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Is iron treatment related to weight gain in female patients with iron deficiency anemia?
Osman Yokus, Habip Gedik
April-June 2016, 41(2):42-44
Objectives To assess the relationship between iron treatments and to gain weight in the female patients. Materials and methods This study was conducted prospectively between 2013 and 2014 to assess the relationship between iron treatments and to gain weight in the female patients who were admitted to hematology clinic, Ministry of Health İstanbul Research Hospital with a diagnosis of iron deficiency anemia and iron therapy between the ages of 18 and 50 and signed informed consent. Results After 3 months of iron therapy, significant hemoglobin (Hgb) increase was observed in 30 of 33 patients. Weight gain and Hgb increase have not been found in three patients. Hgb increases in patients who gained weight more than 3 kg were found to be statistically significant than patients who gained weight 3 kg or less (P = 0.008). Conclusion Obesity and metabolic syndrome are current health problems in terms of mortality and morbidity. Weight gain related to iron therapy is a common problem in female patients with iron deficiency anemia. Patients under iron therapy should be counseled in terms of weight gain complication and benefits of diet and followed up serum ferritin and Hgb levels to prevent prolonged iron therapy. Physicians should pay attention to patients who do not gain weight without dieting.
  283,436 1,599 -
Platelet indices: consideration in thrombocytopenia
DA Elsewefy, BA Farweez, RR Ibrahim
July-September 2014, 39(3):134-138
Background There is increasing evidence that platelet indices, such as mean platelet volume (MPV), platelet distribution width (PDW), and platelet large cell ratio (P-LCR), have a significant role in the discrimination between hyperdestructive thrombocytopenia and hypoproductive thrombocytopenia, and they can be of great help as they are routinely generated by automated cell counters. Objective In this study, we aimed to assess the sensitivity and specificity of these indices and set cutoff values that aid in the diagnosis of thrombocytopenia cause. Materials and methods We recruited 20 individuals as the control group and 80 thrombocytopenic patients, who were divided into two groups: group I ( n = 40) included newly diagnosed immune thrombocytopenic purpura (ITP) patients (hyperdestructive thrombocytopenia), whereas group II ( n = 40) included hypoproductive thrombocytopenia patients. The MPV and platelet distribution width were derived from automated cell counter results. The P-LCR was calculated. Results In ITP (hyperdestructive thrombocytopenia) patients, the MPV and P-LCR were significantly higher; the best cutoff value for MPV was greater than 9.7 fl and for P-LCR was greater than 33.6%, with a diagnostic accuracy of 70.1 and 99.6%, respectively. Conclusion The MPV and P-LCR provide information about the underlying conditions of thrombocytopenia. These indices should be considered in the diagnosis of thrombocytopenia. The P-LCR can be safely relied upon for a positive diagnosis of ITP.
  30,425 985 1
Blood indices to differentiate between β-thalassemia trait and iron deficiency anemia in adult healthy Egyptian blood donors
AR Soliman, G Kamal, A Elsalakawy Walaa, TH Sallam Mohamed
July-September 2014, 39(3):91-97
Background β-Thalassemia trait (BTT) often shows microcytosis, a normal or an increased red blood cell (RBC) count, and an elevated level of HbA 2 , which provide the basis for laboratory screening. BTT is an important differential diagnosis of iron deficiency anemia (IDA). Donors with BTT have hemoglobin values comparable with normal; hence, they are accepted for donation and they usually escape diagnosis. Aim The aim of this work was to differentiate BTT from IDA through blood indices performed in routine complete blood count. Patients and methods A total of 200 samples were obtained from apparently healthy adult Egyptian blood donors randomly. Complete blood count and mean corpuscular volume (MCV) were performed to all individuals. Hemoglobin electrophoresis and/or serum ferritin was performed to samples with MCV less than 78 fl. Results Prevalence of BTT in this study was 6%, whereas IDA represented 4.5% of total 200 samples investigated. The cutoff value of MCV 73 fl was 91.7% sensitive and 100% specific in differentiating BTT from IDA. Red blood cell distribution width at level 14.5% or below can differentiate BTT from IDA with 83.3% sensitivity and 100% specificity. RBCs count at value above 5.47 million/mm 3 can differentiate BTT from IDA with 100% sensitivity and 100% specificity. Conclusion The cutoff values of MCV 73 fl or less, RBC count above 5 × 10 6 /mm 3 , and red blood cell distribution width 14.5% or less were suggested to be associated with a high probability of BTT.
  17,582 995 2
How to approach drug-induced agranulocytosis in ICU
Seema Mahant, Piyu Deo Mahant, Upasana Shobhane
July-September 2015, 40(3):109-112
Many drugs can cause agranulocytosis and neutropenia by bone marrow suppression. Drug-induced agranulocytosis (DIA) is a relatively rare, but life-threatening disorder that frequently occurs as an adverse reaction to drugs. The overall incidence of DIA ranges from 2.4 to 15.4 cases/million patients exposed to drugs per year. DIA remains a serious adverse event because of the occurrence of severe sepsis with severe deep infections (such as pneumonia), septicemia, and septic shock in around two thirds of patients. In this setting, older age (>65 years), septicemia or shock, metabolic disorders such as renal failure, and a neutrophil count below 0.1×10 9 /l are poor prognostic factors. The severity of neutropenia (<0.1×10 9 /l) and its duration (>10 days) may also impact negatively on the outcome. Commonly used drugs such as antibiotics (b-lactam and cotrimoxazole), antiplatelet agents (ticlopidine), antithyroid drugs, sulfasalazine, neuroleptics (clozapine), antiepileptic agents (carbamazepine), nonsteroidal anti-inflammatory agents, and dipyrone are the most common causes of neutropenia and agranulocytosis. Recent investigations suggest that there are at least three mechanisms by which it can be produced, namely, differences in drug pharmacokinetics, abnormal sensitivity of myeloid precursors, and adverse immune responses to drug administration. Genetic factors are important and could act by any of the above mechanism. In management, use of hematopoietic growth factors, such as granulocyte colony-stimulating factor and granulocyte-macrophage colony-stimulating factor, reduced mortality rate from 21.5 to 5%. Now a days, physicians use many drugs to increased life expectancy, as well as the development of new agents, should be aware of this complication and its management.
  6,294 512 1
Effect of Nigella sativa on hemodynamics, hemoglobin, and blood coagulation in patients with type 2 diabetes
Fatma M. Lebda, Abdullah O. Bamosa, Huda Kaatabi, Abdulmohsen Al Elq, Ali Al-Sultan
April 2012, 37(2):73-80

