Department Of Hematology Research Articles

Molecular and Clinical Spectrum of Hemoglobin D: An Experience at a Tertiary Care Diagnostic Center

Objective: To determine the clinical and molecular pattern of Hemoglobin D in patients presenting at tertiary care hospital. Study Design: Cross-sectional study. Place and Duration of study: Department of Hematology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jul 2020 to Mar 2021. Methodology: An automated cell analyzer was used to determine the whole blood count and red cell indices. D-10 BIORAD HPLC was used for quantitative assessment of Hb A, Hb F, Hb D and Hb A2. Where D-10 BIORAD HPLC showed an abnormal Hb D, capillary electrophoresis was performed using Sebia Capillary 2 Flex Piercing. Chelex DNA Extraction method was used. Molecular analyses for the confirmation of homozygosity and heterozygosity were done using Polymerase Chain Reaction (PCR) amplification. The clinical symptoms of the patients such as anemia, jaundice, pallor, weakness, hepatomegaly and splenomegaly were also noted Results: Among 90 patients, Hemoglobin D trait was found in 78(80.4%) of the patients out of which HbD-Punjab was seen in 57(73%) and HbD-Iran was found in 21(27%). Compound Heterozygotes (HbD/β) was found in 17(17.5%) and Compound Homozygous HbD/D was found in 02 (2.1%). All HbD-Punjab and HbD-Iran traits patients were asymptomatic, and few clinical symptoms were found in Compound Heterozygotes (HbD/β) and Homozygous HbD/D. Conclusion: Collective clinical history records, full blood count and electrophoresis and molecular results allow for the conclusive detection of the variant of Hemoglobin D. More multicenter, organized and detailed studies with larger sample size are required to draw concrete conclusions.

Association of serum bilirubin levels and glycemic measurements in Type 2 diabetic patients

Introduction: Bilirubin, a waste product of the heme catabolic pathway, has proven to be a natural antioxidant associated with a lower prevalence of oxidative stress-mediated diseases. This study evaluates the association of serum bilirubin levels with Glycated Hemoglobin (HbA1c), Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in diabetic patients. Methods: A retrospective analytical study was conducted at the Department of Haematology of the Sri Jayewardenepura General Hospital. Data was obtained through a laboratory information system of randomly selected 201 adult patients diagnosed with T2DM and grouped as poorly and well controlled using HbA1c values over and below 7%, respectively. Normal ranges for serum bilirubin, FBS, and PPBS were (0.3-1.2) mg/dL, (75-110) mg/dL and (80-140) mg/dL, respectively. Data were analyzed using (SPSS) version 20, descriptive statistical methods, Pearson’s Correlation test and independent sample t-test. P<0.05 was considered significant. Results: A negative correlation between total bilirubin and HbA1c (r = -0.234, p=0.001) was observed. There was no statistically significant correlation between total bilirubin level and FBS (p=0.131), PPBS (p=0.408), and age (p=0147). However, the mean values of total bilirubin (p=0.001), FBS (p<0.001) and PPBS (p<0.001) were significant between diabetes well controlled and poorly controlled groups. A statistically positive correlation was observed between HbA1c and FBS (p<0.001) and PPBS (p<0.001), but not with age (p=0.887). Conclusion: There was a significant relationship between total bilirubin with FBS, and PPBS in both groups. A significant negative correlation was found between total bilirubin and HbA1c, suggesting a potential protective or modulatory role of bilirubin in glycemic control. No significant correlation was observed between total bilirubin levels and FBS, PPBS, or age in the total population.Keywords: T2DM, HbA1c, bilirubin, FBS, PPBS

Correlation of T Regulatory Cells, Cytotoxic T-lymphocyte-associated Antigen 4, and Transforming Growth Factor-β1 with Treatment Response in Patients with Chronic Myeloid Leukemia Receiving Dasatinib Therapy.

