Asian Hematology Research Journal

Acute Pediatric Immune Thrombocytopenic Purpura with Severe Thrombocytopenia: A Case Report

2026-05-25T10:51:56+00:00

Immune thrombocytopenic purpura (ITP) is an acquired autoimmune disorder characterized by isolated thrombocytopenia and an elevated risk of bleeding. It frequently manifests in pediatric patients following viral infections. We present a case of a one-year-old female child who presented with petechial rash and gum bleeding. Laboratory investigations revealed severe thrombocytopenia. The patient was diagnosed with ITP and managed with corticosteroids and supportive care. Early diagnosis and prompt intervention resulted in clinical improvement, underscoring the significance of timely management in pediatric ITP.

Haemophilia A in Female Carriers: Diagnostic and Therapeutic Insights from Two Case Reports

2026-06-04T16:48:41+00:00

Haemophilia A is a rare X-linked inherited bleeding disorder caused by a deficiency or a defect in coagulation factor VIII. Due to a recessive X–linked inheritance pattern, most men are affected, whereas their female relatives remain carriers. There is little experience about the rare symptomatic haemophilia carriers (1 in 100,000 women); there is no standard protocol to prevent the bleeding complications. We report two cases of first-time diagnosed haemophilia A carrier- one is a young adolescent girl, and another is an antenatal woman. Pregnancy normally induces a hypercoagulable state with increased Factor VIII, vWF, and fibrinogen. However, in haemophilia A carriers and women with von Willebrand disease, factor levels may remain low until the second trimester, increasing miscarriage risk. Effective management necessitates early recognition of the condition, the implementation of targeted haemostatic interventions, and coordinated multidisciplinary care. However, therapeutic options remain limited in resource-constrained settings, thereby posing significant challenges to optimal clinical management. In this context, strengthening clinical awareness, alongside the development and implementation of standardised management protocols, is essential to improve patient outcomes and reduce morbidity among affected women.

Seeing Beyond the Marrow: Periorbital and Multi-site Myeloid Sarcoma as Extramedullary Manifestations of Acute Myeloid Leukemia

2026-06-30T06:50:28+00:00

Myeloid sarcoma is an uncommon extramedullary manifestation of acute myeloid leukaemia (AML), and orbital involvement in adults is particularly rare. Delayed recognition may occur because periorbital swelling, proptosis, facial swelling and soft-tissue masses can resemble inflammatory or infectious disorders. This case report describes two young adults with AML who presented with prominent periorbital disease and were subsequently diagnosed with myeloid sarcoma by tissue biopsy. The first patient had unilateral periorbital and maxillary swelling with cytopenias and circulating blasts. Bone marrow evaluation confirmed AML, and biopsy of the facial soft-tissue mass confirmed myeloid sarcoma. The second patient presented with fever, progressive periorbital swelling, conjunctival chemosis, proptosis, visual impairment and a breast mass; bone marrow examination confirmed AML with an FLT3 internal tandem duplication mutation, and biopsies confirmed myeloid sarcoma at extramedullary sites. Both patients required transfusion support and received induction chemotherapy followed by high-dose cytarabine consolidation. Given the high-risk context of extramedullary disease, both proceeded to allogeneic haematopoietic stem cell transplantation, with post-transplant FLT3 inhibitor maintenance used in the FLT3-mutated case. These cases emphasise the need to consider myeloid sarcoma in patients with atypical orbital or periorbital masses, particularly when cytopenias or circulating blasts are present. Early tissue diagnosis and AML-directed systemic therapy may support favourable remission outcomes.

