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Objective: To determine the prognostic significance of bone marrow fibrosis grade in predicting the outcome of myeloproliferative neoplasms. Study Design: Prospective longitudinal study. Duration and Place of Study: Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jun 2021 to May 2022. Methodology: A total of 114 patients with myeloproliferative neoplasms were included. Under aseptic conditions, a bone marrow aspiration and a Trephine biopsy were obtained. Folowing processing, the samples underwent staining with Hemotoxylin and Eosin and Reticulin. The WHO bone marrow fibrosis grading system was used to grade the fibrosis. Clinical findings and haematological parameters documented at initial diagnosis were compared with one-year interval folow-up counts. Results: Out of a total 114, 72(63.2%) were male and 42(36.8%) were female. Generalised weakness and palor were documented in 51(44.7%) and 27(23.7%), respectively. While splenomegaly and/or hepatomegaly were detected in 61(53.5%) and 27(23.7%), respectively, 16(14.9%) transformed into other MPNs and 3(2.6%) into acute leukemia. People who had higher levels of MF-2 and MF-3 reticulin fibrosis had the worst prognosis when it came to peripheral blood cytopenias, disease progression, and transformation. Conclusion: Myeloproliferative neoplasms are very different from one another in terms of how they look and behave. As the grade of fibrosis rises, there is a high chance that the disease wil progress to myelofibrosis or change into acute leukaemia, both of which are very bad for overal survival. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequencies of different cytogenetic abnormalities in patients of Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan. Methods: It was descriptive cross-sectional study conducted in Hematology Department of a Tertiary care referral institute from June 2015 to July 2017. All newly diagnosed cases of Acute Leukemia were analyzed. Cytogenetic analysis was performed on bone marrow aspirate samples using Giemsa-trypsin banding technique. Karyotypes were identified and interpreted according to ISCN criteria. Results: A total of 355 newly diagnosed patients of Acute Leukemia were analyzed. Out of these, 180 patients had AML and 175 had ALL. In Acute Myeloid Leukemia chromosomal abnormalities were detected in 28.2 % cases. Of these the common ones included t(8;21),t(15;17),+8, Inversion 16 and Monosomy 7. Other abnormalities included Complex karyotype, Down’s syndrome related AML, Hyperdiploidy, del 16q,-8,+Y and t(3p;17q)del 10. In Acute Lymphoblastic Leukemia chromosomal abnormalities were detected in 40% cases. Common ones included Hyperdiploidy, Tetraploidy and t(9;22). Other abnormalities included t(1;19) and t(2;8)t(8;14). Conclusion: Cytogenetically favorable abnormalities are commonest occurring chromosomal defects in both Acute Myeloid Leukemia and Acute Lymphoblastic Leukemia in Northern Pakistan, i.e., t(8;21) in AML and Hyperdiploidy in ALL. [ABSTRACT FROM AUTHOR]

Background: Acute lymphoblastic leukaemia is characterized by the presence of more than or equal to 20% lymphoblast (early lymphoid precursors) in peripheral blood and/or in bone marrow. Lymphoblast can infiltrate different organs and clinically patients can present with fatigue, pallor, fever, bone pain, bleeding or bruises and lymphadenopathy. ALL is the most common type of malignancy in children. To determine the cytogenetic abnormalities in patients of Acute Lymphoblastic Leukaemia as a predictor of response to induction chemotherapy. It was a descriptive cross-sectional study. Methods: This study was conducted at the Armed Forces Institute of Pathology, Rawalpindi over a period of six months from June to November 2019. Bone marrow and peripheral blood samples of newly diagnosed 80 patients of all the age groups and either gender, who received one month treatment for ALL, were analyzed for cytogenetic study. Patients who were previously diagnosed with ALL, who presented with relapse and those who required induction treatment outside the trial hospital were excluded. UK ALL 2011 treatment protocol was adopted for patients up to 25 years old and for patients above 25years old UK ALL 2014 treatment protocol as induction chemotherapy was adopted. Evaluation for remission was carried out at the termination of initial induction chemotherapy on day 29 of treatment. Results: A total of 80 patients were enrolled in the study, comprising 36 (45%) females & 44 (55%) males. The median age of paediatric patients was 5years (<19 years) who were 56/80 (70%) in number whereas the median age of adults was 27 years (>19 years) who constituted 24/80 (30%) of the participants. Cytogenetic of 51 (63.75%) patients revealed hyperdiploidy (chromosome number 51-66) whereas 29(36.25%) of the participants had miscellaneous mutations [(Hypodiploidy, t (9; 22), t (1; 19) and t (12; 21)]. On immunophenotyping 51/80 (63.7%) of the leukemias were of B cell origin and 29 (36.25%) of T-cell origin. Conclusion: Patients with hyperdiploidy, t (12;21) ETV6/RUNX1 and t(1;19)TCF3/PBX1 had better prognosis and higher remission rate compared to those with the other mutations like t(9;22)Ph+ and hypodiploid which were associated with poor prognosis. Association of gender with remission was not statistically significant. [ABSTRACT FROM AUTHOR]

