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18th World Hematology Congress
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Journal of Blood & Lymph

ISSN: 2165-7831

Open Access

18th World Hematology Congress

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Pages: 4 - 5

Diagnostic accuracy of Red Cell Distribution Width (rdw) in the diagnosis of iron deficiency anemia and beta thalasshemia trait

Ghazala Qamar, Hijab Batool, Mavra Fatima, Ayisha Imran, Nauman A Malik

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Iron deficiency is the leading cause of anemia in developing countries like Pakistan, particularly in children and females of child bearing age. This is mainly due to inappropriate dietary iron intake and increased demand of iron during pregnancy. Iron is a major component of hemoglobin and lack of this essential element results in lower hemoglobin content in red cells. Complete blood count (CBC) can provide us with a better estimate of iron deficiency.  Red cell distribution width (RDW) is a significant CBC parameter and a credible marker of variation in red cell size (anisocytosis) on many routine hematology analyzers. RDW is usually elevated in IDA due to variation in size of erythrocytes while it is normal in beta thalasshemia trait.  Ferritin is a gold standard measure in IDA but as it is also an Acute Phase Reactant which tends to falsely elevate in various infections and inflammatory disorders. Therefore it is not of considerable significance in detection of IDA in such clinical conditions.

Objective:

The study aims to detect the sensitivity and specificity of RDW in iron deficiency anemia (IDA) and beta thalasshemia trait (TT). In under resourced areas, tests like iron studies, Ferritin assays and Hb electrophoresis are usually not available. Hence, RDW is cost effective and a reliable parameter in detecting IDA in the absence of many other diagnostic and clinical choices. .

Materials and methods:

The study was conducted at Chughtai Institute of Pathology Lahore from September 2019 –November 2019. It was a Cross sectional Prospective study and included 115 Patients which were divided in to two main groups i.e. Group 1 and Group 2. Group 1 included patients of IDA, both males and females ranging from 1-50 year of age. Patients with a hemoglobin <11g/dl, mean cell volume (MCV) < 26fl, mean cell hemoglobin (MCH) < 76 g/dl and serum ferritin <15ug were included in Group1. Group 2 included patients with beta TT having Hb A2 values of >3.5 diagnosed on Capillary Hb Electrophoresis.

Results:

Patients in Group 1 had a mean Hb of 7.5g/dl (SD±1.74), mean MCV of 68.9 fL (SD±16.7),mean MCH of 20.3 pg (SD±6.6) and a mean RDW of 21.4 % (SD±4.4). Patients in Group 2 had a mean Hb of 11.0 g/dl (SD±1.72), mean MCV of 60.9 fL (SD±4.9), mean MCH of 18.4 pg (SD±1.21) and a mean RDW of 16.3 % (SD±1.0). There was a significant difference in RDW of Group 1 and Group 2 (p value <0.001). In group 1, RDW had a sensitivity of 75.8%, specificity of 84.6%, negative predictive value of 61.11% and positive predictive value of 91.6%. In group 2, RDW had a sensitivity of 69.2%, specificity of 82.7%, negative predictive value of 85.7 % and positive predictive value of 64.2%.

Conclusion:

RDWis a reliable and useful index for the diagnosis of IDA and differentiates it from beta TT.

Editorial Note

Pages: 1 - 1

Past Conference Editorial of Hematology 2020

Maho Iwamoto, Bello Jamoh Yusuf

Conference Series LLC Ltd hosted the “Hematology 2020”, during March 16-17, 2020 at London, UK with the theme, “Breezes of transformation and revolution in Hematology”, which was a great success. Eminent keynote speakers from various reputed institutions and organizations addressed the gathering with their resplendent presence.

We extend our grateful thanks to all the momentous speakers, conference attendees who contributed towards the successful run of the conference.

