Abstract: The World Health Organization (WHO) has categorized acute undifferentiated leukemia (AUL) as a rare subtype of acute leukemia of ambiguous lineage (ALAL). The prognosis of AUL is considered poor and it expresses no known lineage-specific markers. In majority of the cases, AUL has been associated with karyotypic abnormalities, most commonly deletion 5q and complex karyotype. Deletion 17p correlation with acute myeloid leukemia and myelodysplastic syndome has been previously established and is associated with poorer outcomes. Herein we are reporting a case of forty years old male who was referred to National institute of blood diseases and bone marrow transplantation with complains of fever, multiple neck swellings, and early satiety and was diagnosed as Acute Undifferentiated Leukemia along with deletion 17p. This is a rare entity and can aid in further diagnostic and therapeutic approaches. Keywords: Acute undifferentiated leukemia, Deletion 17p, Flourescnece in situ hybridization, Allogeneic haematopoetic stem cell transplantation, Flow cytometry.
Background . Most of the hematological disorders are heterogenous with regard to morphology, immunophenotype, and genetic rearrangements. Multiple recurrent chromosomal aberrations have been identified by conventional cytogenetic analysis, which is now widely recognized as one of the most important diagnostic and prognostic determinants in these patients. Though rarer, complex karyotype has been associated with worst prognosis. Materials and Methods . A total of 1185 bone marrow or peripheral blood cytogenetics samples were taken with different hematological diseases. They included both benign and malignant disease entities. In each case, cells were cultured and conventional cytogenetic analysis was performed. Results . Among 1185 subjects, 41 (3.4%) patients possessed complex cytogenetic abnormalities. Out of these 41, 33 (80%) were males. The mean age was 37 years (median age 39 years). Myelodysplastic syndromes had the most numbers of complex karyotypes (8%), followed by acute myeloid leukemia (7%) and acute lymphoblastic leukemia (4%). Also we found few patients with acute promyelocytic leukemia, aplastic anemia , chronic myeloid leukemia, and diffuse large B cell Lymphoma possessing complex karyotype. Frequencies of different cytogenetic abnormalities were assessed with respect to disease as well as independently. Trisomy 21 was the most common chromosomal abnormality found in 28% of patients. Conclusion . Complex karyotype was most frequently associated with myelodysplastic syndromes and acute myeloid leukemia. Trisomy 21 and deletion 5q were the commonest cytogenetic abnormalities found. We also assessed complex karyotype in benign diseases and detected one patient of aplastic anemia with complex karyotype. This is the first study highlighting the presence of complex karyotypes in hematological disorders in our region.
Topic: 31. Transfusion medicine Background: Patient blood management (PBM) encompasses all aspects of the transfusion decision-making process, beginning with the initial patient evaluation and continuing through clinical management. PBM involves the timely, multidisciplinary application of evidence-based medical and surgical concepts aimed at diagnosing and appropriately treating anemia along with minimizing surgical and iatrogenic blood losses and managing coagulopathic bleeding, and supporting the patient while appropriate treatment is initiated Haemovigilance is the set of surveillance procedures covering the entire blood transfusion chain, from the donation and processing of blood and its components, through to their provision and transfusion to patients, and including their follow-up. Aims: In this study, we reviewed the past 3 years performance and data of Regional blood centre, Karachi regarding the concept of patient blood management, transfusion parameters including the C/T ratio, transfusion index and to induce the concept of haemovigilance in the government sector hospitals. This study will allow us to critique as well as appreciate our performance in this regard. Methods: It is a retersopective analysis of our data of previous 3 years. All the data will be taken from BBMIS software (Zaavia), we calculated the Cross match to transfusion ratio and transfusion index of all three years for comparison, we also calcualted the number of requests from surgical ward before the start of Maximum Surgical blood ordering Schedule and after it was implemented to compare the results. Also the reporting of transfusion reactions, will be inculded. All the data was analyzed