BackgroundAlthough blood donation saves lives, it may be associated with adverse reactions. These reactions may be immediate or delayed and may be a factor in donor nonreturn. However, there is limited knowledge about blood donation–related adverse reactions and risk factors specific to the Ghanaian context.AimTo determine the prevalence of adverse blood donation reactions and associated risk factors among successful blood donors at a tertiary hospital setting.Materials and MethodsThis mixed‐methods research (May–June 2024) used observational techniques and semistructured questionnaires to investigate adverse reactions during and after blood donation. The study recruited 279 participants (241 mobile session donors and 38 in‐house donations) in a tertiary setting blood collection center. Bivariate logistic regression analysis was performed to evaluate the influence of some donor demographics on adverse reactions.ResultsOverall, the prevalence of immediate adverse reaction was 44.4%; 51.4%, 36.5%, and 12.1% were local, vasovagal, and allergies, respectively. Blood donors who experienced adverse events had a statistically significantly lower median age (p = 0.007), lower systolic blood pressure (p = 0.004), lower diastolic pressure (p = 0.007), and lower weight (p = 0.030). Also, 22.1% of adverse donor reactions persisted 24 h postdonation; 38.7%, 58.1%, and 3.2% were local, vasovagal, and allergies, respectively. Bivariate logistics regression analysis showed that 16–19 years (aOR, 2.572, p = 0.477), males (aOR, 1.492, p = 0.125), students (aOR, 2.421, p = 0.325), the mobile session (aOR, 1.063, p = 0.928), and first‐time donors (aOR, 1.139, p = 0.690) were associated with nonstatistically significantly increased risk of immediate adverse donor reactions.ConclusionThere is an urgent need to build staff competencies and operationalize standard operating protocols to enable staff to identify and handle adverse blood donation events quickly. Further studies are needed to understand the factors responsible for the high prevalence of adverse donor reactions to inform improvements in blood donor care.

AimB‐cell maturation antigen (BCMA) is a nontyrosine kinase receptor expressed during plasma cell differentiation. Binding of ligands such as APRIL and BAFF to BCMA on malignant plasma cells leads to proliferation of tumor cells and plays an important role in the pathogenesis of multiple myeloma. Recent studies have explored the role of serum‐soluble BCMA (sBCMA) in assessing tumor load as well as monitoring of response. In this study, we aimed to detect serum sBCMA levels in newly diagnosed multiple myeloma patients as well as monitor the levels at follow‐up to correlate with response to therapy.MethodsThis was a prospective, longitudinal study conducted between March 2023 and July 2024. We documented the routine disease characteristics along with sBCMA levels at baseline and followed up sBCMA levels as a marker of therapy response.ResultsBaseline sBCMA levels were significantly higher in patients presenting with anemia and hypercalcemia and in patients having high‐risk cytogenetics. There was a trend toward correlation of sBCMA levels with bone marrow plasma cell percentage, β2‐microglobulin, and thrombocytopenia. We also found significant association of the sBCMA level with both ISS and R‐ISS staging. Furthermore, we assessed the response to therapy in terms of IMWG response criteria and sBCMA‐based response. The response according to conventional response criteria correlated significantly with sBCMA‐based response. We also found a significant association of decline in sBCMA levels to that of M band on response to therapy. There are certain advantages of using sBCMA as a response monitoring tool, such as in patients with renal impairment and in nonsecretory myeloma.ConclusionOur study provides an important insight into the relation of sBCMA to disease characteristics and the kinetics of decline in sBCMA on response to therapy.

Multiple myeloma (MM) is a heterogeneous hematologic malignancy, with high-risk cytogenetic abnormalities (HRCAs) such as del(17p), t(4; 14), t(14; 16), and gain(1q) contributing to poor prognosis in approximately 20%–25% of newly diagnosed patients. These abnormalities are associated with aggressive disease, frequent relapses, and inferior progression-free and overall survival. This review explores the evolving therapeutic landscape for high-risk MM, focusing on induction strategies for both transplant-eligible and transplant-ineligible patients, the role of autologous stem cell transplantation (ASCT), and the use of consolidation and maintenance therapies. Emerging modalities such as bispecific antibodies and chimeric antigen receptor T-cell (CAR-T) therapies are examined, particularly in the context of their integration into earlier lines of treatment. Quadruplet induction regimens incorporating proteasome inhibitors, immunomodulatory drugs, and monoclonal antibodies have shown promise in improving outcomes and are becoming a cornerstone of frontline therapy. The review also emphasizes the potential of personalized, risk-adapted approaches based on cytogenetic profiling and minimal residual disease (MRD) monitoring. Ongoing clinical trials investigating the early use of CAR-T cells and bispecific antibodies may further transform the standard of care for patients with high-risk MM.

