Normocytic Normochromic Anemia Research Articles

Exploring the Diagnostic Challenges of Pseudotumoral Peritoneal Tuberculosis That Mimics Advanced Ovarian Cancer in Women: The Role of Laparoscopy in a Case Study

This case involves a 63-year-old multiparous woman with no significant medical history and no known exposure to tuberculosis. She presented with chronic abdominal pain and weight loss, anorexia, and subjective fevers. During the clinical examination, the patient was found to have ascites, bilateral pleural effusion, fever, and a general deterioration in her condition. Blood tests revealed normochromic normocytic anemia. The C-reactive protein was elevated, and the erythrocyte sedimentation rate was accelerated. Ferritin levels were raised. Her blood sugar, hepatic and renal functions were normals. The electrolyte panel showed no abnormalities. Serologies for hepatitis B, C, and HIV were negative, and the immunological profile was normal. The ascitic tap yielded a citrine-yellow fluid, and the cytochemical analysis indicated that the ascites were exudative. Analysis of the ascitic fluid revealed that the DNA test for Mycobacterium tuberculosis was negative, but the adenosine deaminase (ADA) level was elevated. Additionally, the CA125 level was significantly elevated, exceeding 600 UI/ml. A pelvic ultrasound identified a cystic pelvic mass with thick septations but without any solid tissue component, measuring 92x69 mm. The complementary CT (Computed Tomography) scan revealed enlarged ovaries, heterogeneous on the left, associated with a moderately abundant peritoneal effusion. The laparoscopic exploration revealed inflammatory peritoneal nodules, parietal adhesions, and serous ascites. Anatomopathology confirmed peritoneal tuberculosis. The peritoneal form, particularly in its pseudotumoral manifestation, can mimic ovarian cancer. Definitive diagnosis often requires invasive procedures.

8252 Central Adrenal Insufficiency Masquerading as Syndrome of Inappropriate Antidiuretic Hormone (SIADH): A Case Report

Abstract Disclosure: J.G. Sazon: None. J.L. Reyes: None. J.V. Chua: None. S.A. Kho: None. Hyponatremia, the most common electrolyte imbalance encountered in clinical practice, has various causes and presentation. Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a frequent hospital-related cause, potentially leading to misdiagnosis with adrenal insufficiency due to shared clinical features which may cause potential deleterious effect. We present a case of a 41-year-old male hyponatremic patient with a two-month history of progressive generalized body weakness and lightheadedness, initially managed as SIADH. Upon admission, the patient persistently showed low serum sodium level (122mmol/L) (NV: 135-145mmol/L), exhibited signs of euvolemic hyponatremia despite fluid restriction, intravenous furosemide, and sodium chloride tablets. Further work-up revealed normocytic normochromic anemia (Hgb 107 g/L) (NV: 120-160g/L), elevated ESR of (31mm/hr) (NV: 0-15mm/hr), low Ft4 (2.97 pmol/L) (NV: 12-22 pmol/L) and normal TSH (2.2 uIU/mL) (NV: 0.27-4.20 uIU/mL). During hospital stay, he experienced an episode of hypotension at 80/50mmHg and hypoglycemia at 65 mg/dL. Investigation revealed adrenal insufficiency secondary to pituitary macroadenoma with apoplexy as showed in magnetic resonance imaging. Patient was started on Prednisone. Pre-operatively, hydrocortisone 100mg IV every 8 hours preoperatively. He underwent transsphenoidal surgery; excising a 2.5cm soft and grayish suprasellar mass. Post-operatively, he was given Prednisone and Levothyroxine resulting in symptom improvement and normal sodium levels.The occurrence of hyponatremia due to adrenal insufficiency is relatively uncommon, emphasizing the need for heightened suspicion when assessing patients with prolonged or recurring hyponatremia. This paper highlight the need to replace glucocorticoid prior supplementation of thyroid hormone in such cases, averting the occurrence of adrenal crisis. This case indicated a mechanism of persistent hyponatremia attributed to secondary adrenal insufficiency, with added therapeutic benefits observed through the use of glucocorticoids and transsphenoidal surgery. Presentation: 6/1/2024

Managing RS3PE: Diagnostic approach, initial steroid response, and long-term management with DMARDs

