Abstract: BACKGROUND: Thrombocytopenia is broadly classified, based on underlying etiology, into thrombocytopenia due to peripheral platelet destruction and those due to bone marrow hypoproliferation. In recent years, platelet indices and serum thrombopoietin (TPO) have gained attention as potential noninvasive markers reflecting platelet production and turnover. OBJECTIVES: The present study aimed to assess the diagnostic usefulness of platelet indices and serum TPO levels in distinguishing immune thrombocytopenia (ITP) from hypoproliferative thrombocytopenia secondary to aplastic anemia or chemotherapy-induced thrombocytopenia (AA/CIT) in children. MATERIALS AND METHODS: This prospective case–control study involved 60 pediatric patients (aged 2–16 years) with thrombocytopenia: 34 children with newly diagnosed ITP and 26 children with thrombocytopenia due to AA/CIT, with 23 healthy children included as a control group. Platelet indices were measured using an automated hematology analyzer, and serum TPO concentrations were determined by enzyme-linked immunosorbent assay. RESULTS: Platelet count and plateletcrit were significantly higher in controls than in thrombocytopenic patients ( P < 0.001). Serum TPO was markedly elevated in the hypoproliferative group compared with the ITP group and controls ( P < 0.001). Conversely, immature platelet fraction (IPF), platelet–large cell ratio (PLCR), and mean platelet volume (MPV) were significantly higher in ITP ( P < 0.001). CONCLUSIONS: Elevated TPO level can be a useful marker for identifying hypoproliferative thrombocytopenia, while elevated IPF, PLCR, and MPV favor ITP. These parameters may have value in identifying the underlying pathophysiological mechanisms of thrombocytopenia.
Abstract: BACKGROUND: Acute myeloid leukemia is a genetically heterogeneous disease in which genetic alterations play a key role for diagnosis, prognosis, and therapy options. Fms-Like Tyrosine Kinase 3 (FLT3), Nucleophosmin 1 (NPM1), and isocitrate dehydrogenase 2 (IDH2) mutations have clinical significance by influencing the biological features and treatment outcomes. OBJECTIVE: The aim of this study was to characterize the mutational profile of FLT3, NPM1, and IDH2 in acute myeloid leukemia (AML) patients and determine their association with remission status, AML subtypes, and overall survival (OS). MATERIALS AND METHODS: A prospective longitudinal study was performed on 40 newly diagnosed AML patients. The responses for 21 patients were monitored after induction chemotherapy. Bone marrow and blood samples were collected and genomic DNA was extracted. FLT3-internal tandem duplication and FLT3-TKD and of NPM1 and IDH2 mutations analyzed by the polymerase chain reaction followed by Sanger sequencing. Survival rate was assessed using the Kaplan–Meier approach for OS. RESULTS: The molecular heterogeneity of AML is reflected by the most commonly observed mutations: Overall NPM1 mutations (100% of cases possesses various mutations), followed by FLT3 (25%) and IDH2 (7.5%). Remission rates for patients with a single gene mutation or wild-type FLT3 were greater than those with co-occurring mutations/FLT3 mutations. While NPM1 mutations, particularly exon 11 insertions and duplications, were associated with favorable outcomes, NPM1 “deletions” were observed in only 62.5% of cases and exhibit a clear pathogenic role. OS analysis showed no significant differences in survival between FLT3 mutation and NPM1 mutation groups. CONCLUSION: These results support clinical significance of FLT3, NPM1, and IDH2 mutations in AML and highlight the potential role of these genes in targeted therapy considerations.
