الفهرس 
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Abstract
Introduction: Tumor necrosis factor (TNF) is a pleiotropic cytokine that is produced by a variety of cells including monocytes/macrophages, T, and B lymphocytes, and fibroblasts. A strong body of evidences has confirmed the role of TNF-? in the pathogenesis of many hematologic diseases. This has been shown in acute and chronic leukemias, in malignant lymphomas particularly of the Non-Hodgkin type, and in myelodysplastic syndromes. Also, in thalassemia, TNF was found to have a role in reactive thrombocytosis postsplenectomy especially in more heavily transfused older patients . Aim of the Work: Determination of the serum level of TNF-? in a group of patients with different haematological disorders to evaluate its importance in the pathogenesis of those diseases as well as its diagnosic capability. Subjects and Methods: Ninty newly diagnosed patients with different blood disorders were included. They were selected from cases attending the hematology units of the Almansoura University Hospital and Almansoura University Children Hospital. They were 47 males and 43 females and their ages ranged from 3 to 85 years. All cases were subjected to: Accurate history tacking, Thorough clinical examination, laboratory investigation in form of; Complete blood count with examination of peripheral blood smears; reticulocytic count; ESR, liver function tests, creatinine and LDH and assay of serum level of TNF-?. Results: High levels of TNF-? were encountered in ALL, AML and MDS groups due to its production by blast cells in acute leukemias and from normal monocytes or transformed MDS progenitor cells in MDS. Conclusion: Serum TNF-? levels were variable among different patient groups as well as among members within the same disease category. Recommendation: The finding of variable TNF-? levels among patients with the same disease secondary to the polymorphic nature of TNF-? gene expression may justify serum measurement of TNF-? in particular patients especially if the point of anti-cytokine therapy is to be thought of.