Common Hematological Abnormality Research Articles

Autoimmune Thrombocytopenia in Pregnancy: Insights from an Uncommon Case Presentation and Mini-Review

Thrombocytopenia, defined as a platelet count below 150 × 109/L, is the second most common hematological abnormality after anemia found among European women in the third trimester of pregnancy. Most of the cases are mild, asymptomatic, and diagnosed accidentally. The primary causes of thrombocytopenia are linked to the pregnancy itself and include gestational thrombocytopenia (GT), autoimmune thrombocytopenia (ITP), and pre-eclampsia or HELLP syndrome-associated thrombocytopenia. First-line therapies for ITP include corticosteroids and intravenous immunoglobulin (IVIG). We came across a case of severe thrombocytopenia (platelet count of 9 × 109/L) associated with severe anemia (Hb 5.9 g/dL) at 30 weeks of gestation, with no personal or family history of bleeding disorders. A comprehensive hematologic, infectious, and rheumatological workup was performed to narrow the diagnosis. Despite aggressive corticosteroid therapy and immunoglobulin treatment, the patient’s thrombocytopenia persisted, imposing delivery at 34 weeks. This article highlights the complex presentation and management of severe thrombocytopenia and anemia during pregnancy.

Interest of Immature Platelet Fraction (IPF) in the Etiological Diagnosis of Thrombocytopenia.

Background: Thrombocytopenia is a common hematological abnormality with diverse etiologies, including peripheral platelet destruction and central production failure. The Immature Platelet Fraction (IPF) is a new parameter that quantifies reticulated platelets and provides an indication of the quality of thrombopoiesis. Objective: This study aimed to evaluate the diagnostic utility of IPF in distinguishing thrombocytopenia etiologies. Methods: A prospective cross-sectional study was conducted on 120 thrombocytopenic patients for over two months at the Hematology Laboratory of Arrazi Hospital, Marrakesh. IPF was measured using a Sysmex XE-5000 analyzer. Statistical analyses included the Mann-Whitney U test, Kolmogorov-Smirnov test, and Receiver Operating Characteristic (ROC) curves to determine the IPF cutoff values and diagnostic accuracy. Results: The cohort included 46,7% males and 53,3% females, with a median age of 44 years. The median IPF was 8,0% [1.5–40,6%], with significantly higher values for peripheral thrombocytopenia (9,5%) than for central thrombocytopenia (6,0%; p = 0.019). ROC analysis yielded an Area Under the Curve (AUC) of 0,65, with a cutoff value of 8,1% (sensitivity, 65,9%; specificity, 78,6%). The Kolmogorov-Smirnov test confirmed significant differences in distribution between the groups (p = 0,003). Conclusion: IPF provides significant insights into thrombocytopenia etiologies, with higher levels observed in peripheral cases. While its moderate discriminatory capacity suggests the need for complementary diagnostic tools such as bone marrow aspiration in central thrombocytopenia. IPF remains a promising marker for improving the diagnostic accuracy in thrombocytopenia management. Standardization of cutoff values and larger studies are needed to refine its clinical application.

Equine piroplasmosis: Case descriptions and overview of the epidemiological situation in Europe with focus on Germany

Equine piroplasmosis (EP) is caused by Babesia (B.) caballi and Theileria (T.) equi and is transmitted by hard ticks. Predominantly, the Mediterranean region is known as being endemic for both pathogens in Europe. However, autochthonous infections in central European countries such as Germany can no longer be ruled out due to individual case reports in horses without any stays abroad as well as the geographical expansion of the habitats of different tick species. The case reports presented underline the risk of infection for horses travelling to endemic areas and in horses imported from such areas to non-endemic countries. Clinical signs are often unspecific and include fever, icterus, lethargy, inappetence, weight loss, and reduced performance. Mild to severe anemia is the most common hematologic abnormality, but thrombocytopenia has also been described. Direct (polymerase chain reaction, microscopical analysis of blood smears) and indirect detection methods (detection of antibodies) are available for the diagnosis of pathogen contact and/or infection. Imidocarb-dipropionate is recommended as treatment of choice against EP. Infections with B. caballi can be cleared, while infections with T. equi often result in a life-long carrier status despite treatment. Prevention is limited to controlling or avoiding tick contact. Aside from potentially severe and life-threatening clinical signs, equine piroplasmosis has a significant economic impact on the international trade of horses worldwide. EP is classified as a notifiable disease according to WOAH guidelines, which recommend serological screening for B. caballi and T. equi according to the respective national guidelines when travelling across borders. To date, EP is not classified as a notifiable nor reportable disease in Germany.