Tyrosine kinase inhibitors improve chronic myeloid leukemia (CML) outcomes. Dasatinib inhibits breakpoint cluster region-Abelson 1 proto-oncogene tyrosine kinase better than imatinib in CML. T-regulatory cells prevent autoimmune diseases and aberrant immune responses by reducing oncoprotein antigen reactivity. They also reduce self-antigen-induced immune responses to maintain peripheral tolerance. In this study, T-regulatory cells in peripheral blood of chronic myeloid leukemia-chronic phase patients were measured, together with serum levels of cytotoxic T-lymphocyte-associated antigen-4 (CTLA-4) and transforming growth factor (TGF)-β1 at diagnosis and 3 months postdasatinib therapy. The Pathology and Clinical Haematology Departments at King George's Medical University, Lucknow, India, conducted this prospective analytical study. Forty CML-chronic patients and 10 healthy controls were analyzed. Flow cytometry was used to determine T-regulatory cell percentage in peripheral blood mononuclear cells of newly diagnosed CML patients before and after 3 months of dasatinib treatment; ELISA was used to measure serum levels of CTLA-4 and TGF-β1. T-regulatory cells, CTLA-4, and TGF-β1 significantly decreased in CML-chronic phase patients after 3 months of dasatinib therapy compared to the initial diagnosis. No significant change in T-regulatory cell, CTLA-4, or TGF-β1 percentages were seen between responders and poor responders. However, responders had a lower percentage of T-regulatory cells than suboptimal responders. The study concluded that dasatinib treatment improved response in CML patients with decreased Treg cells. Dasatinib reduces Treg-mediated immunological suppression, reducing CTLA-4 and TGF-β1 levels.

Management of acute pain in adults with sickle cell disease: the experience of the Clinical Hematology Department of the University of Dakar.

The evolution of sickle cell disease (SCD) is marked by the occurrence of painful episodes linked to the obstruction of microvessels by sickle cells, known as vaso-occlusive crisis (VOC). The aim of this work was to report the practical aspects of the management of acute pain in adults with SCD. Recommendations based on these practices are also provided. This prospective, cross-sectional, descriptive, and analytical study was conducted over a four-month period of all sickle cell patients admitted to emergency departments for VOC. The parameters studied were sociodemographic, clinicobiological, therapeutic, and evolutionary. There were 118 cases of VOC identified, representing a prevalence of 78.14% of sickle cell emergencies. The mean age of the patients was 28.41 years. The SS sickle cell phenotype accounted for 86.61% of the cases. Osteoarticular pain was the reason for admission for 88.39% of the patients; it was located in the lower limbs in 39.08% and in the spine in 27.1%. Pain intensity was moderate in 6.25% of the patients, intense in 31.25%, and unbearable in 55.55%. Multimodal analgesia was the most commonly used treatment method, combining those of levels one and two (74.31%) and levels one and three (8.25%). The mean dose of morphine administered was 17.14 mg when morphine alone was prescribed for titration, 13.57 mg when paracetamol and morphine were combined, and 15.83 mg when nefopam and morphine were combined. Clinical outcome was favorable in 68.87% of the cases. Wide variability was observed in the modalities of analgesic treatment of sickle cell VOC. These variations reflect different views on the appropriateness of opioids. This study highlights the efficacy of multimodal analgesia in the management of acute pain in patients with SCD, particularly in regard to morphine sparing. Context-specific recommendations will be needed to harmonize practices.

Effect of educational interventions addressing blood groups and donation aspects on the knowledge and attitude of allied health sciences students

