Pattern of Antimicrobial Sensitivity in Microbiologically Documented Infections in Neutropenic Patients with Haematological Malignancies: A single Center Study.

Febrile neutropenia is a medical emergency that complicates the clinical course and treatment of haematological malignancies, significantly enhancing the financial burden and worsening the overall outcome. This study was carried out to evaluate the efficacy of institution's current first-line antibiotic regimen for febrile neutropenia in view of recent spectrum of institution's local flora and its susceptibility pattern. 163 episodes of microbiologically documented infections in 110 adult patients were studied over a period of 1 year. Of 110 patients, 61 patients were male. The mean age of the patient population, mean absolute neutrophil count and temperature as documented were 30.1 years (SD ± 16.8), 450 cells/ul, and 101.9 °C respectively. Gram-negative and gram-positive organisms accounted for 79% and 21% of the febrile neutropenic infections respectively. E. coli and Staphylococcus aureus were the most common gram positive and gram negative pathogens respectively. A susceptibility pattern of > 60% was documented for all the gram negative pathogen's associated febrile neutropenic infections for the current first-line antibiotic combination of Piperacillin/Tazobactum and Amikacin. Comparative analysis of results with the institutional data of 2015 study revealed no statistically significant difference in the resistance pattern of the organisms hence, validating the persistent use of Piperacillin/Tazobacum and Amikacin combination as a potent and efficacious therapy for febrile neutropenia patients with haematological malignancies. However, continuous surveillance remains prudent for the emerging changes in the spectrum and resistance pattern of local flora so that timely revision of empirical antibiotic regimens can save the added financial burdens and associated high morbidity and mortality.

A rare incidence of severe dermatological toxicities triggered by concomitant administration of all-trans retinoic acid and triazole antifungal in patients with acute promyelocytic leukemia: a case series and review of the literature.

BACKGROUND: All-trans retinoic acid (ATRA) is an indispensable part of the treatment of acute promyelocytic leukemia (APL). Although, mild cutaneous toxicities like mucocutaneous xerosis, rash, and pruritus are well reported, ATRA associated severe dermatological toxicities are extremely rare. ATRA is primary metabolized by cytochrome P450 (CYP450) enzyme system, and triazole antifungals are notorious for their strong inhibitory effect on CYP450. CASE PRESENTATION: Three Asian APL patients experienced rare ATRA-induced severe dermatological toxicities: exfoliative dermatitis (ED) in cases 1 and 2, and necrotic scrotal ulceration in case 3. Both case 1 (33-year-old female), and case 2 (28-year-old male) landed in emergency department with dehydration, generalized skin erythema and xerosis during their induction chemotherapy. Both of these patients also developed invasive aspergillosis and required concomitant triazole antifungals during their chemotherapy. For ED, intravenous fluids and broad-spectrum antibiotics were started along with application of local emollients to prevent transdermal water loss. Although their general condition improved but skin exfoliation continued with complete desquamation of palms and soles. Dermatology was consulted, and clinical diagnosis of ED was established. Discontinuation of ATRA resulted in complete resolution of ED. Case 3 (15-year-old boy) reported two blackish mildly tender scrotal lesions during induction chemotherapy. He also had mucocutaneous candidiasis at presentation and was kept on triazole antifungal. Local bacterial & fungal cultures, and serological testing for herpes simplex virus were reported negative. Despite adequate local care and optimal antibiotic support, his lesions persisted, and improved only after temporary discontinuation of ATRA. After a thorough literature review and considering the temporal association of cutaneous toxicities with triazole antifungals, we speculate that the concomitant use of triazole antifungals inhibited the hepatic metabolism of ATRA, resulting in higher serum ATRA concentration, and markedly accentuated cutaneous toxicities in our patients. CONCLUSION: By highlighting this crucial pharmacokinetic interaction, we want to caution the fellow oncologists to be mindful of the inhibitory effect of triazole antifungals on CYP450. We propose using a non-myelosuppressive combination of ATRA and arsenic trioxide for management of APL hence, obliterating the need of prophylactic antifungals. However, in the event of invasive fungal infection (IFI), we suggest using alternative class of antifungals.

Dengue virus infection in hematopoietic stem cell transplant recipients: A case series and comparative literature review from dengue endemic region.