Background. RS3PE, or Remitting Seronegative Symmetrical Synovitis with Pitting Edema, is a unique and relatively rare form of inflammatory arthritis that predominantly affects older adults. It is distinguished by its hallmark features: symmetrical swelling of the joints, significant pitting edema in the extremities, and a negative serological profile for common markers associated with rheumatoid arthritis, such as rheumatoid factor (RA factor) and anti-citrullinated protein antibodies (anti-CCP). This condition is often characterized by a remitting course, meaning that symptoms may improve or resolve over time, particularly with appropriate treatment. The condition usually affects older adults and can sometimes be associated with other underlying health issues, such as malignancies or infections. The “remitting” aspect of RS3PE refers to the fact that the symptoms often improve or resolve over time, particularly with appropriate treatment, which usually involves corticosteroids or other anti-inflammatory medications. Case report. This case study details the clinical presentation, diagnosis, and management of a 56-year-old female patient with known hypertension who presented with bilateral dorsal hand swelling, pain, and early morning stiffness over a 15-day period. The patient’s initial examination revealed bilateral pitting edema and active arthritis in the proximal interphalangeal joints, with significant warmth and tenderness. Laboratory tests showed elevated ESR and CRP, normocytic normochromic anemia, and negative rheumatoid factor and anti-CCP antibodies. Imaging studies, including X-ray, ultrasound, and mammogram, showed no erosive changes or malignancy, while a Pap smear and serum CA-125 levels were within normal limits. The clinical picture, combined with the exclusion of other conditions, supported the diagnosis of RS3PE. Treatment commenced with intravenous low-dose dexamethasone, which led to significant symptomatic improvement. This was followed by a transition to oral prednisolone, and the patient initially showed complete resolution of symptoms. However, recurrence of symptoms occurred upon discharge, prompting the introduction of steroid-sparing agents: methotrexate and hydroxychloroquine, alongside continued oral steroid treatment. Over a two-month follow-up period, the patient experienced no signs of relapse. This case fits the clinical and investigative criteria for RS3PE. The patient showed symptomatic improvement after treatment with low-dose steroids.

A Comparative Study of Peripheral Smear Findings with RBC Indices and Automated Analyzer Generated RBC Histograms in the Diagnosis of Anemia's

Abstract Introduction The red blood cell (RBC) indices generated by cell counters help in the morphological classification of anemia. The importance of microscopic examination of peripheral blood smears (PBSs) stained by Leishman stain cannot be used alone when it comes to interpretation of the underlying cause of anemia. Hence, all three RBC histograms, indices, and microscopic examination of PBSs are very essential for a complete assessment of anemia. Aims and Objectives To diagnose the type of anemia by examination of PBSs, automated cell-generated RBC histograms, and RBC indices and to compare and correlate the findings of RBC indices and automated cell-generated RBC histograms with PBS examination. Materials and Methods This was a prospective comparative study done on 500 cases of anemia for a period of 5 months from August 2023 to December 2023 in a rural tertiary care teaching hospital and all the patients' RBC indices, RBC histogram findings, and PBS findings were noted and analyzed. Results Among 500 samples, normocytic normochromic anemia consists of the majority of the cases 272 (54.4%), followed by microcytic hypochromic anemia cases 183 (36.6%), macrocytic anemia cases 27 (5.4%), normocytic hypochromic anemia were 10 (2%) cases, and dimorphic were 8 cases (1.6%). When compared with RBC histogram, 265 (53.0%) cases showed normal bell-shaped curve, 188 (37.6%) cases showed left shift, 27 (5.4%) cases showed broad based curve, 10 (2%) cases showed right shift, and 10 (2%) cases showed bimodal curve suggesting normocytic normochromic, microcytic hypochromic, normocytic hypochromic anemia, macrocytic, and dimorphic anemia, respectively. Conclusion This study showed a well correlation in the findings of the automated hematology analyzer with the microscopic examination. Histogram alone could be used as a screening method but when combined with RBC indices and PBS findings, they act as useful supplements and by correlating findings of all three, we could diagnose the majority of anemia.

RBC histogram: Useful diagnostic tool in evaluating anaemia

: Anaemia is a widespread public health problem, more common in developing countries. Red blood cell histogram is a vital part for evaluation and diagnosis of anaemia. Histogram can be a useful modality for arriving at the probable diagnosis of anaemia reporting in short span of time.: To observe various RBC Histogram on haematology Analyser in anaemia and analyse the usefulness of RBC Histogram to correlate with peripheral smear.: A prospective study was done in Department of Pathology of Secondary Care hospital from January 2024 to March 2024 on 300 anaemia patients. RBC Histogram were observed, analysed and correlated with peripheral smear. Out of total 300 patients, Most common anaemia is Microcytic Hypochromic (60%), Normocytic normochromic (21.33%), Dimorphic anaemia (12.33%) and macrocytic anaemia (6%). 95.5% microcytic hypochromic anaemia showed left shifted curve, 84.3% Normocytic normochromic anaemia showed normal curve, 88% macrocytic anaemia showed right shift curve. Considering the speed, reliability and less inter observer variation of the modern haematological analysers RBC histogram are important diagnostic tool for various types of anaemia and provide accurate morphological typing of anaemia in most cases hence presumptive report can be released based on RBC histogram.