Abstract: BACKGROUND: Familial Mediterranean fever (FMF) is an autosomal recessive autoinflammatory disorder. This study aimed to compare the clinical and laboratory profiles of FMF patients stratified by their MEFV genotype into three groups: simple heterozygotes, compound heterozygotes, and homozygotes. OBJECTIVES: To evaluate the association between MEFV gene mutations and clinical features, acute phase reactants, and hematological parameters in patients with FMF in Nineveh Province, Iraq. PATIENTS AND METHODS: This retrospective cohort study included 60 FMF patients from Nineveh Province, Iraq. Diagnosis was based on both Tel Hashomer and Livneh criteria. Genetic analysis targeted 12 common MEFV mutations. Patients were re-classified into three genetic groups for analysis. RESULTS: Among the 60 patients, 25 (41.7%) were simple heterozygotes, 20 (33.3%) were compound heterozygotes, and 15 (25.0%) were homozygotes. The most frequent mutations were M694V and M694I. Abdominal pain and fever were the most prevalent symptoms, with homozygotes showing the highest frequency. Homozygous patients exhibited significantly higher levels of erythrocyte sedimentation rate, C-reactive protein, neutrophils, and lymphocytes compared to the other groups. Proteinuria was also most frequent in the homozygous group (86.7%). CONCLUSIONS: Genetic stratification reveals a clear gradient in clinical and inflammatory severity. Homozygous mutations are associated with a more severe phenotype, including higher inflammatory markers and more frequent proteinuria, followed by compound heterozygotes. These findings underscore the critical importance of detailed genetic profiling for risk stratification and management in FMF.
Abstract: BACKGROUND: Immune thrombocytopenia (ITP) is an autoimmune disorder causing isolated thrombocytopenia. Monoclonal gammopathy of undetermined significance (MGUS) is an asymptomatic plasma cell disorder that may progress to multiple myeloma. The relationship between ITP, splenectomy, and MGUS development remains unclear. OBJECTIVES: This study aimed to investigate the association between splenectomy and MGUS development in adults with primary ITP and to evaluate long-term hematological changes after splenectomy. MATERIALS AND METHODS: This retrospective study included 94 adults with primary ITP followed for ≥3 years. Data were obtained from electronic medical records. Patients were categorized into splenectomized ( n = 35) and nonsplenectomized ( n = 59) groups. Hematological parameters and serum protein electrophoresis (SPE) were assessed. Statistical significance was set at P < 0.05. RESULTS: The cohort included 94 patients (mean age 45.9 years), 37.2% of whom underwent splenectomy. Comorbidities were present in 42.6%, most commonly diabetes mellitus and hypothyroidism, with no intergroup differences. Splenectomized patients had higher rates of ongoing treatment ( P = 0.001) and increased white blood cell, lymphocyte, monocyte, neutrophil ( P = 0.029), and platelet counts (PLTs) (all P ≤ 0.001). Although baseline PLTs were lower ( P = 0.001), final platelet levels were higher after splenectomy ( P = 0.001). The observed prevalence of MGUS was 1/94 (1.06%; 95% confidence interval = 0.19%–5.78%). Only one SPE-detected M-band occurred in a nonsplenectomized patient. CONCLUSIONS: Splenectomy was associated with sustained hematological changes, but MGUS prevalence was low. The study was underpowered to assess MGUS risk definitively. Larger prospective studies are needed.
Abstract: BACKGROUND: Many factors contribute to the alteration of zinc levels in patients with sickle cell anemia (SCA). Furthermore, Zinc deficiency may aggravate many pathophysiologic changes of SCA, contributing for many complications. OBJECTIVES: The study was carried out to assess zinc status in a pediatric cohort with SCA during steady state and its relation with their anthropometric and disease-severity variables. MATERIALS AND METHODS: A prospective case–control research was conducted, including 255 children with SCA (ages 1–15 years) and 271 age- and sex-matched healthy children, in Basrah, Iraq. Anthropometry was evaluated using BMI-for-age (BMIZ) and height-for-age (HAZ) Z-scores. Disease severity was determined based on frequency of vaso-occlusive crises, hospitalizations, blood transfusions, and fetal hemoglobin levels. Laboratory tests included complete blood count, reticulocyte count, and serum zinc and copper measurement. RESULTS: The study revealed that thinness and stunting were significantly higher in SCA patients ( P < 0.01), while overweight was significantly higher in the control group ( P = 0.011). The mean serum zinc level was significantly lower in SCA patients (63.51 ± 14.93 μg/dl) compared to the control group (91.14 ± 14.93 μg/dl), while serum copper was significantly higher among patients (128.93 ± 39.35 μg/dl) than healthy controls (96.86 ± 20.30 μg/dl), P < 0.001. Around 49% of patients exhibited low serum zinc, compared with 0.8% of controls, P < 0.001. Although none of the nutritional and SCA-severity indicators were associated with low serum zinc level in SCA patients, multivariate logistic regression analysis revealed that living in peripheries is associated with low serum zinc (odds ratio: 0.472, 95% confidence intervals: 0.264–0.845). CONCLUSION: Children and adolescents with SCA show markedly lower serum zinc levels. However, the analysis did not reveal significant associations between zinc levels and SCA-severity indicators and nutritional variables among the studied patients.
