Iraqi Journal of Hematology

Abstract:
INTRODUCTION: The impact of severe acute respiratory syndrome coronavirus 2 on global health has
been considerable since its emergence. Clinical laboratories are crucial in the diagnosis, treatment,
and prognosis of patients with coronavirus disease 2019 (COVID‑19). The study aims to review the
published literature on the abnormal morphological features found in the peripheral blood smears
of patients with COVID‑19.
MATERIALS AND METHODS: A nonsystematic narrative review was carried out, utilizing four
databases to search for publications that presented qualitative alterations in the peripheral blood
cells of individuals with COVID‑19. Thirty‑three studies published between January 2020 and July
2022 were ultimately included in the review.
RESULTS: The majority of the studies reviewed focused on qualitative changes, with peripheral blood
cell shape identified as an indicator of post‑COVID‑19 syndrome severity. Plasmacytic cells were
found to be a relatively specific marker for COVID‑19, while fragmented neutrophils were identified
as an extremely sensitive morphological marker. Activation of monocytes was a strong predictor of
disease outcome, and platelet aggregates served as an indicator of disease progression.
CONCLUSIONS: The identification of morphological abnormalities in peripheral blood cells can aid in
diagnosing and prognosticating COVID‑19 patients. Daily complete blood count tests in hospitalized
patients are crucial for identifying numerical and morphological irregularities that indicate poor clinical
outcomes and disease progression.

Abstract:
BACKGROUND: Angiopoietin‑2 (ANG‑2) regulates angiogenesis and enhances the formation of
new vessels in tumors by boosting the effect of vascular endothelial growth factor as part of dynamic
neovascularization. ANG‑2 is a marker of disease progression and therapy response in multiple
myeloma (MM).
OBJECTIVES: The study aimed to assess the level of ANG‑2 in MM patients at diagnosis and in
remission state and elaborate on its correlation with interleukin‑6 (IL‑6) and beta‑2 microglobulin
(B2M) levels.
PATIENTS, MATERIALS, AND METHODS: Sixty MM patients; 20 newly diagnosed (ND), and
40 patients in remission were included. Twenty healthy individuals were included as a control group.
Plasma levels of ANG‑2, B2M, and IL‑6 were tested by enzyme‑lin ked immunosorbent assay.
RESULTS: There are significant statistical differences between ND patients and those in remission
in hemoglobin, neutrophil count, blood urea, serum creatinine, glomerular filtration rate, B2M, IL6,
and ANG‑2 (P = 0.001, 0.033, 0.005, 0.001, 0.001, 0.001, 0.004, and 0.001, respectively). ANG‑2
showed significant positive correlations with B2M (P = 0.001) and IL‑6 (P = 0.012).
CONCLUSION: The low ANG‑2 level in the remission group with an insignificant difference from
that in the control group with a high level in the untreated patients renders it a useful indicator for
treatment response follow‑up in MM. The positive correlation of ANG‑2 with B2M and IL‑6 reflects
the active angiogenesis with a high tumor burden and disease progression.

Abstract:
BACKGROUND: Platelet parameters in steady‑state sickle cell anemia (SCA) are affected by the red
cell sickling, vaso‑occlusion, and chronic hemolysis occasioned by the disease; and the occurrence
of bone pain crises may further alter these parameters. Knowledge of platelet parameters in SCA
augments our understanding of the pathophysiology of the disease and may influence disease
management modalities.
OBJECTIVES: The objective of the study is to determine and compare platelet parameters of SCA
patients during bone pain crises and in steady states.
PATIENTS AND METHODS: A longitudinal study involving 50 adult SCA patients who had platelet
parameters determined during bone pain crises and later in steady states. Platelet count and
platelet indices (mean platelet volume, platelet distribution width, plateletcrit, and platelet‑large cell
ratio (P‑LCR)) were determined through automation.
RESULTS: SCA patients during both bone pain crises and steady states had higher mean platelet
counts when compared with normal non‑SCA reference values. P‑LCR was found to be significantly
different between the bone pain crises and steady states with mean values of 18.20 ± 5.55 versus
15.96 ± 4.91 respectively; P = 0.034. During the bone pain crises state, platelet parameters did not
significantly differ based on the severity of pain.
CONCLUSIONS: Platelet count of both steady and bone pain crises states SCA patients were
higher than the reference range for the normal non‑SCA population. The P‑LCR was the only platelet
parameter that significantly differed between the two clinical states of SCA as it rose during the bone
pain crises state; a finding reflecting increased peripheral platelet activation and the presence of
larger circulating platelets during the vaso‑occlusive crises.

