Iranian Journal of Blood and Cancer
Volume:7 Issue: 2, Winter 2015

Tumor lysis syndrome caused by widespread tumor cell damage may lead to electrolyte imbalances and express as metabolic disturbance causing clinical abnormalities. Patients and All patients younger than 16 years with documented malignancy candidate for chemotherapy, in Hamedan province of Iran were enrolled. Out of 69 cancer patients the laboratory form of tumor lysis syndrome was detected in 8 patients (11.6%) and its clinical form was observed in 2 patients (2.9%). Those two patients with clinical tumor lysis syndrome were treated using hydration, allopurinol, rasburicase and dialysis with good metabolic response. Although our sample size was limited we found a comparable prevalence of tumor lysis syndrome among our patients in comparison with previous studies. Further evaluation of the prevalence of this syndrome among Iranian cancer patients is recommended.

Venous thromboembolism, which comprises deep vein thrombosis and pulmonary embolism and is a significant cause of morbidity and mortality among patients with cancer. The aim of the present study was to report a rare presentation of arterial thrombosis after venous thrombosis in a patient with gastric cancer. Report of the Case: A 45 year-old female patient with locally advanced gastric cancer referred to our clinic. Before initiation of chemotherapy and in clinical examination, right lower leg pitting edema was observed. In color Doppler ultrasonography, deep vein thrombosis was documented, and she was treated with 60 unit /Bid of subcutaneous low-molecular-weight heparin and chemotherapy was continued. After two days despite a decrease of leg edema, pain in her leg increased, the distal part of the leg became cold and a decrease of pulsation was observed. Patient continued her therapy with diagnosis of phlegmasia alba dolens. After 7 days of this arterial thrombotic event that lasted for 48 hours, the life threatening event subsided. We should be aware of the unusual clinical presentations of deep vein thrombosis as in this case with background of gastric cancer. The rare event of phlegmasia alba dolens occurs only in 1 % of venous thrombosis events and with close observation, correct diagnosis and on time treatment we can prevent the need for amputation.

Midface bones are an unusual site for primary presentation and relapse in acute lymphoblastic leukemia. Herein, we describe a case of acute pre B cell lymphoblastic leukemia with leukemic infiltration of maxilla and bone marrow involvement. At the time of relapse, the patient presented again with maxilla involvement and the phenotype changed to biphenotypic lymphoblastic leukemia. Our case suggests that leukemic involvement of the maxilla should be considered in differential diagnosis of patients presenting with acute painful midface swelling. These patients should be evaluated using imaging modalities, blood parameters and histopathology.

Oral cancer is among the 10 most common cancers worldwide with an increasing global incidence. Compromised antioxidant defense system plays a role in occurrence of cancer. This study evaluated the salivary antioxidant level of oral cancer patients compared to a control group. Patients and This case-control study was conducted on 22 oral squamous cell carcinoma patients presenting to Imam Khomeini Hospital in Tehran, Iran, as the case and 20 healthy controls that matched the case group in terms of age, sex and race. Total salivary antioxidant level was measured in both groups. The salivary antioxidant level of patients was significantly higher than that of healthy controls (P=0.029). Salivary antioxidant level of oral squamous cell carcinoma patients was significantly higher than healthy individuals. Saliva increases the anti-oxidant level as a compensatory action, thus, by administration of antioxidants we may help saliva in the fight against free radicals that are considered as predisposing factors for cancer.

The purpose of the present in vitro study was to evaluate the effect of long term storage of conventional platelet concentrates (PCs) on major platelet receptors CD42b and CD41/CD61 by flow cytometry method and also measuring the overall platelet procoagulant activity status using platelet factor 3 (PF3) assay. Six random units of conventional platelet concentrate were prepared and after collection and resting period, were placed in a standard platelet incubator under continuous agitation at 22-24°C for eleven days. Samples of each platelet concentrate unit were taken on days 1, 5 and 11 after their preparation. Two types of samples; one pooled sample for flow cytometry analysis and also individual samples for PF3 assay were prepared and tested. Flow cytometric analysis of CD41, CD61 and CD42b found 99.8%, 94.8% and 28% activity on the first day which decreased to 68.3%, 75.1% and 3.4% respectively at the end of the storage period (11 days). The overall platelet procoagulant activity status measured by PF3 assay was 95.0% and 41.7% at the beginning and the end of the storage period respectively. Our results indicated that storage lesion occurs during long-term storage of platelets with a nearly constant slope. In spite of lower expression of CD42b, higher expression levels of CD41/CD61 and platelet procoagulant activity measured by PF3 method were observed at the end of the storage period which confirms that platelet procoagulant properties are moderately preserved even after an eleven days period.

