Publications by authors named "Natasha Ali"

57 Publications

COVID-19 and adult acute lymphoblastic leukemia: Presentation and management.

Hematol Transfus Cell Ther 2021 Mar 1. Epub 2021 Mar 1.

Aga Khan University, Section of Hematology Oncology, Department of Oncology, Karachi, Pakistan.

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http://dx.doi.org/10.1016/j.htct.2021.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7919537PMC
March 2021

Current practice of oral care for hematopoietic stem cell transplant patients: A survey of the Eastern Mediterranean Blood and Marrow transplantation group.

Hematol Oncol Stem Cell Ther 2021 Feb 11. Epub 2021 Feb 11.

Oncology Center, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.

Introduction: The oral cavity is one of the most common sites impacted by hematopoietic stem cell transplantation (HSCT) with acute complications including mucositis, bleeding, salivary gland dysfunction, infection, and taste alteration. These complications may result in significant morbidity and can negatively impact outcomes such as length of stay and overall costs. As such, oral care during HSCT for prevention and management of oral toxicities is a standard component of transplant protocols at all centers. The objective of this study was to evaluate the current oral care practices for patients during HSCT at different transplant centers within the Eastern Mediterranean region.

Material And Methods: An internet-based survey was directed to 30 transplant centers in the Eastern Mediterranean region. The survey included five sections asking questions related to (1) transplant center demographics; (2) current oral care protocol used at the center and type of collaboration (if any) with a dental service; (3) use of standardized oral assessment tools and grading systems for mucositis; (4) consultations for management of oral complications; and (5) oral health needs at each center. Data are presented as averages and percentages.

Results: A total of 16 responses from 11 countries were collected and analyzed, indicating a response rate of 53%. Eight centers reported that a dentist was part of the HSCT team, with four reporting oral medicine specialists specifically being part of the team. Almost all centers (15/16; 93%) had an affiliated dental service to facilitate pre-HSCT dental clearance with an established dental clearance protocol at 14 centers (87%). Dental extraction was associated with the highest concern for bleeding and the need for platelet transfusion. With respect to infection risk, antibiotic prophylaxis was considered in the setting of low neutrophil counts with restorative dentistry and extraction. All centers provide daily reinforcement of oral hygiene regimen. The most frequently used mouth oral rinses included sodium bicarbonate (68%) and chlorhexidine gluconate (62%), in addition to ice chips for dry mouth (62%). The most frequently used mucositis assessment tools were the World Health Organization scale (7/16; 43%) and visual analogue scale for pain (6/16; 37%). Mucositis pain was managed with lidocaine solution (68.8%), magic mouth wash (68.8%) and/or systemic pain medications (75%).

Conclusions: Scope and implementation of oral care protocols prior to and during HSCT varied between transplant centers. The lack of a universal protocol may contribute to gaps in oral healthcare needs and management for this group of patients. Further dissemination of and education around available oral care guidelines is warranted.

Clinical Relevance: Considering oral care during HSCT a standard component of transplant protocols, the current study highlights the common oral care practices for patients at centers within the Eastern Mediterranean region.
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http://dx.doi.org/10.1016/j.hemonc.2021.01.006DOI Listing
February 2021

Fludarabine-based salvage therapy for refractory/relapsed acute leukemias: A single center experience.

Leuk Res Rep 2021 28;15:100235. Epub 2021 Jan 28.

Department of Orthopaedics and Sports Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, United States.

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http://dx.doi.org/10.1016/j.lrr.2021.100235DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869002PMC
January 2021

The curious case of HLA-DR-positive APL.

Clin Case Rep 2021 Feb 16;9(2):825-829. Epub 2020 Dec 16.

Department of Pathology and Laboratory Medicine/Oncology Aga Khan University Karachi Pakistan.

