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.

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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.

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Background: Thalassemia is the most common genetic disorders worldwide, widely spread throughout the Mediterranean region including Iraq. One effective method to reduce incidence of thalassemias and sickle cell disease is premarital screening. Objective: The aim of this study was to determine the prevalence of β-thalassemia trait and other hemoglobinopathies among subjects attending the premarital screening center in Erbil. Materials And Methods: Over a period of 1 year, 6224 couples were screened for hemoglobinopathies. Screened subjects were categorized according to the result of complete blood count, serum ferritin, and hemoglobin (Hb) electrophoresis into six groups, namely, normal, β-thalassemia carriers, α-thalassemia carriers, sickle cell carriers, Hb-H (HbH) disease, and iron deficiency anemia. Results: The prevalence of β-thalassemia trait was 6.94% (864/12448) with nearly equal proportions between male and female (male to female ratio = 1:1.1). HbH disease and sickle cell trait were less common. Iron deficiency anemia was reported in 52 subjects (0.4%). Conclusion: We found a relatively high prevalence rate of heterozygous β-thalassemia among the studied sample in comparison to prevalence figures from reports in the nearby geographic locations.

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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.

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Background: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world. The zeta-chain-associated protein (ZAP-70) an intracellular tyrosine kinase which play an important role in T-cell receptor signaling, natural killer cell activation, and early B-cell development. Interleukin-10 (IL-10) production has strong immunosuppressive effects through inhibition of Th1 type cytokines. IL-6 is a pleiotropic cytokine produced by a variety of cell types, including normal hematopoietic cells, and lymphocytes. Objectives: The objective of this study is to assess the level of ZAP-70, IL-10, and IL-6 in CLL and to correlate these levels with prognosis. Materials and Methods: A prospective cohort study carried out at the National Center of Hematology from October 2013 to September 2015. Eighteen patients with newly diagnosis of CLL compared to 19 apparently healthy controls were also involved in this study. ZAP-70 was measured by while IL-10 and IL-6 were measured using serological methods including the enzyme-linked immunosorbent assay. Results: ZAP-70 range between (24% and 90%) with a mean of 46.89 ± 19.15, two patients out of 18 were negative (<24%) for ZAP-70 as compared with control. The levels of IL-6 in the serum of untreated patients with CLL were increased in compared with healthy control (2.53 ± 1.98), ranged between (0.12 and 6.94) pg/ml. The range of the IL-10 expression of the untreated CLL patients was between (the lowest positive value (212 pg/ml) and which is the highest positive value (987 pg/ml) with a mean 614 ± 301 pg/ml, with all the morphologically diagnosed CLL cases show positive expression for IL-10. Conclusion: ZAP-70 level was higher in CLL patients than control and immunochemotherapy can normalize this which indicated good response to treatment. On the other hand, IL6 and IL10 were also higher in patients with CLL but not affected by therapy.

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Background: Hemophilia is a sex-linked bleeding disorder. Affected patients suffer spontaneous or post-traumatic bleeding into various sites of the body, mainly into joints, depending on the level of coagulation factor deficiency. Aims: This descriptive study is designed to assess the prevalence and extent of arthropathy and evaluate the functional status of hemophiliacs in Erbil, Northern Iraq. Settings And Design: A descriptive study of all registered hemophiliacs at Nanakali Hemato-Oncology Teaching Centre, Erbil, Iraq. Patients And Methods: Over 15 months (October 2015 to February 2017), a total of 133 hemophilia patients were studied. Their hospital records were used to retrieve clinical and laboratory data, mainly their coagulation profile. All patients were clinically examined at the daycare center; plain radiography was used to evaluate the degree of joint damage based on Petterson score. The magnitude of joint disease was assessed, and patients' functional status was evaluated depending on Functional Independence Score in Hemophilia (FISH). Statistical Analysis Used: Statistical analysis used MS Excel 2010. Results: Hemophiliacs mean age was 12.9 years. Patients with severe hemophilia presented earlier and had more bleeding episodes. At least one bout of hemarthrosis was recorded in 103/133 patients during the course of their disease with knee joint most frequently involved (in eighty patients) followed by elbow, ankle, wrist, and shoulder. The Petterson score related significantly to age of the patient, number of bleeds, and severity of hemophilia. Majority, 67%, of hemophiliacs found to have the limitation of movement. FISH score significantly related with factor activity level. Functional disability was encountered in 9.7% of cases; majority had severe hemophilia. Conclusions: The incidence and severity of joint bleeding and functional disability were high. The FISH and Pettersson scoring systems are very useful tools in assessing patients with hemophilic arthropathy.

