Hematologic Problems Research Articles

New Maintenance Treatment for Recurrent Ovarian, Fallopian Tube, or Primary Peritoneal Cancer.

Rucaparib (Rubraca) can now be used as maintenance treatment in patients with recurrent ovarian, fallopian tube, or primary peritoneal cancer that is completely or partially responding to platinum-based chemotherapy.The most common adverse effects of rucaparib treatment include fatigue, rash, gastrointestinal complaints, hematologic problems, and nasopharyngitis/upper respiratory infection.

Study of Anaemia in Children with Severe Acute Malnutrition

Introduction: Severe anaemia is a leading cause of paediatric morbidity, hospitalization, and mortality and it is very important co morbidity in children with severe acute malnutrition. Severe Acute Malnutrition (SAM) with anaemia has been shown to have 2.62 times higher mortality as compared to SAM with no anaemia. So this study was done to evaluate this co-morbidity further. The aim of present study was to determine the prevalence and type of anaemia and to evaluate the possible aetiologies of anaemia in severe acute malnourished (SAM) children.Material and Methods: In tertiary care hospital a cross sectional study was conducted over a period of 8 month with 100 cases of SAM children and 101 cases of normal children. In both cases disorders of primary haematological problem were excluded. Auto analysers were used to measure blood counts. Blood smear was analysed by pathology consultant of institute and recorded for all patients with anaemia. Grade of anaemia and morphologic type of anaemia was analysed. Data were entered in Excel spreadsheets and analysed using SPSS 20.0.Results: Patient with SAM 42% had moderate anaemia and 19% had severe anaemia in contrast 41.6% and 16.8% in NON SAM child respectively. Predominant morphologic type in SAM patient was macrocytic anaemia (33%), while in controls microcytic anaemia (40.6%) was more prevalent.Conclusion: There was a high prevalence of anaemia in SAM children. Major morphologic type in SAM children was macrocytic anaemia which may indirectly show vitamin B12 or folic acid deficiency in these children.

Prevalence of thrombocytopenia in neonates admitted in NICU with culture proven sepsis

Background: Thrombocytopenia is a common haematological problem encountered during neonatal period, particularly in the sick, premature neonates admitted in the NICU, and usually indicate an underlying disease process. Thrombocytopenia may be considered as an important and early tool in diagnosis of septicaemia in neonates.Methods: It is a hospital based cross sectional study. A total 105 neonates with blood and/CSF culture positive sepsis and associated thrombocytopenia admitted in NICU. This study was conducted to find the prevalence of thrombocytopenia in neonates admitted in NICU with culture proven sepsis and to observe the outcome of thrombocytopenia and sepsis.Results: Out of 105 culture positive neonates K. pneumoniae 47/105 (44.8%) was the commonest micro-organism isolated, followed by Pseudomonas 26/105 (24.8%), E. coli 14/105 (13.3%), Staphylococcus 11/105 (10.5%), Candida 2/105 (1.9%) in decreasing order. Thrombocytopenia was present in 100/105 (95.2%). Among thrombocytopenic neonates 38/100 (38%), 36/100 (36%) and 26/100 (26%) having severe, moderate and mild thrombocytopenia respectively. 38 (38%) newborns of severe thrombocytopenia among them K. pneumoniae (50.0%) was commonest organism, followed by Pseudomonas. (23.7%) and Staphylococcus (15.8%) in the decreasing order. 36 (36%) newborns of moderate thrombocytopenia among them K. pneumoniae (47.2%) again commonest organism associated, followed by Pseudomonas. (25.0%), and E- coli (11.1%). In severe thrombocytopenic newborns both GI and pulmonary (60.50%) haemorrhage was the most common bleeding manifestation. Mortality rate (37.1%) was high in newborns having sepsis.Conclusions: Bacterial sepsis is significantly complicated by thrombocytopenia. Severe thrombocytopenia in a suspected case of bacterial sepsis might predict Klebsiella sepsis and hence it may be rational to start empirical antibiotics covering the same.

