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.

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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 1^st of Mar 2015 till the 1^st 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.

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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: 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.

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Microangiopathic hemolytic anemia (MAHA) is a Coomb's-negative hemolytic anemia characterized by red cell fragmentation (schistocytes). Thrombotic microangiopathy anemia, including thrombotic thrombocytopenia and hemolytic-uremic syndrome, malignant hypertension, preeclampsia are among the most common causes. We present a case of MAHA presenting with thrombocytopenia initially diagnosed as MAHA secondary to thrombotic thrombocytopenic purpura and received five sessions plasmapheresis without improvement but with worsening of anemia and thrombocytopenia. On further inquiry, glucose-6-phosphate dehydrogenase deficiency was identified, and the patient showed dramatic recovery after the trial of B12 and folate.

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Bleeding from the small intestine is an uncommon condition, of about 5%–10% of all gastrointestinal (GI) hemorrhages. Small intestinal malignancies (SIMs) are very rare, accounting for only 1% of the whole GI malignancies. SIM has few and nonspecific symptom and signs as iron deficiency anemia, weight loss, abdominal pain, and upper and lower GI bleeding. Usually, the diagnosis was delayed and most of them present in advances stage. GI stromal tumor, adenocarcinoma, carcinoid tumor, and lymphomas are among the common malignancies. Diagnosis of such cases is difficult as the upper and lower GI endoscopy often normal, capsule visualized endoscopy may show bleeding site and lesion, biopsy also a difficult issue as in our case. Here, we present a 44-year-old male patient who complained of lethargy and fatigue for 2 months duration. On physical examination, he was unremarkable apart from pallor. The initial investigations showed moderate hypochromic microcytic anemia, with low serum iron studies. The stool examination for occult blood was positive for that we did upper and lower GI endoscopy which was normal. On capsule visualized endoscopy revealed a bleeding small intestinal lesion (jejunum) later, we used pediatric colonoscopy for deep enteroscopy which was successful in identifying the lesion and biopsy took from the lesion confirming the diagnosis of GI adenocarcinoma. Surgical removal of tumor performed and the patient treated by oncologist after proper staging had been done. We emphasized that successful use of other diagnostic tools as using pediatric colonoscopy set for diagnosing such rare tumor is an option.

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