This case series describes the wide spectrum of clinical presentation, laboratory findings, and morbidity/mortality associated with dengue fever in hematopoietic stem cell transplant recipients, treated in a dengue endemic region. The risk of acquiring viral infections increases manifold after transplant due to the severely immunocompromised state amid conditioning toxicity and immunosuppressive therapy. The classical warning signs of dengue viremia are often masked in posttransplant patients, leading to a missed diagnosis of dengue and grave consequences observed in some of the patients. Accurate and timely diagnosis of dengue fever especially in dengue prevalent areas can prevent the unwarranted complications and reduce the morbidity and mortality associated with dengue in allogeneic/autologous transplant recipients.

Microbiota as a New Target in Cancer Pathogenesis and Treatment.

The microbial ecosystem of humans is an integral part of human health and disease. A significant percentage of tumors worldwide are thought to be microbially induced. The relationship between cancer and microbes is complex. In this article review, we aim to give an overview of human microbiota and its role in carcinogenesis, emphasize the relation between microbiota and cancer immunity, and highlight its role in the future of cancer therapy. The term microbiota refers to the collection of microorganisms that are located in an individual, whereas the total genome of these microorganisms is referred to as the microbiome. The microbiota in humans has many physiological functions. The microbiota within the gut lumen has a profound effect on the local and systemic immune system. The immune system can change the gut microbiota. Microbiota may induce carcinogenesis by several mechanisms. It also affects tumor progression. Thus, microbiota modulation may aid in the prevention and treatment of cancer. Intentionally introducing microorganisms into the oncological patient is assumed to mobilize the immune system to become able to, at least, limit the development of cancer. Microbes are used as vectors which are carriers of particular antineoplastic agents that reduce the side effects of chemotherapy. Inflammation and tumor microenvironment play an essential role in promoting chemo-resistance. There is now considerable evidence, both in humans as well as in laboratory animals, that the commensal microbiota has important effects on carcinogenesis, tumor growth, and therapy response.

A Rare Occurrence of Ectopic Parathyroid Carcinoma Presenting as a Case of Recurrent Fractures.

Ectopic parathyroid tumors are uncommon, accounting for only 6% of parathyroid adenomas, and even fewer cases are attributed to parathyroid carcinomas. While ectopic parathyroid carcinoma in the anterior mediastinum is a rare condition, the occurrence of recurrent skeletal fractures in the presence of mild hypercalcemia is even rarer. In this report, we present the case of a 52-year-old man with a medical history of hypertension, chronic kidney disease, and a previous right-sided intertrochanteric fracture of the femur one year earlier. He presented to the emergency room with left-sided hip pain and shortness of breath due to volume overload. Laboratory tests revealed mild hypercalcemia and hyperparathyroidism, with normal vitamin D levels. An X-ray showed a left neck of femur fracture. Further evaluation with a three-phase skeletal scintigraphy indicated the presence of metabolic bone disease. A contrast-enhanced computed tomography of the chest revealed a solitary soft tissue nodule in the anterior mediastinum, representing an ectopic parathyroid adenoma. The lesion was successfully removed using video-assisted thoracic surgery, and the histopathological analysis confirmed the diagnosis of parathyroid carcinoma. The combination of mild hypercalcemia and recurrent fractures is an unusual presentation of ectopic parathyroid carcinoma, underscoring the importance of considering this condition as a potential cause in similar cases to ensure timely and appropriate treatment.

Impact of COVID-19 on the Volume of Pediatric Surgery Cases in a Referral Hospital in the Al-Madina Region of Saudi Arabia.

Background The COVID-19 pandemic has affected healthcare systems worldwide, leading to prioritizing resources for the diagnosis and management of COVID-19 cases. As a result, providing medical care to patients with health conditions, including pediatric surgeries, has been significantly affected. Objectives The objective of this research is to evaluate the impact of the COVID-19 pandemic on the prevalence of pediatric surgeries in a referral hospital in Al-Madina, KSA. Method An observational retrospective cross-sectional study was conducted in a referral hospital in the Al-Madina region of Saudi Arabia. We retrospectively reviewed all pediatric surgical records that met the inclusion criteria from March 2018 to March 2022. Results Out of the patients who underwent surgeries (5704), it was indicated that the number of patients who underwent surgeries during the COVID-19 pandemic (42.7%) was less than those who underwent surgeries before the COVID-19 outbreak (57.6%). The number of patients presented to the OPD significantly increased during the COVID-19 period compared to before COVID-19. The number of emergency cases before and during COVID-19 was similar. The period between diagnosis and surgical intervention for emergency cases was significantly shortened during the COVID-19 pandemic. The hospital stay period significantly decreased during the pandemic. Conclusion The study found that the pandemic has caused a considerable decline in the number of pediatric surgery cases compared to the previous years. The longer observation period of this study likely allowed for a better understanding of the pandemic situation, which contributes to strengthening our understanding of the pandemic's impact on healthcare services.

