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  Most popular articles (Since December 19, 2013)

 
 
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ORIGINAL ARTICLES
An analytical study on peripheral blood smears in anemia and correlation with cell counter generated red cell parameters
Ashutosh Kumar, Rashmi Kushwaha, Chani Gupta, US Singh
October-December 2013, 4(4):137-144
DOI:10.4103/1658-5127.127896  
Context: Manual examination of peripheral blood smear in diagnosis of anemia has taken a backseat with the advent of automated counters. Though a lot of studies have been done to assess the efficacy and significance of red blood cell parameters in different hematological conditions fewer efforts have been made to standardize the visual examination of peripheral blood smears for diagnosing anemias. Aims: Standardization and grading of abnormal red cell morphology in peripheral blood smear and counter based red cell indices in cases of anemia of various etiologies. Settings and Design: Cross-sectional study of one year duration conducted in the Hematology laboratory, in a tertiary care hospital in North India. Materials and Methods: In 60 anemic patients, automated counts and peripheral blood smear were prepared and evaluated by three observers, according to a red cell morphology grading guide. Statistical Analysis Used: ANOVA, Tukey post hoc test were used. Results: Objective grading of peripheral blood smears in cases of anemia have a good inter observer correlation and hence have reduced subjective variation. Manual parameters like microcytosis, macrocytosis and hypochromia expressed as a percentage, have shown significant correlation, with their corresponding automated parameters, and the regression model so generated may provide a novel way for quality control of automated counters, if calculated for different models. Conclusions: Even in the age of molecular analysis, the blood smear remains an important diagnostic tool and sophisticated modern investigations of hematologic disorders should be interpreted in the light of peripheral blood features as well as the clinical context.
  6,111 889 -
Association of ABO Rh blood group with dengue fever and dengue hemorrhagic fever: A case-control study
Vitthal Khode, Goutam Kabbin, Komal Ruikar
October-December 2013, 4(4):145-148
DOI:10.4103/1658-5127.127899  
Background: Data on frequency distribution of ABO Rh blood group in pediatric dengue patients are not available. Dengue disease an emerging arthropod borne infection of public health concern belongs to Flaviviridae. The studies defining the relationship between blood groups and dengue disease and its severity are limited. Blood group antigens are generally known to act as receptors for various etiological agents. Hence, we hypothesized there will be an association between blood group and dengue disease and its severity and conducted this case-control study. Study Design: Hospital-based case-control study. Materials and Methods: Study was conducted in department of pediatrics, 244 pediatric subjects (age group 1 - 13 years) were enrolled divided into cases who were admitted cases of dengue (119, 65 males, 64 females) and controls who were attending outpatient department for various other ailments. (125, 67 males, 58 females) and demographic data (age, gender, blood group, and dengue infection status) were collected from them. The risk of acquiring dengue disease and severity and its association with factors such as blood group, gender were analyzed statistically. Results: The data of this study showed a possible association between blood groups of the study population with dengue infection. We observed that dengue infections were higher in individuals with O positive blood group 42.8% when compared with controls 32%. (P = 0.043) But blood groups were not associated with severity of infection. These data present further evidence for the association of the blood groups, gender to susceptibility to dengue infection. Further studies are needed to confirm these findings. Conclusion: Dengue disease is more common with blood group O. But severity of the disease is not associated with any blood groups.
  6,126 648 3
REVIEW ARTICLE
Advances in pregnancy management in carriers of hemophilia
Rezan Abdul-Kadir, Joanna Davies, Susan Halimeh, Claudia Chi
October-December 2013, 4(4):125-130
DOI:10.4103/1658-5127.127894  
Recent advances in prenatal diagnosis and multidisciplinary management has improved the reproductive outlook for carriers of hemophilia and their offspring. Pre-pregnancy planning allows the woman and her partner to explore reproductive options and prepares the family for the potential delivery of an affected male infant. Non-invasive methods of prenatal diagnosis are advancing, with the aim of providing a definitive test for hemophilia. Carriers of hemophilia have an increased risk of primary and secondary postpartum hemorrhage. The affected male offspring is potentially at risk of cranial bleeding during delivery. A multidisciplinary approach provides advanced planning for the optimum mode of delivery and provision of appropriate haemostatic cover to reduce the risk of bleeding complications. This review summarises current recommendations for pregnancy management in carriers of hemophilia, from the initial pre-pregnancy counseling through to delivery and care of the neonate.
