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Introduction: ITP is an autoimmune blood disorder in which platelet destruction is mediated by anti-platelet antibodies. The mechanisms of anti-platelet antibodies development are still a little known. The rate of some bacterial or viral agents in cause of ITP is well known. Recently, some study proposed that H pylori infection may be associated with ITP and H pylori eradication can improves platelet counts in infected ITP patients.Material and method: A baseline platelet count

Menorrhagia is the most common symptom that is experienced by women with bleeding disorders. Von Willebrand disease (VWD) is the most common congenital human bleeding disorder that is manifested as a quantitative deficiency in Von Willebrand factor (VWF) or dysfunction of this factor. The frequency of VWD is similar in both men and women. However, VWD is more readily detected in women due to the presence of severe bleeding associated with menstrual cycles and childbirth. The present study was carried out to find the frequency of VWD, its types, and clinical features of the disease among women with menorrhagia who referred to the Hematology Clinic of the Kermanshah University of Medical Sciences. The study comprised 482 women with menorrhagia. After excluding patients with confounding factors, 56 (11.6%) patients were evaluated for inherited bleeding disorders. We detected 31 (55.3%) patients with VWD. Type 3 of VWD was the most frequent subtype (45.1%) followed in frequency by type 2, (32.2%), and type 1 (22.5%). In conclusion, our study indicated that menorrhagia can be the first symptom of VWD. Therefore, rare coagulation disorders should be considered in women with idiopathic menorrhagia, particularly in regions with high rates of consanguinity.

Background: Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. Unnecessary discontinuation of blood is a major wastage of scarce blood, as well as man, hours and funds. The aim of the present study was to describe the main characteristics of acute transfusion reactions reported in the 4 hospital of Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran.Material and Methods: The study was carried out at 4 teaching hospital of Kermanshah University of Medical Sciences, Kermanshah, Iran over18 months from April 2010. All adult patients on admission in the hospitals who required blood transfusion and had establish diagnosis and consented were included in the study.Results: In the year 2010 until 2012, a total of 6238 units of blood components were transfused. A total of 59 (0.94%) cases of transfusion reaction were reported within this 3 years period The commonest were allergic reactions which presented with various skin manifestations such as urticarial, rashes and pruritus (49.2%), followed by increase in body temperature of > 1◦C from baseline which was reported as febrile non-hemolytic transfusion reaction (37.2%). pain at the transfusion site (6.8%) and hypotension (6.8%).Conclusion: It is important that each transfusion of blood components to be monitor carefully. Many transfusion reactions are not recognized, because signs and symptoms mimic other clinical conditions. Any unexpected symptoms in a transfusion recipient should at least be considered as a possible transfusion reaction and be evaluated. Prompt recognition and treatment of acute transfusion reaction are crucial and would help in decreasing transfusion related morbidity and mortality, but prevention is preferable.

Background: Acute myeloid leukemia (AML) is a heterogeneous clonal disorder characterized by immature myeloid cell proliferation and bone marrow failure. Various genetic and epigenetic factors have been found to be influential in such patients. Methylation silencing of APAF-1, a putative tumor suppressor gene (TSG), has been found in several human malignancies. In this study, we explored the association of APAF-1 methylation status with AML patients. Subjects and Methods: We studied the methylation status of APAF-1 gene in 101 AML patients and 50 healthy subjects as controls. Genomic DNA was extracted from leukocytes in peripheral blood or bone marrow and the methylation status of APAF-1 gene promoter was detectedusing methylation-specific PCR (MSP) method with specific methylated and unmethylated primers. Gene expression was analyzed using real time RT-PCR. Results: The prevalence of methylated (MM) and hemi-methylated (MU) CpG dinucleotides within the APAF-1 gene promoter of AML patients was 12 (11.9%) and 45 (44.6%), respectively, while no methylation was detected in the control samples (p < 0.001). Our results showed a higher frequency of methylated APAF1 in FLT3-ITD mutated cases(p=0.04). APAF1 mRNA expression was significantly lower in methylated cases compared with normal cases. Conclusion: The present study indicated the increased frequency of hypermethylation of APAF-1 gene promoter in AML patients. APAF-1 aberrant CpG island methylation was associated with transcriptional downregulation in AML patients. Therefore, promoter methylation of APAF-1 gene could be considered as an epigenetic factor that contributes to the development of AML.

