Hematological Abnormalities In Patients Research Articles

Hematological Abnormalities in Patients with Decompensated Chronic Liver Disease: A Cross- Sectional Analysis

Hematological Abnormalities in Patients with Decompensated Chronic Liver Disease: A Cross- Sectional Analysis

Evaluating Reduced Blood Monitoring Frequency and the Detection of Hematological Abnormalities in Clozapine-Treated Patients With Schizophrenia: A Chart Review Study From the COVID-19 Pandemic.

In response to Health Canada's March 2020 directive, patients on clozapine for over 12 months were allowed to extend hematological testing intervals from 4 to 8 weeks during the COVID-19 pandemic. We hypothesized that this change would not affect the timely detection of hematological abnormalities in patients with severe mental illness. A chart review was conducted of patients at the Royal Ottawa who were prescribed clozapine from March 2019 to March 2021. We analyzed clinical and hematological data from electronic health records and Clozaril Support and Assistance Network database to compare occurrences of hematological abnormalities [leukopenia (white blood cell count <3.5 × 109/L) and agranulocytosis (absolute neutrophil count <0.5 × 109/L)] from March 17, 2020 to March 16, 2021, between standard and extended monitoring protocols using binomial logistic and zero-inflated negative binomial regressions. Of 621 patients, 196 were on extended blood monitoring, and 425 followed standard blood monitoring. Clozapine dose did not differ between groups (standard: 370 ± 201mg; extended: 352 ± 172mg; P = .14, ds = 0.10). Clozapine treatment duration up to March 2021 was 12.6 ± 8.3 years, with the extended group (10 ± 7.9 years) having a significantly (P < .01, ds = 0.50) shorter duration than the standard (14 ± 8.2 years). Extended monitoring did not significantly impact likelihood of detecting hematological abnormalities (OR = 0.83, 95% CI [0.58,1.41], P = .55) after controlling for age, sex, total bloodwork, and other psychotropics associated with neutrophil counts (ie, valproate, olanzapine). No patient on the extended regimen developed agranulocytosis. Reducing blood monitoring frequency in patients on clozapine for more than 12 months did not compromise detection of hematological abnormalities.

Hematologic Abnormalities in Patients With Hidradenitis Suppurativa Receiving Adalimumab

This post hoc analysis of PIONEER I and II randomized clinical trials assesses whether receiving adalimumab is associated with decreased hematologic abnormalities and increased clinical improvement in patients with hidradenitis suppurativa.

Hematological impact of COVID-19 mRNA vaccination in patients treated with Clozapine

IntroductionClozapine is an atypical antipsychotic that is primarily prescribed for treatment-resistant schizophrenia. Despite its proven efficacy, the prescription of clozapine is sometimes limited by its hematologic side effects, including agranulocytosis. During the SARS-CoV-2 pandemic, schizophrenia is recognized as a risk factor for developing severe forms of the infection. Early and complete vaccination of patients has been recommended. However, there is limited data on the effect of the vaccine on the risk of hematologic abnormalities in patients treated with clozapine.ObjectivesTo study the hematologic effect of the mRNA vaccine against COVID-19 in a population of patients with treatment-resistant schizophrenia treated with clozapine.MethodsTwenty-five patients hospitalized for schizophrenia at the forensic psychiatry department of Razi Hospital in Manouba, Tunisia, were included. Eighteen patients were treated with clozapine, and seven patients were treated with other antipsychotics. Consent from patients and/or their relatives was obtained before vaccination. The results of complete blood counts performed as part of the therapeutic protocol were compared between the two groups before and after administration of the vaccine.ResultsNo patient experienced agranulocytosis induced by clozapine after vaccination against COVID-19.Blood cells counts,red blood cells counts,and platelets were within the normal ranges.However,a decrease in the number of WBCs,neutrophils,and lymphocytes was observed in patients treated with clozapine without significant difference compared to the patients treated with other neuroleptics, but there was no severe neutropenia or need to stop treatment.ConclusionsThe prescription of clozapine, the introduction protocol, and treatment administration have been greatly influenced by the COVID-19 pandemic due to the hepatotoxic risk of the drug. Vaccination is essential to prevent severe forms of the infection, especially in at-risk populations such as patients treated for schizophrenia.The potentiation of hematologic side effects induced by clozapine by the vaccine is not documented.The COVID-19 mRNA vaccine is safe even with clozapineDisclosure of InterestNone Declared

Hematological Abnormalities and Associated Factors Among Patients with Hypothyroidism at the University of Gondar Comprehensive Specialized Hospital.