Background: Duffy-null associated neutrophil count (DANC) causes neutropenia without clinical sequelae. 25%–50% of people of African ancestry in the United States are thought to have Fy(a-b-) status and are often erroneously identified as having pathologically low neutrophil counts.Results: We performed a retrospective chart review of new neutropenia referrals to the Hematology Clinic at Boston Medical Center (BMC) to evaluate diagnostic patterns for Fy(a-b-) status. 103 new referrals for neutropenia were made from 1/2020 to 2/2022, of which 78 were included for further analysis. DANC was the etiology for low neutrophil count in 64.1%, 82% of whom were African American or Black or were born in an African or Caribbean country. 66% of these patients underwent confirmatory blood bank testing, and 97% of patients tested were confirmed to have Fy(a-b-) status. The average cost of a laboratory visit for patients with typical neutrophil count with Fy(a-b-) status was on average lower, but not negligible, than those without ($363.82 vs. $737.93; p < 0.005). These patients were also statistically less likely to have a follow-up appointment (p=0.039).Conclusions: Expanded use of serological Fy(a,b) antigen testing for patients with chronic, asymptomatic neutropenia could reduce the cost of care and referrals to the hematology clinic.

Treating chronic lymphocytic leukemia (CLL) with the BCL-2 inhibitor venetoclax has shown favorable results in randomized clinical trials (RCTs). Regulatory authorities have recognized the need for also investigating the efficacy and safety of new antineoplastic therapies in real-world (RW) studies with patients often characterized by higher age and comorbidities than patients treated in RCTs. We present a RW single-center study of 112 patients with CLL or small lymphocytic lymphoma (SLL) treated with venetoclax at Zealand University Hospital. A total of 74 patients were treated according to the standard clinical practice and 38 were included in RCTs. No significant differences in efficacy profiles, or safety measures were observed between the two cohorts. Both groups presented overall acceptable tolerability and safety profiles to venetoclax. Moreover, our results suggest that tumor lysis syndrome (TLS) was not a clinical challenge in RW patients even when 6- and 12 h blood samples for TLS were omitted. RW CLL/SLL patients treated outside a clinical trial also had comparable safety and efficacy profiles as reported in the MURANO, CLL13, and CLL14 trials. In conclusion, patients with CLL treated with venetoclax in a RW clinical setting exhibit similar efficacy and safety outcomes to those observed in RCTs.

Sodium-glucose Cotransporter 2 inhibitors (SGLT2i) are widely used and effective pharmacotherapeutic options that are first-line therapy for Type 2 diabetes mellitus (T2DM) and congestive heart failure. A major adverse effect of SGLT2i usage is diabetic ketoacidosis (DKA). SGLT2i-induced DKA commonly presents as euglycemic DKA (EDKA). The safety of empagliflozin in cancer patients is not well established. High intensity treatment of hematologic malignancy poses a unique set of risk factors for EDKA. Four cases of empagliflozin-associated EDKA in hematologic malignancy patients were identified through pharmacy adverse event reporting at a cancer research hospital. All patients were euglycemic except one patient who required CRS/ICANS treatment with dexamethasone, causing steroid-induced hyperglycemia. All four patients had weight loss due to reasons including, but not limited to, reduced oral intake, diarrhea, nausea, and pain. Infections and/or neutropenic fever were also commonalities throughout the four patients. In all patients, DKA contributed to iatrogenic ICU admissions and prolonged hospital stays. SGLT2i use in hematologic malignancy patients may increase the risk of DKA due to high risk of anorexia, weight loss, and infections, all highly associated with intensive treatment that can disrupt the availability and sensitivity to insulin. In patients receiving SGLT2i, clinicians should be aware of risk factors for DKA as well as potential euglycemic presentation to ensure close clinical and laboratory monitoring to facilitate rapid diagnosis and treatment of DKA.

Background: Diabetes is a significant worldwide health challenge associated with significant metabolic, cellular, and hematological disturbances. Hematological alterations are well-documented complications of diabetes and play a crucial role in the progression of diabetes related pathology. While extensive data exist globally on hematological parameters in type 2 diabetes mellitus (T2DM), specific insights into these parameters and their local determinants within study area remain limited. Therefore, this study aimed to assess the hematological parameters among adult patients diagnosed with T2DM in JUMC at Jimma, Southwest, Ethiopia, 2024. Methods: A total of 200 medical charts of adults with T2DM who registered for follow-up at Jimma University Medical Center were reviewed from December 2023 to February 2024. Data were collected using a data extraction checklist. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with hematologic abnormalities. A p value less than 0.05 indicates statistical significance. Result: The overall prevalence of anemia and leukocytosis in adults with T2DM was 14.0% and 12.0%, respectively. Neutrophilia was the common white blood cell (WBC) abnormality detected in 9.5% of the patients. Besides, thrombocytopenia and thrombocytosis were observed in 2.5% and 1.5% of the patients, respectively. Increasing age 5.28 (95% CI: 1.07-26.1) and duration of diabetes mellitus (≥ 3 years) (AOD = 3.1 (95% CI: 1.02-9.5)) were significantly associated with anemia and leukocytosis, respectively. Conclusion: This study found a prevalence of hematological abnormalities in adults with T2DM, including anemia, elevated WBC count, increased neutrophils, and thrombocytopenia. Anemia was associated with advanced age, while leukocytosis was associated with a longer diabetes duration. Therefore, it is recommended to start regularly screening T2DM patients for hematological abnormalities to improve clinical practice, guide treatment decisions, and develop targeted interventions.

