SCIENTIFIC MEETING

1ST MALAYSIAN SOCIETY OF LABORATORY HAEMATOLOGY

Haematology Morphology Workshop

28th - 30th September 2011 New Pacic Hotel, Kota Bharu, Kelantan

2011

Organized by: Members of Malaysian Laboratory Haematology Society (MMLHS) Supported by: Universiti Sains Malaysia (USM)

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CONTENTS
Page Contents Welcome Address Organizing Chairperson MMLHS President Floor Plan - Venue & Exhibition Steering Committee Agenda 4 5 6 7 8-10

11-20 Speakers 21-22 Corporate Talk 23 Lunch Talk

24-32 Plenary Talk 33-36 Entrant Registers 34 38 Sponsors Appreciation

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

WELCOME ADDRESS
BY ORGANIZING CHAIRPERSON ASSOCIATE PROF. DR. ROSLINE HASSAN
Dear colleagues, On behalf of the organizing committee, I would like to extend the warmest welcome to all of you to Kota Bharu, Kelantan and Morphology Workshop. The combination of an outstanding location with an equally exciting scientific program augurs well for a stimulating workshop. I would like to take this opportunity to publically thank the Members of Malaysian Laboratory Haematology Society (MMLHS) for giving the honor to us to organize the first educational event. The workshop will showcase many current updates in the field of major area in haematomorphology that include the latest classification on myeloid and lymphoid neoplasm followed by case studies shared by local and international speakers. We are honored to offer an outstanding and inspiring speakers including Emeritus Professor Cheong Soon Keng, Professor Han Kyung-Ja, Associate Prof Surender Juneja and Assoc Prof Narazah Mohd Yusoff. I would also like to thanks all individual responsible for the success of this workshop, the organizing committee and all our exhibitors who contribute generously to the corporate talk and lunch-hour CME session to make this truly the best morphology workshop meeting. We encourage all participants to visit the exhibits to update on the innovations the exhibitors offer.

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

WELCOME ADDRESS
BY MMLHS PRESIDENT
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ASSOCIATE PROF. DR. NARAZAH MOHD YUSOFF
Dear colleagues and friends, The Members of Malaysian Laboratory Haematology Society (MMLHS) has great pleasure in welcoming you to the 1st MALAYSIAN SOCIETY OF LABORATORY HAEMATOLOGY SCIENTIFIC MEETING 2011 and Haematology Morphology Workshop to be held on 28th to 30th September 2011 in Kota Bharu, Kelantan. This meeting and workshop will be the first event organised by this society (MMLHS) where internationally renowned speakers will share their experience and invaluable insights. We will be introduced to the current state of knowledge on haematomorphology and the latest advancement and technologies in haematology. I would like to take this opportunity to say thank you to all the speakers, members of the organising committee and society and those who have supported us. A special thank you to the companies which present their innovative products, technologies and services in our industrial exhibition. We look forward to seeing you in Kota Bharu.
1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

FLOOR PLAN
VENUE & EXHIBITIONS
Exhibition Booth Dining Area VIP Dining Area LAYOUT LEGEND: Participant Table Room Pillar Morphology Quiz Area Elevator

EXHIBITION BOOTH LIST 1.Scientech Medical Sdn. Bhd 2. 3. 4. 5.Abbot Laboratories M Sdn Bhd

6.Straits Scientific (3S) M Sdn Bhd 7. Fresenius Kabi M Sdn Bhd 8. DPC Healthcare Sdn Bhd 9. All Eights M Sdn Bhd 10.Sysmex M Sdn Bhd

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

STEERING COMMITTEE
1ST MALAYSIAN SOCIETY OF LABORATORY HAEMATOLOGY SCIENTIFIC MEETING 2011 HAEMATOLOGY MORPHOLOGY WORKSHOP

PATRON & ADVISER Prof. Madya Dr. Narazah Mohd Yusoff CHAIRPERSON Prof. Madya Dr. Rosline Hassan VICE CHAIRPERSON Prof. Madya Dr. Wan Zaidah Abdullah SECRETARY Ahmad Zakwan Mustafa TREASURY Dr. Salfarina Iberahim SECRETARIAT Wan Soriany Wan Md Zain Selamah Ghazali, Norleha Mohd Noor HOSPITALITY Khairiah Yazid, Narishah Sharif PUBLICITY & SPONSORSHIP Norizah Tumin, Maseta Ismail Rohani Bakar, Lim Seng Hock Dr. Wan Haslindawani Wan Mahmood TECHNICAL & AVA Nik Mohd Fariz Nik Zahari Noor Azmizam Abdul Rahman MORPHOLOGY QUIZ Prof. Madya Dr. Wan Zaidah Abdullah Dr. Wan Haslindawani Wan Mahmood Ang Cheng Yong

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

DAY 1: 28TH SEPTEMBER 2011 (WEDNESDAY)

AGENDA

Time

Tentative

12.00 pm Participant Registration 2.00 pm Corporate Talk (Beckman Coulter 3S) Haemato-Flow - The trend? by Mr. Choong Chuan Yong of Beckman Coulter 2.45 pm Corporate Talk (Cell-Dyn Abbot) Changing The Way We Look At The Cells by Dr. Wan Hayati Binti Mohd. Yaakob of Hospital Tengku Ampuan Rahimah, Klang 3.30 pm Free Session Morphology Quiz & Booth Tour 4.15 pm High Tea 5.15 pm MMLHS Meeting

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

DAY 2: 29TH SEPTEMBER 2011 (THURSDAY)