Abstract: BACKGROUND: Minimal residual disease (MRD) is the strongest prognostic indicator in acute lymphoblastic leukemia (ALL). Studying its associations with cytogenetics and various clinical and laboratory parameters may be valuable in identifying predictors for its occurrence, and thus guide risk-adapted treatment. OBJECTIVES: To determine the frequency of day-28 MRD positivity in pediatric B-ALL, and assess its associations with baseline clinical, cytogenetic risk categories, and treatment assignments. MATERIALS AND METHODS: This ambispective cohort study included 87 children with precursor B-ALL diagnosed and followed by two major Pediatric Oncology Centers in the Kurdistan Region of Iraq. All patients were screened for cytogenetic aberrations by fluorescence in situ hybridization at diagnosis, and were stratified according to UKALL-2019 criteria to receive appropriate regimens. MRD was assessed at day 28 using eight-color multiparameter flow cytometry. Associations between MRD status and various clinical and laboratory parameters were analyzed using Chi-square testing, Fisher’s exact test, and multivariate logistic regression. Kaplan–Meier analysis and Log-rank test were used to assess event-free survival (EFS). RESULTS: The enrollees had a median age of 5 years (range: 1–16), and a male-to-female ratio of 1.23:1. After receiving assigned induction therapy as per United Kingdom Acute Lymphoblastic Leukemia 2019 (UKALL-2019) criteria, MRD negativity at day-28 was achieved in 68 patients (78.2%), while 19 (21.8%) patients were MRD-positive. Univariate analysis revealed that MRD positivity was significantly associated with age ≥10 years, white blood cell ≥50 × 10 9 /L, less favorable cytogenetic risk categories, and treatment regimen allocation ( P = 0.014, 0.03, 0.0005, and 0.03, respectively). Of the latter parameters, it was only cytogenetic aberrations that remained significant by multivariate analysis ( P = 0.003). After a median follow-up of 18 months, EFS was 89.7% in MRD-negative patients compared to 84.2% in MRD-positive patients ( P = 0.332). CONCLUSIONS: Postinduction MRD positivity was encountered in 21.8% of B-ALL patients from Iraqi Kurdistan. Several MRD positivity predictors were identified; however, cytogenetic aberrations at diagnosis were the only significant MRD predictors by multivariate analysis. This underscores the crucial role of both postinduction MRD and cytogenetics to guide treatment decisions in this type of leukemia. Further studies with larger sample sizes and longer follow-up are needed to further validate these observations.
Abstract: BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common diagnosed malignancy in children, representing nearly 1/4 of all cancers seen in the age group of 0–14 years, worldwide the survival of ALL has increased tremendously over the last four decades. OBJECTIVES: The objective of this study was to study the clinical characteristics and outcome of pediatric patients diagnosed with ALL (intermediate and high risk), treated with two different protocols over 6 years’ period. MATERIALS AND METHODS: A retrospective analytic study carried out over 6-years in the period from January 1, 2017 to December 31, 2022, on 586 newly diagnosed pediatric patients with ALL. Two hundred and fifty-seven cases were excluded from the study. All the demographic data, disease characteristics, diagnosis, treatment, its complications, and outcome were taken from electronic archived files, or patients personal files. Two protocols adapted in the period of the study (UKALL 2011 andUKALL 2019) with modifications adapted to our own setting. RESULTS: Of 329 patients, male was predominant in 205 (62.3%). Out of 329 patients who received prephase steroid, 186 (56.5%) were good responders, 125 (38%) were poor responders with a significant P = 0.03. Induction remission was reported in 296 patients (90%), induction failure in 18 patients (5.5%), induction death was reported in 15 patients (4.6%). Five-year overall survival of both groups of patients was (54.9%), 5-years event free survival (EFS) was (52.2%). CONCLUSIONS: Steroid responsiveness and initial white blood cell count at diagnosis are considered to be a good prognostic factor. High-dose methotrexate (MTX)-based protocol showed better results in regard to OS and EFS rates than Capizzi style-MTX style protocol, in Group C patients.
