Normocytic Normochromic Anemia Research Articles

DEMODICOSIS WITH TICKS INFESTATION AND BABESIOSIS IN A MIXED DOG

Demodicosis is a skin disease that often affects dogs caused by Demodex sp. Babesiosis is a parasitic disease in the erythrocytes that attacks dogs caused by Babesia sp. This paper discusses cases of demodicosis with ticks infestation and babesiosis in a dog. A 6-year-old Shih tzu and local mixed-breed male dog named Dede has skin problems such as hair loss and itching. During clinical examination, the dog had a rancid odor, slow skin turgor, alopecia, erythema, crusting, hyperpigmentation and hemorrhage, accompanied by pruritus and infestation of Rhipicephalus sanguineus ticks. The mucous membranes of the eyes and mouth appear pale. On examination of skin scrapings, Demodex sp. were found. Complete blood count showed that dog had normochromic normocytic anemia, leukocytosis, lymphocytosis, granulocytosis, erythrocytopenia and thrombocytopenia. On examination of the blood smear, protozoa Babesia sp were found. The dog was diagnosed with demodicosis and babesiosis. Treatment is carried out by administering ivermectin, diphenhydramine HCl, clindamycin, caviplex, fish oil, and shampoo containing miconazole nitrate, lime sulfur, salicylic acid, benzoyl peroxide, and triclosan, and spraying the dog's place with deltamethrin. Evaluation on the 7th, 14th and 21st day the dog's condition showed an improvement.

BRONCHOPNEUMONIA IN DOMESTIC CAT

Bronchopneumonia is a part of pneumonia that is often observed in veterinary medicine which is usually caused by viruses, bacteria, parasites, fungi and foreign bodies. This case describes cases of bronchopneumonia caused by bacteria, and describes the causes of the disease based on physical examination and supporting examinations in order to determine clinical symptoms and treatment management that can be given to cats. A local cat named Momo, female, aged 2 years, was brought in with complaints of sneezing and coughing for 3 weeks and sometimes had a mucopurulent discharge in the morning and started to get worse 1 week before the examination. Physical examination showed that the cat's nose secreted a mucopurulent discharge accompanied by a serous discharge in the eye area, the cat looked short of breath and heard a sound when auscultated crackles. Investigation with X-ray showed a picture radiopaque in the pulmonary area and the spread of spots in the bronchial area, routine hematological examination showed that the case cat had normochromic normocytic anemia and thrombocytopenia and when carrying out a cytological test bacteria with round chracteristics like grape stands was found. Causative therapy in the form of antibioticsAmoxicillin trihydrate with a dose of 5 mg/kg BW per oral (PO) of 1 mL twice a day for one week and supportive therapy was given multivitamins with administration of 1 mL once a day for 1 week and after being evaluated the treatment was continued with the administration of clavulanic acid. Evaluation on the 7th and 14th day after treatment showed a change in clinical symptoms indicating a change in nasal discharge which was previously mucopurulent to mucus and there was no discharge in the eyes and there was no sneezing and coughing and there were still small white spots on the lungs.