  4,118 2,536 1
The new, direct, target-specific oral anticoagulants
Nevine A Kassim
October-December 2015, 6(4):141-147
DOI:10.4103/1658-5127.171993  
In recent years, numerous alternatives to VKAs have been developed, the first competitors to warfarin are the novel oral anticoagulants (NOAC) or better referred to as Direct Oral Anti-Coagulant (DOAC) or Target Specific Oral Anti-coagulant (TSOAC): These drugs have definite advantages and disadvantages that should be clear to the physicians before prescribing any of them for patients. Many clinical trials, which involved thousands of patients provided definite information about the efficacy and the safety of DOACs, yet, many physicians remain reluctant to prescribe these drugs due to lack of answers to real world questions. The concerns are directed towards appropriate patient selection (The choice should be made according to age, renal function, compliance, cost, clinical condition, intake of other drugs), the mechanism of switching between agents. How to manage regarding any procedural measurement? How these drugs affect routine laboratory tests and when do we need monitoring? Knowledge of other drugs that interact with the DOAC and management of severe bleeding will be reviewed and recommendations will be given to all these concerns.
  3,206 3,007 -
ORIGINAL ARTICLES
Dapsone as a cheap and safe second-line drug for chronic immune thrombocytopenia in developing countries: A prospective cohort study
Yasir Bashir Khan, Asif Ahmed, Syed Sajad Geelani, Shabeer Ahmad Mir, Javid Rasool Bhat, Nusrat Bashir, Javeed Iqbal Bhat
July-September 2014, 5(3):86-90
DOI:10.4103/1658-5127.141991  
Objective: The aim was to evaluate the efficacy and safety profile of dapsone as a cheap second-line treatment for chronic immune thrombocytopenia (ITP) in developing countries. Materials and Methods: A prospective study on 100 chronic ITP patients. These patients were put on dapsone after ruling out glucose 6 phosphate dehydrogenase deficiency and secondary causes of ITP. Results: The basic work up for secondary causes of ITP was negative. All these patients had been treated with steroids in the past. Anti-D had been given acutely in 20 patients, and intravenous immunoglobulin G had been given in 10 patients. Vincristine had been given to 20 of these patients. Dapsone was started in these patients, and 44% patients showed a response to treatment. The mean time to onset of response was 21 days. Out of these 44 patients, 21 (47.7%) went into remission and had platelet count >100,000/μl at 2 years post tapering of the treatment. Remaining 23 patients were kept on low dose dapsone and maintained their platelet counts. Adverse drug reactions included mild skin eruptions in 5% of patients, pruritus in 10% of patients, dose-related hemolysis in 1% of patients, methemoglobinemia in 1% of patients and Stevens Johnson syndrome in 1% of patients. 56 patients were nonresponders to the available, affordable conventional medical treatment and were referred to the surgical department for splenectomy, with a cure rate of 86% postsurgery. Conclusions: Dapsone is a safe, cheap and effective treatment option for patients with chronic ITP, who cannot afford the usual costlier second-line drugs.
  5,538 435 -
REVIEW ARTICLE
Guidelines of management of musculoskeletal complications of hemophilia
Mousa Mohammad Alhaosawi
July-September 2014, 5(3):75-85
DOI:10.4103/1658-5127.141988  
Hemophilia is an X-linked heritable coagulopathy with an overall prevalence of approximately 1 in 10,000 individuals. The most common form is factor VIII deficiency (hemophilia A), which comprises approximately 80% of cases. Factor IX deficiency (hemophilia B), comprises approximately 20% of cases. In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (hemophilic synovitis) that contribute to end-stage degeneration (hemophilic arthropathy); with pain and limitation of motion severely affecting patients' quality of life. The author conducted a comprehensive review and synthesis of the relevant literature. The author reviewed all compiled reports from computerized searches. Searches were limited to English-language sources and human subjects. Literature citations were generally restricted to published manuscripts appearing in journals listed in Index Medicus and reflected literature published up to July 1, 2013. The aim of this updated paper is to provide comprehensive and timely evidence-based guidelines and recommendations on the treatments of damaged joint among hemophilia patient. Further recommendations included the control of risk factors, interventional approaches for treatment of hemophilia, the use of bypassing factors for the inhibitors, and preventing recurrent bleeding especially in high-risk populations are provided. Prophylaxis by replacement of the missing factor in patients with hemophilia is the optimal way to prevent the occurrence of haemarthrosis and thereby the onset of arthropathy, provided that it is started early in life. Dosing should be individualized and increased in case of bleeding. Prevention of bleeding episodes through early treatment will prevent accumulation of blood in joint and the subsequent inflammation and potential hemophilic arthropathy. Treatment must be maintained until bleeding remission and patients have recovered as much of their ROM and muscular strength as possible. Clinical evaluation of the joints, gait, motion, muscle tone, functional level of disability, pain, and swelling, as well as imaging techniques, must be performed to assist in the diagnosis of chronic synovitis and to guide treatment decisions. The first step to treating synovitis, refractory to medical treatment, is the use of synovectomies, non-surgical or surgical interventions. In many cases, joint deformities have to be treated by open orthopaedic surgery. State-of-the-art treatment of patients with hemophilia requires a multidisciplinary team. Level of evidence: Level III (Systematic Literature review).