Abnormalities in blood cells are frequently associated with thyroid hormone disorders as a result of their involvement in the proliferation and production of blood cells. This study aimed to determine the magnitude and associated factors of hematological abnormalities in patients with hypothyroidism. A cross-sectional study was conducted from January 1 to June 30, 2023, at the University of Gondar Comprehensive Specialized Hospital. The present study included a total of 300 patients with hypothyroidism prospectively using the systematic random sampling technique. The hematological parameter data were collected using data extraction sheets, whereas the associated factor data were collected using both structured questionnaires and data extraction sheets. For complete blood cell counts, 4 mL of anticoagulated venous blood was collected and analyzed. The data were entered into Epi-data version 3.1 and analyzed with Stata version 14. Both bivariate and multivariate logistic regressions were performed to identify factors associated with hematological abnormalities. A P value < 0.05 was considered to indicate statistical significance. The median value of red blood cell, hemoglobin, mean cell volume, white blood cell, and platelet were 4.63 x1012/µL, 14 g/dL, 84.3fl, 5.3 x103/µL, and 228, respectively. The overall incidences of anemia, leucopoenia, and thrombocytopenia in patients with hypothyroidism were 26.3% (95% confidence interval (CI): 21-32), 15.7% (95% CI: 14.2-17.2), and 9% (95% CI: 7.5-10.5), respectively. Lymphopenia was detected in 9% (95% CI: 8.6-10.1) of the patients, and neutropenia was detected in 6% (95% CI: 4.4-7.6) of the patients. Only three factors, female sex (adjusted odds ratio (AOR) =2.1, 95% CI=1.3-3.1), alcohol consumption (AOR= 3.8, CI=1.7-8.9), and febrile illness (AOR=2.7, 95% CI=1.3-5.4), were found to be significantly associated factors for anemia. The present study revealed heterogeneous hematological abnormalities in patients with hypothyroidism. Thus, early diagnosis and monitoring strategies are required to minimize complications in patients.

STUDY OF HEMATOLOGICAL PARAMETERS IN PATIENTS WITH NON-HEMATOLOGICAL MALIGNANCIES AND THEIR CORRELATION WITH STAGE OF THE DISEASE

Background: The incidence of various non-hematological malignancies is on the rise due to increasing awareness and effective screening programmes. An abnormal hematological parameters like anemia, leucocytosis, thrombocytosis may be the first manifestation in patients with non-hematological malignancies. The present study was conducted to detect the hematological abnormalities in patients with non-hematological malignancies and correlate these parameters with the stage of the disease. Materials And Methods: 100 cases of non-hematological malignancies were randomly seleted. Their blood samples were collected and examined. Observation And Results: Out of 100 patients, most of them were in the age group of 51-70years. among them 53% were males and 47% were females. Anemia was detected in 78%, leucocytosis was detected in 42% and thrombocytosis was found in 26% of patients. The incidence(93.1%) and severity(72.4%) of anemia increases with the advancing stage of the disease. The incidence of leucocytosis(51.7%) and thrombocytosis(44.8%) also increases with the advancing stage of the disease. Conclusion: The present study showed a definite association of hematological abnormalities like anemia, leucocytosis and thrombocytosis in patients with various non-hematological malignancies. These parameters increases with the advancing stage of the disease. Hence early detection and proper intervention can help in better patient outcome and improvement in quality of life.

Establishment of Haematological Reference Values for Healthy Individuals Attending Ruhengeri Referral Hospital in Rwanda

Background: The Laboratory investigations are very important for reaching to definitive diagnosis of diseases orientation and thus enabling optimal patient management based on informed diagnoses. Decision, and these are very difficult to obtain in the absence of reference values. In many cases, laboratory diagnosis such as haematological analyses are dependent on pre-defined locally established reference values. Objective of the study: The objective of this study was to describe ranges of haematological reference values for healthy individuals attending Ruhengeri referral Hospital in Rwanda Methodology: The cross sectional study was carried out in Northern Province at Ruhengeri referral hospital from July 2018 to September 2018. Participants were 252 healthy individuals aged less than one year to 68 years. From each participant, 4mL of blood samples were collected using K3 EDTA containers, and then analysed by Sysmex XS-500i automated haematology analyser. Results: Haemoglobin levels varied with age and sex. The level decreased with the increasing age, and males had high haemoglobin level than females (15.69g/dL versus 14.46g/dL). Minimum mean values of haematological parameters for study participants were slightly on the high side with narrow confidence intervals compared to the Manufactured Sysmex values. Conclusion: The findings may be used to define normal haematological values for Rwandan population and help physicians to better define haematological abnormalities in patients.