Objective: To determine the effect of educational interventions on knowledge and approach of Allied Health Sciences Students regarding blood groups and blood donation. Methods: It was a cross-sectional study conducted at the department of Hematology and Transfusion Medicine, University of Child Health Sciences, The Children’s Hospital, Lahore from October 2022-January 2023. A self-designed questionnaire was used to assess the baseline knowledge of students followed by educational interventions in the form of small group discussions, video lectures and practical demonstrations. Post-interventions assessment was done using the same questionnaire 30 days later. Data obtained was analyzed using SPSS-23 software. A p-Value <0.05 was considered significant. The reliability of the questionnaire was checked after the pilot study by using the SPSS-23 software and calculated Cronbach’s Alpha was 0.82. Results: Of the 99 participants, there were 13 males and 86 females with mean age of 21.41±1.478 years. Pre-interventions, majority participants had moderate knowledge (81.8%). Medical Lab technologists showed better baseline knowledge than the rest. Post-interventions, the level of knowledge among students increased to 94.9%. Pre-interventions, knowledge about blood groups and donation ranged from 14.1-79% and 25.5-77.8% correct responses respectively while post-interventions it went up to 92-100% for both aspects. The willingness to donate blood in future raised from 46.4% to 92.9%. Conclusions: Educational interventions were effective in improving the knowledge of Allied Health Sciences students about blood groups and blood donation. The enlightenment strategies positively influenced students towards the active participation in blood donation campaigns. doi: https://doi.org/10.12669/pjms.40.10.8803 How to cite this: Saqlain N, Habib H, Riaz S, Hareem S. Effect of educational interventions addressing blood groups and donation aspects on the knowledge and attitude of allied health sciences students . Pak J Med Sci. 2024;40(10):2261-2266. doi: https://doi.org/10.12669/pjms.40.10.8803 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

CD36 cell surface expression as a surrogate marker to identify ABL/JAK-class kinase fusions in pediatric BCP-ALL.

Genetic alterations are the cornerstone of risk stratification in B-cell precursor acute lymphoblastic leukemia (BCP-ALL), and their accurate identification is critical for optimal treatment. Most cases with ABL-class fusion are classified as high-risk yet display good responses to tyrosine kinase inhibitors (TKIs). Current clinical protocols recommend adding a TKI to chemotherapy as soon as possible, making it mandatory to rapidly identify these alterations. We investigated here whether the identification of immunophenotypic features associated with these molecular alterations could be a valuable screening tool. CD36 expression was shown to be a characteristic feature of ABL- or JAK-class kinase fusions. The main genetic subgroups clustering in the subset with Philadelphia (Ph)-like features were also found to display specific immunophenotypic characteristics. A predictive multiparameter scoring system was generated, segregating genetic subtypes with aberrant kinase activation (PAX5/CRLF2alt, BCR::ABL1, ABL/JAK-class). The most robust markers identified were the TSLPR with CD19/22/9/38/81/304 and CD49f. As TKI adjunction is currently limited to the ABL-class kinase fusions, immunophenotypes distinguishing ABL from JAK-class were also investigated. The flow cytometry method reported here, accessible to most hematology departments, is thus a new useful tool to quickly screen for Ph-like kinase fusion with a good sensitivity (95%) and specificity (96%).

Prognostic factors in children with acute T-lymphoblastic leukemia: a single-center clinical study of the CCCG-ALL-2015 protocol

To explore the clinical characteristics of children with acute T-lymphoblastic leukemia (T-ALL) and analyze their relationship with prognosis. A retrospective analysis was conducted on the clinical data and follow-up results of 50 children with T-ALL who were treated using the CCCG-ALL-2015 protocol at the Department of Hematology and Oncology, Children's Hospital of Nanjing Medical University from November 2015 to December 2019. Kaplan-Meier survival analysis and Cox regression analysis were employed to identify factors affecting prognosis. Among the 50 T-ALL patients, there were 7 cases of relapse. There was no statistically significant difference in the baseline clinical data between the relapse group and the non-relapse group (P>0.05). However, the positive rate of minimal residual disease (MRD) (≥0.01%) on day 46 after induction remission therapy in the relapse group was significantly higher than that in the non-relapse group (P=0.037). The 5-year overall survival rate for the 50 patients was (87±5)%, and the 5-year event-free survival rate was (86±5)%. Multivariate Cox regression analysis indicated that the MRD level on day 46 after induction remission therapy was an independent prognostic factor (HR=0.104, 95%CI: 0.015-0.740, P=0.024). MRD is of significant importance for the prognosis of T-ALL children. Personalized treatment should be provided based on MRD levels to prevent relapse and improve prognosis in these patients.

