Peripheral Blood Examination Research Articles

Myeloid sarcoma mimicking as recurrent squamous cell carcinoma: What is the etiology?

Abstract Introduction/Objective Myeloid sarcoma is an extramedullary malignancy of primitive myeloid cells and can occur during, preceding, or as a relapse of acute myeloid leukemia that occurs mostly in the soft tissue and skin. Methods/Case Report A 77-year-old white male with a history of oral squamous cell carcinoma status post resection (18 months ago) followed by radiation and chemotherapy (15 months prior), presented to the ear nose and throat clinic with increasing weakness and dizziness. He received two doses of Cisplatin and was currently on Pembrolizumab. On examination, there were two lesions in the oral cavity, one on the right gingivobuccal sulcus and a second on the left posterior mandibular ridge, suspicious for squamous cell carcinoma recurrence. Interestingly, the biopsy did not show evidence of recurrent squamous cell carcinoma but showed sheets of blasts that were positive for MPO, CD117, CD43, and CD68, consistent with myeloid sarcoma. Subsequent peripheral blood and bone marrow examinations showed acute myeloid leukemia. Results (if a Case Study enter NA) NA Conclusion Myeloid neoplasms post-cytotoxic therapy (MN-pCT) occur after radiation, alkylating agents, DNA topoisomerase II inhibitors, antimetabolites, and PARP1 inhibitors for a non-myeloid malignancy. Topoisomerase inhibitors are associated with MN-pCT after a latency period of 1 to 3 years; alkylating agents and radiation are associated with MN-pCT after a latency period of 5 to 7 years. Interestingly, this patient developed myeloid sarcoma in a previously irradiated area within 2 years. Cisplatin was discontinued after 2 doses due to side effect complications and is unlikely to be the culprit. Pembrolizumab is not considered to be a cytotoxic therapy and has not been reported to be associated with MN-pCT, however, the latency period for radiation-induced MN-pCT is unusually short in this patient and this raises the possibility of a Pembrolizumab-induced secondary myeloid neoplasm; additional investigation with other patients on this medication with second subsequent malignancies is required.

Rare Adult acute leukemia with Coexisting myeloblastic (basophilic differentiation) & B-lymphoblastic subpopulations Case Study

Abstract Introduction/Objective Acute basophilic leukemia is a very rare subgroup of acute myeloid leukemia that is defined in the 2022 WHO classification by presence of at least 20% blast cells in peripheral blood or bone marrow with immature and maturing cells of basophil lineage. The simultaneous occurrence of two hematological malignancies in a middle- aged adult patient is quite a rare event as evidenced by the rare cases reported in the literature. To our knowledge, this is the first case to be reported with concomitant acute basophilic and B-lymphoblastic leukemia in adult patients. these findings necessitates the comprehensive systematic approach to attain accurate diagnosis and plan the appropriate treatment protocol. Methods/Case Report Bone marrow aspiration & biopsy procedure was performed under local anesthesia and marrow samples were subjected to: lieshman staining of marrow films and direct examination. Immunophenotypic analysis of marrow aspirate by FACS Canto II flow cytometer. Cytogenetics studies were done as karyotyping and gene mutation detection by FISH. Results (if a Case Study enter NA) NA Conclusion Morphology of marrow films: 50% Blast cells, group of them are medium to larg-cells with high nucleocytoplasmic ratio and immature chromatin and the other group shows blast cells with sparse basophilic granulations, plus 20% immatue and maturing basophils. IPT shows two populations: the Myeloblast population (basophilic differentiation) is Positive for CD45dim, CD34het, CD13, CD33, CD117prt, CD25het, CD123het, cyt MPO part, HLA-DR partial. the B lineage lymphoblast population is Positive for CD45dim, CD34het, CD19, CD79a, TdT, CD20het, CD38. Cytogenetics studies: hyperploidy 56, (X, Y, 9, 10, 12, 13, 15, 18, 22, mar+ extra-chromosomes) FISH: +ve for FLT3-ITD mutation. the picture is by morphology & IPT consistent with biclonal leukemia, myeloid clone (acute basophilic leukemia) & ProB-ALL. The systematic laboratory approach from careful morphological examination of peripheral blood and bone marrow smears to confirmatory immunophenotypic analysis of marrow specimens by flow cytometry, and the comprehensive cytogenetics analysis, has a vital role in diagnosing such rare and aggressive phenomenon and provide a good chance for planning the appropriate treatment protocol with critical timesaving and cost effectiveness.