Acute emergencies in oncology

The spectrum of dermato-oncological emergencies is multifaceted. They are particularly observed in cases with malignant melanoma due to the large number of patients and prolonged survival rates that are associated with new therapies for advanced disease. Dermato-oncological patients present to the hospital with symptoms like nausea and emesis, unexpected neurological deficits, various gastrointestinal problems, and even acute abdomen, acute breathlessness, or hemoptysis. Furthermore, emergencies can be caused by hematological problems like anemia and leukopenia. In addition to standardized care for medical emergencies, there are many other problems caused by metastases and/or therapeutic side effects that need interdisciplinary skills to optimize procedures and deliberate on surgical interventions, radiotherapy, and medical therapeutic choices with regard to the overall situation of the patient. The article deals with aspectrum of acute organ-specific emergencies, including recommendations for medical treatment and considerations for therapeutic decisions. Recommendations for supportive care in patients who are severely ill are summarized. In addition to stage-adapted pain therapy, supportive measures such as nutritional supplementation, the use of dronabinol in cases of loss of appetite, and antipruritic therapies are outlined. This article provides asuccinct summary of the most frequently observed dermato-oncological emergencies with references to the respective detailed literature of associated medical societies and guidelines.

Particularités de la numération formule sanguine et apport de la cytologie en période néonatale

The challenge of hematologic problems in the newborn is still present. In the present article, the main cytological characteristics of the blood cells in healthy neonates as well as the physiological blood parameters variations at birth and during the first month of life of the newborn and the preterm neonates will be reminded. Indeed, the values of many hematologic variables change markedly in the first days, weeks and months of life and a good knowledge of normal reference values according to gestational age is required to enable the proper interpretation of blood count parameters. In the second part of this article, we will focus on the main morphological alterations of the red cell, platelet and leukocyte encountered in hereditary or acquired disorders with a neonatal revelation which can lead to ever more effective interventions of neonatalogists in this vulnerable population.

Investigation of Parvovirus B19 IgM and IgG Positivity Rates in Pediatric Hematology Patients

AbstractHuman parvovirus B19 is a frequent etiologic agent causing erythema infectiosum in children. It has recently been suggested that parvovirus B19 may be latent after infection and cause reactive infections especially in immunosuppressed patients with hematological problems. In this study, we aimed to investigate the parvovirus B19 immunoglobulin M (IgM) and immunoglobulin G (IgG) seropositivity rates of patients evaluated in a pediatric hematology clinic. We retrospectively screened the laboratory results of parvovirus B19 IgM and IgG antibody assays of children less than 18 years, who consulted pediatric in-and-outpatient clinics between 2013 and 2016. Parvovirus B19 IgM and IgG antibodies were investigated in serum samples by using enzyme-linked immunosorbent assay method in the Medical Microbiology Laboratory. Parvovirus B19 IgM antibodies were detected in 109 of 602 patients attending pediatric hematology clinics (18.1%). Parvovirus B19 IgG antibody was detected in 244 of 952 patients attending pediatric hematology clinics (25.6%). Parvovirus B19 IgM and IgG positivity in samples from pediatric in-and-outpatient clinics other than pediatric hematology were 2.8% and 35.7%, respectively. Parvovirus IgM and IgG positivity in serum samples sent from the pediatric hematology clinic and outpatients was statistically significant compared with those sent from pediatric clinics other than pediatric hematology (p = 0.0001 and p = 0.0008, respectively). The higher detection rate of serum parvovirus B19 IgM positivity in patients under the follow-up of pediatric hematology clinics suggests that immune suppression-related viral reinfection or persistence may occur in these patients.

The Side Effects of the Most Commonly Used Group of Antibiotics in Periodontal Treatments.