A descriptive study was carried out to assess the mean ranges of red blood cell (RBCs) indices in ß-thalassemia carrier patients with frequency of different common and uncommon/uncharacterized mutations that are IVS 1-5 (G-C), Fr8-9 (+G), Fr 41-42 and Cd 5 mutations of ß-thalassemia traits. A total 293 ß-thalassemia carrier patients were included in study. Fr 8-9 (+G) was found the most common mutation of ß-thalassemia carrier patients in the population which was 112 (38.2%), followed by IVS1-5 (G-C) which was 82 (28%), Fr41-42 which was 24 (8.2%), Cd 5 which was 20 (6.8%) and others which were 55 (18.8%) patients. The IVS 1-5 (G-C) was the most common mutation in Punjabis while Fr 8-9 (+G) was the most common mutation in Pathan community. Lowest hemoglobin (Hb) level was found in IVS 1-5 mutations of ß-thalassemia carrier patients, while the average Hb in ß-thalassemia carrier patients was 11.54 but it also varied gender-wise, different ethnic origin and in different mutation. The mean MCV was 62.94A, MCH 19.46pg, MCHC 30.74g/dl and RDW 39.06A. The final findings showed that IVS 1-5 (G-C) was the most common mutation in Punjabis and Fr 8-9 (+G) is the most common mutation of Pathan community. Lowest Hb was found in IVS 1-5 Mutation of ß-thalassemia carrier patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Ten-Eleven-Translocation-2 (TET2) gene mutation in Myeloproliferative Neoplasms (MPNs) and to generate a local data for evaluation of disease behavior in ten-eleven-translocation-2 positive and negative Patients. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, from Apr 2017 to Apr 2018. Methodology: A total of 50 adult myeloproliferative neoplasms patients (>18 years of age), diagnosed according to WHO 2016 diagnostic criteria for myeloproliferative neoplasms were included in the study. Mutational screening for ten-eleven-translocation-2 gene was performed by flourescent in situ hybridization technique using Meta Systems XL-TET2 Deletion probe REF D-5038- 100-OG, LOT 18181, manufactured by Meta-Systems GmbH, Robert-Bosch - Germany. Bone marrow samples were used for Fluorescence in situ hybridization analysis. A total of 500 interphases were examined in each of the specimen. Data was entered and analyzed using SPSS-22. Distinctive demographic, haematological and molecular results are summarized by descriptive statistics. Results: Total 50 cases of myeloproliferative neoplasms (14 CML, 10 PV, 12 essential thrombocythemia (ET) and 14 primary myelofibrosis (PMF) were analyzed. On fluorescent in situ hybridization studies, ten-eleven-translocation-2 mutation was detected in 8 (16%) patients. The mutational frequency among different myeloproliferative neoplasm entities was 4 (28.5%) in chronic myeloid leukemia (CML), 2 (20%) in Polycythemia Vera (PV), 1 (8.3%) in essential thrombocythemia and 1 (7.1%) in primary myelofibrosis respectively. Among the 15 cases, 36 (72%) patients were positive for JAK2V617F mutation while 14 (28%) were positive for BCR-ABL1 mutation. Ten-eleven-translocation-2 mutation observed in 4 (11.11%) of JAK2V617F positive and 4 (28.5%) of BCR-ABL1 positive patients. Conclusion: Ten-eleven-translocation-2 mutation occur in both JAK2V617F positive and negative myeloproliferative neoplasms. They are found more in chronic myeloid leukemia as compared to with polycythemia vera, essential thrombocythemia, and primary myelofibrosis. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of Del 13q14 in Chronic lymphocytic leukaemia, to compare its association with clinicpathologic features and to define the contribution of this abnormality to the prognosis. Study Design: Cross-sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Armed Forces Bone Marrow Transplant Centre and Oncology department, Combined Military Hospital Rawalpindi, from Apr 2017 to Jul 2018. Methodology: A total of 56 newly diagnosed cases of CLL were included in the study. Patients were diagnosed on the basis of National Cancer Institute Working Group guidelines for diagnosis of CLL. After detailed history and thorough clinical examination; complete blood counts, biochemical profile, bone marrow examination, immunophenotyping