Eosinophil-Platelet Ratio as a Predictive Marker of the Postoperative Recurrence of a Chronic Subdural Hematoma.

Symptomatic chronic subdural hematoma (CSDH) is caused by repetitive hemorrhage and inflammation, which is commonly treated with burr-hole surgery and has a relatively high postoperative recurrence rate. A decrease in the platelet count is indicative of a hemorrhagic tendency, while an increase in the eosinophil count is associated with inflammation. Assessing the balance between platelet-associated hemostasis and eosinophil-associated inflammation using the indeterminate biomarker, the eosinophil-platelet ratio (EPR), may be essential. Therefore, in this study, the accuracy of the EPR in predicting postoperative CSDH recurrence was evaluated and their correlation was determined. Data on symptomatic CSDHs of the cerebral hemisphere of patients who underwent burr-hole surgery at our institution between January 2013 and December 2022 were retrospectively reviewed. The EPR was calculated from preoperative peripheral blood examination data, and its correlation with postoperative CSDH recurrence was assessed. The hemispheres with CSDH were categorized into recurrence and nonrecurrence cohorts. Data from 459 cerebral hemispheres of 405 patients with symptomatic CSDH were analyzed. In the 459 cerebral hemispheres with CSDH, 39 (8.5%) had postoperative recurrence. CSDH patients with a high EPR (≥1 × 10-3) had a significantly higher recurrent rate than those with a low EPR (<1 × 10-3) (15 of 86 [17.4%] vs 24 of 373 [6.4%], P = .002). In the modified Poisson regression analysis, the crude and adjusted risk ratios of high EPR were 2.79 (95% CI: 1.53, 5.09) and 2.62 (95% CI: 1.40, 4.89), respectively. This study reveals that a high EPR is a useful predictive biomarker for postoperative CSDH recurrence. Cases of CSDH with a high EPR potentially require careful and close postoperative follow-up.

SCKansformer: Fine-Grained Classification of Bone Marrow Cells via Kansformer Backbone and Hierarchical Attention Mechanisms.

The incidence and mortality rates of malignant tumors, such as acute leukemia, have risen significantly. Clinically, hospitals rely on cytological examination of peripheral blood and bone marrow smears to diagnose malignant tumors, with accurate blood cell counting being crucial. Existing automated methods face challenges such as low feature expression capability, poor interpretability, and redundant feature extraction when processing highdimensional microimage data. We propose a novel finegrained classification model, SCKansformer, for bone marrow blood cells, which addresses these challenges and enhances classification accuracy and efficiency. The model integrates the Kansformer Encoder, SCConv Encoder, and Global-Local Attention Encoder. The Kansformer Encoder replaces the traditional MLP layer with the KAN, improving nonlinear feature representation and interpretability. The SCConv Encoder, with its Spatial and Channel Reconstruction Units, enhances feature representation and reduces redundancy. The Global-Local Attention Encoder combines Multi-head Self-Attention with a Local Part module to capture both global and local features. We validated our model using the Bone Marrow Blood Cell FineGrained Classification Dataset (BMCD-FGCD), comprising over 10,000 samples and nearly 40 classifications, developed with a partner hospital. Comparative experiments on our private dataset, as well as the publicly available PBC and ALL-IDB datasets, demonstrate that SCKansformer outperforms both typical and advanced microcell classification methods across all datasets.

An Innovative Hybrid Model for Automatic Detection of White Blood Cells in Clinical Laboratories.

Background: Microscopic examination of peripheral blood is a standard practice in clinical medicine. Although manual examination is considered the gold standard, it presents several disadvantages, such as interobserver variability, being quite time-consuming, and requiring well-trained professionals. New automatic digital algorithms have been developed to eliminate the disadvantages of manual examination and improve the workload of clinical laboratories. Objectives: Regular analysis of peripheral blood cells and careful interpretation of their results are critical for protecting individual health and early diagnosis of diseases. Because many diseases can occur due to this, this study aims to detect white blood cells automatically. Methods: A hybrid model has been developed for this purpose. In the developed model, feature extraction has been performed with MobileNetV2 and EfficientNetb0 architectures. In the next step, the neighborhood component analysis (NCA) method eliminated unnecessary features in the feature maps so that the model could work faster. Then, different features of the same image were combined, and the extracted features were combined to increase the model's performance. Results: The optimized feature map was classified into different classifiers in the last step. The proposed model obtained a competitive accuracy value of 95.6%. Conclusions: The results obtained in the proposed model show that the proposed model can be used in the detection of white blood cells.