The Common Systemic and Local Adverse Effects of the Sinovac COVID-19 Vaccine: An Observational Study From Pakistan.

Background Vaccination acts by boosting the capacity of a person's immune system to identify and effectively resist infection-causing bacteria and viruses, as it stimulates the immune system to respond to the vaccine's antigens. The immunological response may include local and systemic symptoms, including pain at the injection site and fever, respectively. The Sinovac vaccine is an inactivated virus vaccine made in China and is one of the most widely used vaccines in many countries; however, the side effects of the Sinovac vaccine have not been well-studied in our population. Therefore, this study assessed the prevalence of side effects experienced by participants after receiving the Sinovac vaccine. Methodology This multicenter, cross-sectional study was conducted using a non-probability sampling method. The duration of the study was six months from May 1, 2022, to October 31, 2022. A total of 800 participants who were completely vaccinated with the Sinovac vaccine were included in the study. For categorical data, frequencies and percentages were documented, while for continuous data, such as age, height, weight, and the duration of comorbidities, means and standard deviations were evaluated. Results The study findings showed that out of 800 participants, 534 (66.8%) were males and 266 (33.3%) were females, with a mean age of 41.20 ± 13.70 years. Among them, 162 (20.3%) had hypertension, and 104 (13.0%) had diabetes. Following the first dose of the Sinovac vaccine, fever was the most commonly reported side effect in 350 (43.8%) participants. Additionally, pain at the injection site in 238 (29.8%) participants, followed by swelling at the injection site in 228 (28.5%) recipients, were among other common side effects. Following the second dose of the Sinovac vaccine, fever was the most commonly reported side effect in 262 (32.8%) participants. Conclusions This study concluded that fever was the most frequent systemic side effect, whereas pain and swelling at the injection site were the most frequent local side effects following the administration of the first and second doses of the Sinovac vaccine. Both dosages of Sinovac were well-tolerated, and the majority of the adverse effects were minor and self-limiting.

Neurological Features and Their Association With Gender in Diabetes Mellitus Patients.

Introduction Understanding the wide range of clinical signs and symptoms associated with diabetes mellitus (DM) is crucial because people with DM are frequently misdiagnosed, given incorrect care, or poorly controlled. Therefore, the purpose of this study was to evaluate the neurological symptoms associated with type 1 and type 2 DM patients with respect to patient gender. Methods This was a cross-sectional multicenter study that was conducted at different hospitals using a non-probability sampling method. The duration of the study was eight months, from January 2022 to August 2022. The study involved 525 type 1 and type 2 DM patients with an age range from 35 to 70 years. Demographic details such as age, gender, socioeconomic status, past medical history, presence of comorbidities, type, and duration of DM, and neurological features were recorded as frequencies and percentages. A Chi-square test was used to determine the association between neurological symptoms associated with type 1 and type 2 DM and gender. Results The study findings showed that of 525 diabetic patients, 210 (40.0%) were females and 315 (60.0%) were males. The mean male and female mean ages were 57.36±14.99 and 50.52±14.8 years, respectively, with a significant difference with respect to gender (p<0.001). The prevalence of neurological manifestations showed that irritability or mood swings were reported by most of the male 216 (68.6%) and 163 (77.6%) female diabetic patients, with a significant association noticed (p=0.022). Moreover, a significant association was observed between both genders in terms of swelling of feet, ankles, hands, and eyes (p=0.042), confusion or difficulty in concentration (p=0.040), burning pain in feet or legs (p=0.012), and muscular pain or cramps in legs or feet (p=0.016).  Conclusion This study concluded that the prevalence of neurological manifestations was high among diabetic patients. Most of the neurological symptoms were significantly more pronounced in female diabetic patients. Moreover, most of the neurological symptoms were associated with the type (type 2 DM) and duration of DM. The presence of hypertension, dyslipidemia, and smoking also influenced some neurological manifestations.

Correlation of Fasting Blood Sugar and Glycated Hemoglobin (HbA1c) With Thiamine Levels in Diabetic Patients.

