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  Citation statistics : Table of Contents
   2014| October-December  | Volume 39 | Issue 4  
    Online since March 25, 2015

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Quality of life of Egyptian b-thalassemia major children and adolescents
Mohsen S Elalfy, Maisa N Farid, Jonair H Labib, Heba K RezkAllah
October-December 2014, 39(4):222-226
Introduction b-Thalassemia major (B-TM) is a serious health problem in which children are in need of regular blood transfusions from a very young age to survive. They also need to receive iron chelation therapy to remove excess iron from their bodies, which imposes serious risk on their health and quality of life (QOL). Hence, this study was designed to assess the QOL of Egyptian B-TM children and adolescents in comparison with their healthy peers. Materials and methods A total of 127 B-TM patients and 65 healthy volunteers were enrolled and interviewed at the Ain Shams University Thalassemia Center. QOL assessment was made using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale. Results The controls had higher QOL scores in all domains at the start of the study (P<0.0001). Compliant patients had higher total QOL scores (P = 0.004). High pretransfusion hemoglobin levels and low serum ferritin levels were independent predictors of better QOL scores. Conclusion B-TM patients had a poor QOL; high hemoglobin level and low iron overload were associated with improved QOL scores. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
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CD138 expression in plasma cells is volatile and time-lag dependent
Pranav Dorwal, Rashmi Thakur, Sangita Rawat
October-December 2014, 39(4):258-259
  4 2,117 274
Treatment outcome in Egyptian lymphoma patients, 2-year results, single-center experience
Hoda Gad Allah, Mohamed O ElAzzazi, Amal M Elafifi, Hany M Hegab, Mohamed M Moussa, Nevine N Mostafa, Mostafa K Helmy
October-December 2014, 39(4):209-216
Introduction Lymphoma is considered the most common hematologic malignancy in Egypt and accounts for about 8.4% of all new cancer cases annually; however, the treatment outcome needs to be evaluated and compared with those achieved with the standards used worldwide. Patients and methods A retrospective pilot descriptive study of the outcome of patients with lymphoma treated at the Clinical Hematology and Bone Marrow Transplantation Units in Ain Shams University Hospitals over 2 years (2008 and 2009) was carried out. The study included 74 patients, 31 of whom were diagnosed with Hodgkin's lymphoma (HL) (group I), 10 with indolent non-Hodgkin lymphomas (NHL) (subgroup IIa), and 33 with aggressive NHL (subgroup IIb). Results In this study, NHL was the most common type, found in 58% of the cases, and was more common in older patients; low-grade lymphoma was more common in women and aggressive lymphoma was more common in men. However, HL was found in 42% of cases and was more common in young males. Hepatitis C virus was the most common associated infection; it was detected in 6% of HL and 38% of NHL patients, who were usually in advanced stage disease (80.64% stage III and IV vs. 19.36% stage I and II in HL and 89.19 vs. 10.81% in NHL patients). IPS Hodgkin lymphoma (HL) and International Prognostic Index (IPI) non Hodgkin lymphoma (NHL) were not predictors for treatment response or subsequent relapse. The best results of chemotherapy were achieved using ABVD with IFRT in patients with HL, FC protocol in low-grade NHL, and CHOP-R in high-grade NHL. An overall higher response rate was found in patients with HL compared with NHL patients. ASCT in relapsed patients at the time of the second complete remission did not lead to a significant improvement in disease-free survival or overall survival. Conclusion Although auto-SCT in NHL in our unit was not statistically significant, but it yielded a good result compared with the international one.