  4,664 682 -
Management of myelodysplastic syndromes: Expert consensus opinion from the Saudi MDS Working Group
Ahmed Alaskar, Abdul Kareem Al Momen, Ahmad Al-Saeed, Ahmed Al Sagheir, Amr Hanbali, Ayman Al-Hejazi, Hani Al-Hashmi, Khalid Al-Anazi, Mohsen Al Zahrani, Saud Abu Harbesh, Zayed Al-Zahrani
October-December 2014, 5(4):123-132
DOI:10.4103/1658-5127.146946  
Myelodysplastic syndromes (MDSs) constitute a heterogeneous group of clonal hematopoietic disorders. A panel of Saudi hematologists representing the Saudi MDS Working Group convened with two international experts to develop the guidelines for MDS diagnosis and treatment. The recommendations were formulated on the basis of a list of real cases and therapy-related questions. The diagnostic procedures should help distinguish MDS from other causes of cytopenia and dysplasia and other clonal stem cell disorders. Blood smear, bone marrow aspirate and biopsy, and cytogenetic testing are among the mandatory diagnostic tests in MDS. Higher resolution genetic testing like mutational analysis and single nucleotide polymorphisms can be suggested for the workup depending on the clinical condition and availability of these technologies. The Working Group stressed that the heterogeneity of MDS strongly withstands a risk-adapted treatment strategy based on the international prognostic scoring system risk group of patients.
  2,498 2,494 -
ORIGINAL ARTICLES
Translating venous thromboembolism prevention guidelines into practice through system redesign
Ali Al-Aklabi, Mohammad Bo Saeed, Imad Hassan, Mohammad Al-Qahtani, Adel Al-Othman, A Al-Theaby, M Al-Ammari, M Al Firm, Fahad Al-Hameed
January-March 2014, 5(1):6-9
DOI:10.4103/1658-5127.131818  
Background: Venous thromboembolism (VTE) is a major public health problem, which is a primary concern of hospitalized or recently hospitalized patients. Pulmonary embolism resulting from deep vein thrombosis (DVT) is the most common preventable cause of death occurring in the hospital. System redesign is suggested to improve in compliance with practice guidelines. This study assessed the impact of ward-based Knowledge Translation (KT) monitor on the implementations of evidence-based thromboprophylaxis guidelines and its compliance. Materials and Methods: The study was conducted at the Department of Medicine, in a tertiary-care hospital. In addition to staff education, a risk-scoring template and employment of a Knowledge Translation (KT) monitor were undertaken. The KT monitor was specifically trained to assess the risk of venous thromboembolism (VTE) for all medical in-patients. Patients on no, suboptimal or contraindicated prophylaxis interventions were identified by the monitor. The treating team is immediately contacted to initiate the recommended corrective measures. The monitor will subsequently follow these patients to guarantee the commencement of action for treatment. Results: After eliminating the non-eligible patients, 602 individuals were eligible for prophylactic anticoagulation. Four hundred and thirty (71%) of these patients were receiving appropriate VTE prophylaxis, 124 patients (21%) were receiving suboptimal doses of subcutaneous heparin and 48 eligible patients (8%) were not receiving any intervention for prophylaxis. All those 48 patients (not on prophylaxis) were subsequently commenced on the appropriate method and dose of VTE prophylaxis after contacting the primary physicians. Patients on suboptimal prophylaxis were referred to the teams and 82 of these patients thromboprophylaxis were adjusted to the optimal dose. Conclusion: Implementation of multifaceted interventions with system redesign and employment of a ward-based Knowledge Translation (KT) monitor resulted in significant improvements in appropriate VTE prophylaxis.
  4,469 463 1
Study of hemoglobinopathies and Hb variants in population of Western India using HPLC: A report of 7,000 cases
Atul Shrivastav, Umang Patel, Jayesh R Joshi, Amarjeet Kaur, Ashok S Agnihotri
July-September 2013, 4(3):104-109
DOI:10.4103/1658-5127.123308  
Context : Various hemoglobinopathies are one of the major public health problems of India. Aims: High performance liquid chromatography (HPLC) is a speedy and accurate tool for diagnosis of various hemoglobinopathies. In present study about 7,000 cases have been studied for identification of various hemoglobin (Hb) disorders in western India. Settings and Design : Study is conducted from May 2010 till April 2013 for various hemoglobinopathies and variants. The geographical distribution of all cases included states of western India. Materials and Methods: Complete blood count (CBC) is done on CELL DYN 3700 analyzer and then HPLC is performed on BIO-RAD 'VARIANT II' (beta thalassemia short program) in samples received in our laboratory. Simple Statistical analysis is done with help of Microsoft Office Excel 2007. Results: A total of 7,261 cases were included in our study, out of these 1,615 (22.24%) cases showed abnormal Hb fractions. The major abnormality observed was of high HbA2, a cutoff value of > 3.9% was considered for diagnosis of beta thalassemia trait (BTT). A total of 839 cases (11.55%) of BTT were diagnosed. Other hemoglobinopathies were also identified in varying proportions. Conclusions: HPLC is simple, accurate, and superior technique combined with complete automation makes it an ideal method for diagnosis of hemoglobinopathies.