Background: In developed or developing countries, the most common cancer in women is breast cancer with a pick in 40–50 years in Asia. Herein, we compared the association between IHC with FISH in HER2-positive breast cancer patients and affection of trastuzumab on disease free survival and overall survival (OS). Subjects and Methods: Immunohistochemical (IHC) analysis of hormone receptors and HER2 was performed in 133 patients with breast cancer between 2003 and 2014. Patients were selected for Herceptin adjuvant treatment, according to IHC 3+ or FISH+. The specimens for pathology reports were fixed at 10% neutral-buffered formalin (pH=7.4) for 24 hours, then sliced into 4 μm sections. Results: The mean age of patients at diagnosis was 46.39 years (range, 24-78 years), 100% female. Concordance rates between IHC and FISH were 31.1% for IHC 2+ and 84.1% for IHC 3+ (p50 years. Of the 133 patients, 30 patients (22.6%) had metastasis and 72 (54.1%) had right involvement. Ninety three (69.9%) patients had lymph node invasion. 48 patients (36.1%) were treated with trastuzumab and 85 (63.9%) were treated without trsastuzumab. The 10-year survival rate was 70% and the mean survival was 49 months. Conclusions: We recommend clinicians that FISH analysis is as a predictor in breast cancer patients with IHC score 2+. In contrast, FISH analysis of IHC 3+ samples was no useful. Trastuzumab therapy is effective and tolerated for breast cancer with IHC 3+ and probably IHC 2+/FISH+.

Background: Emotional Intelligence (EQ) is positively associated with mental health and it can have a crucial role in mental disorder therapy by suitable coping mechanisms. The present study aimed to evaluate the relationship of EQ with anxiety and depression among the women with breast cancer. Subjects and Methods: During 2013 and in a cross-sectional study, 98 breast cancer patients (14 to 21 years old) entered into the study. For data collection, the following instruments were the Bar-On EQ inventory, Beck Depression Inventory and Cattle Anxiety Inventory. Results: There was an inverse relationship between anxiety with intrapersonal (p

Introduction: The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. These inhibitors are necessary to prevent thromboembolism. Hereditary deficiency of inhibitors is the main cause of alteration in balance between the anti-clotting and the formation of thrombin. Patients with this abnormality are susceptible to venous thromboembolism (VTE). Two major clinical manifestation of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of present study was to investigate the frequency of coagulation inhibitor proteins and resistance to activated protein C (APC-R) in DVT patients from Kermanshah province of Iran with Kurdish ethic background. Materials and methods: We investigated all patients with thrombophilia who referred to Iranian Blood Transfusion Organization from May 2011 to March 2012. The levels of protein C, protein S and antithrombin were measured using STAGO kits, France (Diagnostica Stago) and the APC-R level was detected using Pefakit® kit. Results: After excluding patients with confounding factors, 54 patients were remained. Our results showed that acquired risk factors are the most common causes of DVT in the present study. In our study protein C deficiency was found to be the most hereditary risk factor followed in frequency by APC-R. Also, in 16 patients (29.6%) there were combined hereditary risk factors with deficiency in 2 or 3 factors. Conclusion: Our results showed protein C deficiency was the prevalent cause of DVT in our patients. Also, different pattern of hereditary risk factors in our patients compared to other regions of Iran could be attributed to different ethnic background of our patients.

