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Article
Outcome of 50 Iraqi Patientswith Acute Lymphoblastic Leukemia Treated by Modified German Multicenter Study Group (GMALL) Protocol

Author: Alaa Fadhil Alwan
Journal: Mustansiriya Medical Journal مجلة المستنصرية الطبية ISSN: 20701128 22274081 Year: 2013 Volume: 12 Issue: 2 Pages: 45-51
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background and aim: Acute lymphoblastic leukemia (ALL) is a lymphoidmalignancy, which arises from bone marrow,appearing in marrow, blood circulation and otherorgans. Treatment outcome have significantly improved since the adaptation of intensification and risk adapted therapy-based on identified prognostic markers. Treatment programs in adult ALL have evolved from the successful strategies employed in pediatric ALL and incorporate multiple active agents into complex regimens. The goal of these doses intensive regimens is rapid cytoreduction with restoration of normal hematopoiesis, The aim of the study was to assess the efficacy of a modified German multicenter study group for Acute Lymphoblastic leukemia (GMALL) protocol in adult acute lymphoblastic leukemia (ALL( in respect to disease free survival (DFS) and overall survival(OS) and to determine the prognostic factors affecting this outcome. Patients and method: A prospective study conducted in the hematology unit in Baghdad Teaching Hospital on 50 patients with newly diagnosed (ALL) between January 2006 to January 2008.A written informed consent were obtained from all patients. All patients were undergone full clinical examination with full laboratory investigations. The diagnosis based on morphology and cytochemical stains (periodic acid-Schiff, Sudan Black) of bone marrow examination. In Modified GMALL, induction phase consist of 2 phases, phase 1 induction was given over 5 weeks with weekly vincristine (VCR), Doxorubicin(DOX), and continuous oral prednisolone(RDN), Phase II induction consisted of 3 doses of weekly cyclophosphamide(CYCLO) alternating with 3 doses of weekly cytosine arabinoside (ARA-C) combined with CNS directed therapy using intrathecal Methotrexate (MTX) with daily 6-mercaptopurine(6-MP) followed by cranial irradiation. Consolidation consisted of weekly VCR and two courses of 5 days Ara-C and Etoposide (ETOP) with dexamethasone (DEXA) over a period of 4 weeks and maintenance therapy of daily 6-MP tablets and weekly MTX tablets. Results: The study included 50 patients with median age of (28.5 years), ranged from 16-71 years. Thirty-one patients (62%) were males, while 19 patients (38%) were females. All patients received modified GMALL protocol; forty-two patients (84%) achieved complete remission (CR). The DFS and median OS were 8.5 months, 10 months respectively. The median OS at 1 year was 54%. Deaths occurred in 19 patients (38%). Infection was the main cause of death.In univariate study analysis, age less than 30 years, absence of hepatomegaly and lymphadenopathy, and peripheral blast percent less than 50% were associated with better OS while presence of lymphadenopathy was considered poor prognostic factors and associated with low CR rate, short DFS, and OS. Conclusion: The modified GMALL protocol produced good induction remission rate but with lower survival rate in comparison to other intensive adult protocols. This study also showed that there are certain bad prognostic factors such as age more than 30 years, hepatomegaly and lymphadenopathy which adversely affect the outcome


Article
Assessment of cytogenetic response after treatment with imatinib mesylate in patients with chronic phase chronic myeloid leukemia

Author: Alaa Fadhil Alwan
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2014 Volume: 3 Issue: 1 Pages: 56-61
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

