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REVIEW ARTICLE
The hallmarks of cancer and their therapeutic targeting in current use and clinical trials
Samir Al-Bedeary, Hisham Arif Getta, Dhay Al-Sharafi
January-June 2020, 9(1):1-10
DOI:10.4103/ijh.ijh_24_19  
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.
  16,104 1,962 3
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.
  10,659 455 2
Serum ferritin and hematological indices in thalassemia minor and nontransfusion dependent hemoghlobinopathy
Mehdi Dehghani, Parisa Karimzadeh, Nazanin Azadeh, Alirea Rezvani, Ali Kashkooe
January-June 2021, 10(1):17-22
DOI:10.4103/ijh.ijh_18_20  
BACKGROUND: Iron deficiency is not common in thalassemia minor and nontransfusion dependent hemoglobinophaties. The majority of these patients have normal-to-high serum ferritin. OBJECTIVES: The aims of the study were to evaluate serum ferritin levels in alpha and beta thalassemia minor and intermedia and in, hemoglobin H disease, and sickle cell anemia, and to investigate the effect of iron consumption on increasing serum ferritin levels and the role of Mentzer and Srivastava indices in patients with thalassemia minor and low serum ferritin levels. MATERIALS AND METHODS: In this study, 204 patients with alpha-thalassemia minor, beta-thalassemia minor, nontransfusion-dependent thalassemia intermediate, and sickle cell disease were studied. Serum ferritin levels, Mentzer, Srivastava, and Bordbar's formula were measured using erythrocyte indices. RESULTS: Irrespective of iron deficiency status, which was 5.9% and was more common in women, total iron intake was 39%. Iron deficiency status was 3.3% in alpha thalassemia, 9.8% in beta-thalassemia, and 4.5% in sickle cell disease. High and very high serum ferritin levels are more common in beta intermediate thalassemia and sickle cell anemia. Mentzer and Srivastava indices were not significant for differentiating thalassemia minor and iron deficiency, but the Bordbar's formula in thalassemia minor with iron deficiency was statistically significant (119.75). CONCLUSION: Patients with minor thalassemia and nontransfusion dependent hemoglobinopathy had a lower prevalence of iron deficiency according due to due to serum ferritin levels compared to the general population. High and very high ferritin is more common in intermediate thalassemia, hemoglobin H, and sickle cell patients.
  7,541 268 -
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.
  6,197 581 1
CASE REPORTS
Anemia with erythroid hyperplasia: An unusual presentation associated with parvovirus infection
Kriti Chauhan, Nikhil Shandilya, Varun Hatwal
July-December 2019, 8(2):87-89
DOI:10.4103/ijh.ijh_13_19  
Most of the patients with parvovirus B19 infection manifest with anemia and erythroid hypoplasia in bone marrow when the immunity of host is not competent enough to kill the virus like in posttransplant patients on immunosuppressive drugs and immunodeficiency syndromes. Herein, we present a case of parvovirus infection in an immunocompetent patient presenting with anemia, showing erythroid hyperplasia with hemophagocytosis in bone marrow, and also discuss the pathogenesis with review of literature in such a rare presentation.
  6,389 233 -
ORIGINAL ARTICLES
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.
  5,933 585 4
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.
  5,914 512 -
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.
  5,717 494 5
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.
  5,297 682 5
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.
  5,402 404 -
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.
  5,242 564 3
Prevalence of gestational thrombocytopenia and its effect on maternal and fetal outcome
Vijay Zutshi, Nidhi Gupta, Renu Arora, Supriya Dhanker
January-June 2019, 8(1):21-24
DOI:10.4103/ijh.ijh_17_18  
BACKGROUND: Gestational thrombocytopenia (GT) is considered as the most common cause of thrombocytopenia in pregnancy and accounts for about 75% of cases. OBJECTIVES: The objectives of the study are (1) to estimate the prevalence of GT among antenatal patients at Vardhman Mahavir Medical College (VMMC) and Safdarjung Hospital in New Delhi, India, and (2) to study the fetomaternal outcome in mild, moderate, and severe GT. MATERIALS AND METHODS: This is a prospective observational study done in the Department of Obstetrics and Gynaecology, VMMC and Safdarjung hospital in New Delhi, India, for a period of 6 months. All antenatal women underwent complete hemogram with manual platelet count in the third trimester. Those with platelet count 150 × 109/L were included and divided into three groups on the basis of platelet count. Maternal and fetal outcome was observed. Cord blood was sent for neonatal platelet count. Follow-up was done in these cases till 6 weeks postpartum. RESULTS: The prevalence of GT was 12.82%. Fetomaternal outcome was favorable. A total of five (2.5%) patients suffered from abruption. Postpartum hemorrhage was present in about 7 cases (3.5%). Blood transfusion including platelet transfusion was needed in around 13 cases (6.5%). There was no maternal mortality. Only 6 (3%) neonates were having thrombocytopenia (platelet count < 150 × 109/L) regardless of degree of maternal thrombocytopenia. Twenty-six (13%) neonates were admitted in nursery for monitoring; among these, 11 (5.5%) neonates' ventilation was needed. There was no neonatal death. CONCLUSION: Better fetomaternal outcome is seen in GT, so a vigilant and careful monitoring can prevent any adverse event.
  5,079 618 2
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.
  5,053 547 1
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.
  4,937 599 -
Clinicohematological profile of patients with peripheral blood cytopenias in clinical practice
Rajneesh Thakur, Navjyot Kaur, Malhotra Arjun, Sharma Sanjeevan, Puri Pankaj, Nair Velu
January-June 2019, 8(1):1-6
DOI:10.4103/ijh.ijh_5_18  
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.
