Rabab M. Aly

Prevalence of HBV and HCV infection among multi-transfused Egyptian thalassemic patients

BACKGROUND AND OBJECTIVES Though regular blood transfusion improves the overall survival of patients with β-thalassemia, it carries a definite risk of infection with blood-borne viruses. The present study was carried out to estimate the real frequency of hepatitis B virus (HBV) and hepatitis C virus (HCV) among Egyptian β-thalassemic patients, and determine the infection-associated risk factors in these patients. DESIGN AND SETTING A prospective study conducted in a university hospital from January 2009 to January 2010. PATIENTS AND METHODS Two hundred patients with β-thalassemia major were enrolled in this study. Using enzyme-linked immunoabsorbent assay (ELISA), their sera were tested for hepatitis B surface antigen (HBsAg), antibody to hepatitis C core antigen (anti-HBc), and HCV antibody (HCV Ab). The positive HCV Ab results were confirmed by second-generation recombinant immunoblot assay (RIBA). RESULTS The study sample consisted of 111 males and 89 females, with a median age of 13 years. Eighty-one (40.5%) patients were HCV Ab positive by ELISA and 39 (19.5) were anti-HCV positive by RIBA; 58 (29.0%) were HBsAg positive and 13 (6.5%) were anti-HBC positive. Older age, an increased number of transfusion units, and HBsAg seropositivity were significantly associated with a higher prevalence of HCV and HBV. CONCLUSION The prevalence of HCV and HBV infections are very high among Egyptian β-thalassemic patients, which calls for a critical look into the prevailing transfusion practices and adoption of stricter donor selection criteria to decrease the incidence rate of both HCV and HBV infections effectively. Furthermore, there is a compressing need for the use of more specific and sensitive methods for HCV testing in Mansoura university hospitals.

Frequency of red cell alloimmunization in patients with sickle cell anemia in an Egyptian referral hospital

INTRODUCTION Sickle cell anemia (SCA) is an important public health issue in Tanta, Egypt. Erythrocyte transfusions may reduce the morbidity of SCA, however, they are associated with numerous risks. Among other risk categories, alloimmunization to red cell antigens may result from transfusions. The objective of this study was to explore the frequency of red cell alloantibodies among SCA patients who received regular transfusions. MATERIALS AND METHODS A total of 42 patients with SCA were included in this study. This work planned to study the presence of alloantibodies to different red cell antigens in multi-transfused SCA patients using the ID card micro-typing system. Clinical and laboratory data were collected and analyzed to find out the frequency, pattern and factors influencing red cell alloimmunization secondary to multiple blood transfusion in these patients. RESULTS Of a total of 42 SCA patients included in the study, 21.4% of patients developed alloantibodies. The most common alloantibodies were anti-K, anti-E and anti-C. The rate of incidence of these alloantibodies was 7.1%, 4.8% and 4.8%, respectively. There was significant association between alloantibody and the rate of transfused blood. The mean age of patients with and without alloimmunization was 12.0 and 6.2 years. CONCLUSIONS Alloimmunization to minor erythrocyte antigens of variable clinical significance is a frequent finding in transfused SCA patients. Regular screening for red cell alloantibodies would provide better management of these patients.

Clinical significance of antibody to hepatitis B core antigen in multitransfused hemodialysis patients.