A Middle-Aged Patient Living with HIV (PLHIV), Presented with Persistent Hiccups, Imbalance, and Multifocal Myoclonus Secondary to Disseminated Tuberculosis

AbstractA middle aged male presented with chronic diarrhoea, persistent hiccups and unsteadiness while walking. His illness had subacute onset and progressive course. Clinically patient had cachexia, pallor, oral thrush and hepatosplenomegaly. On neurological examination, he had fine tremors, gait ataxia, and multifocal myoclonus. Investigations revealed normochromic normocytic anemia, transaminitis, hyponatremia and cerebrospinal fluid pleocytosis(lymphocytic predominance). Brain MRI revealed diffuse patchy meningeal enhancement; CECT abdomen showed circumferential bowel wall thickening, hepatosplenomegaly and necrotic lymphadenopathy. CECT chest exhibited mediastinal lymphadenopathy alongwith centrilobular nodular opacities. Sputum GeneXpert® was positive for mycobacterium tuberculosis with sensitivity to rifampicin. His serology for human immunodeficiency virus was positive. He was diagnosed as disseminated tuberculosis with tuberculer meningitis which caused persistent hiccups, gait abnormaliy and multifocal myoclonus. His symptom resolved with anti tubercular therapy. We aim to highlight here that myoclonus is a rare occurrence with tubercular meningitis.

GAMBARAN TIPE ANEMIA PADA IBU HAMIL BERDASARKAN NILAI INDEKS ERITROSIT DI RSIA RESTU IBU TAHUN 2022

Anemia in pregnant women is a global problem that impacts both mother and fetus. Anemia in pregnancy is associated with maternal morbidity and is an indirect cause of maternal death in the entire population of pregnant women. Classification of anemia based on the erythrocyte index value is divided into normochromic normocytic, normochromic macrocytic, hypochromic microcytic and hypochromic macrocytic anemia. The erythrocyte index values ​​are divided into Mean Corpuscular Volume (MCV), Mean Corpuscular Hemoglobin (MCH) and Mean Corpuscular Hemoglobin Concentration (MCHC). The aim of the research is to describe the types of anemia in pregnant women based on the erythrocyte index value at RSIA Restu Ibu Sragen in 2022. This research uses a quantitative descriptive research type with a retrospective approach. The research sample was 51 medical records of pregnant women who experienced anemia at RSIA Restu Ibu Sragen in January-December 2022 using purposive sampling. The materials and tools used were secondary data from laboratory examination results of pregnant women diagnosed with anemia which included hematocrit, hemoglobin, index erythrocytes (MCV, MCH, and MCHC), Microsoft Excel and SPSS Version 21 software. Data analysis used analysis univariate. The results of the study concluded that pregnant women who experienced anemia at RSIA Restu Ibu Sragen were aged 21-34 years with a third trimester pregnancy and were primigravida. Based on the erythrocyte index, normocytic anemia was normochromic in 18 people (35.3%), microcytic hypochromic anemia in 20 people (39.2%), and macrocytic hypochromic anemia in 13 people (25.5%). So it can be said that most pregnant women experience microcytic hypochromic anemia.

Hypomagnesemia, hypogammaglobulinemia, and chronic normocytic normochromic anemia: random association? An unresolved case report of an elderly patient with remitting seronegative symmetrical synovitis with pitting edema syndrome

Hypomagnesemia, hypogammaglobulinemia, and chronic normocytic normochromic anemia: random association? An unresolved case report of an elderly patient with remitting seronegative symmetrical synovitis with pitting edema syndrome

Iron Metabolism in Pediatric Living related Liver Transplantation

Abstract Introduction Iron deficiency is a frequent cause of anemia in liver transplant recipients, especially children. Rejection and infection are incriminated causes for occurrence of anemia after liver transplantation (LR). Aim of the Work We aimed to assess iron homeostasis in children who have undergone living related LT (LRLT) and its correlation with occurrence of rejection and infection. Patients and Methods The study was conducted on 35 children who have undergone LRLT. The patient characteristics, frequency of infection and rejection episodes, laboratory investigations including complete blood picture (CBC) and Iron profile (total iron binding capacity (TIBC),serum iron and ferritin) during the patient follow up visits were reported. Results Males were 68.58% of the studied patients and females were 31.42%. Their ages ranged from 1.3-15 years at time of LT with mean (SD) of 7.18 (3.8)years. The mean (SD) duration since LT was 4.83 (4.2) years. The commonest indication to LT was highgamma-glutamyl transferase (GGT) cholestasis (34.7%) followed by biliary atresia (21.7 %). Thirteen percent of patients had low hemoglobin (Hb) of whom 4.3% had normocytic normochromic anemia and 8.7% had microcytic hypochromic anemia. Serum iron was normal in 79.6% of patients and low in 20.4%, and ferritin was normal in 58.7% of patients and low in 41.3% while TIBC was normal in 82.6% of patients and low in 17.4%. Only serum iron showed significant negative correlation with white blood cells (WBCs) (P < 0.05). The iron parameters levels were not different in patients with no rejection or only one attack of rejection and the patients with multiple rejection episodes (P > 0.05). Conclusion Anemia is a reported complication after pediatric LT. Further studies are needed to assess the long term effect of post-LT anemia on patient outcome after LT.