Immuno-hematological parameters among adult HIV patients before and after initiation of Dolutegravir based antiretroviral therapy, Addis Ababa, Ethiopia.

Immuno-hematological abnormalities are common among HIV infected individuals as well as patients with highly active antiretroviral therapy (HAART). However, the immuno-hematological outcome of Dolutegravir based antiretroviral therapy (ART) usage is not well investigated. To assess hematological and immunological parameters among adult HIV patients before and after initiation of Dolutegravir based ART regimen at St. Peter Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from May to July 2021 at St. Peter Specialized Hospital among adult HIV patients. A total of 422 HIV patients on Dolutegravir based ART (combination of Dolutegravir/lamivudine/tenofovir disoproxil fumarate (DTG/3TC/TDF)) for a minimum of 3 months were selected using convenient sampling methods. Socio-demographic as well as clinical data of the participants was obtained using pre-tested structured questionnaires and a review of medical records. Hematological parameters such as CBC was obtained using Beckman coulter automated hematology analyzer and immunological parameters such as CD4 count were determined using BD FACS presto. Statistical analysis of the data was done using SPSS version 21. Paired t-test was used to compare dependent variables before and after initiation of the new HAART and binary logistic regression was used to determine predictors of immuno-hematological abnormalities. P-value < 0.05 was considered as statistically significant. Of 422 adult HIV patients, about 273(64.7%) were females. The mean age of study participants was 42.2 years (±10.4SD). The mean white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb), platelet distribution width (PDW), CD4 count, as well as lymphocyte percentage, neutrophil percentage, and platelet counts (PLT) were increased significantly(P<0.05) after 3 months of the Dolutegravir based therapy. While, red cell distribution width (RDW) and mean cell hemoglobin (MCH) were decreased (P<0.05) after the treatment. Other hematological parameters such as mean cell volume (MCV), hematocrit (HCT), mean cell hemoglobin concentration (MCHC), mean platelet volume (MPV) and platelet distribution width (PDW) showed no significant change. On the other hand, the most common hematological abnormalities identified after the new HAART were anemia (12.1%); followed by Leucopenia (11.3%), neutropenia (6%), and thrombocytopenia (4%). Anemia was associated with female sex (AOR = 7.8, 95% CI: 1.9-32.2, P<0.005) and WHO clinical stage III/IV (AOR = 16, 95% CI: 10.63-66.46, P<0.01). There was a significant change in certain immuno-hematological parameters such as WBC count, RBC count, PLT count, Hb, PDW, CD4 count, lymphocyte and neutrophil percentage after initiation of the Dolutegravir based therapy. Anemia was the most common hematological abnormality. Further studies are required to fully comprehend the outcome of the new treatment regimen on immuno-hematological parameters.

Maternal Immune Thrombocytopenic Purpura Leading to Severe Neonatal Autoimmune Thrombocytopenia: Report of Two Cases

Introduction: In neonatal intensive care units, neonatal thrombocytopenia is one of the common hematological abnormality seen. Neonatal autoimmune thrombocytopenia should be considered in any neonate who is born to a known case of immune thrombocytopenia purpura (ITP) mother, with early onset thrombocytopenia without any signs of sepsis. Neonatal ITP is a condition of autoantibody mediated platelet destruction. Case details: Two neonates with thrombocytopenia, born to mothers with ITP are described in this report. Lowest platelet count noted was 7000 cells/cmm in one of the neonate. Both neonates received intra venous immunoglobulin (IVIG) while one neonate had persistent and severe thrombocytopenia requiring multiple random donor platelet (RDP) transfusions followed by oral steroid as well. Conclusion: Neonatal thrombocytopenia associated with maternal ITP need close monitoring, early sampling and diagnosis to prevent any possible complications and warrant early initiation of treatment.