TO STUDY THE HEMATOLOGICAL PROFILE IN PATIENTS WITH ALCOHOLIC LIVER CIRRHOSIS IN A TERTIARY CARE HOSPITAL IN MANIPUR

Introduction: Alcoholic liver disease or alcohol-related liver disease (ALD) is damage to the liver caused by excessive alcohol consumption, resulting in serious and life-threatening complications such as cirrhosis, gastrointestinal bleeding, hepatic failure, hepatic encephalopathy and malignancy. Liver cirrhosis is defined as diffuse hepatic fibrosis with replacement of normal liver architecture by nodules. There are also lesser known sequalae including suppression of hematopoiesis due to its toxic effects, hypersplenism and nutritional deficiencies of folic acid and other vitamins. Anemia, leukocytosis, leucopenia and thrombocytopenia occurs in ALD. Most of these hematological parameters are underdiagnosed and understudied. Hence, Manipur being a high ALD prevalence state necessitates this study to evaluate the hematological profile in patients with alcoholic liver cirrhosis and to determine the association between various hematological parameters and different Model of End stage Liver Disease (MELD) scores. Methods: This cross-sectional study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal, Manipur from January 2021 to October 2022.Alcoholic liver cirrhosis patients above 18 years attending Medicine OPD, Liver clinic and those admitted in Medicine ward were enrolled. Blood samples for complete Hemogram, liver function test, kidney function test, prothrombin time, INR, serology (HbsAg, Anti HCV Ab, HIV 1&2) and ANA were collected. Ultrasound whole abdomen and Chest X ray were done whenever indicated. Different types of anemia, leucopenia, leukocytosis, thrombocytopenia in different groups of MELD scores were studied. Result: A total of 146 alcoholic liver cirrhosis patients were enrolled in our study. The mean ± SD age of the patients was 48.63±10.00 years with majority males (91.8%). Anemia detected in >95% of the patients. Severe anemia was detected in 31.5%, moderate anemia in 49.3% and mild anemia in 15.1%. Most of them (47.9%) had leucocytosis and thrombocytopenia was seen in 78.1% patients. Prolonged PT was seen in 89.1% of the patients and elevated INR present in 69.9% of patients. Majority of patients had MELD score between 10-19 and 20-29 (34.2% each). Only 4.1% had MELD score > 40. There is statistically significant association between MELD score of the patients with severity of anemia (p<0.05) and leucocyte count while it is not significant with thrombocytopenia (p=0.139). Conclusion: The prevalence of anemia in the present study was found to be 94.9% with predominant normocytic normochromic anemia (71.2%). There is significant association between MELD score of the patients with severity of anemia and leukocytosis while association with thrombocytopenia was insignificant. This study can now determine the stage at which emergent intervention could help in the recovery and effectively reduce morbidity and mortality of alcoholic cirrhosis patients.

Haemoplasmosis in A Hypoalbuminemic Cat: A Case Report

Haemoplasmosis is a bacterial infection in erythrocytes caused by Mycoplasma sp. This study aimed to report methods of diagnosis, therapy, and evaluation of therapy in cats with haemoplasmosis. The cat showed decreased appetite, conjunctivitis, presence of mucoid mucus on the eyes and nose, gum anemia with a capillary refill time of more than 2 seconds, high temperature, and weakness. Skin and hair examination reported infestations of Ctenocephalides felis and Lynxacarus sp. on the hair. Routine hematologic examination showed normochromic normocytic anemia, leukocytosis, neutrophilia, eosinophilia, lymphocytosis, monocytosis, and hypoalbuminemia. A blood test examination observed Mycoplasma sp. in erythrocyte cells so the cat was diagnosed with haemoplasmosis. Treatment was performed using Oxytetracycline long-acting at 20 mg/kg BW intramuscularly for 2 weeks and revealed support to recovery during the treatment period.

Anemia in HIV Patients Attending Highly Active Antiretroviral Therapy Clinic at Hoima Regional Referral Hospital: Prevalence, Morphological Classification, and Associated Factors.

