Normal Hematological Indices Research Articles

Comparative Evaluation of Different Antivirals against Lumpy Skin Disease in Cattle

India is facing a new wave of Lumpy skin disease outbreaks since May 2022, spreading in more than 22 states and causing morbidity to more than 29 lakh animals and mortality to more than 2 lakh animals. Lack of specific antiviral treatment restores symptomatic therapeutic interventions. However, in the advent of large no. of cases and severity of disease, investigations on specific antiviral drugs are imperative. This scientific study was conducted on a group of LSD-affected cattle (N = 40) from the trans-Himalayan region of Kashmir (Jammu and Kashmir). The affected cattle were subjected to different treatments, including acyclovir (n = 27), symptomatic treatment (n = 7), and ivermectin (n = 6), along with supportive drugs. The animals were carefully monitored and compared both within and between groups at various intervals (0-96 hr) using a two-way analysis of variance (ANOVA). Significant (P ≤ 0.05) improvement in regaining rectal temperature, respiration rate, and heart rate was noted 48 hours after treatment in a group of LSD-affected animals (N = 27) treated with acyclovir at a dose rate of 1 mg/kg body weight (small cattle) to 1.5 mg/kg (large cattle) intravenously in 500 ml normal saline along with supportive drugs including enrofloxacin (2.5 mg/kg), combination of meloxicam (0.25 mg/kg) and paracetamol (7.5 mg/kg) and pheniramine maleate (0.5 mg/kg) all intramuscularly, compared to group of LSD affected cattle (N = 6) treated with ivermectin (0.2 mg/kg subcutaneously) and supportive drugs and another group of LSD affected cattle (N = 7) treated symptomatically with only supportive drugs. Acyclovir treated group showed a significant (P ≤ 0.05) decrease in total leucocyte count, lymphocyte, and basophil count from 0 hour to 96 hour of treatment (23.00 ± 0.534 to 5.59 ± 0.208; 13.97 ± 0.310 to 3.43 ± 0.126; 0.11 ± 0.003 to 0.03 ± 0.001 respectively). Significant (P ≤ 0.05) decrease in total oxidative status (TOS: 73.31%) and increase in total antioxidant status (TAS: 59.9%) was observed in acyclovir treated group followed by ivermectin treated group (TOS: 68.05% and TAS: 27.16%) compared to symptomatically treated group (TOS: 42.41% and TAS: 18.75%). Acyclovir being comparatively more specific antiviral agent than ivermectin may have helped in amelioration of clinical severity and regaining of normal physiological, hematological, and oxidative indices in LSD-affected animals. The current study demonstrates expedited recovery, diminished clinical severity, and re-establishment of physiological, hematological and oxidative markers in animals subjected to acyclovir treatment, followed by animals administered with ivermectin, when compared to animals receiving symptomatic treatment. However, further studies are required to investigate safety or adverse effects, if any.

Evaluation of the Medicinal Potentials of Soursop (Annona muricata Safford) Leaf Extracts against Eimeria tenella Infection in Broiler Chickens

Aims: Poultry industry in Nigeria has recorded considerable expansion in recent times but not without poultry diseases as one of the major threats to boosting poultry production. Protozoa cause the majority of parasitic infections and cause high mortalities. Parasitic diseases such as coccidiosis are of particular importance because of their high incidence in poultry occasioned by the tropical environmental conditions under which the farmer operates. The resistance to common anticoccidial drugs has led to exploring other natural sources for prophylaxis and therapy. This research evaluated the therapeutic efficacies of Annona muricata at different dosages of 100, 125, 165mg/kg body weight using 120 broilers at 4 weeks of age. 
 Place and Duration of Study: Animal Parasitology and Microbiology Research Unit, Department of Animal Production and Health, Federal University of Technology, Akure, Nigeria, between September and December, 2022.
 Methodology: 120 broilers of 4 weeks old were used for this study using completely randomized study design. The birds were infected with sporulated Eimeria tenella oocysts at week 4. Treatment with ethanolic extract of Annona muricata was administered orally at week 5 using different dosages of 100, 125, 165mg/kg body weight for five consecutive days. Treatment commenced after the isolation of Eimeria oocysts in the faeces and onset on coccidial clinical signs as parameters to confirm manifestation of the infection. Blood parameters, faecal oocysts count and biochemical assays were conducted.
 Results: Results revealed that therapeutic administration of Annona muricata leaf extracts at minimum dose 100mg/kg body weight had significant reduction (P<0.05) on excreted Eimeria oocysts counts without any significant deviation from normal haematological and biochemical indices of the broilers.
 Conclusion: This study suggests the use of Annona muricata in the treatment of coccidiosis in broiler chickens. It is therefore recommended that its extracts be further explored for actual phytochemical constituents responsible for the displayed anticoccidial properties.