Características clínicas y epidemiológicas en pacientes con leucemia linfoblástica aguda de un instituto especializado en pediatría de Perú, periodo 2017-2022

Objective: To describe the clinical-epidemiological characteristics at the time of the diagnosis in patients with acute lymphoblastic leukemia (ALL) at a specialized pediatric institute in Peru, from 2017 to 2022. Materials and Methods: An observational, descriptive, cross-sectional, and retrospective study was conducted. Medical records of patients under 18 years old with a recent confirmed diagnosis of ALL were included. Variables analyzed included sex, age, origin, discharge outcome, hospital stay, signs, symptoms, history of chronic diseases, laboratory findings, and hematological complications. Data were collected through medical record review and processed using STATA v. 16. Results: Out of 247 medical records, 25 patients who did not meet inclusion criteria were excluded. The study sample consisted of 222 patients. 54.1% of the patients were male, with a median age of 5 years. 64.0% had fever, and 78.8% had pallor. 91.8% of patients had hemoglobin below 11 g/dL, 65.3% had platelets below 50,000/µL, and 13.1% had leukocytosis above 100,000/µL. The most common hematological abnormality was the simultaneous presentation of anemia, thrombocytopenia, and leukocytosis (43.0%). Conclusion: ALL predominantly occurred in male children and those under 5 years old. A high frequency of hematological alterations such as anemia, thrombocytopenia, and leukocytosis was observed. Clinically, two-thirds of the patients had fever, and nearly three-quarters had pallor. Further studies on the progression of ALL in the Peruvian population are suggested.

In Fanconi anemia, impaired accumulation of bone marrow neutrophils during emergency granulopoiesis induces hematopoietic stem cell stress

Fanconi anemia (FA) is an inherited disorder of DNA repair due to mutation in one of 20+ interrelated genes that repair intrastrand DNA crosslinks and rescue collapsed or stalled replication forks. The most common hematologic abnormality in FA is anemia, but progression to bone marrow failure (BMF), clonal hematopoiesis, or acute myeloid leukemia may also occur. In prior studies, we found that Fanconi DNA repair is required for successful emergency granulopoiesis; the process for rapid neutrophil production during the innate immune response. Specifically, Fancc-/- mice did not develop neutrophilia in response to emergency granulopoiesis stimuli, but instead exhibited apoptosis of bone marrow hematopoietic stem cells and differentiating neutrophils. Repeated emergency granulopoiesis challenges induced BMF in most Fancc-/- mice, with acute myeloid leukemia in survivors. In contrast, we found equivalent neutrophilia during emergency granulopoiesis in Fancc-/-Tp53+/- mice and WT mice, without BMF. Since termination of emergency granulopoiesis is triggered by accumulation of bone marrow neutrophils, we hypothesize neutrophilia protects Fancc-/-Tp53+/- bone marrow from the stress of a sustained inflammation that is experienced by Fancc-/- mice. In the current work, we found that blocking neutrophil accumulation during emergency granulopoiesis led to BMF in Fancc-/-Tp53+/- mice, consistent with this hypothesis. Blocking neutrophilia during emergency granulopoiesis in Fancc-/-Tp53+/- mice (but not WT) impaired cell cycle checkpoint activity, also found in Fancc-/- mice. Mechanisms for loss of cell cycle checkpoints during infectious disease challenges may define molecular markers of FA progression, or suggest therapeutic targets for bone marrow protection in this disorder.

