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   2016| January-March  | Volume 41 | Issue 1  
    Online since March 10, 2016

 
 
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ORIGINAL ARTICLES
Haematological indices and bone marrow morphology in pancytopenia/bicytopenia
Kirti S Dagdia, Anil T Deshmukh, Ramawatar R Soni, Dilip S Jane
January-March 2016, 41(1):23-26
DOI:10.4103/1110-1067.178476  
Introduction Pancytopenia is an important clinicohaematological entity encountered in our day-to-day clinical practice. The possible underlying aetiologies range from transient viral marrow suppression to left-threatening malignant neoplasm. The aetiological diagnosis is essential for the clinical management and prognosis of the patient. Materials and methods In this study, a total of 75 cases of pancytopenia/bicytopenia were studied. Complete evaluation of clinical findings, haematological indices and bone marrow examination was carried out. Results Megaloblastic anaemia (29.3%) was the most common cause of pancytopenia/bicytopenia, followed by hypoplastic/aplastic anaemia (18.6%) and leukaemia (17.3%). Macrocytic anaemia was the predominant finding observed when studying peripheral smears, and a few cases of normocytic or microcytic anaemia were observed. Hypercellular marrow was seen in 68% of cases, whereas hypocellular marrow was present in 21.3% of cases. Conclusion Haematological indices and bone aspiration complemented with trephine biopsy is a useful, simple, economical and safe diagnostic tool in the evaluation of pancytopenia/bicytopenia. Egyptian J Haematol 41:-0 ͹ 2016 The Egyptian Society of Haematology.
  2,044 276 -
Clinicopathologic features and prognostic impact of isochromosome 17q in chronic myeloid leukemia patients
Hoda M El Gendi, Dina A Fouad, Amal A Mohamed, Doaa G Eissa, Nevine N Mostafa
January-March 2016, 41(1):9-14
DOI:10.4103/1110-1067.178464  
Background Isochromosome 17q (i17q) is a well-known nonrandom secondary anomaly in chronic myeloid leukemia (CML), which occurs either solely or with other additional anomalies. Objectives The aim of the study was to explore the influence of i17q in CML patients in different phases of the disease and the prognostic impact of acquiring such an anomaly on disease progression, outcome, and response to therapy. Materials and methods Cytogenetic analysis was carried out on 100 CML patients by G-banding and fluorescence in-situ hybridization using LSI BCR/ABL, LSI p53(17p13)/MPO (17q22) i(17q), CEP 8, and CEP Y probes. Results Isochromosome 17q was detected in 16% of cases. All examined bone marrow smears of i(17q)-positive patients were hypercellular and showed variable degrees of dysplastic changes mainly in myeloid lineage, in the form of hyposegmentation and hypogranulation, together with dysplastic features of megakaryocytes in 70% of them. A highly significant association of i(17q) with poor prognosis was confirmed statistically (P = 0.002) compared with the prognosis in negative patients. The event-free survival of the i(17q)-positive group was 1.6 months compared with 11.5 months in negative patients. However, no statistically significant association was revealed with standard prognostic factors (P>0.05). Conclusion Isochromosome 17q identifies a subgroup of CML with distinct clinicopathologic features and with high risk for aggressive disease progression.
  1,601 175 2
Platelet-dependent von Willebrand factor activity in acute myeloid leukemia patients: role in hemostatic alterations
Hala M.H. Abaza, Botheina A.T. Farweez, Sylvia F Samaan
January-March 2016, 41(1):1-8
DOI:10.4103/1110-1067.178462  
Background Patients with acute myeloid leukemia (AML) may suffer from bleeding tendency, which can aggravate their pre-existing condition. Bleeding in these patients occurs mainly because of thrombocytopenia, disseminated intravascular coagulopathy, and platelet dysfunction. However, other underlying mechanisms are complex and are not completely understood. Von Willebrand factor (vWF) defects have been implicated as contributors to bleeding complication. Aim The study aimed to investigate the pattern of vWF-ristocetin cofactor (RCO) activity in newly diagnosed AML patients and its relation to therapy, to explore its potential role in the prevalent phenomenon of bleeding in AML patients, in order to correlate between vWF-RCO activity and other hemostatic parameters and known prognostic factors in AML. Patients and methods Thirty newly diagnosed patients with AML and 20 healthy age-matched and sex-matched individuals (the control group) were studied. The vWF-RCO activity using the platelet agglutination method was determined on plasma samples of both patients and controls. Results Our results showed significantly reduced vWF-RCO activity in AML patients at diagnosis, which significantly increased 2 weeks after treatment. Our study proposes the following cutoffs for vWF-RCO: less than or equal to 85.2% for predicting AML patients prone to bleeding manifestations and less than or equal to 82.6% for the prediction of bad outcome. Conclusion In AML, vWF-RCO activity at diagnosis represents a valuable prognostic marker for predicting bleeding complication and bad outcome, and the provided cutoffs for vWF-RCO activity represent the first steps for its use as a bleeding predictor and prognostic marker, although future studies with larger series of patients may be needed before it can be incorporated into routine use.