on bone marrow or peripheral blood samples were done and Interphase FISH studies on blood or bone marrow specimens for detection of Del 13q14 were performed. Clinico-pathological features of CLL patients with Del 13q14 were compared with other cytogenetic abnormalities. Results: The frequency of Trisomy 12 was found to be 37.5%. Most of CLL patients with Del 13q14 were aymptomatic and were diagnosed on routine workup. The WBC count and Absolute lymphocyte count was slightly lower in patients with Del13 q14 lower when compared with the CLL patients without 13q14 Deletion. Most of the patients with this aberration presented in early stage (Binet stage A) and this association of Del 13q14 with Binet stage was statistically significant (p<0.05). However, no association was found between 13q14 deletion and ZAP70 as all of our patients were negative for this marker. Many patients with Del 13q14 did not require chemotherapy at diagnosis and during follow up as compared to patients without del13q14, and this association was statistically significant (p<0.05). The study also showed that disease progression in patients with deletion 13q14 become significantly less as compared to patient without Del 13q14. Conclusions: The deletion of 13q14 influence clinical outcome of patients with CLL and was found to be associated with favourable prognosis. A determination of Del 13q14 should therefore be included in the investigations of the prognostic factors of B-cell chronic lymphocytic leukemia. This can prevent unwanted chemotherapy in these patients. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of DEL 11q22 in patients of Chronic Lymphocytic Leukemia and clinicopathological features in Chronic Lymphocytic Leukemia with DEL 11q22. Study Design: Cross sectional analytical study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology Rawalpindi, from Apr 2017 to Jul 2018. Methodology: A total of 61 newly diagnosed cases of Chronic Lymphocytic Leukemia were included. Diagnosis was made according to National Cancer Institute Working Group guidelines for diagnosis of Chronic Lymphocytic Leukemia. After relevant history and clinical examination; complete blood counts, biochemical profile, bone marrow examination, immunophenotyping on bone marrow or peripheral blood samples and Interphase FISH studies on blood or bone marrow specimens for detection of DEL 11q22 were carried out. Results: Deletion 11q22 was detected in 7 (11.4%) of Chronic Lymphocytic Leukemia patients. Median white cell count was 152 x 109/L (74-156) and absolute lymphocyte count was 105.5 x 109/L (74-139) which was higher than patients of Chronic Lymphocytic Leukemia without DEL 11q22. According to Rai staging, 3 (42.9%) patients presented in advanced stage Rai III and 2 (28.6%) patients were in Rai I & Rai II. All patients of Chronic Lymphocytic Leukemia with DEL 11q22 presented with B-symptoms and lymphadenopathy. Bulky disease was found in 2(28.5%) of patients. CD38 expression was in 3 (42.8%) cases. Conclusion: Frequency of DEL 11q22 in Chronic Lymphocytic Leukemia in our population was found to be 11.4%. All patients of Chronic Lymphocytic Leukemia with DEL 11q22 presented with B-Symptoms and lymphadenopathy. [ABSTRACT FROM AUTHOR]

Objective: To determine the diagnostic accuracy of Ret-He in detecting IDA, keep ingserum ferritin as gold standard Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, AFIP Rawalpindi, from Jan to Jul 2017. Methodology: Study involved 165 female patients who presented with anemia (hemoglobin <11g/dl). Ret-He was determined having a level of <27.8 pg/L as diagnostic of IDA. Diagnosis of IDA was confirmed on serum ferritin level <11 ng/ml taking it as gold standard. Accordingly, diagnostic accuracy of Ret-He was determined considering low serum ferritin level as gold standard. Results: The mean age of the patients was 27.52 ± 13.57 years. Mean hemoglobin level was 9.17 ± 1.59 g/dl while mean serum ferritin level was 15.20 ± 12.89 ng/ml. Ret-He ranged from 11.0 pg/L to 39.4 pg/L with a mean of 23.34 ± 8.21 pg/L. IDA on the basis of serum ferritin level was diagnosed in 75 (45.5%) patients while Ret-He labeled IDA in 85 (51.5%) patients. When cross-tabulated, there were 70 TP, 15 FP, 5 FN and 75 TN cases which yielded 93.33% sensitivity, 83.33% specificity, 87.88% accuracy, 82.35% PPV and 93.75% NPV for Ret-He in diagnosing IDA keeping serum ferritin as gold standard. Thus the optimal cut-off value of Ret-He was found to be <27.6 pg/L which gave 93.33% sensitivity and 83.33% specificity in detecting IDA keeping serum ferritin as gold standard. Conclusion: Ret-He was found as fast and reliable technique to diagnose IDA in female population. However, further studies are required for confirmation of its efficacy. