Infantile acute megakaryoblastic leukaemia with T(1:22) in a non-down syndrome child.

Megakaryoblastic leukaemia is the commonest form of leukaemia occuring in Down syndrome infants. However, it’s subtype with translocation t(1;22)(p13;q13)is uncommon comprising <1% of all cases and reported to exclusively occur in infant without Down syndrome. It has a female predominance and carries apoor prognosis. We described this rare form of leukaemia in a 9-month-old girl who presented with bruises, massive hepatosplenomegaly and multiple cervical and inguinal lymphadenopathy. The blood film showed severe anaemia with ovalostomatocytosis, thrombocytopenia and mild leucocytosis. The bone marrow aspirate showed numerous blasts showing high nuclear-cytoplasmic ratio and agranular cytoplasm with cytoplasmic blebs. Peroxidase staining was negative. The immunophenotyping of the blasts showed positive expression of CD117, CD13, CD33 and CD61 which confirmed the diagnosis of acute megakaryoblastic leukaemia. Interestingly, the cytogenetic finding of translocation t(1;22) which is most common in acute megaloblastic leukaemia in infants without Down syndrome was found in this case. She received the AML trial 15 ADE protocol chemotherapy regime and developed severe neutropenic sepsis and respiratory distress requiring ventilatory support and granulocyte colony stimulating factor (G-CSF). She recovered wellmafter the first course of chemotherapy and was discharged. Unfortunately, she was not brought in for follow-up chemotherapy and presented a few months later with relapsed AML. She was re-started on ADE protocol and currently is on oral thioguanine for maintenance therapy

A rare occurrence of plasma cell myeloma with biclonal gammopathy

Plasma cell myeloma is known to cause expansion of a single clone of immunoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal M proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment

The Msi2 protein expression positive correlation with favorable cytogenetics findings in AML

Acute myeloid leukaemia (AML) is the most common subtype of acute leukaemias with a poor outcome. Msi2 protein is a newly discovered prognostic marker and it has been considered as a new target for therapy in AML. The study of Msi2 protein expression in AML cases has not been performed in Malaysia, to date. The main aim of the present study was to observe the expression of Msi2 protein in AML patients by immunohistochemistry (IHC) and to correlate its expression with the well-established prognostic and clinical parameters in AML as well as the overall survival (OS). Sixty four bone marrow trephine biopsy sections were immunostained for Msi2 protein. The percentage of blasts with positive reaction and the intensity of the cytoplasmic and nuclear staining were evaluated. The expression of Msi2 protein was found in 95.3% cases with Msi2 pattern varying between the cases. In 71.9% of cases, the blasts showed total cellular positivity and 23.4% cases showed only cytoplasmic positivity. Majority showed high expression of Msi2 for cytoplasmic staining. Interestingly, there was significant correlation between total cellular staining and the intermediate cytogenetic subgroup (P= 0.04). In conclusion, the results showed that the majority of the patients had high expression of Msi2 but this did not correlate to OS. However, the Msi2 expression correlated to the cytogenetic findings. The results suggest future extensive research to be conducted in order to ascertain the exact role of Msi2 positive blast cells in AML in our population and their association with prognosis and outcome

Red cell antibody screening in pregnancy: a preliminary insight?

Aloimunisasi sel darah merah ditakrifkan sebagai pembentukan antibodi di dalam respons kepada antigen asing sel merah melalui proses transfusi atau mengandung. Di kalangan wanita hamil yang tidak mempunyai sejarah transfusi darah, mereka boleh mengalami aloimunisasi pada kehamilan yang lalu atau semasa disebabkan oleh kehadiran antigen sel merah bapa yang diwarisi kepada janin. Kajian ini bertujuan untuk menentukan prevalens aloimunisasi sel darah merah di kalangan wanita hamil tanpa sejarah transfusi darah di PPUKM dan juga untuk mengaitkan kelazimannya dengan nombor kehamilan dan sejarah komplikasi obstetrik. Ini adalah satu kajian keratan rentas di mana 150 wanita hamil telah dipilih secara rawak di klinik antenatal PPUKM. Sepuluh ml darah periferal telah diperolehi selepas persetujuan diambil dari setiap pesakit. Ujian yang dijalankan ke atas sampel-sampel darah tersebut termasuk ujian jenis kumpulan darah ABO dan Rh D dan saringan antibodi dengan menggunakan teknik ujian antiglobulin tidak langsung. Sampel positif terus dikenalpasti untuk pengkhususan antibodi. Dalam kajian kami, majoriti (37.3%) daripada wanita adalah primigravida. Aloantibodi sel darah merah telah dikesan pada dua daripada 150 (1.3%) pesakit yang kemudiannya dikenalpasti sebagai anti-C dan anti-D. Namun tiada seorang pun daripada primigravida yang mengalami aloimunisasi. Seorang wanita dari gravida 2 (2.9%) dan gravida 3 (3.6%) didapati positif bagi aloimunisasi. Salah seorang daripada mereka juga mempunyai sejarah obstetrik buruk. Kajian ini menunjukkan bahawa kelaziman aloimunisasi sel darah merah di kalangan wanita hamil adalah rendah di pusat ini. Walau bagaimanapun, ujian saringan bagi aloantibodi sel darah merah perlu disediakan untuk mengurangkan komplikasi kepada janin atau ibu yang mungkin timbul akibat aloimunisasi sel darah merah