To determine the prevalence of anemia, the morphological classification and to assess the factors associated with anemia among HIV patients attending Highly Active Antiretroviral Therapy (HAART) clinic at Hoima Regional Referral Hospital. This was a cross-sectional study among 340 participants attending the HAART clinic at Hoima Regional Referral Hospital. Participants were recruited using a simple random sampling technique. A complete blood count (CBC) was performed using the Sysmex XN-550 hematology analyzer. Thick films were made and examined for malaria parasites, while thin films were examined for the morphological classification of anemia. Bivariate and multivariate logistic analyses were conducted using SPSS (version 23). Out of the 340 study participants, 255 (75%) were females, and the median age was 39 years (range: 6-76 years). The overall prevalence of anemia among the study participants was 16.8% (95% CI 13.1-21.1). Normocytic normochromic anemia was the most prevalent form of anemia (47.4%). The logistic regression at multivariate analysis showed that age groups (18-27 years, p = 0.017; 28-37 years, p = 0.005; and ≥38 years, p = 0.009), divorced marital status (p = 0.024), the presence of chronic disease (p = 0.010), a family history of anemia (p = 0.007), and the presence of malaria in the past one month (p = 0.001), presence of opportunistic infection (OR = 58, p = 0.000), use of antihelminthic drug in the past 3 months (OR = 0.10, p = 0.003) and unsuppressed viral load (OR = 10.74, p = 0.000) had a significant association with anemia. Anemia is prevalent in HIV/AIDS patients who receive treatment at Hoima Regional Referral Hospital. Age, marital status, the presence of chronic illnesses, a family history of anemia, experiencing malaria in the past 3 months, the presence of opportunistic infections, the use of antihelminthic drugs in the past 3 months, and an unsuppressed viral load were significantly associated with anemia.

AUTOIMMUNE AND HEMATOLOGICAL STATUS OF GRAVES’ DISEASE PATIENTS

Purpose of the study: comparative assessment of hematological and autoimmune status of patients with Graves’ disease (GD). Materials and methods. 43 GD patients aged between 19 and 64 years, 26 of which were women and 17 were men, have been examined. Assessment of hemograms of examined patients helped to reveal anemia in 28(65.1%) examined patients (group I). In 15 (34.9%) patients (group II) anemia was not detected. Mild anemia was diagnosed in 25 (89.3%), moderate anemia – in 3 (10.7%) patients. Hemoglobin, hematocrit, erythrocyte count and erythrocyte indices MCV, MCH, MCHC, serum Fe and ferritin status was chaecked in clinical analysis. The immune status was assessed by the level of CD3+, CD4+, CD8+, CD19+, CD4+/CD8+, CEC, Ef, TSHRAb and hormonal status by the level of TSH, T4 free. Results. Microcytic anemia was determined in 15 (53.6%) patients, normocytic - in 12 (42.8%), macrocytic - in 1 (3.5%) patient due to volume of erythrocytes’ MCV. According to morphological criteria of МСН (mean content of hemoglobin in erythrocyte) anemia hypochromic type of anemia was noted in 15 (53.6%) patients, normochromic - in 12 (42.8%), hyperchromic - in 1 (3.5%) patient. In 15 (53.6%%) patients in the group I microcytic - hypochromic anemia was diagnosed, which is characteristic for iron-deficient anemia; in 12 (42.8%) patients was verified normocyticnormochromic anemia, which has morphological parameters of anemia of chronic diseases and in 1 (3.5%) patient macrocytic-hyperchromic anemia. Comparative assessment of HGB level and indicators of iron metabolism in GD patients with anemia detected decreasing of HGB by 20%, serum Fe by 20%, ferritin by 29% compared to the corresponding control values. More pronounced depletion of the iron depot (ferritin) due to the fact that the development of anemia is preceded by a “latent iron deficiency”, an indicator of which is ferritin. Conclusions. GD is characterized by high frequency of anemia (65.1%), mostly mild form (89.3%), microcytichypochromic (53.6%), characteristic of iron deficiency anemia. The severe hematological disorders, detected among GD patients with anemia are accompanied by deep autoimmune changes and hyperfunction of the thyroid gland.

Nodular Lymphocyte-Predominant Hodgkin Lymphoma: A Rare Lymphoma with Isolated Hepatic Presentation.

Differential diagnosis of fever, especially in young patients, is very complex and complete investigation takes time, which can delay the diagnosis of malignancies such as primary hepatic lymphoma (PHL).PHL is very rare, and overlapping symptoms with other liver diseases can make the diagnosis very challenging.When the suspicion of PHL is very high, only the hepatic biopsy can lead to the correct diagnosis because the disease has no extrahepatic involvement.