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of hyperdiploidy in childhood acute lymphoblastic leukemia (ALL) and its association with remission status after induction therapy. Study Design: Observational study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology (AFIP) and Pediatric Oncology Department Combined Military Hospital (CMH) Rawalpindi, from Apr 2017 to Apr 2018. Patients and Methods: All diagnosed cases of ALL between 1-12 years of age were selected by convenient nonprobability sampling. All other cases of leukemias including patients of acute undifferentiated leukaemia, acute myeloid leukaemia and patients of ALL who did not yield successful cytogenetic culture or those who died during the induction therapy were excluded from the study. Diagnosis of ALL was done on the basis of morphology, cytochemistry, immunophenotyping and cytogenetics. Cytogenetic analysis was done by using conventional Giemsa banding. Karyotypes were interpreted using the International System for Human Cytogenetic Nomenclature (ISCN). On the basis of cytogenetics two groups were made one with hyperdiploidy and another without hyperdiploidy. Hyperdiploidy was defined as chromosomes >46. All patients of childhood ALL were treated with 'UK ALL 2011' protocol and their remission status was assessed after 1 month of induction therapy by bone marrow examination. Remission status of 2 groups of ALL with and without hyperdiploidy were compared by using chi square test Results: Out of total 80 patients of ALL, 62 (77.5%) yielding successful cytogenetic culture were included in the study. Mean age at diagnosis was 5.6 ± 2.9 years and male to female ratio was 2.4:1. Analytical immunocytometry revealed 58 (93.5%) as B-ALL while 4 (6.55%) were T-ALL. Hyperdiploidy was detected in 19 (30.6%) and t (9:22) (q34:31) in 1 (1.6%). In all other patients no cytogenetic abnormality was detected. Out of 62 patients, Overall complete haematological remission (CHR) was achieved in 47 (75.8%). Out of 19, patients with hyperdiploidy 18 (94.7%) achieved CHR, as compared to other group without hyperdiploidy in which 29 (67.4%) achieved CHR. The difference was statistically significant (p-value 0.021). Conclusion: Remission rate was 94.7% in patients of childhood ALL with hyperdiploidy. Patients with hyperdiploidy achieve higher CHR rate as compared to patients without hyperdiploidy. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequencies of three isoforms of PML RARα fusion gene in APL. Study Design: Descriptive cross sectional study. Place and Duration of Study: Department of Hematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi Pakistan, from Apr 2015 to Oct 2015. Material and Methods: This study involved 97 newly diagnosed cases of APL, aged between 15-70 years from both genders. Double nested PCR was carried out by Applied Biosystems 2720 Thermal Cycler in every patient to determine the isoform of PML RARα fusion gene. A written informed consent was obtained from every patient. Results: The age of the patients ranged from 17 years to 69 years with a mean of 37.87 ± 12.89 years. There were 68 (70.1%) male and 29 (29.9%) female patients in the study group. The bcr1 isoform was found in 9 (9.3%) patients. There was no significant difference in the frequency of bcr1 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years (14.6% vs. 7.0% vs. 0.0%; p=0.223) and genders; male vs. female (7.4% vs. 13.8%; p=0.317). The bcr2 isoform was found in 26 (26.8%) patients. There was no significant difference in the frequency of bcr2 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years (19.5% vs. 27.9% vs. 46.2%; p=0.164) and genders; male vs. female (25.0% vs. 31.0%; p=0.539) while the bcr3 isoform was found in 62 (63.9%) patients. There was no significant difference in the frequency of bcr3 isoform across age groups; 17-34 years vs. 35-52 years vs. 53-69 years (65.9% vs. 65.1% vs. 53.8%; p=0.717) and genders; male vs. female (67.6% vs. 55.2%; p=0.242). Conclusion: The most frequent isoform of PML-RARα fusion gene was bcr3 which was observed in 62 (63.9%) cases followed by bcr2 (26.8%) and bcr1 (9.3%). There was no significant difference in the frequency of isoforms with patient's age and gender. [ABSTRACT FROM AUTHOR]

