The effect of low altitude on blood count parameters

BACKGROUND AND OBJECTIVESHigh altitude has an effect on blood count parameters, but low altitude (especially below sea level) has not been studied.DESIGN AND SETTINGA cross-sectional study of aymptomatic subjects aged between 18 to 35 years of age who had reported to the blood bank at the King Abdullah University Hospital (KAUH)/Irbid and Ministry of Health, Jordan, during the period between January 2010 to June 2011 for blood donation.METHODSHematological values were compared in healthy adult blood donors living in areas 200 to 300 meters below sea level and areas 500 to 1500 meters above sea level. The study population consisted of 800 females and 666 males aged between 18 to 35 years.RESULTSThe mean values for hemoglobin level, mean corpuscular volume and leukocyte counts were significantly higher in people living above sea level than in people living below sea level (P<.0001), whereas platelet count and red cell distribution width were significantly higher in people living below sea level than in people living above sea level (P<.0001).CONCLUSIONWe found a significant difference in hematological parameters in healthy adults living above and below sea level. The hematological values presented here are from a large, representative population sample and the first report of people living below sea level

Stem Cell Transplantation in Pediatric Patients with Myelodysplastic Syndrome at a Single Institution

In MDS, the bone marrow produces abnormal, immature blood cells called blast cells. Imprecise, in half of pediatric MDS, blast count is normal. A retrospective observational study was conducted to review the outcome of our HCT in pediatric patients with MDS. Record of 35 MDS patients after BMT, 1993-2016, were reviewed. Median age at transplant was 4 yrs (0.8-14.8) and median time to transplant from diagnosis 8.1 (2.3-102.5) months. TRM was 17.1% (6); [low risk (LR) = 5 (19.2%) and high risk (HR) = 1 (11.1%)] MDS group succumbed within first 100 days. The rest were fully engrafted; [low risk = 21 (72.4%) and high risk = 8 (27.6%)]. Primary and secondary graft failure was observed in one patient each (2.9%). VOD was seen in 2 patients (5.7%) and 5 (14.3%) had hemorrhagic cystitis. With a median follow-up of 112.4 months and 12 events of mortality, 3-years OS was 68.1% ± 8.0%. No significant risk factor including age, time to transplant, disease risk group, gender, conditioning regimen, source of stem cells, or a GvHD through uni- or multi-variable analyses were found to be associated with OS. Bu/Cy/±ATG conditioning regimen showed a trend of superiority for OS and EFS in our small series. The relapse incidence in our cohort was 11.5% in LR MDS

Implications of Intrachromosomal Amplification of Chromosome 21 on Outcome in Pediatric Acute Lymphoblastic Leukemia: Does It Affect Our Patients Too?

Intrachromosomal amplification (iAMP) of chromosome 21 entity is associated with a dismal outcome in B cell Acute Lymphoblastic Leukemia (B-ALL). This cytogenetic abnormality is caused by a novel mechanism; breakage-fusion-bridge cycles followed by chromothripsis along with major gross rearrangements in chromosome 21.Charts of B-ALL diagnosed at King Faisal Specialist Hospital and Research Center between 2005 and 2015 were reviewed.iAMP is a rare entity occurring at around 2.4% of all pediatrics B-ALL. No statistically significant difference was found among patients with iAMP21, patients with extra copies of 21 and other patients with B-ALL. The reported adverse prognostic effect of iAMP21 could be due to other coexistent adverse factors, including older age at the time of diagnosis. The most common associated abnormality in our population in addition to the hyperdiploidy was ETV6/RUNX1

Discrepancies between DNA index by flow cytometry and cytogenetic studies in childhood B-lymphoblastic leukemia

Background: DNA index by flow cytometry (DNAI-FCM) is a rapid technique used in classification of acute B-lymphoblastic leukemia (B-ALL). The objective of this study is to estimate the reliability of FCM in the early classification of childhood B-ALL and to analyze the causes of discrepancies between the DNAI-FCM and the cytogenetic studies (CG) (Karyotype and Fluorescent in situ Hybridization [FISH]). Materials and Methods: DNAI-FCM and CG (Karyotype and FISH) were analyzed in 69 consecutive children, newly diagnosed with B-ALL in King Faisal Specialist Hospital and Research Centre between January 2013 and June 2014. Results: A statistically significant correlation existed between DNAI-FCM and CG (P = 0.001). DNAI-FCM was proportional to CG in 82.6% (57/69) of the cases. There was a discrepancy between the DNAI-FCM and the CG in 17.4% (12/69) of the cases. Conclusion: DNAI-FCM shows 82.6% concordance with CG in childhood B-ALL with a predictive value of 81%. Discrepancies occur due to either the small size of the chromosome or due to insufficient genetic material representing the abnormality

Predictors of severe hemolysis in patients with glucose-6-phosphate dehydrogenase deficiency following exposure to oxidant stresses

BACKGROUND AND OBJECTIVES: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is a genetic enzymatic disorder that affects millions of people worldwide, and is a major health problem in Jordan. We studied factors that may predict severe hemolysis in children with G6PD deficiency. METHODS: We reviewed the records of patients with low G6PD activity admitted to a teaching hospital between 1996 to 2007. We collected demographic data, details of sign and symptoms, history and type of fava bean ingestion, blood and Rh group, history of neonatal jaundice, history and type of drug use, abdominal pair at admission and the results of tests for hemoglobin, white blood cells (WBC), and hepatic function. We classified patients into mild and severe groups based on hemoglobin levels at admission. RESULTS: Of 428 children with G6PD deficiency, 79 (18%) were severe cases and 349 (82%) patients with milt disease. There were no statistically significant differences in most factors between the two groups. Factors tha achieved statistical significance for severe hemolysis included younger age (P<.05), male gender (P<.05), highe alkaline phosphatase (ALP) (P<.05), presence of fever at admission (P<.01), presence of vomiting during the attack (P=.006), and a negative family history for G6PD deficiency (P=.005). CONCLUSIONS: Severe hemolysis can be predicted during hemolytic episodes in children with low G6PD by young age, male gender, a negative family history of G6PD deficiency, the presence of fever and vomiting and a high ALP

