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10 September 2008
Teruja sangat nak berhari raya!
Bagi Fa-iz perhimpunan keluarga sebegini ini memang amat dinanti-nantikan kerana melaluinya kita dapat mengenali antara satu sama lain dan merapatkan silaturrahim. Bayangkanlah anakanda kepada Wan Mohamed saja dah 10 orang dan cucu-cucu dah hampir 50 orang. Berkumpul pula bersama-sama keluarga adik beradik Wan Mohamed yang lain. Satu perhimpunan besar keluarga yang dijangka menjangkau lebih 500 orang rasanya.
Semoga usaha pihak penganjur ini berjaya dan berjalan lancar. Teruja sangat nak berhari raya!
09 September 2008
Salam Aidilfitri dari Dublin

SALAM Aidilfitri kami tujukan istimewa buat ayahanda bonda dan keluarga tercinta, saudara mara, sahabat handai serta kenalan kami yang berada di seluruh Malaysia terutama di Negeri Sembilan, Melake, Pahang dan Johor. Tidak lupakan juga kepada pensyarah Kolej Universiti Islam Selangor, Kolej Dar Al-Hikmah dan KMB. Doakan kejayaan kami di Dublin, Ireland. Selamat menjalani ibadah puasa, Selamat Hari Raya, maaf zahir Batin. Dari kiri: Diana, Fairuza Feerhana dan Izdzatun Nasyiah.
05 September 2008
Jejak Kasih (Siri II)
Siri kedua kali ini aku fokuskan kepada kengkawan di SMAD Titi Besi, Kepala Batas. Sekolah ini terletak kira-kira 10 KM dari bandar Alor Star berhampiran sangat dengan Lapangan Terbang Sultan Abdul Halim. Aku start masuk sekolah ni pada penghujung 2004 dan ditempatkan di tingkatan dua, kira-kira beberapa minggu je lagi nak periksa hujung tahun. Di sini bermulalah era persekolahan formal aku dan sepanjang di sekolah ini juga beberapa kali jugakla aku keluar masuk asrama (bukan kena buang asrama tau tapi kengkononnye nak fokus belajar). Boleh kata satu kejutan budaya jugak la kat aku bila belajar kat sini.
Tahun 2005 aku amik PMR dan alhamdulillah taklah mengecewakan sangat bolehlah 2A. Ok per belajar setahun jer beb!. Masuk form 4 aku berulang dari rumah di Taman Mahsuri, Jitra. Dan tahun ni pun aku ada amik exam arab (SMRA) dan alhamdulillah resultnya pun ok aku dapat maqbul jer. Okla tu!. 1997 aku kembali ke asrama masa tu parent semua dah balik ke N9 tinggallah aku sensorang kat sana. Tahun tu jugak aku amik SPM dan resultnya taklah gempak sangat tapi steadyla. Kalau susun ikut ranking laki-laki aku dok top ten jugakla. Hehehe. Tapi yang paling aku ingat, tahun tu raya haji tak balik sebab nak dekat ngan periksa. Aku balik raya rumah Mat Zaki Saad kat Pokok Sena.Masa dok asrama memang banyak kenangan. Teringat aku kat ustaz Kamil dan arwah ustaz Long. Hari-hari kena ligan kalau tak pergi sembahyang kat surau. Kalau dapat kat diorang alamat berbiratlah kat kaki. huhuhuh...sian kat aku. Tapi yang paling best bila time outing, memang tak pernah nak balik ikut waktu yang ditetapkan, paling tidak pun kitorang balik masa lepas abis prep. Lubang kat pagar kat hujung bangunan tu lah yang jadi port kitorang masuk. Dan yang paling best sepanjang penglibatan aku alhamdulillah tak pernah kantoi lagi la. Huhuhu.

Ni otai asrama ni...huhuhu. Kamcing diorang ni ngan ustaz Kamil tapi geng aku balik malam jugak ni...sebab tu aku tak kantoi...hehehe. Gambar ni masa kita orang gi Bukit Hijau masa tu aku baru dapat lesen. Sewa kereta sebijik ronda dari pagi sampai malam.