Angelica sinensis polysaccharides ameliorate 5-FU-induced stress anemia via promoting extramedullary erythroblastic island central macrophage-mediated erythroid differentiation

BackgroundChronic anemia, especially chemotherapy-induced anemia, is a common and intractable symptom. Puzzlingly, the conventional anemic treatment may lead to various side effects, and the mechanism of stress anemia remains unclear. MethodsHere, peripheral blood, histopathological and transmission electron microscopical examination, colony forming test, flow cytometry, and qRT-PCR assay were used to investigate the effects of Angelia sinensis polysaccharide (ASP), one main active ingredient of Chinese herb medicine Angelica sinensis, on ameliorating 5-fluorouracil (5-FU)-induced stress anemia. ResultsWe found that intraperitoneal injection to a C57BL/6J mouse ASP 100 mg/kg per day for consecutive 10 days or 14 days, remarkably accelerated the recovery of RBC, hemoglobin, and hematocrit in blood. ASP alleviated 5-FU-caused impairment of bone marrow cell and BFU-E enumeration. Meanwhile, ASP antagonized 5-FU promoting extramedullary erythropoiesis in the spleen, inducing splenomegaly due to stress erythroblastic islands, and occurrence of megakaryocytes and hematopoietic precursors in splenic colonies. ASP increased splenic stress BFU-E enumeration, driving BFU-E differentiation towards Pro-E and end-stage erythroblasts. Furthermore, ASP increased the number of F4/80+VCAM-1+ splenic erythroblastic island central macrophages, upregulating genetic expression of EPOR, Emp, VCAM-1, Hmox-1, Trf, TfR1, Fpn1, Spi-C, DNase2a, Tim4, MertK, and Klf1 in splenocytes. ConclusionsOur findings indicate that the possible mechanism of chemotherapy-induced anemia is related to stress erythroid maturation arrest. Whereas, ASP may promote stress erythroid differentiation via elevated EPO sensitivity in extramedullary hematopoietic organs and enhanced macrophage-mediated adhesion, iron homeostasis and transfer, and nuclear engulfment, which may represent a promising therapeutic strategy.

Automated feathered edge blood smear analysis: early diagnosis of carcinocythemia in a case of disseminated intravascular coagulation with multi-organ failure.

Carcinocythemia, known as the presence of circulating tumor cells in the peripheral blood, is difficult to detect when the carcinoma cells are minimally present. We describe a case of a 56-year-old patient presenting with disseminatedintravascular coagulation (DIC) and multiple organ failure. Despite initial suspicion of sepsis, a peripheral blood smear showed the presence of atypical cells, mainly located at the feathered edge, leading to a presumptive diagnosis of carcinocythemia of unknown primary origin. The presence of a high-fluorescent cell population detected by our hematology analyzer (Sysmex XN-9100) and immunohistochemical staining with pancytokeratin AE1/AE3 confirmed the carcinoma cell origin. The patient died 4 days after referral to our hospital. Postmortem examination revealed a pleomorphic lobular breast carcinoma (triple-negative, androgen receptor-negative). Given the clinical acuity of patients with carcinocythemia, early diagnosis is essential to guide management. This case underscores the importance of optimizing current workflows relying on complex flagging algorithms and enhanced digital imaging to aid in the early detection of such rare condition. When patients present with DIC of unknown origin and high fluorescent signals are detected on the hematology analyzer, carcinocythemia should actively be ruled out by extensive microscopic peripheral blood examination.

Investigate the impact of laser dosages on the regeneration of peripheral blood leukocytes after gamma radiation exposure

This research aims to examine how treatment with lasers affects the regeneration of peripheral blood leukocytes following ionizing radiation exposure. Furthermore, how may laser treatment be administered to people who have inadvertently come into contact with ionizing radiation? After being subjected to one dose of five Gy, non-lethal (1.5 Gy/min) from gamma radiation (cobalt-60), the mice developed radiation-induced sickness, as evidenced by a drop in white blood cell count and hematological symptoms. The mice were subsequently subjected to non-ionizing radiation using a 20 W power laser (Nd: YAG 1064 nm). Within the first two weeks after the application of gamma rays for 30 min, there were a total of five laser treatments. Laser energy yielded a total of 60,000 J/cm2. The energy density in each treatment was 12,000 J/cm2. Based on the peripheral blood examination, the study establishes that the use of lasers had an important influence on the number of lymphocytes two weeks after irradiation. Furthermore, following laser treatment, the lymphocyte lineage of white blood cells recovered more quickly. In gamma-irradiated mice, the study showed that the treatment laser under examination increased the overall counts of several types of white blood cells, indicating an indefinite effect. The investigation's findings may have an impact on how radiation illness is treated for specific patients. The results of this investigation may have a substantial influence on the treatment of radiation sickness in people.