The triad of weak/absent CD34, negative HLA-DR expression, and positivity to CD117 is pathognomonic for the diagnosis of acute promyelocytic leukemia. However, in rare cases, strong positivity to HLD-DR and CD34 may be noted.
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http://dx.doi.org/10.1002/ccr3.3683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869374PMC
February 2021

Improved outcome in early induction deaths in patients with acute promyelocytic leukemia after therapeutic and supportive interventions: a follow up study of seven-years' experience at a tertiary care center.

Am J Blood Res 2020 25;10(4):82-89. Epub 2020 Aug 25.

Chughtai Laboratory Lahore Pakistan.

Introduction And Objectives: Acute promyelocytic leukemia (APL) is a unique subtype of acute myeloid leukemia with characteristic morphology and clinical features. Early mortality rate of 30% has been reported in developed countries despite prompt initiation of treatment. We have previously reported an early induction mortality of approximately 62% in our cohort. Based on this mortality rate, we made changes in our treatment protocol. The objective of this follow-up study was to report the early induction mortality and overall survival of patients with APL after incorporating changes in chemotherapy and supportive care regimen.

Subjects And Methods: This was a prospective descriptive study conducted at Aga Khan University Karachi, Pakistan from October 2012 till October 2019. Data of patients included clinical features, morphological findings, cytogenetic and PCR studies, cytotoxic protocols, overall outcome and causes of early induction mortality. The changes in treatment protocol included prophylactic infusion of fresh frozen plasma, dexamethasone therapy and other changes in supportive care regimen. Results were recorded as frequencies and percentages. Statistical Package for the Social Sciences version 19.0 (SPSS Inc., Chicago, IL, USA) was used to analyze patient's data. Survival curves were calculated using the Kaplan-Meier method.

Results: During the study period, total of 447 patients presented with acute myeloid leukemia at our institution out of which 40 patients were diagnosed with acute promyelocytic leukemia (9%). Out of these 40 patients 24 were males and 16 were females. The median age was 37 years. Twenty-five patients were in low risk group whereas 15 were high-risk. Differentiation syndrome was seen in 14 patients. As a part of induction chemotherapy, 13 patients received only ATRA because they were not eligible for chemotherapy and 17 patients received a combination of ATRA and anthracycline. Among the remaining patients, four received ATRA, arsenic and anthracycline while two received ATRA and arsenic only. Four patients did not receive any treatment because of rapid deterioration of clinical condition and death. The overall survival was 65% and early induction mortality was 30%.

Conclusion: The early induction mortality decreased to 30% from 62% in this study and the overall survival was 65%. With the introduction of prophylactic infusion of fresh frozen plasma, dexamethasone and appropriate supportive treatment during the induction chemotherapy, we were able to improve the induction mortality and overall survival of patients.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7486488PMC
August 2020

Transplant in Aplastic Anemia Using Combined Granulocyte Colony-Stimulating Factor Primed Blood and Bone Marrow Stem Cells: A Retrospective Analysis.

Transplant Proc 2021 Jan-Feb;53(1):386-390. Epub 2020 Aug 7.

Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan.

Introduction: Aplastic anemia (AA) is characterized by diminished hematopoietic precursors in the bone marrow, most often due to injury to the pluripotent stem cell. In Pakistan, AA is not uncommon, and allogeneic hematopoietic stem cell transplant remains the only curative option for these patients.

Objective: The objective of this study was to determine the transplant outcome of combined granulocyte colony-stimulating factor (G-CSF) primed blood and bone marrow grafts in adult and pediatric patients with AA.

Methods: We retrospectively collected the data of all transplant procedures performed from 2004 to 2019 at Aga Khan University in Karachi, Pakistan. Variables analyzed included age, sex, type of stem cells used, conditioning regimens, and overall survival for patients undergoing transplant in AA.