Application of high-throughput drug sensitivity testing in children with relapsed and refractory acute leukemia

To explore the current application of high-throughput drug sensitivity (HDS) testing in children with relapsed and refractory acute leukemia (RR-AL) and analyze the feasibility of salvage treatment plans. A retrospective collection of clinical data from children with RR-AL who underwent HDS testing at the Department of Children's Hematology and Oncology of the First Affiliated Hospital of Zhengzhou University from November 2021 to October 2023 was conducted, followed by an analysis of drug sensitivity results and treatment outcomes. A total of 17 children with RR-AL underwent HDS testing, including 7 cases of relapsed refractory acute myeloid leukemia and 10 cases of relapsed refractory acute lymphoblastic leukemia. The detection rate of highly sensitive chemotherapy drugs/regimens was 53% (9/17), while the detection rate of moderately sensitive chemotherapy drugs/regimens was 100% (17/17). Among the 17 RR-AL patients with highly and moderately sensitive chemotherapy drugs and regimens, the MOACD regimen (mitoxantrone + vincristine + cytarabine + cyclophosphamide + dexamethasone) accounted for 100%, with the highest inhibition rate for single-agent mitoxantrone (94%, 16/17), and the highest inhibition rate for targeted therapy being bortezomib (94%, 16/17). Nine patients adjusted their chemotherapy based on HDS testing results, with 4 undergoing hematopoietic stem cell transplantation. Four patients achieved disease-free survival, while 5 died. Eight patients received empirical chemotherapy, with 2 undergoing hematopoietic stem cell transplantation; 4 achieved disease-free survival, while 4 died. HDS testing can identify highly sensitive drugs/regimens for children with RR-AL, improving the rate of re-remission and creating conditions for subsequent hematopoietic stem cell transplantation.

The prognosis and related factors impacting renal response in newly diagnosed multiple myeloma patients with renal impairment

Objective: To investigate the prognosis and related factors impacting renal response in newly diagnosed multiple myeloma (NDMM) patients with renal impairment. Methods: A total of 375 NDMM patients diagnosed at the Department of Hematology, the First Affiliated Hospital of Nanjing Medical University from August 2012 to April 2022 were retrospectively recruited. Patients were categorized into non-renal impairment group(n=273) and renal impairment group (n=102) according to renal function at initial diagnosis. All patients received≥2 cycles of bortezomib-based induction chemotherapy after admission. The hematological response included stringent complete response (sCR), complete response (CR), very good partial response (VGPR), partial response (PR) and stable disease (SD). The renal responses were defined as CR, PR, minor response (MR) and non-response (NR). General clinical data of the patients were collected, and patients were followed up by telephone. The follow-up deadline was December 3, 2022, and the median follow-up time [M (Q1, Q3)] was 42 (22, 61) months. Kaplan-Meier analysis was used to plot the survival curve. The log-rank test was utilized for inter-group comparisons. Multivariate logistic regression modeling facilitated the exploration of associated factors impacting renal response. Results: In the renal impairment group, there were 68 males and 34 females with a median age [M (Q1, Q3)] of 64 (58, 69) years. In the non-renal impairment group, there were 149 males and 124 females with a median age of 62 (54, 68) years. Compared with the renal impairment group, the age, lactate dehydrogenase and 24-hour urinary protein quantity were increased, the proportion of patients with light chain M protein and the proportion of patients at the DS-Ⅲ stage, ISS-Ⅲ stage and R-ISS-Ⅲ stage were higher, the hemoglobin level and the proportion of patients receiving autologous hematopoietic stem cell transplantation were lower in the renal impairment group (all P<0.05). In 102 patients with renal impairment, renal responses of CR, PR, MR and NR were obtained in 53 (52.0%), 8 (7.9%), 18 (17.6%), 23 (22.5%) patients, respectively, and the overall response rate was 77.5% (79/102). Kaplan-Meier survival curve revealed that the median progression-free survival (PFS) was 24.0 (95%CI: 18.3-29.7) months in the renal impairment group, which was shorter than 31.0 (95%CI: 24.7-37.3) months in the non-renal impairment group (P=0.003). The median overall survival (OS) was 46.0 (95%CI: 36.5-55.5) months in the renal impairment group, which was shorter than 79.0 (95%CI: 59.9-98.1) months in the non-renal impairment group (P=0.002). Among the renal impairment group, patients with renal response of less than PR exhibited a median PFS of 19.0 (95%CI: 9.7-28.3) months, which was shorter than 28.0 (95%CI: 21.4-34.5) months for those achieving PR or better (P=0.048). The median OS was 31.0 (95%CI: 23.5-38.5) months in renal response with less than PR group, which was also worse than 57.0 (95%CI: 42.8-71.2) months for those who achieved PR or better (P=0.003). The results of multivariate logistic regression showed that hematological response achieving VGPR or better was a factor associated with renal response achieving PR (OR=4.20, 95%CI: 1.20-14.68, P=0.025). Conclusions: The prognosis of NDMM patients with renal impairment is poor. The hematological response with VGPR or better is related to the renal response achieving PR.