Introduction: The incidence of malignant melanoma is increasing at a rate greater than any other human cancer. Although melanoma accounts for only 4 percent of all dermatologic cancers, it is responsible for 80 percent of deaths from skin cancer; only 14 percent of patients with metastatic melanoma survive for five years. The optimal therapy varies with the stage of the disease. Surgical excision is the treatment of choice for early disease, while some patients who are at high risk for developing metastatic disease (particularly those with stage II and III cancers may benefit from adjuvant therapy with interferon alfa (IFNa).(1) The management of patients with disseminated disease is a difficult problem. In carefully selected patients, excision of limited distant metastases can occasionally produce durable benefit. However, most patients with stage IV disease require systemic treatment. Traditional systemic treatment approaches include cytotoxic chemotherapy and immunotherapy. Several novel therapeutic approaches are under study, the most promising of which target specific molecular abnormalities that have been identified in melanomas. Molecularly targeted therapy for advanced melanoma will be reviewed here.(2)

Introduction: The myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases characterized by excessive production of blood cells by hematopoietic precursors. Typically, they include polycythemia vera (PV), essential thrombocythemia (ET), idiopathic myelofibrosis (IMF), and chronic myeloid leukemia (CML). Philadelphia chromosome is the final diagnostic test for CML. Recently, JAK2 mutation introduced as a diagnostic marker for other MPNs. The aim of this study is evaluation of Philadelphia chromosome in CML patients and JAK2 mutation in MPNs patients that had been referred to a hematology/oncology clinic in Kermanshah between 2010-2011. Material and methods: In this study we evaluated common genetic disorders in 124 MPNs patients. Expression of B2A2 BCR-ABL mRNA in peripheral blood leucocytes was detected by a reverse transcriptase polymerase chain reaction (RT-PCR) for CML patients. Also, we used AS-RT-PCR method for the detection of the JAK2 mutation for all of 124 patients. Results: We found 93.7% CML patients (60/64) with positive Philadelphia chromosome. Also, 85% PV patients (17/20), 46.6% ET patients (14/30) and 40% IMF patients (4/10) had JAK2 mutation. Notably, we found a CML patient with positive Philadelphia chromosome and JAK2 mutation. Conclusion: Diagnosis of MPNs is often complex and expensive but, JAK2 mutation is a sensitive test, relatively cost-effective for proving clonality in MPNs. Also, more studies are required to determine the exact frequency and prognostic role of the JAK2 mutation in Philadelphia positive CML patients.

Introduction: Transfusion-transmitted infections (TTI) continue to be a major challenge for Blood transfusion organizations in the world and multi- transfused patients (MTPs) are at higher risk of infection. HTLV-1 is a retrovirus that easily transmitted via blood cell products. The aim of this study is determine the seroprevalence of HTLV-1 in major thalassemic patients from Kermanshah Province, western of Iran. Material and methods: A total of 116 serum samples from all major thalassemic patients that exist in Kermanshah providence and 1000 serum samples from healthy individuals as control group were tested for HTLV specific antibody by ELISA method. All of the ELISA positive samples were confirmed by Western Blotting analysis. Results: From major thalassemic patients, 4 subjects (3.4%) had HTLV-I infection. Also, among 1000 control individuals, 5 subjects (0.5%) had HTLV-I infection. There wasn’t any HTLV-II in major thalassemic patients or control individuals. Conclusion: our results showed this infection exist in our region. These results indicated that screening procedure were not doing carefully. More studies are needed to clarify the reason of this unsuccessfully screening of this virus from donated blood.

Introduction: Normal homeostasis system has several inhibitor mechanisms in front of the amplifiers natural clotting enzyme to prevent fibrin clots in the vessels. The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. Patients with hereditary deficiency of coagulation inhibitors are susceptible to venous thromboembolism (VTE). One of the major clinical manifestations of VTE is deep vein thrombosis (DVT). The present study has investigated the frequency of protein C and S deficiency among DVT patients that by using of these results and results from our previous study; we determined the most important hereditary risk factors for DVT in the Kermanshah Province of Iran with the Kurdish ethnic background. Materials and methods: We studied 150 patients from the Kermanshah Province of Iran with Kurdish ethnic background. Patients with hereditary risk factors were excluded from the study. Estimation of protein C and protein S were performed using kits from STAGO, France (Diagnostica Stago). Results: After excluding patients with confounding factors, 50 patients were remained. We found 14 patients (28%) with protein C deficiency and 10 patients (20%) with protein S deficiency. Also, 2 patients (4%) had both protein C and S deficiency. Conclusion: Comparing the results of this study with our previous study on DVT patients indicates that among inherited risk factors for DVT in our population the deficiency of protein C, S and FVL mutation are the most prevalent factors. Our results show that our population has different pattern for hereditary risk factors compared with other Asian pattern for DVT patients.