Background: Chronic myeloid leukemia (CML) is a myeloproliferative disorder affecting hematopoietic stem cells andaffects predominantly granulocyte progenitor line. It is characterized by acquired chromosomal abnormality which calledthe Philadelphia chromosome (Ph+) in 95% of cases. Imatinib mesylate is a powerful and selective competitive inhibitorof BCR-ABL tyrosine kinase. Imatinib mesylate is the first molecular target therapy for the treatment of CMLObjectives: The aim of this study was to evaluate the cytogenetic response in 58 patients with CML in chronic phasetreated with imatinib mesylate.Materials and methods: A prospective study conducted at the national center of hematology /Almustansiriya University,Baghdad, Iraq from April 2011 to December 2013, fifty-eight patients with CML in chronic phase (32 male and 26female) were enrolled in this study. All patients were carrying the BCR-ABL fusion gene and treated with Imatinibmesylate (Glivic® Novartis) at 400 mg daily for at least 12 monthsResults: There were 32 male and 26 female with male to female ratio (1.1:1).the median age was 36 year (range 14-64years). The median duration of treatment with imatinib was 18 months (range 12 to 32 months). Complete hematologicresponses (CHR) were attained in 54 of 58 (93%) patients treated during the first 3 months of imatinib therapy, where 11(19%) of patients reached CHR after 1 month, 35 (60%) got CHR within 2 months of treatment with imatinib.Cytogenetic response rates to imatinib therapy at 6 and 12months. : Major cytogenetic response achieved in 35 (70%), 48(92.3%) patients and minor cytogenetic response attained in 15 (30%), 4 (7.7%) patient at 6, 12 month respectively.Imatinib was usually safe and well tolerated. The vast majority of adverse effects were grade 1 and 2 and bone pain wasthe most common (86.2%).Conclusion: After a median follow-up of 18 months, this study confirm that imatinib therapy induced induce durableand sustained hematological and cytogenetic responses in a high proportion of patients with chronic-phase CML. theresponse rates of imatinib therapy were similar to those reported in other countries. Imatinib was safe and well-toleratedwith manageable side effects.

Keywords

cytogenetic response --- imatinib --- CML


Article
Acute Transformation In Chronic Myelogenous Leukaemia
الحادة في التحول النقوي المزمن سرطان الدم

Author: Alaa Fadhil Alwan علاء الحسيني
Journal: The Medical Journal of Tikrit مجلة تكريت الطبية ISSN: 16831813 Year: 2007 Volume: 1 Issue: 131 Pages: 12-17
Publisher: Tikrit University جامعة تكريت

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Fifty-three patients with chronic myeloid leukaemia (CML) were included in this study (25 females & 28 males) and followed-up from October 2003 till October 2005 included for the evidence of acute transformation. Twenty-one patients (39.6%) transformed to acute phase , 16 patients(76.1%) of them transformed during the first 4 years of diagnosis. Fifteen patients (71.4 %) ) transformed to acute myeloid leukaemia and 6 patients (28.6 %) transformed to acute lymphoblastic leukaemia. The mean age was 36 years with range of 16-60 years. The most common presentation of patients experiencing the acute transformation were fever (95%), splenomegaly (66%) and bone pain (57%).
The mean survival of acute transformation was 5.3 months

ثلاثة وخمسين المرضى الذين يعانون من سرطان الدم النخاعي المزمن (CML) تم تضمينها في هذه الدراسة (25 من الإناث والذكور 28) ومتابعتها من أكتوبر 2003 حتى أكتوبر 2005 وشملت لدليل على تحول حاد. حولت واحد وعشرين مريضا (39.6٪) تحول إلى المرحلة الحادة، و 16 مريضا (76.1٪) منهم خلال 4 سنوات الأولى من التشخيص. خمسة عشر مريضا (71.4٪)) تحولت لمرضى سرطان الدم النخاعي الحاد و 6 (28.6٪) تحول إلى سرطان الدم الليمفاوي الحاد. وكان متوسط ​​العمر 36 عاما مع مجموعة من 16-60 عاما. وكان العرض الأكثر شيوعا للمرضى الذين يعانون من هذا التحول الحاد حمى (95٪)، تضخم الطحال (66٪)، وآلام العظام (57٪).
والبقاء على قيد الحياة يعني التحول الحاد كان 5،3 أشهر


Article
Survival of patients with multiple myeloma diagnosed at the national center of hematology in Baghdad
بقاء المرضى الذين يعانون من ورم نقي العظم المتعدد التي تم تشخيصها في المركز الوطني لأمراض الدم في بغداد