Introduction It has been discovered that low levels of thiamine reserves in the body are related to diabetes mellitus (DM) because thiamine directly influences carbohydrate metabolism. Therefore, the purpose of this study was to assess several metabolic variables and blood thiamine levels in patients with type 1 and type 2 DM and compare them with those in a control group of healthy individuals. Methods This case-control study was conducted at multiple diabetic outpatient centers in Karachi. A total of 90 participants, who were divided into three groups, each containing 30 individuals, were chosen using a convenient non-probability sampling technique. Group A served as the control group and consisted of healthy, non-diabetic individuals. Groups B and C contained subjects with type 1 and type 2 DM, respectively. Descriptive analysis was reported as mean standard deviation, whereas gender and comorbidities were expressed as frequencies and percentages. The chi-square test and Pearson's correlation coefficient were used to determine the associations of the variables with type 1 DM, type 2 DM, and controls. Results The study results revealed statistically significant differences between controls, type 1 and type 2 DM, in the means of blood glucose levels and all lipid profiles, such as glycated hemoglobin (HbA1c), fasting blood sugar (FBS), random blood sugar (RBS), serum thiamine, triglycerides (p < 0.001), high-density lipoprotein (HDL) (p = 0.014), and total cholesterol (p = 0.013). Furthermore, it was shown that among the control group, type 1 and type 2 DM, HbA1c, and FBS were insignificantly correlated with thiamine levels, whereas the HbA1c and FBS of the combined diabetic groups were significantly correlated with the thiamine level (r = 0.465, p < 0.001) and (r = 0.360, p = 0.005), respectively, where 'r' is the Pearson correlation coefficient. Additionally, HbA1c and FBS in the combined three groups were significantly correlated with the thiamine level (r = -0.626, p < 0.001) and (r = -0.561, p < 0.001), respectively. Conclusion This study concluded that patients with type 1 and type 2 DM had significantly higher levels of FBS, RBS, HbA1c, triglycerides, and total cholesterol than controls. Furthermore, both type 1 and type 2 DM patients' serum thiamine and HDL levels were observed to be considerably lower than those of controls. Additionally, among both types of DM and controls, there was a strong correlation between FBS and HbA1c. Therefore, we recommend that serum thiamine levels be routinely monitored in diabetic patients, and thiamine supplementation should be considered to avoid complications, especially vascular complications of DM.

Successful management of colistin- and carbapenem-resistant Klebsiella pneumoniae-associated ecthyma gangrenosum in acute myeloid leukemia: A rare complication.

Pseudomonal ecthyma gangrenosum is a well-known condition in immunosuppressed patients. However, ecthyma gangrenosum associated with Klebsiella pneumoniae is a rare entity that requires early recognition and optimal antibiotic and surgical management. We herein report the first case of colistin & carbapenem-resistant Klebsiella pneumoniae ecthyma gangrenosum in an acute myeloid leukemia patient. A 30-year-old female with acute myeloid leukemia received induction chemotherapy at the National Institute of Blood Diseases and Bone Marrow Transplantation hospital. Post-chemotherapy, she developed fever and a necrotic erythematous papule on right forearm. Colistin-susceptible carbapenem-resistant Klebsiella pneumoniae was isolated in cultures. Susceptibility testing was performed by microbroth dilution method. Worsening necrotic lesion prompted surgical debridement. Histopathology of debrided tissue revealed necrotic inflammation, and tissue cultures grew colistin-resistant carbapenem-resistant Klebsiella pneumoniae (colistin minimum inhibitory concentration >4 µg/mL). We speculate that colistin resistance was acquired due to impaired antibiotic penetration in necrotic nidus. A higher incidence of carbapenem-resistant Klebsiella pneumoniae-associated ecthyma gangrenosum is anticipated in hem-oncology patients, and timely diagnosis, appropriate antibiotics, and surgical debridement remain the only potential cure.

Coagulation Abnormalities and Risk Assessment in Acute Promyelocytic Leukemia: An Experience From a Resource-Constraint Country.