Time Tentative 8.30 am Opening Ceremony - by President of MMLHS 8.45 am Classification of Acute leukemias by A/Prof Dr. Surender Juneja 9.30 am Overview on the classification of MPD/MDS by A/Prof Dr. Rosline Hassan 10.30 am Photography Session & Tea Break 11.00 am The Haemolytic Anemias by A/Prof Dr. Narazah Mohd Yusoff 12.00 pm Application of automated haematology analyser in medical disorders by Prof. Dr. Kyung-Ja Han 1.00 pm Lunch Talk (Morphologic Clues form CBC Results) by Mr Woon Sung Thong (Sponsored by Sysmex) @ Dewan Green Pacific 2.30 pm Case Studies - by A/Prof Surender Juneja 4.30 pm Tea Break 7.00 pm Morphology Quiz Submission Closing
1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

AGENDA

DAY 3: 30TH SEPTEMBER 2011 (FRIDAY)

Time Tentative

AGENDA

8.30 am The Lymphoproliferative Disorders by Emeritus Prof Dr. SK Cheong 9.30 am Interpretation of BMA & Trephine Biopsies in Haematological Disorders (Part 1) by A/Prof Dr. Surender Juneja 10.30 am Tea Break 11.00 am Interpretation of BMA & Trephine Biopsies in Haematological Disorders (Part 2) by A/Prof Dr. Surender Juneja 11.45 am Morphology Quiz Session 12.30 pm Lunch Break & Friday Prayers 2.45 pm Case Studies - by Emeritus Prof. Dr. SK Cheong 4.30 pm Closing & Prize Giving Ceremony 5.00 pm Tea Break

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ASSOCIATE PROFESSOR DR. SURENDER JUNEJA

Associate Prof. Dr Surender Juneja, MD, FRCPath. After graduating from the University of Delhi in 1976, Surender, undertook an MD in Pathology at the All India Institute of Medical Sciences. In 1981, accepted a Fellowship in Haematology at Hospital Henri Mondor, University of Paris XII, France. In 1983 Surender moved to Peter McCallum Cancer Centre as a fellow/registrar in Haematology until 1987. In 1988 he accepted the position as Consultant Haematologist at Peter McCallum Cancer Centre, a post that he held until 2000. During this time, he gained his Fellowship of the Royal College of Pathologists and took the position as Deputy Director of Pathology. Surender is a member of the Haematology Society of Australia & New Zealand (HSANZ), the American Society of Haematology (ASH), the European Society of haematology (EHA) and the International Society of Laboratory Haematology (ISLH). He has been the Principal Morphologist for the Australasian Leukaemia Lymphoma Group (ALLG) since 1987. He is Co-chair & presenter at the QAP Morphology session at the annual HSANZ meetings since 1997. Today, Surender's expertise in Haematology Morphology, Immunohistology, Flow cytometry is revered and duely sought. He has 80 publications mostly in peer reviewed journals and has been invited to speak at a number of International & National Scientific Meetings. He is also an examiner for FRCPA Haematology since 2001, a NATA Assessor and a Committee Member developing guidelines on management lymphomas for the NHMRC. Surender is the Head of Diagnostic Haematology and also holds appointments as Associate Professor in Pathology, University of Melbourne and as an Honorary Clinical Associate, Walter & Eliza Hall Institute of Medical Research Cancer & Haematology Division.

SPEAKERS

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EMERITUS PROFESSOR DR. SK CHEONG

Emeritus Professor Dr Cheong Soon Keng Qualifications: MBBS(Malaya), MRCP(UK), DCP(London), FRCP(Glasgow), FRCP(Edinburgh), FRCPA(Australasia), FAM(Malaysia), FASc(Malaysia), FFSc RCPA (Australasia), FAM(Singapore) Professor Cheong is currently the Professor of Medicine at the Faculty of Medicine & Health Sciences, Universiti Tunku Abdul Rahman, Malaysia. He is also the Visiting Consultant Haematologist to Hospital UKM. He has been conferred Fellow of the Academy of Sciences Malaysia in 2001, Emeritus Professor of UKM in August 2007, Chair of Datuk & Datin Tan Kim Leong Professor of Medicine, UTAR in 2010, and Founding Fellow of the Faculty of Sciences, the Royal College of Pathologists of Australasia in 2011 Professor Cheong is actively involved in postgraduate training in pathology & internal medicine, and supervising currently a number of master and doctorate theses in medical sciences. His current research interests include the biology of blood cancers, dendritic-cell-based vaccines, biology & application of mesenchymal stem cells, and web-based technologies for medical education. He has also authored or co-authored more than 145 peer-reviewed articles and more than 250 abstracts of presentations. His is currently the President of the College of Pathologists, Academy of Medicine of Malaysia. Other positions currently held by him include: Emeritus Member of the American Society of Haematology, Country Representative to the World Association of Pathology & Laboratory Medicine, and Malaysia Councilor of the Royal College of Pathologists of Australasia. He is an Associate Editor for Haematology and Malaysian Journal of Pathology. He is also the Vice President of the National Cancer Council (MAKNA), a non-profit charity organization.

SPEAKERS

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ASSOCIATE PROFESSOR DR. ROSLINE HASSAN

SPEAKERS

Associate Professor Dr Rosline Hassan Qualification : MD(UKM), MMed(Pathology)(Haematology), AM(Malaysia) Currently Associate Prof Dr Rosline Hassan is the Head of Haematology Department and Transfusion Medicine Unit, School of Medical Sciences, Universiti Sains Malaysia. She is also a MS ISO15189 assessor for Department of Standard Malaysia, Ministry of Science Technology Innovation. In addition she is also responsible for undergraduate and postgraduate teaching. She has supervised a handful of postgraduate students from both medical and biomedical sciences course. She is also internal-external examiner of Haematology for Conjoint Board of Pathology, MALAYSIA. Associate Prof Rosline has also authored and co-authored many journals and has presented many abstracts at conferences. Her research interests are mainly molecular aspect of myeloid neoplasm and haematological disorders such as thalassaemia, and transfusion medicine

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ASSOCIATE PROFESSOR DR. NARAZAH MOHD YUSOFF

!