Abstract: BACKGROUND: The CD40 polymorphism increases CD40 expression, leading to heightened pro-inflammatory cytokine levels, which contribute to immune thrombocytopenia (ITP) Purpura progression. Genetic variability influences drug-metabolizing enzymes and transporters, causing inter-individual differences in pharmacokinetics and pharmacodynamics. Consequences may result in disparities in treatment outcomes. OBJECTIVES: This study aimed to evaluate CD40 gene haplotypes, linkage disequilibrium (LD) patterns, and assess their association with the risk of non-response to romiplostim therapy in Iraqi ITP patients. MATERIALS AND METHODS: A descriptive cross-sectional design was carried out from May 1, 2025, to September 1, 2025, involving 78 ITP patients, who were selected according to the diagnostic criteria of the Iraqi hematologists consensus. It was conducted at the Hematology and Bone Marrow Transplant Center, Medical City, Baghdad, Iraq. RESULTS: LD tests showed strong association between (rs4810485 with rs1883832, rs997412137 and rs774291557), (rs1535045 with rs1883832 and rs774291557) with LD coefficient D’ equal 1, while the CD40 gene haplotype (T C T G A*) represents the highest frequency (0.36) of the five single-nucleotide polymorphisms with an odds ratio of 0.4, representing alleles that are non-mutant and may have a protective role in ITP disease in the current study. Whereas haplotype (T T C C T*) with a frequency of 1% may increase the risk of no response with an odds ratio of 10.17. CONCLUSIONS: CD40 gene haplotypes are strong determinants of romiplostim response in Iraqi ITP patients. These findings highlight the intricate genetic framework of therapy response and establish a basis for more extensive, confirmatory investigations focused on personalizing ITP care.
Abstract: BACKGROUND: While somatic DNA methyltransferase 3A (DNMT3A) mutations are known to drive hematological malignancies, the role of DNMT3A genetic variants and expression changes in chronic myeloid leukemia (CML) remains poorly understood, particularly in the context of tyrosine kinase inhibitor (TKI) therapy. OBJECTIVES: This study aimed to investigate the association of DNMT3A gene expression levels and two specific polymorphisms within its catalytic domain with the risk of CML and the clinical response to bosutinib therapy in a cohort of Iraqi patients. PATIENTS, MATERIALS, AND METHODS: In this cross-sectional study, 40 CML patients (20 responsive and 20 nonresponsive to bosutinib) and 20 healthy controls were enrolled. DNMT3A mRNA expression was quantified using quantitative real-time polymerase chain reaction. RESULTS: DNMT3A expression was significantly downregulated in CML patients compared to healthy controls ( P = 0.003), irrespective of their response to bosutinib. The heterozygous (AG) genotype at rs2149275458 and the homozygous (CC) genotype at the other variant were significantly associated with CML susceptibility ( P < 0.0001 for both) but not with treatment response. The corresponding C alleles for both single-nucleotide polymorphisms were identified as significant risk factors for the disease. CONCLUSION: DNMT3A polymorphisms and reduced DNMT3A expression were significantly associated with CML, suggesting a potential role for this epigenetic regulator in disease biology. While these variants may serve as biomarkers for CML susceptibility, the observed downregulation could represent a pharmacodynamic effect of TKI treatment. These findings warrant further investigation into their functional roles and clinical utility.