  1,556 167 -
Serum thrombopoietin and platelet antibodies in thrombocytopenic patients with chronic hepatitis C virus: clinical application of platelet indices
Tamer A Elbedewy, Medhat A Ghazy, Maaly M Mabrouk
January-March 2016, 41(1):15-22
DOI:10.4103/1110-1067.178473  
Background Chronic hepatitis C virus (HCV) infection is prevalent in 160 million individuals worldwide. Egypt has the highest prevalence of HCV in the world. HCV is known to cause thrombocytopenia even in the absence of overt hepatic disease. The pathophysiology of thrombocytopenia with chronic HCV is complex. Aims To evaluate serum thrombopoietin (TPO) and platelet antibodies in thrombocytopenic patients with chronic HCV and to assess the diagnostic utility of mean platelet volume (MPV) and platelet distribution width (PDW). Patients and methods The present study included 70 patients with chronic HCV with thrombocytopenia divided into two groups; 20 age-matched and sex-matched HCV patients without thrombocytopenia were also included as controls. Serum TPO, platelet autoantibodies, MPV, and PDW were measured in all participants. Results A significantly lower serum TPO level and platelet count were found with advancing degree of liver fibrosis and activity. Significantly higher MPV and PDW were found in patients with antiplatelet autoantibodies formation. The platelet count showed significant positive correlations with TPO level, MPV, and PDW, and inverse correlations with aspartate aminotransferase, alanine aminotransferase, and viral load. Conclusion The dominant mechanism in mild thrombocytopenic HCV patients was the formation of antiplatelet autoantibodies, whereas in moderate to severe thrombocytopenic patients, the dominant mechanism was combined bone marrow affection and formation of antiplatelet autoantibodies. Serum TPO level was decreased in patients with HCV-induced thrombocytopenia. MPV and PDW may be used as indicators for the dominant mechanism. Egyptian J Haematol 41:-0 ͹ 2016 The Egyptian Society of Haematology.
  1,382 190 -
Levels of alloantibodies to human platelet antigen in relation to blood dyscrasia occurring at various trimesters of pregnancy
EO Akanni, AO Olayanju, RY Akele, AJ Olayanju, ED Ezigbo
January-March 2016, 41(1):27-30
DOI:10.4103/1110-1067.178477  
Context Thrombocytopenia is major complication in complicated and uncomplicated pregnancies. Aims The aim of this study was to determine the incidence of thrombocytopenia in pregnancy and determine possible immune thrombocytopenia correlates with blood dyscrasia involving other cellular components of blood. Settings and design The study was an institution-based cross sectional study. Participants and methods The full blood count of 200 women attending an antenatal center was determined. Sera of 73 (36.5%) thrombocytopenic women defined by a platelet count less than 80×10 9 /l and inadequate platelet in the peripheral blood film were evaluated for circulating antiplatelet antibody directed against platelet membrane glycoprotein GPIIb/llla. Statistical analysis Pearson and Kendall's tau-b correlation analysis was carried out on data using the SPSS (PASW version 18) statistical package. Results The antibody was detected in two (3%), 13 (17%), and 44 (60%) of the subset of patients in the first, second, and third trimester, respectively. Fourteen (20%) of the women had no detectable antiplatelet antibody. The idiopathic immune thrombocytopenia observed in the patients was associated with anemia and leukopenia in four (9%) patients in the third trimester of pregnancy. A significant correlation was observed between thrombocytopenia and the red cell count, hemoglobin concentration, and packed cell volume of the women. Irregular attendance at an antenatal clinic and nonutilization of hematinic were evident in groups of thrombocytopenic and anemic women. There was a negative correlation between the occurrence of antiplatelet antibody and the severity of thrombocytopenia. Conclusion There is a need to distinguish immune thrombocytopenia from gestational thrombocytopenia and assess other blood parameters in pregnancy for a proper clinical intervention.
  1,126 110 -