Incidence, clinical distribution, and patient characteristics of childhood cancer in Saudi Arabia: A population-based analysis

Purpose: Information regarding the incidence and patterns of childhood malignancies is disproportionately overrepresented by high-income countries, representing mainly the Caucasian population. There is a need to evaluate and disseminate information for other ethnicities, particularly from the Middle East.Methods: Data from the National Cancer Registry, Saudi Arabia (SA-NCR), for pediatric patients (age 0-14 years) diagnosed between 2005 and 2009 and for similar patients at our institution during the same period were analyzed. Population numbers reported in the 2007 national census were used to calculate the annual incidence of childhood cancer.Results: Data from SA-NCR on 3885 patients were included in this analysis. The median age was 5.58 years, and 57.3% were males. The annual age-specific cancer incidence rate (ASR) for children in SA is 99.83 per million population; ASR per million for lymphoid leukemia is 25.75, 12.05 for brain tumors, and 9.82 for Hodgkin lymphoma. Of all childhood cancers in SA, 35% were treated at our institution. The five-year overall survival for these 1350 patients is 74.6% (median follow-up 7.52 years [95% confidence interval: 7.36-7.68]). Significant differences in the distribution of childhood malignancy subtypes were evident compared with other countries.Conclusion: We have reported differences in the cancer ASR and cancer subtype distribution for children in SA as compared with the worldwide incidence and with other populations. This paper provides a comprehensive epidemiological overview of childhood cancer in SA, which could be extrapolated to other regional Arab populations

The microbial spectrum and antimicrobial resistance pattern in pediatric cancer patients with febrile neutropenia at King Abdullah University Hospital, Jordan

Abstract Background Febrile neutropenia (FN) is a life-threatening complication of cancer therapy. Appropriate antibiotic treatment improves the clinical outcome in these patients; however, the increasing rate of anti-microbial resistance makes its therapy particularly challenging. Aim This study aims to investigate the microbial spectrum and antimicrobial resistance pattern in cancer patients with FN at King Abdullah University Hospital, Jordan. Method Blood cultures of 261 FN patients pre-diagnosed with malignancy (age 1–18 years) were enrolled in this study. Results The most common isolated microorganisms were gram-positive bacteria (50.2℅). Gram-infections with coagulase-negative Staphylococcus (CONS) are the most prevalent pathogens, followed by gram-negative infections with Klebseilla pneumonia and fungal infections with nonalbicans strains. All CONS, Methicillin-resistant Staphylococcus aureus (MRSA), and enterococcus species were sensitive to Vancomycin and Teicoplanin. Ten percent of the gram-negative organisms were Extended-spectrum beta-lactamase (ESBL) and all were sensitive to carbapenems. 66.7% of pseudomonas aeruginosa blood cultures were sensitive to Piperacillin-Tazobactam and 83.4% were sensitive to carbapenems. All Enterobacter species were sensitive to Carbapenems. Conclusion Isolates showed various antibiotic sensitivity and resistance patterns; therefore, a judicious management plan is essential to establish an appropriate and effective institutional policy for the use of empirical antibiotics in patients of FN

Poster # 503 Factors determining outcome of hematopoietic cell transplantation in patients with acute lymphoblastic leukemia at King Faisal specialist hospital and research center, Riyadh, Saudi Arabia

Background: Hematopoietic cell transplantation (HCT) is used as a viable treatment option for Acute Lymphoblastic Leukemia (ALL) whose disease demonstrates dismal prognosis with chemotherapy.Objectives: Determining factors that affect outcome after HCT.Design/Method: Records of 82 patients with ALL who underwent HCT (2005–2011) were reviewed after approval from institution review board. Data extracted included those related to clinical characteristics of the patients and their outcome.Results: Forty five patients were male (54.80%). Median age at HCT was 7.46 years (range 0.98–14.31), median time to HCT after diagnosis was 12.56 months. Ten patients were below the age of one year (12%). All patients were in complete remission (CR) at the time of HCT. 40 patients were in CR1, 35 in CR2 and 7 in CR3 at the time of HCT. In 83 transplants, 64 patients received HCT from HLA-identical related donors and 19 from other donors (1 or 2 antigens mismatch cord blood [CB] or one antigen mismatch sibling or related bone marrow [BM]). Stem cell source was BM in 65(78%) and CB in 18(22%). All patients were given myeloablative conditioning regimen. Overall (OS) in our patients was 58.8% and event free survival(EFS) was 54.3%. Median follow-up time for the cohort was 47.2 ± 4.3 months (95%CI: 38.7–55.6) .49 patients were alive with a median follow-up time of 47.2 months (Min: 6.1, Max: 109.9). 17 patients survived for more than 5 years (Min: 61.4, Max: 109.9) months. The cumulative incidence of acute GVHD was 4.8 ± 2.3 and of chronic GVHD was 8.9 ± 3.2. Median time to ANC and platelet recovery was 17 days (range 12–43) and 28 days (range 15–98) respectively. One patient acquired CMV infection after transplant. No one developed VOD, Hemorrhagic cystitis or other complication. Patient\u27s age at HCT and gender, donor‘s HLA status and gender, source of transplant and CR status at HCT did not significantly affect the probability of OS and EFS.Conclusion: Our results show a favorable outcome to HCT for ALL patients comparable to published data, and no single factor was associated with superior outcome. OS and EFS in cord blood recipient graft is similar to BM recipient graft