Author: Alaa Fadhil Alwan علاء فاضل علوان
Journal: Iraqi Journal of Cancer and Medical Genetics المجلة العراقية للسرطان والوراثة الطبية ISSN: 20786123 Year: 2014 Volume: 7 Issue: 2 Pages: 133-139
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Multiple myeloma (MM) is a monoclonal malignant proliferation of plasma cells derived from a single clone. Due to the variety of organ dysfunction caused by this malignant disease with no curative therapy, hence survival becomes a challenge for this group of patients. The aim of this study was to analyze the epidemiology and survival of patients with MM attended the out-patient clinic of the national center of hematology in Baghdad/Iraq. A retrospective study conducted at the national center of hematology, from September 2009 to November 2013 in which the medical records of 46 patients with MM have been reviewed. Survival analysis was estimated by the Kaplan-Meier and multivariate Cox regression analysis. The mean age was 63.4 years, and 54.2% of patients studied were female. The most common clinical manifestations were anemia (93.4%), bone pain (86.9%), and renal impairment (39.1%). In survival analysis, the only variable that achieved statistical significance was renal impairment (p = 0.025). For mortality, renal impairment (p = 0.017) and coagulation abnormalities (p = 0.012) were significant in the Cox regression. In conclusion the epidemiological profile showed a slight predominance in females. Anemia and bone pain were the most frequent complaints. Renal impairment and coagulation abnormalities were associated with mortality for patients with multiple myeloma.

ورم نقي العظم المتعدد هو تكاثر للخلايا الخبيثة وحيدة النسيلة من خلايا البلازما المستمدة من استنساخ واحد. يسبب هذا المرض خلل في كثير من وظائف الاعضاء الحيوية للجسم ويرجع ذلك إلى مجموعة متنوعة من ضعف جهاز المناعة الناجمة عن هذا المرض الخبيث ويصبح بالتالي بقاء المريض تحديا لهذه الفئة من المرضى. وكان الهدف من هذه الدراسة هو تحليل وبائيات وبقاء المرضى الذين يعانون من ورم نقي العظم المتعدد الذين يراجعون العيادة الخارجية للمركز الوطني لأمراض الدم في بغداد / العراق. دراسة استعادية أجريت في المركز الوطني لأمراض الدم، في الفترة من سبتمبر 2009 إلى نوفمبر 2013 حيث تم استعراض السجلات الطبيةل 46 مريضا 46 مصاب بورم نقي العظم المتعدد وتم تحليل البقاء من قبل كابلان ماير والتحليل متعدد المتغيرات كوكس والانحدار. كان متوسط العمر 63.4 عاما، وكانت 54.2٪ من المرضى الخاضعين للدراسة من الإناث. كانت المظاهر السريرية الأكثر شيوعا فقر الدم (93.4٪)، وآلام العظام (86.9٪)، والقصور الكلوي (39.1٪). في تحليل البقاء على قيد الحياة، كان المتغير الوحيد التي حققت دلالة إحصائية القصور الكلوي (p= 0.025). لفيات، كان القصور الكلوي p)= 0.017) وشذوذ تخثر (p= 0.012) كبير في الانحدار كوكس. في الختام أظهر الوبائية غلبة طفيفة في الإناث. كان فقر الدم وآلام العظام الشكاوى الأكثر شيوعا. ارتبطت ضعف الكلى وشذوذ تخثر مع فيات لمرضى


Article
Evaluation of Fludarabine, and granulocyte colony

Author: Alaa Fadhil Alwan*, Adil siwan Alaqabi**,Azher Al-zubaidi**
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 2 Pages: 69-74
Publisher: Baghdad University جامعة بغداد

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Background: Refractory/relapsed acute leukemia has always been a challenging problem for hematologist. Over the past decade emphasis has been made in the development of regimens containing fludarabine, combined with cytosine arabinoside for the treatment of refractory/relapsed acute leukemias. The aim of this study is to evaluate the efficacy and toxicity of the combination of fludarabine, high dose cytarabine, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia,Methods: a prospective study is being conducted at the national center of hematology and hematology unit /Baghdad teaching hospital from July 2008 to July 2010.Twenty Patients with refractory/relapsed acute leukemia were treated with fludarabine 30mg/m2 and cytosine arabinoside (AraC) 2 g/m2 for 5 days, and granulocyte colony stimulating factor G-CSF 300 microgram/day from day 0 till neutrophil recovery (ANC >1.0 x 109/l).Response was evaluated by bone marrow examination on day 30-post chemotherapy.Results: Patients included were refractory acute lymphoblastic leukemia (ALL) (n=5), relapsed ALL (n=4), refractory acute myeloid leukemia (AML) (n=8), relapsed AML (n=3). Complete remission (CR) was achieved in 9(45%) patients, 3 (15%) patients got partial remission. Three (15%) patients died of post chemotherapy complications and 5(25%) patient failed to achieve remission. Major complications encountered were: anemia, fever, bleeding, mucositis and bacterial infections.Conclusion: FLAG protocol is well tolerated and effective regimen in relapsed / refractory acute leukemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation proceduresKey words: FLAG, refractory acute leukemia, relapsed acute leukemia