Application of serum tumor specific protein 70 for prognostic stratification in acute myeloid leukemia

Objective: To assess the value of serum tumor specific protein 70 (SP70) for prognostic stratification in acute myeloid leukemia (AML). Methods: A cohort study design was adopted. 129 newly diagnosed AML patients from September 2022 to January 2024 at the Hematology Department of the First Affiliated Hospital of Nanjing Medical University were included, as well as a control group consisted of 120 healthy individuals and 7 cases with benign hematologic diseases during the same period (total 127 cases). Clinical data were collected from Electronic Medical Records. According to the 2023 edition of the Chinese Leukemia Diagnosis and Treatment Guidelines, AML patients with good or moderate prognosis were categorized as low-to-intermediate risk, while those with poor prognosis were high-risk group. Univariate and multivariate logistic regression analyses were used to identify variables significantly associated with AML prognostic risk. ROC analysis was used to evaluate diagnostic performance. A nomogram for predicting patient prognostic risk was constructed by R 4.0.2 software, and the internal validation was performed using bootstrapping. Results: Among 129 AML patients, there were 71 males (55.0%) and 58 females (45.0%), with 42 (32.6%) classified as high-risk and 87 (67.4%) as low-intermediate risk. The high-risk group had a significantly higher median age [62 (48, 67) years] compared to the low-intermediate risk group [50 (35, 63) years, Z=-2.381, P=0.017], and a significantly higher proportion of males (30 patients, 71.4%) compared to the low-intermediate risk group (41 patients, 47.1%, χ2=6.760, P=0.009). Multivariate logistic regression analysis indicated that serum SP70 (OR=2.54, 95%CI: 1.68-3.84, P<0.001), hemoglobin (HB) (OR=0.96, 95%CI: 0.93-0.99, P<0.05), and bone marrow blast (BM blast) (OR=1.07, 95%CI: 1.02-1.13, P<0.05) were independent risk factors for high-risk prognosis in AML patients. ROC analysis showed that the area under the curve (AUC) for SP70 predicting high-risk patients was 0.908 (cut-off value of 5.74 ng/ml, 95%CI: 0.845-0.952, sensitivity 90.5%, specificity 82.8%). The combined model of serum SP70, HB, and BM blasts had an AUC of 0.931 (95%CI: 0.890-0.973); C-index=0.925 (95%CI: 0.876-0.963),with no statistically significant difference compared to serum SP70 alone (Z=1.693,P>0.05). Conclusion: Serum SP70 may be a promising non-invasive molecular biomarker for prognostic stratification in AML.

