Hyperchromic Anemia Research Articles

Polyglandular Syndrome type III in a young patient: case report

Introduction: Autoimmune polyglandular syndromes (APS) are rare diseases defined by the coexistence of at least two autoimmune endocrine diseases. Objective: To describe a case of type III polyglandular syndrome in a young patient. Case report: Female, 37 years old, with hypothyroidism, presented with a weight loss of 9 kg, daily vomiting, asthenia, fatigue, and postprandial fullness for 3 months. He also reported arthritis in his wrists, shoulders, and hips. In laboratory tests, macrocytic and hyperchromic anemia associated with leukopenia, as well as hypovitaminosis B12, was observed. Pernicious anemia was investigated as the cause of this deficiency. Upper digestive endoscopy showed moderate gastritis – histopathological with gastric atrophy, positive anti-intrinsic factor antibody. Due to inflammatory arthralgia, ANA was requested, with an associated positive anti-dsDNA result of 1:80. In the EULAR/2019 diagnostic criteria for Systemic Lupus Erythematosus (SLE), she presented 14 points, thus she was diagnosed with SLE, and hydroxychloroquine (HXC) was started. Conclusion: SPA is rare, mainly in association with non-glandular autoimmunity, following an early diagnosis.

Circulating in the blood desquamated endotheliocytes at the cardiovascular diseases. Preliminary communication

Introduction and aim. We previously found that diabetic angiopathy is accompanied by an increase in the level of desquamated endothelial cells (CECs) circulating in the blood, commensurate with its severity. In this study, we set ourselves the aim of analyzing the level of CECs in patients with cardiovascular pathology and their relationship with the level of blood pressure and routine clinical indicators. Material and methods. The object of clinical observation were patients with stage II hypertension, who were receiving outpatient treatment. Among them, 23 men (62.3±13.2 ys) and 39 women (65.1±10.6 ys). Concomitant ischemic heart disease was diagnosed in 16 men (70±10%) and 28 women (72±7%). The main subject of the study was blood pressure and the level of CECs. In addition, routine general blood analysis and determined metabolic parameters were performed. Results. Using the method of cluster analysis, the sample was divided into 4 homogeneous groups, different from each other. It was found that in 18 patients of the first cluster, the youngest in the sample, the minimum level of hypertension for the sample occurs against the background of unchanged CECs levels and other registered parameters, instead, it is accompanied by moderate increased creatininemia and a significantly increased rate of erythrocyte sedimentation and a reduced level of hemoglobin and color index. In 18 patients of the second cluster, moderately elevated levels of terminally and markedly changed CECs were found in combination with minimally expressed signs of hyperchromic anemia. In the third cluster (n=16), the levels of terminally and markedly changed CECs are significantly increased in combination with a reduced level of urea and LP index against the background of moderate hyperchromic anemia. Finally, in 10 patients of the fourth cluster, the oldest in the sample, with maximally expressed hypertension, it is accompanied by maximally elevated levels of all three types of СEСs against the background of moderate hyperchromic anemia. Conclusion. Desquamated plasma endothelial cells can be one of the criteria for the severity of hypertonic disease.

VEXAS and Myelodysplastic Syndrome: An Interdisciplinary Challenge.

VEXAS (vacuoles, E1 enzyme, X-linked, autoinflammatory, somatic) syndrome is a recently recognized systemic autoinflammatory disease caused by somatic mutations in hematopoietic progenitor cells. This case series of four patients with VEXAS syndrome and comorbid myelodysplastic syndrome (MDS) aims to describe clinical, imaging, and hematologic disease presentations as well as response to therapy. Four patients with VEXAS syndrome and MDS are described. A detailed analysis of imaging features, hemato-oncological presentation including bone marrow microscopy and clinical-rheumatological disease features and treatment outcomes is given. All patients were male; ages ranged between 64 and 81 years; all were diagnosed with MDS. CT imaging was available for three patients, all of whom exhibited pulmonary infiltrates of varying severity, resembling COVID-19 or hypersensitivity pneumonitis without traces of scarring. Bone marrow microscopy showed maturation-disordered erythropoiesis and pathognomonic vacuolation. Somatic mutation in the UBA1 codon 41 were found in all patients by next-generation sequencing. Therapy regimes included glucocorticoids, JAK1/2-inhibitors, nucleoside analogues, as well as IL-1 and IL-6 receptor antagonists. No fatalities occurred (observation period from symptom onset: 18-68 months). Given the potential underreporting of VEXAS syndrome, we highly recommend contemporary screening for UBA1 mutations in patients presenting with ambiguous signs of systemic autoinflammatory symptoms which persist over 18 months despite treatment. The emergence of cytopenia, especially macrocytic hyperchromic anemia, should prompt early testing for UBA1 mutations. Notably conspicuous, pulmonary alterations in CT imaging of patients with therapy-resistant systemic autoinflammatory symptoms should be discussed in interdisciplinary medical teams (Rheumatology, Hematology, Radiology and further specialist departments) to facilitate timely diagnosis during the clinical course of the disease.