Significance of hematologic abnormalities in COVID-19 severity among infected patients in Lagos, Nigeria

BackgroundThere have been suggestions that hematologic abnormalities in COVID-19 are linked with the progression and severity of diseases and mortality. Lymphopenia, sepsis, and thrombocytopenia were highly reported in patients with COVID-19. This study investigated the significance of hematologic abnormalities in patients with COVID-19 in Lagos, Nigeria, and its potential as a diagnostic tool for COVID-19 severity.ResultsThis was a retrospective observational study with a total of 340 patients with COVID-19 (236 patients included in the analysis). These patients were categorized into two groups, comprising 71 patients with severe COVID-19 (SCP) and 165 patients with non-severe COVID-19 (NSCP). The majority were males in both categories (SCP 74.6% and NSCP 63.6%). The mean ± SD ages for SCP and NSCP were 52.28 ± 16.87 and 42.44 ± 17.18 years, respectively. The SCP (52.1%) and NSCP (20.0%) had underlying health conditions. The SCP exhibited significantly higher neutrophil counts (P < 0.05) and significantly lower mean hemoglobin, red blood cell (RBC), packed cell volume (PCV), and lymphocyte values (P < 0.05). Anemia and lymphocytopenia were more prominent in the SCP group than in the NSCP group (P < 0.05). Hemoglobin, RBC, PCV, and lymphocytes were inversely correlated with age-group in the SCP, while only lymphocytes and platelets were inversely correlated with age-group in the NSCP. The highest area under the ROC curve (AUC) for neutrophils was 0.739 with a sensitivity of 62.0% and specificity of 80.0%, while white blood cells had an AUC of 0.722 with a sensitivity of 73.2% and specificity of 61.2%. The AUC for neutrophil–lymphocyte ratio (NLR) was 0.766 with a sensitivity of 63.3% and specificity of 83.5%, while that for the platelet–lymphocyte ratio (PLR) was 0.695 with a sensitivity and specificity of 61.7% and 77.8%.ConclusionsCOVID-19 affected the levels of hemoglobin, RBC, PCV, and lymphocytes in the blood, and the differences were significant between the SCP and NSCP. The significant changes in neutrophil and lymphocyte counts may be useful in the prognosis and management of COVID-19 severity in hospital settings. Furthermore, NLR and PLR may be used in the prognosis and management of severe COVID-19 infection, as well as provide an objective basis for early identification and management in low-resource settings.

A STUDY ON HAEMATOLOGICALAND HEMOSTATIC ABNORMALITIES IN PATIENTS WITH CHRONIC LIVER DISEASE.

The Liver is the largest organ of the body. It plays a crucial role in maintaining hemostasis and keeping the hematological parameters within normal limits. Hematological abnormalities in patients with cirrhosis of the liver increase morbidity and mortality to the underlying illness. Consequently, it is vital to look into those abnormalities in a patient with liver disease. The purpose of the study was to determine the hematological and hemopoietic abnormalities in decompensated chronic liver disease patients to guide treatment decisions toward reducing mortality and morbidity. Objectives: To assess RBC; WBC; platelet abnormalities and the derangement of clotting factor secretion and function in patients of chronic liver disease; To know the type of anemia in patients with chronic liver disease. Materials And Methods: ACross-Sectional Observational Study was carried out at Narayana Medical College and Hospital for a duration of 18 months from February 2021 to October 2022, about 70 patients were randomly selected among inpatients Inclusion Criteria: All the patients with signs and symptoms of liver disease for more than 6 months of any etiology. Exclusion Criteria: Patients with Acute hepatic failure; Known case of any malignancy and with primary abnormalities in hemostatic functions; Patients suffering from chronic kidney disease, and coronary artery disease. Patients with a preexisting cause of anemia other than liver disease. Results: Most common type of anemia is Normocytic normochromic anemia. Leucopenia is less common than leukocytosis. Most of the patients had Thrombocytopenia, Prolonged PT, and APTT. Conclusion: From this study, we conclude that hematological alterations are very common in a patient with liver disease which needs to be identied and corrected early for a better clinical outcome

Hematological Profile in COVID-19 Infection Among Patients in a Tertiary Care Hospital in Tamil Nadu, South India.