Article
Assessment of the Efficacy and Safety of Intravenous Iron Sucrose in Treatment of Adult Patients with Iron Deficiency Anemia
تقييم فعالية وسلامة علاج حديد السكروز الوريدي في علاج المرضى البالغين المصابين بفقر الدم الناتج عن نقص الحديد

Author: Alaa Fadhil Alwan أ.م.د. علاء فاضل علوان
Journal: IRAQI JOURNALOF COMMUNITY MEDICINE المجلة العراقية لطب المجتمع ISSN: 16845382 Year: 2013 Volume: 26 Issue: 3 Pages: 243-246
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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AbstractBackground: Iron deficiency is the most common cause of anemia worldwide. The treatment for iron deficiency anemia consists of replacement of iron either orally or parenterally. Patients with iron deficiency anemia (IDA) who need intravenous iron are normally treated with iron dextran. One of the major side effects of iron dextran is severe (sometimes fatal) anaphylactic reaction. On the other hand, iron sucrose another intravenous iron preparation that has improved safety and ease of administration. This preparation is being used in dialysis patients with very good results. But this has never been formally evaluated in non-dialysis-dependent patients.Objective: To assess the efficacy and safety of intravenous iron sucrose in treatment of adult patients with iron deficiency anemia.Patients & Methods: Between August 2009 and August 2011, one hundred fifty eight patients with iron deficiency anemia who were seen at the out-patient clinic at the national center of hematology with hemoglobin level < 11 g/d, or inadequate response to iron oral therapy were included in this study. Written informed consent was obtained from all patients. The main laboratory tests done were: complete blood count and blood film, reticulocyte count, serum iron, total iron-binding capacity, serum ferritin. After testing dose, patients received a weekly dose of iron sucrose diluted in 500 mL of 0.9% sodium chloride solution administered intravenously for 3 to 4 hour. The dose was calculated according to special formula. Treatment continued until a hemoglobin level equal or more than 12 g/dL for women and 13 g/dL for men or until full administration of the total dose of parenteral iron recommended for each patient.Results: Mean age of the patients studied was 33 years (ages ranging from 17 to 66 years). One hundred thirty nine patients (88%) were females while 19 patients (12%) were males. The most common cause of iron deficiency anemia was abnormal uterine bleeding observed in 68% of the female patients (95 out of 139) and gastrointestinal causes observed in 63% of the male patients (12 out of 19). Correction of anemia was obtained in 144 out of 158 patients (91%). The mean hemoglobin and ferritin values were 8.09 g/dl and 6.20 ng/ml (before treatment) and 12.42 g/dl and 88.78 ng/ml (after treatment) (p < 0.001), respectively. In general the average increase of hemoglobin was 3.74 g/dl, ranging from 1.30 to 7.60 g/dl. . Among all the patients studied, only 8 patients (5%) had mild reactions related to intravenous iron.Conclusion: The use of intravenous iron sucrose is an effective and safe option in the treatment of adult patients with iron deficiency anemia lacking satisfactory response to oral iron therapy. This treatment option should be considered mainly for patients with severe anemia in order to obtain rapid increase of the hemoglobin level and avoid blood transfusion.Keywords: Efficacy, iron sucrose, iron deficiency anemia