This study made an attempt to make the quantitative and qualitative evaluation of hematological research output in five Islamic countries; Iran, Turkey, Malaysia, Saudi Arabia and Egypt; which have the most scientific productions from 1996-2013. The current study was carried out during the 1st to 31st of September, 2014 in Blood Transfusion Research Center, Shiraz, Iran. This bibliometric study evaluated quantities and qualities of publications on hematological researches based on SCImago Journal Ranking, for over 17 years (1996- 2013). Strategy of the research was based on the keyword “hematology “. Neither language nor document type restrictions were considered. Data were extracted, tabulated, and compared to identify the ranks as well as trends. The ranking and analyzing indicators included were: ‘number of documents’, ‘citable documents’, ‘citation’, ‘self-citation’, ‘cites per documents’, ‘H-index’, ‘sited documents’, and ‘international collaboration’. The 5 Islamic countries published a total of 6914 documents in the field of hematology in this period. This number represents 0.248 % of the total documents produced globally in the field of hematology. Results revealed an increase in the number of publications and citable documents for these countries during 1996-2013. Comparison among these countries showed that Turkey, Iran, Egypt have the highest number of documents and citable documents, respectively. Furthermore Turkey and Iran led qualitative indicators like H-index and citation. Despite considerable improvement in recent years these Islamic countries should further support their scientific institutes to increase the quantity and quality of hematology publications.

Neonates affected by hereditary spherocytosis may suffer from significant jaundice. This study was conducted on neonates with jaundice hospitalized at the Children’s Hospital in Bandar Abbas, South Iran, to determine the frequency of hereditary spherocytosis among them. Patients and In this cross-sectional study, 814 neonates with jaundice hospitalized at the Children’s Hospital in Bandar Abbas, South Iran, were studied from August 2013 to August 2014. Neonates with serum bilirubin levels requiring phototherapy were included in the study, while those whose parents did not consent to their children entering the study, those with congenital abnormalities, infections, bile duct obstruction, and ill neonates were excluded from the study. Peripheral blood smears were prepared for neonates with MCHC≥ 36g/dl, and osmotic fragility tests were carried out if spherocytes were found in the blood smear. Of the 814 studied neonates, 58.1% were boys and 41.9% girls. Their average bilirubin, hemoglobin, and MCHC levels at the start of the study were 16.96 ± 3.49, 14.69 ± 2.19, and 34 ± 1.37, respectively. Ninety eight percent (798 neonates) had MCHC levels below 36 and 2% (16 neonates) had MCHC levels equal to or over 36, but the osmotic fragility tests of all these 16 neonates were normal. In the present study none of the hospitalized neonates with jaundice had hereditary spherocytosis. More studies with larger sample size and longer duration are recommended to further study the causes of jaundice and the prevalence of hereditary spherocytosis in Iran.

There are two forms of ITP: acute and chronic. The chronic form is defined by persistent thrombocytopenia for more than 12 months and mostly occurs among young women. The aim of the present study was to evaluate the clinical variables in adult patients with chronic ITP in West Iran. Patients and Between of 2007 and 2014, ninety adult patients with chronic ITP referred to our clinic in Kermanshah, West Iran, entered the study. We surveyed age, sex, platelet count, hemoglobin and WBC among patients. All patients were also screened for H pylori infection using H pylori urea breath test (UBT) and serum H pylori antibody. The mean age of patients was 36.7 years (±14.2). Twenty patients (22.2%) were male and 70 patients (77.8%) were female. H pylori infection was found in 25 patients (27.8%). More patients were in the 14-30 years age bracket for both male and female patients, and with increasing age the number of patients was gradually reduced. There was a statistically significant correlation between H pylori infection and mean Hb, with patients having the infection showing higher Hb. In the present study the peak incidence of chronic ITP was seen among young adults. The prevalence of H pylori infection among patients with chronic ITP in our study was in line with the prevalence reported from North America and France.

A high prevalence of human T-cell lymphotropic virus type 1 (HTLV-I) infection among general population in northeastern Iran has been reported. Multi-transfused patients are known as ‘at-risk’ group for the infection due to frequent blood transfusions. This systematic review and meta-analysis was conducted to review the HTLV-1 infection prevalence among Iranian multi-transfused patients. Electronic databases including PubMed, Scopus, ISI, Google Scholar, ProQuest, Sci­enceDirect, IMEMR, IranMedex, Magiran, IranDoc, ISNet, RICeST and SID as well as grey literatures in both English and Persian were searched up to December 2013 and the related studies were critically appraised. Data were analyzed with R software version 3.1.2. A total of 551 non-duplicate and non-overlapping citations were found in the primary search, of which 18 surveyed HTLV-1 infection prevalence among Iranian multi-transfused patients. Six non-duplicate and non-overlapping studies were added from grey literature search. Out of these sixteen studies conducted among 3922 patients from 14 provinces met the inclusion criteria. The HTLV-1 infection prevalence varied considerably and the highest prevalence (14.4%) was reported among hemodialysis patients from Neyshabur, northeastern Iran. Overall estimation of HTLV-I prevalence was 3.2% (95%CI: 2.2-4.8). The HTLV-1 infection prevalence among patients with thalassemia and hemodialysis were 4.1% (95%CI: 3.4-4.9) and 2.9% (95%CI: 0.96-8.3), respectively. HTLV-1 infection prevalence among patients with frequent transfusions in Iran varies greatly in different parts of the country, but it is endemic in nearly all provinces. Therefore, the infection should be considered as a serious health problem in the whole country.

