Iraqi Journal of Hematology

ABSTRACT
Background: Thalassemia is an autosomal genetic disease leading to anemia and remains one of
the major health problems in Southeast Asia and other parts of the world. Almost 100,000 patients
with major thalassemia need regular transfusion. Human hemoglobin (Hb) is the molecule that
carries and transports oxygen all through the body. Ferritin is the principal iron storage protein,
found in the liver, spleen, bone marrow, and to a small extent in the blood.
Objectives: The aim of this study was to assess serum ferritin levels in B-thalassemia patients,
and to compare it with non-thalassemic anemia and healthy control.
Materials and methods: A prospective cross sectional study conducted at Thalassemia Center in
Ibn Al- Baladi Hospital for Children and Women during the period from1st February to 30th May
2014 during their attendance to out-patient clinic. A total .number of 101 patients complaining of
anemia (51 patients with thalassemia, 50 with non-thalassemia) in addition to 50 healthy subjects
considered as control. All patients were tested for Serum ferritin levels and all results were
obtained through automated quantitative test for use Vidas machine
Results : The mean serum ferritin levels in cases of thalassemia was 9542 + 782 ng/ml while
serum ferritin levels in control sample was 138 +323 ng/ml in male and 28+ 108 ng/ml in female .
in patients with non-thalassemia anemia, the levels of serum ferritin was 1+80 ng/ml. Age of all
patients in this study ranged from 3day-9year .the age of thalassemia patients ranged from 1-6
year and p-value was(0.23) while the age of patients with non-thalassemia anemia was 1-5 year
and p-value was (0.11).
Conclusion: This study confirm that serum ferritin is high in patients wih thalassemia than non
thalassemia.

Background: Venesection or phlebotomy is generally considered to be a safe method, but
occasionally 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 events
occurring 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 October
2011 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 occurring
during 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 in
an 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 observed
were extravasation at site of puncture.
Conclusions: Only 0.3% of phlebotomies were complicated by adverse events which were very
mild and easily managed. Our study confirms the fact that venesection procedure is a very safe
method which could be made even more event-free by following certain friendly, reassuring and
competent practices.

ABSTRACT
Background: Lung cancer is one of the major health problems all over the world. Most of
cases are discovered at advanced stages because of late appearance of symptoms and the lack
of efficient and effective methods for early diagnosis and screening of high risk groups. The
microRNA-21(miR-21) was stably present and reliably measurable in all samples of bronchial
wash whether positive or negative (control) for lung cancer.
Objectives: to evaluate the expressions of the miRNA-21 as a minimally invasive diagnostic
biomarker for non-small cell lung cancer (NSCLC).
Results: Relative quantification of miR-21 gene showed overexpression in samples positive
for NSCLC (non-small cell lung cancer) and ROC study yielding 85% sensitivity and 98%
specificity in distinguishing NSCLC patients from controls with p-value < 0.05.
Conclusion: altered expressions of the miR-21 in samples of bronchial wash may provide a
potential biomarker for detection of non-small cell lung cancer.

Background: Acute Myeloid Leukemia (AML) is a clonal hematopoietic disorder, leading to a
premature arrest of the normal differentiation of stem cells. C - reactive protein (CRP) is a marker
of inflammation. Serum level of C-reactive protein may be increase in patients with AML. This
association between CRP levels and acute myeloid leukemia influenced by multiple factors.
Acute myeloid leukemia commonly associated with iron overload. Many factors are participating
to the hyperferritinemia associated with AML, inflammation chemotherapy, blood transfusion
and ferritin hepatic clearance disorders
Objectives: To assess serum C-reactive protein (CRP) and iron status (serum Iron, Total iron
binding capacity, serum ferritin levels) in patients with acute myeloid leukemia (AML) before
and after chemotherapy
Materials and Methods: A prospective cohort study included 58 patients (30 male and 28
female) with acute myeloid leukemia with age range (15-65 years). Patients divided into two
groups: Group (1) Patients with AML before starting chemotherapy. Group (2) the patients after 4
weeks of chemotherapy In addition to 43 healthy subjects (24 male and 19 female) were
included. 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 Teaching
Hospital in the Medical City from February 2014 to June 2014. All patients were subjected to
complete history and physical examination. Diagnosis as AML patients was established by
complete 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 .
C- Reactive protein and iron status Khitam A.Ali*, Alaa F.Alwan, Hiba A.Mohammed
Iraqi J. Hematology, July 2015, vol.4, Issue1 102
Results: Serum CRP levels increased in AML patients before and after treatment , while there
were a significant increase in mean serum ferritin levels observed in (Group 2) compared to
newly diagnosis patients (Group 1)(P<0.002) and the levels were significantly higher in newly
diagnosis group compared to healthy controls (P<0.015). Patients with (AML) during remission
show significant decrease in iron levels compared to newly diagnosis group (P<0.0001), while
levels 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) after
treatment compared to (Group 1) before treatment(P<0.0001) but the levels were significantly
higher 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 in
predicting infection or inflammation in patient with AML post chemotherapy. Regarding Iron
status: s.ferritin increase significantly post chemotherapy while s.iron and TIBC decrease.