Results: A total of 351 transplants were performed during the study period. Out of these, 239 were allogeneic transplants, whereas 112 were autologous procedures. We performed 70 transplants for AA during the study period, of which 52 were male patients and 18 were female patients. The median age ± standard deviation (SD) was 17.5 ± 9.4 years (range, 2-43 years). Cyclophosphamide/antithymocyte globulin (ATG) was used as a conditioning regimen in 65 patients, while ATG/cyclophosphamide/fludarabine was used in 5 patients. In 60 patients, a combination of G-CSF primed blood and bone marrow stem cells were used. The mean CD34 count was 5.2 × 10/kg. Graft-vs-host disease (GVHD) prophylaxis was done with cyclosporine and methotrexate. All patients received standard infection prophylaxis. Engraftment was achieved in 86% of patients. The median day of myeloid engraftment was 15 (range, 10-22 days). Chronic GVHD was present in 3 patients while 4 had acute GVHD. The overall survival was 71.2% (median duration of 80 months). The main cause of mortality was gram-negative sepsis.

Conclusion: A combination of blood and bone marrow stem cells results in early engraftment with decreased frequency of GVHD in AA. The overall survival was comparable to international literature.
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http://dx.doi.org/10.1016/j.transproceed.2020.06.035DOI Listing
August 2020

Documentation errors in transfusion chain: Challenges and interventions.

Transfus Apher Sci 2020 Aug 13;59(4):102812. Epub 2020 May 13.

Section of Hematology and Transfusion Medicine, Aga Khan University, Pakistan. Electronic address:

Background And Objective: There are several steps in transfusion chain where accurate documentation is critical. This study was conducted to evaluate the frequency of documentation errors during transfusion process and to evaluate the effectiveness of interventions in error-management.

Methods /material: This study was conducted at Aga Khan University, Pakistan during 2016-2018. Transcription and bedside documentation errors were identified from in-house computerized system and from medical charts. Raw WBIT rate was calculated for repeat blood samples and adjusted for frequencies of ABO-groups in our population accounting for silent WBIT. Rate of ABO-mismatched red cell transfusions was calculated for the annual totals of red cell transfusions. Chi-square was used for observing relationship among errors of various data sets.

Results: A total of 43 WBIT was identified during 54,219 repeat blood samples where blood group was already defined in blood bank information system. Annual unadjusted and cryptic WBIT rate was consistent at 0.8 and 0.6 per 1000 samples respectively during 2016-2018 (p 0.859). There were 1161 transcription errors (1.1 %) in blood group documentation in 105,064 blood samples received for arranging blood products. ABO-mismatched transfusion rate was 0.9 for 10,000 RBC transfusions in pre- and decreased to 0.4 in post-typing era. Overall, the compliance for completing checklist, correct ABO technique and appropriate ABO-interpretation was 88 %, 40 % and 24 % in the reviewed medical charts.

Conclusions: Sample labeling errors were not improved through training or counseling. Bedside ABO-typing and checklist prior to blood transfusion can control the ABO-mismatched transfusion if done timely and correctly.
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http://dx.doi.org/10.1016/j.transci.2020.102812DOI Listing
August 2020

Compliance of hand written transfusion requisition form and improvement after online request - a clinical audit.

J Pak Med Assoc 2020 Apr;70(4):694-698

Blood Bank and Hematological Services, Fatimid foundation, Karachi, Pakistan..

Objective: To assess the compliance of healthcare personnel with regard to sending completely filled transfusion requisition forms.

Methods: The audit was conducted at Aga Khan University Hospital, Karachi, and comprised requisition slips received at the hospital blood bank from September 2014 to February 2015. The British Committee for Standards in Haematology guidelines was used as the standard. Percentage of each variable on the proforma was analsyed. Rating <50% for each form was defined as "needs improvement", 51-99% as "good compliance" and 100% as "excellent compliance". After implementing strategies to increase awareness and the launching of an online transfusion requisition form, a re-audit of physician compliance was done from February to April 2016 and the results were compared with the initial audit.. Data was analysed using SPSS 21.

Results: The audit and the re-audit both comprised 1000 transfusion requisition forms each. In the audit, The sum of total scores of all the transfusion requisition forms was 4911, indicating a compliance rate of 46.9%, while the corresponding numbers in the re-audit were 10000 and 100%.