Background: Chronic myeloid leukaemia (CML) is myeloproliferative disorder. The t (9;22), encoding the formation of the BCR/ABL1 fusion gene, is the hallmark chromosomal abnormality detected in CML. This translocation is detectable by RT-PCR or Conventional Karyotyping in 95% patients of CML. However, in 5-10% of cases, the patients fail to demonstrate the presence of Philadelphia chromosome at diagnosis, despite the presence of the BCR/ABL gene rearrangement. Objective: To study the atypical BCR/ABL gene rearrangement patterns by Fluorescence in situ hybridization (FISH) in patients of CML and to determine their clinico-haematological characteristics and response to treatment. Study design, settings and duration: A prospective study, conducted at the department of Haematology, Armed Forces Institute of Pathology, Rawalpindi, from 1st June 2017 to 30th May 2018. Subjects and Methods: The study group included all patients diagnosed as CML based on WHO criteria. RTPCR and conventional cytogenetics were done on all samples. All patients negative on PCR and cytogenetics were then analyzed by FISH. Interphase FISH analysis on at least 500 nuclei, using a commercially available BCR/ABL1 dual colour dual fusion probe, was performed on initial presentation on bone marrow cells prepared according to standard cytogenetic techniques. Results: Two hundred three diagnostic samples of CML were analyzed of the total, 128 (63%) patients were male and 75 (36.9%) were female. Median age of diagnosis was 38 years. On FISH analysis, atypical signals patterns were observed in 16 (7.9%) patients. These atypical patterns included atypical BCR/ABL gene rearrangements with co-existence of der (9q) and der (22q) deletion in 13 (6.4%) patients and mBCR/ABL gene rearrangement associated to 9q deletion of non-rearranged chromosome 9 in 3 (1.5%) patients. Conclusion: Atypical patterns in CML though rare, however, should be kept in mind when morphological diagnosis supports CML. FISH, in conclusion, is a sensitive, specific and efficient tool to infer these BCR/ABL gene rearrangement patterns. [ABSTRACT FROM AUTHOR]

Objective: To determine frequency of different types of leukemias and aberrant CD markers expression on these types. Study Design: Descriptive study. Place and Duration of Study: Department of Immunology, Armed Forces Institute of Pathology, Rawalpindi from Jul 2015 to Dec 2015. Material and Methods: All peripheral blood and bone marrow samples to confirm the suspicion of acute leukemia with flow cytometric immunephenoltyping were included in the study. Cells were stained with lineage specific monoclonal antibodies against cell specific CD markers through lyse wash procedure. Cell acquisition and analysis was done on Cell Quest software in multi parameter flow cytometer. Data was entered in SPSS v 20.0 to determine the frequencies of different types of leukemias and aberrant CD markers expression. Results: Over 6 months, 102 males and 49 females were tested with mean age 26 ± 21 years. Commonest leukemia was AML M2. Among 69 pediatric cases with mean age 7.4 ± 5.8 years, precursor B ALL was commonest. Among 82 adults with mean age 41.5 ± 15.7 years, AML M2 was commonest leukemia. Total 32 cases (18 children and 12 adults) expressed cross lineage aberrant markers, CD13, CD33 and CD7. Conclusion: Aberrant CD markers expression must be kept in mind during lineage assignment of acute leukemias while performing flow cytometric immunophenotyping. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of prothrombin gene mutation in venous thromboembolism in our population. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology Rawalpindi, from Jun 2015 to Dec 2016. Material and Methods: This cross sectional study was conducted in the Department of Haematology, Armed Forces Institute of Pathology Rawalpindi from Jun 2015 to Dec 2016. This study involved patients of both genders aged between 15-45 years who presented with one or more episodes of deep vein thrombosis or pulmonary embolism. Outcome variable was frequency of prothrombin gene mutation which was assessed by PCR of genomic DNA. Results: A total of 96 newly diagnosed patients of venous thromboembolism were analyzed. Out of these, 79 patients had deep vein thrombosis and 17 had pulmonary embolism. Prothrombin gene mutation was seen in 4 (4.2%) patients. The frequency of prothrombin gene mutation was significantly higher among patients with pulmonary embolism (p=0.002) and recurrent episodes (p=0.046). Conclusion: The frequency of prothrombin gene mutation was found to be 4.2% in the present study. It was significantly higher in patients with pulmonary embolism and recurrent thrombosis. [ABSTRACT FROM AUTHOR]