Introduction A wide range of hematological abnormalities has been observed in SARS-CoV-2 infection which is directly related to the disease progression, clinical severity, and mortality among affected individuals. The objective of this study was to evaluate the abnormalities in hematological parameters among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a tertiary care hospital in south India. Methods This was a cross-sectional study carried out in the pathology department of Karpaga Vinayaga Institute of Medical Sciences and Research Centre,Chengalpattu, Tamil Nadu, India from 1st May 2021 to 30th June 2021. The hematological reports including complete blood count (CBC), neutrophil-lymphocyte ratio (NLR), serum ferritin, serum C-reactive protein (CRP), serum lactate dehydrogenase (LDH), and D-dimer levels of all the blood samples from COVID-19 positive patients were retrieved from the laboratory records. The Leishman-stained peripheral smear findings were also tabulated and analyzed. Results Out of 65 patients, 38 (58.5 %) were males and 27 (41.5%) were females with amajority (78.4%) of them being more than 40 years of age. The salient hematological abnormalities were leukopenia (21.5%), elevated NLR (43%), and thrombocytopenia (6.2%). Peripheral smear showed schistocytes (15.4%), neutrophils with ring nuclei (84.6%), and toxic granules (81.5%). A statistically significant association between elevated NLR and serum CRP was seen among male patients. The association between the presence of schistocytes with serum LDH and D-dimer levels was statistically insignificant. Conclusions The significant hematological abnormalities in patients with COVID-19 infection were elevated NLR, lymphopenia, thrombocytopenia, and elevated D-dimer levels. Careful evaluation of the hematological parameters will help in categorizing the high-risk cases and thereby initiating early intervention and appropriate intensive care management. This will bring down the morbidity and mortality among COVID-19 patients.

A Comparative Study on Haematological Changes before and One hour after Haemodialysis in Patients with End Stage Renal Disease

Introduction: Normal kidney function is very important for maintaining homeostasis. Any deviation of normal renal function leads to deviation of normal homeostasis. End-stage renal disease (ESRD) is the last stage of chronic kidney disease (CKD) resulting from different aetiologies. Different haematological abnormalities in patients with ESRD result from multiple pathogenesis. Treatment of this condition requires multidisciplinary approach. Among all the treatment options haemodialysis (HD) is the most common, widely accepted and available treatment option. Objective: To find out the effectiveness of haemodialysis in the improvement of different haematological deviations developed during the course of ESRD. Materials and Methods: A total of 72 patients with ESRD of both sexes with the age ranging from 25 years to 70 years were included in this comparative cross sectional study and carried out in Combined Military Hospital and Armed Forces Institute of Pathology, Dhaka Cantonment from November 2014 to October 2015. Results: The pre dialysis haematological parameters found in this study were TRBC: 3.4 ± 0.5 X 1012/L, haemoglobin (Hb) level : 9.5 ± 1.4 gm/dL, Haematocrit (HCT): 29.1 ± 4.4%, Mean corpuscular volume (MCV): 83.5 ± 7 fl, Mean corpuscular Hb (MCH): 28 ± 1.8 pg, Mean corpuscular Hb concentration (MCHC): 31.0 ± 2.9 gm/dl, Total leucocyte count (TLC): 6.6 ± 1.9 X109/L, Neutrophil: 66.3 ± 7.8 %, Lymphocyte: 24.5 ± 6.9 %, Monocyte: 5.0 ± 1.8%, Eosinophil: 4.1 ± 2.4 %, Platelet: 184.3 ± 66.5 X 109/L. One hour post HD values are: TRBC: 3.6 ± 0.6 X1012/L, Hb level:10.1 ± 1.6 gm/dl, Hct: 30.9 ± 5 %, MCV:82.6 ± 6.9 fl, MCH: 29.1 ± 2.3 pg, MCHC: 32.2 ± 3.4 gm/dl,TLC: 7.3 ± 2.3 X 109/L, Neutrophil: 69.2 ± 7 %, Lymphocyte: 21.6 ± 5.5 %, Monocyte: 5.3 ± 2 %, Eosinophil: 3.9 ± 2.3%. Platelet: 206.1 ± 63.6 X109/L. Among these values TRBC, Hb level, Hct, MCH, MCHC, TLC, Neutrophil, Lymphocyte and Platelet count significantly improved after HD (p value &lt; .05). Conclusion: Haemodialysis in the management of patients with CKD/ESRD played a pivotal role in improving haematological parameters deranged by these conditions. JAFMC Bangladesh. Vol 18, No 1 (June) 2022: 39-42

