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   Table of Contents - Current issue
October-December 2017
Volume 42 | Issue 4
Page Nos. 129-174

Online since Friday, February 9, 2018

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Hematological changes among children with dengue fever in Saudi Arabia Highly accessed article p. 129
Marwa H Abdel Hamed
Background Dengue fever is Vector born viral infections endanger billions of people. About 50 million cases of dengue infection every year all-over the whole world has been estimated by World Health Organization (WHO). DF occurs primarily in tropical areas around the world affecting both children and adults. It is endemic in certain cities of Saudi Arabia, such as Jeddah and Makkah. Dengue fever has nonspecific symptoms and signs, so laboratory confirmation of dengue infection is mandatory. Objectives To assess hematological changes of patients with dengue fever in pediatric age group among Saudi children. Design Descriptive retrospective study. Patients and Methods All data were collected from the medical records of 90 children aged from 2 to 15 years who had diagnosed to have dengue fever in Jeddani Group Hospital. The presenting clinical features were collected and analyzed. The laboratory results analyzed were blood count including Hemoglobin level, hematocrit level, lecucocytic count and platelet count. Results All 90 patients included in the study had both fever and myalgia, 2.2% of children had bleeding (epistaxis, bleeding gum). Mean±SD of Hemoglobin level was 10.82 ± 1.2 g/dl. Thrombocytopenia (platelets <150000/UL) was found in 74.45% of cases, leucopenia (<4000/UL) was detected in 66% of cases. Conclusion Dengue fever is mosquito transmitted viral infection, it needs accurate physical examination and proper follows up of hematological changes, this will lead to decrease morbidity and mortality among children.
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Programmed death receptor ligand-1 plasma concentration in chronic myeloid leukemia under first-line tyrosine kinase inhibitor therapy p. 134
Mohamed M Elkhawanky, Amro M El-Ghammaz, Hany M Hegab, Mohamed O El-Mesery
Background Chronic myeloid leukemia (CML) cells can suppress the immune system by secreting programmed death receptor ligand-1 (PDL-1) that acts as a coinhibitory molecule for T cells leading to T-cell exhaustion and disease progression. Aim The aim of this study was to assess the plasma level of PDL-1 in patients with chronic myelogenous leukemia and its correlation with prognostic parameters and response to first-line therapy. Patients and methods This study was carried out on 40 patients with CML in chronic phase and 40 control healthy participants. Patients with CML were subdivided into three subgroups, including 11 newly diagnosed patients, 17 imatinib mesylate-responding patients, and 12 imatinib-resistant cases. All patients were subjected to laboratory investigations including complete blood count, peripheral blood smear examination, bone marrow aspiration (if indicated), quantitative real-time PCR for Philadelphia chromosome, and plasma PDL-1 measurement by enzyme-linked immune sorbent assay. Results Our results showed high plasma levels of PDL-1 in patients with CML. Plasma PDL-1 levels showed a negative correlation with total lymphocyte count in imatinib-resistant subgroup. Imatinib-resistant subgroup showed a significant decreased level of PDL-1 versus newly diagnosed subgroup of patients with CML. The suggested PDL-1 cut-off value for prediction of patients with CML was 1327.5 ng/l. Conclusion Patients with chronic-phase CML (newly diagnosed, imatinib responding, and imatinib resistant) showed a highly significant increased PDL-1 level compared with the control group. Increased plasma PDL-1 level is a predictive risk factor for CML incidence and disease progression.