Ni pulak kat bilik ketua dorm, port bebudak malas pergi surau, konfom waden pun tak kacau bilik ni. Ketua konon! Hampehla korang!
Banyak dengan diorang ni aku dah lost contact, entahla masing2 dah bawa diri. Setakat yang aku pernah jumpa lepas abis sekolah dulu antaranya wan lah (MPI), fakhrul, zaki yaman, hanif (Kisdar), spotlight (Seremban) tapi itu pun 7-8 tahun dulu. Wan lah masa kat MPI dulu selalu jugakla aku jumpa tapi bila dah posting ke mana entah dia pun terus hilang. Cuma yang aku dah jumpa dalam tahun ni Mat Deris dan adiknya. Kebetulan umah Mat Deris kat Tokai ni dekat ngan kampung Pak Mertua aku.
Last sekali, takziah aku ucapkan kepada keluarga arwah ustaz Long, ustazah Khairiah, Pak Cha dan lain-lain yang telah kembali ke rahmatullah. Al-fatihah.
31 August 2008
Jejak Kasih (Siri I) - Update!
Pada kesempatan ini diucapkan Selamat Menyambut Ramadhan Al-Mubarak. Semoga kehadiran bulan yang penuh keberkatan ini dapat dipenuhi dengan amalan-amalan sunat dan lebih baik dari bulan Ramadhan yang lalu.
Mengimbau kembali zaman pra-remaja teringat zaman belajar di sebuah "sekolah pondok" di daerah Kota Star yang terletak di antara jalan Bukit Pinang - Langgar. Banyak sekali pengajaran yang diperolehi sepanjang menuntut ilmu agama di sekolah ini. Satu dinamakan Madrasah As-saadah dan satu lagi dinamakan Madrasah Al-Irsyadiah. Sesekali terkenangkan sawah padi, panjat pokok rambutan, mandi sungai, meredah 'bah', naik motor kapcai pastinya teringat tempat yang dinamakan Lepai ini.
Paling tidak dilupakan kawan-kawan yang turut sama berjuang semasa dalam zaman pengajian "sekolah pondok" ini. Teringat pada zam, shidi, husni, mujahid, pakya, cikgu lah, zahir, nasir (chet), sir jaafar, zaki saad, din pisang, zamri, adi belacan, awang, tebuan, wan tepui, din kura, pendek, shuib, rozek, sodri, haikal, asri, shahrin sawai antara pelajar dan penduduk berhampiran sekolah ini. Tidak dilupakan juga pelajar yang di luar Kedah antaranya zul dan adiknya, kaman, sopi, yuz, mamat, atan, abang din, azrul penang dan kakaknya, madihah dan adik-adiknya, bob sungai petani, ilyas tebu, reza dan lain-lain yang namanya tercicir dari senarai ini maklumlah tahun 1994 adalah tahun terakhir aku disini. 1994 - 2008, 14 tahun mana mungkin lagi dapat mengingati kesemuanya. Yang ada dalam ingatan inipun sekadar dapat mengingati nama sahaja, berselisih bahupun belum tentu dapat dikenal.
Cuma dari senarai diatas ini, sebahagiannya telah dapat aku hubungi terutamanya ketika menjemput ke majlis perkahwinan aku pada tahun 2006 yang lalu. Antara yang hadir masa tu zul dan mujahid dan selang beberapa bulan lepas tu aku seisi keluarga pula pergi ke kenduri zul. Terbaru aku jumpa mamat JB di masjid negara, bini majistret tuuuuu. Masa balik kampung bini aku raya cina tahun ni aku berkesempatan jumpa husni, din kura, shuib, kaman, azrul kat rumah/tempat masing-masing. Zam, sodri ngan zaki saad aku dah ada berbalas mesej tapi tak kesempatan lagi nak jumpa lagi. Wan tepui, shidi aku ada juga jumpa masa diorang promote MLM kat aku. Beriya-iya nak jumpa aku ingatkan nak tanya khabar aku tup tup mintak join MLM diorang cehhhh terkena aku.