Clinical Approach to Advanced Mantle Cell Lymphoma: A Detailed Case Analysis

Mantle cell lymphoma (MCL) is a rare and aggressive subtype of non-Hodgkin lymphoma (NHL) originating from cells in the mantle zone. Herein, we present a case report of a 49-year-old male patient diagnosed with stage VI MCL, illustrating various diagnostic methods and procedures utilized in his evaluation. The patient presented with progressively enlarging cervical lymph nodes, fatigue, weight loss, anorexia, chronic diarrhea, abdominal pain, and rectal bleeding. Clinical examination revealed cutaneomucosal pallor, tachycardia, expiratory polypnea, bilateral jugulocarotid adenopathies, and splenomegaly. Laboratory investigations showed normocytic normochromic anemia, hyperleukocytosis, lymphocytic predominance, and thrombocytopenia. Peripheral blood smear analysis indicated a lymphoproliferative disorder, confirmed by flow cytometry revealing monotypic lymphoid cells. Bone marrow biopsy showed hypoplastic marrow with atypical cells. Immunohistochemistry confirmed mantle cell lymphoma localization. Subsequent thoraco-abdomino-pelvic CT scan revealed mediastinal and abdominal adenopathy with splenomegaly, leading to a diagnosis of stage IV MCL. The case highlights the importance of early and comprehensive diagnostic approaches in MCL management.

Patterns of Geriatric Anemia – A Clinicopathological Study

Background : Anemia is a common condition in elderly especially in hospitalized geriatric patients and is known to be associated with increased morbidity and mortality. The UN agreed cut off to refer to the older population is 60years and above. Anemia in the elderly is defined as a haemoglobin concentration below12 gm/dl in women and below 13gm/dl in men. Objectives: To study the grade and patterns of anemia in Geriatric age group of both sex with clinicopathological correlation. Materials and Methods: It is a Prospective study of 2 years from May 2018 to April 2020 carried out in KIMS, Hubbali. A statistically significant sample size was 400. Results: Among the total geriatric cases of 400, males were 233 (58.25%) and females were 167 (41.75%). In which majority of them were in the age group between 60-69 years that is 237 (59.25%) cases, followed by 121 (30.25%) cases, 38 (9.5%) cases and 4 (1%) cases were in the age group between 70-79 years, 80-89 and above 90 years respectively. The study showed that majority of the cases belonged to the Grade 1 anemia (69.25%). On smear examination most common morphological pattern was Normocytic Normochromic Anemia (75%), followed by Microcytic Hypochromic Anemia (18%). On clinical history correlation, majority of them were asymptomatic 52% and 38% of cases presented with fatigue. Conclusion: The study concludes that diagnosing different morphological patterns of geriatric anemia and its clinical correlation helps in reducing the morbidity and mortality of geriatrics related to anemia and also facilitate the clinicians to improve the treatment protocols and prophylactic therapy. Keywords Geriatrics, Patterns, Anemia

#1572 Recurrent parvovirus B19 infection-associated pure red cell aplasia in kidney transplantation

Abstract Background and Aims Anemia is frequent in kidney transplant (KT) recipients, with multiple potential causes. Parvovirus B19 (PVB19) infection-associated pure red cell aplasia (PRCA) becomes an important diagnosis in KT recipients experiencing persistent anemia, in whom other etiologies have been excluded. PVB19-associated PRCA is described in up to 27% of KT recipients with anemia and recurrent disease in up to 33% of cases. The authors describe a case of a recurrent PVB19-associated PRCA in a KT recipient. Method - Results A 42-year-old male with chronic kidney disease of unknown etiology underwent KT from a deceased donor after circulatory death in January 2021. He received induction immunosuppression (IS) with thymoglobulin and maintenance IS with prednisolone, tacrolimus, and mycophenolate mofetil (MMF). Three months after KT, the patient complained of progressive asthenia, and normocytic normochromic (NN) anemia was detected. A thorough investigation revealed normal leucocyte and platelet counts, low reticulocyte count, and no signs of bacterial infection, iron deficiency, or hemolysis; thyroid function, erythropoietin, folate, and vitamin B12 levels were normal, direct Coombs test was negative and no monoclonal spike was detected on protein electrophoresis. Endoscopic studies and cervico-thoraco-abdomino-pelvic computer tomography were unremarkable. Serum PCR of PVB19 was positive and confirmed the diagnosis of PVB19-associated PRCA. MMF was discontinued but anemia continued aggravating (nadir hemoglobin [Hg] level of 6.6 g/dL) with a sustained PVB19 load. He was admitted to the hospital, received blood transfusions, and was started on intravenous immunoglobulin (IVIG) 2 g/kg. A bone marrow aspirate was performed and was compatible with recovery after erythroid aplasia. The patient was discharged with Hg 8 g/dL and reduced PVB19 load. Although MMF remained suspended, and close monitoring of Hg and PVB19 load was performed, four months later he developed recurrent PVB19-associated PRCA, which motivated another hospital admission for IVIG with excellent response. In addition, he presented kidney dysfunction, and a kidney biopsy revealed borderline acute T-cell mediated rejection. In this setting, IS was altered to TRANSFORM SCHEEME. Four months later, he presented a second recurrence of PVB19-associated PRCA, requiring new hospitalization and treatment with IVIG. Considering the recurrent PVB19-associated PRCA, in a patient with chronic allograft dysfunction, high immunologic risk, and the foscarnet's probable nephrotoxicity, preventive therapy with IVIG (0.4 mg/kg) every 4 weeks was started. After 7 months of preventive IVIG infusion, no relapse was identified, the Hg is 11.5 g/dL (and increasing, without erythropoiesis stimulants) and the PVB19 load remains low. Conclusion PVB19-associated PRCA is characterized by persistent NN anemia with low reticulocyte counts, which is unresponsive to erythropoietin. One significant risk factor is induction IS, particularly thymoglobulin. In the setting of solid organ transplants, the absence of PVB19 antibodies does not exclude this diagnosis and viral detection should be performed. The initial therapeutic approach involves reducing IS. However, the risk of allograft rejection must be acknowledged. If this approach proves insufficient, IVIG treatment is usually successful. In our patient, considering the facts that allograft rejection limits the reduction of IS, the need for blood transfusions, and the inherent immunization, in a young patient that will possibly require a second KT, the undesirable nephrotoxicity of foscarnet, the successful response to IVIG, and patient's quality of life, chronic IVIG therapy was thought to be the best choice and proved efficacious in preventing relapses. Despite the absence of precise guidelines for chronic PVB19 infection management, maintenance therapy with prolonged IVIG infusions may be a therapeutic option for recurrent PRCA, but more studies are necessary to define the appropriate duration of treatment.