  3,912 621 1
Under filled di potassium-ethylene di amine tetra acetic acid vacutainers and its effect on automated blood cell indices in healthy blood donors: Is there a need to re-investigate it as a rejection criterion?
Vibha Gupta, Vikas Shrivastav, Gita Negi, Harish Chandra, Shelly Mittal, Debasis Biswas
July-September 2014, 5(3):101-106
DOI:10.4103/1658-5127.141997  
Introduction: Standard guidelines assert that any vacutainer, which is 10% less under-filled should be rejected as it may affect the results. These guidelines refer to the studies using liquid K 3 -ethylene diamine tetra acetic acid (EDTA). Although the new guidelines recommend K 2 -EDTA instead of earlier K 3 -EDTA but has not clearly commented upon whether the same holds true for the new anticoagulant K 2 -EDTA. Materials and Methods: Blood samples from 100 healthy blood donors were included. We took 7-8 ml of blood and was then transferred to three 3 ml capacity vacutainers-up to 3 ml, 2.5 ml, 1 ml (marked a, b, c respectively) containing spray-dried K 2 -EDTA as anti-coagulant. Thus, b and c vacutainers were under-filled. Hematological parameters in all the samples were analyzed immediately using automatic analyzer (Cell Dyn). Statistical analysis was done with the help of SPSS v. 17.0 (Chicago, IL, USA) using one-way ANOVA. Results: The results showed that three groups were comparable with respects to hemoglobin, hematocrit, total leukocyte count, differential leukocyte counts, total platelets, mean corpuscular volume, mean hemoglobin concentration, mean cellular hemoglobin concentration along with red cell distribution width. Conclusion: Our study suggested that under-filling till 67% (1 ml in 3 ml standard capacity) of the recommended volume in a spray-dried K 2 -EDTA vacutainers did not affect hematological parameters in healthy people. In view of these results, there is need to further investigate the same in diseased. If further studies done on under filling of the pathological samples also give similar results as in our study then only the present guidelines related to under filling could be revised when K 2 -EDTA is used as an anticoagulant.
  4,117 397 -
A study on knowledge, attitude, and practice on blood donation among health professional students in Anand: Gujarat
Killol N Desai, Vidya Satapara
April-June 2014, 5(2):51-53
DOI:10.4103/1658-5127.137140  
Context: Role of youngsters in voluntary blood donation (VBD) is crucial to meet the demand of safe blood. Therefore understanding the various factors contributing to knowledge, attitude, and practice of VBD among college students is important. Aims: The present study aims to assess the level of knowledge, attitude, and practice regarding blood donation among the health care students. Settings and Design: Cross-sectional study done at Anand from July 2012 to December 2013. Subjects and Methods: A cross-sectional study was conducted among 1000 health care medical students at Anand, Gujarat, India using a structured survey questionnaire. Statistical Analysis Used: The data were tabulated, and master chart was prepared. Analysis was performed by using the percentage. Results: Overall knowledge on blood donation among respondents was 37.3%, majority of the participants (78.7%) never donated blood in which 43.7% of the nondonors had negative attitude like blood donation leads to weakness (10.2%), anemia (25.5%), and 8.0% of nondonors felt that blood donation leads to reduced immunity. Majority of nondonors showed a positive attitude (53.1%) by expressing their willingness to donate blood if they were asked to donate blood (35.3%), about 9.8% of the nondonors don't know the importance of blood donation and 11.2% of nondonors don't know where to donate blood. In this study, 11.5% of students had donated blood only once, in which 38.8% of blood donors said no privacy was provided while donation, few (12.2%) had experienced some discomfort after donation and 50.4% of respondent said that they have not tried again. Conclusions: The present study recommends that even health care students' needs to be educated about the importance, awareness and motivation of blood donation on a regular basis and addressing the problems faced, while blood donation will strengthen the recruitment and retention of blood donors to donate blood on a regular basis.
  3,995 471 -
CASE REPORTS
Tuberculosis and autoimmune hemolytic anemia: Case report and literature review
Hussain Bahbahani, Maryam Al-Rashed, Mohammed Almahmeed
October-December 2014, 5(4):164-167
DOI:10.4103/1658-5127.146953  
Tuberculosis (TB) is a mycobacterial infectious disease that can affect any organ system. The wide varieties of manifestations that TB can present with make the disease a challenge for treating physicians. Anemia is commonly seen in patients with TB, and it is usually anemia of chronic disease. However, the occurrence of autoimmune hemolytic anemia in the setting of TB infection is rare.