Conclusions: The implementation of online blood transfusion requisition system had a positive impact on compliance rate.
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http://dx.doi.org/10.5455/JPMA.14958DOI Listing
April 2020

Outcome of donor and recipient sex match versus mismatch in stem cell transplant procedure.

Int J Hematol Oncol 2019 Dec 18;8(4):IJH21. Epub 2019 Dec 18.

Professor Haematology, Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University Karachi, Pakistan.

Aim: We determined the frequency of graft-versus-host disease (GvHD) and overall survival (OS) in sex matched vs mismatched transplant.

Methods: Medical records were analyzed of patients undergoing transplant from 2004 to 2016. Variables included age, sex of patient and donor, indication, conditioning regimen, stem cell source, frequency of GvHD and OS.

Results: We performed n = 162 allogeneic stem cell transplants. The most common conditioning regimen was busulfan/cyclophosphamide (n = 64). There was no difference in the frequency of GvHD in both groups. The transplant related mortality was higher (8.7%) in sex-mismatched transplants. The OS in both groups was similar.

Conclusion: Our study showed higher transplant-related mortality in sex-mismatched transplant. There was no difference in GvHD and OS in both groups.
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http://dx.doi.org/10.2217/ijh-2019-0006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6939220PMC
December 2019

Granuloma whorls.

Clin Case Rep 2019 Nov 8;7(11):2287-2288. Epub 2019 Oct 8.

Section of Haematology, Department of Pathology & Laboratory Medicine/Oncology Aga Khan University Karachi Karachi Pakistan.

What is the significance of bone marrow examination in presence of peripheral cytopenias? It is still regarded as a mandatory investigation to diagnose hematological disorders. In this case, bone marrow trephine was initially done as a diagnosis of exclusion for ITP, whereas it revealed multiple granulomas suggesting mycobacterium tuberculosis infection.
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http://dx.doi.org/10.1002/ccr3.2470DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6878094PMC
November 2019

Infections in patients with multiple myeloma treated with conventional chemotherapy: a single-center, 10-year experience in Pakistan.

Hematol Transfus Cell Ther 2019 Oct - Dec;41(4):292-297. Epub 2019 Jun 14.

Department of Pathology & Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality.

Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period.

Method And Results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was the lung, followed by the genitourinary system. The most common infections were bacterial, followed by viral. Escherichia coli were the most common organism. In 160 (65.5%) episodes, the organism was not isolated. Thalidomide with dexamethasone was the most common treatment regimen, followed by melphalan with dexamethasone. Infection was the main cause of death in 26 (6.3%) out of all 412 patients.

Conclusion: Infections are a notable cause of morbidity and mortality in the clinical course of MM patients. By considering patient and disease characteristics, a risk-adapted selection of the MM treatment should be employed, with special attention toward patient age and disease-associated organ dysfunction. Patient education, access to healthcare and physician vigilance are also essential. Vaccination and antimicrobial prophylaxis may be considered prior to or during therapy.
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http://dx.doi.org/10.1016/j.htct.2019.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6978542PMC
June 2019

Blood film says it all! Rare case of congenital TTP misdiagnosed as ITP.

Int J Pediatr Adolesc Med 2019 Jun 20;6(2):58-60. Epub 2019 Feb 20.

Associate Professor Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University Karachi, Pakistan.

We report a case of a 16-year-old female who presented with bleeding diathesis. Peripheral blood film examination was consistent with microangiopathic hemolytic anemia with 7% fragmented red blood cells. The ADAMTS13 level was 40 ng/ml (reference range: 630-850 ng/ml). She responded to plasma exchange therapy and methylprednisolone and was discharged in a stable condition.
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http://dx.doi.org/10.1016/j.ijpam.2019.02.005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6676363PMC
June 2019

Safety and efficacy of bendamustine in the conditioning regimen for autologous stem cell transplantation in patients with relapsed/refractory lymphoma.

Blood Res 2019 Jun 25;54(2):108-113. Epub 2019 Jun 25.