#1274 Post kidney transplant parvovirus disease presenting as refractory anemia—case series of 21 patients

Abstract Background and Aims Kidney transplant recipients (KTRs) are susceptible to a wide range of infections, one of which includes Parvovirus B19 (PVB19). It usually presents in the first year after transplant, with anemia and causes increased morbidity and risk of graft dysfunction. Method Charts of patients undergoing kidney transplant between May 2013 and March 2022 were reviewed. 21 patients had PVB19. Their clinical presentation, laboratory parameters and outcome was studied. The diagnosis of PVB19 was established by PVB19 polymerase chain reaction (PCR) and by bone marrow examination(BME) in 6 patients. Results Prevalence of PVB19 disease was 1.9% (21/1164) with a median time to onset was 39 days post-transplantation. Clinical presentation included fever, generalized weakness, dyspnea, and myalgia in 47%, 76%, 23%, and 33% of patients respectively. Anemia, leukopenia, and thrombocytopenia were present in 100%, 14%, and 9.5% of patients respectively. Graft dysfunction was observed in 61.9% (13/21) patients. 20/21 (95%) patients had a positive PVB19 PCR and one patient had a typical viral inclusion on BME. Immunosuppression especially antiproliferative was reduced in all patients. 8 patients received IVIG, 8 received packed cell blood transfusion and 7 received Erythropoietin therapy. All patients recovered with median time to normalization of hemoglobin was 30 days. One patient had graft loss secondary to non-responsive graft rejection. Conclusion PVB19 is a rare but clinically significant cause of refractory anemia during the early post-transplantation. Any kidney transplant patient in first 4 months who has unexplained normocytic normochromic refractory anemia with or without graft dysfunction should be screened for PVB19 by DNA PCR or BME to rule out PVB19 infection. The use of PCR for diagnosis and reduction in immunosuppressants particularly antiproliferative drugs is the mainstay of treatment.

A puzzle unravelled: pancytopenia and hepatosplenomegaly in juvenile autoimmune hypothyroidism

Autoimmune thyroiditis is a common cause of hypothyroidism in adolescent females. While normocytic normochromic anemia is a recognized association with hypothyroidism, pancytopenia is seldom reported. This case report discusses a young adolescent girl with autoimmune hypothyroidism presenting with severe pancytopenia and hepatosplenomegaly. After extensive evaluation, hypoproliferative marrow with extramedullary hematopoiesis secondary to uncontrolled hypothyroidism was considered to be the most likely cause. Swift recovery following appropriate levothyroxine replacement further supports this hypothesis. Thus, hypothyroidism can be a potential cause of pancytopenia with hepatosplenomegaly. Early recognition and appropriate management can lead to prompt resolution and prevent unnecessary invasive procedures.