  3,854 438 2
ORIGINAL ARTICLES
A prospective clinico-hematological study in 100 cases of pancytopenia in capital city of India
Sweta , Sumit Barik, Raj K Chandoke, Anand K Verma
April-June 2014, 5(2):45-50
DOI:10.4103/1658-5127.137139  
Context: Pancytopenia is not a disease but a clinico-hematological entity encountered in clinical practice. A prompt intervention is required to avoid complications, which can occur in these patients. The relevant clinical history and complete hematological workup is required to treat patient of pancytopenia. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Aims: To diagnose different conditions producing pancytopenia on the basis of clinical, hematological and bone marrow studies. To estimate the frequency of different diseases producing pancytopenia. Subjects and Methods: The study was conducted in Department of Hematology of our college in capital city of India. A prospective study was carried out among 100 consecutive patients with pancytopenia. Blood samples of the patients were analyzed for red cells, white cells and platelets morphology along with presence and absence of immature cells and abnormal cells. In bone marrow examination, morphology of all cells lineage, cellularity, parasite and abnormal cells were scrutinized. Trephine biopsy was done where ever indicated. Results: The age of patients ranged from 5 to 80 years. 74% of patients in this study were vegetarian. The most common cause of pancytopenia was megaloblastic anemia (66%) followed by aplastic anemia (18%), malaria (6%), kala-azar (4%), acute myeloid leukemia (2%), multiple myeloma (2%), myelodysplastic syndrome (1%), and tuberculosis (1%). Conclusions: The present study concludes that detailed primary hematological investigations along with bone marrow examination in cytopenic patients is helpful for understanding disease process, to diagnose or to rule out the causes of pancytopenia. It is also useful in planning further investigations and management.
  3,602 616 2
Hematologic scoring system (HSS): A guide to decide judicious use of antibiotics in neonatal septicemia in developing countries
Arijit Majumdar, Angshuman Jana, Anirban Jana, Soumali Biswas, Swagata Bhattacharyya
July-September 2013, 4(3):110-113
DOI:10.4103/1658-5127.123310  
Background: Septicemia is one of the major causes of neonatal morbidity and mortality. Objective- The objective of our study was to determine the role of hematologic scoring system (HSS) in early diagnosis of neonatal septicemia and provide an effective guideline in decision making regarding judicious use of antibiotics. Materials and Methods: The study was done taking 60 neonates admitted in the hospital. The hematological parameters were studied in all of them. Blood cultures were performed as gold standard for diagnosing septicemia. Results: Analysis of the hematologic profiles in the light of the HSS found that an abnormal immature to total neutrophil (I:T) ratio followed by an abnormal immature to mature neutrophil (I:M) ratio were the most sensitive indicators in identifying infants with sepsis. The study also found that the higher the score the greater the certainty of sepsis being present. The score ≥ 4 was more reliable as a screening tool than any individual hematological parameter. Conclusion : HSS is rapid, easy to perform, cost-effective screening tool for early diagnosis of neonatal sepsis and thereby helps in making of decisions regarding judicious use of antibiotics.
  3,573 583 -
REVIEW ARTICLE
Paroxysmal nocturnal hemoglobinuria: Diagnosis and management protocol
Abdul Kareem Almomen, Abdul Ghani Al Bakistani, Ahmad Alsaeed, Asma Al Olama, Ayman Hejazi, Christian Awarji, Fahed Almhareb, Faisal Alsayegh, Hazzaa Alzahrani, Mahmoud Almarashly, Mohammad Qari, Mohammad Aslam, Rania Seliem, Salam Al Kindi, Saud Abuharbesh, TareK Owaidah, Wafaa Bassuni
April-June 2014, 5(2):37-44
DOI:10.4103/1658-5127.137081  
Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, rare clonal blood disorder, characterized by chronic intravascular hemolysis, bone marrow failure, renal failure and pulmonary hypertension, and a heightened risk of thrombotic complications. PNH etiology is an Υ-linked gene somatic mutation of the phosphatidylinositol glycan class ΐ (PIG-A ), that results in deficiency of the glycosylphosphatidylinositol anchor structure responsible for fixing a wide spectrum of proteins on blood cell membranes, absence of these proteins, particularly CD55 and CD59, dysregulates the complement on cell membranes and results in significant chronic complement-mediated hemolysis. Early diagnosis of PNH is crucial for effective disease management. However, the heterogeneity of clinical symptoms and rarity of this disease usually results in untimely diagnosis, severe disability of patients, and increased risk of fatal complication. These recommendations are formulated by a panel of experts from the gulf cooperation countries. This information reflects their experience and to assist specialists looking after PNH patients, including hematologists, nephrologists, dialysis specialists, gastroenterologists, cardiologists, and surgeons.