Hematology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan.

Background: Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas.

Methods: We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT.

Results: Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×10 CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days-19 mo). At the final follow-up, 7 patients (50%) were alive and in CR.

Conclusion: Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.
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http://dx.doi.org/10.5045/br.2019.54.2.108DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614092PMC
June 2019

Chimeric antigen T cell receptor treatment in hematological malignancies.

Authors:
Natasha Ali

Blood Res 2019 Jun 25;54(2):81-83. Epub 2019 Jun 25.

Department of Pathology and Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan.

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http://dx.doi.org/10.5045/br.2019.54.2.81DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6614098PMC
June 2019

Outcome of hairy cell leukemia patients treated with cladribine - a 10-year single-center experience in Pakistan.

Hematol Transfus Cell Ther 2019 Apr - Jun;41(2):134-138. Epub 2018 Dec 31.

Aga Khan University, Karachi, Pakistan. Electronic address:

Introduction And Objective: Hairy cell leukemia is an uncommon, indolent B-cell lymphoproliferative disorder. Therapy with cladribine (2-chlorodeoxyadenosine) is able to induce complete remission (CR) in the majority of patients after a single course of treatment. We report the outcomes of patients treated at Aga Khan University Hospital, Karachi, Pakistan.

Methods: This was a retrospective review. Medical records of patients were used to collect data.

Results: A total of 21 patients with hairy cell leukemia were treated with cladribine. All patients achieved an initial CR. Four patients (19%) required hospitalization and therapy for neutropenic fever. Six patients (29%) relapsed at a median of 48 months. All 6 patients were treated for relapse, out of which 4 achieved CR, 1 had partial response and 1 had refractory disease. The overall survival rate was 90.5%, with a median follow-up of 35 months.

Conclusion: A single course of cladribine is able to induce CR in a vast majority of patients. Unfortunately, relapse is not uncommon. Patients who relapse can be successfully retreated with cladribine. Cladribine has impressive efficacy and a favorable acute and long-term toxicity profile when administered to patients with HCL.
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http://dx.doi.org/10.1016/j.htct.2018.08.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6517679PMC
December 2018

Patient and Physician Perspective on Sperm Banking to Overcome Post-Treatment Infertility in Young Cancer Patients in Pakistan.

J Adolesc Young Adult Oncol 2019 02 25;8(1):54-60. Epub 2018 Sep 25.

2 Department of Pathology and Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan.

Background: Cancer survivor rates have increased over the past few decades leading to a growing interest in research related to quality of life (QoL). We attempted to explore the unique barriers that might prevent adult male cancer patients from accessing sperm cryopreservation in Pakistan.

Methods: Semi-structured interviews of male cancer patients aged 18-45 years were audio-recorded in Urdu and translated to English and were transcribed ad verbatim. The topics included information regarding risk of infertility following chemotherapy, future reproductive choices, and barriers to sperm cryopreservation. Questionnaire to physicians containing four content domains of knowledge, attitude, practice, and barriers to sperm banking was also delivered. Data were entered and analyzed on SPSS.

Results: Of the 25 patients interviewed, there were 10 cases of leukemia, 3 cases of lymphoma, 2 cases each of colorectal carcinoma and multiple myeloma, 1 case each of neuroblastoma and osteosarcoma, and solitary cases involving the lung, breast, thymus, brain, jaw, and testis. Four patients knew about the risk of infertility. All patients were aware of the option of sperm cryopreservation. Two patients had their sperm preserved before the initiation of chemotherapy. Perceived treatment-related expenses appeared to be the major barrier to sperm cryopreservation in nine patients. This was followed by lack of information, which was cited by eight patients, and religious reasons (n = 2 patients). Other barriers were female gender of the doctor and patient's preferences. Four patients stated no barriers. Nine physicians responded to the questionnaire. Seventy-eight percent of physicians agreed that cancer treatment increases the risk of infertility. 33.3% strongly agreed and 55.6% agreed that infertility can have an adverse impact on QoL.