Leptospirosis in a mixed breed female dog (Canis familiaris)

The present study aimed to report a clinical case of leptospirosis diagnosed in a mixed breed dog where treatment was chosen without hospitalization. Leptospirosis is an infectious and contagious zoonotic disease caused by the spirochete of the genus Leptospira spp. All pathogenic lineages belong to a single species, Leptospira interrogans. This microorganism can affect both humans and animals, be they domestic, wild or production. Dogs and cats are susceptible, but felines have greater resistance to leptospirosis. Synanthropic rodents in large urban centers or rural areas constitute a major problem, as they end up transmitting it to domestic and stray animals. Animals become infected and end up eliminating spirochetes into the environment through contaminated urine, since leptospirosis has a predilection for the renal tubules. Transmission can be direct through contaminated urine, venereal secretions, placental transfer, bite wounds or ingestion of contaminated tissues. Leptospira can enter the body through intact oral, nasal or ocular mucous membranes, or through skin that is damaged or macerated by moisture. Indirect transmission occurs through contact with contaminated water, soil and food sources. In Brazil, where many locations lack a garbage collection system and sewage disposal is precarious, the tropical climate favors rain during summer, all increasing the role of rodents as vectors of this zoonosis due to flooding. The canine mentioned in this study did not have their vaccination protocol up to date, lived in a place with the presence of rodents, and was diagnosed positive for L. interrogans serovars Bratislava, Pomona and Copenhageni by the microscopic agglutination test (MAT), considered the gold standard. The changes in the blood count were limited to normocytic normochromic anemia and hyperproteinemia. No noteworthy changes were observed in the white blood cell count and, in the biochemical tests, liver and kidney changes consistent with the pathology were evident. The therapeutic protocol chosen was antibiotic therapy and supportive therapy, both carried out at the guardian's home, and the prognosis was favorable. Preventive vaccination measures according to the challenge faced in the environment, rodent control and also public policies regarding basic sanitation are important in preventing in zoonosis.

Peculiarity of Systemic Lupus Erythematosus with Cardiac Involvement in Case Report and Literature Review

Systemic lupus erythematosus (SLE, or lupus) is a condition in which the immune system attacks healthy cells and tissues throughout the body, it is characterized by aberrant activity of the immune system, leading to variable clinical symptoms. Case: A Moroccan 54 years old women presented a progressive dyspnea associated with palpitations with a history of hyperthyroidism, a pericardial effusion of great abundance punctured, the remainder of the diagnostic workup had revealed lupus erythematosus. The echocardiography found a global hypocontractility with an ejection fraction at 25%, a dilated atrial mass and mitral regurgtitaion, moderate aortic regurgitation with an image of vegetation on the non-coronary cusp, right ventricular dysfunction. Laboratory investigations revealed bycitopenia with high inflammatory markers, a renal dysfunction test result. Immunological tests showed a high positive antinuclear antibodies ans DNA antibodies. While hospitalization the patient presented a constrictive chest pain , the electrocardiogram showed an st segment elevation in the inferior derivation in relation with a coronary spasm.Three days later the patient presented a sudden neurological deficit type of right hemiparesis with facial paralysis and aphasia, the emergency MRI objectified a cortical frontotemporal stroke, in the acute phase, patient was thrombolysed by metalysis , finally the diagnosis of vasculitis of the central nervous system (CNS) was retained with ischemic and hemorrhagic lesions in favor of lupus vasculitis of the CNS . Discussion: Systemic lupus erythematosus (SLE) is a chronic autoimmune disorder that may affect several different organs(5) , the underlying pathophysiologic mechanism remains unknown, new autoantibodies, such as antibodies to DNA , antibodies to extractable nuclear antigens , and anticardiolipin antibodies, were recognized as causative of clinical subsets of lupus(5) SLE is an unpredictable disease, it is characterized by alternating periods of remission and exacerbation and by a wide variety of clinical manifestations that may affect any organ. The case of our patient with SLE involved: cardiac type of lupus myopericadtitis in biventricular dysfunction with LVEF: 25%, , Normochromic normocytic anemia with positive coombs test and lymphopenia and thrombocytopenia ; lupus nephropathy satde IV ; Cerebral vasculitis. Cytopenias are common in patients with lupus, and moderate to severe lymphopenia is associated with high disease activity and organ damage. Up to 50% of patients with SLE have evidence of renal disease at presentation (10) Lupus end-stage kidney disease is associated with worse survival among dialysis and transplant patients. The risk for ischemic stroke is higher in patient with SLE. Stroke affects 3–20% of patients with SLE and usually occurs within the first 5 years of the diagnosis(13,14). The main Cardiovascular diseases of SLE are valvular heart diseases associated with Libman-Sacks disease lesions, sterile vegetations, serositis associated with pericardial disease. African-American patients are at increased risk for development of myocarditis(20); low ejection fraction is detected in the majority of the patients (25)Our patient had an ejection fraction around 25% . The most characteristic valvulopathy of SLE is Libman- Sacks endocarditis (LSE), which mainly affects the left cardiac valves (22) . Non-steroidal anti-inflammatory drugs (NSAIDs) are considered as the first choice in mild cases with minimal pericardial effusion (28) Corticosteroids should be used in refractory cases with or without antimalarials. Corticosteroids in combination with immunosuppressives (25) Cyclophosphamide and intravenous immunoglobulins (IVIGs) have been shown to improve cardiac function and mortality (30), in addition to the medical treatment of Heart failure. Conclusion: Diagnosis of SLE can be challenging and while several classification criteria have been posed, their utility in the clinical setting is still a matter of debate. Despite several agents shown to be efficacious in the treatment of SLE, the disease still poses significant morbidity and mortality risk in patients.