Clinical outcomes of allogeneic hematopoietic stem cell transplantation from matched sibling donor for myelofibrosis

Objective: To evaluate the efficacy and safety of matched sibling donor allogeneic hematopoietic stem cell transplantation (allo-HSCT) for the treatment of myelofibrosis (MF). Methods: In this case series, the clinical data of 18 patients with MF who received allo-HSCT in the Department of Hematology, Peking University People's Hospital from December 2008 to December 2023 were retrospectively studied. Kaplan-Meier survival analysis and competitive risk model were used to evaluate the probabilities of 3-year overall survival (OS), disease-free survival (DFS), cumulative incidence of relapse (CIR), and transplant related mortality (TRM). The transplant related complications were also analyzed. Results: Among the 18 patients included, there were 12 males and 6 females, with a median age of 50 (range: 28-64) years. All 18 patients achieved neutrophil engraftment, and the time of neutrophil engraftment [M (Q1, Q3)] was 16.0 (11.8, 18.0) days. Twelve patients achieved platelet engraftment, and the platelet engraftment time was 21.0 (16.2, 43.2) days. Six patients had grade Ⅱ to Ⅳ acute graft-versus-host disease (GVHD), and six patients had chronic GVHD. The 3-year OS rate and DFS rate after transplantation were 62.2% and 52.2%, respectively. The 3-year CIR and TRM were 29.7% and 24.6%, respectively. Four patients died during follow-up, with the main cause of death being infections. Conclusion: Matched sibling allo-HSCT is a feasible option for the treatment of MF.

Clinical Characteristics and Survival Analysis of Single Center Adult Chronic Myeloid Leukemia in Chronic Phase

To investigate the clinical characteristics and prognosis of single center adult chronic myeloid leukemia in chronic phase (CML-CP). Clinical data of 41 adult CML-CP patients in Department of Hematology, Shanghai Fengxian District Central Hospital from January 2015 to May 2021 were retrospectively analyzed. The clinical characteristics and prognosis of patients between <60 years group and ≥60 years group were compared. The 41 patients included 27 (65.9%) males and 14 (34.1%) females. The median age of the patients was 56(19-84) years, with 22 cases (53.7%) <60 years and 19 cases (46.3%) ≥60 years. Univariate analysis indicated that the proportions of patients with comorbidities, intermediate/high-risk Sokal score, myelofibrosis, and lactate dehydrogenase ≥1 000 U/L were significantly increased in ≥60 years group compared with <60 years group at initial diagnosis (all P <0.05). There were no statistical differences in the distribution of sex, ELST score, white blood cell count, platelet count, peripheral blood basophil percentage, peripheral blood eosinophil percentage and bone marrow primitive cell percentage between the two groups (P >0.05). The proportion of patients taking reduced-dose imatinib in ≥60 years group significantly increased (P <0.001). Patients <60 years had a higher proportion of molecular biological remission after treatment of tyrosine kinase inhibitors (TKIs) than patients ≥60 years (P <0.001). The incidence of non-hematologic adverse reactions to TKI therapy significantly increased in patients ≥60 years (P <0.001). Multivariate analysis showed that no adverse factors affecting the efficacy and prognosis of TKI. Compared with adult CML-CP patients <60 years, patients ≥60 years gain fewer benefits from TKI treatment and increased adverse reactions.

Promoting and supporting leadership in hematology departments

Promoting and supporting leadership in hematology departments

Clinical Analysis of Reversible Posterior Encephalopathy Syndrome after Allogeneic Hematopoietic Stem Cell Transplantation in Children

To summarize the clinical features of reversible posterior encephalopathy syndrome (PRES) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children. The clinical data of six children who developed PRES after undergoing allo-HSCT in the Department of Hematology of Wuhan Children's Hospital from June 2016 to December 2022 were retrospectively analyzed, and their clinical characteristics, imaging examination, laboratory examination, and treatment regression were summarized. Among 281 children underwent allo-HSCT, 6 cases (2.14%) developed PRES, with a median age of 5.1(1.5-9.7) years old. 4 cases underwent related haploidentical donor transplantation, and 2 cases underwent sibling allografting and unrelated donor allografting donor transplantation, respectively. All six children had an acute onset of illness, with clinical manifestations of nausea and vomiting, seizures, psychiatric disorders, visual disturbances. The five cases elevated blood pressure. All children with PRES were treated with oral immunosuppressive drugs during seizures, and 3 cases were combined with different degrees of graft-versus-host disease. Most of the children showed effective improvement in clinical symptoms and imaging after adjusting/discontinuing suspected medications (cyclosporine, etc.) and symptomatic supportive treatments (oral antihypertensive, diazepam for antispasmodic, mannitol to lower cranial blood pressure), and one of them relapsed more than 8 months after the first seizure. PRES is rare after hematopoietic stem cell transplantation in children, and its onset may be related to hypertension, cytotoxic drugs, graft-versus-host disease, etc. Most of them can be recovered after active treatment, but not completely reversible, and the prognosis of those who combined with TMA is poor.

