Hematological Evaluation Research Articles

Abstract 117: Digitally Subtracted Angiogram & Biopsy Negative Recurrent Spontaneous Bilateral Anterior Cerebral Artery Territory Intracranial Hemorrhage

Introduction Up to 18% of spontaneous intracerebral hemorrhages are cryptogenic despite a thorough workup, usually noted in a lobar location. Although undetected on DSA, a significant proportion of these represent ruptured micro‐AVM/AVF or cavernous malformations that ultimately are amenable to surgical resection if detected on biopsy. However, occult cerebral amyloid angiopathy can also present similarly, and their management is markedly different. Methods We present a case of recurrent bilateral medial frontal hemorrhage in a patient without known cerebrovascular disease that evaded diagnosis despite hematologic evaluation, MRI, CTA, two DSAs, three clot evacuations with pathology, and brain biopsy. Results The patient is a 60‐year‐old previously healthy woman who presented with sudden onset right hemiparesis and speech arrest. CT revealed a left parasagittal hemorrhage. She was brought to the OR for clot evacuation. Pathology from the clot revealed blood vessels of multiple sizes consistent with meningeal vessels or underlying AVM/AVF. A 6‐vessel cerebral angiogram as unremarkable. The patient’s inpatient course was complicated by new onset Afib with RVR and asymptomatic DVT with PE, however no etiology of coagulopathy was detected. MRI brain showed no evidence of cerebral microbleed or other underlying pathology, noting only DWI + FLAIR hyperintensity in the left ACA territory. The patient was diagnosed with ACA territory stroke complicated by PH2‐type hemorrhagic conversion. She was initially placed on IV Heparin, before transition to apixaban uneventfully. She continued to recover in the hospital and was eventually discharged to rehab. She re‐presented 1 month later with worsening behavioral arrest and right hemiparesis. CT head revealed recurrence of left parasagittal ICH. She underwent clot evacuation in the OR again and repeat pathology was unrevealing. A repeat MRI showed only the evident bleed and a subtle hyperintensity in the right occipital cortex suspicious for an interval subacute occipital lobe stroke with laminar necrosis, ostensibly from Afib. She improved clinically and was discharged to rehab with a diagnosis of recurrent hemorrhage attributed to anticoagulant use and recent stroke. She was discharged this time on no anticoagulant or antiplatelets. She re‐presented 1 month later with sudden onset speech arrest, but now with left hemiparesis. CT revealed a right parasagittal hemorrhage. She was brought to the OR for emergent clot evacuation and parenchymal biopsy – which was initially normal. A repeat 6‐vessel DSA was again unremarkable as was repeat brain MRI. The patient’s parenchymal biopsy was sent for specific congo‐red and immunohistochemistry for beta‐amyloid. IHC revealed beta‐amyloid plaques in the parenchyma and vessel walls, confirming a diagnosis of CAA. Conclusion Apparently cryptogenic lobar hemorrhage may be caused by both occult micro‐AVM/fistula and CAA. As in this case, when a patient experiences recurrent DSA negative lobar hemorrhages, biopsy should be pursued. This case was particularly challenging given the anatomical plausibility of parasagittal AVM/fistula given its midline location and venous drainage, considering the patient’s evident predisposition to systemic venous thrombosis hemorrhagic venous infarction mimicking lobar ICH is also possible. We present this case to raise awareness of the potential need for early biopsy, especially in patients who may also require anticoagulation or antiplatelet medications.

ABDALA, a preventive vaccine against SARS-CoV-2, is safe in Chlorocebus aethiops sabaeus monkeys

Background: The ABDALA vaccine is a subunit vaccine developed for preventing SARS-CoV-2 infection and the progression of COVID-19 to severe forms, using as an active pharmaceutical ingredient a recombinant version of the SARS-CoV-2 spike protein receptor-binding domain (RBD) expressed in Pichia pastoris. The aim of the paper was to describe the safety profile of the ABDALA vaccine in monkeys (Cholorocebus aethiops sabaeus). For such aim, the vaccine was administered to the monkeys intramuscularly six times every 14 days, following the same scheme used in clinical trials done against COVID-19. Animals were allocated to four groups: Placebo, ABDALA Low-dose (50 µg per animal), ABDALA High-dose (100 µg per animal), and Reversion (100 µg per animal) to be submitted to a clinical, hematological and serum biochemical evaluation. Histopathological assessment of all tissues and organs was also conducted. Results: As the main results, all animals survived and negative effects were not detected during animal clinical evaluations. The body weight and rectal temperature exhibited no variations and hematological and serum biochemical parameters showed no alterations associated with ABDALA administration. Finally, the histopathological study confirmed the proliferation of spleen white pulp due to ABDALA administration. Conclusions: Therefore, results strongly suggest ABDALA does not cause toxic effects or damage in the organs of Chlorocebus aethiops sabaeus monkeys, indicating that it is a promising and safe novel vaccine to prevent SARS-CoV-2 infection in humans and the progression of COVID-19 to severe forms.