Congenital Dyserythropoietic Anemia Type II Mimicking Chronic Hemolytic Anemia: A Case Report

2026-07-04T12:47:31+00:00

Congenital dyserythropoietic anaemia type II is a rare inherited disorder of ineffective erythropoiesis that can resemble chronic haemolytic anaemia. This case describes a 25-year-old female with long-standing anaemia, recurrent jaundice, previous packed red blood cell transfusions, and splenomegaly measuring 13.5 cm. Initial laboratory evaluation showed haemoglobin of 8.9 g/dL, red blood cell count of 3.37 × 10⁶/µL, haematocrit of 31.6%, increased red cell distribution width, reticulocyte count of 4.1%, markedly increased circulating nucleated red blood cells, depleted haptoglobin, and normal haemoglobin electrophoresis. The direct and indirect Coombs tests were negative. Eosin-5-maleimide binding by flow cytometry showed a 22% reduction in mean fluorescence intensity, initially suggesting hereditary spherocytosis. Bone marrow examination was performed because of the discrepancy between the haemolytic phenotype and prominent nucleated red blood cells. The aspirate showed marked erythroid hyperplasia, with a myeloid-to-erythroid ratio of 0.2:1, binucleation, multinucleation, and karyorrhexis in erythroid precursors. Pseudo-Gaucher cells were also observed. Trephine biopsy confirmed hypercellular marrow with dominant erythroid hyperplasia, severe dyserythropoiesis, normal reticulin, and markedly increased iron stores graded as 5/6. Whole exome sequencing detected a single heterozygous SEC23B mutation. The overall findings supported congenital dyserythropoietic anaemia type II as the most likely diagnosis. This case highlights diagnostic overlap with chronic haemolytic disorders and the value of marrow morphology and extended genetic evaluation when initial screening tests are misleading.

Mixed Nutritional Anaemia in Chronic Alcohol Abuse: A Case Report

2026-07-17T10:47:17+00:00

Chronic, excessive alcohol consumption exerts direct toxic effects on the haematopoietic system and causes severe nutritional deficiencies. Rarely, multiple nutritional deficiencies coexist, creating a dimorphic red cell population that can normalise standard red cell indices, such as mean corpuscular volume, and result in significant diagnostic delays. A 56-year-old male civil servant with a 30-year history of heavy alcohol consumption (145 units/week) presented with a five-month history of progressive weakness, dizziness, fainting spells, and significant weight loss (>10 kg). Physical examination revealed severe pallor, tachycardia, hypotension, and hepatosplenomegaly. Initial laboratory evaluation revealed bicytopenia (haemoglobin: 8.3 g/dL; platelets: 77 × 10⁹/L) with a deceptively normal mean corpuscular volume (MCV: 84 fL). However, the red cell distribution width (RDW-SD) was markedly elevated at 71.8 fL. A peripheral blood film showed a dual morphology comprising macrocytes, hypochromic microcytes, and pencil cells, while a bone marrow aspirate confirmed combined megaloblastic and micronormoblastic erythropoiesis with absent iron stores. Serum folate (2.3 ng/mL) and vitamin B12 (322 pg/mL) levels were both reduced. Concurrent nutritional deficiencies involving folate, vitamin B12, and iron can morphologically mask one another, yielding a normal MCV that obscures the underlying pathology. Alcohol-induced liver disease may destabilise haemostatic and metabolic balance; in vulnerable patients, nutritional restitution alone may be insufficient, and early, multidisciplinary intervention may be required to reduce the risk of fatal multiorgan failure.

HIV – Associated Pure Red Cell Aplasia in the Absence of Parvovirus B19 and Zidovudine Exposure: A Rare Case Report

2026-07-21T11:01:29+00:00

Background: Pure red cell aplasia (PRCA) is an uncommon haematological disorder characterised by severe anaemia, reticulocytopenia, and selective suppression of erythroid precursors in the bone marrow, with preservation of other haematopoietic lineages. In patients with human immunodeficiency virus (HIV), PRCA is uncommon and is most frequently associated with parvovirus B19 infection or zidovudine therapy. HIV-associated PRCA in the absence of these common aetiologies is rare and poses a diagnostic challenge.

