Day :
- Hematologic Malignancies
Location: 1
Chair
Ken Mills
Queens University Belfast, UK
Co-Chair
Ulla Randen
Oslo University Hospital, Norway
Session Introduction
Michael Keng
University of Virginia, USA
Title: The current landscape of myelodysplastic syndromes
Biography:
Michael Keng received his BS and MD degrees from Michigan State University in East Lansing, Michigan. He completed his Internal Medicine residency at University of Southern California in Los Angeles, California, and Hematology and Medical Oncology fellowship at the Cleveland Clinic in Cleveland, Ohio. He then joined the University of Virginia (Charlottesville, Virginia) in 2014. He currently holds a faculty appointment in Medicine in the Division of Hematology/Oncology at University of Virginia. His clinical areas of interest are focused on clinical trials in hematologic malignancies, including myelodysplastic syndromes, leukemias, and other myeloid malignancies and bone marrow failures. He has a special interest in treating the elderly population, determining optimal combinations and timing of targeted agents, and studying patient safety and quality improvement
Abstract:
Myelodysplastic syndromes (MDS) are a heterogeneousgroup of clonal hematopoietic stem cell disorders characterized by cytopenias as a result of ineffective hematopoiesis and a propensity to progress to acute myeloid leukemia and premature mortality in many patients. MDS, especially lower-risk MDS, can be diagnostically challenging with substantial morphologic overlap with nutritional deficiencies, toxic injury, infections, and some inherited disorders. Recent studies have identified novel genetic changes, which help to provide a better understanding of the underlying pathobiology of MDS. This session will review how to distinguish lower-risk from higher-risk MDS, goals of therapy, and standard, non-transplant treatment approaches. The session will then build on these basics to highlight mechanistic-based approaches justifying novel monotherapies and combinations of drugs to treat lower-risk and higher-risk disease.
Ken Mills
Queen’s University Belfast, UK
Title: Identifying novel epigenetically induced synthetic lethality therapeutic combinations for high risk MDS/AML
Biography:
Ken Mills is Chair of Experimental Haematology in the Centre for Cancer Research and Cell Biology (CCRCB) in Queen’s University Belfast. He coordinates the activities of the Blood Cancer Research Group with a focus on the molecular aspects of MDS and AML to identify novel therapies. He has published over 135 papers, several book chapters and is on several editorial board and a regular reviewer for high impact journals and national and international funding bodies.
Abstract:
High risk myelodysplastic syndromes (MDS) and acute myeloid leukemia (AML) are diseases of the aging; with many patients are unable to tolerate intensive therapies and an unmet need for novel therapeutic approaches. Epigenetic silencing of genes in MDS and AML can occur via the recruitment of histone deacetylases (HDACs) or by aberrant DNA hyper-methylation; these changes can be reversed making them prime targets for therapy. The development of agents that inhibit HDACs (HDACi) or the DNA methyl transferase activity (DNMTi) have proven successful in certain malignancies and have shown promise of increasing treatment tolerability. However, it is an over-simplification to assume that epigenetic based therapies simply allow the expression of tumor suppressor genes; so a greater understanding of their mode of action is required to develop more rationale combinations. Integrative analyses involving transcriptomics with methylation profiling or ChIP-seq of chromatin associated with histone acetylation modification marks has been undertaken to identify epigenetic primed induced synthetic lethal therapeutic combinations. The integrated analysis has identified novel primed gene and network targets specifically activated as a response to the epigenetic therapies. These studies not only provide further insight into the molecular mode of action of the epigenetic therapies but have identified agents that might work synergistically in combination thus providing potential novel therapies for MDS / AML patients.
Biography:
Robert H Schiestl has obtained his PhD from the University of Vienna at the age of 23 years. He was Postdoctoral fellow at Edmonton, Alberta, Rochester, NY, and Chapel Hill, NC before being Professor at Harvard at the age of 31 where he stayed for 10 years. Since 15 years he is Professor at UCLA with 187 publications, 10 patents and 2 startup companies.
Abstract:
Intestinal microbiota plays a role in the nutrient metabolism, modulation of the immune system, arthritis, obesity and intestinal inflammation. In the literature there have been huge differences in the same Atm deficient mice in different labs reported. When our lab moved from Harvard to UCLA we found a similar difference in genetic instability and logevity. When we changed the intestinal microbiota back to conventional microbiota we could reproduce the phenotype at Harvard. We tested Atm deficient mice for genotoxicity, genetic instability, DNA damage, inflammation markers, cancer latency and longevity and high throughput sequencing of the intestinal microbiota. Isogenic mice from different housing facilities showed a four fold difference in life expectancy, a 4.5 fold difference in genetic instability and DNA damage. The onset of lymphomas was significantly 2 fold different. We sequenced the microbiota of both facilities and found Lactobacillus johnsonii 456 as dominant bacterial strain in the health beneficial microbiota. Just this bacterium by itself reduced genotoxicity, reduced inflammation and reduced levels of cytotoxic T cells in the liver and blood. We also found similar differences in Trp53 deficient and even in wildtype mice. The underlying mechanisms are probably due to inflammation promotion or suppression mediated by the intestinal microbiota. The understanding of this effect may lead to a breakthrough in the understanding of the causes of carcinogenesis, which might lead to prevention of AT, a currently incurable progressive disease and possibly other cancer-prone DNA repair deficient diseases or even wildtype mice and people.
Ulla Randen
Oslo University Hospital, Norway
Title: Primary cold agglutinin disease (CAD) associated lymphoproliferative disease: a new entity
Biography:
Ulla Randen is a consultant pathologist at Oslo University Hospital with a speciality in hematopathology, including flow cytometry. She has performed research on different small B-cell lymphoproliferative diseases with a special interest in patients with chronic cold agglutinin disease (CAD).
Abstract:
Primary chronic cold agglutinin disease (CAD) is a rare hemolytic disease (1:1.000.000) mediated by monoclonal IGHV4-34-encoded cold agglutinins with a predominant specificity for the blood group antigen I. These patients have previously been given a variety of diagnoses on bone marrow biopsies, from ‘no signs of lymphoid infiltration’ to an overt lymphoma, most often lymphoplasmacytic lymphoma (Mb. Waldenström). However, studies including flow cytometry have shown that >90% of them, if not all, have a monoclonal B-cell proliferation. We have therefore performed studies on a larger group of CAD patients and examined bone marrow aspirates and biopsies to better type the underlying lymphoproliferative disorder. Bone marrow biopsies typically showed small infiltrates (median infiltration: 10% of marrow cells) with a mature B- cell immunophenotype. Morphologically, the infiltration did not fit with lymphoplasmacytic lymphoma, as neither mast cells or plasmacytoid cells were present, nor did the small B cells express plasma cell differentiation-associated markers. A limited number of mature monoclonal IgM+ plasma cells were present outside the lymphoid nodules and were diffusely scattered throughout the marrow and regarded as part of the lymphoproliferative disease, as these produce the monoclonal anti-I antibodies. Of interest, the MYD88 L265P mutation, typical of lymphoplasmacytic lymphoma, was not detected. We conclude that cold agglutinin-associated lymphoproliferative disease displays homogeneous histological and immunophenotypic features that distinguishes this entity from lymphoplasmacytic lymphoma, and thereby distinguishes chronic cold agglutinin disease from Mb. Waldenström.
Katarzyna Piwocka
Nencki Institute of Experimental Biology, Poland
Title: The therapeutic potential of the translation initiation factor eIF2α serine 51 phosphorylation for chronic myeloid leukemia
Biography:
Katarzyna Piwocka has obtained her MSc degree in Microbiology from the Warsaw University in 1994 and PhD in Biology, specialization Biochemistry from the Nencki Institute in Warsaw, Poland in 2001. She has received Postdoctoral Training at the Bio-Sciences Institute, University College Cork, Ireland (2003-2004). In 2014, she has received Habilitation in Biological Sciences. Currently, she is an Associate Professor, Head of the Department of Biochemistry (since 2015) and Head of the Laboratory of Cytometry (since 2010) at the Nencki Institute in Warsaw, Poland. She has won several awards including a five-year ISAC Scholar fellowship from the International Society for Advancement for Cytometry
Abstract:
The t (9; 22) chromosomal translocation present in almost all CML patients’ results in the expression of a 210 kDa fusion protein known as Bcr-Abl. Bcr-Abl is a tyrosine kinase with potent oncogenic properties, which is the underlying cause of CML. Although Bcr-Abl has been an attractive target for therapeutic intervention, CML patients frequently develop resistance to pharmacological inhibitors of Bcr-Abl. Therefore, the identification of intracellular pathways that contribute to the oncogenic effects of Bcr-Abl and development of drug resistance has been an important goal of CML research. As a result of an international collaboration between Poland and Canada, we have identified a novel pathway of Bcr-Abl signaling, which is the phosphorylation of α subunit of the translation initiation factor eIF2 at serine 51 (eIF2αS51P). The eIF2αS51P is a master regulator of stress and an important mechanism utilized by cells to adapt to various forms of environmental stress through the translational control of select mRNAs that can promote either cell survival or death. We found that Bcr-Abl induces eIF2αS51P in CML cells in culture, CML patients and mouse xenograft tumor assays via the activation of the endoplasmic-reticulum (ER)-resident kinase PERK. Genetic inactivation of eIF2αS51P impairs the oncogenic properties of Bcr-Abl and increases the sensitivity of CML cells to the anti-tumor drug imatinib in culture and mice. Our work demonstrates that pharmacological inhibition of eIF2αS51P is likely to be a suitable approach to increase the sensitivity of anti-tumor drugs targeting Bcr-Abl as a means to combat CML disease.
Biography:
Abdel Rahim Mahmoud Muddathir has completed his PhD at the age of 32 years from Alzaiem Alazhari University and did his PhD practical work in CMM at Karolinska Institute (Sweden). He had the fellowship of IBMS and also is Sudan advisory board member of ASCP. He is Editorial board member of Austin Journal of Cancer and Clinical Research and he was the dean of Medical Laboratory Sciences School in Sharq Elniel College.
Abstract:
Objectives: In Sudan, CML is the most common cancer among males and the second most common cancer among females our study aimed to determine the frequencies of BCR-ABL transcript variants studied in Sudanese patients with chronic myeloid leukemia (CML). Methods: This is a descriptive cross-sectional study carried out in 112 CML patients who attended at different clinics of Khartoum state, Sudan from February 2007 to December 2010. Transcript analysis was successful in 109 venous blood and bone marrow samples using quantitative real-time-polymerase chain reaction (RT-PCR). Results: The transcripts analysis of 109 patients showed that 32.1% (35/109) expressed one or both of the P210 BCR/ABL rearrangements (b2a2 andb3a2). Of those 35 (32.1%), 21 patients expressed b2a2, 6 expressed b3a2, and 8 expressed both transcripts b2a2/b3a2. The remaining 74 patients revealed transcripts combination of P190 BCR/ABL and P210 BCR/ABL (e1a2/b2a2/b3a2), of which 19 patients had all the transcripts (e1a2/b2a2/b3a2), 33 revealed 2 transcripts (e1a2/b2a2), and the remaining 22 patients had (e1a2/b3a2).
Biography:
C Cameron Yin has received her MD from Beijing Medical University and her PhD from the University of Wisconsin-Madison. She is currently an Associate Professor in the Department of Hematopathology at the University of Texas MD Anderson Cancer Center. In addition to clinical responsibilities on the Leukemia, Lymphoma and Molecular Diagnostic services, she has been actively participating in multiple research projects in the molecular genetic abnormalities in leukemia and lymphoma, which has led to over 100 research papers and over 20 book chapters.
Abstract:
CD5-posiitve B-cell lymphomas are a heterogenous group of neoplasms. Classification of this group of lymphomas has important clinical and prognostic significance. CD5-positive B-cell lymphomas consist primarily of chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) and mantle cell lymphoma (MCL). However, CD5 expression has been reported in a number of other B-cell lymphomas. We report the clinical, morphologic, immunophenotypic and molecular genetic features of several series of CD5-positive B-cell lymphomas that lack the prototypic characters of CLL/SLL or MCL, including follicular lymphoma, MALT lymphoma, nodal marginal zone lymphoma and lymphoplasmacytic lymphoma. Our results show that CD5 expression is often associated with an increased tendency of disseminated disease in MALT lymphoma and nodal marginal zone lymphoma, but these patients usually have an indolent clinical course and excellent overall survival with appropriate management. However, in follicular lymphoma, CD5 expression is associated with a higher International Prognostic Index, higher rate of transformation to diffuse large B-cell lymphoma, and shorter progression-free survival. We summarize that CD5 expression not only produces diagnostic challenges in the classification of CD5-positive B-cell lymphomas, but also bears prognostic significance.
- Diagnosis, Treatment and Management of Blood Disorders
Chair
Rania A Zayed
Cairo University, Egypt
Session Introduction
John Batchelor
Central Manchester Foundation Trust, UK
Title: Risk factors for intracranial haemorrhage in elderly patients with blunt head trauma
Biography:
J S Batchelor is currently a Consultant in Emergency Medicine at Central Manchester Foundation Trust, England UK. He graduated from Leeds University England, in 1982. He has written extensively on the subject of minor head injuries. He was one of the first investigators to identify the importance of headache and vomiting in patients with minor head injury. He has also recently published a meta-analysis on the effect on mortality of platelet transfusions in adults with spontaneous or traumatic anti-platelet associated intracranial haemorrhage. His current research interest lies in the area of risk factors for intracranial haemorrhage in TBI, particularly in patients on warfarin and antiplatelet agents.