492. TYPES AND INCIDENCE OF POSTOPERATIVE ANEMIA AFTER ONCOLOGICAL ESOPHAGECTOMY AND GASTRECTOMY

Abstract According to current literature, anemias that develop after oncological esophageal and gastric resections are classified as deficiency anemias. Due to the surgery-related changes in the mechanical and biochemical conditions of the upper gastrointestinal tract, there is an alteration in the processing and absorption of hematopoietic-relevant vitamins and trace elements like iron, vitamin B6, vitamin B12, folic acid, copper and essential amino acids in the postoperative phase. Between January 2015 and December 2019, 232 patients underwent a (sub)total gastrectomy or esophagectomy at our center. In this monocentric retrospective analysis of prospectively collected follow-up data, 157 patients were included after applying the exclusion criteria: Age below 18, primary bone marrow disease, hereditary forms of anemia, postoperative tumor recurrence and R1/R2 situation. 103 patients (=66%) belonged to the esophagectomy group and 54 patients (=34%) to the (sub)total gastrectomy group. Preoperatively and three, six, twelve, 18, and 24 months postoperatively the following laboratory parameters were collected and descriptively analyzed: Hemoglobin, MCV, MCH, serum iron, ferritin, transferrin, and vitamin B12. Two years after the oncological resection 28% of patients with esophagectomy, EE, and 48% of patients with (sub)total gastric resection, (S)GE, show anemia. Normocytic anemia was the dominant type. The MCV distribution of anemic patients in the EE group was as follows: 3% microcytic, 77% normocytic, and 20% macrocytic. The anemic patients in the (S)GE group show the following MCV distribution: 16% microcytic, 81% normocytic, and 3% macrocytic. The (S)GE collective has more anemic patients in percentage terms than the EE collective throughout the whole follow-up period. This difference is significant at the 12th (p = 0.032) and 18th-month (p = 0.023) postoperative follow-up. A high percentage of patients with oncological resection of the upper gastrointestinal tract have a relevant postoperative anemia. The known postoperative iron and vitamin deficiencies, that would be associated with microcytic hypochromic and macrocytic hyperchromic anemia, are not the relevant causes for this anemia as it is predominantly a normocytic form. Normocytic anemia is an indication for an anemia of chronic disease. The reason for the predominance of normocytic anemia is not specifically known.

Influence of two species of Ticks and Lice on some hematological parameters in black goats during spring and summer seasons in Sulaimani Governorate - Kurdistan region.

This study was carried out in Sulaimani province Kurdistan region-Iraq during the spring and summer seasons from April to September 2015 on 400 head of black goat Capra aegagrus were infected with ticks and lice, have been selected from different herds and regions were elonging to the districts and sub-districts of Sulaimani province, to identified and effect of their parasites on some blood values in the local goats. It has been diagnosed two species of hard ticks of the genus Rhipicephalus: R. sanguinaus and R. turanicus, its percentage 82.30% and 17.70% respectively, also have been diagnosed two species of lice: Biting lice is Damalinia capriae and other species Sucking lice was Linognathus stenopsis, its percentage 71.44% and 28.56% respectively. The results showed a significant difference P ˂ 0.01 in the infection rate between the spring and summer seasons where the total infection rate during the spring and summer seasons for ticks and lice: 32.25%, 19.75% respectively. As for ticks were more infections in the spring season and the least in the summer season, which were 44%, 20.5% respectively, whereas the infection rate of lice was more during the summer season and less during the spring season, which was 25.5% and 14% respectively. The study results showed presence of a significant decrease according to Chi-Square Test in the total number of red blood corpuscles RBC , the amount of hemoglobin Hb , packed cell volume PCV and the average weight of mean corpuscular hemoglobin MCH in the goats that infected with the lice and ticks, that anemia in the goats that infected with the ticks was Microcytic - Hyperchromic anemia type , while in the goats that infected with lice , anemia was of the the type Normocytic - Hyperchromic anemia. Also identified a significant increase P ˂ 0.05 in the total number of white blood cells WBC in the goats that infected with lice and goats because of the significant increase in the number of Lymphocyte and Neutrophils while the the ratio of Eosinophil, Basophil and Monocyte was decreased in all infections as compared with the control samples.