This study aimed to determine the efficacy of a Nigella sativa (NS) seed supplement on hemodynamics, hemoglobin (Hb) levels, and blood coagulation in patients with type 2 diabetes mellitus.

Study design

This study included 94 patients who were divided randomly into three dose groups. Capsules containing NS seeds were administered orally at a dose of 1, 2, and 3 g/day for 12 weeks. In all patients, the hemodynamic markers [systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate (HR), and rate pressure product (RPP)], Hb levels, and coagulation markers (prothrombin time, partial thromboplastin time, fibrinogen levels, and platelet count) were determined before treatment and after 4, 8, and 12 weeks.


Patients receiving 1 g/day NS for 12 weeks (group 1) showed nonsignificant changes in the hemodynamic parameters, whereas patients who received a supplement of 2 g/day NS (group 2) showed a significant reduction in the systolic blood pressure, diastolic blood pressure, mean arterial pressure, HR, and rate pressure product, compared with the baseline values. An increase in the NS dose to 3 g/day exerted less effect on the blood pressure and reversed the effect on HR. The Hb levels decreased slightly, but significantly in the three groups. Partial thromboplastin time showed a significant increase in group 2 at the end of the treatment period and a nonsignificant increase in groups 1 and 3 throughout the treatment period. However, the fibrinogen levels increased significantly in groups 2 and 3 compared with the baseline values.


Ingestion of 2 g/day NS seeds for 12 weeks exerted a favorable impact on the hemodynamic parameters. However, NS should be administered with caution in diabetic patients with anemia.

  6,161 254 -
Lipid profile in children with β-thalassemia major
Samera Z. Sayed, Sheren E. Maher, Ghada Adel, Lamea Hamdy
October 2012, 37(4):183-186

β-Thalassemia major is a very serious blood condition, as affected patients are unable to synthesize enough healthy red blood cells and depend on blood transfusions throughout their life.

Aim of work

The aim of the study was to evaluate the lipid profile in patients with β-thalassemia major.

Patients and methods

Fifty patients with β-thalassemia major and 25 healthy controls were included in this study. They were subjected to complete history taking, a thorough clinical examination, and laboratory investigations including complete blood count, liver function test, and assessment of serum ferritin levels and fasting lipid profile including total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides (TGs) levels.


Patients with β-thalassemia major showed significantly lower total cholesterol, HDL-cholesterol, and LDL-cholesterol when compared with controls. Serum TG levels of β-thalassemia major patients were found to be significantly higher than the levels in control individuals. Our results revealed that the lipid profile changed in patients with thalassemia major.


In thalassemic patients, adequate chelation therapy with normalization of serum ferritin level and monitoring of TGs is highly recommended, and they are treated aggressively if the levels are increased. Several interventions including antioxidant therapy and vitamin-lowering and lipid-lowering agents should be used in high-risk patients with β-thalassemia major to decrease the risk of atherosclerosis.