on SPSS version 23. Results: There was a mark reduction in the CT ratio in the 3 years, starting from 15:1 now to 1.5-1:7:1. after the start of MSBOS, the surgical practices were markedly improved regarding the ordering and wasting of blood. By introducing the concept of blood distribution by blood bank service, the wastage of blood was also markedly reduced. Initially we didnot have any transfusion reaction reported, but after all the awarness sessions and CME, the concept of haemovigilance was improved and the proper reporting of transfusion reactions was started. Summary/Conclusion: : To conclude, Regional blood centre Karachi was able to achieve the better transfusion services to the patients, it was a tough journey, dealing with majority of the illiterate people and with the doctors, who were used to the old blood banking sevices and procedures. However, with the hard work, regular awarness sessions, CME’s, quartely Hosptial transfusion committee meetings and proper distribution of blood products, we have achieved great success in terms of better quality of transfusion services.Keywords: Blood transfusion
Abstract: Background: Pakistan has a high prevalence of hepatitis and increasing prevalence of HIV, these infections imply a serious risk to the health of those who need blood transfusions. As blood donors are generally considered as the healthy population, assessing the risk of these silent killers in the blood donors can overall help in understanding the potential impact of these infections on the general population. Objective: As the TTI prevalence is increasing rapidly in our region, it is much needed to take necessary actions for its prevention. The first step should be the actual frequency of these TTI’s in healthy blood donors, so our study aimed to identify the positive ratio of Hep B, Hep C, HIV, malaria and syphilis in exchange and voluntary blood donors, their comparison and need of effective testing. Materials and Methods: It is a retrospective analysis in which all the data is taken from BBMIS software and analyzed by SPSS version 23. We included 56732 donors from 2020-2022. Screening of Hepatitis B, Hepatitis C and HIV was done by Chemoimmunoliscence (CLIA) whereas ICT based screening was done for Syphilis and Malaria. Result: Among donors, 50147 (88.4%) were exchange while 6585 (11.6%) were voluntary donors. The frequency of HCV was 3.1% followed by HbsAg (2.3%) and syphilis (1.6%), HIV 0.3% and the least was malaria 0.2%. As 88% of the donors were exchange, TTI positivity was also more in them. Conclusion: The prevalence of TTI in donors of RBC Karachi is worrysome. It highlights the fact of Nucleic Acid testing significance. Though CLIA is a sensitive technique, 100% safety of blood products requires the implication of Nucleic Acid testing, moreover the implication of voluntary blood donation should also be considered significantly.
Background: There is a sharp decline in new SARS-CoV-2 cases in Karachi from July onwards; most of them were asymptomatic.Seroconversion rates vary markedly in different countries.Previously, 36% of seropositivity was reported in the adult population of Karachi in July this year.The current study was conducted to report if seroprevalence has increased and has a possible role in community immunity.Methods: This was a prospective cross-sectional study conducted in the first and second weeks of September 2020 at the National Institute of Blood disease and Bone Marrow Transplantation Hospital (NIBD), Karachi, Pakistan.Blood samples were collected from different segments of the population of Karachi workforce/community.An anti-SARS-CoV-2 test was performed using ECLIA from Roche Diagnostics International.Results: A total of 2404 subjects' blood samples were received from healthcare workers, the industrial workforce, and healthy blood donors.Seroprevalence in industrial workers was highest (70%) as compared to healthcare workers (40%).Overall seropositivity in males (39%) was higher than females (16%).Blood donors (all males) showed seropositivity of 37.8%.The comorbid state was not significantly associated with seropositivity (p-value >0.05).Total cases of antibody-positive were 1322 of 2100 (55%).Conclusion: Our results confirmed the current seroprevalence of 55% in the adult population in Karachi.There was a sharp rise from 36% reported previously in July.This rise coincided with a sharp decline in new reported COVID 19 cases.We can conclude that the adult population from Karachi has shown an upsurge in seropositivity which will certainly have a beneficial role in SARS-CoV-2 control in the future.