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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.

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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.

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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.

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Background: Acute myeloid leukemia (AML) is a common acute leukemia in adult. Recent studies have shown that cytokine systems influence leukemic cell biology and clinical investigations. Among various cytokines, interleukin-6 and interleukin-10 (IL-6 and IL-10) participate an essential function in progression of the disease. Objective: The aim of this study is to quantify of IL-6 and IL-10 levels in AML patients who are newly diagnosed and evaluate lipid profile to assess the relationship between lipid profile level and body mass index (BMI) in myeloid leukemic patients. Materials And Methods: Samples were collected from 45 patients with AML from AL-Yarmouk Teaching Hospital in addition to another 45 healthy individuals were served as a control group during a period from October 2015 to October 2016. Patients ages ranged from 40 to 60 years. IL-6 and IL-10 were measured in all patients before any treatments and compared with control group. Results: There was an increase in age, white blood cell, and hemoglobin in AML patients as compared to control, but it was not significant. There was a significant increase in neutrophils and lymphocyte count, (P = 0.001). Furthermore, there was an increase in BMI, fasting blood sugar, and lipid profile except high-density lipoprotein cholesterol for AML patients as compared to control, but it was not significant. There was a significant increase in serum IL-6 and IL-10 for AML patients compared to controls (P = 0.001). Conclusions: The present study refers that AML patients were associated with high concentration of IL-6 and IL-10 in comparing to the control group.

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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.

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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.

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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.

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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.

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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.

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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.

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Background: Differences in blood group have been associated with predisposition to some diseases. Activated partial thromboplastin time (APTT) measures the efficiency of the intrinsic and common coagulation pathways, whereas prothrombin time (PT) test assesses the extrinsic and common coagulation pathways. Objective: The aim of this study was to assess the variations in PT and APTT among individuals of different ABO blood groups. Materials and Methods: A research was conducted at College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, and a total of 200 students were recruited, consisting of 106 females and 94 males. Six milliliters of blood was withdrawn from each individual, after obtaining ethical clearance and informed consent. ABO blood grouping was done by the tile method while APTT, and PT were analyzed using the standard manual methods. Statistical analysis was carried out using Statistical Package for the Social Sciences version 21. Results: The result shows that blood group O was predominant among the test individuals (45%) followed by blood groups A (31%) and B (15%), while blood group AB has the least percentage (9%). Blood group O showed a significantly higher APTT value (44.24 ± 15.10 s) compared to blood groups A (39.35 ± 12.12 s), B (35.93 ± 9.78 s), and AB (37.22 ± 8.15 s) (P < 0.05). Similarly, blood group A showed a significantly higher PT value (16.70 ± 2.53 s) compared to blood groups O (14.32 ± 2.37 s), B (13.53 ± 2.16 s), and AB (15.38 ± 1.79 s) (P = 0.05). Blood groups B and AB male individuals had a significantly higher PT and APTT levels, respectively, when compared with females (P < 0.05). Conclusion: This study showed that APTT and PT levels differ among different ABO blood groups; therefore, variations in blood group of individuals may affect their intrinsic and extrinsic coagulation mechanisms.