Electrochemotherapy for Mammary Tumour in Dogs

Background: Mammary neoplasms are the most common tumours in the bitch. Even though surgery remained the treatment of choice for mammary gland tumours except those with inflammatory carcinomas or distant metastasis; it did not seem to reduce the chances of recurrence in case of malignancy in dogs. Other alternatives to surgery are chemotherapy, immunotherapy, radiation therapy, hormonal therapy etc. The major disadvantage of chemotherapeutic agents was the lack of selectivity for tumour cells. To overcome this problem, electrochemotherapy could be used as a single or as an adjuvant therapy to surgery which could be used for treatment of inoperable tumours. Cisplatin and bleomycin are the two chemotherapeutic agents used in veterinary oncology for electrochemotherapy. This study was carried out on clinical cases of mammary tumours to study and compare the efficacies of electrochemotherapy using Cisplatin and bleomycin Methods: The research was carried out on clinical cases of canine mammary tumour presented to the Small Animal Surgical Out-Patient Unit of Madras Veterinary College Teaching Hospital for a period of one year from September 2018 to May 2021. Routine Clinical, Haematological, Biochemical and Radiographic evaluations were performed. Twelve dogs with mammary tumours, with a single solitary lump were selected for the study irrespective of the age, breed and location. Group I Cases were treated by electrotherapy with cisplastin and Group II were treated by electrotherapy with bleomycin intralesionally following which surgical excision was performed. Result: Most cases in the cisplatin group produced partial response (3/6) according to the response evaluation criteria, whereas most cases in the bleomycin group produced complete response (100% regression). Bleomycin was comparatively more efficient (1.7 times) than cisplatin in electrochemotherapy for mammary tumours. The time under anaesthesia was low which makes this procedure a suitable alternative to geriatric dogs that cannot be anaesthetised for a longer duration for surgery.

The Role of Reirradiation in Childhood Progressive Diffuse Intrinsic Pontine Glioma (DIPG): An Ongoing Challenge beyond Radiobiology.

To investigate the clinical impact of multiple courses of irradiation on pediatric patients with progressive diffuse intrinsic pontine glioma (DIPG), we conducted a retrospective case series on three children treated at our institution from 2018 to 2022. All children were candidates to receive systemic therapy with vinorelbine and nimotuzumab. Radiotherapy was administered to a total dose of 54 Gy. At any disease progression, our local tumor board evaluated the possibility of offering a new course of radiotherapy. To determine feasibility and assess toxicity rates, all children underwent clinical and hematological evaluation both during and after the treatment. To assess efficacy, all children performed contrast-enhanced MRI almost quarterly after the end of the treatment. In all children, following any treatment course, neurological improvement (>80%) was associated with a radiological response (41.7-46%). The longest overall survival (24 months) was observed in the child who underwent three courses of radiotherapy, without experiencing significant side effects. Even though it goes beyond the understanding of conventional radiobiology, first and second reirradiation in pediatric patients with progressive DIPG may represent a feasible and safe approach, capable of increasing overall survival and disease-free survival in selected patients and improving their quality of life.

Tilapia Fish Skin Treatment of Third-Degree Skin Burns in Murine Model.