Case Presentation: We report a case of PRCA in a 56-year-old HIV-positive woman receiving tenofovir, lamivudine, and dolutegravir (TLD), who presented with progressive fatigue and severe symptomatic anaemia requiring packed red blood cell transfusion. The patient reported easy fatigability and reduced appetite; however, she had no evidence of gastrointestinal or other bleeding. Bone marrow examination revealed reduced erythropoiesis with relative granulopoietic predominance and findings consistent with PRCA. There was no history of zidovudine exposure, and parvovirus B19 serology was negative. Although serology alone cannot completely exclude parvovirus B19 infection in immunocompromised individuals, the overall clinical, laboratory, and bone marrow findings supported a diagnosis of presumed HIV-associated PRCA after common causes had been excluded.

Conclusion: This case demonstrates the importance of considering PRCA in the differential diagnosis of severe unexplained anaemia in patients with HIV, even in the absence of zidovudine exposure or positive parvovirus B19 serology. Early bone marrow examination is important for accurate diagnosis. Reporting such rare cases may improve clinical awareness and patient care.

Cardio-hematoprotective Effects of Manihot esculenta and Vernonia amygdalina Leaf Extract against Phenylhydrazine-induced Hemolytic Anemia in Rats

2026-06-03T09:22:00+00:00

Phenylhydrazine (PHZ)-induced hemolytic anemia is associated with oxidative stress and hematological dysfunction. This study evaluated the cardio-hematoprotective effects of combined Manihot esculenta and Vernonia amygdalina leaf extracts in PHZ-induced rats. Rats were divided into four groups: neutral control, PHZ-treated, PHZ + standard drug (Oreifer), and PHZ + plant extract. Oxidative stress biomarkers (MDA, SOD, CAT, GSH) in cardiac tissue and hematological parameters (WBC, RBC, Hb, PCV, PLT) were assessed. PHZ administration significantly increased malondialdehyde (MDA) levels while reducing antioxidant enzymes (SOD, CAT) and glutathione (GSH), indicating oxidative stress. It also caused marked reductions in red blood cells (RBC: 2.9 ± 0.82 ×10⁶/µL), hemoglobin (HGB: 31.42 ± 7.0 g/dL), and packed cell volume (PCV: 26.14 ± 5.5%), while elevating white blood cells (WBC: 13.12 ± 2.1 ×10³/µL) and platelets (PLT: 72.68 ± 12.4 ×10³/µL). Treatment with the combined plant extract significantly (p < 0.05) reduced MDA levels and restored antioxidant defenses, with notable improvements in CAT and GSH levels. Hematological parameters were also significantly improved, with restoration of RBC, Hb, and WBC levels toward normal. The effects of the extract were comparable to the standard drug in most parameters. These findings suggest that Manihot esculenta and Vernonia amygdalina leaf extracts possess potent antioxidant, cardioprotective, and hematoprotective properties, and may serve as promising therapeutic agents against oxidative stress and hemolytic anemia. Further dose and duration optimization are recommended.

Assessment of Some Haematological Parameters in Patients Infected with Hepatitis C Virus in Owerri, Nigeria

2026-06-03T11:35:08+00:00

Background: Hepatitis C virus (HCV) infection is a chronic viral disease of global public health importance characterized by progressive liver injury and numerous extrahepatic manifestations. Haematological abnormalities are among the most common systemic complications and contribute significantly to disease morbidity and prognosis.

Objective: This study evaluated selected haematological parameters - packed cell volume (PCV), platelet count, total white blood cell (WBC) count, and differential WBC counts - among HCV-infected patients in Owerri, Nigeria.

Methods: A hospital-based case control study involving 60 participants aged 18–60 years was conducted. Thirty serologically confirmed HCV patients and 30 age- and sex-matched healthy controls were recruited. Blood samples were analysed using standard manual haematological techniques. Statistical analysis was performed using SPSS version 25.0 with significance set at p ≤ 0.05. Results: HCV patients had significantly reduced PCV, platelet count, WBC count and neutrophil percentage, while lymphocyte percentage was significantly higher. No significant sex-based differences were observed. Strong negative correlations existed between lymphocyte and neutrophil percentages.