Objective: To evaluate Immunophenotyping patterns in Mixed-Phenotype Acute Leukemias (MPAL). Study Design: Descriptive study. Place and Duration of Study: This study was carried out in the department of Hematology, Armed Forces Institute of Pathology Rawalpindi, from 1st Jan 2013 to 31st Jan 2017. Material and Methods: After taking informed consent from the patients fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn for blood complete picture. The patients suspected to have acute leukemia were subjected to bone marrow examination (aspiration and trephine biopsy) for further cytochemical staining (SBB) and Immunophenotyping. Results: Total 680 new cases of acute leukemias on initial workup of either gender age were included. Patients of other haematological disorders were excluded from the study. Among 680 new cases of acute leukaemia, 23(3.4%) cases were of MPAL immunophenotyping using scoring system proposed by EGIL (European Group for the Immunological Characterization of Leukemias) classification. Among MPAL, 19(83%) cases were Biphenotypic [13(57%) cases of My/B-ALL, 5(22%) cases of My/T-ALL, and 1(4%) case of T/B-ALL]. 4(17%) cases were Bilineage (My/B-ALL). Most of the cases were diagnosed at less than 10 years of age. Conclusion: My/B-ALL is the most common immunophenotype followed by My/T-ALL. Therefore immunophenotyping is indispensable for diagnosis and for therapy decisions of MPAL. [ABSTRACT FROM AUTHOR]

Objective: To determine the frequency of thrombocytopenia in Plasmodium vivax (P.vivax) malaria cases at two hospitals. Study Design: Cross-sectional descriptive study. Place and Duration of Study: The study was conducted at the departments of Pathology, Combined Military Hospitals Malir and Sibi, Pakistan from Jul 2011 to Mar 2012. Patients and Methods: A total of 2709 samples were collected from febrile patients for detection of malaria parasite (944 from CMH Malir and 1765 from CMH Sibi). Cases having infection with P. falciparum alone or having mixed infection with P. vivax and P. falciparum were excluded from the study. Both thick and thin film microscopy and immunochromatographic method (OptiMAL-IT) were used for detection of malarial parasite. Platelet counts were done using automated haematology analyser (Sysmex KX 21) with re-evaluation of low counts with manual methods. Results: Total of 170 patients were found positive for P. vivax malaria (44 from CMH Malir and 126 from CMH Sibi). Platelet counts ranged from 21 - 457 × 109/l with a mean of 134 × 109/l. Ninety five (2.1%) from CMH Malir and 4.2% from CMH Sibi out of 170 patients had thrombocytopenia, and the difference in thrombocytopenia at the two hospitals was insignificant (0.017). Conclusion: Thrombocytopenia in patients with P. vivax infection is equally prevalent in the two hospitals, representing a widely different geographical area and should prompt a more thorough search for malarial parasite. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 7- months-old infant with progressive pallor and high grade fever and cough. Topics discussed include red cells with uniform elliptical shape being under the category for hereditary elliptocytosis (HE), presence of elliptocytes in the patient's elliptocytes with marked anisocytosis and red cell fragmentation, absence of family history of thalassaemia and presence of common beta thalassaemia confirmed by polymerase chain reaction (PCR).

Objective: To evaluate the association of chromosomal translocations in multiple myeloma (MM) detected by Fluorescent In Situ Hybridization (FISH) and its clinical characteristics., Study Design: Cross-sectional study. Place and Duration of the Study: Department of Haematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan, from February to August 2022., Methodology: A total of 40 cases of MM were included. All cases were diagnosed using international myeloma working group (IMWG) criteria. Clinical presentations like bone pain, backache, fatigue, pallor, and weight loss were noted. The workup for myeloma-defining events was done. FISH analysis was done for t (4;14), t (11,14), t (14;16), t (14;20), and del 17p. Data were analysed using the chi-square test. A p-value ≤0.05 was considered statistically significant., Results: Out of 40 patients, 8 (20%) were females and 32 (80%) were males. The highest frequency of cases were noted among males in the age group >60 years and females in the age group 40-60 years. FISH for t (4;14) was positive in 22 (55%) patients, for t (11;14) was positive in 4 (10%) patients, for t (14;16) was positive in 3 (7.5%) patients, and for t (14;20) was positive in 3 (7.5%) patients, while for del17p was positive in 8 (20%) patients. Cases with t (4;14), t (11;14), and t (14;20) had bone pain, fatigue, and backache as the most common presentations. Among the various parameters studied, lytic lesions, beta-2 microglobulin, spike protein, deranged haemoglobin, TLC, ESR, albumin, and creatinine were significant risk factors in patients who were tested positive for various mutations., Conclusion: The FISH technique has brought an immense uprising in the genetic analysis of MM. Among translocations, t (4;14) and del17p are associated with poor clinical outcomes and prognosis. If the diagnosis of MM is delayed, then an increase in morbidity and mortality can occur., Key Words: Multiple myeloma, FISH, Translocations.