Background: In spite of the progress made in the prevention of transfusion transmitted infections over the last few years, transmission of HBV infection through transfusion of HBsAg negative blood has been documented. Objectives: To assess the frequency and clinical significance of anti-HBc in multitransfused hemodialysis patients. Materials and Methods: One hundred and forty-three hemodialysis patients who had been receiving blood regularly with an average of 39.4 ± 7.579 months on hemodialysis were enrolled in this study. HBV markers (HBsAg, anti-HBc, anti-HBs) were measured in these patients and in 100 healthy controls by the ELISA technique. The following data were obtained for all patients: socio demographic data, number of blood transfusions and some laboratory investigations. Results: In our patients, anti-HBc was positive in 9%, anti HBs in 7%, coexistant HbsAg/anti-HBc in 2.8% and anti HBc/anti HBs in 18.9%, meanwhile no patients were positive for HBsAg alone. In patients with only positive anti-HBc, the levels of anti-HBc were significantly related to abnormal results of liver function. In patients with positive anti-HBs/anti-HBc (n = 27), 18 patients had abnormal liver function, and 9 patients had normal liver function with no significant difference between them. Conclusions: This study suggests that hepatitis B prevalence in our multitransfused hemodialysis patients is far in excess of that anticipated on the basis of HBsAg prevalence. Absence of HBsAg in the blood of hemodialyzed patients may not be sufficient to ensure lack of circulating HBV, and isolated positivity of anti-HBc may be a possible indicator of active hepatitis B infection.

Prognostic value of plasma levels of thrombomodulin and von Willebrand factor in Egyptian children with acute lymphoblastic leukemia

Background Acute lymphoblastic leukemia is the most common childhood malignancies, representing nearly one-third of all pediatric cancers. Thrombomodulin is a membrane glycoprotein in the vascular endothelium. Its plasma level depends on the integrity of the endothelium. Soluble thrombomodulin is derived from injured endothelial cells or proteolytically cleaved from thrombomodulin by proteases. Von Willebrand factor is a blood glycoprotein involved in homeostasis. Its plasma level increases in neoplastic diseases and arises from adverse changes in the endothelium. Severe endothelial dysfunction is present during the acute phase of acute lymphoblastic leukemia. Plasma levels of von Willebrand factor and soluble thrombomodulin have been used as indexes of endothelial dysfunction. Objective The aim of this study was to assess serum soluble thrombomodulin and von Willebrand factor levels in children with acute lymphoblastic leukemia during acute phase of the disease to assess their potential prognostic value. Patients and methods Forty patients with acute lymphoblastic leukemia included 26 males and 14 females with their ages ranged from 2 to 10 years and 20 healthy children of matched age and sex were included in this study. We analyzed serum soluble thrombomodulin and von Willebrand factor levels by enzyme-linked immunosorbent assay. Results In children with acute lymphoblastic leukemia, there was a significant increase in soluble thrombomodulin, and von Willebrand factor levels during the acute phase of the disease. Children with an unfavorable outcome had higher levels of thrombomodulin and von Willebrand factor levels. Conclusions Serum thrombomodulin and von Willebrand factor levels as a parameter of endothelial dysfunction during the acute phase of acute lymphoblastic leukemia might represent an additional prognostic marker in childhood acute lymphoblastic leukemia.

Association of ABO Blood Group and Risk of Breast Cancer

ABO blood type has been observed in previous studies to be associated with the risk of certain malignancies, including pancreatic and gastric cancer. Our aim is to explore the possible relationships between blood groups and characteristics of patients and whether it is associated with the risk of breast cancer. Our study consisted of 160 breast cancer patients with serologically confirmed ABO blood group. A group of 92 healthy blood donors was identified as a control group. Overall distribution of ABO blood groups was comparable between patients (53.1% A, 21.8% O, 17.5% B and 7.5% AB) and controls (39.1% A, 32.6% O, 18.4% B and 9.7% AB). There were no significant differences in clinicopathologic characteristics among patients with different ABO blood groups. We found that patients with A blood group was positively associated with the risk of breast cancer (adjusted Odds Ratio=2.13, 95% Confidence Interval=1.04-2.96, P=0.03). We conclude that A blood type was associated with increased the risk of breast cancer and it might increase the probability to generate high-risk individuals if further studies confirm the present preliminary findings.