Abstract:
Falls in the elderly are a common problem with an ever aging population. Head injury causing intracranial haemorrhage from a fall from standing is the major cause of mortality in the elderly age group. A meta-analysis by Batchelor et al. (2012) studied the effect of warfarin on mortality in patients with blunt head trauma. Eleven papers were identified, which met the criteria for the meta-analysis. Despite the heterogeneity between the studies (Q test: 27.421, 10 DF, P=0.002), the fixed effects model was the preferred model based on the fact that 10 out of the 11 studies had an odds ratio greater than one. The results showed that warfarin anticoagulation increases the mortality from blunt head trauma by an odds ratio of 2.008 (95% CI 1.634 - 2.467). The risk of intracranial haemorrhage from blunt head trauma in patients on aspirin agents is approximately 1.5 and the mortality is OR =2.435 (95% CI: 0.637-9.314). The result is not statistically significant and the level of evidence for this is poor. Previous investigators have published case series advocating the use of platelet transfusions in patients with blunt head trauma with intracranial haemorrhage who are taking antiplatelet agents. The evidence for this approach is poor. Desmopressin may be the preferred option. This paper aims to discuss these areas in more detail.
Annie Viallat
University Aix-Marseille, France
Title: Characterization of RBC mechanical properties by microfluidic techniques
Biography:
Annie Viallat is engineer of Ecole Polytechnique (Paris, France). She received her PhD in Physics from the University of Grenoble (France) in 1987, working on polymer gels and NMR. After a theoretical postdoctoral work on conjugated polymers in the Materials Departments (UC Santa Barbara), she joined the Spectrométrie Physique lab (Grenoble) in 1989, studying polymer gels and heterogeneous polymer solutions. Her research moved to biological physics in 1999. Since 2005, she is a group leader in Marseille (France). She works in The Interdisciplinary Center for Nanosciences (CINaM). She is interested in the dynamics in microflows of vesicles and blood cells. Her recent work focuses on the dynamics of red and white blood cells in shear flow and in biomimicking capillary networks. She is currently working on RBC mechanical properties and margination phenomenon in sickle cell anemia and on RBC elimination in the spleen. - See more at: http://hematology.conferenceseries.com/scientific-program.php?day=2&sid=972&date=2015-11-03#sthash.dz697VkX.dpuf
Abstract:
Red blood cell (RBC) deformability is postulated to be a major determinant of impaired perfusion, increase of blood viscosity and occlusion in micro-vessels. Deformability refers to the ability for the RBC shape to change in response to external mechanical stresses. For instance, current deformability tests such as ektacytometry1 measure global parameters related to shape changes at the whole cell scale. But for large surface area-to-volume ratios, many shapes can be found for a given set of values of cell surface area and cell volume. Shape change is obtained by redistribution of the inner cytoplasmic volume of the cell and involves only a small perturbation of the membrane energy due to local changes of the membrane curvature. However, strong shear deformation of membrane elements can occur without shape change, for instance after a displacement of the membrane elements along the discocyte shape. These local deformations are typically involved during the tanktreading motion of RBCs in blood flow. They are governed by the viscoelastic properties of both cell membrane and cytoplasm. Finally, the term deformability is also often used to evoke the propensity of the cell membrane to rupture under a tension, for example in a vessel constriction or in the spleen. Despite strong advances in our understanding of the molecular organization of RBCs, the relationships between the global deformability tests, the cell behavior both in micro-flows and in vivo and the rheology of each element of RBCs composite structure are still not elucidated.We propose microfluidic tools to assess the mechanical parameters of RBCs at both suspension and single-cell level. We believe that these tools can be exploited to probe cellular-scale changes to environmental factors. We first show that i) the critical shear rate of the tanktreading-to-tumbling transition and ii)the variation of the swinging frequency with the shear rate of RBCs in shear flow enable the determination of two mechanical parameters2. First, an effective viscosity that accounts both for the cytoplasm and the membrane viscosity, and, second, an effective shear elasticity that accounts both for the shear modulus of the membrane and the stress-free shape of the cell. The stress-free cell shape is the shape for which the membrane elements are not deformed. Recently it was suggested that this shape is close to the sphere for healthy cells. The existence of other possible stress-free shapes in pathological cells has never been investigated and is still an open question. We also show that, in less viscous fluids, the orientation of RBCs versus the shear rate is a signature of the cell shear modulus. We then show that the entrance of RBCs in narrow channels enables the characterization of the fragility of RBCs to membrane rupture. Finally, we show that microfluidics enables to subject flowing RBCs to various environmental factors (such as oxidative stress or variation of dioxygenation) and to measure their mechanical response in-situ. - See more at: http://hematology.conferenceseries.com/scientific-program.php?day=2&sid=972&date=2015-11-03#sthash.dz697VkX.dpuf
Rania A Zayed
Cairo University, Egypt
Title: Indoleamine 2,3 dioxygenase and regulatory T cells in acute myeloid leukemia
Biography:
Rania Zayed is Assistant Professor of Clinical and Chemical Pathology, Faculty of Medicine, Cairo University, Egypt. She completed the Doctorate degree at the age of 31 and is an imminent member of the hematology department team. She participated in several national and international conferences in hematology and stem cell research.
Abstract:
Background & Objectives: The microenvironment of acute myeloid leukemia (AML) is suppressive for immune cells. Regulatory T cells (Tregs) have been recognized to play a role in helping leukemic cells to evade immunesurveillance. The mesenchymal stem cells (MSCs) are essential contributors in immunomodulation of the microenvironment as they can promote differentiation of Tregs via the indoleamine 2,3-dioxygenase (IDO) pathway. The aim of the present work was to evaluate the expression of IDO in bone marrow derived MSCs and to study its correlation to percentage of Tregs. Methods: 37 adult bone marrow samples were cultured in appropriate culture medium to isolate MSCs. Successful harvest of MSCs was determined by plastic adherence, morphology and positive expression of CD271 and CD105; negative expression of CD34 and CD45 using flowcytometry. MSCs were examined for IDO expression by immunocytochemistry using anti-IDO monoclonal antibody. CD4+ CD25+ cells (Tregs) were measured in bone marrow samples by flowcytometry. Results: MSCs were successfully isolated from 20 of the 37 bone marrow samples cultured. MSCs showed higher expression of IDO and Tregs percentage was higher in AML patients compared to control subjects (p=0.002 and p<0.001 respectively). A positive correlation was found betweenIDO expression and Tregs percentage (p value=0.012, r=0.5). Conclusion: In this study we revealed an association between high IDO expression in MSCs and elevated levels of Tregs which has an important role in the pathogenesis of AML, providing immunosuppressive microenvironment.
P K Sasidharan
Govternment Medical College Kozhikode, India
Title: ‘Kozhikode Criteria’ for diagnosing SLE as a haematological disorder
Biography:
P K SasidharanP. K. Sasidharan Professor of Medicine& Head, Department of Medicine & Hematology, Government Medical College, Calicut, He had been the best outgoing student of the University of Calicut and took M.D General Medicine, from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh. He was recipient of several awards and fellowships. 72 publications in journals including two land mark studies on Vitamin D deficiency and on SLE. Author of two books DOCTORS POCKET COMAPININON and HEALTHY INDIA. Written chapters in text books of Medicine and Hematology. Actively involved in health promotion in India. He had held before posts like Chairman PG Board of studies Kerala University of Health Sciences; Member, Editorial Board “Indian Journal of Hematology and Transfusion Medicine”, PhD research Guide for University of Calicut, President Association of Physicians of India (API) Kerala State Chapter, Scientific Advisory committee Member- National Institute of Immuno Hematology, Mumbai, Vice President Hypertension Society of India, Dean Faculty of Medicine, University of Calicut, Director Malabar Cancer Center- additional charge, State President, Kerala Govt. Medical College Teachers Association.
Abstract:
Systemic Lupus Erythematosus (SLE), is an autoimmune disease in which cells and tissues undergo damage mediated by tissue binding auto antibodies. At its onset it may involve any one organ alone or more than organs simultaneously; over a time additional manifestations due to involvement of multiple organs may occur. The criteria used till 2012 was the American College of Rheumatology (ACR) Criteria, which is only a classification criteria and not really for diagnosis; if we rely on ACR criteria, the diagnosis is often delayed denying the benefit of early treatment. Time required for satisfying all 4 of the 11 criteria is variable and prolonged. Moreover hematological manifestations, which are commoner than other manifestations, are underrepresented in the ACR criteria. Based on the clinical observations made on patients evaluated in our tertiary center in North Kerala, an alternate diagnostic criteria named the ” Kozhikode Criteria” was proposed. The present study was an attempt to validate the same and to look for any association of diet and lifestyle to the disease
Rehman Suhailur
Aligarh Muslim University, India
Title: Blood transfusion reaction in pediatric age group: A tertiary care centre based study
Biography:
Dr Suhailur Rehman, known for his experience in Hematology, Transfusion Medicine, Histopathology and Cytopathology, was born in 1st May 1984 in District Bijnore. He belongs to a very small town NOORPUR and with his hard work and consistenty, reached the present position. He has done his MBBS and MD Pathology from JN Medical College, AMU, Aligarh. He worked in world famous Institute SGPGIMS, Lucknow, India as a Senior Resident in Transfusion Medicine. At present he is working in JNMCH, AMU, Aligarh, India. His wife, Dr Sana Siddiqui is also a good and meritorious student. She got gold medal in Pediatrics and honours in Anatomy during MBBS examinations. His 13 papers are published, out of which 11 are published in International and 2 in National Journals. He presented 10 Oral papers and 24 poster papers in various Conferences/CMEs attended. He got First prize in one Oral paper and one poster paper presentation. He attended 37 conferences/CMEs/symposium and 15 workshops/training programmes. He is a sincere, enthusiastic and a dedicated young Doctor, who has a strong inclination towards research work. His approach to diagnostic work is logical and he is able to correlate his knowledge with patient’s clinical information properly. He loves to teach and his teaching style is very much appreciated by undergraduate and postgraduate students.
Abstract:
Pediatric transfusion concerns are usually divided into two periods: Neonates from birth through 4 months and older infants (>4 months) and children. Neonate and infants in this age group are considered separately, not only because of their small blood volume but also due to unique physiological factors such as decreased production of endogenous Erythropoietin (EPO) in the premature infant in response to anaemia and physiological anaemia of infancy. Similarly the transfusion associated reactions also differ in neonates and children from adult. While analyzing the transfusion reaction, it was found that febrile non hemolytic transfusion reaction was the most common transfusion reaction encountered during study period. Transfusion reactions were most commonly seen in whole blood as compared to other components. Febrile reactions were more common in whole blood and Platelet transfusion. Also comparison of whole blood and Packed RBC transfusion was done in terms of mean rise in haemoglobin and transfusion reaction.
- Symposium on Tropical Blood Disorders
Session Introduction
Erhabor Osaro
Usmanu Danfodiyo University, Nigeria
Title: Effect of plasmodium parasitaemia on some haematological parameters in children living in Sokoto, North Western, Nigeria
Biography:
Erhabor Osaro completed his PhD in Immuno-hematology at Rivers State University of Science and Technology at Rivers State, Nigeria. He is a fellow of the Institute of Biomedical Science London. He has many scientific awards including the British Blood Transfusion Society and Margaret Kenwright- young scientist’s awards. He has written more than 140 articles, 4 books and 5 book chapters. He is reviewer and editor of several scientific journals from around the World.
Abstract:
Objectives: Malaria infection is a major public health problem and cause of morbidity and mortality particularly among children in tropical and subtropical regions of the world. The aim of this present study was to determine the effect of plasmodium parasitaemia on some haematological parameters of children visiting the children emergency unit of Sokoto State Specialist Hospital in Sokoto, North Western, Nigeria. Method: This study was conducted among 126 children aged 2-11 years with mean age 5.36± 2.50 years presenting to the children emergency unit of Sokoto Specialist Hospital with history of febrile illness. Out of the children studied, 66 (52.4%) were positive for malaria while 60 (47.6%) were negative. Haematological parameters were analyzed using Mythic 22 CT 5- part differential Haematology analyzer (Orphée, Switzerland). Testing for malaria was carried out using the Onset Malaria Plasmodium falciparum (Pf) antibody (Ab) rapid test (CTK Biotech, Inc., USA) and speciation and number of parasites per high field was carried out on the Giemsa stained thing blood film. Results: The mean PCV, haemoglobin and platelet count of plasmodium- parasitized children was significantly lower compared to un-infected controls (29.48, 10.36 and 188.68) versus (32.76, 11.34 and 327.50) respectively (p=0.01). The prevalence of anaemia and thrombocytopenia was significantly higher among Plasmodium parasitized subjects compared to non-parasitized controls. Plasmodium falciparum was the predominant specie among the parasitized subjects. A negative and significant correlation was observed between the high number of parasite per high field and platelet count as index of thrombocytopenia and haemoglobin as index of anaemia (r=0.62 and p=0.75) respectively (p= 0.01) among parasitized subjects. Plasmodium parasitaemia was more prevalent among children in the 2-5 years age group (52.4%) compared to children in the 6-11 years age group (47.6%). Male children were more predisposed to malaria (53.0%) compared to female children (47.0%). Conclusion: Plasmodium parasitaemia has a significant impact on the haemoglobin, packed cell volume and platelet count of malaria parasitized children in Sokoto, Nigeria. Preventative strategies including regular chemoprophylaxis, intermittent preventative treatment with anti-malarials, provision of iron supplementation and insecticide-treated bed nets should be implemented urgently to prevent the negative impact of malaria parasitaemia on the haematological parameters of children in the area. There is need for community and peer-based awareness and education initiatives to strengthen the malaria prevention programme by educating parents on the benefits of effective environmental sanitation to destroy the breeding sites of Anopheles mosquito –the vector of malaria.