Restrictive type and infectious complications might predict nadir hematological values among individuals with anorexia nervosa during the refeeding period: a retrospective study.

BackgroundAlthough hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period.MethodsWe recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake.ResultsThe initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 103/μl decreased by 24.3% to 171 ± 80 × 103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion.ConclusionsNadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.

Common Hematological Abnormalities in patients with Malaria presenting at Saidu Teaching Hospital, Swat Pakistan

Objectives: To determine the frequency of common hematological abnormalities in patients with malaria. Study Design: A cross-sectional study. Place and Duration of the Study: Department of Medicine, Saidu Teaching Hospital, Swat Pakistan from November 2019 to May 2020. Material and Methods: A total of 137 patients of both genders aged between 18-60 years and who presented with malaria in emergency or outpatient department were analyzed. Ten cc blood was taken from all enrolled patients and sent to institutional laboratory for the detection of anemia, thrombocytopenia, leucopenia and disseminated intravascular coagulation (DIC). Frequency of common hematological abnormalities among patients of malaria was noted. For data analysis, SPSS version 26.0 was used. Results: In a total of 137 patients, 95 (69.3%) were male and 42 (30.7%) female. Overall, mean age was 29.2±13.18 while 84 (61.3%) patients were aged between 18 to 30 years. Mean duration of disease was 1.2±1.09 weeks while 89 (65.0%) patients had duration of disease &lt;1 week. Table-1 is showing baseline characteristics of all patients. Anemia was found in 121(88.3%) patients, thrombocytopenia in 67(48.9%), leucopenia in 20 (14.6%) and 35 (25.5%) had DIC. Conclusion: The frequency of hematological abnormalities in patients with malaria was high. Anemia was found in 88.3% malaria cases, thrombocytopenia 48.9%, leukopenia 14.6% and DIC 25.5%. Keywords: Anemia, Leukopenia, malaria, thrombocytopenia.

Can blood glucose levels predict biochemical and haematological abnormalities in COVID -19 patients - Experience from a tertiary care hospital in Balochistan.

To find out the association between poor glycaemic levels and biochemical and haematological abnormalities in patients of corona virus disease-2019. The prospective, observational, cohort study was conducted at the Combined Military Hospital, Quetta, Pakistan, from September 2020 to February 2021, and comprised all patients who tested positive for coronavirus disease-2019 on polymerase chain reaction test and were subsequently admitted. The patients were divided into two groups on the basis of random blood glucose level at the time of admission; ≥11.1mmol/l (206mg/dl) in group A and 4-11.1mmol (74-206mg/dl) in group B. Association between categorical variables was evaluated and hazard ratio was measured. Data was analysed using SPSS 21. Of the 349 patients, there were 56(16%) in group A; 40(71.4%) males and 16(28.6%) females with age range 39-61 years. There were 293(84%) subjects in group B; 239(81.5%) males and 54(18.5%) females with age range 27-53 years. Overall, 75(21.4%) patients were known type 2 diabetics. A significant association was found between poor glycaemic control and raised levels of C-reactive protein, lactate dehydrogenase, ferritin, erythrocyte sedimentation rate, troponin, creatine kinase, creatine kinase-MB, alanine aminotransferase, creatinine and D-dimers (p<0.05). Inter-group differences were significant for acute kidney injury, acute liver injury, Intensive care unit admission for coagulation abnormalities and for overall mortality (p<0.05). Poor glycaemic control was found to be a risk factor for developing multisystem complications in patients of coronavirus disease-2019.