Introduction The objective of the study was to assess the impact of coagulopathy in risk-stratified acute promyelocytic leukemia (APML) patients irrespective of bleeding manifestation. Patients and methods This was a cross-sectional study design conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation (NIBD & BMT) from November 2019 to December 2021. A total of 62 patients between three years to 74 years of age of either gender and treatment-naive cases of APML were included in the study. Morphological diagnosis was made on bone marrow samples, and confirmation was done by karyotyping/fluorescence in situ hybridization (FISH) and/or polymerase chain reaction (PCR). Complete blood count (CBC), prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, and fibrinogen levels were done for bleeding risk assessment. Cases other than APML and cases on treatment were excluded from the study. Results A total of 85 APML patients were registered at our institute. Among them, 62 (73%) were included in the analysis as per the inclusion criteria of the study. The median age was 32 (3-74) years, with a male predominance of 34 (55%). According to the Sanz score, 18 (29%) patients were noted to have low risk; however, 22 (35.4%) patients were found to have an intermediate-risk disease and 22 (35.4%) patients had high-risk disease. There was positive bleeding history among 44 (71%) patients, followed by fever in 28 (45%) patients. Raised PT, APTT, and D-dimer were found in 46 (74%), 38 (61%), and 52(83.8%) patients, respectively. Low fibrinogen levels were observed among 16 (26%) patients. The association of risk stratification and bleeding history with CBC and coagulation parameters was observed. Platelet count and total leucocyte count were noted to be significantly associated with risk stratification. However, there was no association observed between the rest of the parameters with risk stratification and bleeding. Conclusion The results of our study suggest that regardless of bleeding symptoms, coagulation parameters must be investigated at the time of diagnosis in patients with suspected APML, and in addition to all-trans-retinoic acid (ATRA), transfusion of fresh frozen plasma should be done. It has clinical value, and adding it to the algorithm of treatment would be beneficial to the patients in the developing world, where resources are already meager.

Highly specific functional equivalence of XN-HPC for optimum CD34+ cell count in harvested allogeneic bone marrow stem cell products.

OBJECTIVES: To establish a reliable XN-HPC cutoff, for an effective CD34 + cell count of ≥2 × 106cells/kg of the recipient's body weight, in harvested bone marrow products in allogenic transplantation. METHODS: The study was carried out in two phases. In retrospective Phase 1, data from 47 donors were analyzed. Sysmex analyzer XN-20 and BD FACS Calibur were employed to process XN-HPC and CD34 + cell enumeration, respectively. To make the two variables comparable, both XN-HPC and CD34 + cell counts were reported as the number of cells/kg of the recipient's body weight. Spearman's rank correlation coefficient was calculated for CD34 + cells and XN-HPC, followed by the calculation of the receiver operating characteristic (ROC) curve to identify the XN-HPC value which could effectively predict the cutoff of ≥2 × 106 CD34 + cells/kg of the recipient's body weight. In Phase 2, the computed XN-HPC cutoff was validated in a prospective set of 53 donors by obtaining the positive and negative predictive values. RESULTS: Statistically significant correlation was obtained between XN-HPC and CD34 + cell count with Spearman's rho of 0.54 (p-value <0.001). The optimal XN-HPC cutoff, for the required CD34 + ve cell count of ≥2 × 106 cells/kg of the recipient's body weight, was calculated to be ≥2.80×106 cells/kg of the recipient's body weight with the specificity and sensitivity of 100% and 31%, respectively. The ROC curve demonstrated the area under the curve to be 0.74. Phase 2 validation revealed 100% PPV. CONCLUSIONS: For harvested bone marrow products with XN-HPC of ≥2.80×106 cell/kg of the recipient's body weight, CD34 + cell enumeration by flow cytometry can safely be disposed of.

Frequency and Risk Factors of Cyclosporine-Induced Neurotoxicity in Allogeneic Stem Cell Transplant Recipients.