Sclerosing angiomatoid nodular transformation of the spleen in a child with anemia: a case report and review of the literature

BackgroundSclerosing angiomatoid nodular transformation of the spleen is a relatively rare benign vascular lesion in both adult and pediatric age groups with unclear etiopathogenesis and variable clinical presentations. Many benign and also malignant splenic masses could mimic sclerosing angiomatoid nodular transformation, both clinically and radiologically. Herein, we report our experience with a case of sclerosing angiomatoid nodular transformation in a 3-year-old girl.Case reportA 3-year-old Iranian girl presented with abdominal pain, back pain, and constipation for 2 weeks. She was being followed up by a pediatrician due to her short stature and persistent anemia. Physical examination showed stable vital signs, short stature, pallor, and a puffy face. Laboratory evaluation showed normochromic normocytic anemia with a normal reticulocyte count, ferritin, and hemoglobin electrophoresis. Radiologic assessments revealed a hypoechoic lesion in the spleen with high vascularity, clinically suspected to be lymphoma. She was operated on, and after partial splenectomy, pathologic evaluation of the spleen showed a solitary, well-demarcated, and unencapsulated dark mass. Microscopic examination revealed micronodular appearance composed of irregular-shaped vascular spaces lined by plump endothelial cells and surrounded by concentric collagen fibers, features in keeping with sclerosing angiomatoid nodular transformation. The patient’s anemia was resolved after surgery, and no clinical or radiologic deficits were noted during the 10-month follow-up visits.ConclusionAlthough sclerosing angiomatoid nodular transformation is exceedingly rare in children, it should be considered a differential diagnosis in pediatric splenic neoplasms with concurrent hematologic manifestations, such as anemia.

A rare case of bilateral lung metastasis from renal cell carcinoma 26 years after nephrectomy

Renal cell carcinoma (RCC) is a malignant tumor that often metastasizes early. About 33% of RCC patients present with metastatic masses, mostly in the lungs. Our patient was a 66-year-old woman who had a left-sided nephrectomy for RCC 26 years ago. Before the current presentation, she sought medical advice for about a year because of her easy fatigability, which was attributed to her normocytic normochromic anemia. Incidentally, a mass was discovered in each lung, which was found histopathologically and immunohistochemically to be a metastasis of RCC. The patient received sunitinib, which is the standard treatment for patients with advanced RCC and metastases without benefit at initial doses and cycles. Consequently, the dose was increased up to 4 times the initial dose, and by the third cycle, side effects appeared in the form of impaired consciousness up to deep coma, hypertension, hypercarotenemia, pancytopenia, hyponatremia, hypokalemia, and subclinical hypothyroidism. She was taken to the hospital and then sadly passed away.

Case Report: Tropical sprue, diagnostic challenges of an old but unrecognized disease

Tropical sprue (TS) is a post-infective disease of the small bowel characterized by a malabsorption syndrome affecting tropics inhabitants and visitors. Diagnosis of TS remain challenging since it can be confused with common diarrheal diseases, especially in non-endemic areas. We report a Tunisian case of latent TS. A 58-year-old male with a history of chronic watery diarrhea, was admitted to the intensive care unit for confusion which was related to dehydration[J1] . Despite the neurological improvement after hydro-electrolytic resuscitation and acid-base disorders correction, the patient continued to have three to five loose stools daily. A nutritional assessment showed a malabsorption syndrome: iron, Vitamin B12 and folate deficiencies; normochromic normocytic anemia and hypoalbuminemia. Gastrointestinal endoscopy showed duodenal villous atrophy and biopsy confirmed subtotal villous atrophy with increased intraepithelial lymphocytosis and a thickened hyalinized [J2] sub-epithelial basal lamina. Celiac disease was evoked, however the patient did not improve on a gluten-free diet and the celiac serology was negative. On re-interviewing, we discovered that the patient had spent two months in India three years prior. Given the travel history, clinico-biological and histological data TS was highly considered and a good response to a five-month antibiotic course combined to nutritional supplementation supported this diagnosis. Clinico-biological, endoscopic and histological findings were overlapping between TS and other malabsorption diseases, explaining diagnosis difficulties. TS should be systematically discussed in tropics visitors presenting with chronic diarrhea. Improvement after micronutrient and vitamin deficiencies replacement combined to a prolonged antibiotic course supports the diagnosis of TS. [J

