Reticulocyte Count and Platelet Count as Predictors of Morphological Remission/Hemopoitic Recovery in Acute Lymphoblastic Leukemia (ALL) after Induction Chemotherapy

Objectives: To determine the predictive values of reticulocyte and platelet count for remission in cases of acute lymphoblastic leukemia after induction therapy.   Materials and Methods:This cross-sectional observational study was conducted in the department of hematology, MTI Hayatabad Medical Complex, Peshawar. All cases of ALL referred to the department for remission after taking induction therapy, irrespective of age and gender were included. Relevant information wascollected on a predesigned proforma prepared in accordance with the objectives of the study.   Results: A total of 84 cases referred for remission were included, 56(66.7%) were males and 28 (33.3%) were females. 50(59.5%) cases were in the age range of 5-18 years. The mean with a standard deviation of the age of patients was 15+ 4 years. 75(89.3%) of the cases were classified into ALL-1) by FAB classification. 50(59.5%) of the referred cases had achieved morphological remission by bone marrow aspiration. There was a statistically significant rise in Platelet count of the remission vs non-remission cases (p-0.001). Again there was a statistically significant difference in the retic count of the cases with remission (p-0.05). We observed a statically significant downhill moderate correlation ofretic count with remission (in termsof blast count of BM aspiration) (p-0.04, r:-0.32). Platelet count also had an inverse significant correlation with remission ( p-0.01, r:-0.37). The diagnostic roles of the peripheral platelet count and retic yielded an area under curves of (0.768 and 0.648 respectively) to predict remission.We observed that the retic count and platelet count havebeen shown to have strong predictive valuesfor remission in ALL with interaction values of (R= 0.28**, ΔR²=0.02, p=0.08). Similarly, an increase in platelet also has a strong predictive value for remission in ALL cases with interaction values of (R= 0.41**, ΔR²=0.16, p=0.001)   Conclusion: In ALL cases of post-induction therapy, The peripheral blood reading for an increase in Retic and platelet count predictsremission with 95% confidence. These values if strictly observed can reduce the frequency of invasive procedures like bone marrow aspiration.   Keywords: ALL, Remission, Reticulocyte count, Platelet count

Reticulocyte Count and Platelet Count as Predictors of Morphological Remission/Hemopoitic Recovery in Acute Lymphoblastic Leukemia (ALL) after Induction Chemotherapy

Objectives: To determine the predictive values of reticulocyte and platelet count for remission in cases of acute lymphoblastic leukemia after induction therapy.   Materials and Methods:This cross-sectional observational study was conducted in the department of hematology, MTI Hayatabad Medical Complex, Peshawar. All cases of ALL referred to the department for remission after taking induction therapy, irrespective of age and gender were included. Relevant information wascollected on a predesigned proforma prepared in accordance with the objectives of the study.   Results: A total of 84 cases referred for remission were included, 56(66.7%) were males and 28 (33.3%) were females. 50(59.5%) cases were in the age range of 5-18 years. The mean with a standard deviation of the age of patients was 15+ 4 years. 75(89.3%) of the cases were classified into ALL-1) by FAB classification. 50(59.5%) of the referred cases had achieved morphological remission by bone marrow aspiration. There was a statistically significant rise in Platelet count of the remission vs non-remission cases (p-0.001). Again there was a statistically significant difference in the retic count of the cases with remission (p-0.05). We observed a statically significant downhill moderate correlation ofretic count with remission (in termsof blast count of BM aspiration) (p-0.04, r:-0.32). Platelet count also had an inverse significant correlation with remission ( p-0.01, r:-0.37). The diagnostic roles of the peripheral platelet count and retic yielded an area under curves of (0.768 and 0.648 respectively) to predict remission.We observed that the retic count and platelet count havebeen shown to have strong predictive valuesfor remission in ALL with interaction values of (R= 0.28**, ΔR²=0.02, p=0.08). Similarly, an increase in platelet also has a strong predictive value for remission in ALL cases with interaction values of (R= 0.41**, ΔR²=0.16, p=0.001)   Conclusion: In ALL cases of post-induction therapy, The peripheral blood reading for an increase in Retic and platelet count predictsremission with 95% confidence. These values if strictly observed can reduce the frequency of invasive procedures like bone marrow aspiration.   Keywords: ALL, Remission, Reticulocyte count, Platelet count

An Analytical Study to Explore Iron Stores in a Population of Nowshera Based on Age and Gender Perspective

