HLA Matching Status Among Patients Requiring Hematopoietic Stem Cell Transplant: The Need for a National and Regional Stem Cell Bank.

OBJECTIVES: Hematopoietic stem cell transplant is a strategic treatment for many malignant and nonmalignant blood diseases. Finding an HLA-matched donor is a requirement for a successful transplantation. The aim of the current study was to explore indications, demographics, and HLA patient-donor matching status among Bahraini patients requiring this transplant. MATERIALS AND METHODS: Records of 100 patients who required hematopoietic stem cell transplant at the Salmaniya Medical Complex, Ministry of Health tertiary hospital in Bahrain were retrospectively studied. Data were analyzed and compared with data from similar studies. RESULTS: For the 100 patients, 294 potential donors were HLA typed. Indications for transplant included malignant diseases (50%) and hereditary blood diseases (50%). For those in the 0- to 5-year age group, the main indication was acute lymphoblastic leukemia, whereas acute myeloid leukemia was the main indication for those who were >5 years old. Sex distribution showed that 55% of patients were males and 45% were females. With regard to age distribution, 22% of patients were less than 5 years old, 30% were 5 to 17 years old, and 48% were 18 years and older. Patient-donor HLA matching status was 50% HLA identical, 32% haploidentical, 15% more than haploidentical, and 3% less than haploidentical. The number of potential donors per patient ranged from 1 to 11 typed for each patient (average of 2.94 ± 1.86). CONCLUSIONS: The rate of finding a family member as HLA-matched donor for hematopoietic stem cell transplant in our study on Bahraini patients was higher than reports in western countries yet close to other reports from countries with almost similar family sizes. We recommend forming a national Bahrain registry in addition to a regional Eastern Mediterranean stem cell bank to increase the success rate of finding an HLA-matched donor.

T Regulatory Cells in Rheumatoid Arthritis with Reference to Anti-Citrullinated Peptide Antibody and TNF-alpha Inhibitor Therapy.

T regulatory cells (Tregs) plays an important role in maintaining self-tolerance and preventing autoimmune diseases by inhibiting proliferation and cytokine production of self-reactive T cells. Controversy was reported regarding the frequency of CD4+CD25+ Tregs in the peripheral circulation of rheumatoid arthritis (RA) patients compared to normal controls. Also, some showed that treatment with TNF-α inhibitor restored the capacity of Tregs. This work aimed to study Tregs in the peripheral blood of RA patients versus control in addition to those on TNF-α inhibitor therapy compared to those who have not received it and to correlate with status of anti-cyclic citrullinated peptide antibody (ACPA). Two groups of RA patients were studied; one on TNF-α inhibitor therapy and the other not. Additionally, age-matched apparently healthy controls were studied. The percentage of CD4+CD25+ T cells in the total lymphocytic cell population was determined by flow cytometry analysis while ACPA concentration was measured by a second-generation peptide-based ELISA. Mean level of Tregs was significantly lower in the studied RA patients compared to the control group. Patients in early disease (0-5 years) had low mean Tregs percentage compared to patients with long duration of disease (> 10 years) (P=0.044). Patients on TNF-α blocker therapy had elevated Tregs percentage relative to patients on methotrexate (MTX) (P=0.022) and other therapies. No effect of gender or age was found on Tregs levels. In RA patients, 85.4% were ACPA seropositive and 65.9% of seropositive patients have concentration of > 100U/ml. The mean Treg percentage was significantly lower in ACPA seronegative group compared to the seropositive group (P=0.013). In conclusion, the studied RA patients have low Treg, and TNF-α blocker therapy increased its number, compared to other therapies.

A severe inflammatory cutaneous reaction after continuous epidural analgesia.

A very rare, but important, risk factor in placement of epidural catheters is skin reactions to the antiseptic solution, adhesive tape, or the catheter itself. We describe a case of a severe inflammatory cutaneous reaction after continuous epidural analgesia used after an abdominal perineal resection. We highlight the importance of making the proper diagnosis and initiating timely therapy.