SPEAKERS

Associate Professor Dr Narazah Mohd Yusoff Qualifications: PhD (Clinical Genetics), Kobe University Graduate School of Medicine, Kobe, Japan, Master in Medical Sciences (Haematology), University of London, Diploma in Clinical Pathology, University of London, Bachelor Medicine, Bachelor Surgery (MBBS), University of Malaya. She is currently a consultant haematologist in Advanced Medical and Dental Institute (AMDI), USM, Bertam, Penang. Among the posts held: Head, Department of Haematology, Director, Human Genome Centre, School of Medical Science, USM, Kubang Kerian, Deputy Director (Clinical Services), AMDI. Her research interests include medical genetics, G6PD deficiency and red cell membrane disorders and has authored and co authored numerous peer reviewed articles. She is the Editor of Bio-health Science Bulletin. Associate Professor Dr Narazah Mohd Yusoff is actively involved in post graduate training in haematology and transfusion medicine at Masters and Doctorate level. She is currently the President of Members of Malaysian Society of Laboratory Haematology.

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PROFESSOR DR. KYUNG-JA HAN

SPEAKERS

Professor Dr Kyung-Ja Han Dr. Kyung-Ja Han, M.D., Ph.D, is the Professor of the Department of Laboratory Medicine of The Catholic University of Korea. Dr. Han graduated from The Catholic University Medical College. She has authored articles, abstracts, and book chapters on subjects including diagnostic haematology and flow cytometry. Dr. Han has served as a scientific board member of Association of Clinical Scientists for several years. Currently, she is an active member of several professional societies, including the Korean Society of Laboratory Medicine and the Korean Society of Diagnostic Haematology where she chairs and serves several committees, while holding elected positions. Her clinical research interests focus in the areas of haematologic diseases, haematology laboratory, haematopathology and flow cytometry.

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MR. CHOONG CHUAN YONG

SPEAKERS

Mr Choong Chuan Yong

Mr Choong Chuan Yong has combines over 13 years of clinical laboratory experiance including strategic marketing and new product commercialization.

He is currently the Marketing Manager for Beckman Coulter Malaysia and holds a Bachelor of Science in Biomedical Sciences from UKM, Malaysia.

In his work with Beckman Coulter, he has responsibilities for all diagnostics products including strategy, positioning and future additions.

He is passionate about haematology and flow cytometry and serving costumers needs in all facets of his works.

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1st Malaysian Society of Laboratory Hematology Scientic Meeting 2011

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HbA1C Analyzer Thalassaemia Analyzer EQAS ( External Quality Assurance System ) Quality Control for Diagnostics Analyzer.

Flow Cytometry, Monoclonal Antibodies Tropical Disease Diagnostics Vacutainer Tubes

Microbiology Products

Hematology Analyzer (FBC) Coagulation Analyzer

HQ : 1201, Taman Uda Murni, Jalan Pengakalan Chepa, 15400 Kota Bharu, Kelantan. Branch : No. 6, Lorong Shahzan IM 4, Taman Shahzan Indera Mahkota, 25200 Kuantan, Pahang Darul Makmur.

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

Tel : 609-771 3661 Fax : 609-771 3662 Email : enquiry@teraslab.com.my Website : www.teraslab.com.my

DR. WAN HAYATI BINTI MOHD. YAAKOB

Dr Wan Hayati Binti Mohd. Yaakob Dr. Hayati is a graduate form Universiti Sains Malaysia in 1998 she also holds a Master of Pathology in Haematology from Universiti Kebangsaan Malaysia in 2006. Her vast working experiances begins in 1998-1999 as housemanship in Hospital Kuala Lumpur where she covers 4 months in Paediatric Department, 4 months in Surgery Department and 4 months in Obstetric and Gynaecology Department In 1999- 2000 she begin practising as Medical Officer in Pusat Perkhidmatan Darah, Hospital Kuala Lumpur, then in 2000- 2002 as Medical Officer in Pusat Darah Negara. Afterwards in 2002- 2006 in Hospital Universiti Kebangsaan Malaysia and Hospital Kuala Lumpur she enrolled for post-graduate course (Masters in Pathology) in UKM. After she holds her masters she practising at Hospital Tengku Ampuan Rahimah Klang, Selangor as a Haematologist in charge of haematology and transfusion medicine unit form June 2006 to date. She also sits in the Hospital Transfusion Committee member.

SPEAKERS

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MR. WOON SUNG THONG

Mr. Woon Sung Thong Mr Woon is a graduate from University of Malaya and began his career as a Medical Laboratory Technologist in the University of Malaya Medical Centre in Kuala Lumpur from 1968 to 1999. During his tenure there, he was involved in the training and teaching of Medical Technologists, Medical Students, Biomedical Sciences students as well as doctors doing the Master in Pathology program. He is also very active professionally. He is the President of the Malaysian Institute of Medical Laboratory Sciences, Secretary of the Laboratory Quality Assurance Scheme (LABQAS), which is a joint activity with the College of Pathologists Malaysia and a member of the National Medical Testing Accreditation Committee which oversees the implementation of ISO 15189 as well as a ISO 15189 technical assessor.

SPEAKERS

Regionally, he was instrumental and a founder member in the formation of the ASEAN Association of Clinical Laboratory Sciences and he Asia Association of Medical Laboratory Scientists. He is the current President of the ASEAN Association of Clinical Laboratory Sciences and a director of Asia Association of Medical Laboratory Scientists. Today he is a freelance consultant to Sysmex Malaysia Sdn Bhd and Roche Diagnostics.