Bone Marrow Aspiration and Biopsy Findings in Patients with Hematological Disorders in a Tertiary Care Center from Eastern Nepal: An Institutional Experience

Background: Bone marrow study is an important study which is performed when the peripheral blood examination and other laboratory tests and clinical signs and symptoms are suggestive and sometimes inconclusive of both hematological neoplastic and non-neoplastic conditions. The aim of this study was to study about the indications of bone marrow to assess the diagnostic value and comparison of microscopic findings with immunophenotyping and molecular studies. Methods: A total of 102cases were analyzed retrospectively and prospectively from January 2022 to October 2023. All the bone marrow aspiration and trephine biopsy received at the laboratory during this period were included in the study and other cases were analyzed form medical record of the department. Results: Among the 102 cases, mean age of the patient was 48 years and majority were male patients. The age range was between 17-80 years. The male: female ratio was 1.25:1. Weakness was most common presenting complain. Acute leukemia was the most frequent diagnosis (24.5%) followed by myeloproliferative neoplasm (7.8%), primary aplastic anemia (6.9%), myelodysplastic syndrome (5.8%), megaloblastic anemia (4.9%) and plasma cell dyscrasia (3.9%), CLPD (2.9%), ITP (1.9%). Reactive marrow constituted 3.9% and few of the rare diagnosis included hypereosinophilia with PDGFRA mutation, Leishmaniasis etc. Conclusions: The study concludes the bone marrow aspirate and biopsy examination is still the gold standard technique for screening and definite diagnosis of hematological conditions. Immunophenotyping and molecular studies are important for treatment purpose and in case of cytomorphological dilemma.

Lymphoglandular bodies as useful morphological clue in diagnosis of Lymphoid malignancies- A Case Report

Lymphoglandular bodies, observed as round basophilic cytoplasmic fragments on Giemsa stain, are linked with lymphoid malignancies, aiding in distinguishing lymphomas from other small round cell tumors. This case report underscores the diagnostic significance of Lymphoglandular bodies in Acute lymphoid leukemia diagnosis through bone marrow biopsy. We present a case of a 21-year-old male with chest pain and weakness. The bone marrow biopsy revealed a monomorphic cell population with a high nuclear cytoplasmic ratio, prompting immunomarker analysis that confirmed the presence of blasts as lymphoblasts, leading to the diagnosis of Acute lymphoid leukemia. The identification of Lymphoglandular bodies in bone marrow biopsy facilitated the diagnosis, as peripheral blood examination did not indicate the presence of blasts suggestive of leukemia. Literature on the role of Lymphoglandular bodies in lymphoma diagnosis is limited, with more emphasis on cytological preparations. Lymphoglandular bodies serve as an adjunct in differentiating between lymphoma and non-lymphoma malignancies, being more frequently associated with Malignant lymphoma. The study aim to prove Lymphoglandular bodies as useful morphological clue in diagnosis of Lymphoid malignancies.

Modern management of leukemoid reactions

ABSTRACT. Leukemoid reaction (LR) is a transient hematological syndrome of reactive nature characterized by persistent leukocytosis of more than 50,000 cells/µL. LR can be caused by a variety of factors, including infections, intoxications, malignant neoplasms, severe hemorrhages, or acute hemolysis.&#x0D; The most common form of LR is neutrophilic myeloid reaction, which occurs in 80-90 % of cases. The diagnosis of LR is based on clinical examination and laboratory test results, including complete blood count with differential leukocyte formula, determination of leukocyte alkaline phosphatase level, aspiration and biopsy of bone marrow.&#x0D; Differential diagnosis of LR from other forms of leukemia is a challenging task. For this, it is necessary to conduct a thorough examination, including cytogenetic and molecular analysis of peripheral blood and bone marrow granulocytes. Despite certain advances in the differential diagnosis of LR, the mortality rate of patients in the world remains high, which requires the attention of doctors of various profiles.&#x0D; Treatment of LR depends on the underlying cause that caused it. The article proposes a diagnostic and treatment algorithm for LR in the case of its toxico-infectious origin.