Objective: To determine the frequency of anaesthetic risks in children having Obstructive Sleep Apnea Syndrome (OSAS), undergoing adenotonsillectomy., Study Design: A case-control study., Place and Duration of Study: Department of Anaesthesiology, Armed Forces Hospital, Najran, Saudi Arabia from November 2006 to January 2008., Methodology: The study was carried out in 60 children scheduled to undergo adenotonsillectomy and divided into two equal groups of 30 each. Group-1 had obstructive sleep apnoea syndrome and group-2 had children without it. Both groups were given a standard general anaesthesia and frequency and rate of complications and medical interventions taken in such children were studied. P-value and odds ratio were determined., Results: The age ranged from 3 to 10 years. The frequency of difficult intubation was higher in the group-1 than in the control group (16.6 vs. 3.3%, odds ratio 5.8). At the time of induction of anaesthesia desaturation was higher in group-1 (33.3 vs. 6.6%, p=0.021, odds ratio 7). At the time of extubation, desaturation was significantly higher in group-1 (43.3 vs. 6.6%, p=0.002, odds ratio 10.70). The complications at extubation, for example cough, laryngospasm and postoperative nausea and vomiting were higher in group-1 but not statistically significant. In the postanaesthesia care unit, the frequency of complications and medical interventions were also higher in group-1. More patients of group-1 required oxygen (63.3 vs. 10%, p < 0.001, odds ratio 15.54) and insertion of an oropharyngeal airway (20% vs. nil, p=0.023) respectively., Conclusion: Children with OSAS, operated for adenotonsillectomy, are at significant risk of certain life-threatening perioperative anaesthetic complications. These results may be used as a guideline for safe and successful anaesthetic management of these children.

Objective: To evaluate out come of allogeneic Stem Cell Transplantation (SCT) in chronic myeloid leukaemia (CMC) at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from April 2002 to October 2004., Methods: Twenty-two patients with CML underwent allogeneic SCT from HLA matched siblings. Patients were divided into standard (n=14) and high-risk (n=8) groups. Patients were subjected to conditioning regimens consisting of Busulphan and Cyclophosphamide. Cyclosporin, Prednisolone and Methotrexate were given for GvHD prophylaxis. All donors were subjected to PBSC harvest after G-CSF therapy for five days. All received G-CSF from Day+5 until ANC >0.5 x 10(9)/l., Results: The median age of the patients was 29 years (range 7-53 years) with a male to female ratio of 6.3:1. Engraftment was achieved in all patients. Median time to achieve neutrophil (ANC 0.5 x 10(9)/l) and platelet (20 x 10(9)/l) recovery was 13 days and 12 days respectively. Median stay in hospital was 18 days. Acute GvHD (Grade-II-IV) was observed in eleven patients (50%) while chronic GvHD was seen in four patients (18%). One patient relapsed 8 months post transplant. Two patients (9%) developed Veno-occlusive disease (VOD) liver. One patient had haemorrhagic cystitis. Four patients (18%) had post transplant infectious complications, which included pseudomonas septicemia, aspergillosis, tuberculous pleural effusion and herpes zoster. Overall mortality was 22.7% (n=5). The major causes of mortality were VOD liver, GvHD grade IV, Pseudomonas septicaemia and aspergillosis. Overall survival was 77.2% (n=17) and disease free survival was (n=16) 72.7%. Follow up ranges were from 23 to 828 days (median 212 days)., Conclusion: The preliminary results of SCT in this small series of patients with CML are very encouraging. To improve the long-term survival it is imperative that patients are transplanted early after diagnosis and conditioning regimens are selected carefully.

Objective: To evaluate the frequency and outcome of graft versus host disease after allogeneic stem cell transplant in haematological disorders at Armed Forces Bone Marrow Transplant Centre, Rawalpindi from July 2001 to December 2004., Methods: Eighty-six patients with various haematological disorders namely aplastic anaemia (n=32), b-Thalassaemia (n=25), CML (n=22), ALL (n=3), AML (n=1) Fanconi's anaemia (n=2), and Gaucher's disease (n=1), underwent allogeneic stem cell transplantation. All patients received cyclosoprin, prednisolone and short course of methotrexate as GvHD prophylaxis. The patients who developed acute GvHD > grade-II or chronic extensive GvHD received steroids at a starting dose of 2 mg/kg body weight along with gradual increase in cyclosporine dosage (max dose 12.5 mg/kg)., Results: The overall incidence of acute GvHD grade-II to IV was 44.2% (n=38/86) where as the incidence of chronic extensive GvHD was 14% (n=12/86). Acute GvHD was 68% (n=17/25) in beta-Thalassaemia, 50% (n=11/22) in CML, 50% (n=2/4) in Acute Leukaemias and 25% (n=8/32) in Aplastic Anaemia. Chronic GvHD was 25% (n=1/4) in Acute Leukaemias, 18.8% (n=6/32) in Aplastic Anaemia, 18.2% (n=4/22) in CML and 4% (n=1/25) in beta-Thalassaemia. The overall survival in acute GvHD was 84.2% (n=32) where as the overall survival in chronic GvHD was 50% (n=6). The overall mortality in acute GvHD was 15.8% (n=6) and 50% in chronic GvHD (n=6)., Conclusion: The morbidity and mortality due to severe acute and chronic GvHD remains high despite standard prophylaxis against GvHD. New strategies are needed to prevent and treat GvHD.

