Iraqi Journal of Hematology

Abstract:
Cutaneous T‑cell lymphoma (CTCL) is the most common primary cutaneous lymphoma but
rarely encountered. It is often misdiagnosed with allergic or infectious dermatological conditions
and is usually a diagnosis of exclusion. The subsets of CTCL primarily consist of CD4 + and
CD30 + lymphoproliferative disorders including mycoses fungoides. Herein, we report a case of CD
8 + ve CTCL stage IA that was previously misdiagnosed with cutaneous tuberculosis with no response
to antitubercular therapy. After a confirmatory diagnosis of CTCL with multiple sites involved, he
was treated with definitive local radiotherapy alone and had a complete response to treatment with
no recurrence at 5 year’s follow‑up.

BACKGROUND: Neuroblastoma is the third most common cancer in pediatric age group; it is
the most common malignancy in the 1st year of life. The majority of the patients (50%–65%) have
advanced disease at diagnosis. Diagnoses, staging investigations, and risk categorization have a
great success in neuroblastoma, trying to classify the patient into risk groups according to the age,
stage, and molecular study and this in turn has important value in the treatment strategies. Despite
of this improvement in the early diagnosis and treatment protocol, neuroblastoma stills is one of the
malignant diseases that are associated with high morbidity and mortality.
OBJECTIVES: The aims of this study were to evaluate the pattern of presentation, studying
the correlation between age, sex, and site of primary tumor with disease staging in patients with
neuroblastoma.
PATIENTS AND METHODS: This study was done prospectively over a period of 6 years from
February 2008 to February 2014. Sixty‑two patients with newly diagnosed pediatric neuroblastoma
admitted to Hiwa Hematology/Oncology hospital were included in this study. Age, sex, clinical patterns,
staging, and important laboratory findings were assessed. The patients staged according to the
International Neuroblastoma Staging System. We divided our patients into three groups according
to the risk categories.
RESULTS: Data analyzed using SPSS- 13 and P value obtained by Chi‑square test, a median age
at diagnosis was about 24 months with male predominance. Most common site of the primary tumor
was the abdomen; approximately 69% of our patients with neuroblastoma studied were Stage 4.
CONCLUSION: The stage in our study was age dependent, but it was neither depending on the sex
nor the site of the primary tumor.

Abstract:
BACKGROUND: Diffuse large B‑cell lymphoma (DLBCL) is a heterogeneous form of hematological
malignancy which comprises about 30% of lymphomas with variable outcome. Onset is usually in
the sixth decade of life with male predominance. Morphological, clinical, and biological variation of
DLBCL confirms the coexistence of several subtypes of the disease with distinct behavior of each type.
OBJECTIVE: The aims of this study were to determine the demographics and outcome of patients
with DLBCL and compare these parameters with regional and international data.
PATIENTS AND METHODS: A retrospective study was conducted on 61 patients with confirmed
diagnosis of DLBCL. The diagnosis was based on histopathological and immunohistochemistry which
was done in the Department of Pathology, Shorsh General Hospital in Sulaimani. The cases were
randomly selected according to the availability of data since March 2013–March 2017.
RESULTS: Median age at diagnosis was about 51 years with peak age of incidence between 50
and 64 years, with female predominance. The most common site of the primary tumor was nodal
in which cervical lymph node is the most common site, and majority of the patients were in Stage
III with predominance of B‑symptoms. Vast majority of the patients have normal chest X‑ray, and
majority of the patients were in remission over a period of 19 months of follow‑up.
CONCLUSION: We found that there is a significant relationship between age, stage, and performance
of the patients, while no significant relation between other parameters and the outcome of the patients
is near to their Peers internationally.