Hematology Congress 2020 will include speaker talks, brief keynote presentations, workshops and exhibitions, where researchers and associations will exchange ideas and discuss the methodology for new Diagnostics and treatment methods for Hematologic Disorders, Management and Care of Patients, new approaches emerging in Hematology etc.

Conference Series LLC Ltd extends its warm gratitude to all the Honorable Guests and Keynote Speakers of "Hematology 2020”

  • Maho Iwamoto, Nihon University School of Medicine, Japan
  • Bello Jamoh Yusuf, Ahmadu Bello University Teaching Hospital, Nigeria

Conference Series LLC Ltd is privileged to felicitate Hematology 2020 Organizing Committee, Keynote Speakers, Chairs & Co-Chairs and the Moderators of the conference whose support and efforts made the conference to move on the path of success. Conference Series LLC LTD thanks every individual participant for the enormous exquisite response. This inspires us to continue organizing events and conferences for further research in the field of Hematology & Oncology.

Conference Series LLC Ltd is glad to announce its “19th World Hematology Congress during March 15-16, 2021 Berlin, Germany. We cordially welcome all the eminent researchers, Hematologists, Oncologists, Haematopathologists, Scientists, Young Researchers, Medical Students, Physicians/Consultants/ General Practitioners

Nurses, Delegates to take part in this upcoming conference to witness invaluable scientific discussions and contribute to the future innovations in the field of Hematology with 20% abatement on the Early Bird Prices.

Bookmark your dates for “Hematology 2021, Edinburgh” as the Nominations for Best Poster Awards and Young Researcher Awards are open across the world.

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Pages: 5 - 5

High frequency of anti-D antibodies in men-what to do?

Donskov SI

Introduction:
Alloimmunization of recipients with D antigen of the Rhesus system, as most transfusiologists around the world believe, is not a serious problem, since donor and recipient antigen D matching prevents this undesirable complication. However, the analysis of the structure of alloimmunization of the population, primarily the male contingent, gives reason to doubt the adequacy of this generally accepted way to ensure the safety of blood transfusion.

Aims:
Тo analyze the structure of alloimmunization of men with red blood cell antigens.

Material and Method:
From the databases of Surgut and Khanty-Mansiysk for 2016–2019 347 men were selected (39 patients and 308 donors) who had antibodies against red blood cells of various specificity.

Results:
The frequency of anti-D antibodies among alloimmunized patients was 33.3%, among alloimmunized donors - 12.6%. Dynamics of the structure of alloimmunization in 2016–2019 in general, it reflects positive shifts towards a decrease in the frequency of anti-D antibodies in men. In particular, the proportion of anti-D among all detected antibodies decreased from 50 to 33.3% in patients and from 18 to 3% in donors. Nevertheless, the fact of the presence of anti-D antibodies and their relatively high frequency in the structure of male alloimmunization are of concern, as are the cases of detection of not only anti-D antibodies, but also anti-C, -E and -c in Rh-positive men who had antigens D, C, E and c in the phenotype.

Discussion:
It is unlikely that the presence of anti-D antibodies in Rh men was in all cases the result of a transplacental transfer of antibody-producing cells from the allo-immunized mother to the fetus during childbirth, sexual contacts with D-plus women or due to emergency blood transfusions that were not D-identical. More likely, anti-D antibodies in Rh negative men were the result of blood transfusions from donors mistakenly classified as Rh negative due to the presence of weak and partial forms of D antigen in their red blood cells. Such forms of antigens can be called "serologically negative - immunogenic positive." “According to the Blood Center. OK. Gavrilov (Moscow) 38.9% of male immunized patients (291/730) had anti-D antibodies. According to the REDS-III register, among US donors with anti-erythrocyte antibodies, more than 15% of men had anti-D antibodies. 
The presence of anti-D antibodies in Rh-negative male, as well as anti-C, -E and -c in Rh-positive men who had D, C, E and c antigens in the phenotype, indicates the prevalence and immunogenicity of partial forms of not only D antigen, but also antigens C, E and c.