Conclusion: Chronic HCV infection is associated with anaemia, thrombocytopenia, leukopenia, neutropenia and relative lymphocytosis. Routine haematological monitoring is essential in clinical management.

Effect of Ionizing Radiation on Blood Parameters of Workers in the Field of Medical Radiation, White Nile State, Sudan

2026-06-29T11:05:39+00:00

Background: Ionising radiation can cause various forms of cellular damage, including an increased incidence of chromosomal aberrations. The cytotoxic effects of low-dose ionising radiation in occupationally exposed radiation workers have been reported; therefore, laboratory workers should be aware of the risks associated with handling radioactive materials.

Objective: This study aimed to examine the effect of ionising radiation on the haematological parameters of medical radiation workers.

Methods: A case-control study was conducted among medical radiology workers in White Nile State, Sudan, from July to October 2024. A total of 100 participants, divided into two groups (50 cases and 50 controls), were analysed for blood parameters using an automated blood analysis method (Sysmex), and the results were statistically processed using SPSS (version 21).

Results: The study identified statistically significant differences in red blood cell count and total white blood cell count between the groups under comparison. In contrast, platelet count and the majority of other haematological parameters did not differ significantly. Although variations in the mean haematocrit and mean corpuscular haemoglobin values were observed among certain medical radiographers, these differences were not statistically significant. Furthermore, no significant associations were detected between the duration of occupational exposure and most haematological parameters among medical radiographers.

Conclusions: In conclusion, the study demonstrated significant differences in red blood cell count and total white blood cell count between radiation-exposed workers and the control group. However, no statistically significant differences were observed in platelet-related parameters or in most differential white blood cell indices. Overall, the findings suggest that occupational radiation exposure was associated with only limited detectable alterations in haematological parameters within the study population.

Comparison of Red Blood Cell Parameters and Indices between Alcoholics and Non-Alcoholics in Okrika Local Government Area, Rivers State, Nigeria

2026-07-04T08:17:41+00:00

Alcohol consumption may influence haematological status and red blood cell indices; however, local data from Okrika Local Government Area, Rivers State, remain limited. This study compared selected red blood cell parameters and indices between alcohol-consuming adults and non-alcohol-consuming controls in Okrika. A total of 100 adult participants were recruited through convenience sampling, comprising 50 alcohol-consuming participants and 50 non-alcohol-consuming participants. Venous blood samples were collected into dipotassium ethylenediaminetetraacetic acid containers and analysed for full blood count using an automated haematology analyser. The parameters assessed were packed cell volume, haemoglobin concentration, red blood cell count, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration and red cell distribution width-coefficient of variation. Data were analysed statistically, and p≤0.05 was considered significant. The alcohol-consuming group had a higher mean packed cell volume than the non-alcohol-consuming group (38.68±5.22% versus 35.12±3.37%; p=0.01). Haemoglobin concentration was also higher among alcohol-consuming participants than among non-alcohol-consuming participants (12.8±1.7 g/dL versus 12.21±1.36 g/dL; p=0.05). No statistically significant differences were observed in red blood cell count, mean cell volume, mean cell haemoglobin, mean cell haemoglobin concentration or red cell distribution width-coefficient of variation. These findings suggest that alcohol consumption in the study population was associated with significant differences in packed cell volume and haemoglobin concentration, while other red blood cell indices showed no significant variation.

Polycyclic Aromatic Hydrocarbons in Grilled Meat (Suya): HPLC Profiling in Keffi, Nigeria

2026-07-09T10:28:00+00:00

Background: Polycyclic aromatic hydrocarbons (PAHs) are a group of environmental contaminants that arise from the incomplete combustion of organic matter or fuel. They consist of more than 200 organic compounds containing two or more fused aromatic rings.

Aim: This study aimed to assess the occurrence and quantify polycyclic aromatic hydrocarbons present in grilled meat (suya) sold around Keffi metropolis.