High expression of GTPase regulator associated with the focal adhesion kinase (GRAF) is a favorable prognostic factor in acute myeloid leukemia

BACKGROUND GRAF is a recognized tumor suppressor gene that was found inactivated in AML. However, the prognostic role of a GRAF transcript has not been studied in patients with AML. METHODS In this study, we investigated the expression of the GRAF transcript by real time quantitative PCR in 60 AML patients and 30 healthy age and sex matched controls. RESULTS GRAF expression was significantly lower in patients with AML when compared to controls (P=0.008). There were no significant differences in clinical features, FAB subtypes and cytogenetic risk subgroups between patients with high and low GRAF expression levels. Kaplan-Meier analysis showed that patients with high GRAF expression had longer overall survival (OS). Multivariate analysis revealed that, besides WBC count, GRAF expression was also an independent prognostic factor for AML. CONCLUSION We provide evidence that high GRAF expression is a favorable prognostic marker in patients with AML.

Prognostic Significance of Lymphoid Enhancer-Binding Factor-1 Expression in Egyptian Adult B-Acute Lymphocytic Leukemia Patients

Objective: Lymphoid enhancer-binding factor-1 (LEF-1) is a key transcription factor of wingless-type (Wnt) signaling in various tumors and it is associated with a number of malignant diseases such as leukemia. We explored the expression profile of LEF-1 in acute lymphoblastic leukemia (ALL) and determined its specific prognostic significance in this disease. Materials and Methods: We studied LEF-1 expression in 56 newly diagnosed B-acute ALL adult patients using real-time quantitative polymerase chain reaction to investigate whether LEF-1 expression was associated with clinical patient characteristics and treatment outcomes. Results: High LEF-1 expression was associated with significantly poorer disease-free survival (p=0.03) and overall survival (p=0.005). Patients with high LEF-1 expression had a significantly higher relapse rate compared with low LEF-1 expression (p=0.01). Conclusion: We provide evidence that high LEF-1 expression is a prognostic marker in adult B-acute ALL patients.

Influence of interleukin-15 polymorphism on the survival of adult patients with acute lymphoblastic leukemia in Egypt

Abstract The aim of this study was to analyze the association of the rs10519612 and rs17007695 polymorphisms with the risk of acute lymphoblastic leukemia (ALL) and also to evaluate their impact on the survival of adult patients with ALL. The study included 164 adult patients with ALL and 158 healthy subjects as a control group who were genotyped for the interleukin-15 (IL-15) gene using the polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. We observed a higher risk of developing ALL for rs10519612 CC, rs17007695 TC and rs17007695 CC genotype carriers. There was increased risk for T-cell type in patients with the rs10519612 CC genotype. Notably, increased risk to develop B-cell type was found with rs17007695 TC and CC genotypes. There was no impact on overall survival or disease-free survival at 3 years. It is concluded that there is an association between both gene polymorphisms and the risk of ALL and with disease immunophenotype. However, there was no impact on the outcome of patients.

Prognostic Significance of Secreted Frizzled-Related Protein 2 Expression in Cytogenetically Normal Primary Acute Myeloid Leukemia.

Background:Deregulation of secreted frizzled-related protein 2 (sFRP2) has been found in many types of cancer. However, the pattern of sFRP2 expression in acute myeloid leukemia (AML) is still unclear. Methods:This study aimed to validate the prognostic significance of sFRP2 expression in 54 older patients with cytogenetic normal acute myeloid leukemia (CN-AML) using real-time quantitative polymerase chain reaction. Results:sFRP2 expression was decreased markedly in patients compared with controls (P < 0.001). No correlation was found between sFRP2 gene expression and WBCs, hemoglobin, platelets, FAB type, NMP1 and FLT3/ITD mutations at diagnosis. All patients were treated with standard induction chemotherapy. Patients with high sFRP2 expression had higher incidence of complete remission rate (P = 0.04) and better overall survival (P = 0.026). Multivariate analysis revealed that high sFRP2 expression was a prognostic factor for older patients with CN-AML. Conclusions:This study demonstrated that sFRP2 gene expression at diagnosis had an impact on outcome of elderly CN-AML patients.