Conclusion:
It is necessary to expand studies of the structure of alloimmunization, as well as the frequency of weak and partial forms of erythrocyte antigens in various populations, especially multiethnic ones, where the risk of alloimmunization with erythrocyte antigens is especially high.

 Biography:
Donskov SI is affiliated from Moscow State Medical Dental University, Russia

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Pages: 6 - 6

The need of blood transfusion during emergency laparoscopic appendicectomies: a quality and cost improvement project QIP/CIP

Kallis Sideri

Aim:

a) Identify the number of patients that required blood transfusion during laparoscopic appendicectomy in our Hospital the last 10 years.

b) Is G/S really required before emergency laparoscopic procedures according to literature evidence?

c) What is the quality/ cost impact of this practice as well as financial and time impact of rejected/duplicated samples?

Method:

1. Identification of sample: electronic patient’s records and blood transfusion electronic database.

2. Sample size and time period: 1288 patients adults and children >5 years old that had emergency laparoscopic appendicectomy the last 10 years in Worthing Hospital.

3. Sample collection: consecutive and time sampling

4. Data analysis: Incidence of blood transfusion, no need for complex statistical analysis.

Results:
Only seven patients were recorded as having had blood transfusion:1) Two patients over 70 years old  postoperative blood transfusion due to other co-morbidities, 2)Two no electronic record of transfusion 3)Two patients transfused other blood products such as FFP's for INR inversion and coagulation problems, 4) One patient had caecal tumour,  transfused for anaemia and had later right hemicolectomy.

Conclusion:
Our results show that none of our patients needed intraoperative blood transfusion for vascular injury. Major haemorrhage protocol can be used when needed. We will use those data for cost improvement project.

 Biography:
Kallis Sideri is affiliated from Western Sussex Hospitals, and also present working in the Worthing Hospital NHS Foundation Trust, United Kingdom

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Pages: 10 - 10

Identification of JAK2 (V617F) mutation in Myeloproliferative Neoplasms by using Allele Specific Polymerase Chain Reaction (AS-PCR)

Khin La Pyae Tun

Myeloproliferative neoplasms (MPNs) is a group of clonal haematopoietic stem cell disorders characterized by the proliferation of one or more myeloid cell lineages. According to WHO classification, the Janus associated kinase 2 (JAK2) V617F mutation is the one of the major diagnostic criteria in BCR-ABL1 negative myeloproliferative neoplasms .The aim of this study is to detect the JAK2 (V617F) mutation in patients with myeloproliferative neoplasms to get accurate diagnosis and proper management. A total of 90 clinically diagnosed MPN patients attending to Department of Clinical Haematology, Yangon General Hospital were enrolled in this study. The mean age was 53.4 ± 14 years which ranged from 16 to 81 years old and male and female ratio was 2.4:1.  The identification of JAK2 (V617F) point mutation was found to be positive in 44/90 MPN patients (48.9%).  According to MPN subtypes, the JAK2  mutation positivity  was found  in 19 out of 46 polycythemia vera patients ( 41.3 %), 17 out of 25 essential thrombocythemia patients (68%), 8 out of 15  primary myelofibrosis patients (53.3%),  0 of 4 others myeloproliferative neoplasms (0%).  Confirmation of each of nine JAK2 mutation positive and negative samples were done by Sanger sequencing. The arterial or venous thrombotic attack was found in 32 /44 JAK 2 mutation positive cases (72.7%) and 12 /44 JAK2 mutation negative cases (27.3 %).The association between thrombotic attack and presence of JAK2 mutation was statistically significance with p=0.000. In our study, prevalence of JAK2 (V617F) mutation was lower in polycythemia vera patients compared to other studies which showed over 90% positivity of JAK2 mutation in PV . It might be due to the secondary polycythemia in which the chronic heavy smoking is the common cause. The diagnosis of myeloproliferative neoplasms mainly relies on the molecular genetics according to WHO classification. The Allele specific PCR reaction is sensitive, simple test and relatively cost effective. Therefore, the identification of JAK2 (V617F) somatic point mutation should be implemented as a routine diagnosis procedure for patients with chronic and suspected myeloproliferative neoplasms.