Successful Retreatment With Venetoclax in a Patient With Chronic Lymphocytic Leukemia.

Successful Retreatment With Venetoclax in a Patient With Chronic Lymphocytic Leukemia.

Haematological and serum biochemical indices of growing pigs fed varying levels of beniseed (Sesamum indicum L.) hull in replacement for maize.

A feeding trial was conducted to evaluate the nutrient content of beniseed hull (BSH) as a substitute for maize, and its effect on haematological and serum biochemical indices of growing pigs. Sixty 8-weeks old growing pigs (Landrace x Large white) were randomly allotted into five dietary treatments with three replicates of four animals per replicate in a completely randomized design. Five diets were formulated by incorporating BSH into the basal diet to replace maize at 0, 25, 50, 75 and 100% designated as D1 (control), D2, D3, D4 and D5, respectively and fed to growing pigs for ten weeks. Diets had no significant effect on the parameters measured, except White blood cell (WBC) and Lymphocytes. The highest WBC count (x109/L) (P < 0.05) of 23.70 was obtained in pigs fed 50% BSH-based diets compared with 15.55 (0% BSH), 14.00 (25% BSH), 21.45 (75% BSH) and 15.10 (100% BSH), respectively. The lymphocyte counts of pigs fed 25% BSH (60.00%) and 75% BSH (76.50%) were statistically similar to those on other dietary treatments. The cholesterol values recorded in pigs fed with the control diet (0% BSH) (125.00 mg/dL) and 25% BSH (122.50 mg/dL) were similar but significantly (P < 0.05) reduced to 119.50 mg/dL (50% BSH), 118.00 mg/dL(75% BSH) and 104.00 mg/dL (100% BSH), respectively, as the level of BSH increases. The High-density lipoprotein, HDL value (20.95 mg/dL) of pigs fed with control diet (0% BSH) was significantly (P < 0.05) lower than HDL values of pigs placed on other diets. The total protein (g/dL) 7.08 (0% BSH), 7.11 (25% BSH), 7.00 (50% BSH) were similar (P > 0.05) but significantly (P < 0.05) higher than 6.81 (75% BSH) and 6.66 (100% BSH). Beniseed hull poses no health challenge to the growing pigs as depicted by normal haematological and serum biochemical indices including lowest cholesterol at 100% BSH; beniseed hull could safely replace maize in pig’s diets up to 100% level.

The monocyte-to-lymphocyte ratio: Sex-specific differences in the tuberculosis disease spectrum, diagnostic indices and defining normal ranges.

BackgroundThe monocyte-to-lymphocyte ratio (MLR) has been advocated as a biomarker in tuberculosis. Our objective was to evaluate its clinical value and associations.MethodsBlood counts, inflammatory markers and clinical parameters were measured in patients with and those screened for tuberculosis. Complete blood counts (CBCs) from a multi-ethnic population aged 16 to 65 years were evaluated; a sub-group with normal hematological indices was used to define the range of MLRs.ResultsMultivariate analysis in proven tuberculosis (n = 264) indicated MLR associated with low serum albumin, high white cell counts and a positive culture; values were higher in sputum smear-positive pulmonary tuberculosis (S+PTB). Analysis in S+PTB (n = 296) showed higher MLRs in males and those with high neutrophil counts, low serum albumin and high C-reactive protein. The diagnostic value of MLRs was assessed by comparing notified patients with TB (n = 264) with denotified cases (n = 50), active case-finding in non-contacts (TB n = 111 and LTBI n = 373) and contacts of S+PTB (n = 149) with S+PTB found at screening (n = 75). Sensitivities and specificities ranged from 58.0–62.5% and 50.0–70.0% respectively for optimal cut-off values, defined by ROC curves. In CBCs obtained over one month, ratios correlated with neutrophil counts (ρ = 0.48, P<0.00001, n = 14,573; MLR = 0.45 at 8–8.9 x 109/L) and were higher in males than females (P<0.0001). The MLR range (mean ± 2SD) in those with normal hematological indices (n = 3921: females 0.122–0.474; males 0.136–0.505) paralleled LTBI MLRs. Ratios did not predict death (n = 29) nor response to treatment (n = 178 S+PTB with follow-up CBCs). Ratios were higher in males than female in the 16–45 years age group, where immune differences due to sex hormones are likely greatest.ConclusionsSevere tuberculosis and male sex associated with high MLRs; the same variables likely affect the performance of other biomarkers. The ratio performed poorly as a clinical aid.

