Common Hematologic Disorder Research Articles

COMPARISON OF PLATELET INDICES IN HYPOPRODUCTIVE AND HYPERDESTRUCTIVE THROMBOCYTOPENIA

Background: Thrombocytopenia is one of the most common haematological disorders and is also a life-threatening condition. The two types of thrombocytopenia, hypoproductive and hyperdestructive can best be distinguished by bone marrow examination; but it is an invasive, time-consuming and expensive process. The aim of this study was to determine the role of platelets indices in distinguishing between the two types which is a cost-effective and non-invasive modality of investigations. Methods: It was a cross-sectional study, conducted in the Pathology Laboratory, Rehman Medical Institute, Peshawar, conducted from 1st July 2019 to 30th June 2020. Non-probability convenience sampling technique was used. Sample size was calculated using WHO formula, and a total of 74 thrombocytopenic patients referred for bone marrow aspirate and trephine biopsy were included in the study. Clinical record, complete blood count (CBC) and bone marrow trephine biopsy were obtained and computed. Results: Mean Platelet Volume was 10.57±1.33 fl in hypoproductive group and 11.637±1.98 fl in hyperdestructive group. The difference between the groups was statistically significant (p=0.017). Platelet Distribution Width was 12.68±3.16 fl in hypoproductive group and 14.811±3.61 fl in hyperdestructive group (p=0.014). Platelet Large Cell Ratio was 30.81±9.23% in hypoproductive group and 36.993±10.25% in hyperdestructive group (p=0.010). Conclusion: Platelet indices can be used as a reliable tool for distinguishing between hypoproductive and hyperdestructive thrombocytopenia. Pak J Physiol 2021;17(2):3–6

Kinome Expression Profiling in Multiple Myeloma Identifies New Therapeutic Targets

Multiple Myeloma (MM) account for approximately 10% of hematological malignancies and is the second most common hematological disorder. Active research on MM allowed great improvement in treatment, including proteasomes inhibitors or immunomodulatory agents, that enhanced significantly the patients median survival from 3-4 years in the 90's to 7-8 years nowadays. However there is a vital need for additional therapies since until today, MM is a condition that cannot be cured, and all patients finally relapse. Although numbers of kinases inhibitors are currently in preclinical and clinical development in cancers, kinases have only be poorly studied in MM. Thus only one study (Tiedeman RE Blood 2010) examined the kinome in MM by using a screening of siRNA in Human Myeloma Cell lines (HMCL).Here, in contrast to Tiedeman et al., we evaluated the potential of kinase involvement directly on patient outcome. We first performed kinome in silico analysis in three independent cohorts of patients, and identified 36 kinases significantly and identically involved in MM patient's survival. We built a Kinome Index (KI) from the 36 kinases expression, and showed that KI: 1) is related to OS and EFS prognosis in 3 independent cohorts, 2) is linked to proliferation and poor prognosis subgroups of MM molecular classification, 3) is associated with relapse. Among the 36 targets, 7 had available inhibitors and were not already consistently studied in MM (PBK, SRPK1, CDC7-DBF4, MELK, CHK1, PLK4, MPS1/TTK). We then tested the therapeutic interest of these 7 kinase inhibitors using 4 HMCLs representing two IL-6 independent (AMO1, OPM2) and two IL-6 dependent (XG1, XG21) cell lines. All tested inhibitors significantly reduced viability of the cells, and had IC50 from the nanomolar (for MELKi, CHK1i and PLK4i) to the micromolar range (for PBKi, SRPK1i, CDC7-DBF4i and MPS1/TTKi). Annexin, PARP and cell cycle analysis following treatment with selected concentration of the inhibitors in AMO1, showed significant increase in apoptosis, associated for most of them with a perturbation of the cell cycle. Treatment of primary myeloma cells from patients with MELKi, CHK1i and PLK4i induced MM cell death while they didn't impacted significantly the cellular microenvironment. Similarly experiments using murine MM cells, from 5TMM models, confirmed the potential of these three inhibitors.Next, IC20 of the different inhibitors were tested in co-treatment with melphalan, lenaledomide or velcade in XG1, XG21, AMO1 and OPM2 to challenge the capabilities of the selected kinases inhibitors to synergize with major routinely used therapeutics. We didn't observed any synergy for the co-treatments with bortezomib. However, CHK1i, MELKi, PBKi, DBF4i synergized with melphalan to induce MM cell death. Furthermore, CHK1i, MELKi, PLK4i, PBKi, SRPK1i demonstrated also a synergistic effect when combined with lenalidomide, highlighting their potential therapeutic interest in MM. Analysis of apoptosis and cell cycle following co-treatments with melphalan and lenaledomide using AMO1 cell line demonstrated an increase in PARP cleavage and annexin V staining in association with significant cell cycle deregulation. One of the outstanding co-treatment effects was the reversion of the natural AMO1's resistance to lenaledomide with CHK1, MELK and PBK inhibitors used at their IC20. We then tested their therapeutic interest to overcome melphalan drug resistance using wild-type (XG7-WT) and melphalan-resistant (XG7-Mres) cell lines. PLK4 and DBF4 inhibitors demonstrated higher activity on XG7-Mres cells compared to their WT control. In addition CHK1, PBK and DBF4 inhibitors (IC20) were able to re-sensitize XG7-Mres to melphalan at a similar level than XG7-WT. Altogether we identified 36 new potential kinases deregulated in MM in association with a poor prognostic value. Seven of them represent potential new MM therapeutic targets alone or in combination with conventional therapies in high-risk MM patients. DisclosuresBruyer:Diag2tec: Employment. Cartron:Sanofi, BMS, Jansen, celgene, Roche, Gilead: Equity Ownership; Celgene: Consultancy, Employment; Roche: Consultancy, Equity Ownership, Honoraria, Research Funding. Hose:Sanofi: Research Funding; EngMab: Research Funding; Takeda: Membership on an entity's Board of Directors or advisory committees.