CLINICO-INVESTIGATIVE PROFILE OF THROMBOCYTOPENIA IN THIRD TRIMESTER OF PREGNANCY

Background:Thrombocytopenia often occurs in pregnancy, ranking as the second most common hematologic abnormality following anemia. It affects approximately 6% to 10% of pregnant women.1 This research aimed to explore the factors linked to thrombocytopenia among rural Indian women in their third trimester of pregnancy. Methods:This prospective observational study was conducted at Dr.BalasahebVikhePatil Rural Medical College and Dr.VitthalraoVikhePatilsPravara Rural Hospital in India. The study specifically targeted rural Indian women in their third trimester of pregnancy with a platelet count below 150,000 per cubic millimeter. Results:In the present study, among the 86 cases examined, the largest proportion (44.2%) were diagnosed with Gestational Thrombocytopenia, followed by 27.9% diagnosed with hypertensive disorders of pregnancy and 16.3% with HELLP syndrome. Among the 39 cases of gestational thrombocytopenia, 41.01% were categorized as mild thrombocytopenia. Of the 38 cases of hypertensive disorders of pregnancy accompanied by thrombocytopenia, 63% were associated with pre-eclampsia and 36.8% with HELLP syndrome. Additionally, 61.6% of the babies were born with low birth weight, and 73.5% of these cases were linked to maternal platelet counts below 100,000 per cubic millimeter.. Conclusions:The research underscores gestational thrombocytopenia as the leading cause during the third trimester, followed by hypertensive disorders such as pre-eclampsia and HELLP syndrome. It emphasizes the need for careful monitoring, particularly for first-time mothers and those in their third trimester, due to increased risks. The link between maternal platelet count and neonatal outcomes, particularly low birth weight, highlights the complex relationship between maternal health and fetal well-being.

Equine Granulocytic Anaplasmosis: A Systematic Review and Meta-Analysis on Clinico-Pathological Findings, Diagnosis, and Therapeutic Management.

Equine granulocytic anaplasmosis (EGA) is a tick-borne disease affecting horses worldwide, caused by Anaplasma phagocytophilum. The disease ranges from non-specific clinical signs to fatal outcomes. This paper aimed to analyze EGA cases reported in peer-reviewed journals, particularly on clinico-pathological findings, diagnosis, and therapeutic management. Overall, 189 clinical cases from 31 publications were included in the study. Extensive symptomatology for the EGA cases was reported, of which mostly was fever (90.30%), followed by limb edema (48.51%), anorexia (41.79%), depression (32.84%), icterus (22.39%), ataxia (17.91), tachycardia (16.42%), and lethargy (15.67%). Laboratory tests revealed thrombocytopenia (90.32%), anemia (75%), decreased hematocrit (70.59%), leukopenia (55.88%), lymphopenia (58.14%), and neutropenia (41.67%) as the most common hematological abnormalities. For a subset of tested animals, hyperbilirubinemia (20/29), hyperfibrinogenemia (13/15), and hyponatremia (10/10) were also reported. The diagnosis was established by microscopic identification of morulae (in 153 cases), and/or PCR (120 cases), isolation (1 case), or serology (56 cases). For treatment, oxytetracycline was used in the majority (52.24%) of EGA cases, but recovery without antibiotherapy (10.34%) was also noted. In conclusion, the variety of clinical and pathological findings and the challenging therapeutic approaches reported suggest that EGA should be included in the differential diagnosis when fever occurs.

Association of Hematological Parameters with Malaria Positive Patients in District Bannu

Background: Malaria is one of the most widespread parasitic blood infections caused by plasmodium parasite. Well known feature of malaria is change in hematological parameters such as red blood cell, hemoglobin, platelets, white blood cell and differential count are significantly low. This study aim was to find the association of malaria with Complete Blood Count in malaria positive patient. Methods: A six-month cross-sectional research was carried out in the Bannu district. Venous blood samples from 500 individuals were taken and placed in EDTA tubes for smear preparation and total blood counts. The Sysmex Hematology Analyzer was used to evaluate blood counts. Using SPSS-22, all data were calculated. Results: Among total, 60 Malaria positive patient samples were processed for association of malaria with CBC. Out of total, male were 78% and female were 22%. Malaria positive patient with anaemia were found 53% in which male and female were 81% and 18% respectively. Thrombocytopenia were found in 16% in which male were 60% and 40% female patients. Malaria positive with abnormal TLC were observed in 11% patients (male 8%, female 3%). Moreover, Malaria positive with abnormal DLC were found 70% (male 73%, female 26%). Conclusion: This study shows a significant change in hematological parameter in Malaria patients. Thrombocytopenia is second most common hematological abnormality. In TLC abnormality, rare cases of leukocytosis were noted. In malaria-endemic regions, hematological indicators may be a suitable and reliable adjuvant in the early identification of individuals with mild-to-severe parasitemia.