Antibiotic combinations are preferred for the treatment of periodontal diseases, with the aim of hitting the bacterial flora, according to its characteristics—aerobic, anaerobic, gram-negative, and gram-positive—with certain antibiotics that act on certain bacteria. The aim of this study is to analyze the side effects of the antibiotics used. Data on the side effects (preferably expressed in percentages) of some antibiotics, the favorites in periodontal recipes, are gathered from the literature. These data are listed according to the antibiotic used. In the case of providing a periodontal prescription, the patient is at risk of allergy (5%), nephritis (3%), hematological problems (2–2.5%), gastrointestinal problems (5.5%), disturbance in the nervous system (2%), allergic signs on the skin (5.5%), and problems with electrolytes displayed in lower percentages. Interaction with different medications is present in almost all cases. The influence on the body systems is 4% in total, the maximum value of which is expressed on the skin, and the minimum value is expressed in the nervous system. Cross allergies are at a high value because of the expressed structural similarity of antibiotics. Given a recipe, we have a balance of the percentage of side effects, the percentage of bacterial resistance, and the percentage of the success of the recommended dose of antibiotics.

Thrombocytosis Development due to the Use of Methotrexate in a Patient with Rheumatoid Arthritis

Rheumatoid arthritis is a systemic rheumatic disease that affects various organs and systems. In the course of rheumatoid arthritis, various blood disorders including thrombocytosis (>400.000/mm3), an increase in the platelet count are observed. Methotrexate is a disease-modifying agent used in the treatment of Rheumatoid Arthritis and various rheumatic diseases. During methotrexate treatment, hematologic problems such as leukopenia, anemia, and thrombocytopenia are observed generally due to bone marrow suppression. In our case report, we aimed to present a 56 year-old patient who has arthritis of both hands and was diagnosed with rheumatoid arthritis and whose platelet values were initially within normal limits and then increased up to the level of 808.000/microliter despite a clinical and laboratory suppression in the disease activity after the initiation of methotrexate treatment, and quickly returned to normal values after the termination of methotrexate treatment. In conclusion, we think that the response of the blood profile to drugs may be very different, as in our case, and therefore, patients should be carefully monitored.

Incidental Detection of Sickle Cell Anaemia as a Significant Haematological Problem in an Island Based Population

Incidental Detection of Sickle Cell Anaemia as a Significant Haematological Problem in an Island Based Population

Investigating the effects of two different pump heads (Centrifugal vs. Roller Pump) on hematological and immunological mechanisms.

Technological developments and enhancement of knowledge level enable heart surgery with low mortality rates in most centers. On the other hand, increased systemic inflammatory response against cardiopulmonary bypass (CPB) plays a critical role in the development of postoperative complications. We aimed to compare the effects of centrifugal pump where it is claimed that blood is exposed to minimal trauma and roller pump techniques on inflammatory response and oxidant status during CPB. : A total of 40 patients, who had coronary artery disease and underwent coronary artery bypass graft (CABG) surgery using either roller or centrifugal pump between June 2012 and June 2013 were enrolled in this study. Patients over 40 years old and without any known immunologic, infectious, or inflammatory incidents and hematological problems for the past 6 months were included in the study. Two study groups (Group R: roller pump group and Group C: centrifugal pump group) were created. During CABG surgery tumor necrosis factor (TNF) alpha, interleukin (IL)-6, IL-8, superoxide dismutase (SOD), catalase (CAT), and nitric oxide levels were measured before and after CPB. TNF alpha, IL-6, and IL-8 levels measured before and after CPB were found to be similar between groups. SOD, CAT and Nitric oxide levels were also similar between groups. After the CPB period, glutathione peroxidase enzyme activities in Group R measured after CPB were significantly lower than those measured in Group C. The platelet-activating factor (PAF) levels before CPB usage period were same in both groups, where PAF levels after CPB were found to be significantly higher in roller pump group than centrifugal pump group. At inter-group comparisons, the levels of PAF were same at each group before and after CPB. The study findings indicate that usage of the centrifugal pump does not have a clear superiority in terms of the effects on inflammatory response and oxidant status during CPB when compared to roller pump. Nevertheless, we believe that our results should be supported by further clinical and experimental studies.