Biography:
Erhabor Osaro- completed his Ph.D. in Immuno-hematology at Rivers State University of Science and Technology at Rivers State, Nigeria. He is a fellow of the Institute of Biomedical Science London. He has many scientific awards including the British Blood Transfusion Society and Margaret Kenwright- young scientist’s awards. He has written more than 140 articles, 4 books and 5 book chapters. He is reviewer and editor of several scientific journals from around the world.
Abstract:
Despite the availability of adequate preventatives, falciparum malaria is still responsible for the deaths of hundreds of thousands of people yearly. The majority of these victims are young children and pregnant women. The key question is why does this occur? The vulnerability of these populations is likely caused by a deficiency in nutrition affecting the host immune system. Scientists have demonstrated that falciparum malaria patients (FMP) have a biochemical deficiency caused by insufficient amounts of the amino acid L-arginine (L-arg). L-arg is substrate for the enzyme- nitric oxide synthase 2 (NOS2) which generates large amounts of nitric oxide (NO). NO reacts with a form of oxygen which generates a substance which can kill the malarial parasite. The parasite protects itself by producing and releasing L-arginase which degrades the l-arginine of the host thus preventing the NO-based toxicity. Children need L-arginine as an essential amino acid to be healthy so the parasite depletes this amino acid and prevents a needed substance from being used by their body and it also prevents the production of this key ingredient to fight the parasite. This same scenario likely occurs to the unborn child in pregnant women. In addition, pregnancy produces a somewhat immunosuppressed state causing increased morbidity and mortality. We plan to study the combination of artemether and lumefantrine with several types of sustained release nitric oxide nutritional supplements compared to drugs alone in these two populations
Biography:
Okorie, H. M. is the Faculty of Health Sciences, Department of Medical Laboratory Science, Imo State University, Owerri, Nigeria.
Abstract:
Platelet selectin (P-selectin or CD62P) is an intercellular adhesion molecule with a strategic role in malaria. Homogenous sampling of subjects with normal haemoglobin (Hb AA), Sickle Cell trait (Hb AS) and Sickle Cell anemia (Hb SS) subjects was carried out in the ratio of 50:30:20 and by real time PCR, the normalized transcript level of P-selectin (SELP-ncn) were measured in malaria infections compared to non-infection control group within the sampled population. I also established malaria infection by standard PCR method, blood film microscopy and rapid diagnostic testing (RDT). Haemoglobin levels and age distribution of the participants across the different genotype groups were analyzed. The results show that the ABI-1 quantity passed normality test (Kruskal Wallis test, P = 0.0403) but did not differ significantly when compared across groups indicating good sample quality. SELP-ncn showed no significant difference across all Hb genotypes studied (Kruskal Wallis test, P = 0.2796) suggesting that P-selectin is expressed in both normal and sickle haemoglobins. Though the SELP-ncn did not differ significantly when compared across the groups studied, targeting it may help reduce the complications of malaria. RDT showed moderate sensitivity (41%; 95% CI: 21%-64%) and a high specificity (98%; 95% CI: 89.7%-99.9%). Blood film microscopy had a moderate sensitivity (68%; 95% CI: 52%-81%) and specificity (90.3%; 95% CI: 74%-97.6%) when PCR was considered as the gold standard. Median Hb concentrations of M-AA and M-SS; M-AA and NM-SS; M-AS and M-SS, M-AS and NM-SS; M-SS and NM-AA; M-SS and NM-AS; NM-AA and NM-SS; NM-AS and NM-SS differed significantly (Kruskal Wallis test, P = 0.0001). Median age of participants across groups differed significantly between M-AA and M-SS; M-AA and NM-SS (Kruskal Wallis test, P = 0.0020).
Iwunze Vincent Okechukwu
Life-link Medical Diagnostic & Laboratories Ltd, Nigeria
Title: Effect of malaria infection on packed cell volume and hemoglobin levels among patients at Ojo district of Lagos State Nigeria
Biography:
Iwunze Vincent Okechukwu has graduated from the University of Calabar, Nigeria in 1991. He has specialized in Hematology and Blood Transfusion. Presently, he is the MD/CEO of Life-link Medical Diagnostic and Laboratories Nigeria Ltd, one of the fast growing diagnostic and research centers in the country. It is situated at the former capital of Nigeria, Lagos. He has delivered many scientific papers on some conferences especially in Nigeria. He has also headed many scientific workshops and has served in several scientific Ad-hoc committees.
Abstract:
Malaria is a worldwide migrating diseases associated with anemia especially in tropical Africa. It causes high rate of mortality and morbidity among Sub-Saharan Africans. Anemia is a hematological disorder caused by a decrease in the production of Red blood cells, a born marrow failure or by an increase in the Red blood cells destruction. The study is to evaluate the effect of malaria infection on the packed cell volume and hemoglobin levels of patients. Blood samples were collected in EDTA bottles from patients attending Life-link Medical Diagnostic and Laboratories Ltd and patients from Ojo Health Center, all in Ojo district of Lagos state Nigeria. Presence or absence of malaria identified by staining with Giemsa stain and examined under oil immersion, PCV and Hb were estimated using Hawskley Haematocrit machine and Microfield colorimeter respectively. A total of 250 patients were studied between the month of June to October 2013, 180 (72%) malaria infected patients, 160 (89% Adult), 20 (11% children) and 70 (28%) of non-infected. The overall means for the Packed Cell Volume and Hemoglobin showed a significant difference in malaria infected patients. The mean Hb, PCV in infected were lower than the non-infected. Conclusively, there was a decrease in packed cell volume and Hemoglobin which seems to be due to the excessive destruction of red blood cells by the malaria parasite
Echonwere Beauty
Rivers State University of Science and Technology, Nigeria
Title: Changes in some haemostatic parameters in pregnancy and peurperium in Port Harcourt
Biography:
Echonwere Beauty is a researcher in Rivers State University of Science and Technology, Nigeria. Her main area of research is haematology.
Abstract:
Introduction: This was a cross-sectional study carried out in Braithwaite Memorial Specialist Hospital, Port Harcourt with the aim of determining the changes in some haemostatic parameters in pregnancy and puerperium. Method: A total of four hundred (400) apparently healthy women of reproductive age, which consisted of 200 (40%) pregnant women and 200 (40%) puerperium mothers constituted the subjects in this case-controlled study. One hundred aged-matched non-pregnant women served as controls. The study was carried out between March, 2012 and January, 2014. The ages of the subjects ranged from 16 to 41 years (mean 27.4±4.3 years). Platelets count was carried out as described by Bain and Seed, PT and (PTTK) by Quick’s methods while modified Clauss method was used in the determination of fibrinogen concentration. Result: The pregnant women had significantly lower values of platelet count, 203.89±65.2×109/L (range, 78-416) as compared to 257.0±69.0×109/L, (range, 90-396×109/L,) for the non-pregnant controls and the 249.1±75.0×109/L, (range, 95-406×109/L) of the puerperium women (F=28.437; p<0.05). The prevalence of thrombocytopenia among the pregnant, puerperium mothers and non pregnant control women were 53 (26.5%), 15 (7.5%) and 12 (12.0%) respectively. The mean prothrombin time (PT) of the non-pregnant control women 15.48±2.49 seconds (range, 14-16 seconds) was significantly higher than the mean prothrombin time of the pregnant and the puerperium women 11.36±3.12 seconds (range, 10-16 seconds) and 14.28±4.22 seconds (range, 13-16 seconds) respectively (F=57.843; p<0.05). The International Normalized Ratio (INR) of the pregnant women as compared to the non-pregnant and puerperium women were not statistically significant (F=2.206; p>0.05). The mean partial thromboplastin time with Kaolin (PTTK) of the pregnant women, 44.1±7.2 seconds (range, 43.3-46.1 seconds) were significantly higher than the mean partial thromboplastin time with Kaolin (PTTK) of the non-pregnant women, 39.4±8.1 seconds (range, 38.4-44.3 seconds) and the puerperium women, 40.32±6.4 seconds (range, 41.3-43.3 seconds) (F=20.512; p<0.05). Conclusion: The mean fibrinogen concentration, 4.4±0.80 g/L (range, 2.9-5.1 g/L) of the pregnant women were significantly higher than the mean fibrinogen concentration, 3.6±0.88 g/L (range, 2.8-4.4 g/L) of the puerperium women and the non-pregnant control women, 2.6±0.72 g/L (range, 2.6-4.3 g/L) (F=164.877; p<0.05). The results point towards a hypercoagulable state in pregnant women, which is normal during pregnancy.
Azuonwu Obioma
Rivers State University of Science, Nigeria
Title: Screening for HBsAg and HCV antibodies among military personnel in the Niger Delta of Nigeria
Biography:
Azuonwu Obioma is working currently for Rivers State University of Science and Technology, Nigeria. His field of research is Health Sciences, Medicine and Infectious Diseases.
Abstract:
Despite the high job-related risk of exposure to sexually -transmitted diseases including HBV and HCV among the military, there is paucity of data regarding Hepatitis B and C viruses’ prevalence among military personnel in Nigeria. The aim of this present study therefore was to determine the prevalence of HBV and HCV among military personnel in the Niger Delta of Nigeria. In this cross-sectional case study, a total of One hundred and fifty military personnel aged 20 and 55 years attending the Nigerian Army Hospital, Air Force Clinic and Police Clinic in Port-Harcourt in the Niger Delta of Nigeria were consecutively recruited for the study. Samples were tested for HBV and HCV using Acon Diagnostics (USA) HBsAg and anti-HCV kits. Results of the study showed an overall HBV and HCV prevalence rate of 4% and 0% respectively. The prevalence of HBV was significantly higher among subjects in the 20-39 years age group (4%) compared to 40-55 (3.85%) (p = 0.05). The HBV prevalence was investigated based on gender of subjects. The HBV prevalence was concentrated among male subjects (4.76%) compared to female (0%) military personnel (p = 0.001). There is need for the development of a strategic plan that integrates STIs into existing prevention and control programme particularly among the military to foster behavior change through information dissemination. Policies should be instituted to make condoms regularly available and freely distributed among military personnel to reduce the risk of HBV and other sexually transmitted infections. There is the need for an effective voluntary counseling and testing (VCT) and sentinel surveillance survey among military personnel. A fully integrated and comprehensive care and support system including provision of universal access to hepatitis B vaccination, treatment and support for military personnel should be establishment
Emmanuel Kufre Uko
University Of Calabar, Nigeria
Title: Disharmony and lack of teamwork among health professionals; an emerging challenge in the management of blood disorders in Nigeria
Biography:
Emmanuel Kufre Uko is a Professor of haematology and Blood Transfusion Science, University of Calabar. He received his Doctorate in Immuno-Hematology from University of Calabar. He is also a holder of Associate and Fellowship of Medical Laboratory Science Council of Nigeria (MLSCN). Before becoming a full time Lecturer, he worked as a practicing Medical Laboratory Scientist, undertaking routine Hematology Laboratory investigations, take Emergency calls and organizing hematology practical to Medical students and Medical Laboratory Science students of College of Medical science, University of Calabar. He is up to present a Professor of Medical Laboratory Hematology at College of Medical Science, University of Calabar, where he is teaching and supervising projects in Hematology and Blood Group Serology to Medical students, Medical Laboratory Science students and several Msc & PhD Students. He is a Consultant Laboratory Hematologist with University of Calabar Teaching Hospital up to present. He has attended many International and local conferences which includes: International Conference on Hematology & Blood Disorders held in Baltimore, USA and he is a reviewer of many articles in many international and local journals which include: Journal of Medical Disorders (open access journal), Journal of Medical Laboratory Science. His interest in Antioxidant Immunology of diseases revolves around the evaluation of Malaria and HIV infections, management and cause- effect of treatment of these diseases. In Immuno- Hematology, he is interested in molecular models, particularly the pathogenesis and survival pattern of these diseases in the host. He has published his Research in leading International journals.
Abstract:
Primary hematologic diseases are common in the aggregate but hematologic manifestations secondary to the disease occur even more frequently. Patient with Blood disorder in Nigeria make about 1: 1000 ratio of overall patients that visit the outpatients department of Nigerian hospitals. Blood disorders basically can affect Red blood cells, which carry oxygen to the body tissues; White blood cells which fight infections; and Platelet which help blood to clot. Blood disorder can also affect the liquid portion of the blood cell plasma. Harmony is an agreement or being in one accord. It is a pleasing combination of elements that makes things successful, while a team is a group of people involved in the same activity or work. However with harmonious agreement, a group of health professionals involved in the management of blood disorders could accomplish a better patient recovery outcome. Health professionals in Nigeria include: Medical Doctors, Medical Laboratory Scientist, Nurses, Physiotherapists, Radiologists/Radiographers, Occupational Therapist, Pharmacists, Social care professionals, Cleaners etc. Team work cannot be accomplished in the absence of disharmony. Global best practice advocates that patient management through team work and harmonious working relationship between health professionals results in better patient outcomes. Lack of harmony and team work among health workers have been reported as the greatest factor resulting in unproductive teams. Reports show that there is lack of harmony and teamwork among health professionals in Nigeria. This is traceable to many factors which include, struggle for supremacy “who is who” and “who is above who” in our hospitals. Self glorification, superiority, ego, self realisation and feeling of being an island of knowledge are all root causes of disharmony in the Nigerian health sector. Literature and reports from previous studies indicate that harmony among health workers is very vital to improving health indices. The aim of this paper is to have in-depth look at the scope of harmony and teamwork among health workers in Nigeria in the management of blood disorders, arranging them in categories that cover the full array of human concerns, from professionalism to the materialism and from corporate to the personal agenda. However, it is concluded that the degree of disharmony among health professionals in Nigerian Health care system is censorious. This has translated into poor team working, resulting in poor patients’ management.
Fredrick Christy C
1University of Abuja, Nigeria
Title: Malaria parasitaemia among long distance truck drivers in the Niger Delta of Nigeria
Biography:
Christy C Fredrick is currently working with Department of Haematology, University of Abuja, Abuja, Nigeria. Area of interests includes blood malignancies and haematology.