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Cerebrospinal fluid and serum levels of monocyte chemoattractant protein 1 in acute leukemia patients: correlation to other prognostic factors
Mohammad I Ahmed, Dalia A Nafe, Maha Y Kamal
October-December 2014, 39(4):183-189
Background Acute leukemia (AL) is a malignancy with accumulation of blasts in the bone marrow (BM). The blast cells enter into the peripheral blood stream and secondary localized extramedullary sites. The regulation of this process has not been clearly explained so far. Objective The aim of this study was to evaluate the cerebrospinal fluid (CSF) and serum levels of monocyte chemoattractant protein 1 (MCP1) in AL patients with correlation to other prognostic factors and tumor load. In a case-control study, 80 de-novo AL patients and 30 healthy age-matched controls were included. All patients were subjected to thorough history taking, full physical examination, and laboratory investigations such as complete blood count, BM examination, and flow cytometry (by enzyme-linked immunosorbent assay method). Results MCP1 was significantly elevated in both blood and CSF in AL patients in comparison with the control group (P < 0.05). In AL patients, there was a significant positive correlation between MCP1 level in both blood and CSF and the following parameters: hepatomegaly, splenomegaly, lymphadenopathy, purpura, fever, platelet count, white blood cells, and blast % in peripheral blood and BM (P < 0.05) were observed. There was no correlation between MCP1 in blood and CSF and Hb, lactate dehydrogenase and first hour of erythrocyte sedimentation rate. Conclusion Significant increase in the CSF and blood levels of MCP1 level was observed in AL patients compared with the control group. This may be related to extramedullary leukemic infiltration, tumor load, and disease activity in these patients. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
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A clinicohaematological profile of elderly patientsbeing investigated for anaemia in a tertiary care centre in north-west India
Anil Raina, Ajay Kumar, Aneeta Singh, Geetika Gupta, Pavan Malhotra, Sunil K Raina
October-December 2014, 39(4):190-194
Background There are plenty of studies on prevalence of anaemia in high-risk groups such as pregnant and lactating women and children. Reliable data on the prevalence and causes of anaemia in the elderly population are not available, particularly in this region. Thus, the present study was carried out to profile anaemia in geriatric patients in our setup. Objectives The aim of this study was to profile anaemia clinicohaematologically among elderly. Materials and methods A total of 168 geriatric patients aged 65 years and above, male and female patients with haemoglobin less than 12 g/dl admitted in the Tertiary Care Hospital, were included in the study. Investigations were carried out, mainly haematological with supporting biochemical parameters, which included complete blood count, peripheral blood film examination, serum B12 and folate studies, bone marrow cytology, iron studies, liver and renal function tests, urine examination and radiological examination when required. Detailed clinical history, systemic examination and complete haematological, biochemical and radiological investigations were carried out when patients were being managed in the respective wards/units. Results Various underlying pathologies encountered were nutritional deficiency anaemia (47.6%), anaemia of chronic disease (20.2%), bone marrow infiltration (8.3%), multiple myeloma (7.1%), myelodysplastic syndrome (4.8%), myelofibrosis (4.8%), acute myeloid leukaemia (3.6%), anaemia of renal disease (2.4%) and chronic lymphocytic leukaemia (1.2%). Anaemia associated with chronic diseases included cases of pulmonary tuberculosis, rheumatoid arthritis, bronchiectasis, pneumonia and ischaemic heart diseases, which predisposed the patient to greater morbidity. Conclusion The incidence of anaemia is quite high among elderly patients, more so when associated with chronic diseases and malignancies. The major cause found is nutritional anaemia due to deficiency of iron, folic acid/vitamin B12 or dual deficiency. It is very important to diagnose the cause of anaemia by detailed investigations before initiating the required therapy. Egypt J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
  1 2,362 1,612
Evaluation of growth hormone and insulin-like growth factor-1 in children during and after therapy for acute lymphoblastic leukemia
Mahmood A Al-Azzawi, Ibrahim Elmadbouh, Thabit N Al-Azzawi, Tariq A Humood, Naglaa M Ghanayem
October-December 2014, 39(4):238-245
Background Higher levels of growth hormone (GH) and insulin-like growth factor-1 (IGF-1) stimulate the growth of myeloid and lymphoid cells and may contribute to leukemogenesis. Aim The aim of this study was to evaluate serum GH and IGF-1 levels in children with acute lymphoblastic leukemia (ALL) during active disease and after achieving clinical remission. Patients and methods Forty children with newly diagnosed ALL on the basis of history, physical examination, and blood and bone marrow analysis were included in the study. Patients were treated with vincristine, prednisolone, intrathecal methotrexate, l-asparaginase, and adriamycin and followed up for 6 weeks, in order to achieve clinical remission. Twenty healthy children of the same age group were used as the control group. Serum GH and IGF-1 levels of both controls and patients before and after therapy were measured. Results After the diagnosis of ALL and before therapy, GH was found to be nonsignificantly higher compared with healthy controls (8.80 ± 6.80 vs. 5.76 ± 2.77 ng/ml, P = 0.061), but IGF-1 was significantly higher in patients than in controls (233.50 ± 100.1 vs. 179.70 ± 77.94 ng/ml, P = 0.040). After achieving remission with 6 weeks of therapy, GH was found to be highly significantly decreased (2.04 ± 1.31 ng/ml) in patients compared with the level before treatment and compared with the control group (P = 0.0001). Also, IGF-1 was reduced significantly (192.93 ± 81.15 ng/ml) compared with the level before treatment (P = 0.0001) but was nonsignificantly higher compared with the level of the control group (P = 0.569). There was significant correlation between GH and IGF-1 levels in ALL patients before therapy and after achieving remission (P < 0.05). Conclusion The higher levels of GH and IGF-1 during active ALL and their reduction after treatment may be helpful in assessing the disease activity and predicting the response to chemotherapy.