A review of oilfield wastewater treatment using membrane filtration over conventional technology

The oil and gas industry has been a constant developing industry as it is of importance to the maintenance of industrial civilization in its current configuration and play vital roles in many other industries. Some oil and gas industry operations have been accountable of water contamination through by-results of refining and oil slicks. One of the biggest by-products that have raised a critical environment concern is oilfield produced water. Oilfield produced water (OPW) is coproduced aqua liquid phase which originate from well alongside oil phases in normal production process. The content of OPW consists of different type of organic and inorganic mix. Discarding this kind of wastewater can lead to surface pollution especially on water sources as well as soil. Hence, to meet environmental regulations as well as reuse and recycling of produced water, many researchers have focused on treating oily saline produced water. Conventional technologies used to treat produced water consist of clarifiers, dissolved air flotation, hydro cyclones, and disposable filters/absorbers. Typically, additional chemicals for coagulation or settling are needed which are expensive and are incapable of achieving recently required standards of cleanliness. Therefore, researchers have swung to membrane filtration plans because of their capability to minimize extra expenses and surpass issues connected with current advances. Thus, the purpose of this review is to highlight the current and developed membrane technology used in treating the oilfield produced wastewater and its current progress

The paediatric iron deficiency assessment with reticulocyte haemoglobin equivalent (Ret-He) in comparison with biochemical markers of serum ferritin and transferrin saturation

Diagnosis of iron deficiency anaemia (IDA) is a challenge as the conventional methods often diagnose the disease at the later stage. Haemoglobin content of reticulocytes is useful to identify IDA at earlier stage. The objective of this study was to evaluate reticulocyte-haemoglobin equivalent (Ret-He) in diagnosing IDA in children and to compare it with other conventional methods. This prospective study was conducted on 120 paediatric patients aged 12 years and below, who attended Hospital Sultanah Aminah Johor Bahru, Malaysia with haemoglobin <12 g/dL. Ret-He and serum iron, ferritin and transferrin saturation were measured. Using a cut-off point of 20% for transferrin saturation, 81 out of 120 subjects (67.5%) were found as iron deficient. Based on the diagnosis of IDA, cut-off value for Ret-He using the Receiver Operating Characteristics (ROC) curve analysis was found as 22.65 pg. Ret-He showed a good sensitivity and specificity of 77.8% and 66.7%, respectively. As compared with Ret-He, serum ferritin showed a sensitivity of only 18.9%. However, a good specificity of 100% suggest it is useful for ruling in the disease but not suitable for screening. Transferrin saturation showed a good sensitivity and specificity, but it is biologically variable and not cost effective as a screening tool. Correlation study showed serum iron and transferrin saturation have significant positive correlation with Ret-He (r=0.415 to 0.518). However, there was no correlation between Ret-He and serum ferritin (r=0.051, p=0.578). This study shows that Ret-He at a cut-off point of 22.65 pg has a better sensitivity and potentially be useful as a screening tool in the paediatric population