Abstract:
Introduction: Malaria is a life threatening disease caused by the Plasmodium parasite which is transmitted through the bite of the infected female mosquito. Malaria poses an enormous public health burden and greater than 75% of the global clinical episodes of malaria infection each year are concentrated in Africa. Methods: A comparative cross-sectional descriptive study was conducted among long distance truckers plying one of the major national highways in the Niger Delta of Nigeria. The study was conducted between April and June 2009. A total of one hundred consecutively recruited long distance truck drivers aged 21-60 years with a mean age of 42.36±5.23 years were screened for the presence of malaria parasitaemia. Results: Out of the 100 truck drivers screened, 35 (35%) were positive for malaria while 65 (65%) were negative. Plasmodium falciparum was responsible for all cases of malaria infection. The highest prevalence of malaria occurred among drivers in the 51-60 years age group (40.5%). The mean and standard deviation (SD) of parasite load was 1020 (125) parasites/l in subjects positive for malaria. The mean CD4 count was significantly higher among non-parasitized truck drivers compared to P. falciparum parasitized drivers 820±42.0 (731-902 cells/μl) and 570±30.0 (510-630 cells/μl) respectively (chi square=74.00; p=0.03). We observed a significant negative correlation between plasmodial infection and CD4 lymphocyte count among Plasmodium falciparum-infected subjects with r=-0.56 (p=0.001). Conclusion: This study indicates that long distance drivers are susceptible to malaria infection. There is a need for interventions such as mass media campaigns, peer/outreach education and life skill programs in the halting point where these drivers meet in order to bring about a reduction in the prevalence of malaria infection. There is also the need for the promotion of long lasting insecticidal bed nets (LLINs), intermittent preventive treatment (IPTp) and effective case management of malarial illness among long distance drivers.
- New Drug Development in Hematology
Session Introduction
Knox Van Dyke
West Virginia University, USA
Title: Development of a new approach to treat children and pregnant women infected with falciparum malaria using effective antimalarial drugs and supplements which stimulate the immune system
Biography:
Knox Van Dyke completed his PhD in Biochemistry in the Nobel Prize Department of Dr. Edward A Doisy at Saint Louis University in 1966. He began to study about malaria at West Virginia University Medical School and developed the first high throughput screening system for antimalarial drugs identifying mefloquine and halofantrine which were commercially developed. He and Associate Professor Zuguang Ye recognized bisbenzylisoquinolines synergize with chloroquine causing resistance reversal to chloroquine as demonstrated in Aotus monkeys creating a malarial cure. He edited and published 7 books for CRC Press, Boca Raton Florida and has written over 300 manuscripts.
Abstract:
Despite the availability of adequate preventatives, falciparum malaria is still responsible for the deaths of hundreds of thousands of people yearly. The majority of these victims are young children and pregnant women. The key question is why does this occur? The vulnerability of these populations is likely caused by a deficiency in nutrition affecting the host immune system. Scientists have demonstrated that falciparum malaria patients (FMP) have a biochemical deficiency caused by insufficient amounts of the amino acid L-arginine (L-arg). L-arg is substrate for the enzyme- nitric oxide synthase 2 (NOS2) which generates large amounts of nitric oxide (NO). NO reacts with a form of oxygen which generates a substance which can kill the malarial parasite. The parasite protects itself by producing and releasing L-arginase which degrades the l-arginine of the host thus preventing the NO-based toxicity. Children need L-arginine as an essential amino acid to be healthy so the parasite depletes this amino acid and prevents a needed substance from being used by their body and it also prevents the production of this key ingredient to fight the parasite. This same scenario likely occurs to the unborn child in pregnant women. In addition, pregnancy produces a somewhat immunosuppressed state causing increased morbidity and mortality. We plan to study the combination of artemether and lumefantrine with several types of sustained release nitric oxide nutritional supplements compared to drugs alone in these two populations.
Biography:
Erhabor Osaro completed his Ph.D. in Immuno-hematology at Rivers State University of Science and Technology at Rivers State, Nigeria. He is a fellow of the Institute of Biomedical Science London. He has many scientific awards including the British Blood Transfusion Society and Margaret Kenwright- young scientist’s awards. He has written more than 140 articles, 4 books and 5 book chapters. He is reviewer and editor of several scientific journals from around the world.
Abstract:
Despite the availability of adequate preventatives, falciparum malaria is still responsible for the deaths of hundreds of thousands of people yearly. The majority of these victims are young children and pregnant women. The key question is why does this occur? The vulnerability of these populations is likely caused by a deficiency in nutrition affecting the host immune system. Scientists have demonstrated that falciparum malaria patients (FMP) have a biochemical deficiency caused by insufficient amounts of the amino acid L-arginine (L-arg). L-arg is substrate for the enzyme- nitric oxide synthase 2 (NOS2) which generates large amounts of nitric oxide (NO). NO reacts with a form of oxygen which generates a substance which can kill the malarial parasite. The parasite protects itself by producing and releasing L-arginase which degrades the l-arginine of the host thus preventing the NO-based toxicity. Children need L-arginine as an essential amino acid to be healthy so the parasite depletes this amino acid and prevents a needed substance from being used by their body and it also prevents the production of this key ingredient to fight the parasite. This same scenario likely occurs to the unborn child in pregnant women. In addition, pregnancy produces a somewhat immunosuppressed state causing increased morbidity and mortality. We plan to study the combination of artemether and lumefantrine with several types of sustained release nitric oxide nutritional supplements compared to drugs alone in these two populations.
- Special session
Session Introduction
Jay S Raval
University of North Carolina, USA
Title: Acquired thrombotic thrombocytopenic purpura: Disease pathogenesis, laboratory monitoring and current treatment strategies
Biography:
Jay S Raval has received his Undergraduate and Medical degrees from the University of North Carolina at Chapel Hill, during which he was a Howard Holderness Distinguished Medical Research Scholar. He was trained at the University of Pittsburgh where he has completed a Surgical Internship followed by Residency Training in Clinical Pathology. He went on to complete Blood Banking/Transfusion Medicine Fellowship Training in the joint program between the University of Pittsburgh and The Institute for Transfusion Medicine, where he has developed an interest in therapeutic apheresis and hematopoietic progenitor stem cell collection and processing. He stayed as Faculty at University of Pittsburgh and The Institute for Transfusion Medicine before joining the University of North Carolina at Chapel Hill, where he is the Medical Director of Therapeutic Apheresis, Associate Medical Director of Transfusion Medicine Services and Associate Medical Director of the Hematopoietic Progenitor Cell Laboratory. He has published over 50 peer reviewed articles, authored 8 book chapters and is on the Editorial Board of 7 journals. His research interests include: Thrombotic thrombocytopenic purpura; red blood cell storage lesion; evidence-based therapeutic apheresis and transfusion medicine practices; hematopoietic progenitor stem cell collection and processing and pathology education
Abstract:
that is due to platelet-von Willebrand Factor microthrombi in the circulation. The discovery of ADAMTS13, its role in cleaving unusually-large von Willebrand Factor multimers, and the detection of autoantibodies/inhibitors directed against this essential enzyme have reinforced the important roles of plasma exchange and immunosuppression in patients with this critical illness. TTP disease pathogenesis, routine and novel laboratory markers for diagnosing and following patients with TTP, and up-to-date treatment strategies will be covered in this lecture.
- Special session
Location: 2
Session Introduction
Robert Michael Davidson
The American Institute of Stress, USA
Title: Biophysical aspects of the Sanarelli-Shwartzman phenomenon
Biography:
Robert Michael Davidson completed his PhD in Pharmaceutical Chemistry at the age of 26 from UCSF, NSF postdoctoral fellowship at the National Bureau of Standards, Center for Analytical Chemistry, MD degree at St Louis University School of Medicine, Nuclear Medicine residency at Baylor College of Medicine, Houston, Texas, and Internal Medicine residency in Phoenix, Arizona. He was Associate Medical Director for DuPont Pharma’s Radiopharmaceutical Division 1990-1992. He has published more than 30 papers in peer-reviewed journals. He is a Fellow of The American Institute of Stress (2012-present) and presently practicing complementary/alternative/integrative internal medicine in Gladewater, Texas (USA).
Abstract:
In consideration of the “universal nonspecific mesenchymal reaction”, also referred to as the Sanarelli-Shwartzman phenomenon, we raise the question: how can the SULTs (sulfotransferases) and PAPS molecules assemble and perform the multitude of sulfation reactions required to produce all of the many posttranslational modifications of mucopolysaccharides and proteoglycans? It seems improbable to us that SULTs, which are typically highly-specific in their stereochemical requirements, would have sufficient enzymatic “promiscuity” to permit the proper positioning of the sulfuryl groups for each of many distinct locations in the 3-dimensional structure of heparan sulfate proteoglycans (HSPGs) and proteoglycans which typically populate the “mesenchyme”. We have proposed a novel chiral, paramagnetic orthomolecule as a potential candidate universal “sulfation factor”, which would potentially circumvent the high metabolic energy requirement of the SULTs/PAPS system, thru use of ELF EM energy sources. We postulate that such a factor may involve miRNAs, molecular mimicry, water-mediated allostery, and highly-stereotyped, nonspecific chemistry of the type that might have taken place on a primordial/prebiotic planet where, at least initially, only smaller and simpler orthomolecules existed. We propose that enantionmeric enrichment and chiral induction was enabled by the effect of ELF EM fields on nanoassociates of water which formed adjacent to hydrophilic surfaces in various mixtures of solutes. Hexagonal symmetry, helices of variable pitch and helix angle, and fractality are predicted to arise from an ice-like hexameric, cyclic radical-cationic cluster of water, as the basis for the “fractal dimension”, within “fractones”, which have been identified in the brain, heart, gut, and bone marrow.
- Track2: Blood- Components and Functions
Track3: Hemato-immunology & Stem Cell Research
Location: 2
Chair
Dianzheng Zhang
Philadelphia College of Osteopathic Medicine, USA
Co-Chair
Jay S. Raval
University of North Carolina, USA
Session Introduction
Dianzheng Zhang
Philadelphia College of Osteopathic Medicine, USA
Title: MicroRNA as biomarker for acute graft versus host disease
Biography:
Dianzheng Zhang has completed his PhD from University of Arizona and Postdoctoral studies from Baylor College of Medicine. He assumed an Assistant Professor position at PCOM in 2006 and promoted to an Associate Professor in 2011. He has published more than 40 papers in reputed journals and has served as a chairman for multiple international conferences.
Abstract:
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a valuable therapeutic strategy for a wide variety of diseases. Acute graft-versus-host disease (aGVHD) is a major complication in up to 75% of allo-HSCT. It is known that donor-derived T lymphocytes are the primary effector cells responsible for triggering aGVHD and mechanistically an enhanced Th1 response is considered the leading cause of aGVHD. However, the exact mechanisms involved in aGVHD development remain largely unknown. The lack of a reliable predicative biomarker of aGVHD onset prevents preemptive treatment and impedes widespread and successful application of this therapy. By monitor the changes of the miRNA levels after transplant, we found that the levels of miR-181a were reduced significantly 3-4 days prior to the onset of aGVHD. Importantly, the degree of its reduction correlated with the severity of aGVHD. Mechanistically, miR-181a affects the function of T lymphocytes by down-regulating IFN-γ in a dose-dependent manner. In addition, using a murine allo-HSCT model, we demonstrated that murine miR-181b, the human miR-181a homolog, served as an effective predictor of aGVHD. Moreover, expression of this microRNA also ameliorated the severity of aGVHD. Collectively, we demonstrated that the level of miR-181a can serve as a reliable biomarker for the prediction of the aGVHD and this provided a window for treating aGVHD preemptively. Finally, results from the experiments conducted in the mouse model indicate that manipulation of miR-181a levels may be a potential strategy in prevention of aGVHD.
Abishek B Santhakumar
Central Queensland University, Australia
Title: Role of antioxidants and polyphenols in thrombosis and haemostatic function
Biography:
Abishek B Santhakumar obtained his Masters in Laboratory Medicine at RMIT University, Australia in 2010. Linking up isolated facts into comprehensive understandings to discover something is what science is described as and this cognitive process fascinated him to pursue a PhD in Haematology at Griffith University, Australia (2011-2014). His research interest is to get cogent evidence on how natural dietary antioxidants may help alleviate the risk of thrombosis and its potential as anti-platelet therapy. He has published a number of peer-reviewed journal articles, reviews and successful in research grants. He is currently an academic/researcher at CQ University, Australia doing what he loves the most.
Abstract:
Platelet hyperactivity and oxidative stress play a central role in the pathogenesis of many disorders including cardiovascular disease, thrombosis and type 2 diabetes. Natural antioxidants and polyphenols are believed to exhibit cardio-protective properties via their free radical scavenging activity. In this research, the anti-thrombotic potential of taurine, caffeine, anthocyanin polyphenol and its active metabolite hippuric acid was evaluated. It was found that taurine and caffeine, in vitro, synergistically lowered platelet aggregation and prolonged time taken for clot formation. Dietary supplementation with a novel variety of Queen Garnet plum juice (QGPJ), rich in anthocyanins, for 4 weeks reduced platelet hyperactivity/aggregation, reduced biomarkers of oxidative stress, and favorably altered coagulation parameters in normal healthy individuals. This antithrombotic activity of QGPJ was greater under an exercise-induced model of oxidative stress in healthy individuals. Hippuric acid, in vitro, also demonstrated reduction of platelet hyperactivation. Supplementation with QGPJ did not alter thrombosis specific gene expression. The results demonstrate the potential of natural antioxidants in reducing platelet hyper activation related thrombogenesis in both normal and prothrombotic conditions. Further mechanistic studies are warranted to unveil the potential of such natural compounds in complementary antiplatelet therapy.