PROGRESSIVE FAILURE AFTER GASTRIC AND DUDEON RESECTION

The scientific literature reviews on the origin of anemia and the development of anemia after gastric and duodenal resection, the state of advanced hyperchromic anemia, both experimental and clinical observations on the possibility of developing forms of anemia are given in this article.

TNFα Controls the Delicate Balance between Erythropoiesis and Stem Cell Exhaustion during Inflammatory Stress

Anemia of Inflammation (AI) is prevalent in patients with chronic inflammatory states, such as infection, autoimmunity, or cancer. Induced expression of hepcidin by pro-inflammatory cytokines results in iron-restricted anemia. In particular, abnormally elevated levels of the cytokine Tumor Necrosis Factor-α (TNFα) is a hallmark of AI, however its contribution to the pathophysiology of AI is not well understood.In this study, we investigated the role of TNFα in the development of anemia in a TNFα knockout (TNFαKO) mouse model of AI, which is induced with a single intraperitoneal (i.p.) injection of heat-killed Brucella Abortus (BA) (Kim et al. Blood). We hypothesized that TNFαKO mice would show a less severe form of AI compared to WT animals when challenged with BA.Our results showed that WT-BA mice developed severe anemia within 2 weeks, which was resolved by 8 weeks, whereas the TNFαKO mice developed leukocytosis and an irreversible macrocytic, hyperchromic anemia. Serum analysis at 8 weeks showed that erythropoietin (EPO) and iron parameters were elevated in TNFαKO compared to WT mice, which ruled out iron-restriction as the cause for the persistent anemia. However, serum cytokine measurements of TNFαKO mice at 4 weeks showed continual elevation of interleukin (IL)-12p40 and Interferon-γ (IFNγ) compared to WT-BA controls. We hypothesized that TNFα served an anti-inflammatory role that restrained prolonged inflammation after BA, and in its absence, pro-inflammatory macrophages continuously secreted IL-12p40 levels and induced the proliferation of IFNγ secreting cells.To test if concurrent loss of IFNγ would correct the inflammatory phenotype, we crossed TNFαKO with IFNγKO mice (DKO). Indeed, IFNγKO and DKO mice challenged with BA showed complete reversal of the anemic phenotype present in WT-BA and TNFαKO-BA at 2 weeks. Additionally, serum levels of IL-12p40 were normalized by 4 weeks in IFNγKO-BA and DKO-BA compared to TNFαKO-BA mice. Flow cytometry analysis of the bone marrow (BM) and spleen (SPL) at 8 weeks showed T-lymphocytes and macrophages were markedly expanded, whereas erythrocytes and B-lymphocytes were reduced in TNFαKO-BA mice. However, only modest differences in erythrocytes, macrophage, T- and B-lymphocyte in WT-BA, IFNγKO-BA and DKO-BA in the BM and SPL were detected. Additionally, we performed immunohistochemistry using an anti-CD3 antibody in SPL and livers of BA treated mice sacrificed at 8 weeks. We found complete disorganization of the white pulp in the SPL and infiltration of T-Lymphocytes in livers of TNFαKO-BA but not in WT-BA, IFNγKO-BA or DKO-BA animals.These results led us to question if lack of TNFα skewed the BM towards T-Lymphocytes. We investigated the hematopoietic stem cell (HSC) LSK, multipotent myeloid progenitors (MPP) LK, and common lymphoid progenitor (CLP) compartments by flow cytometry. Shockingly, the TNFαKO had over a 30% increase of Lin-cKit+Sca1+ LSKs, compared to TNFαKO controls, while the Lin-cKit+Sca1- LK population was drastically reduced. By contrast, the Lin-CD217-cKit+Sca1+ CLP population was expanded by more than 40% in the TNFαKO-BA compared to TNFαKO controls.Considering this data, it is difficult to disentangle the effects of TNFα in AI in vivo from its role in regulating upstream stem and progenitor cell differentiation using a germline KO strategy. However, our observations reinforce the link between iron homeostasis and HSC self-renewal and provide a new model to study inflammation associated bone marrow failure. The TNFα-BA mice displayed severe anemia, which seems to result from persistent IFNγ elevation. A recent study identified TNFα as a major pro-survival and pro-regeneration factor for HSCs (Yamashita & Passegue, Cell Stem Cell). Other studies have shown that IFNγ restricts HSCs self-renewal (Chen et al. Blood). Our results in the TNFαKO-BA treated mice suggest that TNFα preserves balanced progenitor output by countering the action of IFNγ at the HSC level. Ongoing work aims to understand the relationship between TNFα and IFNγ in regulating HSC quiescence, self-renewal, and overall pool size. DisclosuresPaulson: Forma Therapeutics: Consultancy. Rivella: Meira GTx: Consultancy; Ionis Pharmaceuticals: Consultancy.