Abstract:
BACKGROUND: Caregivers knowledge regarding thalassemia is one of the vital areas in the
prevention of the disease. Studies related to caregivers knowledge and its sociodemographic predictors
are very few in number which is helpful in designing interventions across different study settings.
OBJECTIVES: the study aimed to find out the knowledge level of caregivers of thalassemic children
and its sociodemographic determinants.
MATERIALS AND METHODS: It was a cross‑sectional observational study conducted in a
thalassemia day care unit of Eastern India. The study included 328 caregivers of thalassemic children
attending thalassemia day care unit during May 2015–April 2016. Data were analyzed using Statistical
Package for the Social Sciences (SPSS) (version 16).
RESULTS: Out of 328 caregivers only 47.6% knew about genetic etiology of the disease, while only
52.4% and 50.9% knew about premarital counseling and antenatal screening, respectively. Regarding
treatment of the disease, 75.9% knew that both blood transfusion and iron chelation are the treatment
of thalassemia, while only 19.2% and 2.7% of them had knowledge regarding splenectomy and bone
marrow transplantation, respectively. Only 52.7% had satisfactory knowledge regarding the disease. In
multivariable model, caregivers educational level (adjusted odds ratio, AOR‑3.13 [1.87–5.25]), working
status (AOR‑2.18 [1.23–3.86]), place of residence (AOR‑2.05 [1.19–3.52]), and socioeconomic
class (AOR‑2.11 [1.25–3.58]) were significant predictors of their knowledge.
CONCLUSION: Caregivers’ knowledge regarding thalassemia was not at all satisfactory. Regular
counseling of caregivers should be done addressing the knowledge lacunae’s among them.

Abstract:
BACKGROUND: Sickle cell disease (SCD) is prevalent in Basrah city and affects the red blood
cell (RBC) deformability and thereby causes disease symptoms. Hydroxyurea (HU) is effective in
reducing morbidity and mortality in SCD patients by different mechanisms.
OBJECTIVES: The aim of the study was to investigate the effect of HU on RBC deformability among
SCD patients by direct laser optical trapping (OT) technique.
MATERIALS AND METHODS: Blood samples from SCD patients and control groups were prepared
in the medical laboratory of Basrah Center for Hereditary Blood Diseases and transferred into physics
laboratory wherein the laser system was presented and built‑in. RBCs from each sample were exposed
to three different powers of laser 5, 15, and 20 mW for 15 s and then were released and followed
for 2 min. The images for each trapped RBC were obtained and at relaxation sequential times. The
percentage changes in the diameters of trapped RBCs were measured for control and patient groups.
RESULTS: SCD patients were divided into two groups depending on whether they were receiving
HU (39 patients) or not (43 patients). They were matched with 50 healthy individuals (control) regarding
age and gender. We found that all the trapped RBCs were affected during the trapping time and then
returned toward near normal with some differences between the groups and according to the power
used. The deformability of HU group was better and closure to the control.
CONCLUSION: The presented laser system and OT technique with optimal power are effective
to study the RBC characteristics and deformability. HU is effective in improving RBC deformability
among SCD patients.

BACKGROUND: Platelet function plays a crucial pathophysiological role in the development of
atherothrombosis in patients with type 2 diabetes mellitus (DM). Platelet count (PC) and mean
platelet volume (MPV) are simple, effective, and cheap tests that may be used to predict angiopathy
in type 2 DM.
OBJECTIVES: The aims of this study were to analyze various platelet parameters including PC,
plateletcrit (total mass of platelets) (PCT), and mean platelet indices that are MPV, platelet distribution
width (PDW), and platelet‑large cell ratio (PLCR) in the type 2 DM patients, to compare various
platelet indices between DM patients (with and without complications) and controls.
MATERIALS AND METHODS: This was a cross‑sectional study conducted over a period of 3 months.
Complete blood count along with blood glucose and HbA1c was estimated. The study population
was divided into three groups: Group 1: Normal controls (n = 30); Group 2: DM patients without
complications (n = 30); and Group 3: DM patients with complications (n = 30). Based on HbA1c
levels among the diabetic patients, the diabetic groups were also classified as DM with HbA1c <7%
and DM with HbA1c >7%.
RESULTS: All the platelet parameters were found to be higher among DM with complication as
compared to DM without complication, and this was found to be statistically significant. Among the
platelet parameters, MPV, PCT, and PDW were found to be higher among DM with HbA1c >7% as
compared to DM with HbA1c <7%, and this was found to be statistically significant while there was
no significant differences in PC and PLCR between the two groups.
CONCLUSION: Monitoring of DM to prevent the occurrence of vascular complications is the need
of the hour. The results of the study suggest a role of various platelet indices as a simple and
cost‑effective tool to monitor the progression and control of DM.