Haematological and Blood Glucose Evaluation in Rats Treated with Methanolic Root Bark Extract of Chrysophyllum Albidum

Aim: This study investigated the outcome of administration of the methanolic root bark extract of Chrysophyllum albidum orally on normal blood glucose levels and haematological indices in rats. Materials and methods: Twenty adult rats were grouped into 4 groups of 5 rats each. The control group (A) was administered distilled water of 0.5 ml while the treatment groups B, C and D received 200, 400 and 600 mg/kg body weight of methanolic root bark extract of C. albidum respectively for 21 days. Before the commencement of the experiment, blood glucose was checked for all the groups. Blood was collected at the end of the test period to analysed changes in blood glucose levels and haematological parameters. Results: The RBC, PCV, Hb, MCH, MCV, lymphocytes, monocytes, basophils were not significantly (P&lt;0.05) different in all the extract doses when compared with the control group. Furthermore, WBC, eosinophils, neutrophils and platelets counts were significantly increased (P&lt;0.05) in all the groups treated with the extract in a dose-dependent form when compared to that of the control. Also, a significant (P&lt;0.05) reduction in blood glucose in groups administered with 400 and 600 mg/kg body weight of the C. albidum relative to the control group was noted. However, a significant (P&lt;0.05) increase in body weight of all groups treated with the extract when compared with the control group was also noted. Conclusion: The results suggest that methanolic root bark extract of C. albidum may be used to boost thrombopoiesis and also has hypoglycemic properties.

Regulatory Mutation Study in Cases with Unsolved Hypochromic Microcytic Anemia and α-Major Regulatory Element Haplotype Analysis in Iran

α-Thalassemia (α-thal) is an inherited blood disorder with different clinical manifestations. Although genetic causes of anemia are identified routinely in the majority of α-thal cases, a pathogenic variant in a few cases remains undiagnosed. In this study, some reported regulatory mutations have been investigated in five unsolved α-thal carriers. α-Major regulatory element (α-MRE) haplotype analysis has also been performed in Iran for the first time. Four regions, including the HBA2 core promoter, the highly conserved sequence of hypersensitive-40 (HS-40), a region containing regulatory single nucleotide polymorphism (SNP) CR062116, and a region containing rs7203560, were screened for changes by Sanger sequencing in a total of five unsolved suspected α-thal carriers. The frequencies of α-MRE haplotypes B and C were also determined in control samples with normal hematological indices. No pathogenic variant was found in the investigated regions. Haplotype frequencies observed for B and C haplotypes fell into the range of frequencies observed in previous studies. The investigated genotypes in the control group were in the Hardy-Weinberg equilibrium. This study can provide evidence that there is no association between the B haplotype and microcytic hypochromic anemia. The cause of anemia remains a mystery in our unsolved cases, which demonstrates the need for further studies on the causes of hypochromic microcytic anemia in individuals with intact α- and β-globin genes without iron deficiency.

Feed intake, haematological and biochemical indices of West African dwarf

A sixty-three-day feeding trial was conducted to evaluate the feed intake, haematological and biochemical indices of West African dwarf does fed maize offal substituted with ureamolasses treated rice husks diets. Twenty-five does aged 2-2½ years with weight of 14.78 ±0.31kg were used. Five experimental diets were formulated such that maize offal was replaced with urea-molasses treated rice husks meal at ratio 0, 20, 30, 40 and 50%. The twenty-five does (5 does per group) were randomly allocated to each of the five diets in completely randomised design. Chemical composition of diets revealed that dry matter ranged from 91.26 to 91.69%, the diet E had the highest crude protein (16.23%). Neutral detergent fibre ranged from 41.18 to 46.00 % and the highest energy was 16.62 KJ/100gDM. Nutrients intake was significantly (p&lt;0.05) influenced by inclusion of urea-molasses treated rice husks meal in the diets. The highest dry matter (559.46g/day), crude protein (79.78g/day) and energy (21.88kcal/g) intake were obtained in does fed diet C. Nutrients digestibility was significantly (P&lt;0.05) influenced by the treatment, an indication that the diets were palatable and digestible. All does maintained normal haematological andbiochemical indices, thereby keeping all does on healthy condition. Does fed diet B that contained 20 % urea-molasses treated rice husks meal had Keywords: Blood indices, does, performance, rice husks, urea-molasses, the best weight gain (63.81 g/day)and feed to gain ratio (8.42). It can be concluded that does fed B performed better than other does thus; the diet would be a better source of protein and energy to support the performance of West African dwarf does.

