Antiplatelet drugs represent a key class of drugs that are of proven value in arterial thromboembolic disorders. There is a need for effective, safe antiplatelet agents or their combinations to provide predictable therapeutic benefits, dosage flexibility, and unique pharmacologic profiles, such as rapid onset in acute thrombotic state and sustained antiplatelet effect in chronic platelet activation state (e.g., post-stent placement). Aspirin, clopidogrel or their combination have shown improved clinical outcomes in certain unique settings, and the search for additional antiplatelet agents is ongoing. Current studies suggest that combination antiplatelet therapy with existing agents is best considered a use-adapted strategy, with the greatest clinical benefit of combination therapy realized in acute platelet-activating and pro-thrombotic state.

With the introduction of safe recombinant products and advances in the purification of plasma concentrates, the ravages of the HIV and hepatitis C epidemics in hemophilia patients have begun to subside in many countries. Indeed, the life spans for many patients with hemophilia A and B are approaching those of the non-hemophilic population. However, challenges remain, and new agents and treatments are in development to meet these challenges. Prophylactic therapy is reducing the burden of joint damage caused by joint bleeding. The challenge is to reduce the frequency and increase the convenience so that prophylaxis will become the primary mode of therapy for adults as well as children. For patients with inhibitors to factors VIII or IX, the challenge is to increase the efficacy of treatments and develop forms of prophylaxis so that treatment of these patients will no longer require immune tolerance therapy, simply a shift to a different agent. The global challenge is to make therapy available to all patients regardless of the location, as we move safely toward the ultimate goal of a genetic cure. In the near future, new devices to speed and simplify factor administration and increasing numbers of room temperature-stable clotting factors will increase user convenience. Long-acting clotting factors will enhance and simplify prophylactic therapy. Novel high-activity and long-acting clotting agents will enhance treatment and allow prophylaxis in inhibitor patients. Oral therapies will obviate the need for these factors in mild patients, convert the phenotype of many patients with moderate disease to a mild form, and augment factor replacement in both severe hemophilia patients and those with inhibitors. It is an exciting time to be involved in hemophilia care, but bringing these new agents to the clinical arena will require a combined effort of the industry, academic health centers, health care professionals, and patients.

The DiaMed-ID Micro Typing System (gel test) has become the technique of choice for immune-hematological investigations in blood banks. The aim of this study was to compare the performance of the gel test with the conventional tube low-ionic-strength solution (tube test) technique for the detection of red cell alloantibodies in pregnant women and multi-transfused patients. We prepared sera from the clotted samples of 100 blood donors (controls), 87 pregnant women, 28 ?-thalassemia patients, 34 sickle cell anemia (SCA) patients, and 17 leukemia patients. In the control samples, no antibody was detected with either method. For the pregnant women samples, the most prevalent antibodies detected using the gel test were of the Rhesus type: anti-D (41.4%), anti-E (9.2%), anti-C (5.7%), and anti-Cw (1.1%). We also detected combinations of antibodies against the major Rhesus antigens: anti-C+E (1.1%), anti-E+K (1.1%), anti-C+D (2.3%), and anti-E+S (1.1%). Anti-K was the most prevalent non-Rhesus antibody (18.4%). The gel test also detected other antibodies with minor clinical importance: anti-S (1.1%), anti-M (1.1%), and anti-Lua (1.1%). The gel test also detected a few weak antibodies: anti-D (1.1%), anti-C (2.3%), and anti-E (1.1%). In the same samples, the tube test detected the following antibodies: anti-D (25.3%), anti-E (5.7%), anti-K (12.6%), anti-C (2.3%), non-specific (9.2%), anti-C+D (1.1%), anti-Fya (1.1%), and weak anti-K (1.1%). For the -thalassemia samples, only the gel test detected a single antibody (anti-Kpa). For the SCA samples, the gel test detected one anti-K (2.9%)antibody and 2 antibody combinations: anti-D+K+C (2.9%) and anti-E+K (2.9%). The tube test also detected anti-K (2.9%); however, for the anti-D+K+C combination, it only detected anti-C (2.9%), while it only detected anti-K from the anti-E+K combination. For the leukemia samples, both methods gave negative reactions. In conclusion, the gel test is more sensitive than the tube test at detecting alloantibodies; moreover, it is technically easier to perform, with clear readable agglutination reactions, requires small volumes of sera and reagents, and has no washing steps.