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Zinc and malondialdehyde levels among Egyptian patients with acute myeloid leukemia and their relation with disease phenotype and genotype
Inas A Asfour, Maryse S Ayoub, Amro M.S. El-Ghammaz, Ibtesam M Khalifa
October-December 2015, 40(4):153-158
Objectives This study was conducted to evaluate serum zinc and plasma malondialdehyde (MDA) levels in de-novo acute myeloid leukemia (AML) before and after induction chemotherapy and their relation with AML phenotype and genotype. Materials and methods Twenty-five AML patients were subjected to serum zinc evaluation using flame atomic absorption spectrophotometry and plasma MDA evaluation using colorimetric method at day 1 before induction chemotherapy and at day 21 after induction chemotherapy. Results Pretreatment MDA levels were higher in patients in comparison with controls (P = 0.03). Pretreatment zinc levels differed significantly compared with post-treatment levels (P = 0.005). The percentage of bone marrow infiltration by blasts at diagnosis correlated inversely with zinc levels (P = 0.011) and positively with MDA levels (P = 0.041). Finally, pretreatment MDA levels were higher among patients harboring adverse cytogenetics (P = 0.004). Conclusion The elevated plasma MDA status at diagnosis in AML patients correlates with a higher tumor burden in the bone marrow and adverse cytogenetic risk.
  2,103 3,856 -
Effects of oral iron (ferrous versus ferric) supplementation on oxidative stress and antioxidant status in pregnant women with iron deficiency: controlled trial
Sanaa S Aly, Hanan M Fayed, Samar S Ahmed, Ahmed H Abdella, Abdel-Aziz E Tamam, Nadia A Mohmmed
April-June 2016, 41(2):31-41
Background Pregnant women are more prone to oxidative stress. Iron deficiency anemia not only affects hematological parameters but also disturbs body oxidative balance, which impairs pregnancy outcome. Besides, iron therapy may generate harmful oxygen species. Objectives The aim of this study was to investigate the effect of the nature of oral iron supplementation (ferrous vs. ferric) in pregnant women with iron deficiency on oxidative stress and its correlation with peripheral systemic inflammatory response markers. Patients and methods A clinical trail study involves study included 30 healthy and 50 anemic pregnant women in their 20th-36th gestational weeks who fulfilled the inclusion criteria. They were randomly distributed to receive either ferrous sulfate or ferric polymaltose complex. Outcome was assessed after 8 weeks of iron supplementation and included hematological parameters, neutrophil : lymphocyte ratio, platelet : lymphocyte ratio, mean platelet volume, serum malondialdehyde (MDA), total antioxidant capacity (TAC), iron, and ferritin. Results Anemic pregnant women have increased oxidative stress with high levels of MDA and TAC, both at baseline and following iron supplementation (P < 0.001). Following 8 weeks of iron supplementation, there were a significant increase (P < 0.001) in hemoglobin and serum ferritin, and a significant decrease (P < 0.001) in the peripheral inflammatory markers neutrophil: lymphocyte ratio, platelet: lymphocyte ratio, mean platelet volume, and absolute lymphocyte counts. Conclusion Iron polymaltose complex was as effective as ferrous sulfate as both were able to correct hematologic parameters in parallel to a decrease in MDA and peripheral inflammatory markers together with an increase in TAC levels to maintain oxidative balance.
  5,355 492 3
Novel immunophenotyping marker in acute myeloid leukemia: does it implicate prognosis?
Amira Y Abd El-Naby, Amr Gawaly, Shereen Awni
October-December 2016, 41(4):155-160
Introduction AML is a heterogeneous group of neoplasms that affect hematopoietic cells responsible for the production of myeloid lineages in bone marrow (BM). Novel immunophenotyping marker in AML (CD30) is a 120 kDa cell membrane glycoprotein that shares sequence homology with tumor necrosis factor (TNF) receptors; it is expressed by myeloblasts (CD34+ and/or CD117+) in a substantial number of cases of non Monocytic AML, either de novo or arising from MDS. CD30 expression is more common in AML patients with unfavorable chromosomal abnormality. It is suggested that CD30 could be a target for therapy by using anti-CD30 antibodies in a subset of patients with non Monocytic AML; also it might provide useful information for patient prognosis and stage of disease. Aim of work Is to assess novel immunophenotyping marker in AML (CD30) and cytogenetic abnormality and its correlation with prognosis. Materials and methods This prospective cohort study included 120 patients with newly diagnosed acute myeloid leukemia. Their ages ranged from (2 to 75) years with a mean of (40.15±23.55) years. Chromosomal analysis by karyotyping was done in all AML patients and Multicolor flow-cytometry immunophenotypic analysis was performed on bone marrow aspirates of the AML patients using fluroisothiocyanate (FITC) conjugated antibodies to assess CD30 expression on BM myeloblasts. Results The previous study showed that CD30 was expressed in all AML cases rather than M4 and M5 cases that showed negative expression. In addition, this study showed that there is more CD30 expression in myeloblasts with unfavorable chromosomal abnormalities. A significant association between platelets counts and CD30 expression was also observed. There was a higher degree of thrombocytopenia and a greater tendency to have higher leucocytic counts in patients having +ve CD30 expression than those with –ve CD30 expression. Conclusion The analysis of CD30 expression has a potential role to be used as a prognostic marker in AML.
  2,081 3,495 -
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.
  1,685 3,647 1
Plasma interleukin-22 and its cellular receptor (IL-22RA1) expression in chronic lymphocytic leukemia
Nihal M. Heiba, Shereen A. Elshazly
November 2013, 38(4):123-129