Background and objective The calcineurin inhibitor cyclosporine A is routinely used for prophylaxis against graft-versus-host-disease (GvHD) in human leukocyte antigen (HLA)-matched allogeneic stem-cell transplant patients and is a major etiological factor for neuropathological symptoms that are reversible in most cases. In this study, we aimed to determine the frequency and risk factors of cyclosporine-induced neurotoxicity (CIN) in HLA-matched allogeneic stem cell transplant patients. Methods The study spanned the period from January 2016 to December 2019. Consecutive HLA-matched allogeneic stem-cell transplant patients of all ages were included in the study. Descriptive and risk factor analyses for the development of CIN with respect to age, sex, primary diagnosis, conditioning regimen, electrolyte abnormalities, and cyclosporine trough levels during the neurological episode were performed. Results A total of 106 HLA-matched patients with a median age of 6.3 years [interquartile range (IQR): 0.5-46 years], of which 37 (35%) were females, were included in the study. The mean cyclosporine trough level was 500 ±286 mg/dl. Neurological symptoms were found in 27 (26%) patients. A total of 14 (13%) patients were diagnosed with CIN. The frequency of other neurological symptoms included headache in 46 (43%), disorientation in 17 (16%), seizures in 12 (11%), visual disturbance in 11 (10%), and aphasia in seven (7%) patients. Posterior reversible encephalopathy syndrome (PRES) was found in six (6%) patients. All patients with CIN had hypertension and none had a fever. Multivariate logistic analysis showed that the presence of seizures [odds ratio (OR): 10.0, p<0.001] and the absence of fever (OR: 0.02, p<0.001) were associated with the diagnosis of CIN. Conclusion The prevalence of CIN is not uncommon (13%) in patients receiving cyclosporine for GvHD prophylaxis. Neurological complications, especially seizures, are common in CIN, and fever might indicate an alternative diagnosis. Prompt recognition of neurological signs and symptoms and early intervention can halt the progression of the disease.

Validity of Sequential Organ Failure Assessment and Quick Sequential Organ Failure Assessment in Assessing Mortality Rate in the Intensive Care Unit With or Without Sepsis.

Introduction Sepsis and septic shock (sepsis-induced hypotension not improved by adequate fluid resuscitation) are among the most common reasons for admission to an intensive care unit (ICU) and display high mortality rates. Different scoring systems are used to diagnose and predict the mortality of patients having sepsis. This study aims to validate the prognostic accuracy of Sequential Organ Failure Assessment (SOFA) and Quick Sequential Organ Failure Assessment (qSOFA) in determining the mortality of both septic and non-septic patients. Materials and methods This retrospective cohort study was conducted in May 2018 in the Surgical Intensive Care Unit (SICU) of a tertiary care hospital in Karachi, Pakistan. Past 200 patient records, from January 2018 to April 2018, were examined, and 20 records were discarded due to insufficient data. Sufficient observational data were collected, which was used to assess the validity of the SOFA and qSOFA in determining the mortality rate of sepsis. A comparison of the two modalities was made. Results Out of the 200 patients, 180 were enrolled. Data from their entire ICU stay were used to calculate their initial, highest, and mean SOFA and qSOFA. Mean SOFA score up to nine correlated with a mortality rate of up to <79%, while scores 10 and above predicted a 100% mortality rate. A mean qSOFA score of three predicted a 67% mortality rate. Univariate logistic analysis performed with odds ratio showed that the mean qSOFA score was in comparison more closely able to predict mortality, followed by mean SOFA score (p values < 0.01). Conclusions This study concluded that both SOFA and qSOFA scores are good predictors of mortality. However, qSOFA is more closely accurate in predicting mortality than SOFA. But further analysis with larger sample size for a longer duration as well as the application of these scores in the emergency departments and general wards can prove the precision of this study.

Peripheral Blood Stem Cell Harvest HPC Count Is an Effective Surrogate Marker for CD34+ Cell Count in Allogeneic Stem Cell Transplant Setting.

OBJECTIVE: We assessed the predictive potential of XN-HPC for CD34+ cell count as obtained through Sysmex automated hematology analyzers (XN-1000). METHODS: This study was conducted at the National Institute of Blood Diseases and Bone Marrow Transplantation in 84 donors between December 2012 and December 2017 in the first phase and later validated in 112 donors between December 2017 and December 2018. Sysmex XN-1000 and BD FACS Calibur estimated XN-HPC and CD34+ cells of peripheral blood apheresis product, respectively. Spearman's correlation was assessed between XN-HPC and CD34+ cell count followed by receiver operating characteristic curve calculation to determine the XN-HPC cutoff for a CD34+ count of ≥2 million cells/kg of recipient's body weight RESULTS: There is a moderately positive correlation (P value = .003) between XN-HPC and CD34+ count. Receiver operating characteristic curve analyses demonstrated that a cutoff value for XN-HPC of ≥1·845×106cells/kg of recipient's body weight has a specificity and sensitivity of 100% and 78·2%, respectively, for predicting the CD34+ count of ≥2 million cells/kg of recipient's body weight. This cutoff value of XN-HPC was prospectively validated in 112 donors. The positive predictive value was found to be 100%, while negative predictive value was 17%. CONCLUSION: XN-HPC has a highly promising potential to serve as a cost-effective and time-saving surrogate for CD34+ cell count.