Abstract:
Primary splenic lymphoma is a rare low‑grade non‑Hodgkin’s lymphoma. This is a case of a 52‑year‑old
woman who had an incidental detection of a lesion in the spleen during evaluation for fever which
was found to be a case of primary grade III follicular lymphoma of the spleen. The patient was
started on rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy
postsplenectomy. Rituximab was not added initially as the patient had a high viral load of hepatitis B
virus (HBV). The patient completed six cycles of chemotherapy and rituximab added after four cycles
when HBV DNA titer became negative. The outcome in patients with primary follicular lymphoma is
good with splenectomy followed by multi‑agent chemotherapy.

Abstract:
BACKGROUND: Nilotinib is a potent and selective BCR‑ABL inhibitor approved for use in patients
with newly diagnosed chronic myeloid leukemia (CML) in chronic phase (CML‑CP) and in patients
with CML‑CP and accelerated phase (CML‑AP) who are resistant to or intolerant of imatinib. Patients
with imatinib‑resistant CML, nilotinib treatment resulted in a significant proportion of patients achieving
hematologic and cytogenetic responses in all phases of CML.
OBJECTIVES: The aim of the present study was to assess the treatment outcomes in term of the
molecular response rate of CML patients using Nilotinib as the second‑line therapy after failure of
imatinib therapy.
PATIENTS AND METHODS: A prospective study conducted between December 2014 and December
2016 in Baghdad Teaching Hospital and National Centre of hematology. A total of 100 patients,
who were on nilotinib therapy as the second‑line therapy, were enrolled in this study. The molecular
response was assessed using real‑time quantitative polymerase chain reaction (RQ‑PCR). Major
molecular response (MMR) was defined as the BCR‑ABL1 of <0.1% by RQ‑PCR.
RESULTS: The median age was 39 years, 59 were female and 41 were male. Fifty‑three patients
were classified as high‑risk group, and 47 patients were as low risk. The BCR‑ABL transcription level
had a significant reduction from baseline at 3 months (P = 0.035) and the reduction from 3 months
to 6 months was also statistically significant (P < 0.001). Comparing the patients who achieved
MMR versus NO MMR, there was a significant association between low European Treatment and
Outcome Study score and achieving MMR. An estimated 24 months overall survival (OS) is 95%.
CONCLUSION: This study concluded that nilotinib is an effective therapeutic option for patients
with CML‑CP‑resistant to imatinib therapy. Nilotinib treatment resulted in a high‑OS rate and was
well tolerated.

Abstract:
BACKGROUND: Differences in blood group have been associated with predisposition to some
diseases. Activated partial thromboplastin time (APTT) measures the efficiency of the intrinsic and
common coagulation pathways, whereas prothrombin time (PT) test assesses the extrinsic and
common coagulation pathways.
OBJECTIVE: The aim of this study was to assess the variations in PT and APTT among individuals
of different ABO blood groups.
MATERIALS AND METHODS: A research was conducted at College of Health Sciences, Nnamdi
Azikiwe University, Nnewi Campus, and a total of 200 students were recruited, consisting of
106 females and 94 males. Six milliliters of blood was withdrawn from each individual, after obtaining
ethical clearance and informed consent. ABO blood grouping was done by the tile method while
APTT, and PT were analyzed using the standard manual methods. Statistical analysis was carried
out using Statistical Package for the Social Sciences version 21.
RESULTS: The result shows that blood group O was predominant among the test individuals (45%)
followed by blood groups A (31%) and B (15%), while blood group AB has the least percentage (9%).
Blood group O showed a significantly higher APTT value (44.24 ± 15.10 s) compared to blood
groups A (39.35 ± 12.12 s), B (35.93 ± 9.78 s), and AB (37.22 ± 8.15 s) (P < 0.05). Similarly,
blood group A showed a significantly higher PT value (16.70 ± 2.53 s) compared to blood
groups O (14.32 ± 2.37 s), B (13.53 ± 2.16 s), and AB (15.38 ± 1.79 s) (P = 0.05). Blood groups B
and AB male individuals had a significantly higher PT and APTT levels, respectively, when compared
with females (P < 0.05).
CONCLUSION: This study showed that APTT and PT levels differ among different ABO blood
groups; therefore, variations in blood group of individuals may affect their intrinsic and extrinsic
coagulation mechanisms.