Clinicohematological Study of Pancytopenia in a Tertiary Care Hospital of Western Region of Nepal

Pancytopenia is a relatively common hematological entity and is a manifestation of many illnesses which can be life threatening at times. The severity of pancytopenia and the underlying pathology determine the management and prognosis. This study was conducted to evaluate hematological and bone marrow findings in patients presenting with pancytopenia. A prospective observational study was conducted in Department of Pathology, Manipal College of Medical Sciences, Pokhara from January 2011 to December 2016. Clinical and hematological parameters including bone marrow aspiration and biopsy were evaluated in all patients who presented with pancytopenia. Among 138 cases studied, patients' age ranged from 2 to 82 years with a mean age of 43.95 years, and there was male predominance. Most of the patients presented with generalized weakness, pallor, dypnoea and fever. Hypoplastic marrow was seen in 38 (27.5%) cases, followed by 26 (18.8%) cases of megaloblastic anemia and 19 (13.76%) cases of acute leukemia. Other findings included one case each of hemophagocyosis, leishmaniasis, plasmodium vivex malaria and metastatic carcinoma. This study highlights that pancytopenia is a common hematological problem and that the study of detailed primary hematological investigations along with bone marrow study in patients with pancytopenia will help to identify the cause for further planning and management.

Hematological parameters are acutely effected by cement dust exposure in construction workers

Cement dust poses an occupational hazard causing respiratory (owing to its inhalation), dermatological, ocular and hematological problems. The purpose of the current study was to evaluate the effect of occupational exposure of cement dust on hematological parameters in construction workers. Apparently healthy sixty five (65) adult male construction workers aged 25-50 years participated in this study. Three (3.0) ml venous blood samples were collected from each participant for hematological analysis at two different time points, one at 8 AM and second at 4 PM at the end of work shift. Differences in means and test of significance were calculated using paired Student’s t-test. The results revealed that post shift samples showed statistically significant increase (p<0.05) in mean total leukocyte count (TLC), lymphocyte %, monocyte % and eosinophil % and statistically significant decrease (p<0.05) in mean hemoglobin, red blood cell (RBC) count, packed cell volume (PCV) and platelet count. The present study confirms that hematological parameters are significantly effected in construction workers which may be attributed to the work atmosphere predominated with cement dust.

Invasive fungal infection in patients with hematologic disorders in a Brazilian tertiary care hospital.

Invasive fungal infections (IFIs) are an important complication in immunocompromised individuals, particularly neutropenic patients with hematological malignancies. In this study, we aimed to verify the epidemiology and diagnosis of IFIs in patients with hematologic problems at a tertiary hospital in Goiânia-GO, Brazil. Data from 117 patients, involving 19 cases of IFIs, were collected. The collected data included diagnosis methods, demographics, clinical characteristics, and in vitro susceptibility to different antifungal agents. Among the 19 cases, 12 were classified as proven IFI and 7 as probable invasive aspergillosis with detection of galactomannan in blood and presence of lung infiltrates in radiographic images. Logistic regression analysis showed that the proven and probable IFIs were associated with increased risk of death. Statistical analysis demonstrated that age, sex, and underlying disease were not independently associated with risk of death in IFI patients. Most bloodstream isolates of Candida spp. exhibited low minimum inhibitory concentrations (MICs) to all antifungal agents tested. Voriconazole and amphotericin had the lowest MICs for Aspergillus spp. and Fusarium spp., but Fusarium spp. showed the least susceptibility to all antifungals tested. Amphotericin B, fluconazole, and itraconazole were found to be inactive in vitro against Acremonium kiliense; but this fungus was sensitive to voriconazole. Considering the high number of IFI cases, with crude mortality rate of 6%, we could conclude that IFIs remain a common infection in patients with hematological malignancies and underdiagnosed ante mortem. Thus, IFIs should be monitored closely.

The tactics and technique of musculoskeletal biopsy

The treatment of musculoskeletal neoplasms and infection is usually based on an initial diagnostic biopsy.Prior to biopsy, a hypothesis should be formed about the most likely diagnosis and a differential diagnosis. These deliberations should consider whether the lesion is a primary benign or malignant tumour, a metastasis, a haematological problem or an infection.A tactical plan should be developed which evaluates the necessity, the risk, the approach and finally defines the technique of biopsy most likely to achieve a representative result in the clinical case.In developing this technical approach, the pitfalls should be anticipated, i.e. inadequate sampling, difficulty of pathological interpretation and contamination.The tactical approach should be developed in conjunction with a multi-disciplinary team together with appropriate pre-biopsy imaging.Cite this article: EFORT Open Rev 2017;2:51–57. DOI: 10.1302/2058-5241.2.160065