Abstract: BACKGROUND: Long noncoding RNAs (lncRNAs) have been progressively documented as vital regulators of gene transcription in cancer biology, including hematological malignancies such as acute myeloid leukemia (AML). Among these, small nucleolar RNA host gene 5 (SNHG5) has received growing attention for its involvement in tumor progression, chemoresistance, and modulation of gene expression. OBJECTIVES: This study was designed to evaluate the level of the lncRNA SNHG5 expression in adult de novo AML patients and to explore its relationship with hematological parameters, treatment response, and overall survival (OS). MATERIALS AND METHODS: Sixty newly diagnosed AML patients and 30 age- and sex-matched healthy controls were enrolled. The expression level of SNHG5 was measured using quantitative real-time polymerase chain reaction. Clinical, hematological data and treatment outcomes were collected and statistically analyzed. RESULTS: The data demonstrated an elevated level of SNHG5 expression in AML patients compared to healthy subjects ( P < 0.001). Elevated SNHG5 expression was substantially associated with increased white blood cell counts, reduced complete remission rates ( P = 0.02), and reduced OS ( P = 0.01). The receiver operating characteristic curve analysis also confirmed the prognostic significance of SNHG5 expression in AML. CONCLUSIONS: Excessive expression of SNHG5 reveals its role in the pathophysiology of AML and indicates its potential role toward the malignant transformation of hematopoietic stem or myeloid progenitor cells. Consequently, SNHG5 may function as a prospective prognostic biomarker and therapeutic target in AML.
BACKGROUND: Signal transducer and activator of transcription 3 (STAT3) is an essential transcription factor that functions through the Janus kinase/STAT signaling pathway, regulating cell proliferation, survival, tumorigenesis, immune surveillance, and inflammatory responses. Although dysregulated STAT3 activity has been implicated in numerous cancers, its specific contribution to non-Hodgkin lymphoma (NHL) remains insufficiently defined. OBJECTIVES: We evaluated STAT3 gene expression and two polymorphisms (rs72823022 T/C and rs744166 A/G) to determined their association with NHL susceptibility in an Iraqi population. MATERIALS AND METHODS: This research follows a case–control study design. Hematological parameters, in addition to serum urea and creatinine levels, were assessed in lymphoma patients (n = 50) and healthy controls (n = 50). STAT3 mRNA expression was quantified by reverse transcription quantitative polymerase chain reaction (RT-qPCR), and STAT3 polymorphisms were genotyped using polymerase chain reaction (PCR) followed by Sanger sequencing (ABI 3730XL platform). RESULTS: STAT3 expression was upregulated in NHL patients compared to controls (mean fold change = 7.88). Some SNP genotypes showed potential protective effects, whereas others showed a trend toward increased susceptibility; however, these associations were not statistically significant. CONCLUSION: STAT3 expression and its genetic variants may serve as potential biomarkers for the risk assessment and early detection of NHL, providing insights that could guide prognostic evaluation and therapeutic strategies.
BACKGROUND: Chronic myeloid leukemia (CML) is driven by the BCR-ABL1 oncogene (t(9;22)) and typically presents in a chronic phase (<10% of blasts). Immune dysfunction in CML includes impaired natural killer-like T (NKT) cells, while NKT-like cells increase with age. Interferon-gamma (IFN-γ), crucial for immunity, activates JAK-STAT signaling, with dysregulation linked to disease. OBJECTIVE: The study aimed to analyze the immunological parameters (NKT-like cells, INF-γ, and interleukin-10 [IL-10]) in CML patients. MATERIALS AND METHODS: The study comprised 60 individuals: 20 with newly diagnosed CML and 40 who were undergoing treatment with TKIs. The present research, which took place from February to September 2025, utilized flow cytometry to measure NKT-like cells. In addition, an enzyme-linked immunosorbent assay was employed to measure the levels of key cytokines, including IFN-γ and IL-10, in patient samples. RESULTS: Newly diagnosed CML patients showed depletion of NKT-like cells and IFN-γ but high levels of IL-10. Controls had higher NKT-like cells (57.5%) than untreated CML (26.1%), with partial recovery posttreatment (51.7%). IFN-γ was elevated in controls (22.6 pg/ml), while IL-10 dominated in untreated CML (49.6 pg/ml). Significant CML correlations revealed NKT-like cells negatively associated with blast (r = −0.651) and BCR-ABL levels (r = −0.547) while showing a positive correlation with IFN-γ (r = 0.460). Conversely, IL-10 positively correlated with (blasts: r = 0.380 and BCR-ABL: r = 0.617) but negatively with NKT cells (r = −0.276). CONCLUSION: The current study reveals profound immune dysregulation in CML, marked by decreased NKT-like cells and IFN-γ alongside elevated IL-10, particularly in untreated patients. These findings support the known BCR-ABL1-mediated impairment of NKT function, highlighting key mechanisms of immune escape in CML pathogenesis.