Inflammation biomarkers in the intracranial blood are associated with outcome in patients with ischemic stroke

BackgroundPerforming endovascular treatment (EVT) in patients with acute ischemic stroke (AIS) allows a port of entry for intracranial biological sampling.ObjectiveTo test the hypothesis that specific immune players are molecular contributors...

A Review of Three Cases of Primary Plasma Cell Leukemia: Incidental Finding Discovered by Blood Smear Revision

Introduction: Plasma cell leukemia (PCL) is the most aggressive variant of the monoclonal gammopathies (MG). Its diagnosis is based on standard morphological examination of peripheral blood, by finding plasma cells with an atypical morphology. The International myeloma working group (IMWG) has updated the diagnostic criteria for PCL considering that patients with newly diagnosed MG with 5% or greater plasma cells in peripheral blood should be considered as PCL. Case report: We present three cases of primary PCL that were admitted to the hospital due to the study of an anaemia and whose diagnosis was an incidental finding. All the patients had &gt;5% of circulating plasma cells, whose clonality and aberrant phenotype was determined by peripheral and blood marrow flow cytometry immunophenotype and all of them had high-risk cytogenetics related with a poor and adverse outcomes of the disease. Discussion: This cases highlight the importance of peripheral blood smear revision, because the identification of aberrant plasma cells leaded the diagnosis of the MG and the patients were able to start treatment as soon as possible. Carefully examination and interpretation of peripheral blood smear should be always performed, with special attention in patients with a suspicion of MG, because with the new IMWG definition, it is possible that this entity is underdiagnosed.

Occult Filariasis in a Case of Lymphocytic Thyroiditis Diagnosed on Fine Needle Aspiration Cytology: An Unusual Finding of Dual Pathology

Filariasis is a common public health problem in Southeast Asia. The two species of worms most commonly associated with this disease are Wuchereria bancrofti and Brugia malayi. Cases of microfilaraemia have also been reported from atypical sites in the past. None of the previously reported cases of microfilaria in the thyroid gland have described occult filariasis against a background of lymphocytic thyroiditis. The authors present a case of incidental microfilaria in a case of lymphocytic thyroiditis, diagnosed on fine needle aspiration cytology of thyroid swelling in a female, a coexistence of dual pathology. There has been no case in literature where filariasis was reported against a background of lymphocytic thyroiditis. Peripheral blood examination also did not show any evidence of filariasis.

Hematologic Recovery in Pediatric Patients with Acute Lymphoblastic Leukemia After Induction Chemotherapy

Link of Video Abstract: https://youtu.be/ulLjSscae2Q Introduction: Myelosuppression in Acute Lymphoblastic Leukemia (ALL) children was associated with high morbidity and mortality. Chemotherapy was aimed to achieve remission conditions, including the elimination of blast cells in the bone marrow. However, the evidence of hematologic recovery after induction chemotherapy was poorly described. This study aimed to evaluate the profile of peripheral blood and the outcome of children with ALL after induction chemotherapy. Methods: A prospective study was conducted in the Hematology-Oncology Pediatric Department at Saiful Anwar Hospital Malang. Patients &lt;15 years old who were newly diagnosed as ALL were enrolled in this study. Peripheral blood examinations were performed on the 1st, 2nd, 4th, and 6th weeks. Clinical outcomes were evaluated by remission status. Comparison and correlation analysis were done by IBM SPSS for Windows, version 26. P-value &lt;0,05 was considered significant. Result: There were 27 children included in this study. The median age was 5 years. There were 15 males and 17 females, 18 patients with LLA-L2 and 9 patients with LLA-L1. All patients received chemotherapy regimens according to the 2018 National Protocol for ALL. The median hemoglobin level was significantly increased after induction chemotherapy (p&lt; 0.05). Meanwhile, the reticulocyte count increased in the 2nd week after induction chemotherapy. The Absolute Neutrophil Count (ANC) significantly improved and reached the normal limit in 4th week after chemotherapy induction. The platelet count and Immature Platelet Fraction (IPF) also increased significantly (p&lt; 0.05) and reached the normal limit in 4th week after induction of chemotherapy. Conclusion: Three cell lines regenerate at different rates at induction chemotherapy, with rapid erythrocyte recovery and slow neutrophil and platelet recovery.