Light-chain deposition disease is a hematologic problem

To analyze clinical and laboratory data and treatment results in patients with light-chain deposition disease (LCDD). Nine patients with LCDD and kidney injury were examined. The diagnosis was based on the results of light and immunofluorescence microscopy of renal biopsy specimens. All the patients received bortezomib, cyclophosphamide, and dexamethasone (VCD) induction therapy. Six patients were diagnosed with multiple myeloma; in 3 patients LCDD was considered within monoclonal gammopathy manly involving the kidney. By the initiation of therapy, all the patients were diagnosed as having chronic kidney disease (Stage III (n=2), Stage IV (n=2), and dialysis-related renal failure (n=5)). After the VCD treatment, 7 of 9 patients achieved a hematologic response. Second-line therapy with lenalidomide proved to be effective in the other 2 cases. Five patients achieved complete remission; 3 had a very good partial remission. Thereafter, 2 patients received high-dose melphalan chemotherapy and autologous hematopoietic stem cell transplantation. Better renal function was noted in only 2 cases. Despite the high efficiency of therapy aimed to reduce monoclonal light chains; improved renal function was observed in only 2 (22%) patients. Such low rates of a renal response were due to the late initiation of therapy.

Congenital bilateral radioulnar synostosis with acute lymphoblastic leukemia: A case report

Radioulnar synostosis (RUS) is a rare, congenital bone anomaly characterized by fusion of the radius and the ulna. RUS occurs more often in males than in females and is bilateral in 50% of the cases. More than 400 cases of RUS have been described since 1793. In the literature, seven cases with RUS and hematologic problems were reported, including the newly named radioulnar synostosis-hematology syndrome. Globally, this is the first reported case of RUS associated with malignancy, that is, acute lymphoblastic leukemia, in a 3-year-old male child.

Congenital bilateral radioulnar synostosis with acute lymphoblastic leukemia: A case report

Radioulnar synostosis (RUS) is a rare, congenital bone anomaly characterized by fusion of the radius and the ulna. RUS occurs more often in males than in females and is bilateral in 50% of the cases. More than 400 cases of RUS have been described since 1793. In the literature, seven cases with RUS and hematologic problems were reported, including the newly named radioulnar synostosis-hematology syndrome. Globally, this is the first reported case of RUS associated with malignancy, that is, acute lymphoblastic leukemia, in a 3-year-old male child.

Determination in vivo viability of a transfused platelet product by corrected count increment and percentage platelet response.