Methotrexate (MTX), a folic acid antagonist, is an important agent in the management of acute lymphoblastic leukemia (ALL), in both adult and pediatric patients. Neurotoxicity is a rare but well-described complication after intrathecal and intravenous MTX administration. We report a 15-year-old girl with B-cell ALL with no central nervous system (CNS) involvement, who developed a sudden left-sided hemiparesis five days after intravenous high-dose MTX and nine days following the eighth intrathecal (IT) MTX. A brain MRI revealed a focal area of restricted diffusion in the right corona radiata, and her symptoms had recovered spontaneously and completely on the same day, which was highly suggestive of being related to methotrexate.
Acute myeloid leukemia (AML) with thrombocytosis is a rare entity, accounting for approximately 1% of AML cases. A 46-year-old male presented with fever and thrombocytosis, and was ultimately diagnosed with AML characterized by the recurrent genetic abnormality t(3;3)(q23;q23), associated with MECOM (EVI1) rearrangement. Despite induction chemotherapy, the disease course was aggressive with short-lived remissions and rapid progression. This case highlights the diagnostic challenges, prognostic implications, and therapeutic considerations of this rare AML subtype.
BACKGROUND: Beta-thalassemia major (β-TM) is a hereditary blood disorder requiring lifelong blood transfusions, which result in iron overload and progressive organ damage. Iron chelation therapy is therefore essential to reduce excess iron and its complications. OBJECTIVES: This study aimed to evaluate the effect of different iron chelation therapies on the expression of iron-regulatory genes and on biochemical markers related to iron metabolism and inflammation in patients with β-TM. MATERIALS AND METHODS: Thirty patients diagnosed with β-TM and 20 healthy controls were enrolled and stratified according to iron chelation therapy, along with a healthy control group for comparison. Expression levels of Transferrin receptor-2 (TFR2) and ferroportin (FPN) were evaluated by the polymerase chain reaction. Serum concentrations of interleukin-6 (IL-6), soluble TFR (sTFR), nontransferrin-bound iron (NTBI), cortisol, thyroid stimulating hormone (TSH), and ferritin were determined using the standard biochemical methods. RESULTS: The expression of the TFR2 gene and serum IL6 was statistically significant, whereas FPN gene showed no statistically change. The treatment elevated cortisol levels; however, the alteration was not statistically significant. sTFR, NTBI, TSH, and ferritin all showed that there was too much iron in the body, however, some comparisons did not show any big differences. CONCLUSIONS: It can be concluded that iron chelation therapy, particularly deferasirox, is related to the extent of TFR2 gene expression and IL-6 levels and changes in terms of iron metabolism and inflammation activity in β-TM patients. TFR2 and IL-6 showed significant alterations and may represent potential indicators of iron overload in β-thalassemia major patients.
BACKGROUND: Chronic lymphocytic leukemia (CLL) is the most common leukemia affecting the elderly. It is characterized by monoclonal B-cell proliferation expressing CD5 and CD23. Interleukin-8 (IL-8) has been found to induce the proliferation of malignant cells and make them resistant to apoptosis. Thus, IL-8 could be implicated in disease progression. OBJECTIVE: The objective of the study was To determine the clinical significance of serum IL-8 levels in CLL patients and to evaluate its potential as a biomarker for disease progression. MATERIALS AND METHODS: A cross-sectional study was conducted on 30 CLL patients and 30 normal individuals (control). Participants were recruited from October 2024 and continuing until August 2025 at The National Center of Hematology/Mustansiriyah University. Patients’ demographics were collected using a special form. Blood samples were collected and analyzed for IL-8 levels using ELISA in addition to complete blood count. RESULTS: The mean serum IL-8 level for CLL patients was 28.83 ± 12.68 pg/mL, which is higher than that of the control group 10.20 ± 1.008 pg/mL, with no statistical significance (P = 0.1483). It was concluded that a statistically significant difference in IL-8 levels existed across all stages of CLL (P = 0.0193). The highest median level was 16.28 pg/mL in Stage A, whereas the median levels in Stages B and C were 7.476 pg/mL and 7.608 pg/mL, respectively. The receiver operating characteristic curve showed that IL-8 powerful in distinguishing between Stage A and C, with a sensitivity of 81.82%, and a specificity of 72.73% at a cutoff of 10.07 pg/mL. IL-8 does not show a significant correlation with other variables. CONCLUSION: As an autocrine growth and apoptosis resistance factor, higher level of IL-8 among CLL patients may be related to the disease persistence, with higher levels among earlier stages of CLL in comparison to later stages, which may be related to immune system exhaustion. Thus, it could be useful in monitoring disease status.