Conclusions: There is a significant lack of awareness among male cancer patients regarding infertility following cancer treatment. It is imperative that physicians inform them of this and discuss treatment options, along with addressing potential barriers.
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http://dx.doi.org/10.1089/jayao.2018.0079DOI Listing
February 2019

Distribution of Chromosomal Abnormalities Commonly Observed in Adult Acute Myeloid Leukemia in Pakistan as Predictors of Prognosis

Asian Pac J Cancer Prev 2018 Jul 27;19(7):1903-1906. Epub 2018 Jul 27.

Section of Hematology and Transfusion Medicine, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, 74800, Karachi, Pakistan. Email:

Objectives: The heterogenous response to treatment in acute myeloid leukemia (AML) can be attributed largely to the difference in cytogenetic features identified in between cases. Cytogenetic analysis in acute leukemia is now routinely used to assist patient management, particularly in terms of diagnosis, disease monitoring, prognosis and risk stratification. Knowing about cytogenetic profile at the time of diagnosis is important in order to take critical decisions in management of these patients. The study was conducted to determine the distribution of cytogenetic abnormalities in Pakistani adult patients with AML in order to have insights regarding behavior of the disease. Methods: A retrospective analysis of all the cases of AML (≥15years old) diagnosed at Aga Khan University from January 2011 to December 2016 was performed. Cytogenetic analysis was made for all cases using the trypsin-Giemsa banding technique. Karyotypes were interpreted using the International System for Human Cytogenetic Nomenclature (ISCN) criteria. Results: A total of 321 patients were diagnosed with AML during the study period, of which 288 samples successfully yielded metaphase chromosomes. The male to female ratio was 1.7:1. A normal karyotype was present in 61% (n=176) of the cases whereas, 39% (n=112) had an abnormal karyotype. Of the abnormal cases, t (8;21) (q22;q22) and t (15;17) (q22;q12) were identified in 8.3% and 4.9% cases respectively. Adverse prognostic cytogenetic subgroups including complex karyotype, monosomy 7 and t(6;9)(p23;q34) were identified in 9%, 1% and 0.7% patients respectively. Conclusions: This largest cytogenetic data in adult AML from Pakistan showed comparable prevalence of favorable prognostic karyotype to international data. The prevalence of specific adverse prognostic karyotype was low.
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http://dx.doi.org/10.22034/APJCP.2018.19.7.1903DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165659PMC
July 2018

Iron overload assessment in β Thalassemia Major - is T2* Magnetic Resonance Imaging the answer?

Authors:
Natasha Ali

Electron Physician 2017 Oct 25;9(10):5609-5610. Epub 2017 Oct 25.

Assistant Professor of Haematology, Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan.

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http://dx.doi.org/10.19082/5609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5718868PMC
October 2017

Red blood cell transfusion in infants and children - Current perspectives.

Authors:
Natasha Ali

Pediatr Neonatol 2018 06 6;59(3):227-230. Epub 2017 Oct 6.

Section of Haematology, Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University, Pakistan. Electronic address:

Children routinely receive packed red blood transfusion when they are admitted in the intensive care unit or undergoing cardiac surgeries. These guidelines aim to summarize literature and provide transfusion triggers exclusively in infants and children.
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http://dx.doi.org/10.1016/j.pedneo.2017.10.002DOI Listing
June 2018

Hematopoietic stem cell transplantation in Pakistan - country report.

Hematol Oncol Stem Cell Ther 2017 Dec 22;10(4):303-304. Epub 2017 Jul 22.

Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan.

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http://dx.doi.org/10.1016/j.hemonc.2017.05.026DOI Listing
December 2017

Paroxysmal Nocturnal Haemoglobinuria Type III Presenting as Portal and Mesenteric Vein Thrombosis in a Young Girl.

J Coll Physicians Surg Pak 2016 Nov;26(11):106-108

Department of Oncology, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi.