Abstract:
BACKGROUND: Therapeutic plasma exchange (TPE) is a treatment option used in many medical
conditions. Response rates are variable as some disorders clearly benefit from TPE as first‑ or
second‑line therapy. This study aims to summarize our experience at King Abdulaziz University
Hospital at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.
MATERIALS AND METHODS: In a retrospective fashion, wdemographic data, underlying disease,
apheresis‑related parameters, and outcomes were collected.
RESULTS: Between January 2005 and March 2020, 159 patients with 177 episodes underwent a
total of 945 sessions of TPE. The majority of patients (96.8%) undergoing TPE in our center are
of categories I to III according to 2019 American Society for Apheresis guidelines. Most patients
had neurologic disorders, 74 (46.5%), where myasthenia gravis was the most common indication,
34 (21.4%) patients with response in 44/45 (97.8%) episodes, followed by thrombotic microangiopathies
31 (17.5%) patients with response in 17/34 (50%) episodes, Guillain–Barré syndrome 27 (16.9%)
patients with recovery in 20/27 (74.1%) patients, and systemic lupus erythematous 25 (15.7%) patients
with recovery in only 11/25 (44%) patients. Complications included hypotension in 29/945 (3.06%)
sessions and citrate‑induced symptoms in 6/945 (0.6%) sessions.
CONCLUSION: Our center complies with the recommended standards of indications for initiating
TPE. Neurologic conditions constitute the largest group of patients requiring TPE.

Abstract:
BACKGROUND: Hodgkin lymphoma (HL) is an aggressive B‑cell lymphoma, considered one of the
most curable hematological malignancies. Hasenclever International Prognostic Score was designed
to predict 5‑year freedom from the progression of HL. D‑dimer is a fibrin degradation element,
validated as a standard test in suspected thrombotic disorders. Elevated D‑dimer levels were found
also in a number of cancers. Its role in the prognosis of these cancers as well as in the mechanism
of tumor development is still debated.
OBJECTIVES: The aim of this study was to assess the reliability of D‑dimer level in relation to clinical
presentations, standard prognostic markers, and early outcomes in patients with classical HL.
PATIENTS AND METHODS: This is a prospective cohort study enrolled 25 adult patients with newly
diagnosed classical HL during a period of 1 year from different hematology centers in Iraq. In addition
to clinical parameters, each patient had performed D‑dimer assay by the expert specialist at the start
of treatment and after the end of delete courses of chemotherapy cycles.
RESULTS: An elevated mean D‑dimer level was observed (1568.9 ± 1365.73 ng/mL). The stage of the
disease showed a significant difference among the patients’ groups (P = 0.042). In addition, the mean
D‑dimer was significantly different between chemotherapy responders and nonresponders (P = 0.004).
Only D‑dimer showed a significant association as a univariate predictor to prognosis (P = 0.003).
CONCLUSION: There is significant a negative strong correlation in mean D‑dimer values and the
outcome (i.e., mean D‑dimer significantly decrease with increased response).

Abstract:
BACKGROUND: Acute leukemias are a group of potentially fatal hematological malignancies. The
purpose of this study was to evaluate the clinical presentation of acute leukemia and estimate the
frequency of its signs and symptoms in Asmara, Eritrea.
PATIENTS AND METHODS: A retrospective cross‑sectional study was conducted consecutively
included all of the patients with the diagnosis of acute leukemia at the National Health Laboratory,
Asmara, Eritrea, from December 2015 to July 2017. The laboratory and medical data of the patients
were obtained using a structured questionnaire based on age, gender, presenting complaints, and
clinical findings.
RESULTS: Twenty cases who were reviewed acute lymphoblastic leukemia constituted (60%), while
acute myeloid leukemia (AML) accounted for 40% of the cases studied. The female patients were
more than males (55% vs. 45%). Acute leukemia mainly affected those aged 1–10 years (45%),
while the least affected were those aged over 40 years (5%). Acute lymphoid leukemia mainly
affects those aged 1–10 years (58.3%), while those aged 20–30 years and over 40 years are
unaffected (0%). AML mainly affects those aged 1–10 years and 21–40 years (25%), while those
aged 11–20 years and over 40 years being the least affected (12.5%). The most familiar presenting
complaint for acute leukemia was fever (70%), followed by fatigue (40%). Splenomegaly (70%),
hepatomegaly (40%), and lymphadenopathy (40%) were the most typical physical examination
findings.
CONCLUSIONS: Acute lymphoblastic leukemia is the most typical kind of acute leukemia affecting
the people of Asmara, Eritrea. The young population suffers the most, and fever, fatigue, and pallor
are the primary presenting complaints. Splenomegaly, hepatomegaly, and lymphadenopathy are the
main physical examination findings among patients with acute leukemia