IntroductionFor many years, platelet concentrates have been used for the prevention as well as treatment of bleeding disorders, especially in those patients with haematological problems involving platelet disorders as well as refractoriness, In addition, platelet concentrates (PCs) have been widely used to support patients undergoing bone marrow transplantation or who are receiving myelotoxic treatments. The aim of this study was to determine the quality of platelet concentrates by assessing platelet counts, volume, pH changes, swirling, residue of the red blood cells and white blood cell counts. Assess the in vivo viability of a transfused platelet product using the corrected count increment (CCI) and the percentage platelets response (PPR). This descriptive analysis study was done in Kenyatta National Hospital Blood Transfusion Unit between July 2016 and December 2016.MethodsThe in vitro Platelets concentrates quality was accurately determined and assessed using certain parameters. Platelet concentrates in ethylene diamine tetra acetic acid (EDTA) was used for analysis using Cell-Dyn 3700 analyser. The volume of PCs used was an average of 2mls of PCs, the pH was measured using digitalised Hanna edge pH kit. Agitation was done using Helmer agitator and centrifugation was done using Roto silenta 630 RS centrifuge. The in vivo viability of a transfused product was determined using corrected count increment (CCI) and percentage recovery (PR) between 1 and 20-hour after transfusion. Pre and post-transfused whole blood in EDTA collected from the recipients was analysed to access the functional platelets in the circulation. Data analysis was done using SPSS.ResultsA total of 384 platelet concentrates were analysed and used in transfusion. The majority 96, (40%) were O Rhesus D+ and the least being AB Rhesus D-at (1%).Centrifugation, separation and agitation was done according to standard procedure (n=384). Only (246 (65%) of the concentrates were found fit for use out of a total of (n=384) leaving 138 (35%) which did not meet the KNH/KNBTS criteria. The minimum specifications for platelet count are 5.5 x (109). The duration of 3 days of storage on average, the WBC count (109) was Mean ± SD 4.50 ± 3.50. Using the Hanna edge pH kit the pH Mean was ±SD 7.18 ± 8.82 and the used Volume (Mls) was at 55 ± 15. The concentrate was issued within 3 days of processing. After transfusion, the percentage platelet response (PPR) was 72% in male recipients at 1-hour and 30% at 20-hours while 69% in female recipients at 1-hour and 25% at 20-hours. The invivo viability of platelet product had a corrected count increment (CCI) of 75% ≥ 7500 at 1-hour and CCI of18% ≥ 30% at 20-hours in male recipients. In the same study, the female recipients had a CCI of 80% ≥ 7500 at 1-hour and a CCI of 25% ≥ 30% at 20-hours.ConclusionThe findings on platelets concentrates quality 65% met platelets transfusion criteria while 35% did not. On preparation of platelets concentrates there was high counts of white blood cells 4.5±3.5×109than recommended counts by Kenya National Blood Transfusion Services < 0.83×109. Both percentage platelet response (PPR) and corrected count increment (CCI) were very low at 20 hours compared to British committee for standards haematology criteria for successful increment of platelet products (PPR ≥ 30% and CCI ≥ 7500). Apheresis platelets transfusion can be introduced at KNH and use of leukoreduction performed on the platelet concentrates which are prepared within the Hospital. With such rate of refractoriness, additional tests to confirm the real cause of unviability of platelets in the patients need to be performed. Recipients should be done evaluation of the pattern of refractoriness followed by HLA compatibility testing. In addition, if there is a high, compatible cross-matched, selected apheresis platelet concentrate pint should be transfused. This unviability was due to recipients with either immune-mediated refractoriness or non-immune mediated refractoriness.

Genetically proven fanconi anemia: a case report

Fanconi anemia (FA) is a rare autosomal recessive disorder characterized by congenital malformations, haematological problems and predisposition to malignancies. It was first described by Guido Fanconi, a Swiss Paediatrician in 1927. The prevalence of FA is 1 to 5 cases per million.The genes that have been found to be mutated in FA patients are called FANC. 16 different FANC genes have been reported, among which 60-65% account for the mutations seen in FANCA genes which is the most frequently seen in FA patients. The disease is most commonly seen in children between 5-15 years. Diagnosis is based on the congenital physical abnormalities and confirmed by genetic testing. Here we report a rare case of Fanconi Anemia in a 4 year old female child with the characteristic clinical findings and the diagnosis was confirmed by genetic studies.

Single-dose intravenous iron for iron deficiency: a new paradigm.

Iron-deficiency anemia is the most common hematologic problem in the world. Although oral iron is often viewed as front-line therapy, extensive published evidence has accumulated that IV iron is superior, in both efficacy and safety, to oral iron in many clinical situations and should be introduced much sooner in the treatment paradigm of iron-deficient patients. In this chapter, we will review the formulations of IV iron that allow total complete replacement doses in 1 or 2 sessions including practical tips for administration. We realize safety concerns abound and therefore will analyze evidence based overstated concerns regarding serious adverse events highlighting unnecessary interventions for minor, self-limiting infusion reactions, which infrequently occur with intravenous iron administration. Recent data for the use of IV iron in a variety of clinic situations will be reviewed including women with heavy uterine bleeding, pregnancy, bariatric surgery, inflammatory bowel disease, and restless legs syndrome. Briefly discussed is the new frontier of IV iron's use in the prevention of acute (high altitude) mountain sickness. It is clear that in many clinical situations IV iron is a new and improved standard of care offering advantages over oral iron in efficacy, toxicity, and convenience to patients and health care providers.