Methodology: Grilled meat samples were collected from four different locations in Keffi metropolis, namely Uke, Total Junction, along Nasarawa State University Road (School Road) and Old Barracks. High-performance liquid chromatography (HPLC) was used to identify and quantify polycyclic aromatic hydrocarbons in the samples.

Results: The HPLC analysis showed extensive contamination of barbecued chicken and grilled meat (suya) sold in Keffi with polycyclic aromatic hydrocarbons, particularly carcinogenic high-molecular-weight compounds such as chrysene, fluoranthene, benzo(a)pyrene and dibenz(a,h)anthracene, in substantial amounts.

Conclusion: This study provides scientific evidence that current street-vending practices for grilled meats in Keffi may pose public health concerns. Without targeted interventions, continued exposure may contribute to an increased burden of diet-related cancers within the population.

Assessment of Selected Laboratory Quality Management Essentials in the Haematology Department at a KENAS-Accredited Level 5 Mission Hospital in Kenya

2026-07-11T12:02:14+00:00

Aims: This study assessed adherence to three selected Laboratory Quality Management System (LQMS) essentials—Process Control, Facilities and Safety, and Equipment Management—in the Haematology Department of P.C.E.A Chogoria Hospital, Kenya.

Study Design: A descriptive cross-sectional study design with independent and joint assessments was used.

Place and Duration: The study was conducted in the Haematology Department of Chogoria Hospital, a KENAS-accredited Level 5 mission hospital in Tharaka Nithi County, Kenya, from February to March 2026.

Methodology: Census sampling covered relevant departmental staff, processes, facilities, equipment and documentation. A customised WHO SLIPTA checklist aligned with ISO 15189:2022 assessed 27 Process Control items (71 points), 24 Facilities and Safety items (57 points), and 16 Equipment Management items (37 points). Data were obtained through document review, interviews, observation and physical inspection. Compliance was scored as Yes, Partial, No or not applicable. Inter-rater reliability and Fisher's exact test were applied.

Results: Process Control achieved 98.6% (70/71), Facilities and Safety 98.2% (56/57), and Equipment Management 100% (37/37). Agreement ranged from 96.3% to 100% (Gwet's AC1, 0.96–1.00). Minor gaps concerned referral technical consultant procedures and fire detection/alarm systems. Fisher's exact test showed no statistically significant difference across domains (p = 1.000).

Conclusion: The department showed high compliance, although targeted corrective action is needed to address the remaining gaps.

Association between Absolute Lymphocyte Count and Platelet-Derived Inflammatory Ratios in Post-Menopausal Women: A Case-Control Study

2026-07-16T12:31:30+00:00

Background: Menopause is associated with hormonal and physiological changes that may influence haematological and inflammatory parameters. Platelet indices and platelet-derived ratios have been proposed as accessible markers of systemic inflammation and thrombotic tendency.

Aims: This study evaluated the relationship between absolute lymphocyte count and selected platelet-related inflammatory markers in post-menopausal women.

Methods: A hospital-based case-control observational study involving 73 participants aged 60-80 years was conducted. Forty-three post-menopausal women and 30 premenopausal women were recruited. Blood samples were analysed using an automated haematology analyser. Statistical analysis was performed using SPSS version 25.0, with significance set at P ≤ 0.05.

Results: Three (7.0%) post-menopausal women had platelet counts between 50 - <100 × 10⁹/L. No statistically significant differences were observed between post-menopausal and premenopausal women in platelet count, platelet indices, lymphocyte count or the calculated inflammatory ratios. In post-menopausal women, lymphocyte count showed a significant negative correlation with mean platelet volume-to-lymphocyte count ratio and platelet count-to-lymphocyte count ratio. Significant positive correlations were also observed between lymphocyte count and platelet count, plateletcrit and platelet-large cell count.

Conclusion: The findings suggest that lymphocyte count is associated with selected platelet-related inflammatory ratios in post-menopausal women. These parameters may provide useful haematological information, but larger studies are required to clarify their clinical relevance in post-menopausal health assessment.