Hairy Cell Leukemia with Severe Leukocytosis

Introduction Hairy cell leukemia (HCL) is a rare indolent mature B-cells neoplasm that typically manifests with pancytopenia and splenomegaly. Nevertheless, significant splenomegaly, high hairy cells count in the blood, elevated β 2 microglobulin, and increased LDH can predict resistance to purine analogs. The absence of BRAF V600E mutation in HCL is rare and is associated with poorer outcomes. Case Presentation A 68-year-old female patient presented with symptomatic massive splenomegaly, leukocytosis (89,000 /microliter), monocytopenia, and thrombocytopenia. β 2microgobulin level was 4.4 mcg/L. Lactate dehydrogenase was 521 U/L. Peripheral blood and bone marrow examinations revealed typical hairy cells morphology, and the cells were positive for CD19, CD20, CD103, CD25, CD11c, CD200 (dim), and surface-Kappa. CD38 was negative. BRAF V600E result was wild-type. IGHV was mutated (IGHV3-49). She received first-line therapy with a 5-day course of Cladribine (0.15 mg/kg/day) with initial resolution of leukocytosis, normalization of platelets, and a 50% reduction in spleen size. This was followed by consolidation with an 8-weekly course of Rituximab (375 mg/m 2). Soon after the 2 nd dose of Rituximab, leukocytosis recurred, and she was initiated on second-line therapy with Bendamustine (90 mg/m 2 on days 1 and 2) along with Rituximab (BR). She has not achieved any durable response following two cycles of BR. Unfortunately, she suffered a septic shock requiring admission to our intensive care unit. Upon routine mental status evaluation, brain MRI revealed innumerable supratentorial and infratentorial bilateral acute/subacute and old microhemorrhages (Figure 1). This prompted further evaluation of unexplained recurrent episodes of pulmonary hemorrhages while on mechanical ventilation that were found to be secondary to pulmonary end-arterial cavitating lesions suggestive of hairy cells infiltration (Figure 2 arrowheads). As she was clinically unstable, we attempted to control leukocytosis with corticosteroids, leukapheresis aggressively and started the patient on Ibrutinib, but she succumbed to her disease. Discussion Recently, the 5 th edition of the World Health Organization classification of hematolymphoid tumors highlighted the splenic B-cell lymphoma and leukemia family that encompasses hairy cell leukemia (HCL), splenic B-cell lymphoma/leukemia with prominent nucleoli (SBLPN), formerly known as hairy-cell leukemia variant, splenic diffuse red pulp small B-cell lymphoma (SDRPL) and splenic marginal zone lymphoma (SMZL). HCL is typically an indolent mature B-cell neoplasm with characteristic pathologic features that preferentially insinuate the bone marrow and the spleen causing impaired hematopoiesis and splenomegaly. Unlike other disorders within this group, HCL commonly harbors BRAF V600E somatic mutation in almost all cases. Rarely, patients with HCL can have extramedullary involvement by the malignant cells. Leukocytosis in HCL appears to increase the risk of developing extramedullary lesions that can present unique clinical challenges necessitating early and effective therapy. According to the literature, brain lesions in HCL were described in three other cases, and leukocytosis was a common denominator. Our patient with significant leukocytosis had brainand pulmonary lesions, and the latter was the cause of her demise due tounusually aggressive and refractory disease. Therefore, we hypothesize that leukocytosis in HCL can be “the tip of the iceberg”. The higher the leukocytosis, the higher the burden of extramedullary disease, as in our case, who had simultaneous lesions in the brain and lungs. Patients with HCL and leukocytosis may warrant initial diagnostic evaluation to ensure the absence of potentially sinister lesions, which can inform subsequent monitoring and management plans. Additionally, more novel therapies could be considered sooner in the treatment course to control the disease and these lesions. Finally, our patient did not harbor BRAF V600E mutation, which likely resulted in further worse outcomes and limited the usage of targeted therapies like BRAF inhibitors.