ABSTRACT
Background: Chronic lymphocytic leukemia (CLL) remains an incurable disease with
variable course. It is typically responsive to several courses of chemotherapy.
Objectives: Evaluation of efficacy of combination of rituximab with chlorambucil plus
prednisolone (R-LP) as first line of treatment of CLL patients whom are not fit for treatment
with fludarabine combination therapy.
Patients & Method: Over 17 months duration, thirty patients with CLL were included in this
a cohort prospective study. All of them were received 8 cycles combinations of rituximab
(day 1) plus chlorambucil plus predinsolon (day1 to day 5). It had been used for those
couldn’t receive or those having intolerance to fludarabin based therapy. At end of courses ,
re-assessment had performed & included clinical examination ,blood count in addition to BM
examination for evaluation of response in term of overall response rate(ORR) ,duration of
response(DOR), and treatment free interval(TFI).
Results: Overall response rate (ORR) reported in 86.67% of patients. Both anemia &bone
marrow lymphocyte percentage has significant relation to the treatment response (p=0.051,
p=0.036 respectively) as well as positive direct antiglobulin test( DAT) & diffuse BM
infiltration (p=0.033,p=0.04 respectively). Mean duration of response (DOR) is 9.23+0.50
months while mean treatment free interval (TFI) is 11.74+0.64 months. Bone marrow
lymphocyte proportion is consistently predictive factor in long term remission durability in
negative correlation( r = – 0.47, p= 0.04).
Conclusion: Rituximab plus chlorambucil and predinsolon (R-LP) combination therapy
might be as good alternative regimen with equivalent response for CLL patients whom are
nonsuitable for treatment with fludarabine combination therapy

Abstract
Background : Type 2 diabetes mellitus is chronic disorder that requires proper medical care
and education of patients to reduce long term complication like nephropathy .
Patients and methods: Forty-five Type 2 diabetic nephropathy patients in early stage were
recruited for this study. Twenty-nine control subjects matched for age were also included.
Results : this study demonstrated a significant increase in glycosylated hemoglobin ,random
blood glucose , blood urea , creatinine and total White blood cell count while a significant
decrease in , estimated glomerular filtration rate in Type 2 diabetic nephropathy patients
compared with healthy control . Urine markers including microalbumin and ceruloplasmin
showed a significant increase in level in Type 2 diabetic nephropathy patients when compared
with the healthy control.
Conclusion: leucocyte count can be considered as indicator for an inflammatory marker and a
ceruloplasmin a good urinary marker.