BACKGROUND: Idiopathic immune thrombocytopenia purpura is an autoimmune bleeding disorder that accounts for approximately one-third of clinical hemorrhagic diseases. Pathophysiologically, it involves a complicated imbalance in the immune system. OBJECTIVES: This study focuses on evaluating the levels of the immunomodulatory cytokines interleukin (IL)-35, interleukin-10, and transforming growth factor-β (TGF)-β in patients with refractory idiopathic immune thrombocytopenia undergoing treatment with romiplostim. MATERIALS AND METHODS: A cross-sectional study encompassed 78 individuals with idiopathic immune thrombocytopenia and conducted measurements of different immunomodulatory cytokines in response to different responses of idiopathic immune thrombocytopenia patients on romiplostim therapy. The research was carried out from May 1, 2025, to September 1, 2025, and it was conducted at the Haematology and Bone Marrow Transplant Centre, Medical City, Baghdad, Iraq. RESULTS: More than half of them have responded to romiplostim 52 (66.7%) with a mean dose of 103.8 mcg. The study demonstrated a notable link between immunomodulatory cytokines (IL-10, IL-35, and TGF-β) and platelet count; however, no significant difference was found between responders and nonresponders regarding these cytokines. CONCLUSIONS: Romiplostim demonstrated effective management in Iraqi patients, and the Treg cells and their associated cytokines (IL-35, IL-10, and TGF-β) may contribute to immune system dysregulation in adult patients with chronic idiopathic immune thrombocytopenia.
BACKGROUND: Iron deficiency anemia (IDA) represents a significant public health challenge worldwide, yet comprehensive epidemiological data from Saudi Arabia integrating clinical surveillance with population-based evidence remain limited. OBJECTIVES: This study aimed to quantify the clinical burden of IDA across demographic groups in Saudi Arabia using laboratory surveillance data, identify key risk factors through literature synthesis, analyze temporal trends from 1990 to 2024, and examine regional variations to inform Vision 2030 health priorities. MATERIALS AND METHODS: We conducted a two-stream study comprising: (1) a secondary analysis of laboratory-based surveillance data from Al Borg Diagnostics Laboratories, including 420,956 individuals tested between January 2014 and February 2024 across all 13 administrative regions, and (2) a narrative review of 14 peer-reviewed epidemiological studies supplemented with WHO Global Health Observatory and Global Burden of Disease Study 2021 data. Iron deficiency (ID) was defined as serum ferritin <30 ng/mL, while IDA was defined as hemoglobin below sex-specific thresholds with concurrent ID. Descriptive statistics and Chi-square tests were performed for laboratory data. Risk factors were extracted from multivariate analyses in reviewed studies. RESULTS: Laboratory surveillance findings: Among 420,956 individuals seeking diagnostic services, IDA prevalence was 19.8%, with nonanemic ID affecting an additional 23.7%, yielding a combined ID prevalence of 43.5%. Women constituted 93% of all iron-deficient cases. Significant regional variation was observed, ranging from 28% in Al-Jouf to 42% in the Makkah region (P < 0.001). Among children <12 years tested (representing clinically suspected cases), 100% had anemia with 45% meeting IDA criteria, indicating extreme selection bias toward symptomatic presentations. Literature review findings: Population-based studies documented IDA prevalence of 49% among infants aged 6–24 months in primary care settings and 40% among women of reproductive age in community-based sampling. WHO national estimates indicated 43.7% prevalence in women of reproductive age and 45.5% in pregnant women. Key risk factors identified across studies included family history of IDA (adjusted odds ratio [OR] 2.91, 95% confidence interval [CI] 1.78–4.76), insufficient iron intake (OR 7.39, 95% CI 1.45–37.57), infrequent meat consumption (OR 1.54–7.70), and short birth intervals (OR 2.23, 95% CI 1.20–4.41). Global Burden of Disease 2021 data demonstrated a 44.5% decline in age-standardized disability burden from dietary ID between 1990 and 2021. CONCLUSIONS: IDA remains an important public health problem in Saudi Arabia, particularly affecting women of reproductive age and infants. The 93% female predominance in clinical samples and substantial regional disparities (28%–42%) necessitate targeted interventions aligned with Saudi Vision 2030 Quality of Life Program objectives, specifically key performance indicators for maternal and child health screening coverage and chronic disease prevention. Strengthening primary care screening, dietary education programs, and iron supplementation initiatives should be prioritized.