Gestational thrombocytopenia: a case-control study of over 3,500 pregnancies.

Gestational thrombocytopenia (GT) affects an estimated ninemillion women annually. Women with GT have recurrent episodes on subsequent pregnancies suggesting that GT is related to a maternal factor rather than a factor unique to the individual pregnancy. We performed a case-control study of over 3500 pregnancies at a single hospital during 2017. We defined GT as any pregnancy with a platelet count <150000/µl during the 100days prior to delivery. We excluded women with platelet counts <50000/µl or with conditions known to cause thrombocytopenia. GT was present in 12% of pregnancies. The median platelet count at delivery was 134500/µl in cases versus 208000/µl in controls, P<0·0001. During the pregnancy, the platelet count declined 31·8% in cases compared with 18·3% in controls (P<0·0001) in association with a significant increase in mean platelet volume during each trimester. Among women with GT, platelet counts rapidly increased during the first week postpartum, consistent with a mechanism directly related to high blood flow rates in the gravid uterus. GT, a recurrent condition of at-risk women, is a common haematological disorder of pregnancy. Future research may focus on genetic gain-of-function polymorphisms resulting in increased turnover of platelets uncovered only during periods of high-shear blood flow.

The Effect of oral Administration of Cichorium Intybus on Reduction of Liver Enzymes in Patients with Major Thalassemia: Randomized Clinical Trial Study

Background: Beta-thalassemia is a common hematological disorder. The aim of this study was to determine the effect of oral administration of Cichorium intybus on reduction of liver enzymes in patients with major thalassemia. Materials and Methods: This study was randomized clinical trial study that was conducted on 100 patients with age over 2 years and major thalassemia referred to Mohammad Kermanshahi Hospital of Kermanshah city (Iran) in 2019-2020. Eligible patients were randomly divided into two intervention (n=50), and control (n=50)groups.The intervention group received 0.028mg/kg/day Cichorium intybus as a medicinal supplement and control group received placebo for 3 months. All patients were evaluated and followed up for 6 months. The Liver enzymes levels (AST and ALT) were measured at four time periods (baseline, 1.5, 3 and 6 months after intervention). Ferritin was also measured at three time periods (baseline, 3, and 6 months after the intervention).The SPSS software version 24.0 was used to data analysis. Results: The results of Repeated Measure ANOVA test showed that therewere significant statistical differencebetween the two groups of intervention and control in term of ALT and AST at different time periods, so that the means of ALT and AST after the interventionwere lower in intervention group than control group(p 0.05). Conclusion: Oral administration of Cichorium intybus can reduce liver enzyme levels (ALT and AST) in patients with thalassemia major. Therefore, Chicory administration in patients with major thalassemia is suggested.

Predictors of Anemia Among Adult HIV Positive Patients on First-Line Antiretroviral Therapy in Northwest Ethiopia: A Retrospective Follow-Up Study.