OBJECTIVES:  To analyze the impact of age and gender on iron stores in a population of the Nowshera region. METHODOLOGY: This cross sectional study was conducted in the Department of Pathology Qazi Hussain Ahmed Medical Complex Nowshera from 1st January 2019 to 31st March 2020. All patients were selected by convenience sampling in the Pathology department irrespective of age and gender.   Both descriptive and inferential statistics were applied to analyze data by the latest SPSS version 25.  RESULTS: Out of the total study population males were 70 (27.1%) and females 188 (77.9%) with median age 30 years.  The median ferritin level was 12.8 ng/ml. Out of total, 142 (55%) of cases were with serum ferritin less than 15ng/ml. A significant (p=0.03) gender based median ferritin level difference was observed with 1.5 times more probability of low iron stores in females as compared to males (OR=1.5). No statistically significant difference in body iron stores exists in different age groups. CONCLUSION:  A significant difference was noted in the iron stores in gender groups and the probability of depleted/low iron stores was higher in female gender as compared to male gender in all age groups in our population.  

Comparison of Hematological and Inflammatory Markers to Predict Outcome in Covid-19 in 1st and 4th Wave

OBJECTIVES: To compare the values of the hematological and inflammatory markers in 1st and 4th waves to predict the outcome of COVID-19 in a hospital-based study. METHODOLOGY: This comparative study was conducted in the Department of Hematology, Hayatabad Medical Complex Peshawar, from April 2020 to 20 August 2021. Tests of significance (Independent t-test/Mann Whitney U test) and Chi-square test were used. Relevant information was recorded on a pre-designed proforma prepared following the study's objectives. RESULTS: A total of 178 patients, 71 from (the 1st wave) and 107 from (the 4th wave) with known outcomes, were studied. A statistically significant difference exists between the groups (1st vs 4th wave) regarding hematological markers; neutrophil to lymphocyte ratio (NLR) (p=0.02), Absolute Neutrophilic count (ANC) (p=0.01) and platelet count (p=0.001). Similarly, significantly higher inflammatory markers values were recorded in the 1st  wave compared with the 4th wave regarding inflammatory markers; CRP (p=0.002) and D-dimer (p=0.001). During the 1st wave, Total Leukocyte Count (TLC), ANC and d-dimer were the leading prognostic indicators to predict mortality/worst outcome in COVID-19 with an Area Under Curve (AUC) of 0.74, 0.70 and 0.7  on receiver operating characteristics (ROC) respectively. In 4th, the Area under the curve (AUC) of d-dimer was 0.84 to predict mortality.  CONCLUSION: TLC, ANC, NLR, and low platelet count were the worst hematological markers in COVID-19 in the first wave, while d-dimer and CRP were the primary prognostic inflammatory markers. Unlikely in the 4th wave, the prognostic values of hematological markers were merely significant. The d-dimer values in both the waves proved to be reliable for predicting the severity and mortality of COVID-19

SARS-COV-2 Neutralizing IgG Antibodies in Patients Recovered from COVID-19 in a Hospital-Based Study: From Predictions to Reality

Background: The duration and immunity nature in form of antibodies to COVID-19 is still not clear. But so far we know that an immune response protects the individuals from future illness for some specific time. The presence or absence of immunity tells us about the future transmission of illness. Objectives: To determine the frequency of antibodies to COVID-19 after three weeks of negative PCR report. To predict the association of the antibodies values with severity of the disease the patient had in recent past. Material and methods: We did a cross sectional study in department of Pathology on 36 patients recovered from COVID-19 from 3rd July 2020 to 31st July 2020. Antibodies level was measured by electro-chemiluminescence immunoassay using Roche Cobas E411 Chemistry Analyzer for which commercial kits of Roche diagnostics were used as per the instructions of the manufacturer, in respondents after 3 weeks of a negative PCR report. Results: The mean with standard deviation for numerical variables i.e. (age and antibodies) was 34+11 years and 34.52+12.71 respectively. 29(80.55%) were males and 7(19.45%) females.  The mean antibodies level was statically significantly higher in patients with age less than 50 years (p-value: 0.01). Patients who had severe symptoms at time of being reported positive by PCR had significantly higher antibodies cut off values as compared to asymptomatic positive patients (p-value:0.04). Clinically sever Covid-19 patients positively moderates with an increase in the values of the post infection anti SARS-COV-2 antibodies supported by an interaction term with (β=0.388**; ΔR²=0.126, p-value=0.02). Male gender supported by the results of an interaction term with (β=0.388**; ΔR²=0.126, p-value=0.02) had sever disease as compared to female. Conclusion: The higher anti SARS-COV-2 antibodies were reported in patients with age <50 years and in patients who had severe symptoms or history of hospitalization during the infectious period. There was a statistically significant relationship supported by the interactions terms of higher post infection antibodies level with male gender, an increase in age and with history of sever disease or hospitalization