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CORPORATE TALK 1
HAEMATO-FLOW - THE TREND?
sponsored by: (M) Sdn. Bhd.
by Mr Choong Chuan Yong Most laboratories uses flow cytometers to further and absolute diagnosis of abnormal patient blood samples. In year 2010, Beckman Coulter has launched a new flow cytometric reagents cocktail, CytoDiff to assist haematologists in their diagnosis. CytoDiff is used during Haemato-Flow process to yield a 9 part Flow cytometry differential. Using CytoDiff combining with the haematology analyser will have a final 16 part differential. Haemato Flow from Beckman Coulter not only saves laboratory time and money but also able to standardize the haematology laboratory workflow process which leads to more accurate and consistent results. Haemato Flow CytoDiff is only available from Beckman Coulter and indeed the future of Cell Differential Analysis.

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

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CORPORATE TALK 2
CHANGING THE WAY WE LOOK AT THE CELLS
sponsored by: Laboratories (M) Sdn. Bhd.

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

MORPHOLOGIC CLUES FROM CBC RESULTS

sponsored by: (M) SDN BHD
by Mr Woon Sung Thong Very often times, just by focusing closely at the CBC results together with the histograms and scattergrams, it is possible to have an advanced knowledge of what is to be expected in a peripheral blood film morphology. Take for example an increased RDW CV may signifies RBC anisocytosis but this is not always correct so by relying on RDW SD the correlation is more reliable. A dimorphic blood picture should be suspected if the RBC histogram shows multiple peaks. Much information can also be elucidated from P-LCR and MPV parameters about giant platelets or platelet clumps. Evidence of fragmented RBC or schistocytes could be easily identified from the retic scattergram. Another piece of important information which can be derived from this same scattergram is fragmented WBC. Sometimes it is important to pay attention to the background colour of the smear. If it is bluish it could mean that it is may be a case of multiple myeloma. The overproduction of immunoglobulin by the neoplastic plasma cells (myeloma cells) leads to marked rouleaux formation and an increase in the background staining (often bluish). If upon microscopic examination show otherwise then, heparin contamination of the blood sample should be considered. A series of slides will be presented to illustrate these examples.

LUNCH TALK

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PLENARY TALK 1
CLASSIFICATION OF ACUTE LEUKEMIAS
by Associate Prof. Dr. Surender Juneja University of Melbourne, Australia Within the past 50 years the first significant attempt at classification of acute leukaemias was made in 1976 when the French American British (FAB) Group of investigators proposed a classification, the so called FAB classification. This was a first major step in standardising the terminology & therefore reproducibility. The classification was based on morphology of Romanowsky stained smears and cytochemistry. Subsequently the FAB Group added further subtypes. However the discovery of a number of genetic lesions that predict clinical behaviour & outcome better than morphology alone meant that those data needed to be incorporated into the classification to be clinically meaningful. Based on deliberations of the European Association for Haematopathology & the Society for Haematopathology, in 2001WHO classification was proposed & updated in 2008. The classification aims to define & subclassify leukaemias, standardise the nomenclature as well as gives an idea of the clinical relevance. This classification uses morphology, cytochemistry, immunophenotype, cytogenetic/molecular features & clinical features to define acute leukaemias. Current outline of classification includes:

Acute myeloid leukaemia (AML) not otherwise categorised includes the 7 FAB categories from minimally differentiated AML (M0) to acute megakaryoblastic leukaemia (M7); in addition, there are other AMLs like acute basophilic leukaemia, acute panmyelosis with myelofibrosis & myeloid sarcoma.

AMLs with recurrent genetic abnormalities like t(8;21) (q22;q22), AML with inv (16)(p13.1q22) or APL with (t15;17) are considered as AMLs regardless of the blast count; for all others blasts >20% of peripheral blood or all nucleated BM cells is required.

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In APLs with t(15;17) (q22;q12), variant RARA translocations with other partner genes may not have typical APL features New cytogenetically defined entities t(6;9)(p23;q23); AML with inv (3) and AML (megakaryoblastic) with t(1;22) AML with MDS related changes has replaced AML with multilineage dysplasia & applies to patients with h/of MDS, dysplasia in >50% of cells of at least 2 lineages or myelodysplasia related cytogenetic abnormality Provisional entities AMLs with NPM1 & AML with mutated CEBPA have been added. It is recommended to test for FLT3 mutation in all cytogenetically normal AML

Acute lymphoblastic leukaemias (ALL) are classified as

Precursor B-lymphoblastic leukaemia/lymphoma with various cytogenetic subcategories & T lymphoblastic leukaemia/lymphoma

Acute leukaemias of ambiguous lineage include acute undifferentiated, mixed phenotype or others. The current classification provides an evidence based classification that can be used in daily practice for therapeutic decisions & yet provide a flexible framework for integration of new data. An essential feature of any classification is that it needs to be updated periodically to incorporate new information that has become available. There is no doubt that the current WHO classification will be updated as more new information accumulates.

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OVERVIEW ON THE CLASSIFICATION OF MPD/MDS

by Associate Prof Dr. Rosline Hassan Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia

PLENARY TALK 2

Myeloproliferative neoplasm is a group of myeloid disorders known previously as myeloproliferative disease (MPD) when it was first identified in 1951 by William Dameshek. Later World Health Organization (WHO) 2001 showed a paradigm shift from previous schemes which were based on morphology, cytochemical, immunophenotypic, and clinical information to incorporate genetic information. 2001 World Health Organization (WHO) classify chronic myeloproliferative diseases (CMPDs) as four classic myeloproliferative disorders (MPDs)chronic myelogenous leukemia, polycythemia vera (PV), essential thrombocythemia (ET) and primary myelofibrosis (PMF)as well as chronic neutrophilic leukemia (CNL), chronic eosinophilic leukemia/hypereosinophilic syndrome (CEL/HES) and CMPD, unclassifiable. In the recent WHO 2008 classification, the term CMPDs is replaced by myeloproliferative neoplasms (MPNs), and the MPN category now includes mast cell disease (MCD), in addition to the subcategories mentioned above. These myeloid neoplasms and several new entities were based on molecular pathogenesis, identification of new diagnostic and prognostic markers, and progress in clinical management. Protein tyrosine kinase abnormalities, including translocations or mutations involving ABL1, JAK2, MPL, KIT, PDGFRA, PDGFRB, and FGFR1 have been used as the basis for classifying myeloproliferative neoplasms (MPN). Two new entities - refractory cytopenia with unilineage dysplasia and refractory cytopenia of childhood have been added to the group of myelodysplastic syndromes (MDS).