الملخصخلفية: نقص الحديد هو السبب الأكثر شيوعا لفقر الدم في جميع أنحاء العالم. علاج فقر الدم بسبب نقص الحديد يتكون من اعطاء الحديد إما شفويا أو بالحقن الوريدي او العضلي، عادة المرضى الذين يعانون من فقرالدم يعالجون بعقار حديد الدكستران و لكن هذا العلاج لديه عوارض جانبية (قاتلة في بعض الأحيان). من ناحية أخرى، حديد السكروز سهل الاستعمال وامن في نفس الوفت. يتم استعمال هذا المستحضر لدى المرضى الذين غسيل الكلى مع نتائج جيدة جدا. ولكن لم يكن هذا تقييم غير رسمي في غسيل الكلى التي تعتمد على المرضىالهدف: تقييم فعالية وسلامة حديد السكروز الوريدي في علاج المرضى البالغين المصابين بفقر الدم الناتج عن نقص الحديد.الطريقة: للفترة ما بين أغسطس 2009 وأغسطس 2011، 158 مريضا يعانون من فقر الدم الناتج عن نقص الحديد الذي شوهد في عيادة الاستشارة في المركز الوطني لأمراض الدم مع مستوى الهيموغلوبين افل من 11، أو غير مستجيب للعلاج عن طريق الفم. في هذه الدراسة. تم الحصول على الموافقة من جميع المرضى. كانت الاختبارات المخبرية الرئيسية التي تم اجرائها: عد الدم الكامل وفيلم الدم، وتعداد الشبكيات والحديد في الدم، ومجموع القدرة الحديد ، الحديد المخزون(الفيريتن). وتلقى المرضى الذين جرعة أسبوعية من حديد السكروز المخفف في 500 مل من 0.9٪ محلول كلوريد الصوديوم عن طريق الوريد، تم حساب الجرعة وفقا لصيغة خاصة. استمر العلاج حتى اصبح مستوى الهيموجلوبين مساوي او أكثر من 12غ/دل بالنسبة للنساء و13غ/دل بالنسبة للرجال أو حتى إعطاء الجرعة الإجمالية للحديد لكل مريض.النتائج: كان متوسط عمر المرضى الخاضعين للدراسة 33 سنة ( تتراوح بين 17 إلى 66 سنة) 139 مريضا (88٪) كانوا من الإناث بينما 19 مريضا (12٪) من الذكور: وكان السبب الأكثر شيوعا لفقر الدم الناتج عن نقص الحديد نزيف الرحم غيرالطبيعي حيث لوحظ في 68٪ من المرضى من النساء (95 من 139) وأسباب الجهاز الهضمي لوحظ في 63٪ من المرضى الذكور (12 من أصل 19). تم الحصول على تصحيح فقر الدم في 144 من بين 158 مريضا (91٪). كان مستوى الهيموغلوبين و الفيريتين 8.09 غم / دل و6.20نانوغرام / مل (قبل العلاج)12.42 غم/ دل و88.78 نانوغرام/مل (بعد العلاج على التوالي)، عموما كانت متوسط الزيادة في(P <0.001 الهيموغلوبين 3.74غ/دل، ( بدءا 1،30 حتي 7،60 غ / دل)، بين المرضى الذين تمت دراستهم، فقط 8 مرضى (5٪) كانت لديهم اعراض جانبية بسيطة نتيجة اعطاء الحديد عن طريق الوريد.الخلاصة: إن استخدام حديد السكروز الوريدي هو خيار فعال وآمن في علاج المرضى البالغين المصابين بفقر الدم الناتج عن نقص الحديد والذين تفتقر استجابتهم للعلاج الحديد عن طريق الفم. وينبغي النظر في هذا الخيار خصوصا للمرضى الذين يعانون فقر الدم الحاد من أجل الحصول على الزيادة السريعة في مستوى الهيموجلوبين وتجنب نقل الدم.كلمات البحث: فعالية، حديد السكروز , فقر الدم بسبب نقص الحدي


Article
Incidence of Von Willebrand Disease Among Patients presenting with Various Bleeding Tendency to Out-Patient Clinic of the National Center of Hematology