 

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Pages: 12 - 12

Factors Affecting ferritin level in children of 6 to 59 Months in the Eastern region of Cameroon

Agokeng D Sylvie

Ferritin is the principal storage protein for iron in tissues and is involved in its uptake, accumulation and release in cells. Only minute amounts of ferritin are present in plasma but in health Ferritin reflects total iron storage and is also the first laboratory index to decline with iron deficiency. It may be less accurate in children with infectious or in?ammatory conditions as an acute phase reactant. Considering the fact that Cameroonian children live in such context, our objective was to study factors affecting ferritin level. A cross sectional study was carried out in children of 6 to 59 months attending the Bertoua regional hospital. Data were collected and blood distributed in EDTA and dry tubes for full blood count, CRP and Ferritin analysis. Obtained data were analysed using SPSS 20.0. 130 children were included with a mean age of 27.4 months, the mean haemoglobin was 10.46g/dl. Ferritin as preconized by WHO for the diagnosis of iron deficiency anaemia, was below 30μg/l in 3.84% (5) independently of anaemic status. Inflammation tested by CRP occurred in 37.7% (49) children. When the ferritin cut-off value was shifted to 50 μg/l, ferritin was low in 9. 2% (12) thus approaching the stated frequency of iron deficiency by Engle and al, 2013. Mean ferritin level was 343.9μg/l. A relatively high level showing that iron storage seems to remain intact in most children despite anaemic or inflammatory status. The cut-off value for iron deficiency in children should be increased to prevent severe iron deficiency anaemia.

Biography:
Agokeng Demanou Sylvie is a PhD student of chemical pathology at the University of Buea, aged of 36 years. She is quality control manager at the Blood bank of the Bertoua regional Hospital. Before her work in public service she served as project manager in the project Kaposi’s sarcoma in Cameroon at Sochimio. Actually working on a project entitles soluble transferrin receptor in the diagnosis of iron deficiency anaemia in children.

 

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Pages: 2 - 3

Elderly-onset Crohn's disease remarkably responsive to ustekinumab: A case report

Maho Iwamoto

Abstract
Crohn’s disease is intractable and is frequently diagnosed in younger people. No clear policies exist regarding medical treatment for seniors with this disease, and its diagnosis and treatment are often hindered by difficulties attributable to comorbidities, complex differential diagnoses, and polypharmacy. We describe an elderly-onset Crohn’s disease patient showing a marked remission-maintaining effect with no adverse events after administration of ustekinumab. A 75-year-old patient with Crohn’s disease and a history of pulmonary tuberculosis had first presented to our hospital at age 64 years, and was hospitalized. Based on physical examinations, colonoscopy, and blood test results, Crohn’s disease was diagnosed. The patient experienced secondary losses of responsiveness to two tumor necrosis factors (TNF)-alpha inhibitors and after repeated hospital admissions, she was administered ustekinumab. The patient’s symptoms, endoscopic findings, Crohn’s Disease Activity Index, serum albumin and physical activity levels improved markedly, and disease remission has been maintained for two years to date. Ustekinumab is an effective treatment option for elderly patients with intractable Crohn’s disease when TNF-alpha inhibitors are ineffective.

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Pages: 4 - 4

Clinical utility of circulating tumour DNA among patients with lymphoma in Zaria, Nigeria

Bello Jamoh Yusuf

Lymphoma has been described as the most common haematological malignancy (Chetan et al., 2014) world-wide. In Nigeria precise frequency of cancers, generally, is difficult, owing to the health-seeking behavior of many patients that is oriented toward alternative traditional medicine with attendant loss of data. Nevertheless, in a hospital-based study in Zaria, demonstrated that lymphoma ranked 5th in the list of all histologically-diagnosed cancers in Zaria (Rafindadi et al 2016). It has been shown that liquid biopsies of ctDNA can be effective when needle biopsies prove difficult, e.g. in isolated central nervous system disease or mediastinal diseases  (Roschewski M et al., 2015, Kurtz et al 2015, Wang et al., 2015).