Microcytic Transformation and Erythropoietic Failure in Helicobacter pylori Infected Pregnant Women with Faecal Occult Blood in Abakaliki, Nigeria

2026-07-27T10:12:35+00:00

Microcytic transformation and erythropoietic failure in pregnancy are commonly attributed to iron deficiency and physiological haemodilution; however, the independent and combined contributions of chronic H. pylori infection and occult gastrointestinal blood loss to anaemia severity remain poorly characterised, particularly in Nigerian obstetric populations. This comparative cross-sectional study enrolled 100 pregnant women in four groups: 40 healthy pregnant women (HPW) and 20 women each who were H. pylori-positive (H. P+), faecal occult blood (FOB)-positive (FOB+), or positive for both. Haemoglobin, packed cell volume, and red-cell indices - mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and mean corpuscular volume (MCV) - were measured and stratified by trimester and infection status. One-way analysis of variance with Tukey's HSD post hoc test assessed intergroup and trimester differences, while Pearson's correlation assessed associations with fibrinogen. Anaemia severity increased progressively across groups, from a mean haemoglobin of 12.07 ± 1.58 g/dL in HPW to 9.03 ± 2.01 g/dL in the co-positive group (p < 0.0001), and packed cell volume followed the same pattern (36.20 ± 4.05% to 28.21 ± 5.14%; p < 0.0001). The co-positive group was significantly more anaemic than either single-positive group (all pairwise p < 0.05) and showed the most marked microcytic, hypochromic pattern (MCV, 78.22 ± 2.33 fL; MCH, 24.67 ± 1.30 pg; MCHC, 30.89 ± 0.89 g/dL; all p < 0.0001 vs HPW). Trimester analysis showed distinct patterns: women in the H. P+ group had a marked MCV decline (88.00 to 79.00 fL; p = 0.001) by the second trimester, whereas the FOB+ group retained normocytosis until the third trimester (84.00 to 78.33 fL). MCHC declined significantly across trimesters in the H. P+ and co-positive groups, but not in the FOB+ group. These findings indicate that H. pylori infection was associated with an earlier, progressive microcytic hypochromic anaemic pattern, whereas isolated FOB positivity was associated with a later, milder iron-deficient pattern.

High-risk Shadows in a Favorable-risk Disease: The Indian Genomic Landscape of CBF-AML

2026-07-28T12:14:41+00:00

Background: Core-binding factor AML (CBF-AML), defined by RUNX1::RUNX1T1 and CBFB::MYH11 fusions, is conventionally classified as favorable-risk. Genomic data from low- and middle-income countries such as India remain limited.

Aims: This study aimed to characterise the co-mutational and cytogenetic landscape of Indian CBF-AML and compare co-mutation frequencies with the TCGA CBF-AML cohort.

Methods: This retrospective study analysed 165 Indian CBF-AML cases from two tertiary-care centres using targeted next-generation sequencing and, where available, cytogenetic analysis. Only Tier I/II pathogenic or likely pathogenic somatic variants with a variant allele fraction of ≥5% were counted as co-mutations; variants of uncertain significance were catalogued separately. Co-mutation frequencies were compared with 18 CBF-AML cases from The Cancer Genome Atlas using Fisher’s exact tests.

Results: Median age was 33.4 years (range 16–45; M:F = 3.1:1). RUNX1::RUNX1T1 predominated (70%; 116/165) and CBFB::MYH11 accounted for 30% (49/165). At least one co-mutation was present in 70% of RUNX1::RUNX1T1 and 80% of CBFB::MYH11 cases. NRAS was the most common co-mutation (32%). Compared with t(8;21), inv(16) cases showed significantly more spliceosome (p=0.028) and WT1 (p=0.021) mutations. Two cases carried complex-karyotype TP53 mutations. Among 62 karyotyped cases, at least one additional cytogenetic abnormality was seen in 32, most commonly trisomy 8 and trisomy 22.