  4,919 560 1
A one year anticipated blood transfusion requirements among patients with acute leukemia undergoing chemotherapy in the National Center of Hematology in Baghdad
Alaa Fadhil Alwan, Nidal Kareem Alrahal, Maha Abdul-Jabbar Alnuaimi
January-June 2019, 8(1):25-28
DOI:10.4103/ijh.ijh_12_18  
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.
  4,943 393 1
Prevalence of hemoglobinopathies among marrying couples in Erbil province of Iraq
Ranan Kardagh Polus
July-December 2017, 6(2):90-93
DOI:10.4103/ijh.ijh_27_17  
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.
  4,683 386 6
Variations in activated partial thromboplastin time and prothrombin time in individuals of A, B, AB, and O blood groups
Chizoba Okechukwu Okeke, Uru Star Okoro, Abiodun Babatunde
July-December 2018, 7(2):85-89
DOI:10.4103/ijh.ijh_11_18  
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.
  4,390 336 1
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.
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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.
  4,110 490 -
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.
  4,168 427 3
Characteristics of splenic marginal zone lymphoma: Clinical, hematologic, and flow cytometry findings of 34 cases
Wafaa Mohammed Al-Anizi, Mohammed Abdul Rassoul Al-Mashta
July-December 2017, 6(2):84-89
DOI:10.4103/ijh.ijh_25_17  
Background: Splenic marginal zone lymphoma (SMZL) is a low-grade disorder that regularly presents with peripheral blood (PB) involvement. A precise description of clinical, laboratory features and immunophenotypic characterization of SMZL are still lacking. Here, we reviewed 34 patients presenting with SMZL to describe the clinical, hematologic features, and flow cytometry immunophenotypic findings of this type of lymphoma at diagnosis. Objectives: The aim of this study is to confirm that SMZL has a specific immunologic profile which enables the hematopathologist and clinician to differentiate this low-grade B-cell lymphoma from other B-cell lymphoproliferative disorder, especially chronic lymphocytic leukemia and hairy cell leukemia, which could sometimes stimulate SMZL morphologically and to emphasize that a correlation of immunophenotypic findings, clinical, and hematologic features of patients plus careful morphological examination of PB and/or bone marrow (BM) aspirate can lead confidently to the correct diagnosis. Materials And Methods: Flow cytometry immunophenotypic findings of 34 cases of SMZL were reviewed. The analysis was performed by BD FACS Calibur™ and FACSCanto II flow cytometers. B lymphocytes were identified according to their Side-Scattered (SSC)/CD19 distribution. A marker was considered positive when expressed in more than 20% of cells above the control. Results: Median age was 60 years, range (35–84 years), both sexes were affected equally. All patients presented with splenomegaly, 71% of patients had absolute lymphocytosis and 88% of patients showed PB involvement. Seventy-four percent of patients had anemia and (53%) of them had thrombocytopenia. Cells from all cases expressed pan B-cell antigens (CD19, CD20), 74% of cases expressed CD79b and Human Leukocyte Antigen – antigen D Related (HLA-DR) expressed in nearly almost all cases (97%). Half of the patients expressed CD11c and SIgD, 41% expressed CD5 and FMC7 while CD25 and CD103 showed positivity in less than 5% of cases. Preferential expression of Kappa light chain was demonstrated, CD10 and CD38, SIgG were negative. Conclusion: SMZL has a distinct immunologic profile which if correlated with morphologic findings of PB or BM aspirates, clinical and hematologic features can help to make the accurate diagnosis and lessens the need of further invasive diagnostic procedure.
  4,308 274 -
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.
  4,183 318 -
ORIGINAL ARTICLES
Immunomodulation of cyproheptadine hydrochloride on albino mice blood lymphocytes
Zainab Yaseen Mohammed Hasan, Ruqaya M Al-Ezzy, Jasim Mohammed Abdullah, Bashar Sabri AL-Hamdi
July-December 2017, 6(2):74-77
DOI:10.4103/ijh.ijh_23_17  
Background: Cyproheptadine hydrochloride (HCl) is antihistaminic drug which used widely in our country as an appetizer and for weight gain especially for low weight children. Objective: The aims of this study were to assess the effects of cyproheptadine HCl on blood picture including white blood cells count, lymphocytes count, and its effect on the level of different cytokines. Materials And Methods: This is an experimental study conducted at Biotechnology Research Center Laboratory in Alnahrain University from November 2016 to April 2017. It included five groups of albino male mice, these groups were treated separately with four doses of the cyproheptadine drug and fifth as control group; the doses were selected according to the British National Formulary (BNF) 2010 calculated on the base of mice/human deference's in body weight: These are (0.065, 0.092, 0.120, 0.24) mg/mice/day, respectively, with fifth untreated mice group considered as control. Results: The untreated mice (control) lymphocyte count was (4000) cell/ml and the total lymphocytes count increased up to (7014) cell/ml than the normal leading changes in interleukins (ILs) level in different manner, such as decreasing in both IL-6 and IL-10 levels with increasing in IL-12 level and no change in IL-4 level. Conclusion: The current study showed that cyproheptadine HCl may have unwanted side effects, and its abuse may lead to disturbances in white blood cell especially lymphocyte which in turn will affect the immunity of persons taking it, especially in children, since the immune system modulates ILs secretion to face the irritability of drug behavior, that will lead abnormalities in human immune system.
  4,216 242 -
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.
  4,157 271 2