ABSTRACT
Background: B-Chronic lymphocytic leukemia (B-CLL) is a monoclonal malignancy
characterized by an accumulation of terminally differentiated small and anergic B lymphocytes in
the blood, bone marrow and other tissues. CLL is typically characterized by CD5+, CD23+,
CD22 -, CD79b-, with weak expression of surface Ig. CD5 also is expressed in B1 subset of
human B –lymphocytes. Mature B cell malignancies, such as B-cell chronic lymphocytic
leukemia, are mostly CD5 +. CD23 promotes the activation and proliferation of normal B
lymphocytes and has an important role in the process of malignant transformation in BCLL.
CD38 is expressed on the surface of leukemic cells in a significant percentage of patients
with B-cell chronic lymphocytic leukemia (B-CLL).Its expression has prognostic value in CLL.
The current immunophynotype antigens is used to diagnosed as CLL cases, and by using the
modern multicolor Flow Cytometry, which made it possible to determine the expression of
several such antigens on specific cell populations of the CLL cases.
Objectives: To measure the expression of CD5, CD23, and CD38 antigens on the B-cells of
morphologically diagnosed CLL cases, and showing their correlation with the hematological
parameters, and with each other.
Material and methods: A prospective cohort study including 20 patients including 11 females
and 9 males morphologically diagnosed with CLL. The patients were attending the National
Center of Hematology, Al-Yarmouk teaching hospital for the period from November 2012 to
March 2013. A total of 2 ml of venous blood were collected from all patients who were selected
randomly with respect to age, sex, duration and stage of the disease. The diagnosis was done by
Flowcytometric Measurement of CD5, CD23, and CD38 Alauldeen M.Z. Alqasim ,Aseel A. Kareem
measuring and calculating the total number of blood cells and lymphocytes and hemoglobin and
other by using autoanalyzer blood counter, then flowcytometry was used to measure the
appearance of antigens surface CD5 and CD23 CD38.
Results: The mean of age of all patients included was 61.95+8.88 SD, and a range of (45-75)
years old. There were 11 (55%) males patients, the most common symptoms of patients is an
enlarged spleen (45%). 85% of patients who were in Binet stage C, the most advanced stage of
the disease. Within Binet stage C there was 94.1% percent of patients showed moderate intensity
expression of CD5 and CD23, while 64.7% of them for CD38. There was no statistical
significance of CD5, CD23 in relationship to age, hemoglobin or platelet, while CD5 showed a
significant relationship with lymphocytes count and the total number of white blood cells (P
<0.05).CD38 showed significant relationship with hemoglobin (P <0.05). There is a significant
correlation between the CD5 and CD23 P) <0.05), while the CD38 show positive correlation with
CD23) P <0.05.
Conclusions
1-There is a significant correlation between CD5 expression and absolute lymphocyte count, so
higher peripheral blood lymphocyte associated with greater CD5 antigen expression.
2-There is a significant correlation between CD5, and CD23 expression, so high CD5 expression
associated with high CD23 expression.
3-There is a significant negative correlation between CD38 expression and Hb level that
reflects a prognostic significance.
4-There is a correlation between CD38 expression and CD23 expression.
5-No correlation between the intensity of expression of CD5, CD23, and CD38 and stage of the
disease.
6-No correlation between CD38 expression and age, WBC count, and lymphocyte count

ABSTRACT
Background: HGV infects patients at risk for parenteral exposure and chronic blood
transfusion, such as those with β- thalassemia major.
Objectives: This study was designed to investigate the prevalence of HGV infection in
thalassemia patient and furthermore to sequence and analyze phylogentic of HGV.
Materials and methods: A prospective study conducted between Feb. to May, 2014. A total
of 154 Beta thalassemia patients (87 male; 67 female), from Alkarama teaching hospital and
Ibn AL-baladi hospital maternity &children's hospital; aged 18-50 years , who received
regular blood transfusions were included in the study. All patients were screened for
Antibody against E2 glycoprotein of HGV (Anti-E2 Ab) by using ELISA to detect the
presence of HGV infection. While Detection of HGV genomes was done by RT-PCR.
Results: One hundred fifty four thalassemia patients (87 male, 67 female) of 18-50 years
were involved in this study. Using the ELISA method, Anti-HGV was detected in 16 patients
out of 154 (10.4%) with peak prevalence age group was between 20-24 years. Reverse
transcription - polymerase chain reaction (RT-PCR) showed HGV-cDNA was detected in 28
(18.2%) only. The peak age prevalence of HGV infection was under 20 years; however, there
were no significant differences in prevalence among two sexes or number of blood
transfusion. The results of genotyping in 12 randomly selected patients showed presence of
genotype 2 and genotype 5 with percentage of 91.7% and 8.3% respectively.
Conclusion: the prevalence rate of HGV RNA in β-thalassemia major patients is 18.2%,
while the prevalence rate of anti-HGV (past infection) is 10.4%. No one of thalassemia
patients had HGV RNA and anti-HGV simultaneously. The Gene sequence analysis of PCR
products identified HGV genotypes 2 and 5 with percentage of 91.7% and 8.3% respectively