We aimed to assess psychological stress status among Iranian patients with cancer compared with non-cancer individuals. Patients and In a case-control study one hundred consecutive cancer patients who referred to Fatemieh hospital in Semnan, Iran (regardless of the type of cancer and its stage) were enrolled. One hundred matched non-cancer individuals were selected as controls. The status of psychological stress was assessed using a questionnaire. The prevalence of psychological stress was 70% among cancer patients and 40% among controls (p<0.001). In a multivariate logistic regression model, the prevalence of psychological stress was shown to be higher among cancer patients compared to controls (OR = 3.01, 95% CI: 1.46- 6.19, p=0.003) (Table 1). Regardless of the type of cancer, Iranian cancer patients suffer a high level of psychological stress which indicates the need for screening for stress among them.

Tumor lysis syndrome caused by widespread tumor cell damage may lead to electrolyte imbalances and express as metabolic disturbance causing clinical abnormalities. Patients and All patients younger than 16 years with documented malignancy candidate for chemotherapy, in Hamedan province of Iran were enrolled. Out of 69 cancer patients the laboratory form of tumor lysis syndrome was detected in 8 patients (11.6%) and its clinical form was observed in 2 patients (2.9%). Those two patients with clinical tumor lysis syndrome were treated using hydration, allopurinol, rasburicase and dialysis with good metabolic response. Although our sample size was limited we found a comparable prevalence of tumor lysis syndrome among our patients in comparison with previous studies. Further evaluation of the prevalence of this syndrome among Iranian cancer patients is recommended.

Venous thromboembolism, which comprises deep vein thrombosis and pulmonary embolism and is a significant cause of morbidity and mortality among patients with cancer. The aim of the present study was to report a rare presentation of arterial thrombosis after venous thrombosis in a patient with gastric cancer. Report of the Case: A 45 year-old female patient with locally advanced gastric cancer referred to our clinic. Before initiation of chemotherapy and in clinical examination, right lower leg pitting edema was observed. In color Doppler ultrasonography, deep vein thrombosis was documented, and she was treated with 60 unit /Bid of subcutaneous low-molecular-weight heparin and chemotherapy was continued. After two days despite a decrease of leg edema, pain in her leg increased, the distal part of the leg became cold and a decrease of pulsation was observed. Patient continued her therapy with diagnosis of phlegmasia alba dolens. After 7 days of this arterial thrombotic event that lasted for 48 hours, the life threatening event subsided. We should be aware of the unusual clinical presentations of deep vein thrombosis as in this case with background of gastric cancer. The rare event of phlegmasia alba dolens occurs only in 1 % of venous thrombosis events and with close observation, correct diagnosis and on time treatment we can prevent the need for amputation.

Midface bones are an unusual site for primary presentation and relapse in acute lymphoblastic leukemia. Herein, we describe a case of acute pre B cell lymphoblastic leukemia with leukemic infiltration of maxilla and bone marrow involvement. At the time of relapse, the patient presented again with maxilla involvement and the phenotype changed to biphenotypic lymphoblastic leukemia. Our case suggests that leukemic involvement of the maxilla should be considered in differential diagnosis of patients presenting with acute painful midface swelling. These patients should be evaluated using imaging modalities, blood parameters and histopathology. Keywords: Face, bone, leukemia, relapse, acute lymphoblastic leukemia.

In this study, we examined a new two step induction protocol for improving the differentiation of human umbilical cord blood-derived mesenchymal stem cells into neural progenitor cells. Human umbilical cord blood-derived mesenchymal stem cells were first cultured in Dulbecco’s modified eagle medium supplemented with 10% fetal bovine serum in a humidified incubator equilibration with 5% CO2 at 37oC. To stimulate neural-differentiation of human umbilical cord blood-derived mesenchymal stem cells, Dulbecco’s modified eagle medium was removed and replaced with pre-induction media including retinoic acid, basic fibroblast growth factor, epidermal growth factor, and basal medium for 2 days. Then, we used nerve growth factor, 3-isobutylmethyl-xanthine, ascorbic acid, and basal medium for 6 days. Real-time PCR was performed to analyze the expression of neural specific genes such as glial fibrillary acidic protein, microtubule-associated protein 2, major basic protein, and Nestin. Real-time-PCR showed that the expression of glial fibrillary acidic protein, major basic protein, and microtubule-associated protein 2 genes, after two step induction, significantly increased compared to common induction protocol. In addition, our study showed that retinoic acid might play a main role in neural-differentiation and fate of mesenchymal stem cells compared to other neural inducers. The combination of chemicals and growth factors in a two step induction protocol may improve the efficiency of differentiation of human umbilical cord blood-derived mesenchymal stem cells into neural progenitor cells and provide a new method for easy and fast application of human umbilical cord blood-derived mesenchymal stem cells in regenerative medicine. Keywords: Umbilical cord blood, mesenchymal stem cell, neural progenitor cells, neural-differentiation.