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Journal of Blood & Lymph

ISSN: 2165-7831

Open Access

Current Issue

Volume 9, Issue 4 (2019)

    Case Study Pages: 1 - 3

    Platelet Transfusion Practice in Dengue Epidemic; Current Trends and Challenges ? an Institutional Study

    Soumya MH, Das S and Kalyani R

    Introduction: Dengue is an arboviral disease with an inherited risk associated with the transfusion of blood components and to prevent unnecessary transfusion during dengue epidemic a standard criteria has to be followed. Aims/objectives: To record clinical features, laboratory investigations and management of hospitalized seropositive dengue patients. To review the appropriateness of platelet transfusion practices in order to ensure optimal utilization of platelets.

    Material and methods: The Retrospective study is being done at RL Jalappa Medical Hospital from April 2015 to June 2019 on seropositive dengue cases. All serologically confirmed dengue cases who received platelet transfusion were included in the study. Patient’s clinical data and platelet counts were obtained from platelet requisition forms and Medical Record Department. Case definition of Dengue/DHF/DSS applied in the present study was as recommended by WHO4 i.e. Guidelines for platelet transfusion in R. L. Jallappa Hospital Hospital were utilized as the criteria to assess the appropriateness of platelet transfusion adapted from British Committee for Standardization in Hematology (BCSH) has recommended a platelet count <10000/cmm for prophylactic platelet transfusion in those with no other risk factors which would increase the risk of bleeding.

    Statistical analysis: Data management and analysis was done by SPSS version 22.0.

    Results: During study period total of 1361 cases were diagnosed as dengue infection (out of which 757-males, 604-females). Maximum cases were seen in the age group of 11-18. All patients were categorized as per WHO dengue case classification into Dengue Fever, Dengue Haemorrhagic Fever, and Dengue Shock syndrome. In which 72.5% of patients were DF, 23.4% were DHF and 4% of DSS. In present study, maximum number of Patients and platelets transfused was seen when platelet count was 11-20 × 1000/cmm that is 777 units in which RDP was 697 and SDP was 80 and lowest number of platelets transfused was seen when platelet count was >60. A total of 2705 RDP and 359 SDP were transfused to 1361 patients, of these 1361 patients, 316 bleeding patient received PT and 1045 non bleeding patient received prophylactic platelet transfusion in which 140 patient was requiring actual platelet transfusion and 905 patients were not needed.

    Conclusion: Inappropriate usage of platelets leads to shortage of platelets. Strict adherence to British Committee for Standardization in Hematology (BCSH) Guidelines will optimize platelet usage with this true DHF and DSS will be benefited during epidemic outbreaks. Educating patients and Patients attenders will help reducing anxiety and this in turn help clinician for better judgment on evidence based transfusion reducing inappropriate transfusion. This study emphasis on platelet usage trends in regional areas and highlighting.

    Research Article Pages: 1 - 5

    Laboratory Assays in Patients with Acute Promyelocytic Leukemia and FLT3-TKD Mutations

    Kanesbi MM, Jarahi L, Ayatollahi H, Sheikhi M and Siyadat P

    Acute Promyelocytic Leukemia (APL) is a well-characterized subtype of Acute Myeloid Leukemia (AML). The majority of patients with acute promyelocytic leukemia harbor the reciprocal translocation of t(15;17)(PML-RARα). Recent studies have shown that FMS-Like tyrosine kinase receptor-3 (FLT-3) mutations occur in approximately onethird of AML patients. Two major categories of clinically significant FLT3 activating mutations have been identified: Internal tandem duplication (ITD) mutations within the juxtamembrane domain of FLT-3 gene and missense point mutations in the tyrosine kinase domai. Several studies have demonstrated a poor overall survival with FLT-3 ITD mutation which is found in approximately 20-40% of AML patients. In contrast, the prognostic significance of FLT-3 TKD alone is still unclear, but some studies indicate that it also confers a poor prognosis in AML patients. The current study was performed on 66 [Male: 27(41%); Female: 39(59%)] APL patients to analyze and compare hematological parameters between APL patients with wild-type FLT-3(FLT3-WT) [87% (n=58)] and APL patients with mutant FLT3- TKD [12% (n=8)]. Quantification of PML-RARα transcripts was performed by Real-time quantitative PCR. FLT3-TKD mutation was detected by Polyacrylamide Gel Electrophoresis and CBC values were measured with a SYSMEX automated hematology analyzer. The participants of both cohorts were stratified into high-risk and low-risk groups based on their hematological parameters. The findings indicated that APL patients with FLT-3 TKD mutation had laboratory features with more favorable outcome compared with patients with wild-type FLT-3.

