فهرست مطالب مینا ایزدیار

Background and ObjectivesFFP (Fresh Frozen Plasma) containing all coagulation factors is used to treat coagulation disorders. In the present study, FFP consumption in Children Medical Center was studied to evaluate transfusion indications leading to blood orders some of which might have been unnecessary bringing about inappropriate blood use or unused blood donations. Materials and MethodsIn this retrospective study, 1262 FFP order and reservation requests during one year for being administered to 735 patients were reviewed by census method. The results were analyzed by Chi square and SPSS. ResultsOut of 1262 requested FFP units, 952 (75.4%) were transfused, and 90 units (7.13%) though thawed were not. Out of 220 reserved units, only 22 units were transfused. ConclusionsTaking more attention in ordering will prevent blood loss and increase economic saving. The blood bank of Children Medical Center does not embark on thawing FFP before its usage is finally confirmed so that blood loss is somehow avoided.

Latent Epstein-Barr virus (EBV) genomes are found in the malignant cells of approximately one-third of Hodgkin’s lymphoma cases. Detection of EBV viral DNA could potentially be used as a biomarker of disease activity. Our goal was to compare of EBV DNA detection in samples obtained from lymphoma patients versus controls. One milliliter uncoagulated and 1ml coagulated blood sample for DNA extraction and serum analysis using ELISA for IgG anti EBNA-1 were obtained from 44 lymphoma patients and from 44 normal controls, respectively. EBV genome, EBNA-2, was examined from DNA extracts of paraffin embedded and blood samples using Nested PCR with type specific inner primers.

Background and objectivesDiversity of heavy chain immunoglobulin (IgH) and T-cell receptor (TCR) molecules occures during B- and T-lymphocyte differentiation through the rearrangement of variable (V), diversity (D), junction (J) and constant (C) gene segments. Lymphoid leukemia cells are similar to normal precursors and have rearranged IgH, Igκ and TCR (cross-lineage rearrangement) genes which can be used as a marker of clonality and evaluation of minimal residual disease (MRD). The purpose of this study is to evaluate the pattern of TCR- δ/γ gene rearrangements using polymerase chain reaction (PCR) in B-precursor acute lymphoblastic leukemia (ALL) in Iranian children. Materials and Methods In our prospective study, bone marrow aspirates of 183 children with early diagnosis of acute leukemia were collected at admission before any chemotherapy. After reviewing cytomorphology and immunophenotyping, only 140 subjects with diagnosis of B-precursor ALLs were selected for study. Sixteen were excluded from our study due to various reasons including cellular degeneration. Mononuclear cells including leukemic blasts were isolated by density gradient. After DNA extraction, hyper-variable regions TCR- δ (Vδ2-Dδ3 and Dδ2-Dδ3) and TCR- γ(V γ; V γ I and V γ II) were amplified by consensus primers using PCR. PCR products were analyzed after heteroduplex analysis and polyacrylamide gel electrophoresis (silver stain). The DNA sequences were compared and aligned to the homologous sequences of Gene Bank for confirmation. T-test, Mann whitney, Fisher exact test and Chi-square were used for data analysis. ResultsClonal rearrangement of TCR-γ (Vγ) and VγI/II were present in 79.3% and 64.9% of patients respectively and only 5% of cases showed biclonal pattern. The VγII rearrangement was the most common (46.8%) type in TCR-γ. 47 (45.2%) and 11 (16.6%) of patients had Vδ2- Dδ3 and Dδ2–Dδ3 partial gene rearrangements, respectively. Biclonal/oligoclonal patterns were present respectively in 27.7% and 4.3% of cases with Vδ2-Dδ3 rearrangement. Only one patient had biclonal Dδ2 Dδ3 rearrangement. ConclusionsClonal rearrangement of TCR-δ (Vδ2-Dδ3 and Dδ2-Dδ3) genes had similar pattern to other populations. Frequency of TCR- γ (V γ I and V γ II) rearrangements were slightly higher than previous reports. and in contrary to others except Brazilian report the V γ II rearrangement was the most common type. We found no significant correlation between presence of different types of rearrangements and quantitative variables and the only significat point was the reduction of Vδ2Dδ3 with increase in age. According to preliminary results, these clonal markers can be used in diagnosis and follow up of MRD.