Itu je la mesej aku kat sini, saja nak cari kengkawan. Siri I ni aku khaskan untuk budak Lepai, siri II aku nak cari budak Titi Besi dan seterusnyala aku cuba menjejak kasih dengan semua rakan taulan yang pernah menjalin persahabatan ngan aku. Sebagai menyahut cabaran ko mamat, aku siarkan gambar2 budak "sekolah pondok" yang adalam simpanan aku. Aku rasa ada lagi gambar2 dalam simpanan aku tapi ntah ke mana la agaknya. Paling aku ingat gambar posing ala-ala 4u2c kat tengah bendang. Aduuuuh kena carik tue...


UPDATE!
Ni gambar-gambar yang baru aku jumpa...selak pi selak mai alhamdulillah jumpa gak...tapi gamba ko jugak yang aku takdak mamat...hahahah

Pak yeh dimana kamu sekarang ya? Kamu meniaga tebu lagi tak?

Dah jumpa...gambar ni la yang aku bgtau ala-ala 4u2c ni...ni silap-silap boleh buat cover album ni...

Pehhhh...Mak ndak bila dah posing maut ngan spek mata hitam...mamat duo orang belakang yus tu sapa ek...lupa la...apa namaaaaa...
30 August 2008
51st Merdeka: Proud of his name despite the ribbing
NST
PASIR MAS: Mohd Merdeka Che Soh has always had to put up with the ribbing from friends because of his unique name.
Mohd Merdeka, who will be as old as the nation tomorrow, said his friends would always insist on calling him "Merdeka" instead of "Mat", which was what he was popularly known as among the people in his village.
"I know from the way they called me 'Merdeka' that they were poking fun at me. After calling my name, they would smile and laugh.
"I would normally just ignore them and walk away," he said when met at his house in Kampung Jias, near Kasa here recently.
Mohd Merdeka Che Soh is all for unique names
"My father, a padi farmer, kept telling me that one day I would be proud of my name. I also spoke to a teacher and he advised me to be patient," Mohd Merdeka said.
Mercifully, the jokes stopped when he entered Universiti Sains Malaysia.
"Friends did not joke about my name but they were curious to know why my parents gave me such a name. I explained the reasons to them and they understood."
The father of six said he finally realised the truth of what his father had told him when he was at the university.
"During my time at the university, I learned that the name was actually a great name and only a few people had it. Since then, I have never thought of changing it," said Mohd Merdeka.
Despite being tormented by his friends when he was younger, Mohd Merdeka is all for unique names.
"For instance, a name like Syawal will remind us of Hari Raya."
On his plans for the Merdeka celebration, he said he would be attending the state-level celebrations.
"Although I will not be celebrating Merdeka Day with the nation in Kuala Lumpur, I will be celebrating my birthday with my family and friends."
Merdekakah kita?
Merdekakah kita hanya kerana kita sebut MERDEKA berkali-kali?
Merdekakah kita hanya disebabkan penjajah tiada lagi?
Merdekakah kita hanya kerana Perdana Menteri pilihan sendiri?
Merdekakah kita hanya kerana iklan berseri-seri?
Namun
Merdekakah kita jika masih ada lagi yang hidup menagih simpati?
Merdekakah kita kerana dadah masih lagi jual beli?
Merdekakah kita jika menjadi kuli dibumi sendiri?
Merdekakah kita jika daya juang masih boleh dibeli-beli?
Merdekakah kita jika niat hanya untuk memburukkan bangsa sendiri?
Merdekakah kita kebahagiaan dan keamanan tidak boleh digerenti?
Merdekakah kita? Merdekakah kita? Merdekakah kita?