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Diagnosis of fungemia among pediatric patients with hematological malignancies: value of panfungal polymerase chain reaction p. 142
Marwa A El-Ashry, Eman A Ragab
Introduction Invasive fungal infections (IFIs) remain a significant threat to pediatric patients with hematological malignancies and to those undergoing stem cell transplantation. IFIs not only increase mortality and morbidity but may also lead to delayed administration of chemotherapy, prolonged hospitalization, and additional costs associated with antifungal therapy. Early detection and appropriate treatment is crucial for the survival of these patients. Aim The aim was to determine the value of real-time (RT) PCR, using a panfungal marker, in screening pediatric patients with hematological malignancies for early detection of IFIs. Patients and methods This study included 50 children previously diagnosed with different hematological malignancies and admitted to the Pediatric Hematology, Oncology and Intensive Care Units of Ain Shams University Children Hospital for treatment and follow-up. Children were clinically suspected as having an IFI. There were 20 (40%) females and 30 (60%) males, with their ages ranging from 2 to 18 years (median: 6; interquartile range: 4–10.25). Venous blood was collected from all patients and was submitted for the diagnosis of IFI by conventional blood culture and RT-PCR assay using universal fungal primers for amplification of the internal transcribed spacer 1 and internal transcribed spacer 4 regions. Results Of the 50 studied cases, 40% were positive for IFI by both blood culture and the panfungal PCR. A total of 12 (24%) patients were positive by the panfungal PCR only and the remaining 36% were negative by both assays. There was a statistically moderate agreement between the results of blood culture and that of RT-PCR for the detection of the panfungal marker (κ=0.545). Conclusion RT-PCR assay, using the panfungal marker, is a rapid and sensitive assay that can be reliably used for screening hematological malignant patients at high risk of IFIs. The negative predictive value of the assay is 100%; thus, it can provide greater confidence in excluding a diagnosis of IFIs when negative results are obtained. This, in turn, can help prevent unnecessary toxicity resulting from empirical antifungal treatment in individuals who may not be at risk of imminent fungal disease. However, the RT-PCR for the detection of the panfungal marker lacks specificity, making the interpretation of positive results a challenge.
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Role of measurement of interleukin 10 in idiopathic (immune) thrombocytopenic purpura p. 148
Hanan Hamed, Mohamed Moussa, Hanaa Fathey, Heba Tolba
Aim Biological markers useful for defining newly diagnosed patient with immune thrombocytopenic purpura (ITP) who are likely to develop the chronic form of the disease are partially lacking. The purpose of this study was to assess the clinical role of a cytokine in patients with ITP and correlate its levels with different stages of the disease. Patients and methods A total of 20 patients with ITP at the onset stage, 40 patients with chronic ITP, and 30 healthy matched controls were enrolled in this study. Serum levels of interleukin 10 (IL-10) were measured in all patients using quantitative immunoenzymatic assays. Result Serum IL-10 levels were significantly higher in patients with an acute evolution of ITP than in either healthy controls or patients with chronic ITP. Conclusion IL-10 seems to predict the clinical course of ITP, as it is significantly higher at the onset of the disease in patients who obtain disease remission in less than 1 year.
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Can CD34/CD123 distinguish between normal and leukemic B-cell precursors? p. 155
Saad S Esh, Nashwa M Al Azizi, Usama R Elsafy, Laila M Sherief, Marwa Zakaria, Marwa M Abdalah
Background/objective B-cell acute lymphoblastic leukemia (B-ALL) is the most common acute leukemia in children. There are many overlaps between leukemic lymphoblast and hematogones regarding their morphologic and immunophenotypic characteristics. CD123 is one of the markers that can be used to distinguish between leukemic lymphoblast and hematogones. In this study, we aimed to demonstrate the pattern of CD34/CD123 expression in hematogones and leukemic lymphoblast to monitor therapy response and detect minimal residual disease. Patients and methods This case–control study was conducted on 40 newly diagnosed patients with B-lineage ALL. They were 14 boys and 26 girls with a mean age of 4.29±2.31 and a range from 2 to 10 years. Expression of CD34/CD123 by flow cytometry was carried out at diagnosis and at the end of induction. In addition, 20 patients with reactive bone marrow were included to asses hematogones. Results In the patient group, cells with dim CD45 were found in 24 cases, 75% of them expressed CD34 and 83.3% expressed CD123. In addition, cells with moderate CD45 were 16, all expressed CD34 and 87.5% of them expressed CD123. Thirty-two (80%) leukemic blasts expressed both CD34 and CD123; in contrast, in four (10%) patients neither antigen was expressed. In hematogones, immature hematogones (dim CD45, CD34+) did not express CD123, whereas 75% of mature hematogones (moderate CD45, CD34) expressed CD123. On the other hand, at the end of induction, 18 (45%) leukemic blasts expressed both CD34 and CD123 and four (10%) showed no expression of both antigens. Conclusion This distinct pattern of CD34 and CD123 expression on B-ALL blasts (concordant) and hematogones (discordant) can help differentiate residual leukemic blasts from hematogones in patients with B-ALL.