  3,597 499 -
ORIGINAL ARTICLES
Comparison of changes in platelet count, mean platelet volume and swirling in stored platelet concentrates with and without platelet additive solution
Saira Bashir, Shahida Mohsin, Huma Amin, Muhammad Rehman, Shabbir Hussain, Tahir Saeed
January-March 2014, 5(1):10-14
DOI:10.4103/1658-5127.131819  
Background: Stored platelet concentrates (PC) are in increasing demand for transfusion to patients with thrombocytopenia or disordered platelet function with active bleeding. Platelets are difficult to preserve in vitro for longer period of time. Different platelet additive solutions (PAS) have been formulated which can increase the survival period of PC during storage. Study Design: Comparative study. Materials and Methods: The study was carried out to compare in vitro changes in platelet indices [platelet count and mean platelet volume (MPV)] and extent of swirling in stored PC with and without PAS stored for 10 day. Results: This study included 42 samples of random donor platelet concentrates, divided into two groups. In one group, PC were stored without PAS while in other group PAS was added to PC before storage. Changes in platelets count and MPV were monitored by using automated hematology cell analyzer, in both groups on day 0, 3, 5, 7, 8, 9, and 10. Bacterial cultures were also applied to detect bacterial contamination of PC. The results showed that mean platelet count of PC stored without PAS was 5.6 + 0.1 x 1010/L on day 0 and it was 5.5 + 0.5 x 1010/L in PC stored with PAS. The difference between the two groups started becoming statistically significant by day 7. Platelet count was significantly lower in PC without PAS as compared to the PC stored with PAS (P value ≤ 0.001). The difference in the mean platelet volume (MPV) between two groups was highly significant during 10 days storage (P value ≤ 0.001). Swirling was better seen in PC stored in PAS as compared to PC stored without PAS during 10 days storage. Blood cultures were applied on 42 samples on days 0, 5 and 10. Bacterial contamination occurred in few samples in both groups, those samples were not processed further. Conclusion: This study showed that the use of PAS in platelet concentrate storage bags increased the shelf life and viability of platelets as compared to those without PAS.
  3,584 488 1
ABSTRACTS
1st Annual Saudi Blood Disorders Research Meeting

June 2016, 7(5):1-32
  1,824 2,106 -
ORIGINAL ARTICLES
Prognostic value of 13q14 deletion and IgH 14q32 rearrangement by interphase fluorescence in situ hybridization in patients with multiple myeloma
Nevine A Kassem, Dahlia A Elswefy, Nermine I Eman, Mahira I Mogy, Mohamed M Moussa, Rania N Ali
October-December 2014, 5(4):141-147
DOI:10.4103/1658-5127.146948  
Background: Multiple myeloma (MM) is a clonal bone marrow (BM) disease characterized by the neoplastic transformation of differentiated B cells with the accumulation of malignant plasma cells in the BM compartment. In Egypt, its extrapolated prevalence is 17,630/76,117,421 with annual rate around 4,085/76,117,421. Chromosomal aberrations in MM are typically complex and represent a hallmark of the disease. The most frequent structural aberrations are 13q14 deletion detected in 33-50% of the cases and 14q32 IgH rearrangement detected in 60-70% of the cases with t (11;14) (q13;q32) being the most frequently detected 14q32 translocation seen in 15% of these patients. Aim: The aim was to detect both 13q14 deletion and 14q32 IgH rearrangement by interphase fluorescence in situ hybridization (I-FISH) on 100 newly diagnosed Egyptian myeloma patients and their relation to the patients' outcome and prognosis. Subjects and Methods: Patients were subjected to a complete history, clinical examination, and laboratory. We have also tested the expression of 13q14 deletion by locus-specific identifier (LSI) D13S319 probe assay and 14q32 IgH rearrangement by IgH dual color FISH break-apart assay on BM aspirates collected from the patients at diagnosis (before starting therapy). Staging and follow-up of the patients were carried out to detect the outcome of the disease. Results: We found that 65% of the examined myeloma patients showed genetic aberrations (13q14 deletion, 14q32 IgH rearrangement or both) by I-FISH. Of which, 40% were positive only for 13q14 deletion, 20% were positive only for 14q32 IgH rearrangement and only 5% were positive for both aberrations. 13q14 deletion was associated with more patients being resistant to chemotherapy or dying indicating its poor impact on patients' prognosis, whereas 14q32 IgH rearrangement was associated with more patients in remission indicating its good impact on patients' prognosis. Comparing myeloma patients who went into remission to those who died or were resistant to chemotherapy after receiving treatment, revealed highly statistical significance in these patients (P ≤ 0.001) as regards to their serum calcium, albumin, B2 microglobulin, and BM clonal plasma cell levels with P values (0.0009, 0.0001, 0.0001 and 0.0001, respectively). Moreover, a statistical significance (P ≤ 0.05) was found in these patients as regards to their total protein and serum M-component with P values (0.0288 and 0.0182, respectively). Summary/Conclusion: 13q14 deletion detected by LSI D13S319 FISH probe in myeloma patients was seen in 40% of the studied cases and was associated with patients being resistant to chemotherapy or dying. Whereas, 14q32 IgH rearrangement detected by IgH dual color break-apart FISH assay in these patients was seen in 20% of the studied cases and was associated with patients in remission.