Vertebrae compression fracture due to osteonecrosis as initial sign of childhood acute lymphoblastic leukemia: A case report

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common cancer in children. Manifestations of ALL vary from pallor, organomegaly, fever, and pancytopenia. Bone pain caused by vertebrae fracture is an uncommon manifestation of ALL, approximately only 16% of all bone pain occurrences. Fractures in ALL could occur at diagnosis and following treatment initiation. This case report described vertebrae compression fracture due to osteonecrosis as the initial sign of childhood acute lymphoblastic leukemia. CASE: An 8-year-10-month girl was referred to an orthopedic because of worsened low back pain since 1 month before, with no history of trauma. The pain was throbbing and radiated to the lower extremities. The patient was non-ambulant due to the pain. Physical examination revealed the visual analog scale was 8, tenderness in the spine, decreased strength, and range of movement in the lower extremities. There was no organomegaly in this patient. Serial laboratory examination revealed mild pancytopenia (leukopenia, mild normochromic normocytic anemia, mild thrombocytopenia) with dominancy of lymphocytes (68.1-81.9%). No blast was found in the peripheral blood smear. Magnetic Resonance Imaging of the spine revealed compression of the vertebral corpus with a pincer fracture and bone infarction. Bone marrow aspiration showed ALL-L2 with lymphoblast 50%. The patient started chemotherapy with ALL standard risk protocols and got zoledronic acid during the treatment. The patient's condition gradually improved, and able to undergo chemotherapy protocol. No side effects of zoledronic acid occurred. CONCLUSION: Vertebrae compression fracture without trauma and pancytopenia can be an early symptom of ALL. Zoledronic acid can be given concurrently with chemotherapy for bone mineralization.

Analytical correlation of Laboratory tests with clinical findings in cases of Paraproteinemia

Multiple myeloma is a malignant plasma cell disorder identified with M spikeon serum protein electrophoresis (SPE) during routine laboratory work up. This study aimed to analyze the utility of laboratory tests suchas SPE, immunofixation electrophoresis (IFE), CBC, RFT, LFT, calcium, phosphorus, beta 2 microglobulins, LDH, serum-free light chain assay (SFLC), Bence Jones Proteinuria (BJP), BM biopsy, BM smear and radiological evidence for lytic lesionsin cases of paraproteinemia. Data for the above parameters from 2017 January to 2021 March were obtained from the data management system of the central lab. Biochemical parameters were correlated with M spike value using Karl Pearson’s correlation coefficient (P-value <0.05 will be significant).7.7% SPE reports had M spike with a mean age of 64 years in males and 63 years in females (male/female ratio, 1: 0.76). M spike showed a significant positive association with total protein, globulin, uric acid and negative association with albumin. IgG kappa type (51%) predominant in IFE reports. The common presentation from hematological data was normocytic normochromic anemia with occasional rouleaux formation. Osteolytic lesion was present in 86% of reported cases. Associated biochemical, hematological, and radiological correlates of the positive cases could be documented in only less than 20% of the positive cases. Ours is a tertiary care hospital and the associated lab is also a reference lab where samples from in and around the city are tested. After the preliminary SPE, it could be possible that the patients were further evaluated and continued treatment at some other facility.

