Reference intervals (RIs) are important tools for improving medical decision-making. Hematology reference values can be influenced by important covariates such as genetic and environmental factors, rendering it essential to define RIs for specific populations. Therefore, we aimed to establish accurate and robust RIs for hematological markers in a healthy adult male Iranian population. This cross-sectional study was conducted in a population of 723 males aged 20-60 years old. Hematological parameters were routinely measured using a Sysmex auto analyser system (KX-21 N). The quality of assays was monitored using commercial quality control samples. The nonparametric rank method, as recommended by the Clinical and Laboratory Standards Institute (CLSI) guidelines, was used to calculate the 2.5th and 97.5th percentiles as the lower and upper reference limits, respectively. Of the 12 hematological parameters assessed, only mean platelet volume (MPV) demonstrated significant age-specific differences, requiring two partitions from 20 to 35 years (8.7-12.2 fL) and 35 to 65 years (8.5-11.5 fL). The remaining hematological parameters (e.g. leukocyte, erythrocyte, and platelet parameters) could be defined by one age range. This study established RIs for 12 routinely used hematological parameters in a healthy male population living in the northeastern region of Iran. Established RIs differed from those previously reported by other cohorts, highlighting the importance of population-specific RIs.

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Background: HbH disease results from dysfunction of three, less commonly two, α-globin genes through various combinations of deletion and non-deletion mutations. Characterization of the mutations and the underlying genotypes is fundamental for proper screening and prevention of thalassaemia in any region. The aim of this study was to explore the genetic arrangements of HbH disease and to correlate the genotypes with the clinical phenotypes.Methods: A total of 44 HbH disease patients were enrolled in this study. They were clinically and haematologically assessed. The patients were tested for 21 common α-globin gene mutations using multiplex PCR and reverse hybridization. According to the genotype, the patients were categorized into two separate sub-groups, deletion and non-deletion types HbH disease. Results: Within the studied HbH disease patients, eight different α-globin gene mutations were detected in nine different genetic arrangements. The --MED and -α3.7 deletions were the two most frequently encountered mutations (37.5% and 35.2% respectively). Patients with deletion genotypes constituted 70.4%. The most common detected genotype was --MED/-α3.7 (59.1%), followed by αpoly-A1α/αpoly-A1α (13.6%). For the first time, coinheritance of two relatively mild mutations (-α3.7/ααAdana) was unpredictably detected in a 1.5 year-old child with Hb of 7.1 g/dL. Conclusion: The HbH disease patients’ clinical characteristics were variable with no ample difference between the deletion and non-deletion types. These results can be of benefit for the screening and management of thalassaemia in this region.

Background: Chronic lymphocytic leukemia is the common adulthood leukemic type, although the incidence rate in the Kurdistan region is low. It is well known that chronic lymphocytic leukemia is prevalent among the elderly age group, however frequent cases of chronic lymphocytic leukemia are newly diagnosed at a younger age. Aim of the study: To analyze the difference in disease presentation, progression, and outcome between young and old age group patients with chronic lymphocytic leukemia in the Kurdistan region/Iraq. Patients & Methods: A retrospective cross-sectional review study carried out in three oncology centers in the Kurdistan region (Nanakaly Hospital in Erbil city, Hiwa center in Sulaimani city, and Azadi center in Duhok city) for ten years through the period from 1st of January, 2010 to 31st of December, 2019 on a convenient sample of 152 patients with chronic lymphocytic leukemia. Diagnosis of chronic lymphocytic leukemia was done by the Oncologists in Kurdistan tumor centers according to the International Workshop on Chronic Lymphocytic Leukemia. The age of patients at diagnosis was categorized into two groups and ranged from 25 years to 94 years. The age cutoff value in the current study was (55 years) depending on previous kinds of literature. Results: The mean age at diagnosis of patients was (63 years); 28% of them were diagnosed at age of ≤50 years and 72% of them were diagnosed at age of more than 55 years. Older age patients were significantly presented with weight loss, while younger age patients were significantly presented with neck lumps. There was a highly significant association between the advanced ECOG performance scale and older age patients at diagnosis. A significant association was observed between the death outcome of chronic lymphocytic leukemia and older age patients at diagnosis. The mean survival duration of younger age patients at diagnosis was significantly longer than the mean survival duration of older age patients at diagnosis. Conclusions: clinical presentation, physical status, death rates, and survival of patients with chronic lymphocytic leukemia in Kurdistan region-Iraq are different between young and older age patients. Keywords: Chronic Lymphocytic Leukemia, age, death, Survival.