Recurrent cytogenetic abnormalities are manifested in approximately fifty percent cases of Myelodysplastic Syndromes (MDS) found as result of genomic instability verifying the presence of oncogenic genetic mutations.Over the years the molecular diagnosis of MDS, has emphasized the relevance of the molecular pathogenesis of this entity by utilizing the refined technology of next generation sequencing.We herein report a case of Myelodysplastic Syndrome with Excessive Blast 2(MDS EB 2) with isolated deletion 5q and the presence of oncogenic somatic driver mutation ASXL-1 elucidated through next generation sequencing.The reports pertaining the association of MDS with deletion 5q and ASXL 1 are relatively exiguous.This case report points towards the diagnostic and prognostic significance of somatic driver mutations, even in patients exhibiting good risk cytogenetics.This will assist in offering better risk adapted therapies in Myelodysplastic syndrome patients.
BACKGROUND AND AIMS Patient blood management encompasses all aspects of the transfusion decision-making process, beginning with the initial patient evaluation and continuing through clinical management.1 It involves the timely, multidisciplinary application of evidence-based medical and surgical concepts, aimed at diagnosing and appropriately treating anaemia, along with minimising surgical and iatrogenic blood losses and managing coagulopathic bleeding, as well as supporting the patient while appropriate treatment is initiated.1 Haemovigilance is the set of surveillance procedures covering the entire blood transfusion chain, from the donation and processing of blood and its components, through to their provision and transfusion to patients, including their follow-up.2 The restrictive transfusion threshold uses a lower haemoglobin concentration as a threshold for transfusion (most commonly 7–8 g/dL), and the liberal transfusion threshold uses a higher haemoglobin concentration as a threshold for transfusion (most commonly 9–10 g/dL).3 MATERIALS AND METHODS In this retrospective analysis, the authors aimed to critique and study their own performance since the establishment of the Regional Blood Centre (RBC) Karachi (2020–2022), Pakistan, and its associated hospital-based blood banks (currently three). The authors calculated parameters, including cross match to transfusion ratio and transfusion index; introduced the concept of maximum surgical blood ordering schedule; assessed the cold chain maintenance through data loggers and transportation containers; reported transfusion reactions; and overviewed the overall haemovigiliance concept over 3 years’ time. RESULTS When the authors started their blood banking in government sector hospitals of Karachi, whole blood was being issued to the patients. From the first day, RBC Karachi worked on blood products and did not issue a single whole blood to any patient. Initially, the cross match to transfusion ratio was 15:1, but with time and management, at the end of third year, they achieved the ratio of 1.5–1.7:1 for different hospitals (Figure 1). Transfusion index was also calculated to be 0.2 at the start of 2020 and was reported to be 0.8 at the end of 2022. Figure 1: Graphical representation of cross match to transfusion ratio of red blood cells and its associated blood banks. CONCLUSION Initially, for 1.5 years, the authors were not able to get a single transfusion reaction reported; however, after several awareness and training sessions, and continuing medical education, they started getting transfusion reactions reporting around 2–3 times fortnightly. Initially, wastage was higher than utilisation; however, with hard work and communication, the authors were able to reduce the wastage and suggested the idea of a restrictive transfusion strategy, so that the right blood component is given to the right patient at the right time. It was a tough journey as there are, unfortunately, no haematologic units in the government sector hospitals, and dealing with doctors along with patients was not easy. The authors’ aim is to provide the best transfusion services to those who cannot afford it and their journey is still ongoing.