Chronic lymphocytic leukemia (CLL) is an environment-dependent hematologic malignancy where interactions with accessory cells through cytokines and their receptors seem to confer a survival advantage, thus contributing to disease progression. Interleukin-22 (IL-22) is a T-cell-derived cytokine that promotes cell proliferation and survival through interaction with its receptor IL-22RA1, normally absent in normal immune cells, including B and T lymphocytes.


This study aimed to determine the plasma levels of IL-22 and the expression of IL-22RA1 on malignant cells in patients with B-cell CLL (B-CLL), together with their relation to clinical and prognostic characteristics of the disease.

Patients and methods

The study was carried out on 62 newly diagnosed B-CLL patients. Twenty-five age-matched and sex-matched healthy individuals served as controls. Patients were diagnosed, according to the International Workshop on CLL guidelines, by cytomophology, immunophenotyping, conventional cytogenetic analysis, and fluorescence in-situ hybridization. Plasma IL-22 levels were measured by an enzyme-linked immunosorbent assay and the expression of IL-22RA1 on leukemic cells was assessed by flow cytometry.


Plasma IL-22 was significantly higher in B-CLL patients (range, undetectable 62.9 pg/ml; median, 6.6) compared with control participants (range, undetectable 6.4 pg/ml; median, undetectable) (P<0.01). IL-22RA1 expression was negative in all normal controls, whereas in B-CLL patients it was positively expressed in 35/62 CLL cases (56%). Taking the median level of IL-22RA1 expression in CLL patients as a cutoff level, overexpression (≥10%) was observed in 32/62 (52%) cases. IL-22RA1 expression correlated significantly positively with plasma levels of IL-22 (rs=0.817; P<0.01). Patients presenting with high CD38 expression had significantly higher plasma IL-22 levels compared with those with low CD38 (undetectable 62.9 pg/ml; median, 19.3 vs. undetectable 50.1 pg/ml; median, 3.1) (P<0.01) as well as overexpression of IL-22RA1. No significant relation could be established between either plasma IL-22 levels or IL-22RA1 expression with other clinical features or prognostic criteria of CLL.


This is the first report to describe the aberrant expression of the IL-22 signaling pathway in B-CLL and to link its overexpression with high CD38 expression, a known poor prognostic marker of the disease.