BackgroundGlobally, anemia is a common hematological disorder among HIV-infected patients. People with anemia often suffer from impaired physical functioning, psychological distress, and poor quality of life. Therefore, the aim of this study was to determine the incidence of anemia and its determinants among HIV positive individuals in northwest Ethiopia.MethodsA total of 486 adult HIV positive patients on the first-line ART with complete information were enrolled in the adult care clinics of northwest Amhara referral hospitals from December 2015 to December 2018. EpiData version 4.2 was used for data entry and Stata version 14 for analysis. Variables having time to event nature were presented with the Kaplan–Meier function. The Cox regression model was used to identify predictors of anemia. Variables with P-values less than 0.2 in the bivariable analysis were considered in the multivariable regression. Adjusted hazard ratio with 95% CI was computed, and variables with less than 0.05 P-values in the multivariable Cox regression were taken as significant predictors of anemia.ResultsThis study noted an overall 26.4 per 100 person-year observations (95% CI: 23.46, 30.74) incidence rate of anemia. According to the multivariable Cox regression, TB co-infection (AHR =1.99, 95% CI: 1.45, 2.74), zidovudine-based regimen (AHR=1.39, 95CI: 1.1, 1.85), CD4 level (AHR= 1.7, 95% CI: 1.23, 2.35), advanced WHO stage (AHR=1.32, 95% CI: 1.01, 1.74), and being underweight (AHR= 1.53, 95% CI: 1.14, 2.07) were predictors of anemia.ConclusionAnemia is a burden among HIV patients in the study setting. Baseline clinical variables, TB co-infection, and zidovudine-based were predictors of anemia. Therefore, early identification of anemia and addressing significant predictors are highly suggested to the study setting.

Referral Pattern and Haematological Disorders in a Tertiary Hospital

This study aimed to determine the pattern of referrals and haematological disorders at Benue State University Teaching Hospital. This was a retrospective study of records of a total of 222 adults and Paediatric patients suspected to have haematological disorders, seen and referred from different clinics and wards within and outside the study facility to the Haematologists for evaluation between June 2012 to July 2019 inclusive. These patients were clerked by the Haematologists, peripheral blood samples were taken for full blood count, red cell indices, reticulocyte count and peripheral blood film examination. Bone Marrow Aspiration was done on all the patients and the slides examined. Where indicated, further flowcytometry was done for complete diagnosis. Of the 222 referred, 127 (57.2%) were males while 95(42.8%) were females, with M:F ratio of 1.3:1. The age range of patients was 3 to 95 years with median age of 36.5 years. Those in the age group of 16-35 years constituted the majority 81(36.5%), while the least 5(2.3%) referred cases were in the age group of 76 years and above. The highest referral to the Haematologists was 40(18%) in 2015 and 2018 each. The bulk of referrals to the Haematologist was from Medicine 103(46.4%), followed by referrals from General Outpatient Department (GOPD) 29(13.1%) and then Paediatrics 27(12.2%), the least was from Ear Nose and Throat (ENT). The main indication for referral was Unexplained Anaemia 68(30.6%), followed by Splenomegaly 26(11.7%). One hundred and eighty (81.1%) of the total referred cases had at least an established haematological disorder. The most common haematological disorder established from the total referred cases was Combined Iron Deficiency Anaemia and Megaloblastic Anaemia (IDA/MA) 52(23.4%). This was followed by Chronic Lymphocytic Leukaemia (CLL) 23(10.4%). In conclusion, referrals from other physicians to the Haematologists have very high likelihood of haematological disorder. We recommend that attending Haematologists treat all referred cases with very high index of suspicion so as not to miss a potentially life threatening haematological disorder.

Clinical profile of thrombocytopenia in pregnancy

Thrombocytopenia is defined as platelet count of less than normal for the laboratory. This typically is at or very close to1.5 lakh/cumm. Hence platelet count of less than 1.5 lakh/cumm is called as thrombocytopenia. Thrombocytopenia in pregnancy is not an uncommon finding; in fact, it is the second most common hematological disorder in pregnancy after anaemia and affects nearly 6 to 15%; on an average 10% of all pregnancies. The reported prevalence of maternal thrombocytopenia is variable. In a recent survey in 2000 involving 6770 pregnant women, prevalence of thrombocytopenia was found to be 11.6%. A prospective observational study conducted to identify causes for thrombocytopenia in pregnancy along with its neonatal outcome Out of total, 30% patients delivered low birth weight babies and 70% delivered babies with birth wt of >2.5kg. Occurrence of low birth weight babies in mothers with GT and ITP were comparable being 27.3% and 33.3% respectively. APGAR score (at 1 min) of neonates was less than 7 in 12% neonates while at 5 min it was below 7 in only 1(2%) baby. Neonates born to mothers with ITP had poor 1 minute APGAR score when compared to neonates born to patients with GT. There was no significant relationship found between maternal and fetal platelet counts in patients with gestational thrombocytopenia. ITP leads to neonatal thrombocytopenia. Keywords: Cord blood, Thrombocytopenia, APGAR scoring, ITP, Gestational thrombocytopenia.