Platelets form the nidus around which the primary hemostatic cascade is amplified and propagated. Desmopressin (DDAVP) has been shown to enhance platelet function through interaction with the endothelium. Evidence suggests that an alternative mechanism of action may exist. We aimed to determine the effect of DDAVP on platelet function and microclotting of plasma proteins in samples from healthy volunteers. We analyzed blood samples in 20 healthy volunteers with no coagulation abnormalities. Control and test samples were drawn from each participant. DDAVP was added in vitro to test samples. All samples were subjected to PFA‐200, viscoelastic (VET) and fluorescence microscopy testing. DDAVP increased TEG MA and decreased K‐time in experimental samples. There was no difference between the means in the clotting times in either of the PFA‐200 groups. Fluorescence microscopy examining platelet activation and microclot formation showed significant increases in both parameters in the test samples. The results contrast current literature, which suggests that DDAVP has no effect on platelet function independent of the endothelium. This is the first study demonstrating an in vitro effect of DDAVP on platelets examined by VET and microscopy. We conclude that a relationship exists between DDAVP exposure, in vitro, platelet activation and microclot formation.

Background: Iron deficiency anemia (IDA) is the most common form of pediatric anemia, with first-line treatment focusing on iron repletion through oral and/or intravenous iron. The American Society of Hematology (ASH)/the American Society of Pediatric Hematology and Oncology (ASPHO) Choosing Wisely Campaign recommends against packed red blood cell (PRBC) transfusion for asymptomatic IDA. PRBCs are a finite resource and carry treatment associated risk compared to iron therapies. The use of oral and intravenous iron is an effective, tolerated therapy modality for IDA which can be overlooked based on the degree of anemia. Study Design and Methods: Plan, Do, Study, Act methodology was used for this single institution quality improvement initiative. The objective was to decrease the percentage of PRBC transfusions in all admitted IDA patients from a baseline of 72% to a target of 50% by December 2022 and to sustain for 12 months. Interventions consisted of multidisciplinary, evidence-based didactic education sessions and development of a single institution clinical practice guideline for the treatment of IDA. Results: In the pre-education/baseline group, 72% (n = 57/79) of patients received PRBC transfusion for the treatment of IDA, compared to the posteducation/intervention group where 38% (n = 29/76) of patients received PRBC transfusion for the treatment of IDA (p value < 0.0001). In the pre-education/baseline group, 19% (n = 11/57) of patients received PRBC transfusions not indicated based on the developed CPG, compared to 6.9% (n = 2/18) in the posteducation/intervention group (p value = 0.20). Discussion: This work demonstrates how multidisciplinary, education- and evidence-based interventions lead to clinically and statistically significant reductions in PRBC transfusion for admitted patients with IDA.

Background: Malaria and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) are widely recognized infectious diseases that pose serious public health challenges in Sub-Saharan Africa and around the globe. A key factor contributing to the rise in human deaths related to malaria and HIV/AIDS is how these diseases can change the hematological parameters in people who are infected with both. Despite the significant effect of malaria and HIV/AIDS on hematological parameters, there are limited data regarding hematological profiles among malaria-HIV coinfected cases. Therefore, this study aimed to determine the hematological profiles of HIV-malaria-coinfected adults receiving highly active antiretroviral therapy at Bonga Gebretsadik Shawo General Hospital.Methods: A hospital-based comparative cross-sectional study was conducted among 196 HIV-infected patients (98 HIV-infected and 98 HIV-malaria coinfected) at Bonga General Hospital from 13 June to 3 November 2022. Five milliliters of venous blood samples were collected to detect parasites, estimate parasite density, measure viral load, and perform a complete blood count. Sociodemographic data were collected using structured questionnaires. Data were analyzed using SPSS Version 25. Descriptive statistics, independent samples t-tests, and Spearman correlation tests were performed. A p value of < 0.05 was set as the cutoff for significance.Results: The study included 196 adults living with HIV. Statistical differences were observed in the mean ± SD values of red blood cells, hemoglobin, and hematocrit (p < 0.05) between HIV-infected and HIV-malaria coinfected study participants. In a total of study participants, significant negative correlations were found between viral load and total white blood cell count, neutrophils, lymphocytes, eosinophils, red blood cells, hemoglobin, hematocrit, mean cell volume, and platelet count. Anemia, leukopenia, and thrombocytopenia were present in 88 (44.9%), 77 (39.3%), and 50 (25.5%) of the 196 participants, respectively. In the HIV-malaria-coinfected group, there was a negative correlation between parasite density and red blood cell count, hemoglobin, hematocrit, and platelets. The prevalence of anemia, leukopenia, and thrombocytopenia among malaria and HIV-coinfected study participants was 60 (61.2%), 43 (43.88%), and 30 (30.6%), respectively. A statistically significant difference (p < 0.001) was observed in the prevalence of anemia between the two groups.Conclusion and Recommendations: The prevalence of anemia was significantly higher in HIV-malaria-coinfected participants than HIV monoinfected paricipants. Mean values of hematological profiles were significantly different in the two groups. Further studies with a larger sample size are needed to support future results.