Dilatated Cardiomyopathy In Two Month Old Puppy

Background: Canine dilated cardiomyopathy (DCM) is a disease that results in a decreased ability of the cardiac contraction to generate pressure to pump blood through the vascular system. DCM is characterized by dilation of the ventricles with ventricular wall thinning. Purpose: The DCM case in Indonesia is rarely reported; therefore, this paper contains information about dilatated cardiomyopathy in a 2-month-old puppy. Case Analyze: A two-month-old local dog arrived with a complaint about coughing, loss of appetite, fatigue, and swelling on extremities, also having a history of seizures and bloody diarrhea. Physical examination shows that the patient breathes using abdominal type and polypnea, tachycardia pulse, pale mucose, and dehydration. Electrocardiogram result shows tachycardia sinus and abnormality in the depression of ST-segment. Radiography examination shows heart dilation and liquid accumulation in the thoracic cavity and abdomen. Hematology routine examination shows microcytic hyperchromic anemia, leucocytosis, and eosinophilia. Feces examination resulted in negative. Pathology anatomy examination show dilatated cardio, pulmonum hepatization, fluid accumulation in the thoracic cavity and abdomen cavity. Result: According to anamnesis, clinical examination, laboratory examination, and anatomy pathology examination can be concluded that the dog, in this case, is diagnosed with dilatated cardiomyopathy.

Changes of hematological indices in patients with diffuse toxic goiter

Objective. To reveal the incidence of various morphological types and degrees of the anemia severity in patients with diffuse toxic goiter.
 Materials and methods. Data of medical histories of 157 patients, operated for diffuse toxic goiter in 2012 yr were analyzed. In accordance to hematological indices estimated there were outlined two Groups of patients: Group I – 98 patients with diffuse toxic goiter and mild anemia, average age (39.4 ± 1.4) yrs old, 57 (58.2%) women and 41 (41.8%) men, and Group II – 59 patients with diffuse toxic goiter and middle degree of the anemia severity, average age (41.1 ± 1.7) yrs old, 48 (81.4%) women and 11 (18.6%) men. Levels of hemoglobin, hematocrit, quantity and average volume of erythrocytes, average content of hemoglobin in one erythrocyte, average concentration of hemoglobin in the erythrocytes were determined in the blood analysis.
 Results. Microcytic type of anemia was noted in 89.8% of patients with anemia of middle degree of severity, while a normocytic one – in 10.2%; in mild anemia – in 87.8 and 12.2% patients, accordingly. Hypochromic and normochromic types of anemia with equal rate were revealed in mild anemia and anemia of middle degree of severity: hypochromic – in 94.9%, normochromic – in 5.1% patients.
 Conclusion. Diffuse toxic goiter is characterized by more frequent development of mild (62.4%), microcytic (88.5%), hyperchromic (94.9%) anemia, caused by iron deficiency.