  2,639 533 -
ARTICLES
Thromboprophylaxis in Cancer Patients Receiving Bevacizumab
Joo-Young Byun, Shaker A Mousa
October-December 2011, 2(4):273-279
Background: Thrombosis is one of the leading causes of death in cancer patients. Anti-angiogenic inhibitors like bevacizumab, a humanized monoclonal antibody targeting vascular endothelial growth factor, increase the risk of thrombosis. Thromboprophylaxis must be provided to patients receiving bevacizumab. Methods: An up-to-date, comprehensive literature search using PubMed for studies performed on bevacizumab from January 2003 to the present was performed. Key words searched included bevacizumab, avastin, thromboprophylaxis, and anticoagulation in cancer patients. Results: Thrombosis risk is increased with bevacizumab therapy. Anticoagulation therapy with bevacizumab may increase bleeding risks; however, these risks are generally low and for minor bleeding. Current guidelines approve thromboprophylaxis in a subset of cancer patients; however, they are not specific for patients receiving anti-angiogenesis therapy. Conclusion: Thromboprophylaxis should be considered for patients receiving bevacizumab, as the benefits outweigh the small risk of adverse effects such as bleeding.
  974 2,165 -
BRIEF REPORT
Concept of P-value
Areej Abdul Ghani Al Fattani
January-March 2014, 5(1):27-28
DOI:10.4103/1658-5127.131823  
P -value has been criticized because it is widely misunderstood and don't tell the researchers what they want to know. Many clinical researches mistaken the conclusion of a significant P-value and may be exaggerate small and unimportant difference. In this regard, understanding of meaning and concept of P-value is critical to investigators as well as to readers. In brief, P-value is the probability of observing a difference equals or more extreme than what was actually observed, if the null hypothesis is true. It is not the proportion of chance that might cause the difference. P-value is not the probability of rejecting the null hypothesis, that probability called α (Type1 error). The smaller the P-value, the stronger the evidence against null hypothesis.
  2,785 287 -
ORIGINAL ARTICLES
Anemia in Infants with Vitamin D Deficiency Rickets: A Single Center Experience and Literature Review
Abdelwahab T H Elidrissy, Mohammed A Zolali, Zakaria M Hawsawi
January-March 2012, 3(1):39-43
We sought to elucidate the relationship between vitamin D deficiency rickets and anemia. This hospital-based study enrolled infants with rickets who were seen in a 300-bed children's hospital as outpatients or inpatients. Hematological parameters were studied and all cases were categorized as active or healed, based on radiological evidence. For the purpose of this study, iron-deficiency anemia was defined as hemoglobin (Hb) below 11 g/L and mean corpuscular volume (MCV) below 70. In 95 infants, Hb levels ranged from 5 to 14 g/L and 48% of active rickets cases were considered anemic. Hb levels in active rickets indicated anemia and were significantly lower than in healed subjects (10.48 g/L vs. 11.52 g/L, p = 0.037). MCV was low in the active rickets group. Many recent cases of rickets and anemia were reported as myelofibrosis and responded well to vitamin D and calcium. We conclude that 3 types of anemia are associated with vitamin D deficiency rickets. The most common is iron deficiency anemia due to common nutritional and other factors; the second most common is hemolytic anemia, known as Northern syndrome, that has been reported in Native Americans in Canada. The third is a very rare anemia due to myelofibrosis involving platelets and neutrophils.
  2,805 214 -
Spectrum of thalassemias and hemoglobinopathies in West Bengal: A study of 90,210 cases by cation exchange high-performance liquid chromatography method over a period of 8 years
Santosh Kumar Mondal, Senjuti Dasgupta, Saikat Mondal, Nikhilesh Das
July-September 2014, 5(3):91-95
DOI:10.4103/1658-5127.141993  
Background: Thalassemias and hemoglobinopathies are highly prevalent in India. Identification of these disorders is important for epidemiologic purposes and for prevention of thalassemia major and clinically severe hemoglobinopathies. Objectives: The aim of this study was to determine the prevalence of thalassemias and hemoglobinopathies in patients of a tertiary care hospital of West Bengal. Materials and Methods: A prospective study was undertaken in which 90,210 cases were included over a period of 8 years. Clinical history and family history were obtained from each patient. The venous blood samples were analyzed for complete blood count, liver function tests, serum iron, ferritin, cobalamin and folate levels. High-performance liquid chromatography (HPLC) was performed on the samples with Biorad Variant using beta thalassemia short program. Confirmatory tests were done whenever required. Results: Normal hemoglobin (Hb) pattern was observed in 79,897 (88.57%) cases and abnormalities were detected in 10,313 (11.43%) patients. β (beta) thalassemia trait was the most common abnormality found in 3870 (4.29%) patients. HbE trait was found in 2418 (2.68%) cases, and then Eβ thalassemia in 1406 (1.56%) patients and β thalassemia major/intermedia in 1135 (1.26%) cases. Other variants detected included sickle cell trait, HbE disease, sickle cell disease, sickle β thalassemia, HbD-Punjab trait, double heterozygous state of HbS and HbE, double heterozygous state of HbS and HbD, Hb Lepore, HbJ-Meerut and HbH. Conclusion: Premarital and antenatal screenings are important measures to prevent birth of children with severe Hb disorders. HPLC is a rapid and reliable technique for identification of various Hb fractions.