Background: There is a sharp decline in newSARS-CoV-2 cases in Karachi from July onwards; most of them were asymptomatic. Seroconversion rates vary markedly in different countries. Herd immunity for this virus is considered to be at 60-70%. Previously, 36% of seropositivity was reported in the adult population of Karachi in July this year. The current study was conducted to report if seroprevalence has reached the threshold of herd immunity.Methods: This was a prospective cross-sectional study conducted in the first and second weeks of September 2020 at the National Institute of Blood disease and Bone Marrow Transplantation Hospital (NIBD), Karachi, Pakistan. Blood samples were collected from different segments of the population of Karachi workforce/community. An anti-SARS-CoV-2 test was performed using ECLIA from Roche Diagnostics International.Results: A total of 2404 subjects' blood samples were received from healthcare workers, the industrial workforce, and healthy blood donors. Seroprevalence in industrial workers was highest (70%) as compared to healthcare workers (40%). Overall seropositivity in males (39%) was higher than females (16%). Blood donors (all males) showed a seropositivity of 37.8%. The co-morbid state was not significantly associated with seropositivity (p-value >0.05). Total cases of antibody-positive were 1322 of 2100 (55 %).Conclusion: Our results confirmed the current seroprevalence of 55% in the adult population in Karachi. There was a sharp rise from 36% reported previously in July. This rise coincided with a sharp decline in new reported COVID cases. We can conclude that we are approaching the target of herd immunity in Karachi.
Background and Aims: While patient blood management (PBM) and haemovigilance are different, they are both significant following evidence-based clinical transfusion. PBM is defined as the timely application of evidence-based medical and surgical concepts designed to maintain haemoglobin concentration, optimise haemostasis, and minimise blood loss in an effort to improve patient outcomes. The main aim is to manage patients such that transfusion is only used when the benefits outweigh the risks. Haemovigilance is the set of surveillance procedures covering the entire blood transfusion chain, to minimise the risk of any transfusion-related event to the donor as well as the patient. In this study, the authors audited, critiqued, and measured their own performance regarding the establishment of PBM and haemovigilance at government sector hospitals of the Regional Blood Centre Karachi, Sindh, Pakistan. Materials and Methods: A retrospective analysis of the 3.5 years since the establishment of Regional Blood Centre (RBC) Karachi and its associated hospital-based blood banks was conducted. Data were taken from Blood Bank Management Information System software and analysed on SPSS version 23 (IBM, Armonk, New York, USA) . The authors calculated the frequency of transfusion reactions and donor-related adverse events, and also calculated cross match to infusion (CT) ratio and transfusion index. Results: Initially, the cross match to transfusion ratio was 15:1, but with time and management, at the end of the third year, the team achieved a CT ratio of 1.7:1.0 for different hospitals. Transfusion index was also calculated to be 0.2 at the start of 2020 and 0.8 at the end of 2022. Similarly, no transfusion reaction was reported for the first 1.5 years since RBC’s establishment, and in the later 2 years, 59 reactions were reported. No whole blood was issued, a maximum surgical blood ordering schedule was initiated, and a restrictive transfusion strategy was applied. Conclusion: While there is still progress to be made, the authors were able to reduce wastage and subsequently suggest the idea of a restrictive transfusion strategy, so that the right blood component is given to the right patient at the right time.
Background An adequate supply of quality blood products is the backbone of any hospital. To maintain it, the utilization and wastage of the products should be closely monitored. Objective To determine the crossmatch to transfusion (C/T) ratio, transfusion probability (%T), and transfusion index (Ti) of packed red blood cells and to review the use of platelets. Materials and methods A total of 6,326 hematological patients receiving packed red blood cells were included in the study. The random donor platelets that were prepared during this period were also included to know the actual utilization of platelets. Results A total of 26,146 crossmatches were requested for these 6,326 patients in three years. Out of these, 26,024 units were issued and transfused to the patients. The CT ratio of our data was calculated to be 1.00, the transfusion probability was found to be 98.1%, and the transfusion index was computed to be 0.99. For random donor platelets, 37,162 were prepared from whole blood during this period, while 30,971 platelets were transfused to the patients. Conclusion The overall results of our analysis showed proper utilization of blood products at our institution. The wastage was considered to be minimal.
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