Conclusion: Indian CBF-AML shares the core biology of Western cohorts but shows a higher co-mutational burden and enrichment of WT1 and spliceosome mutations in the inv(16) subtype. These descriptive findings, together with limited access to gemtuzumab ozogamicin in India, are hypothesis-generating and support prospective, outcome-linked evaluation of whether a uniform favorable-risk label is appropriate in this setting. No survival, MRD, or treatment data are presented; prognostic conclusions cannot be drawn.

Comparative Effects of ACD, CPD, and CPDA-1 on Haematological and Enzyme Parameters in Stored Blood

2026-08-01T07:21:53+00:00

Background: Stored whole blood undergoes progressive haematological and enzymatic changes that may vary according to the anticoagulant-preservative solution used.

Aims: This study evaluated the impact of anticoagulant type (ACD, CPD, and CPDA-1) and ABO blood group on haematological parameters and red cell enzyme activities during a 30-day storage period at 4°C.

Study Design: This was an exploratory, prospective, observational, and experimental study designed to monitor blood component quality over a period of 30 days.

Place and Duration of Study: Department of Medical Laboratory Science, Igbinedion University Teaching Hospital, Okada, from March 2026 to May 2026.

Methodology: This exploratory pilot study was conducted at Igbinedion University Teaching Hospital, Okada. Twelve healthy voluntary donors [three per ABO group] each donated one whole-blood unit [450 mL]. Units were stratified by ABO group and randomly allocated to ACD [n = 4], CPD [n = 4], or CPDA-1 [n = 4; one per ABO group per anticoagulant], thereby ensuring the use of independent donors. Units were stored at 4°C and sampled at 11 time points [Days 1, 3, 6, 9, 12, 15, 18, 21, 24, 27, and 30]. Full blood counts were performed using a Sysmex KX-21N analyser with daily calibration and e-Check controls. G6PD and GR were measured by ELISA [Cloud-Clone Corp.; Catalogue Nos. SEB723Hu and SEB314Hu; detection ranges, 0.312–20 ng/mL and 0.156–10 ng/mL; sensitivities, 0.112 and 0.056 ng/mL; intra-assay CV < 10%]. Data were analysed using the Friedman test, the Kruskal-Wallis test with Dunn-Bonferroni correction, and eta-squared [η²] effect sizes with 95% confidence intervals.

Results: All anticoagulants showed significant time-dependent declines in Hb, Hct, RBC count, and G6PD activity (p < 0.001). By Day 30, G6PD activity had decreased by 6.9–9.0%, whereas GR activity had decreased by 0.5–1.2%. Between-anticoagulant comparisons revealed significant differences in RBC count (p = 0.036), PLT count (p = 0.049), and GR activity (p = 0.037). CPDA-1 showed the least decline in Hb (-23.7%), Hct (-15.3%), PLT count (+11.5%), and GR (98.34 ± 1.32 U/g Hb), although the differences were not statistically significant (p = 0.105). CPD best preserved the RBC count (-23.1%) and G6PD activity (-6.9%). ABO blood group had no significant effect on Day 30 (p > 0.23).

Conclusion: In this exploratory pilot study with a small sample size [n = 12; four per anticoagulant group], CPDA-1 tended to preserve some haematological indices better than ACD and CPD; however, most Day 30 differences were not statistically significant after adjustment for multiple comparisons. Larger confirmatory studies are required before protocol changes can be recommended. ABO blood group did not appear to influence storage quality. The small sample size limits statistical power and generalisability; therefore, the findings are hypothesis-generating.