Shigetaka Shimodaira
Shinshu University Hospital, Japan
Title: Dendritic cell-based cancer immunotherapy
Biography:
Graduated from Shinshu University School of Medicine, Japan received MD in 1990. Specialized in Hematology and Oncology at the Graduate School of Medicine of Shinshu University and received a PhD in 1997. Studied the pathogenesis of HCV in the USC, CA, from 1999 to 2001. Conducted educational and clinical activities to promote transfusion medicine in the Shinshu University Hospital since 2002. Became a Director of Advanced Center for Cell Therapy in the Shinshu University Hospital since 2011. Became a Professor of Advanced Center for Cell Therapy, Shinshu University Hospital since 2013.
Abstract:
Despite the significant recent advances in the therapeutics for cancer, it still remains extremely difficult to treat advanced cancers with organ involvement and distant metastasis. A manufacturing technology for antigen-presenting cell (APC)-based immunotherapy is being developed, with active dendritic cell (DC), the most potent APCs of the immune system, being under investigation for therapeutic vaccination against cancer for strong induction of the T cells against tumor antigens. The ex vivo technique is being developed for DC-based cancer vaccination, most of which is the preparation of autologous mature monocyte-derived DCs derived from apheresis of patients’ blood. Cancer vaccine therapies are principally attributed to the presence of tumor-associated antigens. Wilms tumor 1 (WT1), an attractive target antigen widely expressed in every cancer, sarcoma, and leukemia, has been shown to the most potent cancer-associated antigens for immunotherapy. DC vaccine loaded with HLA class I/II–restricted WT1 peptides may be potentially strong therapeutic activity against cancers. DC-based immunotherapy targeting WT1 was indicated to be safe and feasible for the management of advanced cancers including pancreas, lung, and ovary, exhibiting ‘delayed separation’ curve in some patients. The vaccination would be feasible option even for patients with malignant brain tumor and acute leukemia after hematopoietic stem cell transplantation to control minimum residual disease. In future, the blockade of immune checkpoints in combination with DC-vaccination would be promising therapeutic strategies to activate therapeutic anti-tumor immunity for advanced cancers and hematological malignancies.
Anita Nadkarni
National Institute of Immunohematology, India
Title: Effect of group of genetic markers on induction of fetal hemoglobin and disease severity in hemoglobinopathies
Biography:
Anita Nadkarni has completed her PhD in year 1995 from University of Mumbai and Postdoctoral studies from the National Institute of Advanced Industrial Science and Technology (AIST), Tsukuba Japan. She is the Deputy Director of National Institute of Immunohematology. She made outstanding contribution to the field of molecular genetics of thalassemia and other hemoglobinopathies during the past two decades. She is recipient of many national and international awards. She has published more than 110 papers in reputed journals and has been serving as an Editorial Board Member of repute
Abstract:
As higher HbF levels in patients with β thalassemia or sickle cell anemia are associated with milder phenotypes, several groups are exploring the factors that regulate the switch from fetal to adult hemoglobin and its therapeutic potential. The contributions of cis-acting elements to HbF production are critical to understand the variable clinical phenotypes of β-thalassemia and sickle cell anemia. Recently, there has been considerable progress made in defining the loci or genomic regions that may often be involved in the regulation of the switch from fetal to adult hemoglobin. In the study we enrolled 79 β thalassemia homozygous, 11 sickle cell anemia and 14 sickle-β thalassemia individuals. Fifty age and sex matched healthy individuals were enrolled as the normal control group. Our objective was to study the effect of cis-DNA haplotypes, motifs, or polymorphisms (Pre G γ globin gene haplotypes, Aγ–δ intergenic region haplotypes XmnI and (AT)x(T)y polymorphisms, β-LCR HS2 and HS3 site motifs) that may contribute to higher HbF levels and a milder clinical course. We found that a combination of T haplotype of the Aγ–δ intergenic region,TAG Pre-Gγ haplotype, presence of the XmnI polymorphism along with the (AT)9(T)5 motif constitutes a topography that co-relates with raised HbF levels which may contribute in ameliorating the disease severity.
Sayeedul Hasan Arif
Jawaharlal Nehru Medical College, India
Title: Single donor versus pooled random donor platelet concentrates: A review of literature
Biography:
Sayeedul Hasan Arif has completed his MD in pathology in the year 1991. He has joined the Department of Pathology, J. N. Medical College, AMU Aligarh (India) as Demonstrator for three years and later joined the Department as Assistant Professor in 1995, promoted to Associate Professor in 2004 and joined as Professor in 2010 and still working on same post. He is also In-charge of Blood Bank and of Central Investigation Laboratory. He was Member of Medical Education Unit in Faculty of Medicine since 2009-2014 and Fellow in Medical Education (FIME). He has also served Hospital in the capacity of DMS from 2011-2013. He has more than 30 papers to his credit in various international and national renowned journals. He is the winner of William Harvey Research Award in Hematology-2015 for his publication for Incidental detection of Hemoglobin C trait in a 7 year male child in Journal for Hematology. He is also Member of Review Committee for various national and international journals.
Abstract:
Both platelet concentrates (PC) obtained from 6-7 Buffy coat of whole blood or single donor platelets (SDP) obtained by aphaeresis are indicated to treat hemorrhage secondary to thrombocytopenia which includes Dengue, Malaria, ITP, TTP, DIC, Septicemia etc. Dengue and Malaria are very important indications in developing countries like India. It is also used to provide prophylaxis from hemorrhage in patients with bone marrow suppression. Currently platelet transfusion therapy is limited due to several reasons, including the consequences of alloimmunization in chronically transfused patients and septic reactions caused by bacterial contamination. There is lot of discussion and debate about which platelet product should be used; many transfusion medicine services favor the primary use of PC, whereas others favor SDP. This review will discuss five areas that should be considered when there is a debate between use of SDP or PC: Infectious complications, transfusion reaction rate, leuko-depletion, reduction of transfusion frequency in patients with bone marrow aplasia and alloimmunization associated with their use and prevention. Various authors believe that SDP offers main advantages over PC for most of these issues. However, taken the issue of high cost with SDP, a PC should be considered wherever possible in developing countries like India, taking into account risk benefit ratio.
Biography:
Shyama Soorambail Keshava has completed his PhD degree in 1989 from Mangalore University. He is currently serving as a Professor in Zoology in Goa University since 2006. He has published 30 papers in reputed journals and has been serving as a Reviewer for several journals of international repute.
Abstract:
The lympho-hematopoietic elements undergo rapid multiplication in humans and are also the most radiosensitive cells. Ionizing radiations target DNA and induce mutations. Radiotherapy resulting in optimum absorbed dose will help us to minimize the unwanted side effects irradiation. The present in vivo study is undertaken to know the dispersed radiation dose-response in the peripheral blood leukocytes of cancer patients in the context of partial body irradiation. The genotoxic effect of γ-radiation was studied in HNSCC patients exposed to various cumulative doses 60Co gamma rays during radiotherapy (RT). These patients (P1 to P30) were irradiated for a period of six weeks with a daily fraction of 2 Gy, consecutively for 5 days every week. The genotoxic effects of radiation in these patients were analyzed every weekend employing the chromosomal aberration, comet assay and cytokinesis block micronucleus assay. Blood of these patients collected before starting with RT (pre-therapy) served as control samples, whereas, blood collected during the week ends at weekly intervals of 1 to 6 weeks during the course of RT served as treated (10, 20, 30, 40, 50 and 60 Gy) samples. Radio-sensitivity of these patients was analyzed by employing linear regression analysis. Genetic damage observed in all patients on a weekly basis were recorded and analyzed at the individual level in comparison with their own pre-therapy baseline data, employing student’s t-test. High level (p<0.001) intra-individual variations were observed in the genotoxic response of HNSCC patients exposed to gamma irradiation (ANOVA). Results of this study indicate a dose dependent increase of cytogenetic damage in leukocytes. Thus, cytogenetic studies in peripheral lymphocytes following gamma radiotherapy of tumors may help to understand the optimum/precise dose of radiation to be employed for RT beyond which it may lead towards the induction of secondary tumors in irradiated HNSCC patients.
Biography:
Shyama Soorambail Keshava has completed his PhD degree in 1989 from Mangalore University. He is currently serving as a Professor in Zoology in Goa University since 2006. He has published 30 papers in reputed journals and has been serving as a Reviewer for several journals of international repute.
Abstract:
The lympho-hematopoietic elements undergo rapid multiplication in humans and are also the most radiosensitive cells. Ionizing radiations target DNA and induce mutations. Radiotherapy resulting in optimum absorbed dose will help us to minimize the unwanted side effects irradiation. The present in vivo study is undertaken to know the dispersed radiation dose-response in the peripheral blood leukocytes of cancer patients in the context of partial body irradiation. The genotoxic effect of γ-radiation was studied in HNSCC patients exposed to various cumulative doses 60Co gamma rays during radiotherapy (RT). These patients (P1 to P30) were irradiated for a period of six weeks with a daily fraction of 2 Gy, consecutively for 5 days every week. The genotoxic effects of radiation in these patients were analyzed every weekend employing the chromosomal aberration, comet assay and cytokinesis block micronucleus assay. Blood of these patients collected before starting with RT (pre-therapy) served as control samples, whereas, blood collected during the week ends at weekly intervals of 1 to 6 weeks during the course of RT served as treated (10, 20, 30, 40, 50 and 60 Gy) samples. Radio-sensitivity of these patients was analyzed by employing linear regression analysis. Genetic damage observed in all patients on a weekly basis were recorded and analyzed at the individual level in comparison with their own pre-therapy baseline data, employing student’s t-test. High level (p<0.001) intra-individual variations were observed in the genotoxic response of HNSCC patients exposed to gamma irradiation (ANOVA). Results of this study indicate a dose dependent increase of cytogenetic damage in leukocytes. Thus, cytogenetic studies in peripheral lymphocytes following gamma radiotherapy of tumors may help to understand the optimum/precise dose of radiation to be employed for RT beyond which it may lead towards the induction of secondary tumors in irradiated HNSCC patients.
Jummanah Jarullah
King Abdulaziz University, Saudi Arabia
Title: Glucose 6 phosphate dehydrogenase- A pharmacogenetics gene
Biography:
Jummanah Jarullah is working as a haematological researcher for past 25 years. Her main field of expertise is in molecular hemoglobinopathies. During her career, she has published many papers and is a reviewer of many journals.
Abstract:
G6PD deficiency play important role in establishing the discipline of pharmacogenetics. Personal genomic makeup is responsible for the efficacy and side effect of the drugs in different ethnic groups. G6PD has shown marked polymorphism in many populations in past and present. This makes G6PD gene a marker for the origin, migration and genetic drift. Deficiency of G6PD enzyme is a silence phenomenon. G6PD deficient individuals have sudden unwarranted haemolytic attack. Global burden for this disease is huge. Although many countries have made G6PD neonatal screening mandatory, there remain quite a few populations who are unaware of their prevalence rate. New drug may be safe for one ethnic group while unsafe for other group since G6PD deficiency variants vary from one population to the other. Fresh drugs should therefore be tested in more than one ethnic group for safety parameters, before approval. Continued Drug Monitoring after release should monitor to spot unusual drug reactions early and to allow for prompt control. Detection of G6PD variants in various populations and its effect on various drugs will be helpful in making the drug safely administered in particular ethnic group. We are beginning an era, to learn how to deal with personal preventive and prognostic health approach instead of being draconian in our approach to health.
- Various Aspects of Haematology
Location: 1
Chair
Harald Engan
Mid Sweden University, Sweden
Session Introduction
Harald Engan
Mid Sweden University, Sweden
Title: Hemoconcentration following spleen contraction
Biography:
Harald Engan completed his PhD in Health Sciences in 2015 at Mid Sweden University and is now working as a Researcher in the Norwegian Lung and Heart Association as well as at the Department of Health Sciences at Mid Sweden University. He is working in a multidisciplinary research field including experimental environmental physiology, cardiac exercise and cancer rehabilitation research. He has published 5 papers in reputed journals regarding the effects of spleen contraction on hemoconcentration during physiological stress.
Abstract:
Hemoconcentration following stress has often been explained in terms of increased number of erythrocytes and unchanged plasma volume (polycythemia vera, secondary polycythemia), and decreased plasma volume and constant number of erythrocytes (stress-polycythemia). However, another potential mechanism is hemoconcentration following contraction of the spleen. During exercise and hypoxia many mammals can mobilize large numbers of erythrocytes from the spleen in order to improve oxygenation of metabolically active tissue. Such “autotransfusion” of erythrocytes improves O2-carrying capacity, and increases both the aerobic performance in terrestrial mammals and the diving capacity of, e.g., seals. In adult humans, the splenic reservoir contains on the average 200-250 ml of blood, with more than twice the hematocrit of normal arterial blood. The extent of splenic contraction after apnea and exercise in humans has been reported to be 18-56% resulting in a concomitant increase in hemoglobin concentration by typically 3-6%, a response not seen in splenectomized individuals. The response is not due to hemoconcentration from extravasation of plasma, and is reversible within approximately 10 minutes. Numerous animal studies implicate the importance of the sympathoadrenergic system for initiation of splenic contraction. Adrenoreceptors are located in the splenic capsule and parenchyma, and the splenic nerve is composed of 98% sympathetic nerve fibers. Consequently, neurostimulation, epinephrine, norephineprine all cause α-mediated contraction of the spleen, and infusion by low-dose ephineprine also produce rapid spleen contraction in humans. It is known that spleen contraction can be increased by hypoxia and hypercapnia, and is evident in healthy subjects and COPD and OSA patients.