This study explored the feasibility of using fish skin bandages as a therapeutic option for third-degree skin burns. Following the California wildfires, clinical observations of animals with third-degree skin burns demonstrated increased comfort levels and reduced pain when treated with tilapia fish skin. Despite the promises of this therapy, there are few studies explaining the healing mechanisms behind the application of tilapia fish skin. In this study, mice with third-degree burns were treated with either a hydrocolloid adhesive bandage (control) (n = 16) or fish skin (n = 16) 7 days post-burn. Mice were subjected to histologic, hematologic, molecular, and gross evaluation at days 7, 16, and 28 post-burn. The fish skin offered no benefit to overall wound closure compared to hydrocolloids. Additionally, we detected no difference between fish skin and control treatments in regard to hypermetabolism or hematologic values. However, the fish skin groups exhibited 2 times more vascularization and 2 times higher expression of antimicrobial defensin peptide in comparison to controls. Proteomic analysis of the fish skin revealed the presence of antimicrobial peptides. Collectively, these data suggest that fish skin can serve as an innovative and cost-effective therapeutic alternative for burn victims to facilitate vascularization and reduce bacterial infection.

Clinical and Laboratory Response of Domiciled Dogs with Visceral Leishmaniasis Treated with Miltefosine and Allopurinol.

Canine visceral leishmaniasis (CVL) remains a significant disease worldwide. In Brazil, its treatment is performed using miltefosine, which has demonstrated promising outcomes in dogs. This study represents the first attempt to treat and monitor dogs with CVL in natural conditions over the course of one year. The dogs were divided into two groups: G1 received miltefosine and allopurinol for 28 days, while G2 received miltefosine for 28 days, followed by allopurinol for one year. The follow-up involved clinical, hematological, and biochemical evaluations, as well as the detection of Leishmania DNA in skin and bone marrow samples. By the end of the follow-up, dogs in G2 exhibited improved staging compared to their initial conditions, whereas those in G1 showed worsened staging. Leishmania DNA in skin and bone marrow decreased between 6 and 12 months after treatment. Our observations indicate that the treatment using miltefosine reduces the detection of the parasite in the skin and bone marrow for up to one year following its administration. The continuous use of allopurinol contributes to control of the disease in dogs. These findings provide valuable insights into the response of dogs treated in natural conditions, offering essential information for veterinarians and public health authorities.

Hematological Evaluation of Three Common Teleosts in Relation to The Environmental Changes from Trang Province, Thailand.

Hematological evaluation of fish is essential to the assessment of their physiological status. This study describes the morphometric analysis and comparison of blood cell characteristics in Zanarchopterus sp., Gerres filamentosus Cuvier, 1829 and Leiognathus decorus (De Vis, 1884). The species were collected at two locations off the coast of Trang Province, Thailand. A comparative hematological evaluation was made to assess the effects of environmental conditions on the blood of the fish. Ten individuals of each species were collected from a seagrass bed at Libong Island, where human activities are increasing, and from a secluded sandy beach. Their blood samples were analysed using the blood smear technique. Erythrocytes of all the studied fishes were either elliptical or oval. The morphometric data from both locations showed that erythrocytes were of similar size, except for those of Zanarchopterus sp. Fish from both stations showed several types of leukocytes, including neutrophils and lymphocytes.The highest proportion of leukocytes was made up of lymphocytes, followed by neutrophils. However, monocytes were only observed in fish from Libong Island and the erythrocytic nuclei of fish collected from Libong Island were both reniform and lobate. Our results show the potential of hematological evaluation as an early warning signal of environmental impacts on aquatic animals. The determination of baseline parameters could provide a tool for the monitoring of environmental quality.

Effects of an MCPA-based herbicide formulation on the common carp Cyprinus carpio Linnaeus, 1758 – haematological, biochemical and histological evaluation

Herbicides (weed control agents) are used in crops on a massive scale. MCPA (2-methyl-4-chlorophen- oxyacetic acid) is a herbicide used to control weeds in cereals and other crops. The aim of this study was to investigate the toxic effects of an MCPA-based herbicide formulation (Chwastox Extra® 300 SL) in the common carp (Cyprinus carpio). The fish were exposed for 10 days, to a concentration which corresponded to 1 mg/l or 5 mg/l of MCPA. Our analysis showed fluctuations of the haematological parameters during the treatment. Plasma biochemical changes that were statistically significant, i.e.a decrease of the total protein concentration and alanine aminotransferase activity, were observed after 1 day of exposure. No histopathological lesions in the gills, trunk kidney and liver were identified. The results of the present study indicate that Chwastox Extra® 300 SL has a relatively low toxicity for the common carp. It was also observed that the blood indices were more sensitive to the tested herbicide formulation than the microstructure of the selected organs. Further research aimed at studying the effects of Chwastox on water invertebrates and fish of other taxa is recommended.