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PLENARY TALK 3
THE HAEMOLYTIC ANEMIA
by Associate Prof Dr. Narazah Mohd Yusoff Advanced Medical & Dental Institute (AMDI), Universiti Sains Malaysia (USM) Haemolytic anaemia is defined as anaemia due to haemolysis where there is accelerated and abnormal breakdown of red blood cells (RBCs). This may happen either in the blood vessels (intravascular haemolysis) or elsewhere in the human body (extravascular). The general classification of haemolytic anaemia is either inherited or acquired. In the management of patients with suspected haemolysis, the first step is to confirm haemolysis and once confirmed the subsequent step is to find the cause of the haemolysis. Numerous causes are associated with haemolysis and they may share some common features, however some disorders may have characteristics which are unique to those disorders. These are tests for red blood cell destruction and specific tests can identify the types of haemolytic anaemia. They are usually performed when haemolysis is suspected or has been determined. Treatment depends on the cause and nature of the breakdown.

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APPLICATION OF AUTOMATED HAEMATOLOGY

ANALYSER IN MEDICAL DISORDERS
by Prof Han Kyung-Ja Department of Laboratory Medicine, Hospital Catholic Korea Complete blood cell count (CBC) of automated haematology analyzer is one of main laboratory tests for diagnosis and monitoring of medical and haematology disorders. There are many automated haematology analyzer instruments with different methodology. Recently, Beckman Coulter (BEC) launched a new automated haematology analyzer UniCel DxH800 with innovative principle. At first, I would like to introduce Screening of Malaria and Parasite counting using DxH800. Each year, there are more than 225 million cases of malaria, killing around 781,000 people each year according to the latest WHO report. The endemic area is Africa, Asia including southern China and India. Microscopy of blood smear; The gold standard of malaria diagnosis is microscopic examination of the blood. Although it is a rapid, cost effective and easily applicable method, its sensitivity, specificity and precision are low and needs experts technique and experience, labor intensive and timeconsuming. The automated haematology analyzer has been insufficient for detection and counting of Plasmodium in the blood until now. DxH800 shows characteristic malaria signature position on nRBC plots and 5PD plots. And the size of the population is roughly correlated with the parasite count. Next topic is Screening of Sepsis and Other Diseases using Leukocytes Cell Population Data (CPD). DxH800 reports cell population data(CPD) of many blood cell population as an additional data. They reflect many kinds of cellular characteristics. Using combination

PLENARY TALK 4

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of CBC and leukocytes CPD, decision rules for a specific disease could be developed. Decision rule for sepsis will be presented here. Sepsis(bacteremia & fungemia) is a rapidly progressing, life threatening condition that can cause shock and organ failure, if not treated immediately. Sepsis samples showed much difference in many leukocyte CPD comparing to normal sample. Using combination of CBC and CPD, the decision rule for screening of sepsis and other diseases could be developed and easily applied in Lab environment. The last topic is about Reliable, Accurate Leukocyte Differential counting of Leukopenic Samples using Haematoflow. The manual differential of leukopenic samples has very poor precision because insufficient number of cells are counted. And it is very timeconsuming and sometimes very difficult to classify cells. Number of leukopenic samples has been increased rapidly due to increased patients with chemotherapy, radiotherapy and transplantation. Recently, BEC launched CytoDiff reagent with autogating Flow cytometric differential software. Using combination of CBC of DxH800 and Cytodiff results of Flow Cytometry(this combination of Haematology and Flow cytometry is called as Haematoflow), 16-parameters -WBC differential count is achievable. This method showed higher precision and accurate results than manual differential count especially in leukopenic samples.

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PLENARY TALK 5
T HE L YMPHOPROLIFERATIVE D ISORDERS
by Emeritus Prof Dr. SK Cheong Faculty of Medicine & Health Sciences, Universiti Tunku Abdul Rahman The lymphoproliferative disorders are lymphoid neoplasms resulting from clonal proliferation of mature or immature lymphoid cells. Most lymphoid neoplasms have a corresponding normal maturation stage. They may arise from the central lymphoid tissues or peripheral lymphoid tissues. Many classification schemes have been formulated over the years and the most recent is the WHO Classification 2008. This Classification utilises available information to define disease entities to guide treatment and prognostication. For practical purpose, morphology and immunophenotyping by flow cytometry or immunohistochemistry are sufficient to distinguish most lymphoid neoplasms. Some lymphoid neoplasms have characteristic genetic abnormalities. Precursor lymphoid neoplasms are diseases of childhood. T-cell neoplasms often present as lymphoma with mediastinal disease. 90% of the lymphoid neoplasms are mature B cells, of which DLBCL and Follicular lymphoma constitute about 60% of the B-cell malignancies. Most patients with lymphoid neoplasms lack evidence of immune system abnormalities, but patients with immunodeficiencies and autoimmune diseases are at risk to lymphoid neoplasms. The etiology for most lymphoid neoplasms remain unknown. However, EBV, human herpesvirus 8, human TLV I, hepatitis C, H. pyroli, chlamydia and campylobacter have been implicated in some distinct lymphoid neoplasms.