Biography:
Nilanjan Ghosh earned his medical degree from University of Mumbai, India. He obtained a PhD in Molecular Biology from the University of South Florida. After completing his Internal Medicine Residency he obtained a fellowship in Hematology and Medical Oncology from the Johns Hopkins University, School of Medicine where he also served as faculty. He is currently the Director of Lymphoma program, and Associate Director of Clinical Trials at the Levine Cancer Institute, Charlotte, NC. He has published numerous papers in reputed journals and earned awards from the Leukemia and Lymphoma Society as well as the American Society of Clinical Oncology.
Abstract:
Curative treatment options for relapsed or refractory lymphoma are limited. Both autologous and allogeneic hematopoietic stem cell transplantation have been used in this setting. Traditionally, allogeneic stem cell transplantation has been associated with a lower relapse rate than autologous stem cell transplantation due to the graft versus lymphoma effect. Traditionally, this benefit from allogeneic transplantation was offset due to higher non-relapse mortality when compared to autologous transplant. With the introduction of reduced intensity and non-myeloablative regimens, the non-relapsed mortality from allogeneic transplantation has decreased in the last decade. However, in selected high risk lymphomas, the use of reduced intensity transplant alone may lead to early relapse prior to the emergence of an effective graft versus lymphoma effect. In such situations a tandem approach of autologous transplantation followed by reduced intensity allogeneic transplantation has been successful. In addition, the use of alternative donor transplants has widely expanded the donor pool for allogeneic transplants. Careful selection of transplant modality based on disease characteristics and comorbidities is key to successful stem cell transplantation in lymphoma.
Dalia Omran
Cairo University, Egypt
Title: Epidemiological aspects of intrafamilial spread of HCV infection in Egyptian population: A pilot study
Biography:
Dalia Omran is an associate Professor of Hepatology and gastroenterology at Kasr Al Ainy School of Medicine, Cairo University. She is interested in HCV and HBV related chronic liver disease, factors associated with hepatic fibrosis progression, non alcoholic fatty liver disease, and molecular pathogenesis of HCC. She has many publications in peer reviewed journals
Abstract:
Background: Liver disease is a leading cause of morbidity and mortality among Egyptians. The major cause is infection with HCV, with 70,000 up to 140,000 newly reported cases annually. The objective of this study was to determine the prevalence of anti-HCV antibodies among household contacts of HCV index cases and to identify the possible risk factors of transmission of HCV among Egyptian families. Materials & Methods: The present external pilot study (multi-centre study) was performed on a convenient sample of 125 index cases and their 321 household family contacts recruited from Mansoura and Cairo University where 2 questionnaires were used to collect data from the index and their related contacts. The all were exposed to clinical examinations, routine laboratory testing and screening for the prevalence of Anti-HCV antibodies. Results: The prevalence of anti- HCV seropositivity among household contacts of index cases was found to be 13.7%. Husbands of female index cases ranked first followed by wives of male index cases (36.36% versus 17.86% respectively, p < 0.0001) while sons and daughter followed (6.84% and 4.94% respectively). When the distribution of household contacts by risky behaviour towards index cases was investigated, it was found that significant prevalence of anti-HCV antibodies positivity was detected between household contacts reporting their index cases having haematemsis and/or bleeding wound (p < 0.05), and household contacts giving IV injection to their index cases (p < 0.05) and household contacts visiting the same dentist as the index cases (p < 0.01) when compared to household contacts not exposed to the same risk factors. Conclusion: Transmission might occur during family contact and sexual behavior
Amar Ranjan
All India institute of medical college, India
Title: Extramedullary plasmablastic plasma cell myeloma presenting as plasmablastic lymphoma
Biography:
Amar Ranjan Singh is currently working as an assistant professor at All India Institute of Medical Sciences, under Institute Rotary Cancer Hospital, India in Laboratory Oncology.
Abstract:
Introduction: Multiple myeloma (MM) is a clonal plasma cell proliferative disorder that accounts for 1% of all malignancies and 10% of malignant hematologic neoplasms. Plasmablastic MM is a morphologic subset of myeloma, in which the bone marrow (BM) aspirate smear shows ≥2% of plasmablasts. Short clinical history: 31 year old male presented with pain & rapidly growing swelling in right side of oral cavity & face for one month. Clinical examination showed ulceroproliferative growth covering 40% of oral cavity & cervical lymphadenopathy. Mass lesion was seen in right maxilla on CECT. Skeletal survey was normal at presentation. There was no B symptom. Viral markers were negative. Serum electrophoresis (SEP) shows no M-band. FNAC showed large atypical cells with LCA (CD45)+ve & HMB 45-ve (excludes malignant melanoma) suggestive of NHL. Biopsy showed malignant cells positive for CD79a, CD138, MUM1 & negative for CD20, CD3, CD56, CK & HMB45, suggestive of plasmablastic lymphoma (PL). Peripheral blood smear was normal. BMA smear showed 50% Plasma cells predominantly plasmablasts, was supported by BM biopsy. After 6 cycles of CHOP, repeat BMA showed 20% plasma cells, SEP showed no M-band, Serum free light chain (SFLC) ratio kappa/lambda 429/15.84=27.09 (0.26 to 1.65), B2 microglobulin 3.263 (1.21-2.70 mcg/mL) & creatinine 1.8 mg/dl. Therapy for Plasmablastic myeloma (PBM)/Multiple myeloma (MM) started. After 4 cycles of thalidomide +dexamethasone plan was switched to Bortezomib + dexamethasone. Symptomatic improvement was seen with normal hemogram/biochemistry. Discussion: This case presented with PL, later turned out to be PBM. Initially showed no feature of myeloma, with passage of time on SFLC ratio & B2 microglobulin gave the clue in this case. A careful monitoring of therapeutic response is must for these two.
Ravisekhar Gadepalli
All India Institute of Medical Sciences, India
Title: Role of protease-activated receptors (PARs) and G-proteins in thrombin induced monocyte/macrophage migration
Biography:
Ravisekhar Gadepalli after completing his Postdoctoral studies (2009-2013) from St. Jude Children Research Hospital, Memphis, USA, has joined as a Faculty at AIIMS Jodhpur in 2013. He is an active Member of American Society for Microbiology and American Heart Association. He has several notable achievements and awards to his credit. His work in the field of Clinical Microbiology, Immunology and Vascular Biology has culminated in the publication of 18 research papers in peer reviewed journals (Proceedings of National Academy of Sciences USA, Journal of Biological Chemistry. Arteriosclerosis, Thrombosis and Vascular Biology, etc) of national and international repute with cumulative impact factor: 78.046 (Citation Index: 410).
Abstract:
The recruitment of monocytes/macrophages to the sites of dysfunctional endothelium and transformation of these cells into foam cells by the uptake of oxidized lipoproteins in the sub endothelium are the major pathophysiological features of atherosclerosis. Since thrombin is produced at the sites of vascular injury and in order to understand its involvement in atherosclerosis, we tested its role in the modulation of THP-1 cell migration. Thrombin induced THP-1 cell migration in a dose dependent manner. Thrombin induced sequentially the tyrosine phosphorylation of Pyk2, Gab1 and p115 RhoGEF leading to Rac1 and RhoA-dependent Pak2 activation. Downstream to Pyk2, Gab1 formed a complex with p115 RhoGEF involving their PH domains. Furthermore, depletion of Pyk2, Gab1, p115 RhoGEF, Rac1, RhoA or Pak2 levels using their respective antisense oligos substantially attenuated thrombin-induced THP-1 cell cytoskeleton formation and migration. In addition, SCH79797, a selective PAR1 antagonist, inhibited thrombin-induced Pyk2, Gab1 and p115 RhoGEF tyrosine phosphorylation and Rac1-RhoA-depenedent Pak2 activation resulting in diminished THP-1 cell cytoskeleton formation and migration. Together, these observations reveal that thrombin induces THP-1 cell migration via PAR1-dependent Pyk2-mediated Gab1 and p115 RhoGEF interactions leading to Rac1-RhoA-Pak2 activation. Based on these findings, we envision a role for thrombin and its receptor PAR1 in atherosclerosis.
Udodirim Evelyn Okoro
Federal Medical Center Umuahia, Nigeria
Title: The effect of hematology in African hospitals and patients
Biography:
Udodirim Evelyn Okoro has completed her Postgraduate program at the Imo State University of Education Department. She is the Director of Adult Education Career at the Umuahia South Local Government of Abia state Nigeria. She supervises hospital and patients of about 25 daily at the Federal Medical Center Umuahia. She is an English Instructor that carries health information to Nigerians and the World.
Abstract:
Objectives: This article was designed to investigate and confirm the effect of hematology and blood disorder in Africa hospital and patients with effects of hematology. The purposes are to investigate, analyze, challenges and proffer solutions that would easy the sufferings of the patients as several authorities were consulted. Methods: Reports, articles and references on hematology and blood disorder should be used; reports on people who have blood disorder through HIV status which involved men, women and younger people at the age of 18-28 weeks gestation; Male (12) and Female (18) making 30 patients and one huge hospital were used in the investigations. Clinical study of participants was asked to sign informed consent form. These participants may withdraw from this study at any time; qualitative method usage explores, classify, phenomena being studied. It uses observation and interview; quantitative method was used; surveys, questionnaires or laboratory experiments are used and collected with statistical analysis; interview listens to patients and doctors recount something that happened with open-ended questions; questionnaires gather information among hospitals and patients who have hematology or blood disorder or participated or help evaluate behavior and lifestyle; observation here is “the systematic description of events, behavior and artifacts in the social setting chosen for study.”; “Participant observation involves genuine process of learning through exposure to day-to-day activities of participants in the researcher setting”. Results: This writer spotted hypertension in 14% of the patients. Range age was 18-75 years of the patients. 1 and 4 years duration with 44.2% of males and 55.8% were females had blood disorders, myelofibrosis and thrombocythemia. Others are vein thrombosis, blood clot, portal diagnosis, hepatomegaly and splenomegaly etc. Results patterned include nonverbal expression of patients, reactions, monitor events, observation and better understanding of the context under study. Validity is stronger through the use of interviewing, document analysis, surveys and questionnaires, build theory and answer research questions. Conclusion: We must collectively and individually not rest in the past glory but improve the healthcare, safety and patient effective treatments in our respective hospitals.
EMMANUEL KUFRE UKO
Universityof Calabar, Calabar Nigeria
Title: Impact of an anti-retroviral African herbal preparation with a trade mark ‘Winnie cure’, on some haematological parameters of HIV infected patients in Nigeria
Biography:
E K Uko is a Professor of haematology and Blood Transfusion Science, University of Calabar. He received his Doctorate in Immuno-Hematology from University of Calabar. He is also a holder of Associate and Fellowship of Medical Laboratory Science Council of Nigeria (MLSCN). Before becoming a full time Lecturer, he worked as a practicing Medical Laboratory Scientist, undertaking routine Hematology Laboratory investigations, take Emergency calls and organizing hematology practical to Medical students and Medical Laboratory Science students of College of Medical science, University of Calabar. He is up to present a Professor of Medical Laboratory Hematology at College of Medical Science, University of Calabar, where he is teaching and supervising projects in Hematology and Blood Group Serology to Medical students, Medical Laboratory Science students and several Msc & PhD Students. He is a Consultant Laboratory Hematologist with University of Calabar Teaching Hospital up to present. He has attended many International and local conferences which includes: International Conference on Hematology & Blood Disorders held in Baltimore, USA and he is a reviewer of many articles in many international and local journals which include: Journal of Medical Disorders (open access journal), Journal of Medical Laboratory Science. His interest in Antioxidant Immunology of diseases revolves around the evaluation of Malaria and HIV infections, management and cause- effect of treatment of these diseases. In Immuno- Hematology, he is interested in molecular models, particularly the pathogenesis and survival pattern of these diseases in the host. He has published his Research in leading International journals.
Abstract:
The crystalline powder preparation of the herbal extract was prescribed at a dose of 5 ml containing 250 mg, taken three times daily. Preliminary laboratory studies in animals and humans were reported to be safe in humans. This herbal preparation is reported to manifest a reasonable degree of recovery from HIV symptoms. This may suggest inhibition of viral replication and or a possible restore of human immunity by mobilizing TWBC, especially the CD4+ and other cells. As a supposed anti-retro viral agent, we suspect that it may have some consequences on haematological parameters. The study was to assess the impact of this African herbal preparation; a supposed anti-retro viral agent on some haematological parameters. Thirty one (31) HIV patients on this preparation were enrolled for this study. The haematological parameter assessed were Hb, PCV, TWBC, differential WBC, platelet count and ESR were estimated using coulter ACT differential Analyzer and Westagreen methods respectively. Blood collection was by standard venopuncture method. The haematological parameters were assessed among the 31 confirmed HIV infected patients before they started treatment and three weeks interval from the time they started treatment till the 9th week (second, third, and fourth visits). At the first, second, third and fourth visits, the ESR (mm/hr) values were decreasing, thus indicating a positive patient response to the drug. It was observed that all the parameters showed significant variation at 3rd visit, level of platelets and PCV values being markedly raised (6 weeks of treatment). From the appreciative changes observed in the haematological parameters under assessment it was observed that the herbal preparation (Trade mark – winner cure) seems to obtain peak activity at 3rd and 4th visit (there is the 6th and 9th weeks of treatment). Clinical and pharmaceutical evaluation of the preparation for the possible use in the treatment of HIV patients is suggested.
Erhabor Osaro
Usmanu Danfodiyo University, Nigeria
Title: Challenges associated with the effective management of major haemorrhage in developing countries
Biography:
completed his Ph.D. in Immuno-hematology at Rivers State University of Science and Technology at Rivers State, Nigeria. He is a fellow of the Institute of Biomedical Science London. He has many scientific awards including the British Blood Transfusion Society and Margaret Kenwright- young scientist’s awards. He has written more than 140 articles, 4 books and 5 book chapters. He is reviewer and editor of several scientific journals from around the world.