The Estimation of Foetomaternal Haemorrhage by Flowcytometry

Fetomaternal haemorrhage (FMH) may occur following a sensitizing event, during pregnancy or at delivery. In cases of rhesus (Rh) incompatibility between mother and the fetus, it can thus subject to the haemolytic disease of the newborn. The Kleihauer test for quantification of FMH lacks standardization and results are less accurate. Furthermore, it cannot differentiate the fetal cell from the adult HbF. Flowcytometry analysis using monoclonal antibodies, is a new technique for the quantification of FMH and it allows larger number of cells to be analysed. It is also able to differentiate the fetal cell from maternal HbF, and thus is more sensitive and accurate. The objective of our study was to determine the FMH using the flowcytometric analysis of anti-HbF antibody and to correlate the FMH using flow cytometry and the standard Kleihauer test. Ninety eight peripheral blood samples from pregnant women at more than 20 weeks of pregnancy and post delivery were analyzed by both methods. The percentage of the fetal cells were recorded and the FMH were calculated. We found a fair correlation between the two methods with the correlation coefficient r = 0.633 (p<0.05). The concordance rate was 66.3%. Flow cytometric method, however, gave higher values in 70.4% of cases as compared to the Kleihauer test. These could be due to the autofluoresce of contaminated white blood cell or using anti HbF which is less specific than anti-D. Other possible factors could be due to the fluorochrome used. Therefore, in order to increase the accuracy, we recommend the use of dual labeling of red cells with glycophorin A which is a marker for red cells and compare the use of monoclonal anti HbF and anti-D for analysis

Detection of partial G6PD deficiency using OSMMR2000-D kit with Hb normalization.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzyme deficiency worldwide including Malaysia. Screening of cord blood for partial G6PD deficiency is important as they are also prone to develop acute haemolysis. In this study, we determined the prevalence of partial G6PD deficient in paediatric population aged 1 month-12 years and normal term female neonates using OSMMR-D kit with haemoglobin (Hb) normalization and compare it with florescence spot test (FST). A total of 236 children, aged between between 1 month-12 years and 614 normal term female neonates were recruited for this study. Determination of normal means for G6PD activity and; cut-off points for partial and severe deficiency were determined according to WHO Working Group (1989). Determination of prevalence for partial deficiency for both groups (female patient) was done using this enzyme assay kit and findings were compared with FST. In this study, 15.7% (18/115) female children were classified as partial G6PD deficient by quantitative enzyme method (G6PD activity: 4.23-5.26U/gHb). However, FST only detected 0.9% (1/115) with minimal G6PD activity. The prevalence of partial G6PD deficiency in female neonate group was 3.42% (21/614) by enzyme assay versus 0.49% (3/614) by FST. This study concluded that our routine screening method using FST was unable to diagnose female heterozygotes. We recommend using this quantitative enzyme assay method by OSMMR-D kit since it was more sensitive in detecting G6PD deficiency in female neonates compared to FST

Impact of CD34+ stem cell dose on engraftment period in allogeneic peripheral blood stem cell transplanted patients

Haematopoietic progenitor stem cells acquired from the peripheral blood have been increasingly used to treat patient with haematological malignancy. The success of the allogeneic peripheral blood stem cell transplantation (PBSCT) is significantly dependent on amount of CD34+ stem cell infused which will determine the rate of the haematopoietic recovery and engraftment. This study was aimed to correlate the amount of CD34+ cell infused with the period of engraftment. This retrospective study was conducted on 62 patients with haematopoietic malignancy who have received PBSCT at Universiti Kebangsaan Malaysia Medical Centre from year 2011 to 2015. The impact of CD34+ stem cell infusion on neutrophil and platelet engraftment and obtaining complete chimerism was studied. Patients were divided into two groups based on the amount of CD34+ stem cell. Group A consisted of 9 patients and infused with <5x106 cells/kg CD34+ cell while Group B consisted of 53 patients and infused with ≥5x106 cells/kg CD34+ stem cell. Data were collected and analysed. Group B patients were significantly associated with faster neutrophil engraftment: 12 (10-14) days while group A were 15 (10-21) days, (p=0.002). Platelet engraftment was also faster in group B: 17(12-25) days compared to group A: 18 (15-30) days. Complete chimerism in group B occurred in 30 (15-90) days and in group A was 60 (30-240) days. Platelet engraftment (p=0.149) and complete chimerism (p=0.021) were not significantly influenced by the CD34+ cell count. This study has shown that infusion of ≥5x106 cells/kg CD34+ stem cell shorten the time to haematopoietic engraftment particularly of neutrophilic engraftment