Mild thrombocytopenia prior to elective cesarean section is an independent risk factor for blood transfusion.

Thrombocytopenia is the second most common hematological disorder in pregnancy and complicates approximately 10% of all pregnancies. The data regarding the association of mild thrombocytopenia in women undergoing cesarean section and risk of bleeding or bleeding-related complications are scarce. Thus, the aim of the current study was to assess the association of mild thrombocytopenia with hemorrhage-related morbidities, among patients undergoing elective cesarean section. We performed a retrospective cohort study, in a single tertiary university-affiliated medical center, between 1 January 2012 and 31 May 2019. Medical charts of women who underwent elective cesarean section at term (37+0/7-41 + 6/7weeks of gestations) were retrieved and analyzed. We compared women with mild thrombocytopenia (platelet count of 100-149 × 103/μL) to women with normal platelet count (150-450 × 103/μL). The primary outcome was the need for red blood cell transfusion during the index admission. A secondary outcome was severe bleeding not requiring blood transfusion defined as postpartum hemoglobin decline of ≥ 3g/dL as compared to the prepartum levels. During the study period, 1577 women were included in the final analysis, of them 396 (25.11%) had mild thrombocytopenia prior to delivery. As compared to the control group, women with mild thrombocytopenia had higher rates of blood transfusion (3.79 vs. 1.52%, p = 0.01), and had a significant decline in hemoglobin levels. In a multivariable logistic regression model, mild thrombocytopenia was independently associated with blood transfusion with adjusted OR of 2.34 (95% CI 1.10-4.96, p = 0.03). Preoperative mild thrombocytopenia is associated with an increased risk of blood loss and blood transfusion in women undergoing elective CS. More studies are required to assess those observations in context of urgent cesarean sections and whether any preventive measures can reduce the risk for bleeding.

Incidence and Risk Factors of Thrombocytopenia in Neonates Admitted With Surgical Disorders to Neonatal Intensive Care Unit of Tikur Anbessa Specialized Hospital; A One-Year Observational Prospective Cohort Study From a Low-Income Country

Background: Thrombocytopenia is one of the most common hematologic disorders affecting neonates who are admitted to the neonatal intensive care unit with a reported incidence of 18-35%. Several maternal, neonatal and perinatal factors contribute to the development of thrombocytopenia. This study is aimed to determine the incidence and associated risk factors of neonatal thrombocytopenia. Methods: An observational prospective cohort study was conducted and all neonates admitted to the neonatal intensive care unit of Tikur Anbessa Specialized Hospital with surgical disorders in the study period were included. Data was collected using a checklist and analysed by SPSS version 23. Chi square test and independent sample T- test were used to asses the association among different variables. Findings: A total of 210 neonates were included in the study out of which 56.2% were males. The incidence of thrombocytopenia in the study period was 55.8%. Among neonates with thrombocytopenia, 90.9% had a late onset thrombocytopenia and half of them were in the severe range (<50,000/µl). The presence of sepsis(P=0.000) and atresia (P=0.000) were found to be significantly associated with the development of thrombocytopenia. The mean non feeding hours were found to be significantly longer for patients with thrombocytopenia (t (199), 5.81, P= 0.000). Interpretation: The incidence of thrombocytopenia in neonates admitted with surgical disorders was high in our institution. Preventive methods towards neonatal sepsis including antenatal and postnatal measures should be given due emphasis. Initiation of oral feedings in neonates as early as feasible is recommended. Funding Statement: Addis Ababa University has granted the fund for this study. Declaration of Interests: None. Ethics Approval Statement: Written informed consent was taken from parents of enrolled neonates and each neonate’s clinical data was kept in confidential manner using a coding system. Ethical clearance for this study was obtained from ethical board of the medical college.

Prevalence of β-S Globin Haplotypes in Jazan Region of Saudi Arabia.