The case of a 52 old women with Hodgkin’s disease of 15 years duration is described. During 4 months ago when she be in the remission phase during every 6 months her follow up she complaint with paranoid minds, urinary incontinency, headache, dizziness and blurred vision started. Papilledema and left hemiparesia were detected. Brain MRI pointed to intracranial invasion by the disease. Therapeutic test with steroids brought to amelioration; therefore, subsequent skull irradiation and chemotherapy were given which improved her condition markedly. For the diagnosis we need newer diagnostic procedures that enable for correct diagnosis of intracranial involvement in Hodgkin’s disease. In doubtful cases, therapeutic test with steroids, followed by chemotherapy and skull irradiation, are indicated, and surgery should be advised only if these measures fail.

"nAbstract: This paper represents a novel use of artificial neural networks in medical science. The proposed technique involves training a Multi Layer Perceptron (MLP) (a kind of artificial neural network) with a BP learning algorithm to recognize a pattern for the diagnosing and prediction of five blood disorders, through the results of blood tests from H1 machine. The blood test parameters and diagnosis of physician about the diseases of 450 patients from Taleghani Hospital in Kermanshah, Iran, are used in a supervised training method to update network parameters. This method was implemented to diagnose these disorder and cancer: Megaloblastic Anaemia, Thalassemia, Idiopathic thrombocytopenic pupura (ITP), Chronic myelogenous leukemia and Lymphoproliferative.

Background: Hairy cell leukemia (HCL) is a chronic B-cell lymphoid leukemia characterized by pancytopenia, splenomegaly, myelofibrosis and the presence in peripheral blood, bone marrow and spleen of atypical lymphoid cells with a hairy aspect. The study aims to evaluate a group of patients with hairy cell leukemia, hospitalized in the Clinic of Hematology and Oncology, Kermanshah, Iran, on a period of 15 years and affect of between cladribine therapy and IFN therapy on the patients with HCL. Methods: This is a retrospective analysis of 11 patients in the Clinic of Hematology and Oncology, Kermanshah, Iran, between 2004 and 2013. Clinical features at diagnosis, differential count (platelet, Hb and WBC) types of therapy, survival rate and BRAF mutation have been monitored. As a result, cladribine therapy is the best treatment option for patients. Results: The mean age of patients was 50 years with 100% of men. Approximately 45% of them had splenomegaly at diagnosis. 100% of patients had pancytopenia at diagnosis.9% of patients had mutation of BRAF V600E. Before of treatment, there were fatigue, weight loss, vomiting, fever, night sweat and itching in all of the patients. Conclusion: There is presence of hairy cells in peripheral blood and bone marrow and was associated with pancytopenia, splenomegaly, myelofibrosis in HCL patients. Also, cladribine therapy is best option for treatment of patients and it is better than IFN.

Granulocytic sarcomas (chloromas) are rare extramedullary tumors consisting of primitive granulocytic cells. We report here on a case of a 23-year-old man who presented with a generalized swelling. He is known case of acute myelomonocytic leukemia. Granulocytic sarcomas are rare, destructive, extramedullary tumor masses that consist of immature granulocytic cells. In this unusual patient's case, the location and invasive nature of the tumor be important that can die the patient if we cannot treat patient urgently. Optimal therapy for these patients has not been well defined: standard AML chemotherapy is moderately effective and should be considered for all suitable cases. To reduce the risk of subsequent ANLL in patients with nonleukemic GS, it is important that accurate histologic diagnosis is established initially for GS and that all isolated cases of GS, even those that appear to be cured by resection or irradiation of the tumor, are treated with intensive chemotherapy similar to that used to treat ANLL during the nonleukemic period as soon as possible.