Hematological abnormalities in patients of alcoholic chronic liver disease – A cross-sectional study in a tertiary care hospital in Eastern Zone of India

Background: Alcohol abuse is on increasing trend in world as well as in India, especially in young population. Long-term alcohol intake may leads to alcoholic chronic liver disease which may turns in to end stage liver diseases. Alcoholic chronic liver disease is associated with some hematological abnormalities which if detected at early stage may provide clear therapeutic implications in managing these patients and reducing the adverse events. Aims and Objectives: Our aim of the study was to identify various hematological abnormalities in patients of alcoholic chronic liver disease. Materials and Methods: This hospital-based cross-sectional study includes 100 randomly selected patients with alcoholic chronic liver disease attending Out-Patient Department and admitted in General Medicine ward of Burdwan Medical College satisfying the inclusion and exclusion criteria. Data were analyzed for hemoglobin (Hb), red blood cell (RBC), total leukocyte count (TLC), platelet count, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), MCH concentration, and prothrombin time-international normalized ratio. The mean and standard deviation, percentages, and ratio were calculated and presented in the form of tables with the help of SPSS (IBM) ver-23. P &lt; 0.05 was considered statistically significant. Results: Hematological abnormalities were found more with increased duration of alcohol consumption. Prolonged bleeding time was observed in 23% cases and prolonged clotting time was observed in 21% cases. Maximum patients belonged to Child–Pugh grade C. Hematological abnormalities were more in patients belonging to Child–Pugh grade C. Hb, RBC, platelet, and packed cell volume were significantly lower in patients belonging to Child–Pugh class C, whereas TLC, MCV, and MCH were significantly higher in class C. Conclusion: It can be concluded that related hematological changes, which are common in alcoholic chronic liver disease endanger the lives of these patients. They should be detected and corrected at earliest to minimize morbidity and mortality.

Overexpression of Human TLR8 Causes Fatal Anemia in SLE-Prone Mice By Altering the Bone Marrow Erythropoietic Niche

Anemia is a common hematologic abnormality in patients with active systemic lupus erythematosus (SLE), a disease characterized by innate immune system activation by nucleic acid containing immune complexes and cell debris. Work in mouse models has shown that overactivation of several cytoplasmic innate immune sensors by either self-DNA or self-RNA specifically leads to erythroid cell death in the fetal liver while sparing other hematopoietic cell lineages.The endosomal receptors TLR7 and TLR8 both recognize ssRNA in humans. TLR7 overexpression in mice causes a lupus syndrome that includes the development of mild to moderate anemia (Hb >10) and thrombocytopenia and is associated with spleen histiocytosis, autoimmune hemolysis, erythrophagocytosis and compensatory stress erythropoiesis in the spleen. A recent study demonstrated that patients with TLR8 gain of function mutations present with immunodeficiency, inflammation and bone marrow failure. However the role of TLR8 in SLE has been difficult to study in mice because it has a 5 amino acid deletion that attenuates its RNA binding capacity.To address the role of TLR8 in SLE, we overexpressed human TLR8 in a lupus mouse model (huTLR8tg.Sle1.Yaa) using a BAC transgene. 50% of homozygous huTLR8tg.Sle1.Yaa mice developed severe anemia (Hb<9) resulting in early mortality starting at 3-4.5 months of age. This phenotype required both the Sle1 and Yaa loci that promote the formation of high titer anti-chromatin and anti-RNA antibodies and onset of nephritis at >6 months of age. There was no difference in autoantibody titers between Sle1.Yaa wt and huTLR8tg mice and early death was not due to premature onset of renal disease. All mice had normal RBC indices prior to 10 weeks of age. Anemia was associated with an increase in bone marrow (BM) trabecular bone and a decrease in erythroblastic islands (EBI) in the BM with compensatory stress erythropoiesis leading to reticulocytosis and vast splenomegaly. RBC half-life was normal even after the development of reticulocytosis, but decreased in severely anemic mice as a pre-terminal event. Using CFSE labeling of RBCs we showed that hemophagocytosis occurred in vivo as a result of expansion of phagocytic red pulp macrophages.Flow cytometry of BMs from transgenic mice showed normal erythroid progenitors but a block at the late CFU-E/early proerythroblast stage leading to overall decreased terminal erythroid differentiation. Single cell RNAseq of EBIs isolated from transgenic BMs confirmed the block in erythropoiesis. The erythroblast cluster proximal to the block had a signature of mitochondrial stress and decreased proliferation. Spleen EBIs from transgenic mice were characterized by a low frequency of early erythroblasts compared with BM EBIs. We found 6 related clusters of EBI central macrophages in the BMs of both wt and transgenic mice. In transgenic mice, most of these displayed an inflammatory and Type 1 IFN signature. One cluster (M2) expressed all the classical central macrophage phenotypic markers in wt mice but was characterized in transgenic mice by downregulation of multiple phagocytic receptors and a 5-fold decrease of VCAM1 expression. Loss of VCAM1 and downregulation of CD169 in central macrophages of transgenic BMs was confirmed by flow cytometry. By contrast spleen central macrophages from transgenic mice retained VCAM and CD169 expression.Together, these results suggest that failure of BM erythropoiesis in huTLR8 transgenic SLE.Yaa lupus-prone mice, in which the acquisition of anti-nucleic acid autoantibodies drives excess innate stimulus through TLR7 and huTLR8, is due to a block in differentiation from CFU-E to the early proerythroblast stage; this is associated with an inflammatory phenotype specifically in BM erythroblastic island central macrophages and down regulation of adhesion and phagocytic receptors. Stress erythropoiesis in the spleens is associated with vast expansion of red pulp macrophages with phagocytic properties and fatal anemia is associated with a decrease in red blood cell half-life, suggesting that excessive RBC phagocytosis, coupled with insufficient erythroblast progenitors, eventually exceeds the capability of stress erythropoiesis to replace the RBC mass. DisclosuresKalfa: Agios Pharmaceuticals, Inc.: Other: Steering Committee, Research Funding; FORMA Therapeutics, Inc: Research Funding. Paulson: Forma Therapeutics: Consultancy. Blanc: Keros Therapeutics, Inc.: Consultancy.