Sickle cell disease (SCD) is a common hematological genetic disorder in Saudi Arabia, Africa, the Mediterranean region, and India. The present study aimed to characterize βS haplotypes found in the Jazan region, Saudi Arabia. One hundred sickle cell trait (SCT) individuals, diagnosed during their visit to the premarital screening clinic at King Fahad Central Hospital, were included in the study. Molecular analysis was carried out by polymerase chain reaction (PCR) and six polymorphic sites of the β-globin gene were analyzed using restriction endonucleases Hind II, Xmn-I, Hind III, and Ava II. The results of the current study revealed the presence of five typical haplotypes in which Benin, Bantu, and Senegal were found in homozygous state with 29%, 3% and 1% frequencies, respectively. Interestingly, 29% of the studied population showed atypical haplotypes in heterozygous state and 2% in homozygous state for the first time in Jazan region. In addition to the typical haplotypes, high frequency of atypical haplotypes in this study indicates a diverse genetic mechanism that might have a crucial effect on the severity of SCD in this region. Therefore, considering this study in a cohort population with SCD in Jazan region may provide more indepth details about the correlation between haplotypes and the clinical manifestation of the disease.

Hematologic autoimmune disorders in the course of COVID-19: a systematic review of reported cases

ABSTRACT Objective As COVID-19 is a new emerging disease, the hematological/immunological changes that develop in the infected patients remain unknown. This study aims to systematically review the hematologic autoimmune complications in these patients. Method Data from three online databases including Medline (via PubMed), Scopus and Web of Science were searched on 19 December 2020, and after excluding duplicate, irrelevant and inappropriate records, eligible documents were identified. Afterwards, information such as patients’ history, presentations, paraclinical data, treatment course and outcome were extracted from the records. Results A total of 58 documents were considered to be eligible for data extraction which described 94 patients with COVID-19 who developed hematologic autoimmune disorder in their course of infection. Of these patients with COVID-19, the most common hematologic autoimmune disorder was immune thrombocytopenic purpura (55 cases) followed by autoimmune hemolytic anemia (22 cases). Other hematologic autoimmune disorders include antiphospholipid syndrome, thrombotic thrombocytopenic purpura, Evans syndrome and autoimmune neutropenia. Conclusion The current study would help us to always consider an autoimmune etiology for cases with abnormal hematologic finding which further lead to an appropriate treatment of the patients, especially when the symptoms present in about 1–2 weeks after the first manifestation of the infection symptoms. Maybe, at least in this pandemic, it should be recommended to evaluate patients with unexpected and unexplained decrease in their hemoglobulin or platelet count for COVID-19. Another challenging issue is the treatment options. Given the multiorgan involvement and multifaceted nature of the infection, an individualized approach should be taken for each patient.

CLINICAL AND BIOLOGICAL EVOLUTION OF THE NEWBORN WITH THROMBOCYTOPENIA IN THE NEONATAL INTENSIVE CARE UNIT

ntroduction: Thrombocytopenia is one of the most common haematological disorders detected in the newborn period, especially in neonates admitted to intensive care units and usually indicates an underlying pathological process. Objectives: To determine the etiology, the time of onset, the clinical characteristics and the evolution of newborns with thrombocytopenia. Material and method: 97 newborns with platelet counts (&lt;150,000 / µl) were selected from those admitted to the Neonatology section of the Timisoara Children's Emergency Hospital "Louis Turcanu" for a period of 3 years. The determination of the initial values of platelets was performed at the hospitalization and then daily monitoring or even twice daily in the case of newborns with severe thrombocytopenia. Results: Grade IV thrombocytopenia (&lt;25000 / µl) was present in 13.4% of cases, grade III (25000-50,000 / µL) in 16.5% of cases, grade II (50,000-75,000 / µL) in 9 , 3% of cases and grade I (75,000-150000 / µL) in 60.8% of cases. Most of the newborns (55.7%) were premature and the major causes of thrombocytopenia were sepsis, in 69.1% of cases and hypoxic suffering in 66% of cases. Mortality was 12.6% (n = 14). Conclusion: Thrombocytopenia occurring in newborns admitted to the neonatal intensive care unit is not a negative prognostic factor but rather a marker of severity of the underlying pathology.