Absence of TNF-α Promotes Anemia of Inflammation and Inflammatory Bowel Disease

Anemia of inflammation (AI) is a hallmark of a multitude of disorders including infections, autoimmune diseases and malignancies. The pathophysiology of AI is currently under investigation. While the hematological aspect of AI and the involvement of cytokines such as IL6, IL1α, IL1 β has been subject to extensive study, the inflammatory and immunological arm has only recently begun to be explored. This involves a complex interplay of cytokine mediators both pro and anti-inflammatory, mediating a broader innate and ultimately adaptive immune response that could potentially be linked to the hematological deficiencies seen under AI. In particular, highly elevated levels of the cytokine TNF a have been noted in inflammatory conditions, including an established acute mouse model of AI induced by a single injection of the heat killed pathogen Brucella abortus (BA). The latter results observed by us prompted us to furtherinvestigate the role of this cytokine in BA induced AI.To study the above we injected mice lacking TNFα (TNFα-/-) with BA and studied hematological, inflammatory and immunological changes in our model. Following a single injection of BA, we found that TNFα -/- mice develop an irreversible macrocytic, hyperchromic anemia with hemoglobin levels dropping as low as 7 g/dL within two weeks of BA injection and not returning to normal even after eight weeks unlike their WT counterparts. This is further characterized by a complete abolition of Bone Marrow (BM) erythropoiesis and extra medullary erythropoiesis in the spleen (SPL). We also found elevated serum levels of erythropoietin and iron, indicating that the resulting anemia is not caused by a lack of these factors. The anemia was accompanied by a fall in the lifespan of RBCs in peripheral blood and a concurrent increase in production of reactive oxygen species by progenitors and terminally differentiated RBCs. Moreover, our experiments using WT GFP+ RBCs in BA treated TNFα-/- mice indicate that even the healthy GFP+ RBCs are cleared faster in the latter animals. Preliminary data, suggest that macrophages derived from BA treated TNFα-/- express pro-inflammatory markers and that the same cells can consume more RBCs than macrophages from control animals, suggesting increased macrophagocytosis. Subsequently, we looked at changes in serum cytokine levels over time after injection of BA. We found that unlike WT animals injected with BA, TNFα-/- mice show a sustained production of IFNγ, IL12-p40 and IL1β. We also found an expansion of splenic resident macrophages and T cells which are cell types implicated in the production of the cytokines mentioned previously. Finally, to extend the reach of this model to other disorders we treated TNFα-/- mice with low doses of dextran sodium sulfate (DSS) and found that only these animals developed inflammatory bowel disease (IBD) characterized by blood in the feces and severe anemia, unlike WT animals treated the same way.Our observations on the upregulation of IFNγ and IL12 is leading us to study macrophage activation and T helper cell polarization in the BM, SPL and lymph nodes. Moreover, we are also investigating the potential crosstalk between these effectors, cytokines and erythropoiesis looking at oxidative stress, survival and cell differentiation of erythroid progenitors. As a first step, we are investigating the recovery from BA of IFNγ-/- mice, as TNFα-/- mice with AI show a significant upregulation of IFNγ. Preliminary complete blood count of BA treated IFNγ -/- mice indicates that these animals do recover from an inflammatory insult and the anemia is reversible, unlike the TNFα-/- mice. These results suggest that absence of IFNγ could potentially rescue the severely impaired phenotype that we found in our TNFα-/- mice and the recovery in BA treated TNFα/IFNγ double knock out mice.Given the history of TNFα in enabling inflammatory reactions and promoting cell death, the view of this cytokine in supporting recover under AI as inferred from our results is relatively novel and suggest caution in the use of TNFα inhibitors. Furthermore, our data point to an important role in the crosstalk between TNFα and INFγ and in their effect on erythropoiesis. DisclosuresNo relevant conflicts of interest to declare.

Structure of anaemic conditions comorbid to alcoholic and non-alcoholic steatohepatitis

The retrospective analysis of 378 medical records of inpatients with steatohepatitis (SH) depending on its etiology was performed to identify and study the type of anaemic conditions (AC). Among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.2% of cases, in patients with alcoholic (ASH) - in 36.3%, in patients with non-alcoholic SH (NASH) - in 22.0 % of cases. Macrocytic, hyperchromic anaemia prevailed in patients with anaemia of all groups: in patients with SH of mixed etiology - in 47.9%, in patients with ASH - 56.8%, NASH - 71.4%. Normocytic, normochromic anaemia was registered in 52.1% with mixed etiology of SH, in patients with ASH - 43.2%, NASH - 28.6%.The prospective study of 125 patients with SH showed that anaemia was found in 40.0% of patients with ASH, among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.0%, among patients with NASH the result was 21.7%. The following types of anaemia were found in ASH: vitamin B12 - deficient - in 17.5% of cases, anaemia of chronic disease - in 10.0% of cases and Zieve's syndrome - in 12.5% of cases. Three types of anaemia were found in patients with SH of mixed etiology: vitamin B12 - deficient - in 16.0% of cases, anaemia of chronic disease - in 8.0% and Zieve's syndrome - in 8.0% of patients. The structure of anaemias in patients with NASH accompanied by obesity of I-II degrees is as follows: B12 - deficient anaemia - in 15.0% of cases, anaemia of chronic disease - in 6.7% of people. In patients with NASH, H. pylory contamination was present in 84.6% of patients with anaemic syndrome (AS), including 100% of patients with B12-deficient anaemia. With ASH, H. pylory contamination was present in 80.0% with anaemia, including 100% of patients with B12-deficient anaemia. In patients with SH of mixed etiology, H. pylory contamination was present in 100.0% of people with AS.