Abstract:
BACKGROUND: Biclonal gammopathies are characterized by the production of two distinct monoclonal
proteins. It is defined as the presence of two distinct M bands in serum protein electrophoresis. Biclonal
myeloma accounted for approximately 1% of newly diagnosed cases of multiple myeloma.
OBJECTIVE: The aims was to study the clinical characteristics and treatment outcomes of 13 patients
with biclonal gammopathy treated at a tertiary cancer center.
MATERIALS AND METHODS: The details of clinical presentation, diagnosis, treatment, and survival
were noted from medical records.
RESULTS: The median age was 65 years, there were 10 males and 3 females. Eleven patients had
multiple myeloma, one had plasmacytoma, and one had monoclonal gammopathy of undetermined
significance (MGUS). Twelve patients had biclonal gammopathy at diagnosis and one developed
biclonal gammopathy at relapse. Immunofixation showed IgG/IgA in seven cases, IgA/IgG in four, and
IgG/IgG in two patients. The patient with MGUS is on follow at 44 months and one with plasmacytoma
received radical radiotherapy and alive at 45 months. Ten patients with myeloma received systemic
treatment, eight are alive with survival ranging from 44 to 110 months, and four patients are alive
more than 5 years.
CONCLUSION: Biclonal gammopathies are rare characterized by the presence of two distinct
monoclonal proteins. The most frequent combination was IgG/IgA. Treatment of biclonal gammopathy
is similar to monoclonal gammopathy with comparable outcomes. During follow‑up, both paraproteins
have to be addressed.

Abstract:
BACKGROUND: According to the World Health Organization (WHO), erythropoietin (EPO) is only a
minor criterion for the diagnosis of polycythemia vera (PV), but its diagnostic validity is controversial.
OBJECTIVES: The objective was to assess the diagnostic accuracy of EPO levels and the different
combinations of the laboratory and clinical criteria, defined by the latest WHO report, as markers for
the diagnosis of PV in Iraqi patients.
PATIENTS, MATERIALS AND METHODS: This cross‑sectional study included 158 myeloproliferative
neoplasm‑suspected patients (48 PV, 47 essential thrombocythemia, 25 secondary thrombocytosis,
and 35 nonclonal erythrocytosis). Patients were assessed for the presence of Janus Kinase 2 (JAK2)
V617F mutation. Subsequently, JAK2V617F‑negative patients were evaluated for the presence of
JAK2 exon 12 mutations. Plasma EPO was measured in PV and nonclonal erythrocytosis patients.
RESULTS: Male was more prevalent among the nonclonal erythrocytosis patients. PV patients
were older and had higher levels of all hematological variables examined in the study. Although all
obtained EPO levels were normal, PV patients had significantly lower levels of EPO than nonclonal
erythrocytosis. In addition, the hemoglobin and hematocrit had a better diagnostic accuracy than
EPO levels in both male and female patients with PV. Furthermore, a better diagnostic accuracy
was obtained when JAK2 mutation status was added to the evaluation of hemoglobin or hematocrit.
CONCLUSION: The low EPO level is not a good predictive marker for PV. Hemoglobin and hematocrit
had equal predictive validity in the diagnosis of PV. It is convenient to evaluate JAK2 mutation as
one of the major criteria in the diagnosis of PV.