Detection of an α-Globin Fusion Gene Using Real-Time Polymerase Chain Reaction-Based Multicolor Melting Curve

Genetic recombination between homologous sequences on the human globin gene clusters can lead to the creation of fusion genes. In this study, we report the detection of an α-globin fusion gene by using real-time polymerase chain reaction (qPCR)-based multicolor melting curve analysis (MMCA). The carriers of this fusion gene had a mild α-thalassemia phenotype with a normal hemoglobin (Hb) value and borderline hematological indices. Sequence analysis revealed that the mutant gene was the result of a fusion between the α2 and ψα1 genes. Our results indicate that the MMCA has the ability to detect the fusion gene, which is helpful for genetic counseling in thalassemia prevalent areas.

A Chinese Male with Normal Hematological Indices and High Hb A2 Levels in β-Thalassemia Trait

β-Thalassemia (β-thal) is a common hematological disorder in the Guangxi Zhuang Autonomous Region of Southern China. Heterozygous β-thal is usually associated with reduced hematological indices and increased Hb A2 levels. However, the preventive program of the regional government only conducts the screening of hematological indices [complete blood count (CBC)] especially at primary hospitals. In this study, we describe a male β-thal patient presenting normal hematological indices but with a high Hb A2 level. We proposed that hemoglobin (Hb) analysis and CBC should be performed together in the preventive screening program in regions with a high thalassemia incidence to avoid misdiagnosis.

The eventual successful management of ovarian torsion in a hyperstimulated ovary following in vitro fertilization: A case report

Abdominal pain following in vitro fertilization (IVF) in the presence of enlarged ovaries commonly leads to the diagnosis of ovarian hyperstimulation syndrome (OHSS). Progressively worsening pain with a rise in inflammatory markers with normal hematological indices implies a diagnosis of ovarian torsion of the hyperstimulated ovary. Early recourse to laparoscopic assessment and derotation of the affected ovary even after 72 h following the onset of symptoms can allow a return to viability. This case highlights the clinical scenario and sequences in a successful outcome.

A Novel Pathogenic β-Thalassemia Mutation Identified at Codon 8 (HBB: c.27delG) in a Bangladeshi Family Acquired De Novo

In Bangladesh, the practice of β-thalassemia (β-thal) carrier screening and prenatal diagnosis (PND) by β-globin gene sequencing has been initiated to prevent the birth of affected children. The study aimed to describe a novel de novo mutation of the β-globin gene and its clinical implication. Out of 100 Bangladeshi β-thal carrier families, one patient with hematological and clinical features associated with β-thal and her parents were included. Molecular characterizations of β-globin gene mutations were performed by direct sequencing. A novel nucleotide deletion mutation at codon 8 in the first exon of the β-globin gene (HBB: c.27delG) was found in a 1-year-old child of the studied family in a heterozygous state along with common Hb E (HBB: c.79G>A). The mutation caused a frameshift to a new stop codon at codon 18 resulting in a β0-thal phenotype. The proband exhibited a β-thal intermedia (β-TI)-like genotype, however, showed β-thal major (β-TM)-like complications and was transfusion-dependent. Her mother had a profile consistent with the Hb E trait, while the father had normal hematological indices. Mutation analyses revealed the mother to be heterozygous for Hb E, while the father had a normal genotype. The novel mutation was assumed to be inherited de novo by the paternity test. The study documented a novel pathogenic mutation in the β-globin gene in a Bangladeshi family by β-globin gene sequencing.

A pilot study to determine the normal haematological indices for young Malawian adults in Blantyre, Malawi.