  1 1,876 152
Primary hepatic lymphoma: an unusual hepatic malignancy: case report and review of the literature
Abhishek Purohit, Mukul Aggarwal, Somasundaram Venkatesan, Manoranjan Mahapatra, Amit Kumar Dinda, Pravas Mishra, Renu Saxena
October-December 2014, 39(4):253-255
Primary hepatic lymphoma is a very rare malignancy representing ~0.016% of all cases of non-Hodgkin's lymphoma. It often presents in elderly persons with signs and symptoms of hepatitis, primary liver cancer, or metastatic tumor. In this case report, we present a 58-year-old lady with poor performance status who presented with obstructive jaundice, epigastric pain, and bilious vomiting. Abdominal imaging revealed a large hepatic mass that was pathologically confirmed primary hepatic diffuse large B-cell lymphoma without bone marrow involvement. Because of severe jaundice, she was managed with rituximab, cyclophosphamide, and prednisolone-based therapy but succumbed to neutropenic fever following chemotherapy. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
  - 1,319 106
Fulminant course of a case of idiopathic hypereosinophilic syndrome
Venkatesan Somasundaram, Abhishek Purohit, Mukul Aggarwal, Tulika Seth, Manoranjan Mahapatra, Hara P Pati, Renu Saxena
October-December 2014, 39(4):256-257
  - 1,004 83
Murine double minute-2 expression in B-cell chronic lymphocytic leukemia: correlation with apoptosis and disease outcome
Ashraf M El-Hefni, Tarek A El-Gohary, Naglaa A Khalifa
October-December 2014, 39(4):246-252
Introduction B-cell chronic lymphocytic leukemia (B-CLL) is characterized by accumulation of quiescent monoclonal CD5+ B cells, which arise from undefined defects in apoptotic cell death. murine double minute-2 (MDM2) oncoprotein exists in an autoregulatory feedback loop with the tumor suppressor protein p53 and block p53-mediated transactivation and apoptosis. Aim of this work The aim of the study was to evaluate the overexpression of MDM2 in B-CLL patients and correlate it with apoptosis using annexin-V expression and disease outcome. Patients and methods This study was conducted on 55 patients including 45 patients with typical B-CLL; their ages ranged from 55 to 72 years, with a mean age of 58.55 ± 3.9 years. Ten age-matched and sex-matched apparently healthy individuals were included as the control group. The diagnosis of B-CLL was based on clinical, hematological, immunophenotypic, and cytogenetic criteria. Annexin-V and MDM2 oncoprotein expression was assessed by flow cytometric analysis. Results Our study revealed that MDM2 was overexpressed in 53% of B-CLL cases and it was significantly elevated in comparison with the control group (P < 0.001). There was an inverse correlation between MDM2 overexpression and apoptosis (P < 0.001). The mean level of MDM2 expression was significantly reduced after therapy compared with the pretreatment level in the responder group (P < 0.001), whereas there was no significant difference (P>0.05) in the nonresponder group. The expression of MDM2 significantly correlated with the percentage of CD38 expression, LDH level, and B2M level (P < 0.001, P < 0.001, and P < 0.001, respectively) and patients who had responded to treatment showed a significant increase in the level of annexin-V (P < 0.001). MDM2 expression, percentage of CD38 expression, and LDH and B2M levels were significantly higher in the high-risk patients compared with low-risk and intermediate-risk patients (P < 0.001, P < 0.01, P < 0.05, and P < 0.001, respectively). Conclusion MDM2 expression was inversely correlated with apoptosis, with decreased MDM2 expression in responder patients.