25 August 2008
26 Ogos 2008 - Menuju Kebahagiaan
kebetulan. Tarikh ini pasti diingati andai tsunami politik yang melanda dalam PRU-12 terus hangat lagi. Perubahan yang ditunggu-tunggu sejak era reformasi yang tercetus pada tahun 1999 tak dapat dibendung lagi. Rakyat mahukan perubahan...Menuju Kebahagiaan!06 August 2008
Hikmah Tahnik dan Tahliq
Daripada Abu Musa, katanya: Aku mendapat anak lelaki, lalu aku bawa dia kepada Nabi (sallallahu alayhi wasalam) dan baginda namakan dia dengan Ibrahim dan mentahnikkannya dengan sebijik kurma. Imam Bukhari menambahkan: Nabi s.a.w. doakan untuknya keberkatan, kemudian baginda serahkan dia kembali kepadaku”.HR Bukhari dan Muslim
Tahnik & Tahliq
Tahnik maknanya menggosok kunyahan tamar dengan telunjuk kanan pada gusi dan langit-langit bayi yang baru lahir. Gerakan ke kiri dan ke kanan bahagian dalam mulut bayi hendaklah dilakukan dengan lembut sehingga sampai manisan korma itu ke semua bahagian dalam mulut. Jika tidak ada kurma (tamar), boleh juga digunakan benda-benda manis lainnya seperti madu.
Tahliq pada hari ketujuh kelahiran (Riaszahra)
Tahliq maknanya mencukur habis rambut bayi hingga botak samada bayi lelaki atau bayi perempuan. Sebaiknya tahlig ini dilakukan pada hari yang ketujuh daripada kelahiran. Rambut tersebut hendaklah ditimbang dengan emas atau perak atau wang yang kemudian jumlah itu disedekahkan kepada fakir miskin.
Pencukuran itu dapat memperkuat penglihatan, penciuman dan pendengaran bayi serta dapat menghilangkan keracunan pada pori-pori rambutnya. (Lihat kitab: Tuhfatul Maudud dan Tarbiyah Al-Awlaad).
Bersedekah sejumlah wang yang ditimbang sama berat dengan rambut bayi itu kepada fakir miskin atau sesiapa yang berhak menerimanya mengandungi unsur-unsur kemasyarakatan. Diharapkan semoga setelah bayi itu dewasa kelak ia akan menjadi manusia yang dermawan dan suka menolong anggota masyarakat yang kurang bernasib baik.
- Menggunting rambut bayi sejemput sini dan sejemput sana (tidak teratur)
- Menggunting atau mencukur bahagian tengah kepala bayi dan membiarkan rambut bahagian tepi kiri dan tepi kanannya.
- Menggunting atau mencukur bahagian tepi kiri dan kanan, tetapi membiarkan bahagian tengahnya.
- Menggunting atau mencukur bahagian depan kepala bayi dan membiarkan bahagian belakangnya atau sebaliknya (jambul)
Rujukan : http://www.al-nidaa.com.my
21 July 2008
Puteraku Uwais Razique (10.07.2008)
10 Julai 2008, lahirlah seorang putera Uwais Razique tepat jam 11.36 pagi. Dengan berat 3.1 kg, isteriku selamat melahirkannya secara normal di Pusat Perubatan Kohilal, Taman Melawati, Kuala Lumpur. Kini tanggungjawab kami semakin berat dalam mendidik dan mengasuh kedua-dua putera dan puteri kami agar menjadi seorang insan yang taat dan patuh kepada ajaran-Nya. Doakan kami agar diberikan kekuatan dan ketabahan dalam memberi tunjuk ajar kepada mereka.
01 July 2008
Al-fatihah untuk arwah 'Aruk'
Hari ini genap satu minggu arwah Fairul aka 'Aruk' meninggalkan kita. Arwah dikhabarkan meninggal secara mengejut dirumahnya sebelum disahkan meninggal di hospital. Secara peribadi aku memang tak close sangat dengan arwah tapi kami bekerja di tingkat yang sama, kadang-kadang saja aku bertegur sapa itupun ketika terserempak di tempat punch card, restroom mahupun di lif. Pada aku arwah seorang yang sangat rajin bekerja, peramah dan baik hati.