Prevention of acute respiratory viral infections in children with chronic exudative otitis media in the postoperative period

Introduction. Chronic otitis media vis effusion (COME) is a disease characterized by the presence of exudate in the cavities of the middle ear and hearing loss. Predisposing factors to the development of COME can be recurrent upper respiratory tract infections.Aim. To study the effectiveness of the drug Sinupret® in children who have undergone surgical treatment for COMEMaterials and methods. A clinical study was conducted at the Department of Otorhinolaryngology of TMU and GBUZ TO OKB No. 2 in 2020–2021. This study involved 30 children (15 boys and 15 girls) with HESO. The mean age of all patients was 6.33 ± 0.31 years. In the 1st group of children, consisting of 15 people (10 boys and 5 girls), Sinupret® was prescribed in the postoperative period, in the 2nd group of children, consisting of 15 people (5 boys and 10 girls), Sinupret® was not prescribed. Diagnosis of chronic POE was carried out on the basis of clinical and instrumental examination and integral indices of peripheral blood. Conservative treatment consisted of topical decongestant therapy and rifamycin 2.6% ear drops for a week. The observation period included 12 months.Results. ARVI episodes during the year in group I were observed in 20%, in group II in 60% of children, the average duration of the disease in group I was 5 ± 0.71 days, in group II 7.8 ± 0.42 days (p = 0.01), stable hearing recovery in children of the 1st group was recorded in 100%. POE recurrence in children of group II was registered in 27% (4 people), which required repeated shunting to restore hearing.Conclusions. Prophylactic use of the drug Sinupret® in children who have undergone surgical treatment for chronic OME allows you to achieve a stable restoration of hearing and contributes to complete recovery.

Case report: Malaria and Thrombocytopenia at Pimping Community Health Center, North Kalimantan, an Endemic Area in Indonesia

Thrombocytopenia is one of the most frequent side effects of both Plasmodium vivax and Plasmodium falciparum malaria, despite the fact that it is not a sign of severe malaria. However, few studies said that thrombocytopenia would early recognition of severe malaria. Moreover, thrombocytes play a significant part in inflammatory response during malaria. In these cases, present malaria falciparum and vivax with thrombocytopenia without bleeding and any severe malaria. The case diagnosis with a rapid diagnostic test of malaria and peripheral blood examination.

Peripheral neuropathy associated with chronic lymphoproliferative disorders of natural killer cells (CLPD-NK): a case report and literature review

BackgroundChronic lymphoproliferative disorders of natural killer cells (CLPD-NK) is a rare lymphoproliferative disease. Peripheral neuropathy is an unusual symptom of CLPD-NK. We report a case of peripheral neuropathy associated with CLPD-NK and perform a review of literatures.Case presentationa 62-year‐old woman presented with progressive numbness and weakness in both extremities. Electrophysiological examinations indicated a sensorimotor polyneuropathy. Peripheral blood examination revealed that the number of white blood cells (WBC) and lymphocytes were significantly increased. Flow cytometry analysis identified that 84% of the lymphocytes are NK cells that mainly expressed CD56, combined with variable expression of CD16, CD2, CD7, CD94, granzyme B, perforin, and CD158 but negative for CD3. Sural nerve biopsy revealed that a plethora of NK cells infiltrated into nerve fascicles. On treatment with combined cyclophosphamide and corticosteroids, her symptoms rapidly improved. Moreover, the absolute lymphocyte count and its proportion recovered to normal range after 3 months’ treatment.ConclusionTo the best of our knowledge, this is the first case report of peripheral neuropathy associated with CLPD-NK from Chinese. This rare lymphoproliferative disease should be considered if peripheral neuropathy combines with increased WBC or lymphocytes. Immunosuppressive drugs are the major treatment and most patients can achieve a good prognosis.

A Surinamese Woman with Severe Hypercalcemia and Ascites

A 60-year-old Surinamese woman was admitted to the department of Hematology because of refractory hypercalcemia and weight loss. Three months earlier she presented with aphasia and ataxia due to hypercalcemia (4.32 mmol/L). She was treated with intravenous fluids, calcitonin and pamidronate, resulting in normocalcemia. Serum Parathyroid Hormone (PTH) was 1.93 pmol/L. At that time, a bone marrow and Peripheral Blood (PB) examination and Fluorodeoxyglucose-Positron Emission Tomography (FDG-PET) scan did not show any abnormalities. Physical examination revealed multiple papules and diffuse scaling (Figure 1A). Current PB analysis demonstrated anemia (10 g/dL), thrombocytopenia (103 x 109/L), leukocytosis (20.5x 109/L; 38% lymphocytes), hypercalcemia (3.58 mmol/L) and elevated LDH (652 U/L). FDG-PET/CT at this time point showed ascites and splenomegaly.