Print ISSN: 0027-1446

Online ISSN: 2309-6217

Main Subjects : Hematopathology

Frequency of Haemoglobinopathies in Premarital Screening in Nineveh Province

bassma adnan; Muna Kashmoola; Zainab Alhatem

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 2, Pages 157-163
DOI: 10.33899/mmed.2021.130788.1101

Background: Haemoglobinopathy is a large heterogeneous group of genetic abnormalities of haemoglobin. It is one of the most common inherited diseases worldwide.
Aim of this study: This study aimed to find the frequency of different types of Haemoglobinopathies in premarital couples in Nineveh province.
Subjects and Methods: In this cross-sectional study, the subjects were couples who go to the primary health care centers in Nineveh governorate for routine premarital investigations and the data were collected from the main premarital screening centers in Nineveh governorate.
Results: In this study, 1127 cases were included. 613 (54.4 %) were male, their ages range between (13-80 years), and 514 (45.6 %) were female, their ages range between (10-52 years). 47 cases were diagnosed as βeta-thalassaemia carriers with an overall frequency of 4.2 %. Ten cases had haemoglobin S (HbS) by the High Performance Liquid Chromatography (HPLC) (sickle cell trait in 9 cases and sickle β-thalassaemia in only one case); the overall frequency of sickle cell carrier state is 0.89 %. Eight cases with an overall frequency of 0.71 % were diagnosed as having other types of Haemoglobinopathies (haemoglobin D, haemoglobin E, haemoglobin H). Eighty one cases were diagnosed as having iron deficiency with an overall frequency of 7.2 %. By using the Hardy –Weinberg equation; we found the expected number of children born with homozygous βeta-thalassaemia would be (0.3/1000 from those born) and homozygous sickle cell disease would be (0.01/1000 from those born).
Conclusions: β-thalassaemia trait represented the most frequent Haemoglobinopathy in the region, Iron deficiency was significantly higher in females than in males, HPLC is a good technique for routine use and the expected number of children born with homozygous β-thalassaemia, sickle cell and others (HbD, HbE, HbH) were (0.3/1000, 0.01/1000 and 0.0085/1000 from those born) respectively.

Clinico-Hematological Profile in Patients with Chronic Myeloid Leukemia

Inam Al-abady; Professor Muna Abdulbasit Kashmoola; Professor Khalid N. M. Al-khero

Annals of the College of Medicine, Mosul, 2021, Volume 43, Issue 1, Pages 1-9
DOI: 10.33899/mmed.2020.128677.1054

Background: Chronic myeloid leukemia (CML) is a clonal malignant neoplasms of pluripotent hematopoietic stem cell described by the excessive proliferation of mature granulocytes and their precursors in the bone marrow and peripheral blood. It is characterized by the presence of Philadelphia chromosome, a translocation between chromosome 9 and 22 or BCR-ABL1 gene.
Objectives: To evaluate clinical and hematological parameters in patients with chronic myeloid leukemia and to assess the risk stratification of these patients according to Sokal and European Treatment Outcome Study (EUTOS) scoring systems.
Setting: This case series study conducted at Ibn-Sina Teaching Hospital/Outpatients Hematology Department from November 2019 to April 2020.
Patients and methods: Total seventy patients with chronic myeloid leukemia included in this study. They involved 64 old cases and 6 new cases. The records of old cases were reviewed for clinical history, clinical examination, previous blood counts, bone marrow study and genetic study, where ever it was available. For new cases clinical history and physical examinations were noted. Complete blood pictures, biochemical tests and molecular study (BCR-ABL) were done at private laboratory. The BCR-ABL done by real-time reverse transcription polymerase chain reaction using Xpert BCR-ABL Ultra test on Cepheid GeneXpert® Dx System. All patients were categorized into different risk groups by using Sokal and European Treatment Outcome Study scores that calculated according to standard formulae.
Results: The males were (57.1%) of patients and females were (42.9%) with male to female ratio was 1.33:1, their age ranged from 16-82 years with a mean of 41.9 years. The most common complains were fatigue (87.1%), fullness in the abdomen (78.6%) and constitutional symptoms (64.3-74.3%). About 96% of patients had splenomegaly at presentation. The mean total leucocyte count was 153.7 x10^9/L, basophilia found in (72.9%) of patients and anemia in (85.7%) of them. By Sokal score, (25.7%) of patients were categorized as low risk, (52.8%) as intermediate risk and (21.4%) as high risk. According to EUTOS score, (60%) of patients were categorized as low risk, while (40%) of them as high risk. There were significant differences in high and low risk groups between two scoring systems (P-values 0.016, 0.000).
Conclusion: Middle age groups (35-54 years) were commonly affected by chronic myeloid leukemia and males were predominance over females. Fatigue, fullness in the abdomen were the most common complains, while splenomegaly was the most common clinical sign. Majority of the patients, when categorized by the Sokal score, fall under the low- and intermediate-risk groups, the same is true for the EUTOS score, which, however, does not have an intermediate risk category.