Chronic lymphocytic leukemia (CLL) and chronic myeloid leukemia (CML) are the most common leukemias of the elderly (>43 year). However, the sequential occurrence of CML followed by CLL in the same patient is extremely rare. In our report, a 52-year-old female was diagnosed with CLL (type of bone marrow (BM) infiltration was nodular and interstitial) and was treated with chlorambucil. 64 months after the diagnosis of CLL, she developed CML. She was treated with imatinib (400mg/day). After a few months, signs of CML were disappeared and CLL became dominant. This is first reported case.

Hemoglobinopathies are the most common single gene disorders worldwide with a considerable frequency in certain area particularly Mediterranean and Middle Eastern countries. Hemoglobinopathies include structural variants of hemoglobin (Hb S, Hb C, HbE,…) and thalassaemias which are inherited defects in the globin chains synthesis. The present study was conducted to determine the prevalence of hemoglobinopathies in western Iranian patients. A total of 344 patients (151 males and 193 females) with abnormal CBC and/or hemoglobin electrophoresis were enrolled in the present study. Cellulose acetate gel electrophoresis was performed for all patients and abnormal bands were identified by citrate agar gel electrophoresis and PCR based methods. Iron deficiency anemia (IDA) was present in 156 (45.3%) individuals. Thirty four (9.8%) patients had both iron deficiency anemia and α-thalassemia trait trait, 41(11.9%) patients were with both iron deficiency anemia and minor β-thalassemia. There were 31(9%) patients with α-thalassemia trait and 5 (2.2%) patients with Hb H disease. Fifty six (16.2%) patients had minor β-thalassemia. Also, there were 10 (2.9%) individuals homozygous for hemoglobin D-Punjab and one patient with hemoglobin G (0.3%). There was one sample with hemoglobin C. Further, we found 3 patients (0.9%) with sickle cell trait and more 3 patients (0.8%) with S/ β +-thalassemia. Our results indicated that the most frequent cause of hypochromic and/or microcytic anemia in our population was IDA and the minor β-thalassemia was the second cause that needs to more attention in screening programs.

Introduction: The long-term use of immunosuppressive agents for prevention of allograft rejection increases the risk of malignancy approximately 100 times as high as that in the general population and Kaposi’s sarcoma (KS) is a relatively common malignancy after kidney transplantation. The aim of present study was to investigate the frequency of KS in patients with kidney transplantation in 20 years period. Material and methods: In this study Charts and pathology reports of 1487 recipients for kidney allografts treated at Imam Reza hospital between 1991 and 2012 were reviewed. The SPSS software package version 16 (SPSS Inc., Chicago, Illinois, USA) was used for the statistical analysis. Results: There were 17 of 1487 incident cases of KS kidney transplant population at our hospital in period of study. There is no significant difference between age and gender of patients. The mean time between transplantation and non-KS malignant tumors was 34.4 ± 21.8 months (range 12–140 months), while in KS patients it was 18.7 ± 25.2 months, which was statistically significantly different (P < 0.05). After detection of KS in 12 patients, we perform serum antibody detection against HHV. Among them, 8 (66.6%) were seropositive. Conclusion: KS is a common long-term complication in renal transplant recipients, with an increased incidence compared with the general population. Given that candidates for organ transplantation who are seropositive for HHV-8 -and thus at risk for KS- can now be identified, chemoprevention should be available in this high-risk population.