IJCM_318A: Risk Factors for Anaemia among Type 2 Diabetes Mellitus Patients in Mangalore- A Case Control Study.

Background: Anaemia, a common haematological abnormality, currently stands at a prevalence rate of 24.8% worldwide and 39.86% in India, affecting 1.62 billion individuals overall. Studies have shown that patients with Diabetes are twice as likely to be prone to anaemia. Objective: To study the risk factors for anaemia among patients with type 2 Diabetes Mellitus. Methodology: This is a record-based case-control study of 50 cases (diabetic with anaemia) and 100 controls (diabetic without anaemia) in Government Wenlock Hospital, Mangalore. Patients with haemoglobin concentration below the normal level (as defined by WHO as &lt;13 g/dl for men and &lt;12 g/dl for women) were considered anaemic. Data was entered and analyzed using the statistical software SPSS Version 17.0. Univariate analyses and a Chi-Square test were conducted to identify risk factors. Results: The median age of cases as well as controls was 60 years. The duration of diabetes was 8 years in cases and 7 years in controls. Among 50 cases, there were 39 (78%) males and 11(22%) females and among 100 controls, 68(68%) males and 32(32%) females. On univariate analysis, it was found that the low serum urea, creatinine, albumin, total protein and calcium levels were significantly associated with the presence of anaemia (P &lt;0.05). Conclusion: The above parameters implicate impairment in renal function and hence we can conclude that impaired renal function is a risk factor for developing anaemia in type 2 Diabetes Mellitus patients.

Visceral Leishmaniasis (VL) Clinical Presentation, Laboratory Findings, Treatment Options and Outcome.

Black disease, also known as visceral leishmaniasis (VL), is a parasitic illness caused by various Leishmania species. The risk of morbidity and mortality increases with delayed diagnosis and treatment. Early VL diagnosis and fast appropriate treatment are critical issues in endemic areas. This study was a retrospective cross-sectional study to investigate the diagnostic and therapeutic course of patients admitted with the diagnosis of VL in the Children's Medical Center (CMC) Hospital, Tehran, Iran. All cases of VL in patients under the age of 18 hospitalized between the years 2012 to 2022 were enrolled. Twenty-seven patients were enrolled with an average age of 28.13 months with the majority of females (51.8%). Common clinical signs were fever (96.2%) and splenomegaly (92.59%). However, lymphadenopathy was rare. The largest number of patients was from Tehran Province, followed by Ardabil, Khuzestan, Gilan, and Alborz provinces. The most common hematological abnormalities were anemia (85.1%) and thrombocytopenia (44.4%). In accordance with the treatment strategy, liposomal amphotericin B and amphotericin B deoxycholate were given to 11 and 5 patients, respectively. Eleven of them received glucantime. The average length of hospitalization for liposomal amphotericin B was 15.36 ± 12.49 days. In comparison with glucantime (18.38 ±10.26 days) and amphotericin B deoxycholate (20.20± 6.18 days), liposomal amphotericin B group hospitalization was shorter than others were. VL should be included in the differential diagnosis of any child who presents with fever, splenomegaly, and anemia. Concerning the treatment strategy in this study, liposomal amphotericin B had more efficiency and shorter hospitalization duration.