Objective: To evaluate the efficacy and toxicity profile of the combination of fludarabine, high dose cytarabine, idarubicin, and granulocyte colony stimulating factor in refractory relapsed cases of acute leukaemia, a study is being conducted at Armed Forces Bone Marrow Transplant Centre (AFBMTC) Rawalpindi since January 2003. Data up to June 2004 (early report) is being presented., Methods: Twelve Patients with refractory/relapsed (Ref/Rel) acute leukaemia (AL) were treated with fludarabine 30 mg/m2 and cytosine arabinoside (AraC) Arac 2 g/m2 for 5 days, idarubicin 10 mg/m2 for 3 days, and granulocyte colony stimulating factor G-CSF 5 micro g/kg from day 0 till neutrophil recovery (ANC > 1.0 x 10(9)/1). Response was evaluated by bone marrow examination on day 20-post chemotherapy., Results: Patients included were refractory acute lymphoblastic leukaemia (ALL) (n=2), relapsed ALL (n = 3), refractory acute myeloid leukaemia (AML) (n = 3), secondary AML (n=2) relapsed AML (n = 1) and acute undifferentiated leukaemia (AUL) (n = 1). Complete remission (CR) was achieved in 8 (66.6%) patients. Three (25%) patients died of post chemotherapy complications and one patient failed to achieve remission. Out of 8 patients who achieved CR, 4 underwent allogeneic bone marrow transfusion (BMT), 1 is being evaluated for the same, 1 received idorubicin, AraC and etopuside (ICE) and high dose AraC, 1 did not receive further chemotherapy and 1 relapsed two months after remission. Seven patients are still in CR after a median follow up of 8 months (range 3-18). Major complications encountered were diarrhoea, mucositis, toxic ileus, transient hepatic toxicity, fungal and bacterial infections., Conclusion: In our experience, FLAG-IDA is well tolerated and effective regimen in relapsed/refractory acute leukaemias. The toxicity is acceptable, enabling most patients to receive further treatment, including transplantation procedures.

This case report describes a patient with severe aplastic anaemia, who developed Guillain Barre Syndrome (GBS) 10 weeks after allogeneic haematopoietic stem cell transplantation (HSCT) from HLA-matched sibling-younger sister. GBS was preceded by pneumonia, herpes labialis and oral candidiasis a week earlier. Treatment with ventilatory management, intravenous human immunoglobulin (IVIg) and antimicrobials resulted in smooth recovery in thirty-one days.

Objective: To evaluate three different enzyme immunoassays for serological diagnosis of pulmonary tuberculosis and to compare their diagnostic accuracy in different combinations., Design: A non-interventional comparative study., Place and Duration of Study: The study was carried out at the Department of Microbiology, Armed Forces Institute of Pathology, Rawalpindi between April and September 2001., Subjects and Methods: Sera from patients suffering from pulmonary tuberculosis (n=94) with sputum positive for acid fast bacilli (AFB) and sera from control group of healthy individuals (n=90) with sputum negative for AFB were tested by Pathozyme-Myco G EIA, Pathozyme-TB Complex Plus EIA and Pathozyme Myco M EIA kits for the genus-specific IgG and IgM, and the species-specific IgG antibodies against antigens of Mycobacterium tuberculosis., Results: The detection of IgG against genus-specific antigens by Pathozyme-Myco G had a sensitivity of 46% and a specificity of 93%, of IgG against species-specific antigens by Pathozyme-TB Complex Plus had a sensitivity of 64% and specificity of 97% and of IgM against genus-specific antigens by Pathozyme Myco M had a sensitivity of 67% and specificity of 98%. When the results of these immunoassays were evaluated in combination, their sensitivity improved. Combination of genus-specific IgM and species-specific IgG yielded best results with a sensitivity of 87% and specificity of 93%., Conclusion: The sensitivity of serological diagnosis of tuberculosis is low, but it can be increased by utilizing a combination of several antigens.