Paroxysmal nocturnal haemoglobinuria (PNH) is a rare, acquired, life-threatening haematological disorder. It is characterised by complement induced haemolytic anaemia, thrombosis and impaired bone marrow function. Thrombosis most commonly occurs in the hepatic, portal, superior mesenteric and cerebral veins. A22-year female, previously diagnosed with severe aplastic anaemia treated with anti-lymphocyte globulin (ALG) and cyclosporine, had become transfusion independent for more than 10 years. She presented with abdominal pain and vomiting, initially diagnosed with portal and superior mesenteric vein thrombosis. Immunophenotyping by flow cytometry revealed a diagnosis of paroxysmal nocturnal haemoglobinuria type III. She was treated with vitmamin K anatagonist and platelet transfusion.
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http://dx.doi.org/215DOI Listing
November 2016

Perception of pathology as a future career choice among medical Students from Karachi, Pakistan: Experience from a private medical school.

J Pak Med Assoc 2017 Apr;67(4):627-629

Microbiology, Department of Pathology & Laboratory Medicine, Karachi.

To determine the perception of pathology as a future career choice among medical students of a private medical school from Karachi, Pakistan. A descriptive cross-sectional study was conducted at the Aga Khan University, Karachi, Pakistan. A total of 201 students participated in this study. All Students were approached randomly to participate. A total of 201 students participant survey forms were evaluated in this study. The overall satisfaction level with pathology was observed in 61.8% of the students. Majority of the students understood subspecialties which were a part of clinical medicine. Over half of the students thought pathology as a specialty should be highlighted in a more integrated manner (59.2%) with a minority favouring a separate pathology rotation (11.9%). In conclusion, this study indicates that majority of students have a positive approach towards the field of pathology and favour incorporating it in an integrative way into the medical school curriculum.
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April 2017

An Analysis of Blood Utilization for Stem Cell Transplant Patients in a Tertiary Care Hospital.

Authors:
Natasha Ali

Int J Stem Cells 2017 May;10(1):114-118

Department of Pathology & Laboratory Medicine/Oncology, Aga Khan University, Karachi, Pakistan.

Background And Objective: Haematopoietic stem cell transplant is a potentially curative treatment option in various benign and malignant haematological diseases. Patients undergoing stem cell transplant procedure require blood transfusion on a daily basis. Currently, there is paucity of data from developing countries on transfusion practices. This audit was undertaken to determine the consumption of packed red blood cells (PRBCs) transfusion in the bone marrow transplant unit of the Aga Khan University Hospital.

Subjects And Methods: A retrospective audit was conducted for packed red cell transfusion ordering practice over a period from June 2014∼June 2015. All consecutive patients, admitted for stem cell transplant procedure for various underlying diseases were included. Outcome measures used in this study were (i) cross match to transfusion (C: T) ratio and (ii) transfusion trigger.

Results: During the study period, n=25 patients underwent haematopoietic stem cell transplant. There were n=19 males and n=6 females. One patient was less than 15 years of age while rests were adults. Median age±SD was 26.5±14.5 years (12∼54 years). The underlying diagnosis included Aplastic anemia (n=8), Thalassemia major (n=3), Multiple Myeloma (n=4), Acute leukemia (n=5), Hodgkin's lymphoma (n=4), PRCA (n=1). Grand total consumption of PRBCs during the study period was 204 while 258 products were crossmatch. The C:T ratio was 1.26. The transfusion trigger was Hb level of less than 8 gms/dl.

Conclusion: The results of our BMT unit indicate that the C:T ratio and transfusion trigger is comparable to the international benchmark.
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http://dx.doi.org/10.15283/ijsc16045DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5488783PMC
May 2017

Utility of Peripheral Film Findings and its Correlation with Automated Analyzer - An Audit from Tertiary Care Hospital.

J Lab Physicians 2017 Jan-Mar;9(1):1-4

Department of Pathology and Laboratory Medicine and Oncology, The Aga Khan University, Karachi, Pakistan.