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INTERPRETATION OF BONE MARROW ASPIRATES & TREPHINE BIOPSIES IN HAEMATOLOGICAL DISORDERS

by A/P Dr. Surender Juneja University of Melbourne, Australia Bone marrow examination is a routine investigation performed to assess many haematological & non-haematological disorders. It comprises bone marrow aspirate most often accompanied by a trephine biopsy. Since the aspirate & biopsy provide complementary information, it is exceptional to perform either aspirate or trephine biospy alone. The aspirate smears are stained with one of the Romanowsky stains like the ICSH stain & the trephine biopsies with the haematoxylin & eosin with or without special immunohiostochemical stains. The interpretation of the aspirate is based on examination of a Romanowky stained aspirate smear. This must always be interpreted with the appropriate clinical context, the results of peripheral blood findings ie blood counts & the morphologic examination of the blood smear. It is important that specimens for all ancillary investigations eg flow cytometry, cytogenetics & molecular studies are taken at the time of the procedure & therefore communication between the person doing the biopsy & the one requesting is critical Correlation with trephine biopsy & ancilliary investigations like flow cytometry, cytogenetics & molecular studies may also be required in many cases. For example, the burden of plasma cell infiltrate in myeloma at diagnosis or after treatment is best assessed on CD138 stained trephine biopsy combined with aspirate differential. The

PLENARY TALK 6

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subtyping of lymphoma with marrow involvement often requires correlation with flow cytometry findings and/or immunohistology. Accurate diagnosis & subtyping of leukaemias ofen requires correlation with cytochemistry, flow cytometry & cytogentic/ molecular studies. At our institution the bone marrow aspirate is examined on the day it is performed and the trephine biopsy the next day. A final report combining the aspirate & trephine biopsy is issued. The urgency of reporting depends upon the clinical situation. The aspirate results when diagnostic may be communicated within minutes to hours whereas cases requiring correlation with immunohistochemistry, flow cytometry, cytogenetics or molecular studies may require days. A provisional report may be issued as soon as practical however, it is desirable to issue a final report incorporating all results from all elements of diagnostic studies eg morphology, cytochemistry, immunohistology, flow, cytogenetics & molecular studies. Finally a discussion of the results particularly the difficult cases with the clinician either by phone or at a multidisciplinary meeting will allow clarification & communication of results.

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

ENTRANT REGISTERS
No. 1 2 3 4 5 6 7 9 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Name ABDUL KHADIR MAT (DR) ABDULLAH HAFIZ KAMARUDDIN AEDELLY RAYNER AIDA IBRAHIM ANGELI AMBAYYA ANIS AMIRA JAAFAR (DR) AZHAR ABDUL RAHIM AZILAWATI AZIZAN AZIZON OTHMAN (DR) AZLINDA ABU BAKAR (DR) AZLY SUMANTY AB GHANI (DR) BALAN MENON BASKARAN SUBRAMANIAN (DR) CHOO HUA LEE FAIZATUL SYIMA ABDUL MANAF FARIDAH IDRIS (DR) FATIMAH MD ISA (DR) FAUZANA KAMARUZZAMAN (DR) ELIZABETH GEORGE (PROF DR) GOH BEE HEONG HANAN MAHMOOD (DR) IDA MARHAINIS ISAHAK (DR) ILUNIHAYATI IBRAHIM (DR) JACYKA JAIBI JAZWINA JAUHAR (DR) JESSIE LOI KHAMISAH MOHD GAUS (DR) LEE YIN JONG LEE CHOY HAR Institution JABATAN PATOLOGI, HOSP.TAIPING HAEMATOLOGY,PPSP,USM UNIVERSITI MALAYSIA SABAH PANTAI PREMIER PATH SDN BHD HOSP AMPANG UNIT HEMATOLOGI, HRPZ 11 UNIT HEMATOLOGI,HKL HAEMATOLOGY,PPSP, USM PATOLOGI,HOSP. SEREMBAN Patologi, Hosp Queen Elizabeth H.SULTANAH NUR ZAHIRAH, TRG KLINIK KESIHATAN SEBERANG JAYA UNIVERSITI PUTRA MALAYSIA DRIVE COUNT MEDICAL CENTRE IPPT,PULAU PINANG. UNIVERSITI PUTRA MALAYSIA PATOLOGI,HOSPITAL SERDANG PPUKM HEMATOLOGI,UPM email Fax: 05-8079300 ahafiz@kk.usm.my aellyezra@hotmail.com aida@premierpathology.com.my angeli_100182@yahoo.com dranisamira@moh.gov.my azharahim@hkl.moh.gov.my azilawati@kck.usm.my zizonothmanhtj@gmail.com azlinda74@gmail.com azlysumanty@yahoo.co.uk smbalan28@yahoo.com baskaran72@yahoo.com Syima_am@amdi.edu.my faridah@medic.upm.edu.my fmfati3@yahoo.com.my haustra2002@yahoo.com elizg@medic.upm.edu.my elzageorge@hotmail.com irmawati@premierpathlogy.com.my hananmd@hotmail.com idamarhainisisahak@yahoo.com nurzulaika_amway@yahoo.com drjazwina@phg.moh.gov.my siewthing@alleights.com.my rosnydan@yahoo.com irmawati@premierpathlogy.com.my limhueynee @gmail.com
irmawati@premierpathlogy.com.my

PANTAI PREMIER PATH SDN BHD HOSPITAL KUALA LUMPUR JAB.PATH, HOSP. KUALA LUMPUR UNIT HEMATOLOGI, HRPZ 11 UNIVERSITI MALAYSIA SABAH PATOLOGI,HOSHAS,TEMERLOH ALL EIGHTS SDN.BHD HOSP RAJA PERMAISURI BAINUN PANTAI PREMIER PATH SDN BHD HOSP.RAJA PERMAISURI BAINUN ,IPOH LIM HUEY NEE UNIVERSITI MALAYSIA PERLIS LIM JOO SIANG PANTAI PREMIER PATH SDN BHD MADYAH ABDUL MONIR (DR) UITM KAMPUS SG.BULOH. MAIMUNAH ISMAIL HOSPITAL GRIK MARINI RAMLI (DR) HEMATOLOGI,PPSP,USM MAZRUL EFFENDYDUKOT SOEHARTO PATHOLOGY,HOSP. SG BULOH

madyhahmonir@yahoo.com 019-9457612 (ABD RAHMAN) marini@kb.usm.my FAX; 03-61562645