Reference ranges for haematological and other laboratory tests in most African countries are based on populations in Europe and America and, because of environmental and genetic factors, these may not accurately reflect the normal reference ranges in African populations. To determine the distribution of haematological parameters in healthy individuals residing in Blantyre, Malawi. We also examined the effect of sociodemographic and nutritional factors on the haematological variables. We conducted a proof-of-concept cross-sectional study, involving 105 healthy blood donors at Malawi Blood Transfusion Service in Blantyre. Eligible participants were HIV-negative males and females, aged 19 to 35 years, who did not have any evidence of acute or chronic illness, or blood-borne infection. We performed the haematological tests at the Malawi-Liverpool Wellcome Trust laboratory in Blantyre, and the screening tests at Malawi Blood Transfusion Service laboratories. Out of 170 consenting healthy volunteers, haematological results were available for 105 participants. The proportions of results which were below the lower limit of the manufacturer's reference ranges were 35.2% (37/105) for haemoglobin, 15.2% (16/105) for neutrophils, 23.8% (25/105) for eosinophils, and 88.6 % (93/105) for basophils. The proportions of results that were above the upper limit of the manufacturer's reference ranges were 9.5% (10/105) for platelets and 12.4% (13/105) for monocytes. We also observed that the mean leucocyte and basophil counts were significantly higher in males than females (p = 0.042 and p = 0.015, respectively). There were no statistically significant differences in haematological results observed among different ethnic, age, and body mass index groups. Over half of otherwise healthy study participants had at least one abnormal haematological result, using previously established foreign standards. More detailed studies are needed to establish locally relevant normal ranges for different age groups and other demographic characteristics of the Malawian population. This will lead to accurate interpretation of laboratory results.

Hematological indices in febrile neonates with malaria parasitaemia in Calabar.

Background:Normal hematological indices has been determined in Nigerian newborns and found to be lower compared to their Caucasian counterparts. This was attributed to genetic factors. Malaria is endemic in Nigeria and is one of the major causes of ill health and death. Anemia is an important manifestation of malaria. Resistance by malaria parasites to antimalarial drug exacerbates the situation by continuous hemolysis.Aim:To determine the hematological indices in febrile newborn with malaria parasitemia.Materials and Methods:One-hundred fifty neonates (0-28 days) with fever admitted into the Newborn Unit of University of Calabar Teaching Hospital, over a 6 months period, were recruited consecutively. Blood film for malaria parasites and samples for full blood count were obtained and sent to the laboratory before commencement of the treatment. Data analysis was with SPSS version 14.Results:One-hundred fifty babies were recruited into the study. Most (85.3%) of the babies were aged ≤7 days. Six babies (4%) had malaria parasitemia. Plasmodium falciparum was the only species identified. All the babies that had parasitemia were anemic (mean hemoglobin [Hb] concentration of 12.6 g/dl) even when parasite count was low (average of 30.6/µl) though this could not be attributed solely to malaria. None of these neonates was transfused. All the other hematological indices were within the normal range of healthy newborn population irrespective of parasitization.Conclusion:Neonatal malaria does occur in our environment. While it does not affect the white blood indices, it lowers neonatal Hb. It is recommended that Hb concentration be estimated in newborns with malaria to reduce infant morbidity and mortality in our environment.

Turning sickness in a riverine buffalo naturally infected with Theileria annulata and its successful therapeutic management

Bovine tropical theileriosis (BTT) has been recognized as a persistent major constraint in the genetic improvement programme of native cattle breeds under ‘Operation Flood’. The disease accounts for high mortality in dairy animals especially calves. A riverine she buffalo (Murrah), aged 3.5 years and weighing approximately 400 kg, initially suffered from ruminal hypotonicity, severe dyspnoea, frothy discharge, lacrimation, cessation of defaecation and anorexia, besides icterus, a mild form of anaemia and moderately elevated temperature etc., for the past few days. The buffalo developed neurological signs later on. Laboratory investigations revealed presence of Koch’s blue bodies in the lymphocytes and Theileria annulata meronts in the circulating erythrocytes. The buffalo promptly responded to the specific therapy and restored to normal haematological indices, and later on, erythrocytes were free from the piroplasms. The cerebral form of BTT in the instant case was differentiated and discussed with other diseases causing analogous neurological signs.

Genotype–phenotype correlation related to lipid profile in beta-thalassemia major and intermedia in southern Iran