Evaluation of postnatal growth, hematology, telomere length and semen attributes of multiple clones and re-clone of superior buffalo breeding bulls

The present study comprehensively evaluates the postnatal growth, hematology, telomere length, and semen attributes of multiple clones and re-clone derived from superior buffalo breeding bulls. To the best of our knowledge, we successfully produced multiple clones and a re-clone of an earlier cloned buffalo bull from an embryo developed from an adult bull's skin-derived cell for the first time. The cloned bulls' growth, blood hematology, plasma biochemistry, and telomere length were all shown to be normal at various stages of development. The bulls were used for semen production after being screened for testicular growth and training. Semen characteristics such as volume, concentration, and initial motility of fresh sperm as well as motility and kinetics characteristics such as straightness (STR), average lateral head displacement (ALH), and beat cross frequency (BCF) of frozen-thawed sperms of the cloned bulls were found to be similar to those of non-cloned bulls, including the donor bulls. Additionally, it was found that cloned bulls' functional sperm attributes, including acrosome intactness, mitochondrial membrane potential, and superoxide anion status, were comparable to those of non-cloned bulls. These characteristics are necessary for sperm to pass through the female reproductive system, penetrate the oocyte, and efficiently fertilize. Finally, this study adds to our understanding of the postnatal development, hematology, telomere length, and sperm characteristics of superior buffalo breeding bulls that have been cloned and re-cloned. The findings provide the groundwork for improving cloning practices, refining reproductive procedures, and optimizing the use of cloned genetic material in animal breeding and conservation.

Pediatric Rattlesnake Envenomations Treated With Crotalidae Equine Immune F(Ab') 2 Antivenom : A 3-Year Retrospective Observational Analysis.

Rattlesnake envenomations are uncommon, and the majority occur in adults. Although Crotalidae equine immune F(ab') 2 antivenom (F(ab') 2 AV; trade name ANAVIP) was introduced in 2018, no pediatric specific studies of F(ab') 2 AV have been reported to date. The objective of this study was to evaluate the clinical performance and adverse effects of F(ab') 2 AV in children. A single-center, retrospective chart review was performed on patients with rattlesnake envenomation presenting to a children's hospital between October 2018 and August 2022. Inclusion criteria were age younger than 18 years and F(ab') 2 AV use. Exclusion criteria were other antivenom use at any time and presentation beyond 24 hours postenvenomation.Demographic characteristics, hemoglobin, platelet count, fibrinogen, international normalized ratio, number of F(ab') 2 AV vials used, infusion-related complications, and clinical outcomes were collected. Twenty-six patients, 19 males and 7 females, with a mean age of 7.7 years (0.67 to 16 years) met inclusion criteria. Fourteen (54%) were treated with only the initial 10 vial F(ab') 2 AV doses. Twelve patients were given additional doses with a median additional vials of 10 (4-34 vials; interquartile range, 8.75-12 vials). The median total vials given for all patients was 10 (10-44 vials; interquartile range, 10-20 vials).Two patients developed acute infusion reactions. Both were treated by slowing the infusion rate and with medications (diphenhydramine, corticosteroids). No delayed reactions were noted. No patients required blood products or surgical interventions.After discharge, no complications, recurrent symptoms, return visits, or readmissions were reported. Follow-up by chart review or phone was obtained for 18 patients, and no postdischarge complications were noted. Seven patients had postdischarge hematologic laboratory evaluations and all were normal. Although limited by small sample size and postdischarge follow-up, F(ab') 2 AV was well tolerated in our series of pediatric patients, consistent with prior studies of all age groups.