An Overview of Chronic Kidney Disease with Anemia at Bali Mandara Hospital in 2021-2022

Chronic kidney disease remains a problem in the field of nephrology, with a high incidence rate and a complex and broad etiology. Chronic kidney disease can cause several complications such as hypertension, anemia, metabolic acidosis, albuminuria, mineral and bone disorders, electrolyte imbalance, malnutrition and depression. Anemia is a condition in which the circulating mass of erythrocytes and/or hemoglobin cannot fulfill its function of providing oxygen to the body's tissues. Anemia significantly increases the risk of morbidity and mortality of chronic kidney disease. The aim of this study was to describe cases of chronic kidney disease with anemia at Bali Mandara Hospital in 2021 and 2022. This research is an observational descriptive study with a cross sectional approach, using secondary data in the form of patient medical records. Data were analyzed using SPSS software version 25 to obtain an overview of cases of chronic kidney disease with anemia based on gender, age, place of residence, degree of chronic kidney disease, degree of anemia, and anemia morphology. The results showed that most cases of chronic kidney disease with anemia at Bali Mandara Hospital at 2021-2022 were mostly experienced by men (69.0%) with the most common age range being between 46-55 years old (early elderly) of 34.5%, and the majority of chronic disease patients with anemia patients resides in the city of Denpasar (73.6%). The observed degree of severity of CKD was mostly at stage 5, accounting for 87.4%. The degree of anemia seen in patients with chronic kidney disease at Bali Mandara General Hospital was mostly moderate anemia (72.4%), with the most common morphological appearance being normochromic normocytic anemia at 75.9%. Keywords: chronic kidney disease, anemia, anemia morphology

Confounding role of comorbidities and COVID-19 vaccination uptake in clinical utility of hematological biomarkers in Cameroonian patients infected with SARS-CoV-2

ObjectivesTo analyze variations in blood profile, the extent of hematological disorders, and the impact of comorbidities and COVID-19 vaccination on blood profile parameters and their clinical value for prognostic of SARS-CoV-2 infection. MethodsThis cross-sectional study took place in Douala, Cameroon. A complete blood count and molecular detection of SARS-CoV-2 were performed on patients. Clinical value was appraised using area under the curve (AUC) analysis. ResultsIn total, 420 participants were included. A significant reduction of hematological parameters such as lymphocytes (p < 0.0001), red blood cells (P = 0.0025), mean corpuscular hemoglobin count (P < 0.0001), and platelets (P = 0.02) was seen in SARS-CoV-2 (+) patients. Anisocytosis was the main hematological disorder (95.5%). Normocytic normochromic anemia was predominant in SARS-CoV-2 (+) (35.3%) while microcytic normochromic anemia was more frequently seen in SARS-CoV-2 (-) (16.5%). Neutrophil-to-lymphocyte (NLR) consistently showed statistically significant AUC ∼0.75 upon stratification for age, gender, and comorbidities, with the exception of COVID-19 vaccination uptake. ConclusionIn a context where molecular detection methods are difficultly affordable in health facilities in developing countries such as Cameroon, NLR could be clinically interesting for identifying SARS-CoV-2 infected individuals, especially those with comorbidities.

E52 Juvenile spondyloarthritis, when the pragmatic approach is absent: a case report

Abstract Introduction Juvenile spondyloarthritis is a rare condition in which differential diagnosis is the key step that every practitioner must take to avoid missing other pathologies that can be serious and require early and specific management, such as malignancy. In case of doubt, referring the patient to a referent seems to be the best attitude to adopt. Aim We report a case of a girl who was misdiagnosed as juvenile spondyloarthritis when it was acute lymphoblastic leukaemia with vertebral bone involvement. Observation A 7-year-old girl was referred to us for better management of her juvenile spondyloarthritis refractory to usual treatments. The child first consulted us for excruciating back pain. Diagnosed as juvenile spondylitis, the patient was placed on NSAIDs and then corticosteroids but without any response. On the contrary, her general condition got worsen and her back pain increased. At our level, further questioning found out that the girl had asthenia, anorexia, excruciating low back pain radiating to the lower limbs with neck pain, and abdominal pain that had been evolving for 40 days. On examination, the child was febrile at 40 °C with mucocutaneous palor, she had hepatosplenomegaly with painful palpation of the lumbar vertebrae. On biological examination, the blood count formula showed normochromic normocytic anaemia, hyperleukocytosis with a normal platelet count. Blood smear; presence of 07% blasts. Medullogram: infiltration of 66% of young lymphoid cells. Immunophenotyping was in favor of B-II acute lymphoblastic leukaemia (B-II ALL). The MRI (magnetic resonance imaging) of the spinal cord showed a total and diffuse infiltration of all the dorsal-lumbar and pelvic vertebral parts, resulting in a real spinal cord replacement secondary to a probable hemopathy. The patient was transferred to the pediatric oncology department and commenced chemotherapy. Conclusion Through our observation, JIA is a diagnosis of exclusion and must be considered only after a complete investigation of the other pathologies which require a specific management.