Di kesempatan ini diucapkan takziah kepada keluarga arwah Aruk dan juga pada sesiapa yang mengenali beliau. Semoga rohnya dicucuri rahmat dan ditempatkan bersama-sama orang yang soleh. Amin. Al-fatihah
27 June 2008
Happy Birthday Sayang...
23.06.08 - Selamat Hari Lahir!
Sudah setahun Riaszahra, kini baru nak bertatih...sehari dua atau semingu dua lagi lajulah lagi kakak berjalan...Insyallah
Semoga dimurahkan rezqi dan menjadi anak yang solehah...amin
04 June 2008
Countdown : Riaszahra Birthday
04.06.08 - 19 hari lagi
23 Jun 2008 : (Bakal) Genaplah usia setahun Riaszahra. Kakak tak nak lagi merangkak tapi kakak nak berjalanlah abah! hehehe...masih lagi berpaut pada kerusi, dinding untuk bertatih sambil melepaskan sebelah tangan. Go kakak go...nanti dah cukup setahun kakak mesti boleh jalan ok! Kakak sambut besday nanti kat umah Paroi tau...
Insyallah kalau takde aral mungkin minggu ni atau minggu depan berpindahlah kitorang anak beranak ke Paroi setelah ayahanda mula berpencen bulan lepas. Selamat tinggal Podeh...Selamat tinggal Rombau...
27 May 2008
WIPO NATIONAL SEMINAR ON MADRID PROTOCOL AND ITS IMPLEMENTATION
Each year, increasing number of trademark owners use the Madrid system to protect their trademarks abroad. Governed by the Madrid Agreement of 1891 and the Madrid Protocol (in operation since 1996), the Madrid system offers the possibility to obtain trademark protection in the countries of the Madrid Union by filing a single international application. To date, the Madrid Union has 82 members
The Madrid system for the international registration of marks was established in 1891 functions under the Madrid Agreement (1891), and the Madrid Protocol (1989). It is administered by the International Bureau of WIPO located in Geneva, Switzerland.
Overview
The seminar will be conducted by WIPO speakers. It aims at increasing awareness and practical knowledge of the system among actual and potential users, whether in industry or in private practice. In addition, ample time will be reserved for discussion and practical exercises.
All aspects of the international registration procedure and relevant administrative and legal questions will be dealt with in detail.
19 May 2008
It’s China again
The duo pulled off a sensational 21-12, 19-21, 21-12 win over the more fancied Lee Jae-jin-Hwang Ji-man to give China the winning point in a 3-1 victory over South Korea in the Thomas Cup final.
It was the third consecutive win in the series and seventh overall for China since they made a winning debut in the world men's team championships in London in 1982.
The other two points for China last night were won by world number one Lin Dan and world number three Bao Chunlai.
China dropped a point in the first doubles through Cai Yun-Fu Haifeng, who were blown away by All-England champions Jung Jae-sung-Lee Yong-dae 23-25, 16-21.
It was dejection for the Koreans as they saw their hopes of winning the Thomas Cup go up in smoke. But still, the Koreans can walk tall for reaching their first-ever final and bowing out fighting in the final.
The first match of the night between Lin Dan and Park Sung-hwan set the tempo for the keenly contested tie.
Lin Dan came charging back after losing the first game tamely at 10-21. With more ferocity in his attacks, a pumped up Lin Dan slowly broke Sung-hwan resolve in the second game, winning 21-18. After winning the decider at 21-8, he celebrated as though China had won the Cup.
He bowed to the spectators, waved repeatedly and even threw his shirt to the delight of the thousands of spectators in the stadium.
“I am so happy to have delivered the first point. There was so much of pressure,” said Lin Dan, who crashed to a tame defeat by Malaysia's Lee Chong Wei in the semi-finals on Friday.