Beta-thalassemia is commonly associated with lipid abnormalities. The aim of this study was to search for links between these lipid alterations and different types of β-thalassemia mutations. The study, conducted from 2009 to 2010, included 100 patients with thalassemia major (TM) and 100 with thalassemia intermedia (TI). The control group was selected from 100 age- and sex-matched healthy individuals with normal hematologic indices. Serum lipid profiles, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG), were determined and their relationship with different covariates, including different β-globin gene mutations, was analyzed. Patients with TI had significantly lower values for TC, LDL-C, HDL-C, and LDL-C/HDL-C ratio compared with TM patients and controls (P < .001). TG was greater in TM compared with TI patients (P= .001) and healthy individuals (P= .007). Hemoglobin was positively associated with TC (P < .001), LDL-C (P= .004), and HDL-C (P= .01) in TM patients. Splenectomy correlated with greater TC (P= .006) and LDL-C (P= .01) in TI patients, but only with greater LDL-C in TM patients (P= .02). The average amounts of TC and LDL-C were lower in persons with the β(0)/β(0) mutation compared with the β(+)/β(+) group. Lower amounts of TG, TC, LDL-C, and HDL-C were seen in TI patients compared with TM patients and healthy individuals. The severity of the genotype (ie, β(0) type mutations compared with β(+) type mutations) affected the degree of reduction in serum lipids.

Normal hematological parameters in Iranian cashmere (Raini) goats

Raini goat is an Iranian cashmere goat which is raised in large numbers in Kerman province of Iran where goat production contributes significantly to the agricultural economy. Normal hematological indices are valuable aid in the diagnosis of hematological disorders. Determination of the main hematological and hematochemical parameters of animals helps veterinarians to confirm clinical diagnosis, estimate the severity of cases, administer appropriate treatment, and evaluate outcomes. Limited information is available for normal hematological parameters in Raini goats. The purpose of the present study was to determine reference values of hematological indices for clinically healthy Iranian cashmere (Raini) goats in order to establish a basis for clinical interpretation. In the present study, reference values for packed cell volume, hemoglobin, total RBC, total and differential WBC count were determined.

The Carrier Frequency of α-Globin Gene Triplication in an Iranian Population with Normal or Borderline Hematological Parameters

The −α3.7 rightward deletion is the most frequent α-globin mutation worldwide, while frequencies of the αααanti 3.7 triplication are only sporadically known. Carriers of the αααanti 3.7 triplication show no clinical symptoms or significant hematological changes, but co-inheritance with β-thalassemia (β-thal) has been reported to worsen the clinical and hematological features of the patient as well as the trait. We have screened the α-globin gene rearrangements of 280 individuals with normal hematological indices and 117 persons with borderline hematological parameters. We used multiplex polymerase chain reaction (m-PCR) and multiplex ligation-dependent probe amplification (MLPA) technology to detect triplications and quadruplications. Only the αααanti 3.7 triplication was observed. The carrier frequency in the first group was 2.14% and in the second group 1.7%. No phenotype aggravation was noticed in two carriers of β-thal and the αααanti 3.7 triplication, while a mild β-thalassemia intermedia (β-TI) was observed in a β-thal carrier with six α-globin genes. Due to the high consanguinity in the country, homozygosity for the αααanti 3.7 triplication and for other rearrangements can be expected. Therefore, an accurate determination of the frequencies and a routine control for these mutations is essential for a correct genotype-phenotype prediction during genetic counseling for β-thal.

Hemolytic anemia and distal renal tubular acidosis in two Indian patients homozygous for SLC4A1/AE1 mutation A858D

Familial distal renal tubular acidosis (dRTA) can be caused by mutations in the Cl2/HCO32 exchanger of the renal Type A intercalated cell, kidney AE1/SLC4A1. dRTA-associated AE1 mutations have been reported in families from North America, Europe, Thailand, Malaysia, Papua-New Guinea, Taiwan, and the Philippines, but not India. The dRTA mutation AE1 A858D has been detected only in the context of compound heterozygosity. We report here two unrelated Indian patients with combined hemolytic anemia and dRTA who share homozygous A858D mutations of the AE1/SLC4A1 gene. The mutation creates a novel restriction site that is validated for diagnostic screening.

Pure leydig cell tumour of the ovary in a post-menopausal patient with severe hyperandrogenism and erythrocytosis

A 60-year-old woman, presented with hirsutism, male pattern baldness, deepening voice and plethora over the past 5 years. Hormonal evaluation showed markedly elevated serum testosterone level (>1600 ng/dl) and oestradiol level (220 pg/ml) normal DHEA-SO4 level with suppressed LH and FSH levels. She had markedly erythrocytosis with normal hematological indices. The diagnosis of probable secondary erythrocytosis was made. Trans abdominal ultrasound and CT scan revealed a 14 cm × 11 cm × 9 cm solid pelvic mass. An ovarian androgen secreting tumour was suspected and surgery was performed. Histological examination showed a leydig cell tumour. After the operation testosterone and haematocrit levels returned to normal with regression of clinical symptoms. This is the first case of a leydig cell tumour with an erythropoietic effect of excess testosterone.