Use of Complementary and Alternative Medicine for Children with Sickle Cell Disease: Prevalence and Factors Associated with Use

Sickle cell disease (SCD) is one of the most common hematologic disorders in the world. In the United States, it is the single most common genetic hematologic disorder. The burden of SCD and its complications on pediatric patients is tremendous, especially acute vaso-occlusive pain crises. Although allopathic medicine has provided numerous pain medications to treat this, they do not come without side effects and are not always effective. This review explores complementary and alternative medicine (CAM) methods of pain management available for pediatric SCD patients. A PubMed literature search was conducted, and the reference lists of shortlisted studies and review articles were screened after application of the exclusion criteria; 14 articles were used in this literature analysis. A wide range of CAM therapies exist. Common ones include praying, spirituality, and massage. Factors associated with CAM use are parental use of CAM, gender, SCD/pain severity, patient’s age, caregiver’s education level, and in some cases, financial means to access CAM methods. CAM has shown to be effective in reducing pain, patients’ depression and anxiety, analgesic use, and in increasing daily functioning. Thus, CAM has demonstrated potential in reducing pain and improving the quality of life of pediatric SCD patients. It holds great promise to be regularly encouraged by providers and employed by patients. Further research is needed on a larger scale to better study its efficacy; however, CAM use has repeatedly been associated with improved functioning and pain control.

An Analytical Study on Anemia in Rural Population

Background: Anemia is one of the common Hematological disorders in India and worldwide. It affects all the age groups both in Males and Females. Moderate to Severe Anemia causes increased morbidity and mortality in elderly patients (AWHO expert group) - According to Worlds Health Organization, Anemia is a define when adults males are having Hemoglobin less than 13.5gr% when adults females non-pregnant less than 12 gr% and when pregnant females are having less than 11 ger%. The incidence of Anemia is very high in old age people who are more than 75 years of age. It ranges from 9% to 41%. In India Anemia is commonly due to nutrition, pregnancy, Hookworm infestation, DUB in the case of females, and Malignancy. The prevalence of anemia in the elderly has been found to range from 9% to 42% with the highest prevalence in 80 years and above. The common causes of anemia in India are Nutritional, Pregnancy, Hookworm infestation, and DUB in the case of Females and Malignancy. The common symptom is General weakness, Fatigue, Lack of concentration, Shortness of Breath, and Palpitations. A WHO expert group proposed that anemia should be considered when hemoglobin level below 13.5gr&amp; in adult males; 12gr% in adults females non-pregnant; 11 gr% in adult female pregnant; 12gr% in children over 14yrs(1). The aim is to evaluate the etiology and clinical features of anemia in adults in rural medical colleges. Subjects &amp; Methods: This study is conducted at GEMS Medical College, Srikakulam, A.P for the period of 1 year from April 2018 to March 2019. This study includes 120 patients with Anemia. The age group is between 20 years and 70 years. Males were 56 and females were 64. Results: We have conducted this study at GEMS Medical College, Srikakulam for 1 year, from April 2019 to March 2019 total no. of patients included in this study are 120 males 56 and females 64. The age group is between 20 years and 70 years. The maximum patients are in between 30 years and 70 years in both sexes. Conclusion: Anemia is a common medical problem in developing countries. In a rural part of India, the disorders will complicate the pregnancy also. So periodical examination and education of the people can decrease morbidity and mortality. In our area still, the common cause is nutritional.

MDCT Evaluation of Hepatic Manifestations in Malignant Hematological Disorders

Objective: The aim of this work was to evaluate Multidetector Computed Tomography (MDCT) findings of hepatic manifestation in common malignant hematological disorders. Materials and Methods: This retrospective study included 300 patients with different types of malignant hematological disorders. They were 119 female and 181 male (mean age, 45.4 year; range, 5-70 years). The most common hematological disorder was Non-Hodgkin lymphoma (NHL) detected in 192/300 (64%) patients and then Hodgkin disease (HD) detected in 40/300 (13.3%) patients. All 300 patients had ultrasonography. Clinical evaluation and laboratory assessment were done for all patients. Whole body and triphasic abdominal CT scanning was performed on 64 MDCT systems. Results: MDCT scanning revealed hepatic affection in 82/192 of NHL. All these 82 cases revealed hepatomegaly and focal lesion detected in 36 cases. As regard Hodgkin disease (HD), hepatomegaly detected in 22/40 cases and focal lesion detected in 8/40 cases. Hepatomegaly detected in 8/14 cases of acute myeloid leukemia (AML) and focal lesion detected in 4/14 cases. In cases of chronic lymphocytic leukemia (CLL), hepatomegaly detected in 6/22 cases with no detection of focal lesion. Conclusion: Hepatic involvement is often observed in several malignant hematological disorders, resulting in abnormalities in liver imaging studies. Malignant hematological disorders must be considered in hepatomegaly and hepatic focal lesions either single or multiple. MDCT is the diagnostic modality of choice for diagnosis and follow up of liver affection in different malignant hematological disorders.