Comparative epidemiology and pathophysiology of patent and latent babesiosis caused by Babesia bigemina in buffaloes and cattle from different agroclimatic zones of Punjab State, India.

To conduct comparative epidemiology of parasitologically positive (patent) and polymerase chain reaction positive (latent) cases of bovine babesiosis in Bet Region (low-lying areas adjoining Sutlej, Beas, Ravi, and Ghaggar rivers of Punjab) of diverse agroclimatic zones of Punjab state in relation to haematobiochemical parameters as patho-physiological markers, blood samples from 783 dairy animals (487 buffaloes and 296 cattle) were analysed parasitologically by Giemsa-stained blood smears (GSBS) and by molecular-based polymerase chain reaction (PCR) targeting SpeI-AvaI restriction fragment of Babesia bigemina. We ruled out the endemicity of the disease with 2.17% patent and 3.96% latent cases of B. bigemina with significantly higher prevalence (P < 0.01) in cattle than buffaloes. The spatial distribution for a guideline to local veterinary practitioners and policy-makers indicated highest number of patent and latent cases in western zone and undulating plain zone, respectively. District wise highest prevalence of patent as well as latent infection observed in SBS Nagar of undulating plain zone showed substantial agreement (Kappa value: 0.70) between the two techniques. Haematology revealed marked microcytic hyperchromic anaemia in patent animals of group I (GSBS positive; n = 17) and latent animals of group II (PCR positive; n = 14) as compared to disease-free controls (group III; n = 10). Blood urea nitrogen (BUN), creatinine and gamma-glutamyltransferase (GGT) levels were significantly increased (P < 0.05) in group I in comparison to group II and group III indicated comparative pathogenic effect of babesiosis in patent cases. Though patent cases showed higher pathogenicity of babesiosis, diagnosis of latent infection is significant as it may act as source of infection for spread to other highly prone bovines.

Primary Terminal Haemochromatosis in a 50 Year-Old Patient

Aim. A clinical description of end-stage hereditary haemochromatosis manifested with chronic alcohol abuse.Key points. A 50-yo patient referred with marked general weakness as a major complaint. The patient had a history of long-term alcohol consumption at toxic doses, putative cirrhosis, paroxysmal atrial fibrillation, type 2 diabetes mellitus. The patient's severity on admission was conditioned by marked hypotension. Further examination aimed at excluding occult gastrointestinal bleeding, adrenal insufficiency, decompensated heart failure. Bronze skin and icteric sclerae were positive. Blood tests revealed severe macrocytic hyperchromic anaemia, thrombocytopae-nia, hyperbilirubinaemia, hypoalbuminaemia, hypocoagulation, elevated transaminases, hyponatraemia, elevated creatinine (CKD DPI 63 mL/min), severe hyperferritinaemia. Faecal occult blood test and EGDS for bleeding were negative. Abdominal ultrasound exposed signs of liver cirrhosis and portal hypertension (ascites, splenomegaly). Echocardiographic evidence of dilated cardiomyopathy of all chambers, a reduced 24% ejection fraction at absent acute myocardial infarction. Primary haemochromatosis was suspected upon high ferritin, transferrin iron saturation and multiple organ dysfunction. Genotyping revealed the HFE 845G &gt; A variant diagnostic of haemochromatosis type 1. Clinical diagnosis: Primary disease: haemochromatosis (homozygous variant HFE 845G &gt; A (A/A)): liver cirrhosis, Child-Pugh class C. Portal hypertension: splenomegaly, ascites. Dilated cardiomyopathy. Diabetes mellitus. Complications: multiple organ dysfunction (SOFA 16). Liver failure: jaundice, hypoalbuminaemia, hypocoagulation. Cardiac rhythm and conduction disorder: paroxysmal atrial fibrillation. Acute cardiac failure with underlying CHF IIb, NYHA class 3. Acute renal failure (anuria) with underlying CKD stage 3 (CKD DPI 63 mL/min). Moderate macrocytic hyperchromic anaemia. Acute and chronic adrenal failure. Despite a cardiovascular and renal failure compensation therapy and albumin transfusion, the patient died. Autopsy revealed a marked organ infiltration with haemosiderin (heart, stomach, liver, pancreas, lungs, kidneys, adrenal glands).Conclusion. The case describes a classical clinical manifestation of haemochromatosis: bronze skin hyperpigmentation, liver cirrhosis, diabetes mellitus, cardiomyopathy, adrenal insufficiency. Terminal haemochromatosis, severe cardiac and renal failure decompensation precluded phlebotomy and chelation therapy. A lethal outcome was conditioned by multiple organ dysfunction with underlying massive haemosiderin deposition in most organs.