Abstract:
Major haemorrhage is defined as the replacement of a patient’s blood volume or transfusion of >10 units of packed red cells within a 24 hours period. It can also be defined as the loss of 50% of blood volume within a 3 hours period or a loss of 150 ml per minute. Haemorrhage is a leading cause of early death in most settings in Africa following traumatic injury, intra and post - surgical and ante and post - partum. It is the cause of morbidity in 44% of maternal death in developing countries. More than 536,000 women die every year from pregnancy –related complications including ante and post partum haemorrhage. Haemorrhage accounts for 40% of deaths from trauma and is the most common cause of preventatable mortality in developing countries. The challenges associated with the effective management of haemorrhage particularly in developing countries include; chronic blood shortages, high prevalence of TTI's, reliance on whole blood transfusion, lack of other component required to manage coagulopathy, absence of a functional fit for purpose national blood transfusion service, poor inventory control of blood and blood products, suboptimal use of indication coding tool, poor management of coagulopathy, educational, cultural and awareness-related issues associated with donation and transfusion, absence of specially selected products to meet the special needs of certain patients groups, lack of infrastructure (uninterrupted power supply and challenge of cold chain management of blood product), absence of O Rhesus Negative blood for emergency use, challenge of a diminishing blood supply, challenge associated with the recruitment and retention of voluntary non –remunerated donors, reliance on family replacement and commercial blood donors, inadequate use of pharmacologic and non - pharmacologic alternatives to allogeneic blood. The aim of blood volume replacement with concentrated red cells and other plasma products following massive haemorrhage includes; to rapidly and effectively restore adequate blood volume, prevent hypovolemic shock, allow for adequate haemostasis, oxygen carrying capacity and blood biochemistry, to allow for an early and aggressive correction of coagulopathy, allow for optimal resuscitation, and to reduce potentially preventable deaths. Blood components that can play a role in the management of coagulopathy include; red cell concentrate, fresh frozen plasma, cryoprecipitate and platelet concentrate. Pharmacologic agent that can play a role in the management of coagulopathy and major haemorrhage include; anti-fibrinolytic (aprotinin and tranexamic acid), vitamin K, prothrombin complex concentrate (PCC) and Novo-7. Non-blood components and non-pharmacologic measures to manage major haemorrhage include; direct pressure /tourniquet if appropriate, stabilization of fractures, surgical interventions (damage control surgery, interventional radiology, use of endoscopic and obstetrics techniques and thromboelastometry. Evidenced based management of major haemorrhage require a coordinated approach by all stake holders involved in the management of major haemorrhage; from the managing clinician to the transfusion laboratory scientist to the porters to ensure that the management of haemorrhaging patients is timely and optimal.
- Young Researchers Forum
Session Introduction
Nikhil Mukhi
SUNY Downstate Medical Center, USA
Title: Adult T-cell leukemia/lymphoma (ATLL): Where we are in 2015
Biography:
Nikhil Mukhi has received his MBBS degree from Gandhi Medical College, India. He has completed his Internal Medical Residency from New York Medical College, NY and he is currently in his Hematology/Oncology Fellowship at State University of New York Downstate Medical Center, NY. His clinical interests are in T-cell lymphomas. He has been doing research on effective first line therapy in Adult T-cell leukemia/lymphoma (ATLL) and optimal regimens in relapsed/refractory setting.
Abstract:
ATLL is an aggressive peripheral T-cell lymphoma (PTCL) associated with clonal proviral DNA integration of human T-cell lymphotropic virus type 1 (HTLV1) with T-lymphocyte. Despite enormous advances in our understanding and treatments of aggressive lymphomas, the progress in ATLL has lagged behind. The acute and lymphomatous types have a poor prognosis with median survival of 6-13 months. Molecular and genetic characterization of this malignancy has been limited due to their rarity and often non-specific morphologic and immunophenotypic features. Currently gene expression profiling and gene sequencing studies are underway for better characterization of genetic abnormalities in this disease. Traditional chemotherapy agents are not very effective in this disease and recently the role of epigenetic dysregulation has been recognized in this disease, which may explain its sensitivity to histone deacetylase (HDAC) inhibitors. In the last 6 years, 4 new drugs have been approved by FDA for patients with relapsed/refractory PTCL: Pralatrexate and 3 HDAC inhibitors (romidepsin, belinostat & vorinostat). Multiple trials are currently underway to explore the integration of these agents in first line setting with standard chemotherapy. These recent advances are changing how we view this disease and hopefully have prepared us to change the future of this disease.
Suresh Manapuram
Allegheny General Hospital, USA
Title: Post-ERCP pancreatitis: A rare cause of atypical hemolytic uremic syndrome
Biography:
Suresh Manapuram has received his M.B.B.S degree from Rangaraya Medical College affiliated to N.T.R University of Health Sciences, India. He then served Ministry of Health, Govt of India for 2 years as a medical officer in Primary Health Care Center. Out of his interest in Academic medicine, he pursued a 2 year Clinical Teaching and Research fellowship program at St. George’s University, Grenada. He served as a faculty member in the Department of Neurosciences and Physiology for 3 years at Xavier University School of Medicine, Aruba. He then joined Allegheny Health Network in July 2014; currently he is a resident in Internal Medicine residency program at Allegheny General Hospital, Pittsburgh. His career interests include Academic Medicine, Hematology and Oncology.
Abstract:
Introduction: Atypical hemolytic syndrome (aHUS) is a rare form of thrombotic microangiopathy (TMA). It involves dysregulation of the alternate complement pathway affecting multiple organ systems. Here, we present a previously unreported case of aHUS developing after post-ERCP pancreatitis. Case report: A 52-year-old female with a history of cholelithiasis presented with abdominal pain and jaundice. Physical exam revealed RUQ tenderness without guarding. Laboratory findings showed normal cell counts with elevated bilirubin and liver enzymes. MRCP revealed gallstones with biliary sludge and she underwent ERCP with sphincterotomy. Post-ERCP, she developed severe epigastric pain with vomiting and worsening jaundice. Labs revealed elevated lipase consistent with ERCP induced pancreatitis. After four days, she developed acute anemia, thrombocytopenia and acute renal failure requiring hemodialysis. Laboratory data showed elevated bilirubin, LDH and low Haptoglobin levels. Kidney biopsy confirmed thrombotic microangiopathy. Atypical HUS was diagnosed based on low ADAMTS 13 activity, thrombocytopenia and hemolytic anemia in the presence of pancreatic and renal dysfunction. Therapy with eculizumab was initiated and laboratory findings after 10-weeks of eculizumab therapy showed improvement of platelet count, anemia and renal recovery. Conclusion: Differentiating aHUS from other causes of TMA is challenging, though ADAMTS 13 activity and stool testing can exclude TTP and HUS from aHUS. aHUS needs to be accurately diagnosed since different pathology will necessitate different therapies. Prompt diagnosis and treatment of aHUS is very essential as early initiation of therapy with eculizumab has a major impact on survival and preservation of renal function
Debipriya Banerjee,
Sinha Institute of Medical Science & Technology, India
Title: The role of different aggregating agents in the inhibition of nitric oxide synthesis in platelet aggregation
Biography:
Debipriya Banerjee is a PhD student recently submitted her thesis under Department of Physiology, University of Calcutta, India. Her work focuses on understanding the interplay between nitric oxide and the increased occurrences of acute coronary syndromes. She is a Master degree topper with a gold medal. She has received financial support from Government of India to present her findings in the conference.
Abstract:
The aggregation of platelets is by the activation of cyclooxygenase (COX) that catalyzed the conversion of arachidonic acid to prostaglandins and to thromboxane A2 (TXA2). No mechanism of release of arachidonic acid from the platelet membrane is currently available. The candidate for the first time ever reported that the inhibition of nitric oxide (NO) synthesis ultimately resulted in increased aggregation of platelets that has been reported to result in the development of acute coronary syndrome (ACS). NO was measured by methhemoglobin method. The purified nitric oxide synthase (NOS) was prepared by repeated gel electrophoresis using of the platelet cytosolic fraction by SDS-PAGE and the amino acid sequence of the purified protein was determined by mass spectrometry. Incubation of platelet rich plasma (PRP) with 8.0µM ADP resulted in increased platelet aggregation (~90%) with simultaneous reduction of basal NO level to 0nmol/108 platelets, PË‚0.0001, n=10). It was found that different aggregating agents reduced the basal NO synthesis in platelets by ~50%. This reduction resulted in the appearance of Ca2+ in the platelet cytosol and in the release of arachidonic acid from the platelet membrane for TXA2 synthesis. This novel NOS was identified to be α-1 anti trypsin (AAT), a 47kDa protease inhibitor as determined by amino acid sequence. The results demonstrated that the reduction of NO level in platelets is a priori event in the activation of COX leading to the aggregation of platelets. The identification of the NOS as the AAT can be a therapeutic target for the treatment of ACS.
Ayesha Mahmud
Birmingham Women’s NHS Foundation Trust, UK
Title: Haemostatic techniques for laparoscopic management of cornual pregnancy: The double impact devascularization technique
Biography:
Ayesha Mahmud is a Member of the Royal College of Obstetricians and Gynecologists, UK. She is an Obstetrics and Gynecology Trainee in the West Midlands region and she is currently undertaking research in maternity outcomes as part of her PhD research at the University of Birmingham. She has completed her MBBS with Honors and Distinctions from Foundation University, Pakistan. She is Co-chair of the MROG (Midlands Research Collaborative for Obstetrics & Gynecology trainees), a trainee led research organization. She has published several papers in reputed journals and she has been serving as part of the Editorial Board for StratOG; the RCOG's interactive eLearning resource.
Abstract:
Cornual pregnancy is a rare form of ectopic pregnancy, accounting for up to 2% to 4% of all ectopic pregnancies with a mortality range of 2.0% to 2.5%. Hemorrhage is a key concern in the management of such pregnancies. Traditional treatment options include a conservative approach, failing which patients are offered surgical options such as cornual resection at laparotomy which carries a high risk of hysterectomy. In recent years newer laparoscopic cornual resection or cornuotomy techniques have been used successfully to achieve better outcomes with fewer complications. We present the double-impact devascularization (DID) technique for laparoscopic management of cornual ectopic pregnancies. This technique permits hemostatic control by compression effect, which in turn allows reduction in procedure-related patient morbidity and mortality. We also provide an overview of other reported methods of hemostatic control used in similar laparoscopic procedures. DID is a useful, safe and minimally invasive technique that can be used in both laparoscopic and open surgical procedures
Suhailur Rehman
Aligarh Muslim University, India
Title: Correlative study of Mentzer’s index, RDWI and Hb electrophoresis for β- thalassemia trait
Biography:
Dr Suhailur Rehman, known for his experience in Hematology, Transfusion Medicine, Histopathology and Cytopathology, was born in 1st May 1984 in District Bijnore. He belongs to a very small town NOORPUR and with his hard work and consistenty, reached the present position. He has done his MBBS and MD Pathology from JN Medical College, AMU, Aligarh. He worked in world famous Institute SGPGIMS, Lucknow, India as a Senior Resident in Transfusion Medicine. At present he is working in JNMCH, AMU, Aligarh, India. His 13 papers are published, out of which 11 are published in International and 2 in National Journals. He presented 10 Oral papers and 24 poster papers in various Conferences/CMEs attended. He got First prize in one Oral paper and one poster paper presentation. He attended 37 conferences/CMEs/symposium and 15 workshops/training programmes. He is a sincere, enthusiastic and a dedicated young Doctor, who has a strong inclination towards research work. His approach to diagnostic work is logical and he is able to correlate his knowledge with patient’s clinical information properly. He loves to teach and his teaching style is very much appreciated by undergraduate and postgraduate students.
Abstract:
The two most frequent types of microcytic anemia are beta thalassemia trait (β-TT) and iron deficiency anemia (IDA). Differentiation between the two is very important as individuals with the β-TT are usually asymptomatic and may be unaware of their carrier status unless diagnosed. It is estimated that about 50% of the world’s population with β-TT are in Southeast Asia. Electronic cell counters have been used to determine Mentzer’s index and Red cell distribution width index (RDWI) as a screening tool for β-TT. However, a definitive diagnosis of β-TT is based on the level of HbA2 on Hb electrophoresis. Considering the importance of diagnosing β-TT at an earlier stage, this study was carried out to determine the effectiveness of mentzre’s index and RDWI as a screening tool for β-TT. All those patients who are having MCV< 80, Mentzer’s index < 13 and RDWI< 220 were included in this study. A total of 1418 patients were having MCV< 80, out of which 58 patients were having mentzer’s index <13 and 54 patients having RDWI <220. Hb electrophoresis was done on patients having mentzre’s index <13 and RDWI <220. Hb A2 level between 3.5% and 8% was seen in 86% of the patients in mentzer’s index group and 92% of the patients in RDWI group. This study showed that RDWI was a better and more accurate predictive marker for β-TT as a screening tool, in comparison to mentzre’s index. The importance of mentzre’s index and RDWI lies in the fact that both the screening methods can be used to determine the patients who are the best candidates for Hb electrophoresis. This will ease the diagnosis of β-TT, especially in developing and under developed countries where the facilities are not available so easily. Keywords: Mentzer’s index, RDWI, Hb electrophoresis, β- thalassemia trait
Olivia Ndjib
Antananarivo University, Madagascar
Title: Hemophilia- Evolution and challenges in Madagascar
Biography:
Olivia Ndjib is a third year medical student in the School of Medicine of Antananarivo, Madagascar. Since 2012, she has been facilitating meaningful and open discussions on health issues like AIDS, blood diseases, and autism in the General hospital of Madagascar, where she volunteers as a blood giver and works as a Medical Assistant (on internship). Her ambition is to work as a researcher to develop sustainable scientific method to prevent and cure blood related diseases in Africa
Abstract:
During the last past 5 years, there has being a growing concern on the increasing number of patients suffering from blood diseases in Madagascar. Regardless of illnesses such as Leukemia, Polycythemia and Sickle cells diseases, Hemophilia is the most observed. As a fact, 7 patients out of 10 received in the Hospital of Antananarivo (Hopital Joseph Ravoahangy Andrianavalona) do not survive. This precarious situation could be linked to the lack of specialists to ensure a good treatment, the ignorance of the medical personnel, the lack of sensitization of the population, cultural barriers, poverty and lack of research on these diseases in Madagascar. According to Pr Olivat RAKOTO, (only Hematologist Specialist in the Indian Ocean) but also my lecturer, there is not a reliable databank on the number of people suffering from Hemophilia and other related blood disorder in Madagascar. From her personal research, observations and clinical cases, more than 1700 of people suffering of hemophilia are not receiving adequate follow-up in the only town of Antananarivo. The impact of the situation described above on the mortality rate and the economic balance of the country is alarming. There should be a raise of awareness on this plague, which is becoming a critical public health issue in Madagascar.