  1,252 3,724 -
Flow cytometric evaluation of CD200 as a tool for differentiation between chronic lymphocytic leukemia and mantle cell lymphoma
Dahlia A El-Sewefy, Dina A Khattab, Mohamed T.H. Sallam, Walaa Ali Elsalakawy
April-June 2014, 39(2):42-46
Background In the majority of cases, flow cytometry enables the differentiation of chronic lymphocytic leukemia (CLL) from mantle cell lymphoma (MCL). However, the diagnosis of CLL becomes challenging when CD23 is not expressed by the leukemic cells or in cases of MCL expressing CD23. CD200 is a membrane glycoprotein expressed on a subset of T and B lymphocytes. Its expression has been observed on human myeloma, plasma cells, and CLL cells. Aim of the work We investigated the pattern of expression of CD200 in CLL and MCL patients, aiming to clarify its possible role in differentiating these often overlapping disorders. Patients and methods This study was carried out on 30 patients with newly diagnosed CLL and 10 patients with MCL. Flow cytometric immunophenotyping was performed using the CD200 monoclonal antibody in addition to the standard panel of chronic lymphoproliferative diagnosis. Results CD200 was expressed in 100% of CLL cases with moderate intensity compared with only 10% of MCL cases with low intensity. Conclusion CD200 is a powerful addition to the routine flow cytometric panel in the differentiation between CLL and MCL with high sensitivity and specificity.
  4,148 525 2
Phytochemical analysis, toxicity profile, and hemomodulatory properties of Annona muricata (Soursop)
Kingsley C Agu, Ngozi P Okolie, Ikechi Eze, John C Anionye, Abiodun Falodun
January-March 2017, 42(1):36-44
Background A wide array of ethnomedicinal values have been attributed to the different parts of Annona muricata, and indigenous communities in Nigeria, Africa, and South America extensively use this plant to augment conventional drugs. Aim The beneficial effects of A. muricata on the hematological profile have also been widely reported and this research sought to validate these claims. Design Adult albino Wistar rats were used in this study. Methanolic extracts of the various parts of the plant were used, with which we determined the 50% lethal dose (LD50) and acute toxicity status of the plant before hematological studies for a duration of 28 days (subchronic studies). Materials and methods During the subchronic studies, 100, 200, 400, 600, and 800 mg/kg of the fruit, leaf, stem-bark, and root-bark methanolic extracts were administered to groups 2–6, respectively, whereas group received 2 ml of distilled water and served as control. At the end of the administration period, the rats were killed and blood samples collected for onward hematological studies. Phytochemicals were quantified using standard procedures. Results The obtained results showed that both the leaf and fruit extracts had LD50 of 1918.33 mg/kg, whereas the stem-bark and root-bark both had LD50 above 5000 mg/kg. Subchronic observations were also made, including increased heart rates and diarrhea. The fruit and stem-bark extracts recorded a dose-dependent increase in CD4+ cells, especially from the 200 mg/kg dose. Also, the fruit, leaf, and root-bark extracts showed a dose-dependent increase in white blood cells and lymphocytes. The extracts of the various parts of the plant apart from the stem-bark recorded marked increase in platelet levels. The various extracts of the plant parts recorded striking increase in red blood cells, hemoglobin concentration, and packed cell volume. These observations could be linked to the remarkable quantity of alkaloids, flavonoids, and phenols present in the leaf and fruit fractions. Conclusion Thus, the obtained data suggest and validate the reported hemomodulatory and wound-healing properties of A. muricata, especially the fruit and leaf.
  4,093 425 5
Hematological changes among children with dengue fever in Saudi Arabia
Marwa H Abdel Hamed
October-December 2017, 42(4):129-133
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.
  2,981 1,405 -
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.
  2,478 1,620 1
The application of eosin maleimide-binding test in the diagnosis of hereditary spherocytosis among undiagnosed cases of chronic hemolytic anemia in children
Wessam M El Gendy, Hoda M Hassab, Amal M Ghanem, Irene M Lewis, Sarah M Nawar
July-September 2014, 39(3):109-113
Background Conventional diagnosis of hereditary red blood cell (RBC) membrane disorders, in particular hereditary spherocytosis (HS), is labor intensive, time consuming and requires at least 2 ml of blood, which might be impractical in the neonatal period. Participants and methods We evaluated the use of eosin-5-maleimide (EMA) as a rapid screening test for patients with HS. RBCs from 74 healthy controls and 66 anemic children (35 HS and 31 other hemolytic anemias; 10 cases diagnosed as thalassemia, eight cases of autoimmune hemolytic anemia, one case of ovalocytosis and 12 cases of undiagnosed hemolytic anemia) were stained with EMA and analyzed for their mean fluorescence intensity using flow cytometry. Results RBCs from patients with HS showed a greater degree of reduction in mean fluorescence intensity of EMA compared with those from normal controls and patients with other hemolytic diseases. These findings showed that the fluorescence flow cytometric-based method is a simple, sensitive and reliable diagnostic test for RBC membrane disorders using a small volume of blood, and results could be obtained within 2 h. Such a method could serve as a first-line screening for the diagnosis of HS in routine hematology.
  3,708 315 2
The diagnostic and prognostic value of CD38 and CD49d expressions in chronic lymphocytic leukemia
Olfat M Hendy, Mona A El Shafie, Maha M Allam, Tawfik A Motalib, Fatma A Khalaf, Suzy F Gohar
April-June 2016, 41(2):70-76