Laporan Kasus: Anaplasmosis pada Anjing Peranakan Kintamani

Anaplasmosis is a disease in dogs caused by gram-negative intracellular microorganisms belonging to the Anaplasmataceae family. A 1 year old Kintamani mix dog was examined at the Veterinary Hospital, Faculty of Veterinary Medicine, Udayana University with complaints; itching, tick infestation, weakness, decreased feeding and erythema throughout the dog's body. Clinical examination results show pale mucous membranes in the mouth, weak dogs, Riphicephalus tick infestation of the skin. Routine haematological examination revealed hyperchromic normocytic anemia and thrombocytopenia. Positive blood smear examination found Anaplasma spp. The therapy given is in the form of causative, symptomatic and supportive therapy. Causative therapy was given doxycycline dose 10 mg / kg BW given orally for 28 days, ivermectin dose 0.2-0.3 mg / kg BW, subcutaneously once a week for three weeks, symptomatic therapy with vetadryl dose 1-5 mg / kg BW, subcutaneosly once a week for three weeks, while supportive therapy was given by giving vitamin Livron b-plex once a day for 10 days. Treatment with doxycycline, ivermectin, vetadryl and livron b-plex gave good results in case dogs in terms of animal activity, hair growth, good appetite and free animals from ticks.

Laporan Kasus: Fibrosarkoma Vagina Pada Anjing Golden Retriever

A Golden Retriever bitch, 10 years old, came to the Animal Hospital of Brawijaya University, Malang, Indonesia, her conditions was discharge from the vagina, stink smell, polyuria, polydipsia and swelling in the vaginal area that begin to appear one month ago. Physical examination results found her weight 30 kg, scored three for body condition score (scale 1-5), body temperature at 38ºC, pale mucous membrane, and Capillart Reill Time &gt; 2 seconds. Hard mass was palpable in the vaginal area. Based on the anamnesis, physical examination and clinical symptoms, the bitch appeared have some different diagnosis such as pyometra, endometritis, vaginitis, and vaginal tumors. Hematology, radiograph, and histopathological laboratory tests were performed to confirm the diagnosis. Hematologic results showed the bitch suffered from leukocytosis of 41.7 x 103/?L, granulocytosis 36.5 x 103/?L, and hyperchromic microcytic anemia. The results of the radiograph examination showed a radiopaque solid mass in the vagina and uterus. The results of the histopathological examination found there were hyperchromasia nuclei and pleomorphism of fibroblast cell, and formation spindles cell of connective tissue. Based on the results of physical examination, hematological test, radiographic test, and histopathology, the dog was diagnosed with fibrosarcoma in the vagina. The treatment of this case was ovariohysterectomy and removal of the vaginal tumor. Early diagnosis and early treatment largely determine the patient’s prognosis, metastatic vaginal fibrosarcoma tumors showed poor prognosis.

A case of funicular myelosis combined with severe pernicious anemia

Actual report contains clinical observation of a 73-year-old patient with severe signs of funicular myelosis against a background of severe vitamin B12 defi ciency. This case is specifi c by the fact of the long-term preservation of general well-being of the patient, despite the development of a severe degree of hyperchromic anemia, the detection of signs of both normo-and megaloblastic type of hematopoiesis. Quick and lasting clinical eff ect has been achieved by prescribing vitamin B12

A Reliable Auto-Robust Analysis of Blood Smear Images for Classification of Microcytic Hypochromic Anemia Using Gray Level Matrices and Gabor Feature Bank