A Cross Sectional Analysis of Etiology of Anemia Among Elderly Patients

The aim of this study is to evaluate the etiology and features of anemia in elderly patients from the perspective of hematology and to determine the rate of unexplained anemia. The medical records of elderly patients over the age of 65 who applied to the Hematology Department of Ankara Baskent University Hospital between January 2015 and January 2020 were retrospectively analyzed. According to WHO criteria, the threshold value accepted for anemia was Hb <12 g/dL for women and <13 g/dL for men. The prevalence of anemia was 18% among 3330 elderly patients. The ratio of women to men diagnosed with anemia was 1.5:1, and the mean age was 77.34±8.32. The mean Hb value was 9.79±1.75 g/dl and decreased significantly with advancing age (p<0.001). Polypharmacy was present in 68.3% of the patients. The etiological distribution of anemia was nutritional anemia in 339 (56.5%), hematologic malignancy in 127 (21.1%), anemia of chronic disease in 125 (20.8%), and unexplained anemia in 58 (9.7%) patients. 72% of the patients with indications for bone marrow biopsy had the procedure. Anemia in the elderly is a challenging issue due to comorbidity, polypharmacy, and problems in further examination. Hematological evaluation of anemia in elderly patients will reduce the rate of unexplained anemia. Patient selection for invasive procedures should be based on a risk-benefit ratio in frail elderly patients.

Subacute nodular migratory panniculitis, a rare presentation of a rare disease: a case report

Panniculitis refers to the inflammation of the subcutaneous fat. Subacute nodular migratory panniculitis (Aka Vilanova disease) is a rare type of panniculitis seen predominantly in women. Clinically, it closely resembles erythema nodosum but is often unilateral as opposed to the bilateral involvement in erythema nodosum. Triggering factors include infections, drugs, thyroid disorders, pregnancy, or malignancies. We report a rare case of a 52-year-old female who was a known case of hypothyroidism and presented with sudden onset of red colored painful lesions with raised temperature over both lower limbs. Hematological evaluation was unremarkable except for raised erythrocyte sedimentation rate. Histopathological examination of the lesion showed septal panniculitis with giant cells, suggestive of subacute nodular migratory panniculitis. The patient responded very well to treatment with capsule indomethacin.

Handgrip strength, short physical performance battery, and gait speed: key tools for function in Non-Hodgkin Lymphoma.

This study aimed to determine which performance assessment tools included in Comprehensive Geriatric Assessment (CGA) are the most sensitive for the functional approach in the initial evaluation and during the therapy of old adults diagnosed with Diffuse Large B-Cell Lymphoma (DLBCL). We prospectively recruited 31 patients aged 70years or older presenting for an initial consultation in the Hematology Clinic of a tertiary hospital. We implemented an updated physical performance evaluation as part of CGA at baseline and during treatment. Baseline characteristics of the sample were compared according to age,Geriatric 8 (G8), frailty, Short Physical Performance Battery (SPPB), and sarcopenia measured by handgrip strength (HGS). Functional changes were monitored during the treatment period using HGS, gait speed (GS) and SPPB. The mean age was 79.0 (5.5) years and 51.6% of the sample was frail; 65,5% were treated with standard chemotherapy and 35,5% with a therapeutic regimen with attenuated doses. All the assessment tools included in CGA found functional differences at baseline when the sample was stratified and compared according to frailty, sarcopenia, and SPPB, but not according to G8 score and age. Only SPPB was able to detect functional differences between groups stratified by age at baseline. GS was the only score that identified clinically significant functional changes during the treatment. In conclusion, HGS and SPPB are appropriate performance scores to complete the functional approach in the initial hematologic evaluation, and GS is a promising option to detect functional decline during therapy in old adults with DLBCL.

Eight-Year Study of Haemogregarina stepanowi Infection in Poached European Pond Turtles (Emys orbicularis) Held in Belgrade Zoo Quarantine.

The eight-year study (2015-2023) was performed on a large sample of poached European pond turtles infected with Haemogregarina stepanowi and held in a pond that belongs to a quarantine section of Belgrade Zoo. The protected species of European pond turtles have been found in poor health, with general weakness, anorexia, and low motility. Comprehensive cytological, hematological, molecular, and postmortem evaluations have been performed. Initially, Diff Quick staining of the blood smears revealed rounded or elongated erythrocytes, often bearing premeront or U-shaped gamont of the hemogregarines inside. The reduced erythrocyte numbers, hemoglobin, and hematocrit values found in the examined population of infected turtles indicated anemia. Macroscopically, shell necrosis and massive skin hemorrhages were the most prominent findings observed in diseased turtles. Microscopically, the lungs, liver, kidneys, and spleen revealed hyperemia, hemorrhages, and the presence of parasitic stages in tissue samples in 31 of 40 necropsied turtles. Cytological and microscopic examination of the samples proved to be sufficient for establishing the infection, but molecular analyses of the 18S sequence were used for phylogenetic studies. Over the years, the number of diseased and dead turtles has decreased, which could be hypothetically attributed to the elimination of leeches as the definitive host.