Abstract:
BACKGROUND: Portal vein thrombosis (PVT) is one of the important complication postsplenectomies
which is considered part of treatment if hypersplenism developed. It can be diagnosed clearly with
advance in the quality of X‑ray. It is usually associated with prolonged prothrombin time and increased
level of D‑dimer and alkaline phosphatase. The treatment includes regular blood transfusion and
antithrombotic agents.
OBJECTIVES: The aim was to evaluate incidence of PVT in β‑thalassemia patients and its association
with splenectomy and nonsplenectomy patients.
PATIENTS AND METHODS: A cross‑sectional study was conducted at Babylon hereditary blood
disease center, for 12 months beginning from the first of June 2020, and ending in June 2021. It
includes 150 patients with β‑thalassemia, they classified 70 patients with splenectomy as the first
group and 80 patients without splenectomy as the second group, their age ranged between 3 and
18 years. Doppler ultrasound was done for all patients by a single radiologist to confirm the presence
or absence of thrombosis in the portal vein.
RESULTS: The results showed that 4.6% of patients had PVT and its incidence increased with age
older than 10 years, history of splenectomy, high platelets count, high serum ferritin, low Hb, high
white blood count. Abdominal pain was the most common symptoms.
CONCLUSION: PVT occurred in 4.6% and the major risk are splenectomy and older 10 years of age.
The Doppler ultrasound is considered as simple, noninvasive technique for the detection of thrombus.

Abstract:
BACKGROUND: Selective immunoglobulin (Ig) A deficiency is the most common Ig deficiency in
the world. Serum IgA level is reduced, 7 mg/dL (70 μg/mL), thus, associating with a wide range
of clinical symptoms and signs that are related directly and indirectly to disturbances in the body
immune system. Selective IgA deficiency patients are known to develop antibodies against lacking
IgA. Whenever these antibodies are found in an individual’s circulating blood, a severe allergic
response and anaphylaxis can ensue upon receiving IgA containing blood or blood components.
Hence, certain protocols are recommended in populations with increased prevalence of selective
IgA deficiency including the use of red blood cell (RBC) washing machines or IgA‑deficient blood
components. Both measures are costly and require special maintenance procedures.
OBJECTIVES: The aim of this study was to screen for the presence of selective IgA deficiency in
a group of blood donors and its probable role in the events of transfusion reactions that frequently
occur which may necessitate the application of protocols that involve sophisticated procedures and
highly‑demanding machines.
SUBJECTS AND METHODS: This was a laboratory study that included 300 volunteer blood donors
in the National Blood Transfusion Center. They were screened for their serum IgA levels. Related
questionnaire was conducted and chemiluminescence immunoassay technique with MAGLUMI
600 series machine was used. This machine is already used by the National Center of Teaching
Laboratories for variety of biochemical and immunological assays. Serum IgA levels then were plotted
against age, blood group and smoking status.
RESULTS: No single case of Selective IgA deficiency was documented. Serum IgA levels showed
increased levels with age and smoking demonstrated no significant effect on the Ig levels.
CONCLUSION: In light of these results, it does not seem urgent or necessary at this point of time
to introduce the highly demanding and expensive RBC washing machines in blood banks in Iraq.
We recommend conducting a larger study that is more comprehensive with wider involvement of
population, considering age, gender, and ethnicity.

BACKGROUND: Multiple myeloma is a clonal B-cell malignancy characterized by proliferation of
plasma cells that secrete a complete and/or partial monoclonal immunoglobulin protein. It induces
dysfunction of cytotoxic T cells that may be responsible for immune evasion and therapeutical failure
of immunotherapies. T cells during senescence tend to lose co-stimulatory molecules such as CD27
and CD28 while expressing killer cell lectin-like receptor subfamily G (KLRG-1) and CD57. Therefore,
enhanced knowledge about the actual status of T cells in myeloma patients is needed.
OBJECTIVES: The aims of this study were to detect the senescent cytotoxic T-cell (CD8+) in patients with
refractory/resistance multiple myeloma, and to compare it with newly diagnosed multiple myeloma patients,
and their implications for cellular therapies.
MATERIALS AND METHODS: This is a cross sectional study performed, from January to October
2021. Sixty multiple myeloma patients were sequentially chosen, thirty of them were newly
diagnosed patients and another thirty were relapse/refractory who progress after receiving 2 lines
of chemotherapy containing bortezomib and immunomodulators. And/or patients progressing after
autologous stem cell transplantation. Seventeen apparently healthy age and gender matched adults
were enrolled as a control group. Multicolor flow cytometry was utilized for the analyses of surface
molecules CD 28 and CD57 on CD 8 positive T-lymphocyte using peripheral blood, subsequently
the percentage of T cells senescent were estimate in CD 8+ T cells with CD28- and CD57+.
RESULTS: The mean percentage of senescent CD8 positive T lymphocyte (negative CD28 and
positive CD57) were significantly higher in multiple myeloma patients than control (P<0.001). There
was no statistically significant difference in percentage of CD8+ T cells between newly diagnosed
multiple myeloma and relapsed /refractory cases. However higher percentage of senescent T cells
was found in relapsed cases. No significant correlation was found between percentage of CD8 +T
cells and patients age, or duration of disease.
CONCLUSION: Percentage of senescent CD 8+ T cells with CD28- and CD 57+were significantly
higher in MM patients compared to healthy controls. Percentage of senescent CD 8+ T cells with
CD28- and CD 57+were lower in newly diagnosed MM patients compared to relapsed patients but
the difference was statistically not significant