  - 1,147 92
Eight-hour versus 24-h whole-blood hold before preparation of platelet concentrates by the platelet-rich plasma method
Azza S El-Danasoury, Mahira I El-Mogy, Amal Farouk, Ghada S Neseem, Ghada M El-Gohary
October-December 2014, 39(4):195-201
Background Platelet concentrates (PCs) can be prepared by immediate processing of fresh whole blood (WB); alternatively, they can be prepared from WB stored overnight at room temperature. For blood centers, extension of WB storage time from 8 to 24 h would very useful because of significant operational and logistical benefits. This work was carried out to assess the quality of PCs prepared from WB that had been held overnight at ambient temperature compared with that of PCs prepared from fresh WB donations over a 5-day storage period. Study design and methods Thirty units of WB were collected; 15 U were kept at room temperature for 6-8 h before platelet preparation (fresh group) and 15 U were kept in a controlled environment of 20-24°C for 22-24 h before platelet preparation (overnight group). Results PCs prepared after an 8-h or a 24-h hold were comparable in platelet count per PC. CD62P expression and pH values were significantly lower in PCs prepared from 24-h hold donations. Conclusion The quality of PC may in fact improve because of the ambient overnight hold period as evidenced by lower CD62P expression throughout the storage period, which indicates a lower level of platelet activation. The lower pH values detected in overnight PCs remained within the international acceptable range. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
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Prognostic impact of neuropilin-1 expression in children with B-lineage acute lymphoblastic leukemia
Nahla A Nosair, Adel A Hagag
October-December 2014, 39(4):202-208
Background Neuropilins are transmembrane glycoproteins that act as receptors for vascular endothelial growth factors and are involved in the process of tumor angiogenesis. Objective The aim of this work was to study the prognostic value of neuropilin-1 (NRP-1) expression in children with B-lineage acute lymphoblastic leukemia (ALL). Patients and methods We analyzed NRP-1 expression level in 50 newly diagnosed children with B-lineage ALL and in 20 healthy controls using flow cytometry. Expression of NRP-1 at diagnosis was correlated with standard clinical and laboratory prognostic features. Results The present study revealed a highly significant difference in NRP-1 expression between ALL patients and controls; the mean percentage expression of NRP-1 on bone marrow (BM) blasts of B-ALL patients was 36.86% overall. The highest levels of NRP-1 expression were noted in pre-B-ALL (74.04%) followed by early pre-B-ALL (23.55%) patients, and the lowest expression levels were in mature B-ALL (12.06%) patients, with significant differences between the three subtypes. The expression of NRP-1 was significantly associated with higher white blood cell count, bone marrow blast percentage, and serum lactate dehydrogenase levels at diagnosis. Also, there was a significant association between higher NRP-1 expression and both Philadelphia-positive and CD10-negative ALL types. We found significantly higher levels of NRP-1 expression on BM blasts at diagnosis in patients who relapsed or died compared with those who achieved and maintained complete remission; patients with higher NRP-1 expression had significantly shorter overall survival and disease-free survival than did patients expressing NRP-1 on less than 20% of their BM blasts. Conclusion Our findings suggest that NRP-1 is significantly expressed in children with B-lineage ALL, especially with the pre-B phenotype, and has a bad prognostic impact on the course of this disease. Recommendations We recommend the incorporation of NRP-1 as a prognostic marker in children with B-lineage ALL to offer a chance for intensive therapeutic intervention in patients designated as having poor prognosis, and for studying its role as a potential target for antileukemic and antiangiogenic therapy. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
  - 1,158 131
Detection of hepatitis C virus antibody in the saliva of children and adolescents with b-thalassemia
Manal H El-Sayed, Jonair H Labib, Dalia H Abdel-Hamid, Heba RA Helaly
October-December 2014, 39(4):217-221
Introduction Children with b-thalassemia (BTM) are at risk of acquiring hepatitis C virus (HCV) infections because of their need for multiple blood transfusions. The aim of this study was to evaluate the new rapid antibody test (OraQuick) for detection of HCV antibody in the saliva of BTM major and intermedia patients with known and unknown anti-HCV antibody status. Patients and methods The present study included 150 children and adolescents suffering from BTM enrolled from the Hematology and Oncology Clinic of the Children's Hospital of Ain Shams University. A full medical history, clinical examination, salivary swab detection of anti-HCV in saliva, blood sampling for complete blood count, and liver enzyme assessment were performed. Anti-HCV testing by enzyme-linked immunosorbent assay and HCV RNA testing by PCR were carried out in those studied patients who had not undergone such tests earlier. Results There was significant correlation between HCV status and the total number of blood transfusions. A significant fall in the incidence of HCV infection after 2004 was proven. The sensitivity and specificity of both, the OraQuick test and the enzyme-linked immunosorbent assay test, were the same (97.8 and 100%, respectively). Conclusion The OraQuick HCV Rapid Antibody Test using saliva proved to have a high sensitivity and specificity. Therefore, it could be considered a noninvasive, easy, rapid, and reliable test for screening of patients suspected to have HCV infection.