HAEMOBARTONELLOSIS IN DOMESTIC SHORT HAIR CATS

Haemobartonellosis is a disease caused by Mycoplasma haemofelis, previously called Haemobartonella felis, causing lethargy, fever, pale mucosa, and anemia of varying severity in cats. M. haemofelis is a small, gram-negative bacterium without cell walls that lives on the edge or surface (epicellular) of erythrocytes. The animal used as a case report is a domestic short-haired cat, ± 9 months old, an unsterilized female with a body weight of 3.3 kg. The results of the clinical examination and praesens status showed that the case cat experienced vomiting, loss of appetite, lethargy, mild ectoparasite infestation, pale mucosa, a CRT of more than two seconds, and increased respiratory frequency and body temperature. Routine hematological examination on the first day showed normochromic normocytic anemia, leukopenia, neutropenia, monocytopenia, and thrombocytopenia. Blood biochemical examination on the first day showed hypophosphatemia, hyponatremia, and hyperglycemia. A blood smear examination shows a round or ring-shaped formation on the edge or surface of the erythrocytes, which is morphologically identified as M. haemofelis. Based on the history, physical examination, and supporting examinations, the case cat was diagnosed as having haemobartonellosis. The case cat was treated for five days, and then on the sixth day, the case cat was sent home and underwent outpatient therapy because it showed an improving condition. Causative therapy for M. haemofelis is given oxytetracycline antibiotics for five days, followed by doxycycline antibiotics for 28 days during outpatient therapy. Frontline Plus® antiparasitic is given once to treat ectoparasites. The symptomatic therapy given is tolfenamic acid, once administered. The supportive therapy given is Lactate Ringer's infusion fluid therapy for 5 days and multivitamin, mineral, and hematopoietic supplements, namely Hematodin® by injection for five days, followed by Caviplex Syrup® for 28 days. Therapy for vulnus morsum is enrofloxacin for 8 days. After 28 days of outpatient therapy, the case cat showed clinical improvement and was actively playing.

Study of Etiological Spectrum and Clinicohematological Profile of Nonnutritional Anemia in a Tertiary Care Hospital in Western India

Abstract Background: Worldwide, anemia is a significant public health issue, particularly in developing nations like India. Although the nutritional deficiency is the most common etiology, the nonnutritional anemia (NNA) also constitutes a major proportion of anemias. There has been little work done on etiology of NNA is in Indian patients, hence the present study assesses the etiological spectrum and clinicohematological profile of patients with NNA. Methods: Between August 2019 and August 2021, we observed and cross-sectionally analyzed 100 NNA patients in a tertiary care medical college and hospital to determine their clinical and laboratory characteristics. Results: In our study, anemia of chronic disease (51%) was the most common type of NNA, followed by hemolytic anemia (15%). The most common presenting symptom was easy fatigue (72%). Common findings on general examination were pallor (92%) followed by pedal edema (14%) and icterus (13%), whereas, on systemic examination, splenomegaly (21%) was the most common finding. Normocytic normochromic anemia was the most common pattern on hematological examination (75%). Conclusion: Anemia of chronic disease is the most common etiology among NNA with fatigue as the most common symptom. Practitioners should consider non nutritional etiology in a case of chronic anemia and a comprehensive clinical, hematological and biochemical study helps in the identification of underlying cause and treatment of NNA.

Acquired Elliptocytosis as a Manifestation of Myelodysplastic Syndrome Associated with 20q Deletion

Abstract: Elliptocytes are most abundant in hereditary elliptocytosis. Isolated deletion 20q [del(20q)] associated with elliptocytosis in a patient with myelodysplastic syndrome (MDS) is very rare, and only a few cases are reported in the literature. This report describes a case of an MDS-related autoimmune disease (Sjögren’s syndrome) with acquired elliptocytosis and del(20q). We discuss their clonal relationship and del(20q) status in the process of disease progression. A 58-year-old woman, with a history of Sjögren’s syndrome, was admitted for investigation of pancytopenia. An initial evaluation revealed a regenerative normochromic normocytic anemia with hemoglobin of 9.2 g/dL, an absolute reticulocyte count elevated at 245 × 109/L, a platelet count of 70 × 109/L, white blood cells of 1.4 × 109/L, and polynuclear neutrophils (PNNs) at 0.64 × 109/L. A slightly elevated total bilirubin of 28 μmol/L prompted a hemolytic workup. A peripheral blood smear showed frequent elliptocytes and occasional spherocytes. In addition, the PNNs were hyposegmented and hypergranular. Bone marrow aspirate smears showed significant dysplasia of all hemopoietic lineages indicating a diagnosis of multilineage dysplasia. Cytogenetic analysis showed a 20q deletion. The IPSS-R score was 4, stratifying her to the intermediate-risk IPSS-R group. MDS is frequently associated with a variety of autoimmune disorders. Connective tissue diseases account for 25%–30% of MDS-related autoimmune diseases but Sjögren’s syndrome has been rarely reported.