BACKGROUND: Low platelet counts resulting from increased platelet breakdown and poor platelet generation are the hallmarks of immune thrombocytopenia (ITP), an autoimmune illness. Romiplostim increases platelet counts in the majority of patients and lowers bleeding risk in those with ITP. OBJECTIVES: To evaluate the median dose of romiplostim required to maintain platelet counts ≥50 × 109/L and to assess platelet response rates among adult Iraqi patients with primary ITP. MATERIALS AND METHODS: The cross-sectional study looked at 200 patients’ ages ≥14 years who had primary ITP that failed 1st line treatment. They were treated at Baghdad Medical City from May 2022 to December 2023. Medical records were used to get the information. Romiplostim (Nplate®, Amgen Inc., Thousand Oaks, CA, USA) was injected subcutaneously once a week. The dose started at 1 μg/kg and was increased by 1 μg/kg each time to keep the platelet numbers between 50 and 200 × 109/L (maximum 10 μg/kg). RESULTS: Among 200 patients (60% female), the median age was 38 years and the median treatment duration was 4 months. The median weekly dosage of romiplostim was 250 μg and the median baseline platelet count was 19 × 109/L, which significantly increased to 138 × 109/L after romiplostim therapy (P = 0.011). A total of 73.5% of patients achieved a platelet response ≥ 50 × 109/L. There was no significant difference in response between patients aged ≥ 60 years and those < 60 years (P = 0.25). CONCLUSIONS: Romiplostim has a robust and persistent platelet response in adult patients with refractory ITP and good safety. Its effectiveness as a second-line treatment was confirmed by its age-neutral response.
BACKGROUND: Infantile acute lymphoblastic leukemia (ALL) is associated with poor outcomes worldwide, particularly in low-resource settings. Despite advances in pediatric ALL therapy, survival rates for infants remain substantially lower than those observed in older children. Evaluating treatment outcomes over time may help identify factors associated with improved survival. OBJECTIVES: To assess treatment outcomes and survival trends of infants with ALL treated at a single tertiary center in Iraq over three distinct treatment periods. MATERIALS AND METHODS: This retrospective study included infants (<1 year old) diagnosed with ALL and treated at the Children’s Welfare Teaching Hospital in Baghdad between January 2000 and December 2016. Patients were treated using adapted UKALL-97, UKALL-2003, and UKALL-2011 protocols, with a small subset receiving an infant-specific protocol. Patients were grouped by treatment period (2000–2005, 2006–2011, and 2012–2016). Overall survival (OS) and event-free survival (EFS) were estimated using the Kaplan–Meier method and compared using the log-rank test. RESULTS: Among 59 infants diagnosed with ALL, 11 (19%) refused treatment. Of the remaining 48 treated patients, 24 (50%) achieved complete remission, 4 (8%) were resistant to therapy, and 17 (35%) died during induction. Complete remission rates improved across treatment periods from 36% to 45% and 71%, respectively. Among responders, 6 (25%) relapsed, 10 died during subsequent therapy, and 5 were lost to follow-up. The 36-month OS and EFS for treated patients were 30.2% and 17%, respectively, with a nonsignificant trend toward improved EFS in the 2012–2016 cohort. CONCLUSION: The outcomes of infantile ALL in this low-resource setting remain poor, characterized by high induction mortality and treatment abandonment. Although survival improved over time—particularly following the introduction of a steroid prephase and enhanced supportive care—overall prognosis remains unsatisfactory, underscoring the need for further therapeutic and supportive care improvements.