Authors: Alaa Fadhil Alwan --- Zeyad Ahmed Shabeeb --- Hadeel duraid salman
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2013 Volume: 2 Issue: 1 Pages: 37-42
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Von Willebrand disease is frequent hereditary bleeding disorders with an incidence ofabout 1% in asymptomatic people. Previous Studies available around the Middle Eastdisplayed a prevalence ranged from 3 % to 34 % of Von Willebrand disease within thehereditary bleeding disorders. People with mucocutaneous bleeding represent a major subtypeof hematologic clinical presentations but simultaneously present a substantial diagnosticchallenge. On the other hand, bleeding symptoms are frequent in the general population, buttheir clinical relevance may be difficult to assess The aim of this study was to estimate theincidence of Von Willebrand disease in patients presenting with various bleeding tendencies toout-patient clinic of the national center of hematologyMethods: A total of 146 sequential patients referred to the national center of hematology betweenJanuary 2011 and April 2012 were investigated .Tests performed for the diagnosis of VonWillebrand disease included complete blood count and blood film including platelet count,bleeding time, prothrombin time, activated partial thromboplastin time, Factor VIII:C assay,and von Willebrand Factor Antigen assay.Results: Amongst 146 patients, 29 (19.8%) had Von Willebrand disease. Patients' age ranged from 1year to 65 years, with 35 males and 111 females. Menorrhagia was the most commonpresentation. Amongst vWD patients, there were 7 male and 22 female. Positive family historyin patients with VWD was found in 21 out of 29 patients (72.4 %) while positive familyhistory in bleeding tendency other than VWD was found in 47 patients (40%). Statisticalsignificant differences were found in prothrombin time, activated partial thromboplastin time,Factor VIII: C assay, and von Willebrand Factor Antigen assay between the studied groups.Conclusions: Von Willebrand disease still among the most common cause of inherited bleedingtendency in patients presented with mucocutaneous or menorrhagia, yet many cases of vWDremain undiagnosed due to wide range of clinical presentations and lack in lab diagnosis.

Keywords

incidence --- vWD --- bleeding tendency


Article
Assessment of side effects of venesection (phlebotomy) procedure in Iraqi patients presenting with erythrocytosis: single center experience

Authors: Eaman Marouf Muhammad --- Raid Ahmed Alrubaye --- Alaa Fadhil Alwan
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2015 Volume: 4 Issue: 1 Pages: 61-66
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Venesection or phlebotomy is generally considered to be a safe method, butoccasionally adverse effects of varying severity may occur during or at the end of the procedure.Objectives: The aim of the study was to estimate the frequency and type of adverse eventsoccurring during venesection and to assess the practices which would help to minimize them.Materials and methods: This is prospective single-center study was conducted from October2011 to November 2012 at the emergency unit of the national center of hematology in Baghdad.All phlebotomies procedures made at the center were analyzed. All adverse events occurringduring or at the end of procedure were registered by using a standardized questionnaire.Results: Overall 3 adverse events were reported in relation to 960 venesections done, resulting inan overall adverse event rate of 0.3125%, that is, an incidence of 1 in every 320 venesections.One adverse effect was presyncopal symptoms of mild intensity, and the other two that observedwere extravasation at site of puncture.Conclusions: Only 0.3% of phlebotomies were complicated by adverse events which were verymild and easily managed. Our study confirms the fact that venesection procedure is a very safemethod which could be made even more event-free by following certain friendly, reassuring andcompetent practices.


Article
C- Reactive protein and iron status in Iraqi patients with acute myeloid leukemia before and after treatment