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ENTRANT REGISTERS
No. 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 Name MOHD NAZRI HASSAN (DR) MOHD SALIM ZULKIFLI MOHD SYAHRUL JOGRI MAT ZAIB MOHD TOHIT EUSNI RAHAYU (DR) MOHD YAZID RAMLI MOHAMAD BASIR SELVAM ABDULLAH MUHAMMAD AZNEE AZMAN MUHAMAD HAMIDI HAMID MUHAMMAD JAVED ASIF (DR) Institution email HSP SLTNH NUR ZAHIRAH nazrihas@yahoo.com HOSP.TUANKU JAAFAR,SEREMBAN ms2_salim88@yahoo.com PATOLOGI DEPT. H.SUNGAI BULOH Fax: 03-6156245 FAC. MED, UPM eusni@medic.upm.edu.my JAB.PATOLOGI,HOSP. S.JAYA sallypp@ppg.moh.gov.my IPPT,PULAU PINANG. PANTAI PREMIER PATH SDN BHD irmawati@premierpathlogy.com.my PUSAT KESIHATAN DAERAH GRIK 019-9457612(ABD RAHMAN) SHAIK ZAYED MEDICAL COMPLEX, mjavedrana@gmail.com LAHORE,PAKISTAN MUHAMAD SYAFIQ SHARIAN HOSP.KUALA KANGSAR syafiqsharian@prk.moh.gov.my MUNIRAH ABD RAZAK (DR) PATOLOGI,HOSP. SEREMBAN MUSTAFA LANGA (DR) HAEMATOLOGY,HUKM mustafalanga@yahoo.com NADIATUN ZAWIYAH SUPARDI UNIVERSITI MALAYSIA PERLIS nadiatun@gmail.com NARAZAH MOHD YUSOFF(PROF MADYA) IPPT,USM, KEPALA BATAS narazah@amdi.usm.ed.my NATASYA ANNE ASOKENDARAN (DR) PPUM/HKL natasha_ashok@yahoo.com NAZRI ABDUL MUTHALIB (DR) HOS. SULTANAH BAHIYAH naz81@yahoo.com NIK HAFIDZAH NIK MUSTAPHA (DR) HOSP.TUANKU JAAFAR,SEREMBAN nikhafi@yahoo.com NIK MUHD KHUZAIMI NIK MAN HEMATOLOGI,PPSP.USM NIZMAH MAHANI MOKHRI (DR) PATHOLOGY ,H.QUEEN ELIZABETH salt-pepper@hotmail.com NOOR HASLINA MOHD NOOR (DR) HAEMATOLOGY,PPSP,USM drhaslina@kb.usm.my NOORME ZAIHANE NORDIN PANTAI PREMIER PATH SDN BHD irmawati@premierpathlogy.com.my NOORULHUDA MOHD MOKHTAR (DR) HEMATOLOGI,USM drnoorul@yahoo.com NOR KHAIRUL PUTRA MOHD MADI HAEMATOLOGY,HUSM nkputra@kck.usm.my NORMALA ABD MALIK PANTAI PREMIER PATH SDN BHD irmawati@premierpathlogy.com.my NOR SUHAILA MD RIFFIN (DR) PATOLOGI,H. SULTAN HJ AHMAD Norsuhaila.mv@phg.moh.gov.my SHAH,TEMERLOH, PAHANG NORAHNINZU ARIFIN (DR) HEMATOLOGI,USM drnora03@gmail.com NORASYIKIN MOHAMAD AZMIE (DR) PATOLOGI,H.TENGKU AMPUAN AFZAN Ikin300@yahoo.com NORAZLINA AZMAN (DR) PPUKM anorazlina@yahoo.com NORITA OSMAN NATIONAL BLOOD BANK norita.osman@pdn.moh.gov.my NORSIMA NAZIRAH SIDEK UNIVERSITI MALAYSIA PERLIS norsima.sidek@gmail.com NOR ZILAH MOHAMAD INSTITUT PERUBATAN RESPIRATORI Fax: 03-40218807 NUR ASMA MOHD NAWI HOSP AMPANG pellucid_placebo@yahoo.com NURHANANI AHMAD (DR) PATHOLOGY,HOSP. SG BULOH FAX; 03-61562645 NUR HAZYYAH HASSAN HEMATOLOGI,USM nur_hazz83@yahoo.com NUR ILANI NOH PATOLOGI,HOSHAS,TEMERLOH elainesmile85@yahoo.com

