2nd KHIBC Cancer Research Conference Amman, Jordan 02 - 03 Oktober 2009

Multiple myeloma (MM) is an ancient disease since bones showing typical MM: lesions have been detected in archeological remnants. However, the mortality trends in Malaysia suggest progressive increases in the incidence of the disease - , during the past fifty years. Nevertheless, this must be interpreted with caution because · MM: may have been under-diagnosed. In addition, it has been well-established that MM is ' a disease of the elderly, as the incidence increases steadily with increasing age to a peak age-specific incidence among people older than 80 years, with a median age of 65 years. In addition, MM: has also been reported to be more of an urban disease, than it is a rural one. Over the past few years, a different trend of occurrence ofMM has been noticed at the Hospital University of Science of Malaysia, especially regarding age distribution and type of environment, being urban or rural. Materials and Methods: To study this remark systematically, records of all patients with multiple myeloma at the Hospital ofUniversiti Sains Malaysia (HUSM), from 2005 - 2009 were reviewed. The data was collected and analyzed for the disease distribution according to gender, age group and area of residence. Results: Of the forty patients diagnosed with MM during the study period, in this study 25 (62.5%) patients were at the age group of 40-60 years. The remaining 15 (37.5%) were more than 60 years of age. The median age was 56 years. The sex distribution showed that twenty five patients (62.5%) were males and 15 patients (37.5%) were females, with a male to female ratio of 1.6. The urban: rnral distribution was 1:3, with 10 patients from urban areas, and 30 patients from rurat ·areas. Hence, 75% of all the 40 cases collected came from_ rural areas. Conclusion: The data obtained show that the age distribution of MM in the study area is lowered compared to most published reports. In addition, there is a rural predominance of occurrence of the disease as compared to findings in previously reported studies. These differences in the pattern of disease distribution may be attributable to environmental and occupational factors, including the use of agricultural pesticides, or the presence of other un-determined pollutants. Moreover, the possibility of genetic predisposition cannot be excluded

A study of nutritional anaemia among husm pregnant women and its corretation with the hematological parameters

Nutritional anaemia in pregnancy continues to be a common clinical problem in many developing countries and significantly contributes to maternal mortality and to both maternal and fetal morbidity. The objectives of this study were to determine the prevalence of anaemia and nutritional anaemia among pregnant women at HUSM and to look for correlation between haematological parameters and serum ferritin, serum folate, red cell folate and vitamin 812. A cross sectional study of pregnant women attending antenatal clinic at HUSM was conducted in year 2005. A systematic random sampling method was applied and 278 patients were recruited. Full blood count, serum ferritin, serum folate, red cell folate and vitamin B12 levels were determined by automated haematology analyzer Sysmex KX 21N and Access Immunoassay System respectively and results were analysed by SPSS version 12. The means (SDs) of age, period of amenorrhoea, and gravida were 31.1 (5.9) years, 20.7 (7.7) weeks and 3 (3) respectively. Sixty five percent (65%) of the study population were in the second trimester and 62.2 %were multigravida. Thirty seven percent (37%) were not on any haematinics while 11.9% were taking only one type of haematinics. The mean (SD) of hemoglobin level was 11.3 g/dL(l.l). The prevalence of anaemia (defined by haemoglobin less than 11.0g/dl) was 37.0 % . The means (SDs) for serum ferritin, serum folate, vitamin 812 and red cell folate were 17.7 ~Jg/L (30.4), 22.9 nmoi/L (13.0), 284.6 pmoi/L (135.7) and 951.6 nmoi/L (441.5) respectively. Serum ferritin less than 12.0 ~Jg/L were recorded in 34.7% of patients and 47.6% had serum ferritin between 12.0 11g/L and 50.0 11g /L. Among those with serum ferritin less than 12.0 llg/1, half of them (50.0%) had iron deficiency anaemia whereas the other 50.0% were in the state of iron deficiency. Four patients (1.5 %) had folate deficiency defined by red cell folate less than 372 nmol/1. Three patients (1.2%) probably had vitamin 812 deficiency as defined by vitamin 812 less than 107.0 pmol/1. Gestational age and folate intake were found to be significantly associated with anaemia in pregnancy. Significant positive correlations noted between haemogobin levels and other red cell parameters. Mean cell haemoglobin showed a significant correlation as a predictor for red cell folate, however other haematologkal parameters were not significantly correlated as a predictor for serum ferritin, folate or vitamin 812. In conclusion, the prevalence of anaemia among pregnant women at HUSM is high with iron deficiency being the commonest nutritional deficiency. In addition, it was shown that the assessment of iron, folate or vitamin 8l2 status cannot be predicted by haemoglobin levels or other red cell parameters. It is therefore recommended to perform full blood count and serum ferritin together in pregnant women in centres with facilities, whereas folate and vitamin 812 level are recommended for pregnant mother with clinical suspicion and risk factors

CASE REPORT - THE CO-EXISTENCE OF PURE RED CELL APLASIA AND AUTOIMMUNE HAEMOLYTIC ANAEMIA IN A CHILD WITH MALIGNANT LYMPHOMA

The association between pure red cell aplasia (PRCA) and autoimmune haemolytic anaemia (AIHA) has rarely been reported. PRCA represents an isolated process, characterized by normochromic, normocytic anaemia, reticulocytopenia and erythroid hypoplasia in the bone marrow, and may be attributable to infection with Parvo virus B19. AIHA is a condition in which peripheral red blood cell destruction is induced by the presence of autoantibodies. However, the co-existence of these conditions is very rare, since only few cases of PRCA and AIHA associated with malignant lymphoma (ML) were reported. A case of PRCA and AIHA was detected and described, for the first time in Malaysia, in a 10-year-old child suffering from non-Hodgkin lymphoma from the Department of Haematology, Universiti Sains Malaysia. Following the induction course of chemotherapy, the patient turned anaemic, with tendency for red cell clumping, reticulocytopenia and anisocytosis. AIHA was suspected in spite of the weak Coomb reaction obtained. The bone marrow aspirate revealed the presence of giant pronormoblasts, suggesting PRCA. Serological tests for Parvo virus and other viruses were negative

Thrombotic Thrombocytopenic Purpura: Three Peripartum Cases and Diagnostic Challenges

Thrombotic thrombocytopenic purpura (TTP) is a medical emergency characterized by occlusive microangiopathy due to intravascular platelet aggregation. This event results in damage to the red blood cells (RBCs) known as microangiopathic hemolytic anemia (MAHA). Schistocytes are circulating fragments of damaged RBCs that have different morphological features including keratocytes, helmet cells, and spherocytes. It is critical to report even a small number of these abnormal RBCs in the peripheral blood and to be alert for the possible diagnosis of TTP, especially in unexplained anemia and thrombocytopenia. The application of pentad criteria in the diagnosis has been reviewed, and the challenges still remained on the hematologic evidence of this disorder. In the 3 cases discussed here, the red cell morphological diagnosis gave an impact on TTP diagnosis, but overdiagnosis might be encountered in obstetrical patients due to nonspecific diagnostic criteria