Bone Marrow Findings in Renal Patients: A Single Renal Specialist Center Experience.

ObjectiveThis study evaluated the importance of bone marrow aspiration and trephine biopsy (BM) for the diagnosis of underlying hematological abnormalities in renal patients.MethodsThis cross-sectional study on BM was carried out between August 2010 and April 2019, in our specialist renal center for various unexplained hematological abnormalities in patients with renal diseases [chronic kidney disease (CKD), end-stage renal disease (ESRD) requiring maintenance hemodialysis (MHD), patients with normal renal function but other nephrology and urology issues like stone disease and nephrotic syndrome].ResultsOut of 176 reported BM examinations, 48 (27.3%) were done on ESRD patients on MHD (CKD-D), and 69 (39.2%) on CKD patients not on MHD (CKD-nD). Fifty-nine (33.5%) BM were done on patients with normal renal function (n-CKD). The indication for BM was pancytopenia 50 (28.4%), unexplained anemia 39 (22.2%), and unexplained thrombocytopenia 43 (24.4%). In 91 (51.7%) patients BM was normal. In 30 (17%) patients multiple myeloma (MM) was diagnosed on BM, out of which 18 (26.1%), nine (18%), three (5.3%) were CKD-nD, CKD-D, and n-CKD patients, respectively. In 11 (6.3%) patients BM was suggestive of myelodysplasia (MD), out of these 11 patients, five (10%) were CKD-D patients.ConclusionBM is an underutilized method of diagnosis of hematological abnormalities in renal patients. Our study revealed the importance of BM examination, especially in patients with CKD.

Is There Any Correlation between Anti-Ro 52 Antibody Level with Hematological Abnormalities in Systemic Lupus Erythematosus?