ABSTRACT
Background: Non –Hodgkin's Lymphoma (NHL) are monoclonal proliferation of lymphoid cells that
may be of B-cell (70%) or T-cell (30%) origin and include many discrete entities with characteristic
morphological ,immunophenotypical , genetical and clinical features . Hepatitis C Virus (HCV) is a
hepatotropic and lymphotropic virus, several studies showed that HCV may chronically infect patients
with Non–Hodgkin's Lymphoma with or without producing liver damage.
Objectives: To assess the prevalence of hepatitis C virus infection in Iraqi patients with non-Hodgkin's
lymphoma and to compare with two control group healthy control and patients had general medical
illnesses (unhealthy).
Material and method: A prospective case control study included 40 Iraqi patients with NHL. They were
tested for the presence of anti-HCV using Enzyme Linked Immunosorbent Assay (ELISA). Positive
results were subjected to confirmatory test using Recombinant Immunoblot Assay (RIBA).The diagnosis
of NHL cases was confirmed by two consultants histopathologist and they were classified according to
the Working formulation system (WF) .Two control groups was applied ; the first included 250 healthy
individuals who were age and sex matched while the second group included 50 patients suffering from
general medical diseases who were age and sex matched.
Result: Four out of 40 patients with Non–Hodgkin's Lymphoma (10%) were positive for anti-HCV,
whereas only 1out of 250 healthy individuals (0.4%) were positive for HCV and no patient was positive
in the unhealthy control group.
Conclusion : The current study revealed the high prevalence of HCV infection in Iraqi patients with
Non-Hodgkin's Lymphoma compared to the healthy and unhealthy control groups which support the
lymphogenetic role of chronic HCV infection in the pathogenesis of NHL.

ABSTRACT
Background: Hair loss affects over 25% of women in developed countries. Three hair
disorders, androgenetic alopecia, telogen effluvium and alopecia areata which account for
most cases of nonscarring alopecia in women. Iron deficiency has been reported in the
majority of women presenting with diffuse hair loss. Iron has important function in oxidationreduction
reactions, collagen synthesis, and as a co-factor for enzymes.
Objectives: To assess the percentage of the low serum ferritin hair loss females and their
response to oral iron replacement therapy.
Materials and methods: a prospective cohort study conducted in at Marjan teaching hospital
from August 2013 to January 2015. It included 72 female complained from diffuse hair loss
were enrolled in this study. Full history was taken from all patients and physical examinations
were done both general examination and local examination of the scalp including pull test.
Patients were sent to complete blood examinations, serum ferritin. Patients divided in to three
groups according to their response to treatment. Before the treatment the severity of hair loss
was assess by VAS.
Results: Fifty two patients met criteria of inclusion. Their serum ferritin levels range between
(1.4-14.4) with mean 6.16±3.30 their hemoglobin levels were (8.3-13.4) with mean ±SD
11.98±1.22. Group I patients included 27 patients (51.9%), their severity of hair loss before
treatment was assess by VAS which was 9.18±0.84, after two week of treatment the score
become 7.33±1.03, P value is < 0.0001; confidence interval 95% = ( 1.477 to 2.277). in group
II patients which included 12 patients (23%), their severity of hair loss before treatment was
assess by VAS which was 9.33±0.49, after two week of treatment the score become 9.08±0.66,
P value is 0.081 considered not significant; confidence interval 95% = (-0.037 to 0.537). The
other thirteen patients (25%) represented the third group. All the patients in this group didn’t
show any response to treatment
Conclusion: Measurement of serum ferritin level should be done to all patients with chronic
telogen effluvium before starting other anti-hair loss modalities. Iron replacement is a safe
drug with a few side effects and indicated to all females with low serum ferritin level.