Abstract:
BACKGROUND: Anemia during pregnancy is a public health issue, particularly in underdeveloped
countries, and it is linked to unfavorable maternal and neonatal outcomes. The aim of this study
was to investigate the prevalence of anemia among pregnant women undergoing prenatal care in
Yaqshiid district, Somalia.
MATERIALS AND METHODS: From September 2022 to January 2023, a hospital‑based
cross‑sectional study was undertaken at Alkeyraat Voluntary Hospital. Blood samples from pregnant
women were checked for malaria and parasites as well as hemoglobin (Hb), erythrocytes, hematocrit,
mean cell volume, and hematocrit. Structured surveys collected sociodemographic data. SPSS
Version 25.0 was used to analyze the gathered data. Crosstab descriptive and binary logistic
regression were used for the analysis. P < 0.05 was considered statistically significant.
RESULTS: The prevalence of anemia was 26.7% (95% confidence interval [CI] = 0.086–0.692), of
which 20.0% were mildly anemic, 3.3% were moderately anemic, and 3.3% were severely anemic,
with a mean (±standard deviation) Hb of 8.38 (±1.90) g/dL. The following factors were found to
be associated with anemia: living in a rural area (odds ratio [OR] = 0.337, 95% CI = 0.155–0.732,
P = 0.05), having anemia during the second trimester of pregnancy (OR = 0.351, 95% CI = 140–879,
P = 0.05), having one or two children (OR = 0.361, 95% CI = 0.150–0.868, P = 0.05), history of
abortion (OR = 0.337, 95% CI = 0.155–0.732, P < 0.05), and history of blood transfusion (OR = 0.169,
95% CI = 0.063–0.456, P < 0.05).
CONCLUSION: The prevalence of anemia in the present study was low when compared to earlier
studies conducted in Bangladesh, Pakistan, Sudan, and Nigeria, among others. Regular visits to
maternity care facilities and health education promotion efforts need to be emphasized more to
improve rates of success.

Abstract:
BACKGROUND: Matrix metalloproteinases (MMPs) are proteases responsible for cleaving and
rebuilding connective tissue components and also affect early carcinogenesis events, tumor
development, growth, and neovascularization. The study aimed to evaluate the level of MMP‑2 in
acute myeloid leukemia (AML) patients in comparison with that in remission status, and healthy
subjects, and to find its correlation with hematologic parameters.
PATIENTS, MATERIALS, AND METHODS: This study included sixty newly diagnosed AML
patients. Remission status was assessed after induction chemotherapy. The overall survival (OS)
was determined after 6 months. The plasma MMP‑2 level was measured at diagnosis by enzyme
immunoassay. Twenty‑eight healthy individuals were recruited as a control group.
RESULTS: Plasma MMP‑2 was higher in AML patients than in healthy individuals (P = 0.005). The
level of MMP‑2 was much higher in the M5 subtype than in the other subtypes (P = 0.0001). There was
no statistically significant difference in the level of MMP‑2 between patients who achieved complete
remission and those who did not (P = 0.113). After 6 months, no significant difference in the initial
MMP‑2 levels was found between deceased and alive patients (P = 0.174). A positive correlation of
MMP‑2 level was found with white blood cell (WBC) count and hemoglobin (P = 0.0001 and 0.033,
respectively) while insignificant with age, platelet count, and blast counts.
CONCLUSIONS: The high MMP‑2 level in AML patients suggests a possible role in the pathogenesis.
However, it does not show any association with remission status or OS. The elevation was significantly
associated with marrow monocytosis (M5) and correlated with a higher WBC count.