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

ENTRANT REGISTERS
No. 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 Name Institution NURUL AIN FATHMA ABDULLAH HEMATOLOGI,PPSP.USM NURUL FATHIHAH MOHD JALIL PATOLOGI ,HOSP.SLIM RIVER NURULHUDA ABD KADIR (DR) PATOLOGI,HOSP.SEBERANG JAYA NURUL HAZWANI ABD. HALIM UNIVERSITI MALAYSIA PERLIS NURUL SYUHADA MUHAMED ZAINI HOSP.BALIK PULAU,PENANG NURUL ZHAFIKHA NOOR RASHID UNIVERSITI MALAYSIA PERLIS PIM CHAU DAM (PROF MADYA) PPSK, USM PRATHIBA BALAIKERISHNAN PATOLOGI ,HOSP.SLIM RIVER RAFIZA ROSLIN PATHOLOGY,HOSP. SG BULOH RAHIMAH AWANG HOSP AMPANG RAPIAAH MUSTAFFA (PROF MADYA DR) HEMATOLOGI,USM RASHIDAH MOHAMED (DR) HOSP AMPANG ROHANI BAKAR IPPT,PULAU PINANG ROMINA GREY MELVIN UNIVERSITI SARAWAK ROSLAN ABD AZIZ HOSP KAJANG ROSNAH BAHAR (DR) PPSP, USM ROZIAH ABDUL TALIB JABATAN PATOLOGI, HOSP.TAIPING RUSMAWATI ISMAIL (DR) H.TENGKU AMPUAN AFZAN,KUANTAN SABARIAH MD NOOR (DR) UNIVERSITI PUTRA MALAYSIA SALIM AHMAD PATHOLOGY,HOSP. SG BULOH SALMAH ARSHAD (DR) JAB.FORENSIK,HOSPITAL SERDANG SHAFINI MOHAMED YUSOFF (DR) HAEMATOLOGY ,USM SHAHIZAN MAT JENAN NATIONAL BLOOD BANK SHAIFFUL FIRDAUS JAMALUDDIN HAEMATOLOGY,HUSM SHARIFAH MAI SARAH SYED AZIM (DR) PPUKM SITI AINI SYAZRAH MOHAMAD (DR) JAB.PATOLOGI ,HKL SITI FAIRUZ HASHIM (DR) PATOLOGI,H.TENGKU AMPUAN AFZAN SITI NURUL HAWA ABD RASHID PUSAT KESIHATAN DAERAH GRIK SITI ZUBAIDAH MUSTAPHA (DR) HEMATOLOGI,HTAR,KLANG SRLY SAMAN IPPT, PULAU PINANG SUHAIR ABBAS AHMED (DR) PPSP, USM SUHANA HASHIM JAB. PATOLOGI ,HRPZ II SURYATI ABDULLAH HAEMATOLOGY,PPSP,USM SURYATI HUSSIN (DR) PATOLOGI, HOSP.KUALA KRAI SUZIANA MOHD NASIR (DR) JAB.PATH, HOSP. KUALA LUMPUR email ainfathma@yahoo.com fatimask1@gmail.com Fax: 04-3970751 nurul.hazwani43@yahoo.com bengleowtan@ppg.moh.gov.my fikha.rashid@gmail.com pimcd@kb.usm.my fatimahsk1@gmail.com FAX; 03-61562645 rahimahawang@gmail.com rapiaah@kb.usm.my drrashidah@gmail.com rohani@amdi.edu.my rominagreymelvin@yahoo.com.my roslanabdaziz@sel.moh.gov.my rosnah@kb.usm.my FAX: 05-8079300 rusmahtaa@gmail.com sabariah@medic.upm.edu.my FAX; 03-61562645 dr_sallazrin@yahoo.com shafini@kb.usm.my shah.izan@pdn.moh.gov.my sfirdaus@kk.usm.my ummnaufal@yahoo.com.my sashm_1978@yahoo.com faeruze@yahoo.com.my 019-9457612 (ABD RAHMAN)
mustaphasitizubaidah@gmail.com

ahmed_suhair@yahoo.com Sana0304@yahoo.com suryati@kck.usm.my

neurosciencessuryati@yahoo.com

suzinasir@yahoo.com.my

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

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ENTRANT REGISTERS
No. 106 107 108 109 110 111 112 113 114 115 116 117 118 119 120 121 122 123 124 Name TANG YEE LOONG (DR) THATCHEIANY KUMARIAH (DR) TOH SEE GUAN (DR) Institution UNIERSITI KEBANGSAAN MSIA UNIVERSITI MALAYA DEPT.OF HAEMATOLOGY HOSP.P.PINANG TUAN HULWANI T. MOHAMMAD (DR) HOSP.PULAU PINANG TUAN NOR BALIZA HOSP.RAJA PERMAISURI BAINUN ,IPOH UMA PONNUDURAI (DR) JAB.PATH. HOSP.KUALA LUMPUR WAI ZHUO HAN MERCK SDN. BHD. WAN AMAL HAYATI WAN HASSAN (DR) PATOLOGI,H.TENGKU AMPUAN AFZAN WAN ASMUNI MOHD SAMAN (DR) HEMATOLOGI,USM WAN HAYATI MOHD YAAKOB (DR) HTAR, KLANG WAN LIZA WAN NORDIN PATOLOGI,HOSP.KUALA KRAI WAN SURAYA WAN ALI INSTITUT PERUBATAN RESPIRATORI WAN SURIANA WAN AB RAHMAN (DR) PP.SAINS PERGIGIAN , USM WOO YEE SUET PANTAI PREMIER PATH SDN BHD YOGESWARY A/P SWARAJA PATHOLOGY,HOSP. SG BULOH YUSLINA MAT YUSOFF (DR) PPUKM ZAMRI AHMAD HOSP. MELAKA ZEFARINA ZULKIFLI (DR) PPSK, USM ZUBAIDAH ZAKARIA (DR) IMR, JLN PAHANG ,KUALA LUMPUR email tangyeeloong@yahoo.com
thatcheianykumariah@yahoo.com.my

sg_toh@yahoo.com.my tnhulwani@yahoo.com.my umaponnudurai@yahoo.com

wai.zhuo.han@merckgroup.com

amalyati@yahoo.com wanasmuni@hotmail.com hayatiwan_03@yahoo.com wayercarat@yahoo.com Fax; 03-40218807 suriana@kb.usm.my

irmawati@premierpathlogy.com.my

FAX; 03-61562645 kashalina@hotmail.com zamri.a@mlk.moh.gov.my zefarina@kb.usm.my -

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

SPONSORS

DPC HEALTHCARE SDN BHD

1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

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APPRECIATION

UNIVERSITI SAINS MALAYSIA (USM) SPONSORS PARTICIPANTS ORGANIZING COMMITTEE INDIVIDUALS

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1st Malaysian Society of Laboratory Haematology Scientic Meeting 2011

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