Resilience Development Among Adult Patients With DeNovo Acute Leukemia: A Qualitative Study.

This study aimed to explore the development process of psychological resilience among adult patients with de novo acute leukemia. This study utilized a descriptive qualitative approach, employing a purposeful sampling method to select a sample of 15 newly diagnosed patients with acute leukemia (AL) who underwent their initial induction chemotherapy treatment at the Hematology Department of the First Affiliated Hospital of Zhejiang University School of Medicine, China. Semi-structured interviews were conducted with the selected patients. Content analysis methodology was used to analyze, summarize, and extract themes from the collected data. Three categories emerged-namely, (1) negative period, (2) adaptive response phase, and (3) growth transformation period. The negative period occurs during the initial diagnosis and throughout the treatment cycle. However, influenced by both internal and external protective factors, including personal characteristics and social support, individuals enhance their psychological resilience through emotional regulation, mental adjustment, and adaptive strategies vis-à-vis healthcare decision-making and disease management. Overall, psychological resilience development follows an upward spiral trajectory. This study identified that negative emotions and symptom clusters impede the development of patients' psychological resilience. Moreover, it revealed a substantial need for disease-related information among patients. Therefore, healthcare professionals should prioritize addressing the negative emotions of patients, early identification of protective factors, dynamic monitoring of symptom clusters, effective management, and provision of psychological counseling and interventions. Simultaneously, providing personalized, professional, and systematic disease-related information is vital for promoting psychological resilience development.

Enhancing Hematopoietic Stem Cell Transplantation Success: The Crucial Role of Architectural Design in Transplant Units and Hematology Departments

Aim: This paper aims to explore the critical role of architectural design in Hematopoietic Stem Cell Transplantation (HSCT) procedures, focusing on how various aspects of design influence patient outcomes, staff efficiency, infection control, and overall safety. The study seeks to understand how the physical environment impacts both the immediate and long-term recovery of patients undergoing HSCT and to advocate for design principles that enhance patient and caregiver experiences. Discussion: Hematopoietic Stem Cell Transplantation (HSCT) has emerged as a vital therapeutic modality for a diverse spectrum of hematological disorders and malignancies. As medical and technological advancements continue to evolve, the significance of the physical environment in which HSCT procedures are conducted becomes increasingly evident. This paper delves into how architectural design affects patient well-being, staff efficiency, and infection control, emphasizing the importance of creating environments that support psychological well-being. It examines the impact of design on infection prevention, safety during emergencies, and the overall efficiency of healthcare delivery. The discussion also highlights the role of sustainability and green design principles in minimizing the environmental footprint while promoting patient recovery. Conclusions: The paper concludes that architectural design plays a transformative role in enhancing patient experiences and healthcare outcomes in HSCT settings. It underscores the need for a patient-centric approach to design that integrates wellness-focused elements and advanced technology. The study advocates for a collaborative effort among healthcare institutions, architects, designers, and policymakers to create supportive, efficient, and sustainable healthcare environments. By prioritizing these design considerations, healthcare environments can significantly improve the HSCT journey and contribute to the broader realm of healthcare excellence.

Chemotherapy-Induced Febrile Neutropenia Managed on an Outpatient Basis at the Pediatric Hematology and Oncology Department of the Ibn Sina Children’s Hospital in Rabat

Introduction: Febrile neutropenia (FN) is an important cause of morbidity and mortality in patients with cancer. The general objective of this study was to collect data and analyze the factors influencing management of the febrile neutropenia at the day hospital at the pediatric department of Hematology and Oncology (SHOP) of Rabat.