Authors: Khitam Abdul Wahab Ali --- Alaa Fadhil Alwan --- Hiba Ammar Mohammed
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2015 Volume: 4 Issue: 1 Pages: 101-118
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Background: Acute Myeloid Leukemia (AML) is a clonal hematopoietic disorder, leading to apremature arrest of the normal differentiation of stem cells. C - reactive protein (CRP) is a markerof inflammation. Serum level of C-reactive protein may be increase in patients with AML. Thisassociation between CRP levels and acute myeloid leukemia influenced by multiple factors.Acute myeloid leukemia commonly associated with iron overload. Many factors are participatingto the hyperferritinemia associated with AML, inflammation chemotherapy, blood transfusionand ferritin hepatic clearance disordersObjectives: To assess serum C-reactive protein (CRP) and iron status (serum Iron, Total ironbinding capacity, serum ferritin levels) in patients with acute myeloid leukemia (AML) beforeand after chemotherapyMaterials and Methods: A prospective cohort study included 58 patients (30 male and 28female) with acute myeloid leukemia with age range (15-65 years). Patients divided into twogroups: Group (1) Patients with AML before starting chemotherapy. Group (2) the patients after 4weeks of chemotherapy In addition to 43 healthy subjects (24 male and 19 female) wereincluded. They were age and sex matched to patients group and considered as controls as(Group 3). This study conducted at the National Center of Hematology and Baghdad TeachingHospital in the Medical City from February 2014 to June 2014. All patients were subjected tocomplete history and physical examination. Diagnosis as AML patients was established bycomplete blood count and blood film, bone morrow aspiration and biopsy. C-reactive proteins.iron, s.total iron binding capacity and s. ferritin were estimated for all .Results: Serum CRP levels increased in AML patients before and after treatment , while therewere a significant increase in mean serum ferritin levels observed in (Group 2) compared tonewly diagnosis patients (Group 1)(P<0.002) and the levels were significantly higher in newlydiagnosis group compared to healthy controls (P<0.015). Patients with (AML) during remissionshow significant decrease in iron levels compared to newly diagnosis group (P<0.0001), whilelevels in healthy controls recorded higher values than both (Group 2) and (Group 1) (P<0.0001).Serum total iron binding capacity (TIBC ) levels showed a significant decrease in (Group 2) aftertreatment compared to (Group 1) before treatment(P<0.0001) but the levels were significantlyhigher in healthy controls compared to (Group 1) and (Group 2) (P<0.0001)Conclusion: CRP does not predict response to chemotherapy while it may be of benefit inpredicting infection or inflammation in patient with AML post chemotherapy. Regarding Ironstatus: s.ferritin increase significantly post chemotherapy while s.iron and TIBC decrease.

Keywords

CRP --- iron status --- AML


Article
Estimation of zeta‑chain‑associated protein 70, interleukin‑6 and interleukin‑10 levels in sera of Iraqi newly diagnosed chronic lymphocytic leukemia

Authors: Hassnien S. Muslit --- Alaa Fadhil Alwan --- Haider S. Al‑Dahery
Journal: Iraq Joural of Hematology المجلة العراقية لامراض الدم ISSN: 20728069/25432702 Year: 2016 Volume: 5 Issue: 2 Pages: 173-177
Publisher: Al-Mustansyriah University الجامعة المستنصرية

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Abstract

BACKGROUND: Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in the Western world.The zeta‑chain‑associated protein (ZAP‑70) an intracellular tyrosine kinase which play an important role in T‑cellreceptor signaling, natural killer cell activation, and early B‑cell development. Interleukin‑10 (IL‑10) productionhas strong immunosuppressive effects through inhibition of Th1 type cytokines. IL‑6 is a pleiotropic cytokineproduced by a variety of cell types, including normal hematopoietic cells, and lymphocytes.OBJECTIVES: The objective of this study is to assess the level of ZAP‑70, IL‑10, and IL‑6 in CLL and to correlatethese levels with prognosis.MATERIALS AND METHODS: A prospective cohort study carried out at the National Center of Hematology fromOctober 2013 to September 2015. Eighteen patients with newly diagnosis of CLL compared to 19 apparentlyhealthy controls were also involved in this study. ZAP‑70 was measured by while IL‑10 and IL‑6 were measuredusing serological methods including the enzyme‑linked immunosorbent assay.RESULTS: ZAP‑70 range between (24% and 90%) with a mean of 46.89 ± 19.15, two patients out of 18 werenegative (<24%) for ZAP‑70 as compared with control. The levels of IL‑6 in the serum of untreated patients withCLL were increased in compared with healthy control (2.53 ± 1.98), ranged between (0.12 and 6.94) pg/ml. Therange of the IL‑10 expression of the untreated CLL patients was between (the lowest positive value (212 pg/ml)and which is the highest positive value (987 pg/ml) with a mean 614 ± 301 pg/ml, with all the morphologicallydiagnosed CLL cases show positive expression for IL‑10.CONCLUSION: ZAP‑70 level was higher in CLL patients than control and immunochemotherapy can normalizethis which indicated good response to treatment. On the other hand, IL6 and IL10 were also higher in patientswith CLL but not affected by therapy.

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