  2,594 416 2
REVIEW ARTICLE
Myelodysplastic syndromes: Classification
Hans Peter Horny
January-March 2014, 5(1):1-5
DOI:10.4103/1658-5127.131817  
The updated WHO classification system for myelodysplastic syndromes (MDS) includes some new entities, in particular "refractory cytopenias with unilineage dysplasia (RCUD)". The following review article presents a short overview regarding all subvariants of MDS but with special emphasis on the rare subtypes of MDS that can be exclusively recognized histomorphologically: (1) Hypoplastic MDS (MDS-hypo), (2) Fibrotic MDS (MDS-F) and MDS with associated systemic mastocytosis (SM-AHNMD).
  2,563 416 1
ORIGINAL ARTICLES
Assessment of some plasma fibrinolytic proteins in sickle cell anemia patients in steady state and in vaso-occlusive crises
Timothy Ekwere, Sunday Paul Ogunro, Alani S Akanmu
October-December 2013, 4(4):131-136
DOI:10.4103/1658-5127.127895  
Background: The clinical manifestations of vaso-occlusion result from a dynamic combinations of abnormalities in hemoglobin (Hb) structure and functions, red blood cell membrane integrity, erythrocyte density, endothelial activation, microvascular tone, inflammatory mediators and coagulation factors. Objective: The objective of the following study is to determine the changes in plasma concentration of fibrinolytic proteins among sickle cell anemia (SCA) patients in two clinical states; steady state and vaso-occlusive crises (VOC) and compare with HbAA controls and also to determine if any, the clinical relevance of these proteins in evaluating these patients in the different clinical state. Materials and Methods: A total of 25 (14M: 11F) HbSS subjects in VOC, 24 (13M: 11F) HbSS subjects in a steady state and 30 (17M: 13F) healthy HbAA volunteers matched for age and sex with the subjects were recruited for the study. Hematological parameters, i.e., full blood count, fibrinolytic proteins concentration including plasma concentration of D-dimer, plasminogen, fibrinogen (FBG), tissue plasminogen activator (tPA) and fibrinopetide-A were determined. Result: Plasma fibrinopeptide A (FPA) concentration of 680.99 ΁ 411.37 ng/ml for SCA subjects in VOC and 449.67 ΁ 310.01 ng/ml in steady state subjects were significantly increased (P < 0.001) compared with 163.52 ΁ 86.26 ng/ml for HbAA controls. However, there were no statistically significant changes in the plasma concentrations of D-dimer, FBG, plasminogen and tPA among the subjects in any of the clinical states (steady state and VOC) and controls studied. Conclusion: The significant increase in FPA concentration observed among subjects compared to controls may have been confounded by hyperleucocytosis especially polymorphonuclear leucocytes commonly associated with SCA. Thus, the clinical relevance of these plasma proteins in evaluating these patients in either of the clinical states of this disorder is doubtful.
  2,200 728 1
Totally implanted vascular access devices: A retrospective study of indications and complications in a single pediatric institute
Akram J Jawad, Yassen F Alalayet, Fawaz Alkasim, Saad Alhamidi, Mohammad J Shoura, Eatedal Fathy Ghareeb, Bashar S Najjar
January-March 2014, 5(1):15-18
DOI:10.4103/1658-5127.131820  
Background and Objective: Recently totally implanted vascular access devices (TIVADs) have played an essential role in the management of pediatric patients. The purpose of this study was to describe the indications, techniques and complications of the procedures. Design and Setting: A retrospective study of all patients' files underwent TIVADs procedures between 2009-2012, in a single service providing institute in Saudi Arabia (King Saud Medical city-Riyadh). Patients and Methods: Fifty four TIVADs were inserted in fifty one patients (thirty males and twenty one females). Age ranged six months and twelve years (average 5.6 years). All TIVADs were implanted by pediatric consultant surgeons under general anesthesia. Seldinger technique used in fifty procedures and open approach in four patients. Results: The main indications for TIVADs use were acute lymphocytic leukemia forty six (90%), congenital nephrotic syndrum two (4%), hemophilia two (4%) and solid tumor one (2%). TIVADs were in situe for a total of 35222 days (average 652 days/catheter). Over all complications rate was (30%). Conclusion: TIVADs provided a simple almost pain free venous system access, allow children to conduct a normal life style and sport activities. We believe this study is one of very few reviews originating from developing countries with results comparable to those of world literature.
  2,643 222 1
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