Venous thromboembolism (VTE) is a common disorder that is associated with long-term complications. Deep venous thrombosis(DVT) and pulmonary embolism (PE) are recognized presentation for VTE, although their presentation and managements are variable. This retrospective study explored the presentation, investigational approach and therapeutic interventions used for VTE at Rashid Hospital, Dubai, United Arab Emirates . We included patients (75 male (64%) and 43 females (36%)) diagnosed with VTE who confirmed by supportive laboratory and radiological tests. Data was collected from the medical records using ICD-10 coding of VTE between January 2007 and January 2010. Our cohort represented the multi-ethnical Dubai population comprising 40% Arabs, 37% Asians and 10% European. Sixty-five patients had PE and 53 patients had isolated DVT. Recurrent DVT events occurred in 3 patients. Calf pain and shortness of breath were the common presentation for DVT and PE, respectively. Doppler Ultra Sound Doppler and Computed Tomography were the preferred radiological testing for VTE. Smoking was present in 14% of subjects, active cancer in 11%, history of trauma in 16%, history of recent long distance travel in 15% and chronic illness in 16%. Among the PE cases, 25 patients (38%) had concomitant DVT. A thrombophilia test was positive in 2 (5%) of 37 cases. Presentation of VTE at Rashid Hospital shows similarities to other registries and utilizing clinical prediction models can unify the diagnostic approach. Developing a VTE registry will have an impact in our understanding this disease.

Multidrug resistance mediated by the transporter proteins P-glycoprotein (Pgp-170) and multidrug resistance associated proteins (MRP1-9) is one of the mechanisms that contribute to the failure of chemotherapy in patients with different malignancies. The objective of the present study was to investigate the expression of the drug resistance proteins Pgp-170, MRP2, MRP3 and MRP5 (DRPs) in leukemic patients and to assess their possible association with the clinical features. These proteins were determined using immunocytochemistry and flow cytometry in 88 blood samples from 51 patients. Immunocytochemically, the overall expression of Pgp-170, MRP2, MRP3, and MRP5 in the untreated, remission, and relapsed samples was 8.7%, 13.2%, and 48.2%, respectively. In acute lymphocytic leukemia (ALL), DRPs were detected in 0/4 untreated 1/17 remission, and 7/12 relapsed samples. In acute myelocytic leukemia (AML), DRPs were detected in 2/9 untreated 2/8 remission, and 4/12 untreated relapsed samples. In chronic myelocytic leukemia (CML), DRPs were not detected in the untreated (n=5) or remission (n=1) samples. In chronic lymphocytic leukemia (CLL), DRPs were not detected in the untreated samples (n=3), but they were detected in 1/2 remission and 2/3 of relapsed samples. In multiple myelomas (MM), the 2 untreated samples were negative for DRPs, while 1/10 remission samples was positive. Analysis of 58 blood-samples using flow-cytometry, detected DRPs in 4%, 15%, and 9% of the untreated (n=19), remission (n=18), and relapsed (n=21) samples, respectively. The chi-square test showed that there were no significant associations between immunocytostaining and flow-cytometry or between DRP expression and patients age or sex.

Accurate estimates of the risk of human immunodeficiency virus (HIV) transmis­sion from blood donations is essential to monitor the safety of the blood supply, to evaluate the accuracy of new screening tests, and for health authorities to generate preventive measures. In this study, we estimated the risk of transmit­ting HIV from screened blood units donated over a period of 3 years. Over 3 years, >70,000 blood donors were screened for HIV using different methods. The results of these tests were analyzed and correlated to donor history. The prevalence of HIV among the tested blood donors, which were confirmed by immunoblotting, was 0.02%. The estimated number of HIV cases per 100,000 over the 3-year period was 74 cases. In conclusion, the risk of transmitting HIV by the transfusion of screened blood is very small, and the introduction of new screening tests will reduce this risk even further.

Methods of Cytogenetic analysis methods have became part of routine labora­tory testing, providing valuable diagnostic and prognostic information in hema­tologic disorders Karyotypic aberrations contribute to the understanding of the molecular pathogenesis of disease which may lead to improvement in diagnosis, disease stratification, prognostication, therapeutic response, and survival mo­dalities. Most of the progress in this field stems from the application of metaphase cy­togenetics (MC), but novel molecular technologies have been introduced re­cently that complement MC and overcome many of the limitations of traditional cytogenetics, including a need for cell culture. Whole genome scanning using comparative genomic hybridization and single nucleotide polymorphism arrays (CGH-A; SNP-A) can be used for analysis of somatic or clonal unbalanced chro­mosomal defects.

There is no standard treatment for refractory idiopathic thrombocytopenic purpura (ITP) that occurs during pregnancy. We report the case of a patient with chronic ITP during pregnancy; the condition was refractory to steroids, intravenous immunoglobulin, high dose anti-D, and vincristine. The patient underwent cesarean section for maternal indications and developed postpartum hemorrhage, which was treated successfully with recombinant factor VIIa.