Background Little is known about the prognostic importance of coexpression of CD49d and CD38 in chronic lymphocytic leukemia (CLL) patients. Aim This study aimed to investigate the coexpression of both CD38 and CD49d as prognostic and survival markers in CLL patients. Patients and methods Fifty-two patients with newly diagnosed B-cell CLL were included in the study. Twenty age-matched and sex-matched healthy control participants were also included in the study. Patients were subjected to a clinical examination and abdominal ultrasonography and chest radiography. Laboratory investigations including complete blood count, β2 microglobulin, cytogenetic analysis, and immunophenotyping by flow cytometer (B-lymphocyte markers and the expression of CD38 and CD49d) were performed. Results There was a significant decrease in hemoglobin concentration and platelet counts in patients who coexpressed CD49d+/CD38+ compared with patients who expressed CD49+ alone, whereas white blood cell and lymphocyte counts, lactate dehydrogenase, and β2 microglobulin were significantly higher. In addition, CD49d+/CD38+ coexpression was significantly high in advanced stages of CLL. A positive correlation was detected between CD49d expression and poor prognostic parameters in CLL. The median treatment-free time was shorter in CD49d+ patients (32 months) compared with CD49d- patients (98 months). The median treatment-free duration was shorter in CD38+ patients (28 months) compared with CD38- patients (102 months). In the concordant cases of CD49d+/CD38+, the median treatment-free survival was shorter (24 months) in patients with CD49+/CD38+ patients compared with disconcordant cases of CD49d+/CD38- patients (62 months). Conclusion CD38 and Cd49d expressions are considered prognostic markers for CLL patients and they should be assessed to decided on the patient's therapy and to determine disease prognosis. These molecules should also be tested in a large-scale study to determine their potential in preventing frequent relapses and development of resistance to chemotherapy in CLL.
  3,680 329 1
Iron overload in transfusion-dependent β-thalassemia patients: defining parameters of comorbidities
Deena S Eissa, Rasha A El-Gamal
July-September 2014, 39(3):164-170
Background Iron overload represents a consistent and almost inevitable complication in patients with transfusion-dependent β-thalassemia. The frequently needed erythrocyte transfusions are known to be the leading source of body iron. Increased iron deposition in tissues was strongly suggested to underlie poor growth and development in transfusion-dependent β-thalassemia. This study aimed to investigate the pattern of increase in iron-overload parameters in relation to the therapeutic measures used and explore its effect on the physical growth of patients with transfusion-dependent β-thalassemia. Patients and methods The study included 60 transfusion-dependent β-thalassemia patients (median age 12.5 years, interquartile range 8-17 years) and 20 age-matched and sex-matched controls; each group was further subcategorized into less than 12-year-old and more than 12-year-old subgroups. The studied clinical parameters comprised weight and height, which were used to calculate the body mass index (BMI). Laboratory assays included complete blood counts for the assessment of pretransfusion hemoglobin, serum iron, total iron-binding capacity, ferritin, and growth differentiation factor 15 (GDF15), and the calculation of the transferrin iron saturation percentage (TISP). Results Less than one-third (30%) of the patients had a low BMI; no patient was overweight or obese. The median pretransfusion hemoglobin was 7.1 g/dl (interquartile range 6.8-7.2 g/dl). Fifty-two (86.7%) patients were inadequately chelated, showing serum ferritin levels more than 1000 ng/ml. In patients older than 12 years of age, the BMI was significantly lower in comparison with controls of the same age subgroup as well as patients less than 12 years old. Patients with a low BMI had significantly higher median values of TISP, ferritin, and GDF15 than those with a normal BMI. GDF15 values of the more than 12-year-old patients showed significant positive correlations with TISP and ferritin levels. Setting optimal cutoffs at 63% for TISP and 1210 ng/ml for serum ferritin (area under the curve 0.965 and 0.957, respectively) had indicated low BMI with higher certainties compared with GDF15 at a level of 10 000 pg/ml (area under the curve 0.783) in the more than 12-year-old patients. Conclusion Avoiding iron overload should be warranted for transfusion-dependent β-thalassemia patients to have normal BMI. Although a high GDF15 level is helpful in pointing toward the development of a low BMI, it added no value to TISP or ferritin as indictors of patients' growth retardation.
  3,497 463 1
Value of human CLEC12A expression in acute myeloid leukemia
Gehan M Hamed, Mona F Abdel Fattah
October-December 2016, 41(4):161-167
Background The need for identification of new specific, stable antigens during the course of acute myeloid leukemia (AML) is warranted to improve diagnosis, relapse detection, and eradication of leukemic cells. Aim We measured the surface marker human C-type lectin domain family 12, member A (CLEC12A), in 60 AML patients, 24 acute lymphoblastic leukemia (ALL) patients, and 20 controls by flow cytometry, to determine its diagnostic utility and stability in AML. Results CLEC12A was positively expressed in all studied AML patients, negative expression was detected in ALL patients, and normal CD34+ cells of the controls with significantly higher mean % expression and median fluorescence intensity was detected among AML patients (P<0.001). Receiver operating characteristic curve analysis revealed that CLEC12A at a cutoff value of at least 15.1% can diagnose and differentiate between AML and ALL with 100% sensitivity and specificity. CLEC12A was found to be positively expressed both in children and adult AML patients with significantly higher mean % expression and median fluorescence intensity in children (P=0.046), and a significant difference was found between different French–American–British Classification subtypes (P<0.001). No significant difference was detected as regards sex, newly diagnosed untreated AML patients versus AML patients in relapse (79.1±11.7 vs. 67.4±19.3, P=0.052), CD34+ versus CD34− leukemic blast cells (75.1±20.7 vs. 74.1±21.7; P=0.899), or between different cytogenetic prognostic risk groups (P>0.05). The marker was found to be positively expressed without significant difference in paired diagnosis/relapse samples, indicating its stability during the course of disease and after treatment. Conclusion CLEC12A is a specific and stable diagnostic marker of AML that could improve leukemia-associated immunophenotypes both in CD34+ and the poorly characterized CD34− patients by flow cytometry. In addition, low expression of CLEC12A on normal CD34+ progenitor cells positions the marker as a potential therapeutic target.
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The frequency of iron deficiency among patients with haemophilia-A in northern Nigeria: correlation with the disease severity and clinical implications
Sagir G Ahmed, Modu B Kagu, Umma A Ibrahim, Audu A Bukar
April-June 2015, 40(2):85-89