But China's celebration died off briefly in the first doubles when Jae-sung-Yong-dae fought tooth and nail to level the tie, beating Cai Yun-Fu Haifeng 25-23, 21-16.
In the second singles, Lee Hyun-il gave Chunlai a run for his money in the first game. Hyun-il took a comfortable lead at 14-11 and raised hopes on the Korean ability to lift the Cup but Chunlai refused to buckle.
Chunlai fought back, unleashing his deadly smashes to keep pace with the Korea and hung on for a 28-26 win.
In the second game, Chunlai had no problem against the demoralised Hyun-il, romping home for a 21-11 win.
The lanky Chunlai, who had beaten Hyun-il with less effort in their last five meetings, said: “I certainly did not expect the first game to be so close.
“He (hyun-il) put so much pressure on me but after the deuce, I was more determined. I stayed focused and I am very pleased, I was able to overcome the pressure,” he said.
13 May 2008
Intercontinental Cup: Adebayor in Togo cast
ARSENAL fans could be in for a treat as their top scorer Emmanuel Adebayor may be in the Togo squad featuring in the Intercontinental Cup from May 15-25. Togo are the replacement team for Ghana.
Although the tournament’s organiser has yet to confirm whether Adebayor will be heading here, his name is on the 18-man list.
Meanwhile, Kedah striker Mohd Khyril Muhyamee Zambri is looking forward to partnering Negri Sembilan’s Mohd Zaquan Adha Abdul Radzak in Malaysia’s attack.
Selangor striker Safee Sali and defender Aidil Zafuan Abdul Radzak, Zaquan’s twin brother, have been ruled out of the tournament due to injury.
Khyril, who scored in Malaysia’s 1-1 draw with Maldives in a friendly on Saturday, said: “I haven’t played with Zaquan since the Korat SEA Games last December but we have played together since 2005.
“It’s just a matter of resuming an old partnership.” Malaysia start their campaign in Group A against Ireland while the opening tie will be between Nigeria and Iraq.
Group B comprises Australia, Croatia, Chile and Togo.
Group A matches will be at the Petaling Jaya Stadium while Group B fixtures are contested at the KLFA stadium.
THE MALAYSIAN SQUAD: Goalkeepers: Mohd Nasril Nourdin (Perak), Syed Adney Syed Hussein (UPB-MyTeam), Mohd Farizal Marlias (Shahzan Muda).
Defenders: Norhafiza Zamani Misbah (Pah), Ahmad Azlan Zainal, S. Subramaniam (Prk), Mohd Nasriq Baharom (Sel), Chun Keng Hong (Pen), Mohd Aidil Zafuan (NS), Zairul Fitree Ishak (Kel), Mohd Daudso Jamaluddin, Sumardi Hajalan (Joh FC).
Midfielders: Mohd Shukor Adan, Safiq Rahim, Mohd Asraruddin Putra (Sel), Azi Shahril Azmi (Per), Mohd Khyril Muhymeen, Badrol Bakhtiar (Kdh), S. Kunalan, Shahurain Abu S amah (NS) , Mohd Bunyamin Umar, Mohd Zamri Chin (UPB-MyTeam).
Strikers: Mohd Safee Sali, Mohd Amirulhadi Zainal (Sel), Mohd Zaquan Adha (NS), Norsharul Idlan Talaha (UPB-MyTeam), Mohd Ashaari Shamsuddin (Ter).
08 May 2008
The problems of having too many blood cells in the elderly – an appraisal.
MOST of us are somewhat familiar with medical problems related to lack of blood cells in our body.
For instance, lack of red cells leading to low haemoglobin gives rise to anaemia. Haemoglobin (Hb) is the carrier protein for oxygen. Anaemic patients complain of feeling tired and shortness of breath on exertion, and a sudden onset of severe anaemia may lead to heart failure – the result of reduction in oxygen delivery at tissue level.