Establishment of Reference Intervals of Hematological Parameters and Evaluation of Sex and Age Effect in the Miranda Donkey.

The Miranda donkey is an autochthonous Portuguese breed that is considered endangered. Several studies have been carried out on this breed, but to the authors' best knowledge, no studies have been conducted on their clinical pathology. The aims of this study were to determine the hematological reference intervals (RIs) in healthy Miranda donkeys and to estimate the influence of age and sex. Blood samples from 75 clinically healthy animals were analyzed for 22 hematological parameters on the IDEXX ProCyte Dx, an automated hematology analyzer previously validated for the species. The RIs were estimated following the ASVCP guidelines with the Reference Value Advisor software. Regarding sex, no significant differences were found between groups. Regarding age, significant statistical differences (p < 0.05) were observed for red blood cells, red cell distribution width, white blood cells, lymphocytes, monocytes, platelets, plateletcrit (higher mean in young animals), mean corpuscular volume, mean corpuscular haemoglobin, neutrophils and eosinophils (higher mean in adults). The RIs described here can be used to evaluate and monitor the health status of animals and herds, as well as to guide diagnoses or select fit and healthy animals for reproduction, contributing to the preservation of the breed.

MEN1 syndrome presents as Cushing’s disease with proximal lower limb weakness: A rare phenomenon

Abstract The typical presentation of MEN 1 syndrome in most cases is primary hyperparathyroidism. The manifestation of hypercortisolism due to a functional Pituitary microadenoma in an adult as the first presenting feature in MEN 1 is rare. This report of Cushing’s disease presenting as proximal muscle weakness due to an adrenocorticotrophic hormone (ACTH) producing pituitary microadenoma as the initial feature of multiple endocrine neoplasia type 1 is an unusual occurrence. The patient had presented with proximal muscle weakness of lower limbs along with abdominal striae and uncontrolled diabetes. On hematological and radiological evaluations, she was detected to have a pituitary microadenoma along with a parathyroid adenoma causing increased levels of ACTH, serum (S) cortisol, parathyroid hormone, and S calcium. The patient underwent a transsphenoidal decompression of the pituitary microadenoma using frameless neuronavigation. Within 2 weeks of surgery, the patient achieved normal levels of S cortisol. She is off medication for blood sugar control. At 6 months, follow-up, she is symptom-free.

Successful management of a persistent pneumothorax in a cat using an autologous blood patch pleurodesis

AbstractA 16‐year‐old, neutered, male cat presented to an emergency and specialty care facility for persistent pneumothorax. Bilateral thoracocentesis, biochemical and hematological evaluation, thoracic radiographs, abdominal ultrasound, heartworm antigen test and computed tomography scan were performed. No definitive cause of the pneumothorax was identified, making a diagnosis of spontaneous (idiopathic) pneumothorax most likely. Surgical exploration of the thorax was declined. Evacuation of the pleural space was performed for 4 days, without resolution of air accumulation. An autologous blood patch pleurodesis was performed on the fifth day. The pneumothorax resolved, and the patient was discharged from the hospital the following day. Recheck radiographs were performed 17 days after discharge, which confirmed resolution of pneumothorax. The patient was alive 1200 days after discharge, with no recurrent clinical signs. This case report demonstrates successful use of an autologous blood patch pleurodesis in a feline patient.

Investigation of Plasma Lactate Concentration in Anemic Dogs

In many clinical situations, the importance of determining plasma lactate level is emphasised, while the effect of type and severity of anemia on plasma lactate concentration is not fully known. It was aimed to evaluate the effect of anemia type and severity on plasma lactate concentrations in dogs with anemia in this study. &#x0D; A total of 48 dogs (36 anemic, 12 healthy) of different breeds, ages and sexes were included in the study. Dogs with anemia were classified according to the severity and type of anemia. Hematologic evaluations included RBC, HGB, HCT, and MCV measurements. Plasma lactate concentrations were colourimetrically tested on a point-of-care analyser. &#x0D; Plasma lactate levels were significantly (P