A 12 Year-Old Girl with Severe Iron Deficiency Anemia Secondary to Chronic Pediculosis Infestation

A 12 year-old female presented to an outside emergency department with her grandmother due to worsening fatigue over the preceding six months. She also reported intermittent right-sided abdominal discomfort for two months. The patient's past medical history was only remarkable for chronic infestation withPediculus humanus capitis(head louse), reportedly treated multiple times with topical medications without resolution. The infection had been persistent for six years. She did not consume excessive amounts of cow's milk. Physical exam was remarkable for pallor, tachycardia, systolic ejection murmur and visible nits. Laboratory studies showed hemoglobin 4.7 g/dL, mean corpuscular volume (MCV) 53.4 fL, reticulocytes 3.9%, white blood cell count 14.2 x 103 /µL, platelet count 449 x 103 /µL, total iron binding capacity (TIBC) 472 µg/dL, serum iron 8 µg/dL, iron saturation 2%, and ferritin 2 ng/mL. Peripheral blood smear showed a severe microcytic hypochromic anemia with anisopoikilocytosis, without schistocytes or blasts. She was premenarchal. Stool was negative for occult blood, ova and parasites, and celiac studies were negative. A diagnosis of iron deficiency of anemia (IDA) was made by the classic presentation of microcytic, hypochromic anemia with hypoferritinemia and elevated TIBC, along with an inappropriately low reticulocyte count. The most common etiologies of iron deficiency anemia in children were ruled out by history and laboratory evaluation, making chronic pediculosis the most likely cause in this patient. She received aggressive treatment for pediculosis, packed red blood cell transfusions, and oral ferrous sulfate. By day 65 after presentation, her laboratory values had normalized (hemoglobin of 13.6 g/dL, MCV of 80.3 fL, ferritin of 28 ng/mL). Pediculosis infestation remained resolved. Iron deficiency is the leading etiology of anemia worldwide and the most common hematologic disorder. Parasitic and vector-borne infections are a common cause of IDA internationally, but uncommon in developed countries. Severe iron deficiency secondary to pediculosis in children is an exceedingly rare entity despite high infestation rates, with nearly 40% of North American children affected.Pediculus humanusis an Arthropod species of sucking lice belonging to the familyPediculidae. The two subspecies arePediculus humanus capitis(head louse) andPediculus humanus humanus(body louse). The average child with pediculosis infestation will average 0.008 mL of blood loss per day due to louse consumption; however, heavily infested children can lose up to 0.7 mL per day. Thus, the patient may have had greater than 1.5 liters of blood consumed during her period of infestation. To our knowledge, this is the only reported case of a child in the United States with severe IDA secondary to chronic severe lice infestation. Iron deficiency is likely an under-recognized complication of severe and/or chronic pediculosis. In patients with history of mental health conditions, homelessness, or children who are in neglectful social situations, an evaluation of hemoglobin and iron status by the pediatrician may be a useful adjunct in severe cases. Disclosures No relevant conflicts of interest to declare.

Nociceptors protect sickle cell disease mice from vaso-occlusive episodes and chronic organ damage.

Sickle cell disease (SCD) is a common hereditary hematologic disorder. SCD patients suffer from acute vaso-occlusive episodes (VOEs), chronic organ damage, and premature death, with few therapeutic options. Although severe pain is a major clinical manifestation of SCD, it remains unknown whether nociception plays a role in SCD pathogenesis. To address this question, we generated nociceptor-deficient SCD mice and found, unexpectedly, that the absence of nociception led to more severe and more lethal VOE, indicating that somatosensory nerves protect SCD mice from VOE. Mechanistically, the beneficial effects of sensory nerves were induced by the neuropeptide calcitonin gene-related peptide (CGRP), which acted on hematopoietic cells. Additionally, oral capsaicin consumption, which can activate somatosensory nerves by binding to TRPV1, dramatically alleviated acute VOE and significantly prevented chronic liver and kidney damage in SCD mice. Thus, the manipulation of nociception may provide a promising approach to treat SCD.