Blood count abnormalities in the association of sickle cell disease and malaria in clinical hematology at the CNHU-HKM in Cotonou (Bénin)

Although a protective effect of hemoglobin S has been described, malaria has frequently been associated with increased morbidity and mortality in sickle cell disease patients in Africa. Various cytopenias are frequently found on the haemograms of these patients. In Benin, a malaria-endemic zone with a high prevalence of sickle cell disease, the aim of this study was to establish and compare the blood count profile according to hemoglobin type in the association of sickle cell disease and malaria. This was a prospective descriptive study. It covered a 24-month period from October 2020 to October 2022. It included all patients with major sickle cell syndrome seen in clinical haematology and with a positive thick drop/parasite density, whatever the parasitaemia value. For each patient, a blood count was performed on the Sysmex XT 4000i machine, supplemented by a smear study after staining with May-Grunwald Giemsa. Data were analyzed using R 3.6.1 software. Three hundred non-redundant cases with a positive thick smear were identified in sickle cell patients, including 208 SS homozygotes (69.3%) and 92 SC heterozygotes (30.7%). In contrast, there were 181 non-redundant cases with a negative thick smear, including 119 SS homozygotes (65.7%) and 62 SC heterozygotes (34.3%). Among subjects with a positive thick smear, the majority of patients (70%) exhibited clinical symptoms. Severe malaria was observed in 58% of the cases. The proportion of severe malaria was higher in SS homozygote patients than in double heterozygote SC patients (p < 0.0001). The mean parasite density was higher in SS individuals (4 320.7 ± 2 185 trophozoites/pL) compared to SC individuals (1 564.4 ± 1 221 trophozoites/pL; p < 0.0001). Plasmodium falciparum was the only species identified. The mean hemoglobin level in impaludated SS subjects was 6.1 g/dL, significantly lower than that in non-impaludated SS subjects (p < 0.0001). The average white blood cell count in impaludated SS subjects was 16.58 G/L, compared to 13.2 G/L in those with a negative thick smear (p < 0.0001). Twenty cases of thrombocytopenia were found in SS subjects with a positive thick smear, compared to 6 cases in those with a negative thick smear. As for SC subjects with a positive thick smear, the average hemoglobin levels and white blood cell counts were 9.8 g/dL and 10.63 G/L, respectively, compared to 11.27 g/dL and 7.3 G/L in SC subjects with a negative thick smear. Eighteen cases of thrombocytopenia were found in subjects with a positive thick smear, compared to 17 cases in those with a negative thick smear. Sickle cell disease and malaria represent two major public health problems. However, contrary to popular belief, sickle cell disease is not immune to malaria infestation. Malaria is recognized as one of the main causes of morbidity and mortality in sickle cell patients, particularly children. In Benin, its association with sickle cell emergencies has already been reported.Our study found that malaria was predominantly associated with the homozygous SS form (p < 0.00001). Severe malaria was the most common clinical form. All malaria infestations in our series were due to Plasmodium falciparum, and parasitaemia was significantly higher in SS patients (p < 0.0001).The hematological profile of the association of sickle cell disease and malaria in homozygous SS individuals in our series showed characteristics of a normocytic normochromic anemia with neutrophil-predominant leukocytosis. Compared to non-malaria-infected SS individuals, there was a significant worsening of anemia, neutrophil-predominant leukocytosis, and a decrease in the average platelet count. In SC individuals, there was rather a microcytic normochromic regenerative anemia associated with neutrophil-predominant leukocytosis. Compared to non-malaria-infected SC individuals, there was a significant decrease in the rate of anemia and neutrophil-predominant leukocytosis. Anemia is a constant feature in homozygous sickle cell disease, and the low values recorded illustrate the hemolytic nature of malaria, especially in SS individuals, and the better tolerance of SC individuals. Furthermore, the low baseline hemoglobin levels make SS individuals more vulnerable to malaria-induced anemia compared to SC individuals. The observed leukocytosis is generally accompanied by reticulocytosis in the case of major sickle cell syndrome, which must be taken into account for result validation. It is the expression of compensatory bone marrow reaction to anemia and inflammatory mechanisms resulting from malaria infestation. Finally, thrombocytopenia was significantly more common in SC patients, even though they were adults living in malaria-endemic areas. Malaria can frequently induce thrombocytopenia through platelet consumption during the "rosetting" phenomenon. In SS patients, the effects of "rosetting" could be compensated for by the bone marrow stimulation induced by anemia. In our series with adult subjects living in an endemic area, thrombocytopenia is not a frequent biological disturbance. In a clinicalbiological context combining a systemic inflammatory response syndrome with anemia and neutrophil-predominant leukocytosis in a SS or SC sickle cell patient, the clinician should be able to consider malaria and confirm or rule out this diagnosis.