Retrospective, single-center analysis of autoimmune hepatitis in Jordanian children: clinical features, treatments, and outcomes

ObjectivesThis study describes clinical, biochemical, and histological features and long-term outcomes in pediatric patients diagnosed with autoimmune hepatitis (AIH) at King Abdullah University Hospital, Jordan.DesignRetrospective, single-center study.SettingKing Abdullah University Hospital, Jordan.ParticipantsInclusion of all pediatric patients with AIH diagnosed at our hospital from 2015 to 2023. Exclusion criteria was patients aged over 18 at time of diagnosis and those diagnosed elsewhere.Outcome measuresUnderstanding clinical, biochemical, and histological AIH features in children, evaluating treatment responses, and reporting short- and long-term complications, including mortality.ResultsSixteen pediatric cases were diagnosed, with an average age of 9.84 ± 4.13 years. Females comprised 75% of patients, and 31.3% presented with acute liver failure. Jaundice was the most common symptom, and hepatosplenomegaly was observed in 18% of cases. Most patients had elevated transaminase levels, along with positive anti-smooth muscle antibody (ASMA) and antinuclear antibodies (ANA). Common hematological abnormalities included anemia (56.3%) and thrombocytopenia (37.5%). All patients underwent liver biopsy, with interface hepatitis present in 81.3% of cases. Treatment mainly involved prednisone and azathioprine. Three patients died, one discontinued therapy, two patients were lost to follow-up, and 10 remained on treatment.ConclusionAutoimmune hepatitis affects Jordanian children, primarily female children. Jaundice is the most common presenting symptoms. Only Type I AIH occurred in our cohort. Although of good response to conventional treatment with steroids and immunosuppression, mortality reached 18.8%.

Laboratory profile of scrub typhus in children admitted at Bankura Sammilani medical college, India: a cross-sectional study

Background: An in-depth evaluation of routine baseline investigations is required in clinically suspected cases of scrub typhus fever due to the unavailability and/or delayed arrival of serological testing in all remote health care facilities. This may assist medical professionals diagnose and promptly administer anti-scrub medication. Methods: A cross-sectional research was conducted on 105 children who had scrub typhus fever admitted in a tertiary healthcare facility. The children were selected one after the other till desired sample size was achieved. Basic demographic information, clinical symptoms, and test results were all recorded. Software called EpiInfo 3.5.1 was used for analysing the collected information. For continuous variables, rate and ratio were used to express them, whereas standard deviation and mean were used for categorical variables. Once more, ANOVA was used for analysing association between categorical variables. P-values of &lt;.05 were considered statistically significant. Results: Of the 105 children, 90.48% were from country-side and 56.19% were male. The most common haematological abnormalities were anaemia (84.76%), leucocytosis (42.86%), and, thrombocytopenia (46.67%). The biochemical changes include hypoproteinaemia (28.57%), hypoalbuminemia (23.81%), hyponatremia (50.48%), and elevated serum levels of ALT (66.67%) and AST (84.76%). An extended duration of fever was shown to be related with a statistically significant (P value =&lt; 0.05) association between mean haemoglobin concentration, leucocyte and thrombocyte count, and serum levels of sodium. Conclusions: Early recognition and management of scrub typhus fever may be aided by the presence of anaemia, thrombocytopenia, leucocytosis, hypoproteinaemia, albuminemia, hyponatremia, and elevated serum levels of alanine and aspartate amino transferase.

Baseline Haematological Evaluation in Individuals Prior to Initiating Antiretroviral Therapy for HIV

Introduction: Human immunodeficiency virus (HIV) was discovered in 1983, while acquired immunodeficiency syndrome (AIDS) was first detected in 1981. Since then, it continues to be a public health problem. The phenomenon of HIV/AIDS is best viewed as a pandemic affecting almost all countries of the world. The first case of HIV/AIDS in Bangladesh was documented in 1989.This study was conducted to evaluate the baseline haematologicalcharacteristic in individuals prior to initiating antiretroviral therapy for HIV. Methods: This study was a cross sectional analytical study conducted among one hundred and fifty-four HIV positive patients attending at ART center, Bangabandhu Sheikh Mujib Medical University. Patients were included as per inclusion and exclusion criteria. Co-morbid conditions were excluded mostly by self-reporting and clinically relevant investigations. Result:The study revealed that HIV infected patients were predominantly middle-aged and young comprising &gt; 70% of the patients with the mean age of the patients being 35.5 ± 9.5 years (range: 20-60 years). A male preponderance was observed in the study with a male-to-female ratio being 3:1. The majority (92.2%) of patients received first-line ART. The red cell indices like Hct, MCV, MCH, and MCHC were also low at the initiation of therapy but changed to normality after treatment. Conclusion: From the findings of the study, it can be concluded that HIV infected individuals are predominantly male, middle-aged, and young. The most common haematological abnormality is anaemia which is significantly reduced in percentage after a mean treatment period of nine and a half months with ART. Bangladesh J Medicine 2024; 35(1): 26-32