Böbrek Fonksiyonları Normal Olan Diyabetes Mellitus Hastalarında Anemi Sıklığı ve Bazı Nedenleri

Introduction: Diabetes Mellitus (DM) is one of the most common chronic diseases worldwide according to World Health Organization reports. Anemia is common in patients with DM and anemia is a common hematological disorder in diabetic patients. In our study, we aimed to determine the anemia prevalence and the causes that affect anemia in patients with DM with normal renal function. Materials and Methods: Patients with DM who applied to Eskişehir Osmangazi University Medical Faculty Hospital (the clinics of Family Medicine and Internal Medicine) was included in our study and 229 patients with DM who were not diagnosed with renal dysfunction were included in our study within the last 6 months examinations. Laboratory results that were reviewed in the last 6 months were retrospectively screened and recorded. The hemoglobin (Hb) limit values were evaluated as 12 grams/deciliter (g/dl) in females and 13 g/dl in males and patients with Hb levels below these values were accepted as anemia. The data obtained at the end of the study were analyzed by using SPSS package program. Results: DM patients with normal renal function were included in the study. %25.8 (n=59) of patients had anemia. While 20.3% of the anemia was microcytic anemia, 79.7% was non-microcytic anemia (macrocytic and normocytic anemia). Iron deficiency was found in 57.1% (n = 32), while B12 deficiency was found in 11.8% (n = 7) and folic acid deficiency was found in 3.3% (n = 2) of patients with anemia. Iron deficiency was found in 9.9% (n = 14) of DM patients without anemia. Conclusion: Iron deficiency is the most diagnosed reason of anemia in DM patients. As the clinicians, we can provide early diagnosis and treatment of anemia in diabetic patients especially iron deficiency and we can improve the quality of life of patients and decrease morbidity and mortality.

Clinical and laboratory factors affecting chronicity in children diagnosed with immune thrombocytopenia

Abstract Purpose: Immune thrombocytopenia (ITP) is one of the most common hematologic disorders in childhood. Approximately 20-25% of patients with newly diagnosed ITP become chronic. We aimed to investigate the risk factors that may affect chronicity of ITP. Materials and methods: A total of 75 pediatric patients with ITP who were admitted to the Pediatric Hematology Department of Pamukkale University Faculty of Medicine Hospital between January 2013 and July 2018 were included in the study. 17 of the 75 cases were excluded, because 13 of those had lack of data in the system and 4 of those were persistent ITP. The patients’ characteristics such as clinical features, laboratory results, treatment requirements and type of treatment were retrospectively evaluated using the hospital's information system. Results: 46 (79.3%) of the 58 patients with ITP were acute and 12 (20.7%) of those were chronic. The mean age of the patients with acute ITP was 4±3.84 years, while the mean age of the patient with chronic ITP was 9.6±4.6 years. Statistical analysis revealed that children with a diagnosis age greater than 10 years had a significantly higher rate of chronicity. The dominant season in acute cases was spring with 34.8%, while in chronic cases it was summer with 50%. Acute cases were significantly higher in the spring season. 26 of 46 patients with acute ITP (56.5%) and 3 of 12 patients with chronic ITP (25%) were treated with IVIG firstly. Conclusion: We determined that in newly diagnosed patients with ITP who are older 10 years of age and no history of infection may have high risk of chronicity, while the patients diagnosed in the spring and administered IVIG may have less chronicity.

Prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary and quaternary centre in KwaZulu-Natal.

BackgroundThrombocytopenia is a common haematological disorder, characterised by platelet counts below 150 × 109/L. The aetiology of thrombocytopenia is multifactorial; notably, in a misdiagnosis this condition may be due to pre-analytical laboratory artefacts. Knowledge about the common aetiology of thrombocytopenia will assist clinicians in decision-making and interpretation of laboratory tests and this may lead to prompt, adequate patient management and cost-saving measures.ObjectiveThis study determined the prevalence and aetiology of moderate and severe thrombocytopenia in a tertiary or quaternary laboratory in Durban, KwaZulu-Natal, South Africa.MethodsWe conducted a retrospective study at the Inkosi Albert Luthuli Central Hospital haematology laboratory between October 2015 and April 2016. A total of 2076 full blood count results with a platelet count of less than 100 × 109/L were retrieved from the Inkosi Albert Luthuli Academic Hospital database. Laboratory data were extracted and matched with clinical data and used to identify the potential aetiology of thrombocytopenia.ResultsThe prevalence of thrombocytopenia was 14.9% within the selected study period. The haematology or oncology wards and clinic accounted for 55.2% of thrombocytopenia cases, whereas the adult and paediatric intensive care units accounted for 29.3%. Notably, 15.5% of thrombocytopenia cases were reported in non-haematology wards and clinics. The most common cause of thrombocytopenia was chemotherapy which accounted for 38.5% of all causes.ConclusionIn our tertiary and quaternary setting, thrombocytopenia in adults was most common in patients admitted to haematology and oncology wards. Moreover, chemotherapy-induced thrombocytopenia accounted for more than a third of all these cases.