Running low of white cells (WBC), especially neutrophils (neutropenia), can be problematic as neutrophils are the first line defenders against foreign invaders such as bacteria or fungi. Hence neutropenic patients are prone to infection, which could be deadly.The last blood cells of importance are the platelets, which at low levels (thrombocytopenia), could lead to bleeding tendency as platelets are the major ingredients for forming a stable haemostatic plug or clot to stop bleeding.
The awareness to problems related to excessive amounts of blood cells may not be as high because these problems are not as common as cytopenia (i.e. anemia, neutropenia or thrombocytopenia) and also the complications related to these conditions not as well recognised.
However there are immediate and present dangers associated with excess blood cells and a few patients can land themselves with some nasty long-term complications.
How are blood cells produced in normal circumstances?
The bone marrow produces blood cells in an orderly fashion. It is like a factory that assembles the cells in three production lines and has a back-up reserve of up to six times capacity to step up the production if so needed.
Our blood counts i.e. red cells, white cells and platelets, are generally kept at a very steady narrow range for each individual. For example the normal range for WBC is between 4 to 11 x10^9/L. There are circumstances whereby WBC count increases, for instance in infections or after injuries. However, the elevated WBC count will return to normal once the infection settles.
Similarly the Hb can be high when a person is dehydrated but again Hb will settle once the body fluid balance goes back to the normal state.
What happens if the blood cells continue to be high and continue on an upward trend?
Something has gone wrong in the normal “control” of blood cell production. The medical term to describe this disorder is myeloproliferative disorder (MPD) and there are four subtypes of MPD:
1. Polycythemia rubra vera (PRV): The number of red blood cells is elevated
2. Essential thrombcytosis (ET): Platelets are elevated
3. Myelofibrosis(MF): increase in fibrous tissues in marrow
4. Unclassified: mixed picture
It is important to recognise the various subtypes as the disease course and treatment plans may differ.
The main clinical features of these diseases are the overproduction of mature blood cells and a long clinical course.
How is MPD diagnosed?
Some patients are picked up after they have presented with thrombotic complications, but increasingly, patients are picked up from routine blood tests that showed thrombocytosis or polycythemia.
The follow-up tests would include a bone marrow examination (aspirate and biopsy). Cytogenetic studies and molecular tests done on the aspirate to exclude chronic myeloid leukemia are necessary.
JAK2 mutation study is useful if it is positive as it is the molecular signature of the disease. JAK2 positivity appears to be lower in Oriental patients as compared to Western reports.
What are the clinical problems associated with MPD?
The central theme in PRV and ET are the increased risks of thrombosis. Thrombosis is defined as inappropriate formation of blood clot and the common site of such event is in the cerebral vessels, giving rise to stroke.
In PRV, the increase in plasma viscosity (due to “thick” blood) result in sluggish blood flow, hence the risk of clot formation.
Thrombosis occurs mainly in the arterial circulation rather than venous system. Cerebrovascular accidents (CVA) are the most common thrombotic complications. In untreated PRV, the risk of CVA is as high as 50% over a two-year period. In ET, due to the extremely high platelet count, the cells tend to stick together and start clot formation.
ET and other MPD patients also paradoxically have increased risks of bleeding as well because the platelets do not form stable clots at crucial bleeding areas such as bleeding gastric ulcers.
Myelofibrosis patients have problems related to huge spleen and bone marrow failure after about five years onwards of the onset of the diseases. They tend to lose weight and their blood counts start to drop (despite high counts earlier) once hypersplenism and increased fibrosis of marrow sets in.
There are some long-term complications and the most dreaded one is a low rate of leukaemic transformation occurring in fewer than 5% of PRV and ET patients. The risk of leukaemic transformation is highest in MF patients.
Up to 25% of ET patients can develop myelofibrosis and low blood counts in long-term follow up.
Is it true MPD is a disease of the elderly?
Yes, it is definitely seen mainly in the elderly. However, there is a small (10-15%) but distinct group of relatively young patients with MPD.