  - 2,024 157
Correlation between ABO blood group and vaso-occlusive crisis among adult patients with sickle cell anaemia in northern Nigeria
Sagir G Ahmed, Modu B Kagu, Umma A Ibrahim
October-December 2014, 39(4):227-231
Background In sickle cell disease (SCD), the vascular endothelium is in a continuous state of activation by inflammatory cytokines, leading to increased secretion of von Willebrand factor (vWF), which is a potent mediator of cytoadherence. Vaso-occlusive crisis (VOC) involves cytoadherence of sickle red cells, leucocytes and platelets onto vascular endothelium. Non-O blood groups are also associated with the elevation of vWF levels. Thus, SCD and non-O blood groups are independently associated with the elevated levels of vWF, which is an important cofactor in the pathogenesis of VOC. Objectives We hypothesized that SCD patients with non-O groups would have higher levels of vWF and greater risk of VOC than SCD patients with blood group O. If our hypothesis is correct, SCD patients with non-O groups would have higher frequency of VOC than those with blood group O. Materials and methods We conducted a retrospective study of frequencies of VOC with respect to ABO blood groups and vWF levels in 352 adult patients with SCD in Nigeria. Results In comparison with blood group O, patients with non-O blood groups had significantly higher mean levels of vWF (189 vs. 153%, P < 0.05), significantly higher proportion of patients affected by VOC (75.8 vs. 34.2%, P < 0.05) with a significantly higher mean number of VOC episodes per patient (3.2 vs. 1.5, P < 0.05). The relative risk of VOC for patients with non-O blood groups was 1.94 (95% confidence interval 1.5-2.7, P = 0.004). Conclusion SCD patients with non-O blood groups had higher frequencies and risk of VOC that were attributed to the effect of higher levels of vWF. These data suggest that non-O blood group is a risk factor for frequent VOC and an adverse prognostic index in SCD. This preliminary report calls for further studies to precisely determine the clinical significance of ABO blood groups in SCD within the context of clinical subphenotyping
  - 2,502 189
Quantitative assessment of MLAA-34 expression in a sample of Egyptian patients with acute myeloblastic leukemia
Magdy El-Bordiny, Ashraf El-Ghandour, Mona Wagdy Ayad, Noha Abou-Diba
October-December 2014, 39(4):232-237
Background: MLAA-34 is a novel acute monocytic leukemia-associated antigen. Previous studies found that it might be an antiapoptotic factor and play a role in the carcinogenesis and the progression of leukemia, and its overexpression might be associated with an unfavorable presentation of acute myeloid leukemia (AML). Aim and objectives: The aim of this work was to study the expression of MLAA-34 in AML and its correlation with known prognostic parameters and the clinical outcome. Patients and methods: In 30 patients with de-novo AML compared with a control group of 25 age-matched and sex-matched individuals, MLAA-34 expression was assessed using quantitative real-time RT-PCR. Results and conclusion: Results revealed an overexpression of MLAA-34 in patients with AML-M5 compared with controls. Also, MLAA-34 expression was associated with a poor outcome and unfavorable presentation (a high leukocytic count and extramedullary disease). In conclusion, MLAA-34 may be used as a prognostic tool in AML, especially M5. Egyptian J Haematol 39:-0 © 2014 The Egyptian Society of Haematology.
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