Background And Objective: With the advent of automated hematology analyzer, the use of traditional microscopy of blood film has become limited. The objective of our study was to determine the percentage of peripheral blood smear review in our institution in the era of automation and to identify reasons of manual review.

Materials And Methods: This was a prospective audit from January 1, 2015, to January 15, 2015. Consecutive complete blood count (CBC) samples and peripheral smear requests made up the sample size. All age groups and genders were included. CBCs were performed on Sysmex XE-5000. The variables to be analyzed included inpatient and outpatient samples, frequency of peripheral film review, identifying reasons of smear review, and addition of information missed by the automated analyzer.

Results: We analyzed 1200 consecutive CBC samples. Peripheral smear was reviewed in 500 (42%) of the cases of which, 241 were inpatient, and 259 were outpatient samples. In 384/500, the findings of hematology analyzer correlated with peripheral smear review. Flags identified included nucleated red blood cells (NRBCs) in 155 (40%), immature white blood cell (WBC) 129 (34%), and atypical lymphocytes 100 (26%). In 23% of the cases, the analyzer missed important findings. The sensitivity of abnormal histogram in our study was 91.3%, while the sensitivity of abnormal parameters was 100%.

Conclusion: Peripheral smear review was performed in 42% of the cases. The analyzer identified NRBC, immature WBC precursors, and atypical lymphocytes as the most common abnormality. The information correlated in 77% of the cases.
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http://dx.doi.org/10.4103/0974-2727.189233DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5015490PMC
January 2017

Induction process of trainees in pathology residency.

Adv Med Educ Pract 2016 27;7:321-3. Epub 2016 May 27.

Department of Pathology and Laboratory Medicine, Karachi, Pakistan; Department of Oncology, The Aga Khan University, Karachi, Pakistan.

This article describes the evolution of the induction process of pathology residency at The Aga Khan University hospital. The Department of Postgraduate Medical Education was established in 1985. The induction process is an exhaustive exercise that includes an admission test held simultaneously in Karachi, Hyderabad, Lahore, and Rawalpindi, followed by an interview of the shortlisted candidates. The pathology residency program was started 25 years ago and since then the induction process has undergone major changes with the course of time.
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http://dx.doi.org/10.2147/AMEP.S106038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4890682PMC
June 2016

A Rare Haemoglobin Variant Identified as K Woolwich in a Pakistani Male.

J Coll Physicians Surg Pak 2015 Oct;25 Suppl 2:S100-1

Department of Pathology and Laboratory Medicine, The Aga Khan University, Karachi.

Haemoglobin (Hb) K Woolwich is a rare Hb variant which was first described in a family from West Indies and its occurrence was later reported mainly in Black families from many African countries. We report a case of a young male who came for evaluation of anemia. His complete blood count showed hypochromic, microcytic anemia and his serum ferritin was low. Hb electrophoresis done as part of initial workup showed an abnormal band which moved faster than HbA. For further evaluation, Hb analysis by high performance liquid chromatography was subsequently performed and revealed Hb K Woolwich. This is a rare Hb variant recognized in Pakistani population for the first time through careful interpretation of the chromatographic behavior of the Hb.
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http://dx.doi.org/10.2015/JCPSP.S30S32DOI Listing
October 2015

Dusty trephine.

Hematol Oncol Stem Cell Ther 2015 Dec 1;8(4):185-6. Epub 2015 Aug 1.

Department of Pathology and Laboratory Medicine, The Aga Khan University, P. O. Box 3500, Stadium road 74800, Karachi, Pakistan; Department of Oncology, The Aga Khan University, Karachi, Pakistan.

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http://dx.doi.org/10.1016/j.hemonc.2015.07.001DOI Listing
December 2015

Reduced-intensity conditioning hematopoietic stem cell transplantation: looking forward to an international consensus.

Blood Res 2015 Jun;50(2):69-70

Department of Pathology and Laboratory Medicine/Oncology, The Aga Khan University Hospital, Karachi, Pakistan.

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http://dx.doi.org/10.5045/br.2015.50.2.69DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486159PMC
June 2015