Accurate blood smear quantification with various blood cell samples is of great clinical importance. The conventional manual process of blood smear quantification is quite time consuming and is prone to errors. Therefore, this paper presents automatic detection of the most frequently occurring condition in human blood—microcytic hyperchromic anemia—which is the cause of various life-threatening diseases. This task has been done with segmentation of blood contents, i.e., Red Blood Cells (RBCs), White Blood Cells (WBCs), and platelets, in the first step. Then, the most influential features like geometric shape descriptors, Gray Level Co-occurrence Matrix (GLCM), Gray Level Run Length Matrix (GLRLM), and Gabor features (mean squared energy and mean amplitude) are extracted from each of the RBCs. To discriminate the cells as hypochromic microcytes among other RBC classes, scanning is done at angles (0, 45, 90, and 135). To achieve high-level accuracy, Adaptive Synthetic (AdaSyn) sampling for imbalance learning is used to balance the datasets and locality sensitive discriminant analysis (LSDA) technique is used for feature reduction. Finally, upon using these features, classification of blood cells is done using the multilayer perceptual model and random forest learning algorithms. Performance in terms of accuracy was 96%, which is better than the performance of existing techniques. The final outcome of this work may be useful in the efforts to produce a cost-effective screening scheme that could make inexpensive screening for blood smear analysis available globally, thus providing early detection of these diseases.

Studi Kasus: Babesiosis (Piroplasmosis) disertai Infestasi Caplak yang Berat pada Anjing Gembala Jerman

Babesiosis is a parasitic disease in red blood cells due to protozoan infection of the genus Babesia which is transmitted through tick vectors. A 5-years-old male German shepherd had decreased appetite, weakness, and infestation of ticks throughout his body. Clinical examination showed Capillary Refill Time (CRT) &lt;2 seconds, pale mouth mucosa, erythema throughout the body, philtrum was dry and slow skin turgor. The results of a complete blood examination of the dog had hyperchromic microcytic anemia and lymphocytopenia, while the results of blood smear showed the existence of intraerythrocyte inclusion bodies. The dog was diagnosed with Babesiosis and treated with Ringer Lactate fluid therapy, administration of Clindamycin (25mg/kg BW; PO), Oxytetracycline (15mg/kg BW; PO), Anti-inflammatory Dexamethasone (0.5-1mg/kg BW; PO) and Hematodine (1ml/5kg BB; IV) given for seven days. After treatment, the dog has increased appetite and after 14 days shows improvement in clinical signs.

Hemato-biochemical status of laboratory mice with a GM corn based diet

GM analogues have about 30 plant species, and main share from GM crops belong to soybean and corn. According to the literature data, the introduction of GM fodder in the diet of laboratory mice and rats was accompanied by negative consequences for the health of experimental animals and their offspring. Corn is a component of animal feed and popular product among people, especially sweet canned corn. The lack of experimental data regarding effects of canned sweet GM corn on an organism was the drive behind our research subject. The objective of the research was a comparative analysis of hematological and biochemical parameters of laboratory mice with a conserved GM corn based diet and without it. Clinical blood analysis indicated the development of hyperchromic anemia, leukocytosis due to an increase in the fraction of medium blood cells and thrombocytosis in experimental group mice. Biochemical studies of these mice blood revealed signs of renal and liver pathology, myocardial damage and hyperproteinemia. A comparative analysis of the hemato-biochemical status of laboratory mice indicated the development of signs of anemia, intoxication and allergy in the group of mice with a conserved GM corn based diet as compared to intact mice of the control groups.

The characteristics of application of computer registry in organization of ambulatory polyclinic care of patients with iron-deficiency anemia

Anemia is a clinical hematological syndrome and also a risk factor for the adverse outcome of many chronic somatic diseases. To assess effectiveness of out-patient polyclinic care for patients with anemia, the computer program "Patient Monitoring System with Anemic Syndrome" was used. The study included 1498 patients (males - 491; females - 1007) aged from 18 to 80 years old, who were under medical observation by general practitioners. The prevalence of anemic syndrome in different age and gender groups varied from 11 to 58%. Statistically significant differences between subgroups of men and women were found in the categories 18-30 years, 31-40 years and 41-50 years. In adult patients of working age, anemic syndrome during routine examination was detected in 37% of cases of seeking outpatient medical care (anemic syndrome in women was three times more common than in men). In patients older than working age, the prevalence of anemic syndrome was lower and averaged 25.7%. In the structure of anemia, 48.4% are hypochromic, 5.4% are hyperchromic, 46.2% are normochromic. The study for serum iron was prescribed in 33.9% of cases of hypochromic anemia, in 22.5% of cases of normochromic anemia and in 11.1% of cases of hyperchromic anemia. Serum iron was detected in every second patient with diseases of the urogenital system, every third patient with neoplasm. Therapy with iron preparations was prescribed in 30.6%, and the administration of vitamin B12 - in 1.4% of cases.