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BACKGROUND: In clinical practice, the cytopenias may result from relatively benign causes such as viral infections and Vitamin B12/folic acid deficiency to more sinister causes such as bone marrow failure. In this study, we looked into the clinicohematological profile and etiological factors of bicytopenia and pancytopenia. OBJECTIVES: To study the etiology and clinicohematological profile in patients of peripheral blood cytopenias. MATERIALS AND METHODS: This was a cross-sectional study conducted at a tertiary care hospital over a period of 1 year. Cytopenias were defined as pancytopenia when there was simultaneous presence of hemoglobin <10 g/dL, total leukocyte count <4000/dL, and platelets < 100000/dL or as bicytopenia when two of the three blood cell lines were depressed. All patients who presented with pancytopenia and bicytopenia were included, and their clinicohematological profile was recorded. RESULTS: A total of 204 patients (103 males and 101 females) were diagnosed to have cytopenias. Pancytopenia was observed in 69/204 and bicytopenia was seen in 135/204 cases. The various causes of cytopenias included infections (n = 126 [61.76%]), megaloblastic anemia (MA) (n = 48 [23.52%]), drugs (n = 12 [5.8%]), hypersplenism (n = 8 [3.9%]), bone marrow failure syndromes such as aplastic anemia and myelodysplastic syndrome (n = 7 [3.4%]) and leukemias (n = 3 [1.4%]). We found a significant association between MA and pancytopenia (odds ratio [OR] = 2.47, P < 0.05) and also between infections and bicytopenia (OR = 5.8, P < 0.05). CONCLUSION: The present study concluded that infections and MA are the most common cause of bicytopenia and pancytopenia, respectively. The more serious disorders affecting the bone marrow constitute only <5% of all cases of cytopenias.

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BACKGROUND: Acute leukemia is considered one of the most diseases that required frequent blood transfusion. Despite that blood transfusion is one of the main parts in the supportive management of acute leukemia patients, still, there are few data showing the exact requirements in regard to blood components for those patients. OBJECTIVES: The aims of this study were to review the predicted amount of blood transfusions needed for a patient with acute leukemia under a regimen of chemotherapy and to verify the transfusion frequency practices, according to the types of acute leukemia, levels of treatment, prognosis, and other demographic factors. MATERIALS AND METHODS: A prospective cohort study conducted at the National Center of Hematology/Mustansiriyah University from January 2013 to January 2015. Thirty newly diagnosed patients were enrolled in this study. The inclusion criteria included newly diagnosed acute leukemia whether lymphoid or myeloid except acute promyelocytic leukemia (M3) patients who were excluded. All patients subjected to detailed history and routine hematological investigations. They were followed up and assessed during induction and consolidation phases for both disease entities. RESULTS: Thirty patients were included in this study; 20 were male and 10 were female. The mean age was 31.4 years, ranging from 15 to 66 years. There were 15 cases of AML and 15 cases for ALL. The number of transfused units was found to be higher and statistically significant in those below 40 years of age, male patients and in patients with complete remission, while it was not significant for type of disease. CONCLUSION: This study provides information to estimate the anticipated requirements for blood transfusion for those patients in regard to different factors which can be considered as guideline for these tertiary centers for accurate assessment of transfusion requirements and to direct resources for better outcome.

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Cancer represents one of the most up to date issues worldwide because of the increasing number of affected people and the impact of it on the families and health system. It is one of the new challenges that face scientists and health worker and for many years lots of research and trials were trying to help in fighting this killer. The main aim of this review is to get a general look at the new understanding of cancer pathways and possible causes of resistance and their application in trails and clinical works, this piece of work aims to highlight the importance of pathophysiology of cancer in producing an effective treatment through targeting them. This review depended mainly on reviewing articles in the PubMed and Google Scholar, through writing (The hallmark of cancer, Hanahan and Weinberg) in the PubMed, around 14 articles had been emerged and only articles produced by the same authors in the years 2001 and 2011 had been selected as they were talking about the hallmark of cancer and resistance in details. Then, each pathway was followed as we searched according to a specific pathway and its targeted therapy in the PubMed and Google Scholar. Around 60 articles and trials had proved that targeting these pathways at different levels and even trying to stop these pathways with different targets can help to control cancer, and the new studies showed very promising results and they opened the door for future studies. For long time it was believed that cancer cells share six characteristic between them to develop and growth, however the same researchers who developed the initial hallmark of cancer had added new hallmarks which are : (1) abnormal metabolic pathways, (2) evading the immune system and two enabling characteristics: (1) genome instability, and (2) inflammation. Targeting these pathways has improved survival dramatically in most of cancers.

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