Arsenic intoxication causing Megaloblastic Anaemia- lesson learnt

Megaloblastic anaemia is a common hematological abnormality encountered in clinical practice. We here report a case of 40-year-old male who presented to us with feature of anaemia and typical dermatological manifestation of arsenic intoxication. Complete blood count of patient showed pancytopenia with no circulating atypical cells. Bone marrow examination performed and showed megaloblastic change. Arsenic level in the hair was done and came out very high a. A very few case reports of arsenic causing megablastic anaemia were done in past. Aim of this case report is to create awareness among the physician. J MEDICINE 2024; 25: 90-93

Intravascular Lymphoma-Associated Stroke: A Systematic Review of Case Studies.

Intravascular lymphoma (IVL) is an aggressive systemic large B-cell lymphoma that is a rare cause of stroke. The clinical characteristics of stroke associated with IVL remain underexplored, contributing to diagnostic complexities and a high mortality rate. This study endeavors to elucidate the salient clinical and investigative features of stroke linked to this condition. A systematic review was performed using the PubMed database from the incident to August 2023 including search categories for IVL and stroke. All studies, excluding review articles, were included in this study. There were 58 cases with a confirmed diagnosis of IVL associated with stroke, with a mean age of 62.9 ± 9.6 years (female 50%). Classical lateralizing stroke symptoms were noted in only 69% of cases. Other clinical syndromes included altered sensorium (31%), rapidly progressive cognitive impairment (23%), seizures (22%), and gait disturbances (19%). Common hematological abnormalities included elevated lactate dehydrogenase (LDH, 97%), erythrocyte sedimentation rate (ESR, 79%), C-reactive protein (CRP, 61%), interleukin-2, microglobulins, and cerebrospinal fluid (CSF) protein. CSF flow cytometry was not diagnostic, and cytology was mostly negative. The dynamic pattern for DWI/T2 lesions was predominant and primarily located in the subcortical regions. Diffuse background slowing (64%) was a major finding in the electroencephalogram. Seventy-one percent of cases died (n=45) mostly due to delayed diagnosis. Only 31% were treated with first-line R-CHOP (rituximab, cyclophosphamide, doxorubicin hydrochloride, vincristine, prednisone) chemotherapy, among whom 25% died. This study suggests that IVL-associated strokes carry a high mortality rate, largely due to challenges in timely diagnosis and therapy. Unlike classical stroke syndrome, key indicators to aid in early diagnosis include a clinical syndrome of multiple non-lateralizing neurological symptoms, dynamic MRI DWI/T2-lesions primarily located in subcortical regions, elevated serum LDH, ESR, CRP, interleukins, microglobulin, CSF protein, and CSF polymerase chain reaction analysis, apart from tissue examination. Larger studies should be performed to establish diagnostic and predictive scores.

Hematological Profile Of Hiv/Aids Individuals With Opportunistic Respiratory Mycoses And Immune Status: A Cross Sectional Study In Uyo Nigeria