Background Haemophilia-A (HA) is an X-linked recessive disorder characterized by the deficiency of functional clotting factor VIII resulting in lifelong bleeding diathesis. We predict that HA would be associated with iron deficiency and the risk will be higher in those with severe disease. If our prediction is correct, the frequency and the relative risk (RR) of iron deficiency will be higher in patients with severe HA in comparison with nonsevere HA. Materials and methods We evaluated the levels of haemoglobin concentrations, red cell indices and serum ferritin retrospectively with respect to the disease severity among a cohort of treatment-naive patients with HA as seen at the time of diagnosis in some hospitals in northern Nigeria. Results Out of the 39 patients studied, 19 were iron deficient, yielding an overall frequency of iron deficiency of 48.7%. Out of the 39 patients, 24 (61.5%) had severe HA and 15 (38.5%) had nonsevere HA. Patients with severe HA had a significantly higher frequency of iron deficiency in comparison with nonsevere HA (66.7 vs. 20%, P < 0.004) and the RR of iron deficiency for patients with severe HA was 2.6 (95% confidence interval: 1.9-3.4, P = 0.003). Conclusion Iron deficiency is very common among patients with HA, the frequency and the RR of which is higher among patients with severe disease. Therefore, patients with HA should be regularly screened and treated for iron deficiency to prevent the adverse impact of iron deficiency on wound healing, the immunity and the mental development of haemophilic patients. However, the possibility of undesirable side effects of iron such as erosive gastritis, which can increase the risk of gastrointestinal haemorrhage in HA patients, calls for caution in the choice of oral pharmaceutical iron preparations vis-à-vis nonpharmaceutical dietary supplementation. Healthcare centres should formulate standard guidelines for the effective and safe treatment of iron deficiency in haemophilia patients.
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Assessment of D-dimer and protein S in Egyptian patients with cirrhosis with and without ascites
Wesam A Ibrahim, Nesma A Safwat, Mohamed M.M Ibrahim, Millimi A Djibrin
October-December 2018, 43(4):166-170
Background Liver cirrhosis is characterized by complex hemostatic defects, leading to both hemorrhagic and thrombotic complications. It is also associated with ascites. Being a derivative of plasma that accumulates in the abdominal cavity from transudative leakage out of cirrhotic liver and because ascites re-enters the systemic circulation, cirrhotic ascites may be a pathological fluid that contributes to hemostatic derangement in these patients. The aim of study was to measure plasma levels of d-dimer and protein S (PS) activity as hemostatic parameters in patients with cirrhosis of varying severity with and without ascites to evaluate the role of ascites as a contributor of coagulopathy associated with liver cirrhosis. Patients and methods A total of 90 patients with cirrhosis with varying degree of severity owing to hepatitis C admitted to Ain Shams University hospitals from January 2017 to January 2018 were included in this study. Patients were categorized into two groups: group I included patients with cirrhosis complicated with ascites (n=38), and group II included patients with cirrhosis without ascites (n=52). The severity of liver disease was assessed according to the Child–Pugh classification. Plasma samples from each patient were analyzed for the level of d-dimer and PS activity. Results Plasma d-dimer levels showed a significant increase in patients with ascites (2.04±0.38 mg/l) when compared with those without. However, PS activity was significantly decreased in presence of ascites (45.79±1.66%). These changes appeared to be significantly accompanied by the progression of liver dysfunction. Upon performing regression analysis (backward method), it was proved that ascites formation was a significant independent factor that increases d-dimer levels and deteriorates PS activity in patients with cirrhosis. Conclusion Our results suggest that ascites contributes to the coagulopathy in decompensated liver disease, and the degree of coagulopathy was proportional to the severity of liver disease.
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TET2 expression in a cohort of Egyptian acute myeloid leukemia patients
Nahla A Hamed, Nabil A El Halawani, Heba S Kassem, Mona W Ayad, Enas A Dammag
October-December 2015, 40(4):159-165
Ten-eleven translocation 2 gene (TET2) expression plays a crucial role in DNA methylation and hematopoietic stem cell functions. The prognostic relevance of the TET2 mutation in cytogenetically normal acute myeloid leukemia (AML) patients is still not well established. The aim of the present study was to determine the level of TET2 expression in AML patients, its prognostic significance, and its relation to cytogenetics. We studied TET2 gene expression by real-time PCR in 33 AML patients and 34 healthy controls matched for age and sex. The median age of AML patients at presentation was 40 years, with a female to male ratio of 1.06 : 1. A total of 87.9% were de-novo AML and 12.1% were chronic myeloid leukemia in blastic crisis. In all, 66.6% of cases had normal cytogenetics. Underexpression of the TET2 gene was present in 90.6% (0.3098 ± 0.3846) of the patients. TET2 expression was not affected by age (P = 0.609) or cytogenetic findings (P = 0.057). Yet, it was correlated inversely with pretreatment white blood cell count (rs = −0.366, P = 0.04). It also correlated with lower remission rates (P = 0.002) and relapse (P = 0.000). TET2 probably plays a role in the pathogenesis and progression of AML. This can play a role in targeted therapy in the future. Further studies are recommended to assess TET2 expression in response to hypomethylating agents to determine its predictive role in response to therapy using these agents.
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Nanotechnology-based artificial platelets
Feroz Alam, Mohammed Naim, Suhail-ur Rahman, Mariam Shadan
January-March 2014, 39(1):1-5
Platelets are essential components of blood. Because of drawbacks in collection and storage of platelets, marked shortage is felt especially in the areas endemic for dengue fever and malaria. To meet the shortage, various synthetic and semisynthetic compounds are being produced and tested worldwide, which either enhance platelet function or are a substitute to it. In this study, we discuss these semiartificial and artificial substitutes of platelets along with other compounds that enhance the activity of platelets, with special emphasis on their mechanism of action and biofeasibility.
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Rapid detection of multiple β-globin gene mutations by a real-time polymerase chain reaction in β-thalassemia carriers
Salwa M. Youssef, Mohsen S. El Alfy, Amany A. Osman, Dina A. Khattab, Mervat A. El Feky, Marwa E. Hussein
July 2012, 37(3):147-155