Clonal gene rearrangement of immunoglobulin and T cell receptor may have mono, bi or oligoclonal pattern. Significance of these patterns were studied at diagnosis and follow up of MRD in many countries, however, similar studies have not been conducted among Iranian patients. We investigated the bi/oligoclonal pattern and their association with quantitative and qualitative parameters especially MRD in Iranian children suffering from B-precursor acute lymphoblastic leukemia. In our prospective study, bone marrow aspirates of 140 patients with B-precursor ALLs were selected. Mononuclear cells including leukemic blasts isolated by density gradient. Having DNA extracted, hypervariable regions of IgH, IgK, TCR-δ (Dδ2-Dδ3,Vδ2-Dδ3) and TCR-γ (Vγ, VγI, VγII) were amplified by consensus primers using PCR. PCR products were analyzed after heteroduplex analysis and polyacrylamide gel electrophoresis (silver stain). The DNA sequences were compared and aligned to the sequences homologous for IgH and IgK published by Gene Bank. Bone marrow aspirates of days 14, 28 and 45, as well as months 3, and 6 were treated similarly. IgH gene rearrangements were reported in 114 (90.5%) patients using consensus primers for CDR-III and CDR-I regions (monoclonal:57.8%, biclonal:34.9% and oligoclonal:5.5%). Clonal pattern of Igκ-Kde were present in 59 cases (67%) (biclonal:10%). Clonal rearrangement of TCR-γ (Vγ) and VγI/II were present in 79.3% and 64.9% of patients, respectively, however, only 5% of cases showed biclonal pattern. The VγII rearrangement was the most common (46.8%) type in TCR-γ. 47 (45.2%) and 11 (16.6%) patients had Vδ2-Dδ3 and Dδ2–Dδ3 partial gene rearrangements, respectively. Biclonal/oligoclonal pattern were present in 13 (27.7%) and 2 (4.3%) cases with Vδ2-Dδ3 rearrangement. Only one patient had biclonal Dδ2-Dδ3 rearrangement. No significant difference regarding the quantitative and qualitative parameters and MRD was observed between the two groups. Bi/oligoclonal rearrangement of IgH, IgK, TCR-δ (Dδ2-Dδ3,Vδ2-Dδ3) and TCR-γ (Vγ, VγI, VγII) genes had comparable pattern to other populations. Results of MRD study showed no significant differences between the two groups.

There is a well-recognized relationship between aplastic anemia and viral hepatitis. Clinically apparent hepatitis precedes aplastic anemia by a period of weeks to months. Hepatitis is an infrequent cause of aplastic anemia and is usually severe and fatal if untreated. The clinical features and, particularly the response to immunosuppressive therapy strongly suggest that immune mechanisms mediate the marrow aplasia. The cause of the hepatitis is unknown, but it does not appear to be due to any of the known hepatitis viruses. In this study we present two cases of hepatitis associated aplastic anemia (HAAA) at the ages of 10-11 years old. They both received immunosuppressive therapy, Anti thrombocytic globulin and Cyclosporine. They achieved a persistent clinicohematological remission.

Leukemia is a heterogenous group of ne oplastic disorder which derived [rom malignant transformation of hematopoietic progenitors. In most cases leukemia is associated with definitive cytogenetic disorder, in additi on are induced by chemical and radiation which are use as therapeutical regimens. In the present study, chromosomal damages in acute lymphocytic leukemic (ALL) pati ents due to chemotherapy and radiotherapy protocol by metaphasic analysis has been evalua ted. 30 patients with ALL and 10 con trol wer e used as sample subject according to th e ra peu tica l pr ot oco ls. Pati en ts have been cla ssif ie d in 3 gr oups: with ou t treatment, tre ated with drugs and pat ients treated with drugs and radi otherapy. Results of chromosomal damage by metaphasic analysis show that virgin patients in comparison with control has an elevated chro matid damage. A meaningful difference has been shown between patients which have been received combined ch emotherapy and radiotherapy respects to chemotherapy, virgin and control. Result of this research has been shown a meaningful difference between patients received chemothrapeutic protocols versus virgin and cont rol. Thus results of this resear ch show that leukemic patients have both sp ontaneous and inducible chro mos omal damage.

Leukemia is a heterogenous grou p of neoplastic disorder, which derived from malignant transformation of hematopoietic progeni to rs. In most cases, leukemia is associated with cytogenetic diso rd er. In addition, cytogene t ic dis orde rs are ind uced by chemicals and radiation which arc used as th e rapeutically regime ns. Mic ronuclei assay is one of the sensitive methods in evaluat io n of ge netic and chromosomal aberratio n. In th e present study, genetic alteration due to radiot herapy and chemotherapy protocols in patients with acute lymphoblastic leukemia (ALL) are evaluated by micronuclei assay techniques. Total of 40 patients with ALL and 10 controls we re used as sampic subjects. According to treatment phases, patients were divided arc into four grou ps as a witho ut trea tment, remission induct io n, consolidati on and ma intenance grou ps. Gene tic alteration in these groups were evaluated by micronuclei assay techn iques. The frequency of micronuclei observed for each group was significant ly higher than co ntrol group. Data also indicated thattherc were signi ficant diffe re ces in the freq uency of micron uclei amoung four groups. The findings ind icate th at ra diotherapy and chemo therapy in ALL pati ents mainly kills cells by induction of genetic loss (chromosomal aberration). Observation of genetic loss in erytrocytic cells can be considerd as a significant side of radiotherapy or che motherapy.