Methods: Eighty patients with histological confirmation of lymphoma and another 80 subjects with inflammatory lymphadenopathy were recruited at Ahmadu Bello University Teaching Hospital.  From lymph node tissues of patients, DNA was isolated (using Bioneer AccuPrep Genomic DNA extraction kit) and sequenced (using Beckman Coulter CEQ 2000XL). This same DNA was targeted in the circulating blood of these patients and quantified as circulating tumour DNA (ctDNA). Levels of BCL-2 were determined using multiplex-nested PCR while prognostic scores of these patients were computed according to the International Prognostic Index for Lymphoma. Data were analyzed by using STATA (version 3.0) and GraphPad Prism (version 6.0).

Result: A strong association was observed between the levels of ctDNA and histological features of lymphoma (p <0.00001). A marked difference in the median levels of ctDNA was observed between treatment naïve and treatment-experienced subjects with lymphoma (p < 0.0001) but no statistical difference was observed between Hodgkin’s disease and Non-Hodgkin’s lymphoma (p = 0.45). In regression analysis, ctDNA and BCL-2 levels predict poor prognostic score among study subjects.

Conclusion: ctDNA is a reliable marker for diagnosis, assessment of tumour load, follow-up and prognostication of lymphoma in Zaria.

 

 

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Pages: 8 - 8

Primary Nursing in Pediatric Hematology-Oncology: a relationship-based care

Ciacci G

Acute lymphoblastic leukemia in pediatric age is analyzed through a clinical overview and then moves on to the physical and psychological needs of the child and his family during the whole treatment process. Then it was wanted to retrace the professional development and growth of the nurse, who over the years has acquired skills, autonomy and responsibility and who, within a multi-professional team, is a point of reference for the assisted and his family. In addition both the importance of nursing care in a care path in which technical-practical and above all communication-relational skills are required and the importance of a personalized care process through the use of theoretical nursing models for the detection of bio-psycho-social needs are taken into consideration. Taking care and communication/relationship can improve the quality of life of the child affected by acute lymphoblastic leukemia and his family.

Biography:
Giulia Ciacci, born in Perugia in 1992, is a nurse specialist in Palliative Care and Pain Management. She currently works in a Pediatric Hematology-Oncology Unit. Her interests are mainly focused on research and promotion of palliative care.

Speaker Publications:

  1. Formazione/informazione per l’infermiere della pediatria oncoematologica: la relazione come strumento di cura. Pediatric Reports 2012; 4:s
  2. Prencipe A Diagnosi infermieristiche. Definizioni e classificazioni. 2012. Rigon LA

18th World Hematology Congress; March 16-17, 2020 London, UK.

Abstract Citation:
Ciacci G, Primary Nursing in Pediatric Hematology-Oncology: a relationship-based care, Hematology 2020, 18th World Hematology Congress, March 16-17, 2020 London, UK. (https://hematology.insightconferences.com/abstract/2020/primary-nursing-in-pediatric-hematology-oncology-a-relationship-based-care)