Iron supplementation post-blood donation in Vietnam: Impact on hemoglobin, red cell indices, and iron reserves

Background. Regular blood donation plays a pivotal role in mitigating the formation of free radicals by regulating iron accumulation. However, frequent blood donation can lead to chronic iron deficiency. In this study, we aimed to evaluate the effectiveness of daily iron supplementation as an intervention to expedite hemoglobin (Hb) recovery among frequent blood donors at a hospital in Vietnam. Methodology. Conducted longitudinally within the Hematology Department of a Hanoi hospital from February to July 2023, our study involved 104 eligible participants. They received a daily iron supplement comprising 100 mg of elemental iron, 0.75 mg of folic acid, and 5 mg of zinc sulfate for a minimum of 8 weeks. Blood samples were collected at three key time points: before blood donation during recruitment, immediately after donation, and at least 8 weeks post-donation. Results. Our findings revealed moderate, statistically significant positive correlations between elemental iron administration and changes in platelet count (PLT), hematocrit (HCT), and mean corpuscular hemoglobin (MCH) (r = 0.753, p &lt;0.001; r = 0.887, p &lt;0.001; and r = 0.703, p &lt;0.001, respectively). Additionally, weak but significant correlations were observed between elemental iron administration and red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width coefficient of variation (RDWC), and red cell distribution width standard deviation (RDWS) (r = 0.260, p = 0.002; r = 0.302, p = 0.005; r = 0.160, p = 0.010; r = 0.120, p = 0.020; and r = 0.400, p &lt;0.001, respectively). Conclusion. Over an eight-week duration, the regimen of daily iron supplementation yielded significant improvements in both red cell variables, red cell indices, and iron study variables, demonstrating its potential clinical impact.

Survival of patients affected with multiple myeloma at the Department of Internal Medicine and Haematology of Semmelweis University

Survival of patients affected with multiple myeloma at the Department of Internal Medicine and Haematology of Semmelweis University

Prevalence of Hypothyroidism in Children with Transfusion Dependent Thalassemia Patient Attending in A Tertiary Care Hospital of Bangladesh

Background: Blood transfusions and iron chelation are standard treatments for β-thalassemia major and Hb E-Beta-Thalassemia. However, repeated transfusions raise body iron levels, leading to secondary hemosiderosis and complications in the heart, endocrine system, and liver. Thyroid dysfunction results from gland infiltration, chronic hypoxia, free radical damage, and iron overload. This study aimed to find out the prevalence of hypothyroidism in transfusion-dependent thalassemic children attending Bangladesh Shishu Hospital &amp; Institute. Methods: A descriptive cross-sectional study was conducted at the Thalassemia Centre, Department of Hematology and Oncology, Bangladesh Shishu Hospital &amp; Institute, from December 2019 to November 2020. The study included 140 children with thalassemia, aged 5 to 16 years, who were receiving blood transfusions. Data were collected using a structured questionnaire with participant consent. Statistical analysis was performed using SPSS version 23.0. Results: In this study, hypothyroidism was observed in 26.2% of patients, with 23.5% having subclinical and 2.9% overt hypothyroidism. In most of the patients (n=85), aged 11-16 years, 58.3% had normal thyroid function, 36.5% had subclinical, and 4.7% had overt hypothyroidism, which was statistically significant (p&lt;0.05). Of the 91 patients with hemoglobin levels below 11.5 g/dL, 85.7% had normal thyroid function, 13.2% had subclinical hypothyroidism, and 1.1% had overt hypothyroidism, also significant (p&lt;0.05). In the group with ferritin levels of 1200-2000 ng/mL, 78.1% had normal thyroid function, 18.8% had subclinical hypothyroidism, and 3.1% had overt hypothyroidism, which was not statistically significant (p&gt;0.05). Conclusion: Subclinical hypothyroidism is commonly seen in thalassemia patients aged 5 to 16 years who undergo regular blood transfusions. Regular physical exams and thyroid function assessments are crucial to detect overt hypothyroidism early. Timely hormone replacement can