    Review Article Pages: 1 - 5

    The Human Platelet and Leucocyte Antigens: Locations, Diagnosis and Solutions

    Okolo RC, Ufelle SA, Ogbuabor AO, Peter U, Achukwu PU, Odugu JA, Ozochi JA and Uchejeso OM

    Every platelet has natural proteins on its surface. This is well known as human platelet antigen. The human leucocytes antigens are integral to the platelet membrane and next to ABO system which possess chief barrier to transplantation by the presentation of antigenic peptides T cells. Both the human platelet and leucocytes antigens (HPLA) are highly polymorphic glycoprotein encoded on the different arms of the chromosome. The human leucocytes antigen (HLA) expression is especially high on leucocytes because of their easily availability, and lymphocytes are used to identify the types. The most important function of the HLA molecule is in the induction, regulation of immune responses and in the selection of T cell repertoire. Also the HLA are effective stimulators, graft versus host disease (GVHD) and graft rejection. Moreover, subsets of HLA B27 and B57 are strongly associated with slow progression of acquired immunodeficiency syndrome (AIDS). This review highlights the human platelet and leucocytes antigens, its importance in antenatal screening, transfusion and in health and diseases.

    Review Pages: 1 - 7

    Measurable Residual Diseases in Haematological Malignancies: Current Applications and Future Direction

    Salwa Bakr and Ghada El-Gohary

    Minimal/ measurable residual diseases represents an independent prognostic indicator for several haematological malignancies helping to predict clinical outcome and enables for further assessment of the effectiveness of treatment. The methods of detection of MRD has remarkably improved regarding sensitivity and specificity, and different methods such as real time quantitative polymerase chain reaction (RQ-PCR), multi-parametric flow cytometry (MFC), digital PCR or next generation sequencing (NGS) are currently used in clinical practice. Recently, Digital PCR has been adopted for quantitative assessment of MRD. However, the best method still needs to be determined. While enhancement in standardization of the different MRD approaches was reported, optimal timing and specific threshold for intervention need to be defined. Therefore well-designed clinical studies are required to diminish the risk of relapse and improve overall survival.

    Research Article Pages: 1 - 7

    Nucleophosmin Gene Mutation in Acute Myeloblastic Leukemia: Apoptotic Role

    Khaled SAA

    Introduction and objectives: Since Falini and his co-workers reported the expression of nucleophosmin (NPM) gene mutation in acute myeloblastic leukemia (AML), and various research in succession clarified the role of mNPM in AML. We previously studied the proliferative role of mNPM in AML in a trial to discover its role in AML development and leukemogenesis. This study aimed to complete the scenario and investigate the apoptotic role of mNPM AML. Another objective was to assess the effect of NPM mutational state on response to etoposide treatment in AML.

    Materials and methods: In this study human leukemia cell lines, HL60 and OCI-AML3 were used as models for AMLs bearing wild type (wt) and mutated (m) NPM, respectively. The study was conducted by using viability studies. The obtained results were reaffirmed by immunocytochemical and immunoblotting analyses. Results were interpreted and presented with the appropriate computer softwares.

    Results and conclusions: Interpretation of data showed normal growth and delayed apoptotic response of etoposide treated cells bearing mNPM as compared with cells carrying wtNPM and the control. Also we noted irreversible cytoplasmic translocation of NPM that was dependent on the duration and extent of the etoposide induced cytotoxicity in cells with wtNPM. Proteomic analysis of NPM revealed that protein expression in the etoposid lysates was approximately similar to the untreated controls We concluded that wtNPM has a pro-apoptotic effect while mNPM has an anti-apoptotic effect, suggested that therapeutic response to etoposide treatment in AML could be variable from one patient to another depending on the molecular basis of leukemia development in each case. Also, it was concluded that AML cells bearing nucleophosmin mutation are resistant to etoposide effect.

    Research Article Pages: 1 - 6

    Efficacy of Low Dose Doxorubicin Therapy in Patients with Non-APL Acute Myeloblastic Leukemia

    Khaled SAA

    Background: Doxorubicin is a chemotherapeutic drug that acts by blocking topoisomerase 2 enzyme. It is used for treatment of many solid and hematological cancers; unfortunately it has serious side effects. The usual Doxorubicin dose for patients with acute myeloblastic leukemia (AML) is 40-60 mg/m2. This is the first study that assessed the efficacy of low dose Doxorubicin in patients with non acute promyelocytic leukemia (APL) AML.

    Methods: A retrospective study was done at Assiut University, where data were collected from hospital records of 103 patients with AML, after fulfilling certain inclusion criteria. Patients were treated with the conventional 3/7 induction regimen, however doxorubicin was prescribed in a lower dose compared with other studies.

    Results: The median age of our patients was 38 years, and 86.4% were with primary AML. Complete remission (CR) was achieved in 60.2% of the study patients. Primary AML type and M2 FAB subtype, were found to be good prognostic factors (P=0.000 and 0.067, respectively). Survival analysis showed that the longest overall survival (OS) and disease free survival (DFS) for the study patients were 60 and 55 months respectively. There was no significant difference regarding OS and DFS between male and female patients (P=0.903, 0.848, respectively).

    Conclusion: In conclusion this study provided a novel therapeutic strategy that encourages the use of low dose Doxorubicin for treatment of young age adults with non- APL AML. This will reduce treatment expenses, minimize cardiotoxicity, and allow addition of adjunctive therapy which in its turn minimizes resistance.

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