BACKGROUND: Platelet (PLT) counts (PCs) underwent various changes during pregnancy that
occur due to hormonal profiles. A reduction in PC is the major event that occurs in PLT disorder
during pregnancy. The common laboratory and clinical findings of these disorders make the diagnosis
challenging.
OBJECTIVES: The study aimed to evaluate the effect of pregnancy on PLT indices among healthy
pregnant ladies.
METHODS: A case–control hospital‑based study was carried out from February 2020 to February
2021 on 150 participants, 100 of them were healthy pregnant Sudanese ladies at different trimesters
(36 pregnant in 1st trimester, 33 pregnant in 2nd trimester, and 31 pregnant in 3rd trimester). The control
group included 50 healthy nonpregnant Sudanese ladies matched according to age and body mass
index. A structured questionnaire was used covering data about demographic history, trimetric period,
number of pregnancies, and parity. Five milliliters of blood samples was obtained for the measurement
of PLT indices using Sysmex KX‑21 automated hematology analyzer. Data were analyzed using the
SPSS computer programs version 2S. Independent sample t‑test was used to compare the PLT indices
between the healthy pregnant and nonpregnant (control). P ≤ 0.05 is considered statistically significant.
RESULTS: The mean of participant’s age was found to be 25 years (range of 18–45 years) and all
of the participants were within the reproductive age. In all pregnant groups, the mean of PCs, mean
PLT volume (MPV), and PLT distribution width (PDW) were found to be 284.3 ± 71.7 × 103/μL,
8.8 ± 1.0 fL, and 13.7 ± 2.5, respectively. While in control groups, the mean of PCs, PMV, and
PDW was found to be 218 ± 14.4 × 103/μL, 10.3 ± 3.2 fL, and 11.5 ± 2.5, respectively. The MPV
was not significantly changed during pregnancy (P = 0.774). However, the changes in the PC and
PDW between the pregnant and nonpregnant (control) group were significant with a P = 0.020 and
0.007, respectively. In the course of pregnancy, the PC in the first, second, and third trimesters was
found to be 312 ± 78.3 × 103/μL, 268 ± 62.5 × 103/μL, and 273 ± 65.8 × 103/μL with only statistically
significant change between the 1st and 2nd trimesters of pregnancy (P = 0.027). The MPV in the first,
second, and third trimesters was found to be 8.7 ± 0.92 fL, 8.9 ± 1.1 fL, and 8.8 ± 1.0 fL, with no
statistically significant change during the course of pregnancy. The PDW in the first, second, and
third trimesters was found to be 12.8 ± 2.6, 13.7 ± 2.5, and 15 ± 1.8 with only statistically significant
change between the 1st and 3rd trimesters of pregnancy (P = 0.001).
CONCLUSION: The PC and PDW increase significantly during pregnancy in comparison to the control
group. PC has the highest reading in the first trimester, and the PDW has the highest reading in the
third trimester in comparison to the other trimesters. On the other hand, the MPV is nonsignificantly
decreased throughout the three trimesters of pregnancy in comparison to the general population.
These new values, which are most likely due to the hormonal profile of pregnancy, should be taken
into consideration

Abstract:
BACKGROUND: Calprotectin is a protein found in the cytoplasm of neutrophils and monocytes
and its serum level increases in inflammatory conditions and some cancer cases. It was aimed to
determine the diagnostic and prognostic importance of serum calprotectin levels in patients with
lymphoma in this study.
MATERIALS AND METHODS: In this study, 32 newly diagnosed or relapsed Hodgkin lymphoma (HL),
31 diffuse large B‑cell lymphoma (DLBCL), and 26 healthy cases followed in the Hematology clinic
of Atatürk University Medical Faculty Hospital were evaluated prospectively. Serum calprotectin
levels of lymphoma cases and control groups were compared. In addition, the relationship between
serum calprotectin level and bulky mass, B symptoms, Ann Arbor stage, extranodal involvement,
and response to chemotherapy was investigated in lymphoma groups.
RESULTS: Serum calprotectin level was higher in the HL than that in the DLBCL and control
groups (P = 0.01, P = 0.001, respectively). There was a correlation between serum calprotectin level
and bulky mass, B symptoms, and Ann Arbor stage (P = 0.03, P = 0.02, and P = 0.001, respectively)
in the HL group. Serum calprotectin level and international prognostic score were associated in the
DLBCL group (P = 0.001).
CONCLUSION: Serum calprotectin level can be used as an additional diagnostic biomarker in HL.
In addition, it is associated with some prognostic biomarkers in lymphoma cases.