Prevalence of Anemia, Iron Deficiency Anemia and its Socio-Demographic Factors among Pregnant Women in Garmian Province, Kurdistan region of Iraq

Anemia is the most common hematologic abnormality in pregnancy. Maternal anemia is associated with adverse fetal, neonatal, and childhood outcomes. This study aims to determine the prevalence of anemia, and iron deficiency anemia (IDA), the severity of the condition, and study the effect of some socio-demographic factors on pregnant women in Garmian province. The study was conducted among 157 pregnant women in Garmian province between 17 and 49 years old. Participants completed a questionnaire that included sociodemographic characteristics, disease, and gestational age. A hematological evaluation, including a complete blood count (CBC) and serum for ferritin testing. Results of this study have shown that the prevalence of anemia and IDA were 34.4% and 15.3%, respectively. Almost three-quarters of the pregnant women had mild anemia, while 31 % of the subjects had moderate anemia, and about 60% of the participants were diagnosed with normocytic anemia. The second trimester had the highest prevalence, with 51.9% for the anemic and 45.8% for IDA subjects, while the first trimester showed the lowest prevalence, with 14.8 % for anemic and 12.5% for IDA subjects. Age, occupation, gravidity with anemia, and iron deficiency anemia did not make a significant difference. Moreover, there was no significant difference in blood indices between anemic and IDA participants. The serum ferritin level was unaffected by the pregnancy trimesters.

BELLWAVE-008: A phase 3 study of the efficacy and safety of nemtabrutinib in previously untreated patients (pts) with chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) without TP53 aberrations.

TPS7594 Background: Targeting the Bruton’s tyrosine kinase (BTK) pathway has been a revolutionary treatment option for first-line treatment of CLL/SLL. Nemtabrutinib is a noncovalent, reversible, potent BTK inhibitor that targets both wild-type and C481S-mutant BTK. Results of an ongoing phase 1/2 dose-escalation study (BELLWAVE-001) have demonstrated manageable safety and preliminary antitumor activity of nemtabrutinib in pts with CLL/SLL. BELLWAVE-008 is a randomized, open-label, phase 3 study (NCT05624554) designed to evaluate efficacy and safety of nemtabrutinib compared with investigator’s choice of chemoimmunotherapy (FCR or BR) in pts with previously untreated CLL/SLL without TP53 aberrations. Methods: Eligible pts are ≥18 years old with previously untreated CLL/SLL with active disease and without TP53 aberrations (17p deletion and/or TP53 mutation), with ECOG PS of 0-2 and adequate organ function. Pts with Richter transformation or active central nervous system involvement are excluded. Approximately 300 pts will be enrolled and randomly assigned 1:1 to receive nemtabrutinib (65 mg orally once daily until progressive disease, unacceptable toxicity, or discontinuation) or intravenous infusion of the investigator’s choice of chemoimmunotherapy for 6 cycles lasting 28 days each (FCR: fludarabine 25 mg/m2 and cyclophosphamide 250 mg/m2 on days 1, 2, and 3 of each cycle, plus rituximab 375 mg/m2 initially, followed by 500 mg/m2 on day 1 of each cycle; or BR: bendamustine 70-90 mg/m2 on days 1 and 2 of each cycle plus rituximab 375 mg/m2 initially, followed by 500 mg/m2 on day 1 of each cycle). Randomization will be stratified by risk (high risk: 11q deletion and/or IGHV unmutated vs low risk: absence of high-risk factors) and age ( &lt; 65 years vs ≥65 years). Treatment response (imaging, physical examination, constitutional symptoms, hematologic evaluation, and bone marrow biopsy, as required) will be performed every 12 weeks up to and including cycle 25, and every 24 weeks thereafter. Adverse events (AEs) will be monitored up to 30 days after treatment cessation (90 days for serious AEs) and will be graded per National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and hematologic toxicities will be evaluated according to International Workshop on Chronic Lymphocytic Leukemia (iwCLL). Primary end point is progression-free survival per the iwCLL 2018 criteria as assessed by blinded independent central review. Secondary end points include overall survival, objective response rate (ORR), duration of response, and safety. Exploratory efficacy end points include resistance evaluations, ORR including partial response with lymphocytosis as a response category, pharmacokinetics/pharmacodynamics, and health-related quality of life. Enrollment is ongoing. Clinical trial information: NCT05624554 .