Hematological parameters are affected by different factors that include age, sex, smoking, ethnicity, and environmental altitude. It has been justified that each population must establish its own normal reference intervals to be used in clinical assessments and interpretations. Hematological reference intervals for adults from the Gaza Strip-Palestine have never been addressed. Therefore, this study was designed and aimed at the establishment of normal blood cells reference intervals for healthy adults at the Gaza Strip-Palestine. This study involved 89,491 apparently healthy individuals (from both sexes and from the different governorates of the Gaza Strip) who were referred to the Thalassemia Central Laboratory during the period from September 2000 until February 2008. Complete blood counts were performed. Subjects were categorized into subgroups according to gender, smoking habit, and age (15-18, 19-45, and >45 years old). For each subgroup, descriptive and comparative statistical analysis was performed for hematological parameters. The results showed substantial differences between males and females, between smokers and nonsmokers, and between the different age groups. Moreover, reference intervals derived from our population are markedly shifted downward as compared with Western European and American populations. It was concluded that separate and region-specific reference intervals based on gender, smoking, and age for the Palestinian population at the Gaza Strip should be generalized for clinical laboratories and clinical practitioners, which could help in interpreting laboratory hematological tests more specifically, and potentially develop the quality of medical care provided to patients.

Quantitation of hemoglobin alpha 2 delta 2 (HbA2) is a basic and confirmatory test in diagnosing the carrier state of beta-thalassemia. The present study was designed to investigate the effect of cigarette smoking on the diagnostic reliability of HbA2. A total of 2,867 (654 smokers and 2,213 never smokers) male subjects were involved in the present study. The subjects were categorized into three groups according to their laboratory findings: beta-thalassemia minor, iron deficient, and normal groups. Complete blood count (CBC) parameters and HbA2 levels were compared between smokers and never smokers of each group according to the independent-samples t-test using the SPSS program, significance results were reported at P<0.05. The results showed a significant increase in red blood cell (RBC) mass (RBC count and hematocrit [Hct]) and Hb concentration in smokers of all groups; however, no significant differences were reported in the HbA2 level between smokers and never smokers in all groups. It was concluded that cigarette smoking does not affect the diagnostic reliability of the HbA2 test.

5166 Background. Systemic iron overload (SIO) is characterized by persistently high levels of plasma iron that often surpass transferrin's (Tf) binding capacity and generate chemical forms identified as non-Tf bound iron (NTBI). These forms have been perceived as: a. clinically important indicators of SIO per se and of impending organ damage, because cells chronically exposed to iron overloaded plasma attain iron levels and ensuing ROS formation that override their antioxidant capacities and b. as pharmacological targets for chelation and thereby of prevention of tissue iron overload. However, NTBI determination in the clinical setting has been confounded by the chemical heterogeneity of iron forms found in fluids like plasma/sera of SIO patients, the presence of residual amounts of undefined chelates or chelators and the need to dislodge NTBI from native ligands with agents that facilitate its detection. We have assayed the overt forms of NTBI that represent the native pool of labile (= redox-active, chelatable and membrane permeant) iron in plasma/serum. We defined it as ‘labile plasma iron' or LPI and analyzed it by the Aferrix FeROS™ test (1) and used it to asses chelation regimens in their ability to maintain patients' plasma at relatively low (basal) LPI levels (<0.4 μ M, ref. 2). Detection of NTBI forms with both low redox activity and poor chelator accessibility (defined as cryptic LPI) can also be done with the FeROS™ test by supplementing samples with an agent (nitrilotriacetate= NTA < 0.5 mM) that in plasma “extracts” iron from native NTBI. Thus whereas LPI measures overtly labile NTBI in native plasma (i.e. LPI), LPIplus detects both overt + cryptic forms, as in classical NTBI assays that involve either mobilization + filtration (3) or in the DCI (directly chelatable iron) assay that measures deferrioxamine chelatable NTBI (4). Aim. To compare SIO parameters in polytransfused thalassemia major patients, chelated and non-chelated, as revealed by measurements of overt and cryptic LPI. Methods. The studies involved: 1. The Hadassah Medical Center (HMC) in Jerusalem, where 15–20 (randomly selected, age 14–35) patients were under regular transfusion/chelation treatment and 2. The European Medical Center in Gaza (EMC), where regularly transfused patients (age 10–22) were only sporadically chelated. NTBI assays were performed on sera prepared from blood, (where applicable taken after >10 hrs drug washout, as described for LPI (1,2) and DCI (4); for LPIplus, the LPI test was conducted in the presence of 0.5 mM NTA. Results. As shown previously (2,4), LPI was detected only in patients with >70% Tf-saturation. In HMC, the mean LPI of n=18 patients rose from 0.51±0.41 μ M to 1.00 ±0.46 μ M in the presence of NTA, matching the DCI level of 0.91±0.7 μ M. The LPI rise was detected in 12/15 (= 80%) of samples with LPI>0.4 μ M (≂p 66% of the entire cohort). Thus, despite chelation, a substantial number of patients had relatively low but significant levels of both overt and cryptic NTBI. Among the 3 patients with no significant LPI or DCI (0.2-0.4 μ M), 2/3 became LPI positive (0.6-0.8 μ M) when tested with NTA. Unexpectedly, in EMC-Gaza, among 20 transfused unchelated patients with serum ferritins > 5000 ng/ml and Tf saturation >100%, 8/20 of them (≂p 40%) had undetectable levels of overt LPI but substantial cryptic NTBI. In the remaining 12/20, the mean overt LPI of 0.69±0.65 μ M rose significantly (p<0.01) to 2.05 ±1.56 μ M when the cryptic component (NTA-extractable) was added. Discussion. Overt and cryptic NTBI components were detected by two modalities of the LPI assay in both regularly chelated and unchelated thalassemia patients, although to different extents and proportions. Compared to chelated patients, those unchelated had significantly higher mean values of both overt and cryptic NTBI components, despite the higher proportion of patients with only cryptic NTBI. On an individual basis, the persistent appearance of either/both LPI component(s) of NTBI could provide a measure of SIO and/or the success of individual chelation regimens. However, remaining to be established is the pathophysiological role of each component of NTBI to SIO, disease progression and treatment success. Supported by ISF and the Canadian Friends of HUJI. 1. Esposito et al. Blood 102:2670-7 (2003); 2. Zanninelli et al. Br. J. Hematol. 147: 744–51(2009); 3. Hider R. Eur J Clin Invest 32:S50–4 (2002); 4. Pootrakul et al. Blood 104: 1504–10 (2004). Disclosures: Cabantchik: Aferrix Ltd: Consultancy, Membership on an entity's Board of Directors or advisory committees.