Abstract:
BACKGROUND: Trace elements normally appear in low concentrations in the human body and
play an important role in the enzyme systems in many metabolic processes. Trace elements, mostly
selenium (Se) and zinc (Zn), were involved in the defense against oxidative stress in cells. Oxidation
could lead to the generation of free radicals that have been involved in the pathogenesis of many
diseases, including leukemia. While Cu at the physiological level provides cellular health and at higher
than the physiological level causes angiogenesis and a higher incidence of cancers.
OBJECTIVES: The aim of this study was to measure the essential trace elements (selenium, zinc,
and copper) in the serum of adult patients with acute lymphoblastic leukemia (ALL) and acute myeloid
leukemia (AML) and their relation to some clinical and laboratory parameters.
MATERIALS AND METHODS: This case–control study comprised 39 adult patients with de novo
acute leukemia (AL) (28 patients with AML and 11 patients with ALL) conducted from January to June
2022. The patients were collected from Iraqi Center for Hematology in Baghdad Teaching Hospital
in Medical City. A total of 40 apparently healthy adults were included in this study as a control group.
Peripheral blood and bone marrow smears were examined at the presentation for establishing the
diagnosis. The serum level of selenium, zinc, and copper was measured by a microplate reader for
both patients and the control group, before starting chemotherapy. Immunophenotyping and renal
function tests (RFTs) were taken from the patient's files.
RESULTS: There was a statistically lower median level of selenium among the patients group in
comparison to the control group (P < 0.001), while both zinc and copper did not show statistical
difference between both groups (P > 0.05). Only hemoglobin (Hb) showed a significant negative
correlation between patients with AL and the level of selenium. There was a significantly lower zinc
level among the abnormal RFT group in comparison to the normal group.
CONCLUSIONS: There was a significantly lower serum selenium level in AL patients than in the
control group. Selenium level showed a negative correlation with Hb among AL patients only, in
which an increase in selenium level was associated with a decrease in Hb level among AL patients.
There was no significant difference in the serum level of zinc and copper between AL patients and
the control group. There was a significantly lower zinc level among the abnormal RFT group in
comparison to the normal group.

Abstract:
Amyloidosis is a group of diseases characterized by extracellular abnormal proteinaceous
material (amyloid) deposition in various organs. As amyloid fibrils accumulate, tissues and organs may
fail to function properly. Evidence of amyloid deposition in duodenal biopsies and bone marrow (BM)
aspirates is uncommon and often overlooked. Here, we present a patient diagnosed with primary
systemic amyloidosis who complained of pain in the abdomen, vomiting, loose stools, and generalized
weakness. Histological examination of an endoscopic duodenal biopsy revealed amyloid deposits.
BM aspiration cytology revealed amyloid deposition with BM plasmacytosis. She was eventually
diagnosed with plasma cell dyscrasia based on a series of biochemical tests. To the best of our
knowledge, reports of simultaneous amyloid deposition in the duodenum and BM aspirate smears
are very rare and unpublished. This case serves to highlight the significance of careful microscopic
histo‑cytology and the utility of special stains for prompt diagnosis and treatment outcomes in a
disease of poor prognosis.

Abstract:
Blast ploidy is a distinctive cytogenomic feature related to the prognostic outcome of acute
lymphoblastic leukemia (ALL) patients. Near tetraploidy (NT) (81–103 chromosomes) is a very
rare ploidy anomaly in (ALL). It is observed in approximately 1% of childhood B‑cell precursor
ALL (BCP‑ALL). In T‑ALL specifically in adult T‑ALL, it is furthermore rare entity. Only few case
reports are found in the existing literature. Compared to BCP‑ALL, T‑ALL lacks recurrent genetic
anomalies with independent prognostic value. Although B‑cell ALL associated with NT is related to
a standard cytogenomic risk, the prognostic outcome of NT in T‑cell ALL is yet to be determined.
Conventional karyotyping of this entity is difficult to perform and interpret. Thus, it is recommended
that karyotype results should be supplemented by fluorescence in situ hybridization. Herewith, we
present an adult T‑ALL case detected with NT karyotype with emphasis on prognostic significance.