- Poster presentation
Session Introduction
Vera-Aguilera Jesus
Texas Tech University Health Sciences Center, USA
Title: Bilateral orbital myeloid sarcoma preceding acute myeloid leukemia in an adult: Case report and review of the literature
Biography:
Vera-Aguilera Jesus is a physician of Internal medicine and oncology at Texas Tech University Health Sciences Center, USA. Cancer biology is his area of expertise.
Abstract:
Introduction: Acute myeloid Leukemia is typically a disease of the older population presenting mostly in the fifth decade of life. Myeloid sarcoma is rare presentation of acute myeloid leukemia previously well reported in children and younger population. We present an unusual case of retro-orbital myeloid sarcoma as an initial presentation of acute myeloid leukemia in a 43 year old Caucasian male. Case Report: In the present case, a 43-year-old male with prior unsuccessful retro-orbital masses biopsies presented with pancytopenia, further studies revealed the diagnosis of AML. The presence of retro orbital masses preceding AML is a rare, to our knowledge since 1993, a total of 11 cases of granulocytic sarcoma preceding AML in adults have been reported, most of them presenting with the cytogenic (8:21) feature with fair prognosis, in the present case we describe a very aggressive case of myelomonocytic leukemia positive for CD34 and CD117 and rearrangement of chromosome 11q23 involving MLL gene with fatal outcome. Differential diagnosis in adults who present with similar symptoms is broad and require a high index of suspicion; in a recent review performed by Priego 2012, differential diagnosis should include inflammatory/metabolic disease (orbital inflammatory pseudo tumor, thyroid orbitopathy, sarcoidosis) and neoplasm (lacrimal tumors, lymphoma and metastasis); however, the clinical behavior and response to therapy seem not influenced by age, sex, anatomic site, de novo presentation or clinical history related to AML, MDS or MPN, histotype, phenotype or cytogenetic findings. Conclusion: Granulocytic sarcoma or myeloid sarcoma is an uncommon malignant neoplasm associated with myeloid leukemia, the differential diagnosis in this age is broad and diagnosis is a challenge, therefore a multidisciplinary approach, an appropriate clinical exam and history accompanied by a high index of suspicion are needed for proper diagnosis and treatments to avoid fatal outcomes.
Divyaswathi Citla Sridhar
The University of Texas Health Science Center, USA
Title: Painful calf swelling: Think beyond deep vein thrombosis
Biography:
Divyaswathi Citla Sridhar is a Pediatric Resident at The University of Texas Health Science Center at Houston (UTHealth). She previously worked at Cleveland Clinic, PSG Institute of Medical Sciences & Research, The University of Texas Health Science Center at Houston (UTHealth).
Abstract:
Introduction: The differential diagnosis for unilateral painful swollen limb is broad; deep vein thrombosis (DVT), calf muscle tear, ruptured popliteal cyst, cellulitis, myositis, intramuscular hematoma, compartment syndrome and superficial thrombophlebitis. It is important to rule out DVT, considering the morbidity and mortality if it is unrecognized. Case Report: We present the case of a 4 year old Hispanic male with no past medical history, referred to our institution with left lower extremity pain and swelling after he tripped over a cord and fell one week prior to admission. On physical examination, his left mid-calf was edematous, non-erythematous and tender to palpation Left lower extremity (LLE) Doppler ultrasound (US) from the outside hospital was reported as left posterior tibial DVT and the patient was started on Enoxaparin (1 mg/kg/dose SQ every 12 hours). He was transferred to our institution for anticoagulation management. Repeat LLE Doppler US at our institution did not reveal DVT. In addition, D-dimer was not elevated and his hypercoagulable work up including protein C, protein S, anti-thrombin III, Factor V Leiden and prothrombin gene mutation was negative. On follow up examination, his left calf swelling had worsened and extended into the anterior aspect of the leg. Due to the absence of DVT by repeat Doppler US and clinical suspicion of intramuscular bleeding, Enoxaparin was stopped within 24-36 hours of initiation. MRI/MRV of the affected leg confirmed the presence of a large sub-acute on chronic hematoma identified within the deep muscular compartment of the mid left calf, interposed between the gastrocnemius and soleus musculature measuring 17 mm×26 mm×57 mm with no evidence of DVT. Further coagulation labs showed Factor VIII level at 24% and Factor IX level at 94%, confirming a diagnosis of mild hemophilia A. Hence, Factor VIII concentrate was administered for bleeding control. Discussion: A detailed clinical evaluation in addition to radiological evidence for DVT is warranted before initiating anticoagulation therapy, as it can aggravate non-thrombotic causes of painful calf swelling such as intramuscular bleeding. Between 10-20% of patients with hemophilia A can have an atypical initial presentation with an intramuscular bleed. Early identification and proper management of intramuscular bleeding with factor replacement is important to prevent re-bleeding, neurovascular compromise, permanent contracture and formation of pseudo-tumors. Therefore, a high index of suspicion is warranted in such cases.
Shereen Elazzazy
Hamad Medical Corporation, Qatar
Title: Clinical outcomes of implementing evidence-based practice on venous thromboembolism prevention for cancer patients in Qatar: A retrospective study
Biography:
Shereen Elazzazy has received her Bachelor’s degree in Pharmacy from Egypt in 1997 and her Doctor of Pharmacy degree at Purdue University, USA in 2011. She has extensive international experience working in Egypt, KSA and Qatar and recently completed Internship in Indiana, USA. She is currently an Assistant Director of Pharmacy-Clinical Services in NCCCR, Qatar, an Adjunct Clinical Faculty in College of Pharmacy, Qatar University, a Clinical Preceptor for College of Science, North Atlantic, Qatar, Local Mentor for Pharmacy School, Queen’s University, UK and a Clinical Sponsor, PharmD program, University of Colorado, USA. She has numerous peer reviewed publications and international conferences presentations.
Abstract:
Background: Venous ThromboEmbolism (VTE) is a serious condition; approximately 20% of VTE cases occur in cancer patients and it is a significant cause of morbidity and mortality. Hospitalized patients with cancer require VTE prevention. Breast cancer is considered a high risk for VTE due to different factors (malignancy, surgery, chemotherapy, hormonal therapy, hospitalization and female gender). Objectives: This study focuses on the assessment of clinical outcome in preventing VTE in cancer population in Qatar after implementation of evidence based VTE prevention guidelines. Methods: A retrospective study was conducted to evaluate the incidence of DVT by evaluating Doppler ultrasound, database for 364 cases of in/out-patients over 24 month (Jan 2011-Dec 2012) findings were analyzed by a hematologist to identify patients who developed DVT due to current or previous admission. Relationship between the incidence of VTE overtime and the compliance to VTE prevention protocol were established. Results: The study showed that the increase in the overall compliance to VTE prophylaxis protocol introduced to inpatients population (n=2595) increased from 61.5% to 84.6% (P=0.0297); led to decreased DVT incidence by 66.4% (P=0.0145). 50% of cancer cases developed DVT were breast cancer patients (n=24), 92% of them were outpatients.
Nevene Ramsis
Canal University Medical School, Egypt
Title: Assessment of CCAAT/enhancer binding protein α gene methylation in acute myeloid leukemia patients in Egypt: relation to response to induction therapy
Biography:
Nevene Ramsis Wissa was born in Cairo, on January 18th,1956. She is currently working as a professor at Canal University Medical School, Egypt.
Abstract:
Background: Global gene promoter studies, as well as gene-specific approaches, have revealed that aberrant promoter methylation is a common event in AML. One such gene, CCAAT/enhancer binding protein α (C/EBP α), is a key transcription factor involved in the regulation of cell proliferation and differentiation in a variety of cell types, particularly in the hematopoietic system. Because of the pharmacologic reversibility of epigenetic changes by drugs, such as the DNA-demethylating agent, epigenetic therapy seems prominently among novel leukemia treatment strategies. Purpose: The present work is a cohort study that aimed at assessing the frequency of promoter methylation of the CEBP α gene in 70 cytogenetically normal, newly diagnosed AML Egyptian patients. Furthermore, the relation between the methylation status of the CEBP α gene and the outcome of standard induction therapy on day 28 was evaluated. Patients and methods: purified genomic DNA samples from the 70 newly diagnosed AML patients were subjected to bisulfate modification before methylation-specific polymerase chain reaction was performed to assess the CEBP α gene methylation status. Clinical and laboratory assessment of patients after 28 days of induction of standard therapy was performed. Results and conclusion: fifty-four percent of AML samples showed CEBP α gene methylation at the promotor region. Positive methylation was seen associated with blast expression of T-cell markers and blast counts in peripheral and bone marrow samples; but did not privilege a particular FAB classification subtype or relate to age and gender. The positive CEBP α gene methylation status was seen acceptable to predict AML patients with resistant clone who did not respond to standard induction therapy and blast clearance at day 28 (95% CI: 0.466–0.985, p= 0.005). Assessment of CEBP α gene methylation in AML patients might lead to refined prognostic stratification and suggest differentially tailored treatment based on its methylation status.
Biography:
Amandeep Kaur has completed her Master’s degree in Medical Surgical Nursing (Oncology Nursing) from Baba Farid University of Health Sciences, Faridkot. She is currrntly pursuing Doctorate in nursing from Himalayan University, Arunachal Pradesh. She is teaching anatomy & physiology, Biochemistry, medical surgical nursing and oncology nursing since last four years. She is guiding graduate and master’s students in research work. She has published 3 papers in reputed journals and presented papers in national and international level. She is also a Blog Writer for concept research foundation.
Abstract:
Multiple myeloma is a deadly disease in which relapse is inevitable. Multiple myeloma is a B-cell malignancy of the plasma cells. Its three hallmarks include the presence of a serum or urine monoclonal immunoglobulins, monoclonal plasma cytosis and bony lytic lesions. According to SEER by NCI in 2015, 26850 new cases have been detected and 11240 deaths took place in USA alone. According to population based cancer registries, in India, incidence varies from 0.3 to 1.9 per 100000 for men and 0.4-1.3 per 100000 for women. Delhi has the highest incidence. According to research, translocation of immunoglobulin heavy chain (Ig H) locus (14q32) and deletion of chromosome 13 were found in 75% and 45% of patients with plasma cell disorders, respectively. Clinical manifestations include bone pain, particularly in the back and chest. Others are anemia, uremia and recurrent infections. The most common physical finding related to MM is pallor. Treatment options for patients with MM include primary induction therapy for transplant candidates, primary induction therapy for nont-ransplant candidates, maintenance therapy and salvage therapy. Innovative approaches in high-dose chemotherapy, use of biphosphonates, discovery of a novel proteasome inhibitor, liposomal doxorubicin and development of lenalidomide are among the most encouraging breakthroughs in therapeutics. Non-profit organizations are established for patient education services.
Hessah Alsulami
Arabian Gulf University, Saudi Arabia
Title: Does CD5 have an effect on the expression of ROR1 in Chronic lymphocytic leukemia?
Biography:
Dr. Hessah Alsulami has completed MRCPath at the age of 33 years and had fellowship in transfusion medicine from university of Bristol in UK. She is the director of Laboratory & Blood bank in IAAH
Abstract:
B cell chronic lymphocytic leukemia (CLL) is characterized by accumulation of monoclonal CD5+ mature B cells. The expression of CD5 plays a role in the malignant behaviour of CLL cells via controlling the expression of some genes that enhance the expression of: apoptosis inhibitors BCL-2, NF-κB, Wnt, and cytokine. By being naturally phosphorylated on tyrosines CD5 is chronically activated in CLL cells. Moreover, B CLL cell also characterized by the expression of ROR1. In this study we looked if CD5 has an effect on the surface expression of ROR1 in CLL cells via comparing the fluorescence intensity (MFI) of ROR1 between two groups of CLL cells, CD5 dim group and CD5 bright group. Materials: A retrospective of immune-phenotype results for 100 randomly selected patients diagnosed with CLL in the period from June 2012 till Jan.2014 was performed. 29 cases were excluded because ROR1 test was not performed for them. The study was carried out on 71 patients that divided into two groups depend on the fluorescence intensity of CD5 [dim and moderate to bright MFI]. Four degrees of fluorescence intensity were assigned negative 0 cases, Dim 16 cases (23%), moderate and bright 55 cases (77%). Then, the average ROR1 MFI was compared between the two groups using Wilcoxon-Mann-Whitney test for independent samples with 95% confidence interval Result The study showed that the average ROR1 MFI for CD5 dim group was 12.4 and 16.9 for CD5 moderate to bright group with a P- value of 0.003 which means a significant difference in the expression of ROR1 between the two groups. Conclusion The difference in the expression of ROR1 between the two groups might be due to the influence of CD5 on ROR1