Systemic-onset Juvenile Idiopathic Arthritis in a young child

We present a 31-month-old female child who was referred by the pediatricians with 1-year history of recurrent high-grade fever associated with polyarthritis and recurrent skin rash, which disappears within 24 hours of resolution of fever. She had lost the ability to walk unsupported because of persistent arthritis. Her Full Blood Count (FBC) was remarkable for marked leucocytosis, thrombocytosis, and a mild normocytic normochromic anemia; Erythrocyte Sedimentation Rate (ESR) and C-reactive Protein (CRP) were both elevated at 110mm/hour and 200mg/L (&lt;7) respectively while serial blood cultures were negative for septicemia and blood films were negative for acute leukemia; HIV, hepatitis B and C virus, tuberculosis, rheumatic fever, rheumatoid arthritis, and connective tissue disease screenings were all negative. Her hemoglobin genotype is AA. She had repeatedly received treatments for malaria and ‘sepsis’ with parenteral and oral antimalarials and antibiotics with no permanent relief, hence the reason for referral to the rheumatologist. An assessment of Systemic-onset Juvenile Idiopathic Arthritis (SoJIA) was made when her serum ferritin came back elevated at 670ng/mL (4.63 – 204) and she was commenced on oral ibuprofen with remarkable improvement evidenced by resolution of fever, joint pain and rash and normalization of ESR, CRP and serum ferritin within 8 weeks of treatment. Although SoJIA is rare, it would be worthwhile to include this disease in the differential diagnoses and subsequent evaluation in any child presenting with unexplained recurrent fever associated with body rash and polyarthritis.

A case of canine intestinal malakoplakia

Malakoplakia is a rare chronic granulomatous disease usually affecting the urinary bladder and other locations. In humans, the gastrointestinal tract is the second most common location but there are no reports of intestinal malakoplakia in animals. A 10-month-old female French Bulldog was presented with chronic haemorrhagic diarrhoea and anorexia with normochromic-normocytic anaemia and hypoalbuminaemia. Grossly, there was mucosal thickening and ulceration of the caecum, colon and rectum. Microscopically, transmural sheets of foamy macrophages were seen in these tissues. Macrophages were periodic acid–Schiff, vimentin and ionized calcium-binding adaptor molecule 1 positive and contained von Kossa- and Prussian blue-positive Michaelis–Gutmann bodies. Giemsa staining revealed rod-shaped bacterial colonies and fluorescence in-situ hybridization demonstrated Escherichia coli within macrophages. This is the first reported case of intestinal malakoplakia in domestic animals. Pathological features of intestinal malakoplakia share many similarities with ulcerative histiocytic colitis in dogs but it is unclear if they are different forms of the same pathological process or distinct entities.