Background: Type 2 diabetes mellitus (T2DM) is a common public health problem in metabolism. Metformin is the oral hypoglycemic agent used as a first line together with life style modification in type 2 diabetes patients worldwide. Continuous metformin therapy increases the risk of vitamin B12 insufficiency, and its medical consequences in T2DM patients. Objective: To detect the prevalence of serum vitamin B12 deficiency in T2DM who has been treated with metformin in Erbil Province. Patients and Methods: The study involved 200 cases (100 patients and 100 controls) that met the study's basic criteria. A completed questionnaire, and a blood test for serum vitamin B12 levels were performed. A deficiency of vitamin B12 is defined as <160 pg/mL in serum vitamin B12. Results: Deficiency of serum vitamin B12 was found in 48% of patients (n=48), while HbA1c levels had no impact on this finding. In T2DM level of serum vitamin B12 that has been on metformin at a dose of ≤ 1 gm/ day shows a significant difference with those patients with no history of metformin use. Conclusion: Low levels of serum vitamin B12  came as a result of the overdosing of metformin for long period of treatment.

Background: Type 2 diabetes mellitus (T2DM) is a common public health problem in metabolism. Metformin is the oral hypoglycemic agent used as a first line together with life style modification in type 2 diabetes patients worldwide. Continuous metformin therapy increases the risk of vitamin B12 insufficiency, and its medical consequences in T2DM patients. Objective: To detect the prevalence of serum vitamin B12 deficiency in T2DM who has been treated with metformin in Erbil Province. Patients and Methods: The study involved 200 cases (100 patients and 100 controls) that met the study's basic criteria. A completed questionnaire, and a blood test for serum vitamin B12 levels were performed. A deficiency of vitamin B12 is defined as <160 pg/mL in serum vitamin B12. Results: Deficiency of serum vitamin B12 was found in 48% of patients (n=48), while HbA1c levels had no impact on this finding. In T2DM level of serum vitamin B12 that has been on metformin at a dose of ≤ 1 gm/ day shows a significant difference with those patients with no history of metformin use. Conclusion: Low levels of serum vitamin B12 came as a result of the overdosing of metformin for long period of treatment.

Background: HbH disease results from dysfunction of three, less commonly two, α-globin genes through various combinations of deletion and non-deletion mutations. Characterization of the mutations and the underlying genotypes is fundamental for proper screening and prevention of thalassaemia in any region. The aim of this study was to explore the genetic arrangements of HbH disease and to correlate the genotypes with the clinical phenotypes.Methods: A total of 44 HbH disease patients were enrolled in this study. They were clinically and haematologically assessed. The patients were tested for 21 common α-globin gene mutations using multiplex PCR and reverse hybridization. According to the genotype, the patients were categorized into two separate sub-groups, deletion and non-deletion types HbH disease. Results: Within the studied HbH disease patients, eight different α-globin gene mutations were detected in nine different genetic arrangements. The --MED and -α3.7 deletions were the two most frequently encountered mutations (37.5% and 35.2% respectively). Patients with deletion genotypes constituted 70.4%. The most common detected genotype was --MED/-α3.7 (59.1%), followed by αpoly-A1α/αpoly-A1α (13.6%). For the first time, coinheritance of two relatively mild mutations (-α3.7/ααAdana) was unpredictably detected in a 1.5 year-old child with Hb of 7.1 g/dL. Conclusion: The HbH disease patients’ clinical characteristics were variable with no ample difference between the deletion and non-deletion types. These results can be of benefit for the screening and management of thalassaemia in this region.