β-Thalassemia is a heterogeneous disorder caused by mutations that reduce or abolish the synthesis of the β-globin chain. The clinical severity of thalassemia major makes it a priority genetic disease for prevention programs involving population screening of heterozygotes and an optional prenatal diagnosis for carrier couples.

Aim of the study

This study aimed to determine the most common β-globin gene mutations in Egypt using a real-time PCR and fluorescently labeled hybridization probes specific for each mutation and to assess the feasibility of introducing this technique in an overall thalassemia prevention program.

Participants and methods

The study was carried out on 45 individuals: 37 β-thalassemia carriers [including five amniotic fluid (AF) samples], seven β-thalassemia major cases (including two AF samples), and one normal AF sample. The most common β-thalassemia mutations were characterized by real-time PCR with fluorescently labeled hybridization probes specific for IVSI-110, IVSI-1, IVSI-6, codon 37, and codon 39 in 28/37 (75.7%) carriers.


The most common mutation encountered was IVSI-110 (46%), followed by IVSI-1 (16.2%) and then IVSI-6 (13.5%). Codon 37 and codon 39 were not characterized in any sample. The genotype of the uncharacterized carriers was determined using a less sensitive method (reverse hybridization technique) and a relatively less common set of mutation was characterized as follows: IVSII-1(10.8%), codon 5 (5.4%), IVSII-745 (5.4%), and IVSI-116 (2.7%). The overall number of alleles detected using both techniques was calculated to be 51. The real-time PCR alone, with its assigned probes, detected 38/51(74.5%). Thirteen mutations (13/51=25.5%) remained uncharacterized by this technique (because of the unavailability of the corresponding probes). However, the reverse hybridization technique detected 48/51 alleles (94.1%). However, comparison between both techniques in terms of the shared mutations showed that the real-time PCR detected 38/38 (100%) of these mutations, whereas the reverse hybridization technique detected only 36/38 (94.7%).


Real-time PCR is a very rapid and accurate method for the detection of the β-thalassemia mutation, which may be valuable in cases for which a rapid decision has to be taken. Impediments to prenatal diagnosis as encountered in this study were attributed to refusal of termination of pregnancy by the family for religious/reasons, abortion following amniocentesis, and failure to determine the correct genotype of the AF analyzed.

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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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