Introduction: The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. These inhibitors are necessary to prevent thromboembolism. Hereditary deficiency of inhibitors is the main cause of alteration in balance between the anti-clotting and the formation of thrombin. Patients with this abnormality are susceptible to venous thromboembolism (VTE). Two major clinical manifestation of VTE are deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of present study was to investigate the frequency of coagulation inhibitor proteins and resistance to activated protein C (APC-R) in DVT patients from Kermanshah province of Iran with Kurdish ethic background. Materials and methods: We investigated all patients with thrombophilia who referred to Iranian Blood Transfusion Organization from May 2011 to March 2012. The levels of protein C, protein S and antithrombin were measured using STAGO kits, France (Diagnostica Stago) and the APC-R level was detected using Pefakit® kit. Results: After excluding patients with confounding factors, 54 patients were remained. Our results showed that acquired risk factors are the most common causes of DVT in the present study. In our study protein C deficiency was found to be the most hereditary risk factor followed in frequency by APC-R. Also, in 16 patients (29.6%) there were combined hereditary risk factors with deficiency in 2 or 3 factors. Conclusion: Our results showed protein C deficiency was the prevalent cause of DVT in our patients. Also, different pattern of hereditary risk factors in our patients compared to other regions of Iran could be attributed to different ethnic background of our patients.

Granulocytic sarcomas (chloromas) are rare extramedullary tumors consisting of primitive granulocytic cells. We report here on a case of a 23-year-old man who presented with a generalized swelling. He is known case of acute myelomonocytic leukemia. Granulocytic sarcomas are rare, destructive, extramedullary tumor masses that consist of immature granulocytic cells. In this unusual patient's case, the location and invasive nature of the tumor be important that can die the patient if we cannot treat patient urgently. Optimal therapy for these patients has not been well defined: standard AML chemotherapy is moderately effective and should be considered for all suitable cases.To reduce the risk of subsequent ANLL in patients with nonleukemic GS, it is important that accurate histologic diagnosis is established initially for GS and that all isolated cases of GS, even those that appear to be cured by resection or irradiation of the tumor, are treated with intensive chemotherapy similar to that used to treat ANLL dur ng the nonleukemic period as soon as possible.

Introduction:The incidence of malignant melanoma is increasing at a rate greater than any other human cancer. Although melanoma accounts for only 4 percent of all dermatologic cancers, it is responsible for 80 percent of deaths from skin cancer; only 14 percent of patients with metastatic melanoma survive for five years. The optimal therapy varies with the stage of the disease. Surgical excision is the treatment of choice for early disease, while some patients who are at high risk for developing metastatic disease (particularly those with stage II and III cancers may benefit from adjuvant therapy with interferon alfa (IFNa).(1) The management of patients with disseminated disease is a difficult problem. In carefully selected patients, excision of limited distant metastases can occasionally produce durable benefit. However, most patients with stage IV disease require systemic treatment. Traditional systemic treatment approaches include cytotoxic chemotherapy and immunotherapy. Several novel therapeutic approaches are under study, the most promising of which target specific molecular abnormalities that have been identified in melanomas. Molecularly targeted therapy for advanced melanoma will be reviewed here.(2)

Introduction: Transfusion-transmitted infections (TTI) continue to be a major challenge for Blood transfusion organizations in the world and multi- transfused patients (MTPs) are at higher risk of infection. HTLV-1 is a retrovirus that easily transmitted via blood cell products. The aim of this study is determine the seroprevalence of HTLV-1 in major thalassemic patients from Kermanshah Province, western of Iran. Material and methods: A total of 116 serum samples from all major thalassemic patients that exist in Kermanshah providence and 1000 serum samples from healthy individuals as control group were tested for HTLV specific antibody by ELISA method. All of the ELISA positive samples were confirmed by Western Blotting analysis. Results: From major thalassemic patients, 4 subjects (3.4%) had HTLV-I infection. Also, among 1000 control individuals, 5 subjects (0.5%) had HTLV-I infection. There wasn’t any HTLV-II in major thalassemic patients or control individuals. Conclusion: our results showed this infection exist in our region. These results indicated that screening procedure were not doing carefully. More studies are needed to clarify the reason of this unsuccessfully screening of this virus from donated blood.