Older patients tend to have higher incidence of CVA due to co-existing illnesses such as hypertension, diabetes mellitus and hypercholesterolaemia, which aggravates the thrombotic risks in MPD patients. Hence there is a greater urgency to identify MPD in the elderly.
What are the treatment options in MPD?
Not all MPD patients need treatment right away, especially ET patients who are asymptomatic. Some of them may just require a small dose of aspirin.
There are several considerations, which include the age of the patient, co-morbidities, level of platelet count/Hb and history of previous thrombotic problems.
Almost all elderly MPD patients need some form of myelosuppressive therapy. The challenge in treating MPD is when and how to intervene to ensure prolongation of good quality of life.
Most of the treatment guidelines were developed based on clinical studies done by Western PRV study groups.
The options of treatment include oral therapy with hydroxyurea, anagrelide or busulphan while interferon is an effective injection therapy.
Oral treatment is easy to institute and generally effective. The aim of treatment is to keep platelet count below 450x10^9/L while the Hb should not exceed 15g/L.
Venesection (withdrawing blood) may be the only mode of treatment required in some PRV patients, provided the interval of venesection is not too frequent and there is no associated thrombocytosis.
Interferon is injected via the subcutaneous route and it does give troublesome side-effects such as fatigue, fever and body aches similar to the flu.
There are a small but significant number of patients (up to 15%) who cannot tolerate interferon.
Despite being the most effective mode of therapy, interferon is not as often used due to the immediate side-effects and high cost (above RM2,000/month) incurred.
Interferon is the only “safe” drug to use for MPD patients during pregnancy. It has a theoretical advantage of “stabilising” the marrow and may reduce the risk of leukaemic transformation.
A small but selected group of young MPD patients may need allogeneic stem cell transplant to have a new lease of life.
Has treatment made any impact in the long-term survival of MPD patients?
Definitely! Untreated, PRV patients succumb to the disease within 18 months to four years while treated patients enjoyed more than 15 years of median survival.
ET patients have similar survival curves as the normal population provided they are not struck by thrombotic or bleeding complications.
MF patients are harder to treat and their diseases course more variable as some of them can run into serious problems within three to five years and may warrant more innovative treatment approaches such as allogeneic stem cell transplant.
Have we learned more regarding the pathophysiology of the MPD?
It is important to find out what drives the uncontrolled production of blood cells so that more targeted treatments can be developed.
The discovery of JAK2 – an acquired mutation – is a breakthrough in our understanding of MPD. The mutant protein activates multiple signalling pathways that control the transcription, cell death and differentiation of blood cells and the net result is sustained overproduction of blood cells.
Hopefully in the near future JAK2 inhibitors will be developed to “correct” the uncontrolled activation of cellular pathways. This more targeted approach may control the disorder with less side-effects.
This article is contributed by The Star Health & Ageing Panel, which comprises a group of panellists who are not just opinion leaders in their respective fields of medical expertise, but have wide experience in medical health education for the public.
The members of the panel include: Datuk Prof Dr Tan Hui Meng, consultant urologist; Dr Yap Piang Kian, consultant endocrinologist; Datuk Dr Azhari Rosman, consultant cardiologist; A/Prof Dr Philip Poi, consultant geriatrician; Dr Hew Fen Lee, consultant endocrinologist; Prof Dr Low Wah Yun, psychologist; Datuk Dr Nor Ashikin Mokhtar, consultant obstetrician and gynaecologist; Dr Lee Moon Keen, consultant neurologist; Dr Ting Hoon Chin, consultant dermatologist; Prof Khoo Ee Ming, primary care physician; Dr Ng Soo Chin, consultant haematologist. For more information, e-mail starhealth@thestar.com.my
The Star Health & Ageing Advisory Panel provides this information for educational and communication purposes only and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care.
The Star Health & Ageing Advisory Panel disclaims any and all liability for injury or other damages that could result from use of the information obtained from this article.
24 April 2008
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