Hematological abnormalities are strong predictors of morbidity and mortality among HIV infection. This study was aimed to determine hematological indices, abnormalities and the immune status of HIV/AIDS subjects having opportunistic pulmonary mycoses in Uyo, Nigeria. A cross sectional study was adopted using 230 subjects with pulmonary symptoms attending the Anti-retroviral clinics in University of Uyo Teaching Hospital and Saint Luke’s Hosipital, Anua, Akwa Ibom State, Nigeria. The hematological parameters and CD4 counts was determined using blood and sputum was used for mycological examinations. Data was analysed using statistical package for the Social Sciences (SPSS) and was significant at p = 0.05. HIV subjects were more prevalent in female 98(68.89%) than male 56(31.11%). The most commonest fungi was Aspergillus niger (44.76%) and the least was Cryptococcus species (9.00%). The common hematological abnormality was anaemia with 86(86.9%), lymphopenia 33(33.3%) and thrombocytopenia 3(3.0%) among HIV/AIDS subjects with mycoses. The mean CD4 counts was 396.5±31.61 cells/µl (HIV) and 981.7±17.51 cells/µl (control individual). The CD4 counts below 200 cells/μl was observed in 19.4%(35) of AIDS patients. HIV/AIDS subjects with mycoses may develop hematological abnormalities such as anaemia, neutropenia and leucopenia due to low immune status.&#x0D; &#x0D;

Burden of Anemia among Human Immunodeficiency Virus-Positive Adults on Highly Active Antiretroviral Therapy at Hawassa University Compressive Specialized Hospital, Hawassa, Ethiopia.

Anemia is the most common hematologic abnormality associated with human immunodeficiency virus (HIV)-infected patients and affects 60% to 80% of patients in late-stage disease. It has a considerable impact on the progression of HIV to advanced stages. This study aimed at assessing the burden of anemia in adult HIV-infected patients who are on highly active antiretroviral therapy (HAART) and have follow-up at Hawassa University Comprehensive Specialized Hospital (HUCSH) Antiretroviral therapy (ART) clinic. A hospital-based retrospective study was conducted among HIV-positive adults on HAART at Hawassa University Compressive Specialized Hospital. The systematic sampling method was used to choose a total of 244 study participants. Data on demographic characteristics, related factors of anemia, latest hemoglobin, CD4, and ART regimens were collected using a structured data abstraction format. The data were cleaned and analyzed using SPSS version 21.0 after being manually checked for completeness. Multivariable logistic regression was carried out to detect elements associated with anemia. A P value of <0.05 was used as a cutoff point to announce statistical significance. The records of 244 patients were examined in total. Anemia was present in 29.9% (95% CI 23.8-35.2) among adult HIV patients. Female sex (AOR: 2.576, 95% (CI: 1.295-5.127)), having tuberculosis (TB) (AOR: 4.873, 95% (CI: 1.534-15.484)), taking a zidovudine (ZDV)-containing ART regimen (AOR: 5.216, 95% (CI: 1.239-21.962)), having clinical WHO stage IV and III diseases (AOR: 3.077, 95% CI (1.244-7.612)), having body mass index (BMI) <18.5 kg/m2 (AOR: 2.391, 95% (CI: 1.138-5.023)), and taking cotrimoxazole prophylaxis (AOR: 3.860 95% (CI: 1.097-13.576)) were substantially linked to the development of anemia among adult HIV patients. Conclusion and Recommendation. This study showed that anemia is still a problem among HIV patients on HAART. The burden of anemia was found to be high among patients with advanced WHO clinical stages, having a BMI less than 18.5 kg/m2, TB/HIV coinfection, being on AZT-based ART regimens, and taking cotrimoxazole preventive therapy (CPT). Consequently, it is suggested that early preventative interventions, such as serial hemoglobin follow-up, iron supplementation, and education about dietary consumption, be undertaken targeting the aforementioned groups. In addition, the preferred first-line ART regimen as per the latest national and WHO guidelines is recommended, especially for the above groups.

Anemia and Associated Risk Factors in Pediatric Patients.

Anemia is the most common hematologic abnormality identified in children and represents a major global health problem. A delay in diagnosis and treatment might place patients with anemia at risk for the development of rare but serious complications, including chronic and irreversible cognitive impairment. Identified risk factors contributing to the development of anemia in children include the presence of nutritional deficiencies, environmental factors, chronic comorbidities, and congenital disorders of hemoglobin or red blood cells. Pediatricians, especially those in the primary care setting, serve a particularly critical role in the identification and care of those children affected by anemia. Prompt recognition of these risk factors is crucial for developing appropriate and timely therapeutic interventions and prevention strategies.