Hematological parameters of β-thalassemia Trait in Premarital Screening in Nineveh Province

bassma adnan; Professor Muna Abdulbasit Kashmoola

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 157-161
DOI: 10.33899/mmed.2020.128666.1052

Background: β-Thalassaemia syndromes are inherited group of abnormalities of hemoglobin synthesis. These abnormalities characterized by a defect in β-globin genes which may result either in the reduction or absence of one or more of the β-globin chains of hemoglobin. This genetic defect can be homozygous or heterozygous.
Aim of this study was to detect the hematological parameters of β-thalassaemia trait in premarital screening individuals in Nineveh province.
Subjects and Methods: This is a cross sectional study that was performed in Nineveh province in three main centers for premarital screening program. In the period between the 15 November 2019 and the 15 May 2020 a total of 1127 subjects who attend to these centers were screened for carrier conditions of β-thalassemia. Blood samples of the couples were obtained during attendance to the marriage office. Complete blood counts and hemoglobin variant analysis were performed with automated counter and high performance liquid chromatography technique.
Results : Out of 1127, β-thalassaemia trait was diagnosed in 47 subjects, 31 were male (66 %) and 16 were female (34 %). The mean of their hemoglobins was 14.4 g/dl in males, and 12.5 g/dl in females. The mean of mean cell volume and mean cell hemoglobin were 68.3fl and 22.4pg respectively. The mean for HbA2 concentration was 4.9 % and for HbF was 1.2%.
Conclusion: β-thalassaemia trait is usually presented with low MCV and/or low MCH but the accurate and dependable technique in detecting carriers is the use of High Performance Liquid Chromatography (HPLC).

Evaluation of Interleukin- 6 in Lymphoma

Anfal Saleh Mohammed AL-jubory; Sanaa mohammed taib Al- Hayali

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 2, Pages 162-168
DOI: 10.33899/mmed.2020.128731.1057

Background: Cytokines play a pivotal role in lymphoma ,cytokines either can be produced or exert effects on neoplastic or reactive cells. The elevated level of cytokines can contribute to the clinical and histopathologic alterations associated with malignant lymphoma.
Objectives: to assess the level of IL-6 in newly diagnosed lymphoma patients in relation to their level in normal control subjects and to evaluate the correlation between IL-6 and hemoglobin (Hb), stage of disease and B-symptoms ,age and sex.
Methods: This is a case control study, a total of 40 patients with lymphoma (HL & NHL) who attended private Clincs and hospitals in Mosul city and 40 age and sex matched control were included. A venous blood sample were taken for Complete blood count, Retic and IL-6 level. Enzyme-linked immunosorbent assay(ELISA)was used to determined IL-6 level.
Results: There were a significant difference between the mean level of IL-6 of lymphoma cases and control (p-value=0.00). In the subset of patients with anemia, IL-6 levels inversely correlated with hemoglobin levels (p-value=0.00). There was significant correlation between IL-6 and patients with more advanced stage Ⅲ- IV disease(p-value=0.04). there was positive correlation between IL-6 levels and B-symptoms)p=0.05(
Conclusion: IL-6 level was elevated in lymphoma and it was significantly higher in lymphoma patients .IL-6 plays important role in the development of anemia in lymphoma.The adverse impact of elevated IL-6 is consistent with demonstration of higher level of IL-6 in patients with advanced stage of disease.

Effectiveness of antiplatelet thromboprophylaxis in myeloma patients using immunomodulators in Kurdistan region-Iraq

Rezhen Botany; Ahmed K. Yassin; Firiad Hiwaizi; Abid M. Hassan; Hisham A. Getta; Najmaddin Salih Husen Khoshnaw; Sana D. Jalal; Akram M. Mohammed; Kawa M. Hasan; Dana A. Abdulla; Ameer I.A. Badi; Nassir A. S. Al-Allawi; Banaz M. Safar; Basil K. Abdulla; Rawand P. Shamoon; Truska A. Amin; Zeki A. Mohamed; Ali I. Mohammed; Diveen J. Hussein; Nawsherwan S. Mohammed

Annals of the College of Medicine, Mosul, 2020, Volume 42, Issue 1, Pages 35-41
DOI: 10.33899/mmed.2020.126833.1023


Objective: To evaluate the effectiveness of antiplatelet drugs in preventing thrombosis in multiple myeloma patients treated by immunomodulatory drugs
Methods: The study includes a hundred seventy six patients of symptomatic multiple myeloma treated in hematology unit of three centers in Kurdistan region of Iraq from February 2014 to July 2019. Demographic data were obtained from patient’s file, including the type of immunomodulatory drugs, antiplatelet use, thrombotic events and their site, presence of other comorbidity, and whether the thrombosis was before or after the diagnosis of multiple myeloma.
Background and objectives: Multiple myeloma is a malignant disease that affect both gender and associated with increased risk of thrombosis, one of the effective method of treating myeloma is through using immunomodulatory drugs especially when combined with high dose dexamethasone with in turn boost the risk of thrombosis, in this study we investigate the effect of antiplatelet in preventing thrombosis.
Methods: This is a retrospective study that include 176 cases that are collected from cancer centers at Kurdistan region of Iraq from Feb/2014 to Jul/2019 information gathered through questionnaire.
Results: Regardless the type of therapy in the study sample 11.1% who were taking anti-platelet therapy developed thrombotic attack compared with 46.9% who were not taking the anti-platelets therapy. The incidence of the thrombotic attack among those myeloma patients who used immunomodulatory drugs was 9.6% who were on anti-platelet drugs which is significantly lower than the rate (52%) among patients not taking the anti-platelet drugs.
Conclusions: As multiple myeloma is a malignant disease and treatment with immunomodulatory drugs associated with increased risk of thrombosis, antiplatelet drug is an effective measure when used as a prophylaxis for preventing thrombosis.
Keywords: Multiple myeloma, Thrombosis, Antiplatelet