BONE MARROW OXALOSIS, A RARE CAUSE OF PANCYTOPENIA: A CASE REPORT

Primary hyperoxaluria is a rare congenital metabolic disease characterised by an overproduction of oxalate, secondary to a hepatic enzyme deficiency, alanine glyoxylate aminotransferase (AGT). Calcium oxalate crystals are deposited in many tissues. Involvement of the bone marrow is relatively rare. We report the case of a young 29-year-old patient with a history of recurrent renal lithiasis, progressing to end-stage chronic renal failure at the haemodialysis stage, admitted to the medical ward for investigation of mucocutaneous pallor and anaemia resistant to erythropoietin. Clinical and laboratory examination revealed an oedematous-ascitic syndrome and pancytopenia with normocytic normochromic anaemia. Imaging revealed moderate ascites and homogeneous splenomegaly. The myelogram was inconclusive. An osteomedullary biopsy was performed and showed deposits of oxalate crystals with bone marrow fibrosis associated with foreign body macrophagic granulomas. These crystals were grouped in a rosette and birefringent in polarised light. Primary hyperoxaluria is a rare disease. Involvement of the bone marrow indicates the advanced stage of the disease, hence the importance of anatomopathological diagnosis. Hepato-renal transplantation remains the only effective treatment for this disease.

SULFUR TREATMENT FOR SCABIOSIS IN LOCAL PUPPY

A 2-month-old female local dog named Desi is experiencing skin problems with signs of itching and alopecia since she was resqueed 3 weeks before being examined. Clinical examination showed pruritus, alopecia, scales, erythema, papules and pustules. On examination of deep skin scrapping on the skin found the presence of Sarcoptes sp. mites amounted to one mite per one field of view. Hematological examination showed that the animal had leukocytosis, normochromic normocytic anemia, and thrombocytopenia. The dog was diagnosed with scabiosis. The dog’s owner have given simparica 2 weeks before the dog being examined. The therapy given is by injection of Diphenhydramine HCl 0.26 mL (1 mg/kg BW) once intramuscularly then continued with Chlorpheniramine Maleate 2 x tablets a day (0.5 mg/kg BW) for 7 days, Kalvidog 1 x ¼ tablets a day (1 tablet for dogs weighing 10 kg) for 10 days, and clean the itchy and alopecia skin using a wet tissue and smeared with Scabbless Cream (in the form of an ointment) for 10 days. Dogs are bathed 3 times every 3 days using Dermasep soap which contains sulfur. Evaluation after 10 days (24 days after simparica was given) the dog's condition had improved with reduced scratching intensity, squama, and a healthier looking coat. The results of the deep skin scrapping examination in 7 site also showed the absence of Sarcoptes sp. mites. The therapy continue in the form of smearing Virgin Coconut Oil and giving Kalvidog ¼ tablet every day. The purpose of this case report is to add information on cases of scabies in local puppies with alopecia, scales and pruritus. After 24 days of giving simparica, the dogs have experienced recovery because the simparica treatment was accompanied by treatment using topical soap or ointment containing sulfur for 10 days. Suggestions that can be given are for the owner to bathe the dog regularly, apply Virgin Coconut Oil and give Kalvidog multivitamins every day so that it can accelerate hair growth in the dog.

Characteristics of Anemia in the Elderly: Hospital-Based Study in West Java

Geriatric anemia can cause many problems and is a major health condition worldwide and in Indonesia. It is important to know the characteristics and prevalence of anemia among geriatrics in Indonesia, especially in West Java. By using simple hematology parameters to detect anemia in geriatrics, and then giving adequate treatment, morbidity, and mortality due to anemia may decrease in geriatrics. This study aimed to identify the type of anemia, etiology, age, gender, and prevalence of elderly patients with anemia in West Java. This was a cross-sectional study. Patients above 59 years old attending the geriatric clinic in Hasan Sadikin General Hospital and the geriatric community was included in this study to be evaluated for anemia, the characteristics of anemia (normocytic, microcytic, and macrocytic) based on MCV and MCHC, age group (&lt;=65 and &gt; 65 year old), and gender. Among 247 elderly patients, anemia was found in 33 patients (13.64%) and mostly found in females. Mostly represented as normochromic normocytic anemia (78.8%) and microcytic hypochromic anemia (21.2%), respectively. Individuals older than 65 years old were mostly presented with microcytic hypochromic anemia (66.7%). Meanwhile, normocytic normochromic anemia was more commonly found in individuals below 65 years old (12.1%). Anemia was commonly found in people older than 65 years old. The most common type of anemia in geriatrics in West Java was normocytic normochromic. Females experience anemia more than males.