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Pages: 9 - 9

Newborn Screening Program for Sickle Cell Disease in Western Kenya

Korir RK

Statement of the Problem:
Lack of newborn screening (NBS) for sickle cell diseases (SCD) contributes significantly to increased infant mortality rates especially in Sub Saharan Africa, where majority of the affected   children die undiagnosed under the age of 5. Sickle cell disease (SCD) is a life-threatening genetic disorder that affects the red blood cells. Identification of hemoglobinopathies in some countries like Kenya is usually delayed until clinical signs of the disease appear, yet, little has been done to encourage NBS programs for SCD. Such delays in diagnosis hinder prompt intervention resulting in clinical complications as well as irreversible organ damage or death. The purpose of this paper is to describe the critical role played by NBS program for SCD in Western Kenya. Methodology & Theoretical Orientation: AMPATH-Moi Teaching and Referral Hospital NBS program for SCD was established in the year 2012 with the support from Indiana Hemophilia and Thrombosis Center (IHTC). Laboratory personnel were trained on screening for hemoglobinopathies using isoelectric focusing (IEF) technique. Children with abnormal screening results were recalled for confirmatory testing using Hb Electrophoresis. Those who were diagnosed with SCD were referred to SCD clinics for treatment and further management. Findings: Over 10,000 newborns were screened for SCD. Out of these, about 100 were diagnosed with SCD and close to 500 were found to have sickle cell trait. Those with SCD were enrolled to the clinics and are currently on follow up treatment. Conclusion & Significance: Newborn screening program for SCD plays a major public health role that complements and enhances clinical services through reduction in mortality and improved developmental outcomes for the screened conditions. Training more lab personnel and the use of a point of care screening tools as well as nationwide efforts involving all stake holders are needed for policy development and system change.

Biography:
Korir has expertise in diagnostics of hematological disorders including sickle cell disease, hemophilia and leukemia. She is passionate in improving patient care in Kenya through provision of timely, accurate and highly reliable diagnostic services. Her high level skills have come through international exposure and the years of experience as a laboratory scientist at Academic Model providing Access to Healthcare (AMPATH- Moi Teaching and Referral Hospital) in Western Kenya.

Value Added Abstracts

Pages: 7 - 7

Prognostic value of interim and end of treatment pet/ct scan results in pediatric Hodgkin???s lymphoma

Mohyeldin Saber Abdehlalim

Statement of the Problem:
Treating pediatric Hodgkin lymphoma (HL) involves a delicate balance between cure and reducing late toxicity. Fluorodeoxyglucose positron emission tomography (PET) combined with computed tomography (CT) identifies patients with early response to chemotherapy, for whom radiotherapy may be avoided. The role of PET-CT in upfront risk stratification and response–adapted treatment is evaluated in this study. Methodology & Theoretical Orientation: Patients with HL, who were younger than 18 years, were included. PET-CT was performed at baseline and after two cycles of chemotherapy. Patients were stratified into three risk groups: group 1 (stage I or II with no unfavorable features); group2 (stage I or II with bulky disease/B symptoms); and group3 (stage III/IV). A doxorubicin, bleomycin, vinblastine, dacarbazine–based regimen was used in early disease. A cyclophosphamide, vincristine, prednisolone, procarbazine, doxorubicin, bleomycin, vinblastine–based regimen was used in advanced disease.

Findings:
Forty-nine patients were included. Fifteen (31%), seven (14%), and 27 (55%) patients were included in groups 1, 2, and 3, respectively. Among 36 patients who underwent staging by PET-CT at diagnosis, seven (19%) patients were upstaged and one (3%) patient was downstaged by PET compared with CT. On the basis of negative interim PET responses, 39 (80%) patients were treated without radiotherapy. The 3-year event-free survival for the entire cohort was 91 %( 65.2%) and overall survival was 100%.

Conclusion & Significance:
PET-CT is an excellent stand-alone staging modality in HL. The omission of radiotherapy can be considered in patients who achieve metabolic remission on interim PET.

Biography:
Agokeng Demanou Sylvie is a PhD student of chemical pathology at the University of Buea, aged of 36 years. She is quality control manager at the Blood bank of the Bertoua regional Hospital. Before her work in public service she served as project manager in the project Kaposi’s sarcoma in Cameroon at Sochimio. Actually working on a project entitles soluble transferrin receptor in the diagnosis of iron deficiency anaemia in children.

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