Introduction: The myeloproliferative neoplasms (MPNs) are a heterogeneous group of diseases characterized by excessive production of blood cells by hematopoietic precursors. Typically, they include polycythemia vera (PV), essential thrombocythemia (ET), idiopathic myelofibrosis(IMF), and chronic myeloid leukemia (CML). Philadelphia chromosome is the final diagnostic test for CML. Recently, JAK2 mutation introduced as a diagnostic marker for other MPNs. The aim of this study is evaluation of Philadelphia chromosome in CML patients and JAK2 mutation in MPNs patients that had been referred to a hematology/oncology clinic in Kermanshah between 2010-2011. Material and methods: In this study we evaluated common genetic disorders in 124 MPNs patients. Expression of B2A2 BCR-ABL mRNA in peripheral blood leucocytes was detected by a reverse transcriptase polymerase chain reaction (RT-PCR) for CML patients. Also, we used AS-RT-PCR method for the detection of the JAK2 mutation for all of 124 patients. Results: We found 93.7% CML patients (60/64) with positive Philadelphia chromosome. Also, 85% PV patients (17/20), 46.6% ET patients (14/30) and 40% IMF patients (4/10) had JAK2 mutation. Notably, we found a CML patient with positive Philadelphia chromosome and JAK2 mutation. Conclusion: Diagnosis of MPNs is often complex and expensive but, JAK2 mutation is a sensitive test, relatively cost-effective for proving clonality in MPNs. Also, more studies are required to determine the exact frequency and prognostic role of the JAK2 mutation in Philadelphia positive CML patients.

Ganglioneuromas presented as a retroperitoneal tumor around the vital organs is a rare entity. A case with unusual presentation is reported. Young woman of 44 years old presented without any complaint ,that known during incidental abdominopelvic ultrasonography. It was treated with partial resection for debulking surgery. Debulking surgery with preservation of organ functions is feasible in these slow growing tumors for better quality of life.

Introduction: Normal homeostasis system has several inhibitor mechanisms in front of the amplifier’s natural clotting enzyme to prevent fibrin clots in the vessels. The main inhibitors of coagulation pathway are antithrombin (AT), protein C and protein S. Patients with hereditary deficiency of coagulation inhibitors are susceptible to venous thromboembolism (VTE). One of the major clinical manifestations of VTE is deep vein thrombosis (DVT). The present study has investigated the frequency of protein C and S deficiency among DVT patients that by using of these results and results from our previous study; we determined the most important hereditary risk factors for DVT in the Kermanshah Province of Iran with the Kurdish ethnic background. Materials and methods: We studied 150 patients from the Kermanshah Province of Iran with Kurdish ethnic background. Patients with hereditary risk factors were excluded from the study. Estimation of protein C and protein S were performed using kits from STAGO, France (Diagnostica Stago). Results: After excluding patients with confounding factors, 50 patients were remained. We found 14 patients (28%) with protein C deficiency and 10 patients (20%) with protein S deficiency. Also, 2 patients (4%) had both protein C and S deficiency. Conclusion: Comparing the results of this study with our previous study on DVTpatients indicates that among inherited risk factors for DVT in our population the deficiency of protein C, S and FVL mutation are the most prevalent factors. Our results show that our population has different pattern for hereditary risk factors compared with other Asian pattern for DVTpatients.

The case of a 52 old women with Hodgkin’s disease of 15 years duration is described. During 4 months ago when she be in the remission phase during every 6 months her follow up she complaint with paranoid minds, urinary incontinency, headache, dizziness and blurred vision started. Papilledema and left hemiparesia were detected. Brain MRI pointed to intracranial invasion by the disease. Therapeutic test with steroids brought to amelioration; therefore, subsequent skull irradiation and chemotherapy were given which improved her condition markedly. For the diagnosis we need newer diagnostic procedures that enable for correct diagnosis of intracranial involvement in Hodgkin’s disease. In doubtful cases, therapeutic test with steroids, followed by chemotherapy and skull irradiation, are indicated, and surgery should be advised only if these measures fail.

Ganglioneuromas presented as a retroperitoneal tumor around the vital organs is a rare entity. A case with unusual presentation is reported. Young woman of 44 years old presented without any complaint ,that known during incidental abdominopelvic ultrasonography. It was treated with partial resection for debulking surgery. Debulking surgery with preservation of organ functions is feasible in these slow growing tumors for better quality of life.