Background: Systemic lupus erythematosus (SLE) is a complex autoimmune disease with various clinical and serological manifestations. Previous studies have shown conflicting results about the association of anti-Ro 52 autoantibodies with hematological abnormalities in SLE. We investigated the correlation between anti Ro 52 autoantibody with anemia, leucopenia, and thrombocytopenia in patients with SLE.&#x0D; Methods: Sixty-two bio archives serum of an SLE patient at the Division of Rheumatology, Department of Internal Medicine, Hasan Sadikin General Hospital, Bandung, Indonesia from 2017 to 2019 were enrolled in the study. Anti-Ro 52 levels were examined using the ELISA method. The clinical data, treatment, and hematology paparametersere were analyzed retrospectively.&#x0D; Results: Among 62 bio-archive serum, four subjects were excluded because of incomplete data. Fifty-eight patients, all females were enrolled. We identified 57 (98.3%) subjects corticosteroid, 31 (53.4%) azathioprine and 28 (48.3%) chloroquine. A correlation coefficient of anti-Ro 52 levels and hemoglobin, leukocyte and platelets were -0.037 (p = 0.391), 0.065 (p = 0.315) and 0.092 (p = 0.246), respectively.&#x0D; Conclusion: No correlation was found between anti Ro 52 antibody levels with haematological abnormalities in patients with SLE. Further studies need to evaluate whether other antibodies play important role in haematological abnormalities in SLE.

PERBANDINGAN KELAINAN HEMATOLOGI ANTARA PASIEN INFEKSI DENGUE PRIMER DAN SEKUNDER DI RSUD DR. H. ABDUL MOELOEK PROVINSI LAMPUNG

Dengue Hemorrhagic Fever is an endemic disease caused by the dengue virus. Dengue infection can be classified into primary and secondary dengue infection. The routine blood test is usually do for screening in dengue fever patient by checking hemoglobin, hematocrit, platelet count, leukosit, MCV, MCH, MCHC. This Study aimed to determine the comparison of hematological abnormalities in patients with primary and secondary dengue infection. The research was analytic observational method with cross-sectional research design. The number of samples in this study were 39 patients. Data were analyzed by independent T test and Mann Whitney test. The results showed that there were 5 patients infected with primary dengue (12.8%) and 34 people (87.2%) who were infected with secondary dengue. In primary dengue infection, the mean hemoglobin level was 14.9gr/dL, the mean number of leukocytes was 4.560/µL, the mean hematocrit was 44.80%, the median platelet count was 25,000 / µL, the mean MCV was 85 fL, the median MCH was 29 pg, the median MCHC is 33 gr/dL. In secondary dengue infection, the mean hemoglobin level was 14.0 gr/dL, the mean number of leukocytes was 4.700/µL. The mean hematocrit was 41.88%, the median platelet count was 38.500 / µL, the mean MCV was 85.18 fL, the median MCH was 28 pg, the median MCHC was 33 gr/dL. The results of statistical tests showed that there was no difference in hematological abnormalities between patients with primary dengue infection and secondary dengue infection. Haematological studies such as hematocrit, additional sample size and cohort study methods are required in further research.

Thrombocytopenia as a Diagnostic Marker for Malaria in Patients with Acute Febrile Illness.

Background Thrombocytopenia is the most common hematological abnormality in patients with acute malaria. This study aimed to determine the role of thrombocytopenia as a diagnostic marker for malaria in patients with acute febrile illness. Method A cross-sectional health facility-based study was conducted on 423 consecutively selected acute febrile patients at Ataye District Hospital from February to May 2019 GC. A complete blood count and malaria microscopy were performed for each acute febrile patient. ROC curve analysis was performed to calculate sensitivity, specificity, positive predictive value, and negative predictive value of platelet count in predicting malaria. A P ≤ 0.05 was considered statistically significant. Result Out of the 423 acute febrile patients, 73 (17.3%) were microscopically confirmed malaria cases and the rest 350 (82.7%) patients had negative blood film results. Of the microscopically confirmed malaria cases, 55 (75.34%) were P. vivax and 18 (24.66%) were P. falciparum. The prevalence of thrombocytopenia among malaria patients (79.5%) was significantly higher than those in malaria negative acute febrile patients (13.7%), P < 0.001. About 67% malaria-infected patients had mild to moderate thrombocytopenia and 12.3% had severe thrombocytopenia. The ROC analysis demonstrated platelet counts <150,000/μl as an optimal cutoff value with 0.893 area under the curve, 79.5% sensitivity, 86.3% specificity, 95.3% negative predictive value, and 54.7% positive predictive value to predict malaria. Conclusion Malaria is still among the major public health problems in the country. Thrombocytopenia is a very good discriminatory test for the presence or absence of malaria with 79.5% sensitivity and 86.3% specificity. Therefore, this may be used in addition to the clinical and microscopic parameters to heighten the suspicion of malaria.