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Phenotype analysis of lymphocytes in workers with chronic benzene exposure p. 161
Hanan M Fayed, Sanaa S Aly, Samira M Saleh, Mohamed El-Shahat Ebeid, Yasser A Ahmed
Background Automobile service station workers are at high risk of benzene toxicity because they neither take protective measures to prevent inhalation of petroleum products nor undergo regular medical checkup. Objective The aim of this paper was to study the effects of long-term benzene exposure on blood cells and liver function. Patients and methods The study was a controlled trial, which included 30 automobile service station workers investigated for alterations in blood cells, hepatic functions, and lymphocyte phenotype. Results When compared with controls, benzene-exposed workers had significant increase in alanine aminotransferase (47.80±3.19 vs. 28.50±4.35), aspartate aminotransferase (41.20±2.62 vs. 23.60±4.58), and alkaline phosphatase (305.13± 16.39 vs. 174.40±26.69) levels and significant decrease in total proteins (6.39±0.11 vs. 6.79±0.12), albumin (3.57±0.14 vs. 4.5±0.48), hemoglobin (10.77±0.49 vs. 13.97±0.69), platelets count (146.8±4.9 vs. 217.8±37.4), mean platelet volume (7.68±0.4; 8.83±0.8), white blood cells (3459±444 vs. 6171±1482), monocytes (188±64 vs. 338±190), neutrophils (2095±267 vs. 3487±998), lymphocytes (1177±265 vs. 2138±439) and its subsets [CD3 cells (948±217 vs. 1686±337), CD4 cells (321±81 vs. 1101±222), B cells (228±70 vs. 45.1±13.22), and CD4 : CD8 ratio (0.51±0.04 vs. 1.88±0.08)], with significant increase in CD8 cells (627±138 vs. 585±117) and platelet-lymphocyte ratio (PLR) (130.7±26.66 vs. 104.96±22.49). The duration of exposure positively correlated with PLR and negatively correlated with hemoglobin, platelets, mean platelet volume, white blood cells, neutrophil, lymphocyte (B cells, helper cells, and suppressor cells), and serum albumin. PLR had a negative correlation with CD4, CD8, and CD19 absolute counts. Conclusion Benzene exposure is detrimental to the liver and bone marrow and results in the reduction of all blood and lymphocyte series, intiating immune suppression which may predispose to carcinogenesis. PLR is a valuable, inexpensive, and reproducible index that is closely associated with impaired immune system in benzene-exposed workers.
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Acquired angioedema in a chronic lymphocytic leukemia patient in remission: a case report p. 169
Nahla Osman, Eman A Tawfik
Abstract Acquired angioedema is a rare but a well-recognized complication of lymphoproliferative disorders. It occurs as a result of overactivation of the compliment system due to reduced C1 esterase inhibitors with subsequent release of bradykinin. A 59-year-old gentleman with chronic lymphocytic leukemia experienced recurrent episodes of angioedema while on chemotherapy. Investigations confirmed low C1 inhibitor activity in a few occasions. Acute episodes were treated with replacement therapy. Chemotherapy was stopped after cycle 4 as remission was achieved. He experienced a further episode of clinically more severe acquired angioedema after stopping chemotherapy. He was treated with C1 inhibitor concentrate in the high-dependency unit. Subsequently, antifibrinolytics were started as long-term prophylaxis. He had no recurrence of angioedema since then. Conclusion High clinical suspicion and early diagnosis of this rare complication of chronic lymphocytic leukemia is crucial for reducing the morbidity and mortality in these patients. Although treatment directed to the underlying condition is beneficial in most cases with angioedema, this is not invariable and chemotherapy cannot be justified for those who are in remission.
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Isolated trisomy 6 cytogenetic abnormalities in acute myeloid leukaemia: a case report p. 172
Vikranth Varma, Anil Aribandi, Sushma Chelmeda
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