patients. Conclusion: ED is one of mechanisms that contribute in prothrombogenesis in PV patient.
  1,000 147 -
Evaluation of the expression of CD200 and CD56 in CD34-positive adult acute myeloid leukemia and its effect on the response to induction of chemotherapy
Zainab Najah Muhsin, Subh Salem Al-Mudallal
January-June 2018, 7(1):20-25
DOI:10.4103/ijh.ijh_37_17  
Background: Acute myeloid leukemia (AML) is characterized by an excess number of myeloid cells in the marrow with maturation arrest and infiltration of bone marrow (BM) and other tissues by myeloblasts, resulting in BM failure. Objectives: The main goal of the present study is to investigate CD200 and CD56 aberrant expression in CD34-positive blasts, in newly diagnosed adult AML patients and their relation with the clinical and hematological parameters, as well as to identify their prognostic significance after induction therapy. Materials and Methods: This was a prospective cross-sectional study on thirty patients with newly diagnosed AML, who were tested for the expression of CD200, CD56 using multicolor flow cytometry and re-evaluated after induction therapy regimen. Results: CD200 and CD56 were aberrantly expressed in 53.3% and 20.0%, respectively, while coexpression of both markers was observed in 13.3%. Interestingly, both markers were expressed more in monocytic subtypes. Significantly, the induction failure in CD200 + patients was 75%, while it was 66.7% in CD56+ patients. Conclusion: The findings of this research provide insights that CD200 and CD56 were closely related to bad prognostic parameters, including high total white blood cell count, low platelet's counts, and low response to induction therapy.
  987 132 -
Is there a need to phase out replacement blood donors by voluntary blood donors in hospital based blood transfusion services?
Praneeta Jaswant Singh, Hitesh Bhatt
July-December 2017, 6(2):43-48
DOI:10.4103/ijh.ijh_15_17  
Background: Providing safe blood for transfusion is a responsibility of every blood bank. Screening for transfusion-transmissible infections (TTI) is one of the ways to ensure safety of blood and its products. Prevalence of TTI varies in different countries. It is low in developed countries whereas it is higher in developing countries. Aims And Objectives: This study was carried out to access percentage of blood collected from the first-time voluntary blood donors (VBD) and family/replacement donors (RD) and to access safety of RD by comparing seroprevalence of TTI among voluntary and RD. Materials And Methods: Over 1 year, donors were studied for the type of donation (voluntary or replacement) made at our blood bank. All donors were screened for human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malaria. Comparison of the prevalence of TTI among voluntary and RD was done by entering data into Microsoft Excel 2007 software and using Chi-square tests. Results: Out of total 850 first-time donors, voluntary donors were 109 (12.82%) and RD were 741 (87.18%). Overall seroprevalence of HIV, HBV, HCV, syphilis, and malaria was 0, 23 (2.70%), 12 (1.41%), 7 (0.82%), and 0, respectively. Prevalence of TTI among voluntary donors was very low. All donors were seronegative HIV and malaria. Prevalence of HBV, HCV, and syphilis was higher in RD. Conclusion: Data highlight that RD contributed major source of blood supply in hospital-based blood transfusion services and the prevalence of TTI was higher among them in comparison to first-time voluntary donors. Thus, efforts should be made to increase the number of VBD.
  1,003 113 -
REVIEW ARTICLE
Inherited thrombophilia: Diagnostic approach
Rahem Mahdy Rahem, Rehab Abdul Sahb Al-Waeli
July-December 2017, 6(2):31-37
DOI:10.4103/ijh.ijh_26_17  
Hemostatic abnormalities include both bleeding and thrombosis disorders. Adherence to most common guidelines for the diagnosis of thrombophilia is recommended especially in some developing countries. High level of orientation to thrombophilic disorders needs wide spectrum of knowledge about the causes, primary or secondary, investigations to most common risk factors, selecting candidates to investigations, in addition to covering the possibility of multifactorial background of disease. Limited data are available that focus on the thrombophilic disorders with imperfect diagnostic cooperation between clinical and laboratory aspects to reach the full picture of these hemostatic abnormalities. In this short review of literature, we considered the most important publications that assessed the inherited thrombophilia at levels of presentation, diagnosis, and management with focus on the practical side. The aim of this review is to summarize the most important aspects of the thrombophilia presentation, inherited causes, indications for testing, and investigations required for thrombophilic patients.
  945 137 -
ORIGINAL ARTICLES
Prevalence of hepatitis C virus seropositivity among multitransfused patients with hereditary anemias in Basra, Iraq
Oula Abdullah Najim, Meaad Kadhum Hassan
January-June 2018, 7(1):39-44
DOI:10.4103/ijh.ijh_41_17  
Background: Hepatitis C virus (HCV) infection is a global public health problem and is a leading cause of morbidity and death, with regional variations in genotype prevalence. Objectives: This study aimed to explore the prevalence of anti-HCV seropositivity among patients with hereditary anemias, the association of anti-HCV seropositivity with selected risk factors and the common HCV genotypes. Patients and Methods: This prospective descriptive study was carried out on patients with hereditary anemias from January 2010 through December 2014 registered at the Center for Hereditary Blood Diseases. A total of 2778 patients (1282 males and 1496 females) were recruited, their mean age was 13.19 ± 9.40 years. Patients were screened for HCV antibodies using an enzyme-linked immunosorbent assay test. Quantitation of the HCV viral load and genotype were assessed using polymerase chain reaction (PCR). Results: The frequency of anti-HCV seropositivity was higher in 2010 (33.7%) and declined progressively over the following 4 years (31.7%, 20.2%, 10.8%, and 9.2%), respectively. Out of 424 patients with two positive anti-HCV tests at least 6 months apart, 215 (50.7%) had positive results with PCR. The most frequent genotype was 4 in 43 (56.5%), followed by 1 in 31 (40.7%) patients; 1a: 21.1% and 1b: 19.6%. A significant association was found between anti-HCV seropositivity and type of disease, and deferoxamine pump use, P < 0.05. Conclusions: Anti-HCV seropositivity is declining among multitransfused patients with hereditary anemias in Basra, Iraq, and genotype 4 is the most common in these patients.
  958 123 -