Contemporary Perspectives on Primary Extramedullary Acute Promyelocytic Leukaemia: Expanding the Clinical Spectrum

2026-07-01T04:27:33+00:00

Acute promyelocytic leukaemia is a distinct subtype of acute myeloid leukaemia defined by the PML-RARA fusion gene and responsiveness to differentiation-based therapy with all-trans retinoic acid and arsenic trioxide. Although acute promyelocytic leukaemia typically presents with bone marrow involvement, cytopenias, and coagulation abnormalities, extramedullary manifestations have been increasingly described. Primary extramedullary acute promyelocytic leukaemia refers to leukaemic infiltration outside the bone marrow at diagnosis, with absent or minimal marrow involvement. This rare presentation may create diagnostic uncertainty because it can resemble solid tumours, lymphoma, infection, or inflammatory disease. This narrative review examines current evidence on the epidemiology, biological basis, clinical presentation, diagnosis, treatment, and follow-up of primary extramedullary acute promyelocytic leukaemia. The reviewed literature includes clinical studies, guidelines, reviews, and case reports, with attention to central nervous system, skin, lymph node, soft tissue, orbital, gastrointestinal, bone, and visceral involvement. Molecular confirmation of PML-RARA remains essential for diagnosis, irrespective of disease location. Histopathology, immunophenotyping, cytogenetic assessment, and molecular testing are therefore central to accurate recognition. Treatment evidence remains limited because most data derive from case reports and small series. Systemic all-trans retinoic acid- and arsenic trioxide-based therapy remains central, while chemotherapy, radiotherapy, intrathecal therapy, or site-directed intervention may be considered according to disease burden, anatomical site, and clinical risk. Long-term surveillance is important because isolated extramedullary relapse may occur after apparent remission.

Re-emerging Syphilis Among Blood Donors: Epidemiological Signals, Screening Uncertainties and Implications for Transfusion Safety

2026-07-30T13:00:16+00:00

Syphilis has re-emerged as a major sexually transmitted infection in many regions, and blood services are increasingly detecting reactive and confirmed results among donors. This trend is important for two distinct reasons: it may signal changing infection patterns in populations eligible to donate, and it may alter the residual probability that infectious Treponema pallidum enters the blood supply. These issues are related but not equivalent. This critical narrative review evaluates contemporary donor epidemiology, the biological plausibility of transfusion transmission, the strengths and limitations of current screening algorithms, and the policy consequences of rising seroreactivity. Literature published from 1 January 2000 to 23 May 2026 was selected through live searches of PubMed/MEDLINE, Crossref metadata, DOI records, authoritative institutional sources, and citation networks, with older foundational reports retained where necessary. Recent surveillance from North America, Europe, Latin America, Asia and Africa consistently indicates higher positivity among first-time donors and marked variation by age, sex, geography, migration history and access to care. Yet between-study comparisons are weakened by heterogeneous case definitions, assay combinations, donor populations and denominators. Treponemal screening is highly sensitive but cannot distinguish untreated active infection from previously treated infection, while non-treponemal reactivity is influenced by disease stage, treatment and biological false positivity. Historical transmissions and experimental studies confirm that viable organisms can be present in donated blood, particularly during early infection and in fresh components, but modern processing, storage, donor selection and testing make documented transmission uncommon. Rising donor positivity should therefore be interpreted primarily as an epidemiological and quality-system signal, not as direct evidence of frequent transfusion transmission. Blood services require harmonised definitions of recent infection, transparent confirmatory pathways, donor-centred referral, linked public-health surveillance and resource-sensitive testing policies. Future research should connect serology with treatment history, behavioural data, component fate and recipient outcomes so that safety measures are proportionate to demonstrable risk.

Efficacy of Ponatinib in the Treatment of Chronic Myeloid Leukaemia: A Multicentre Observational Study from Bangladesh

2026-07-29T08:18:04+00:00

Objective: This study aimed to evaluate the use, efficacy, and safety of ponatinib in patients with chronic myeloid leukaemia (CML) treated outside clinical-trial settings in Bangladesh, where trial evidence may not fully reflect routine practice.

Methods: A retrospective, multicentre observational study was conducted among patients with CML treated with ponatinib at four tertiary hospitals between March 2022 and June 2023. Demographic, clinical, treatment, response, and safety data were collected and analysed.

Results: Among 60 patients, the median age was 42 years (range, 22–66 years), which was younger than that reported in major clinical trials. Thirty-six patients (60.0%) had advanced-phase disease (accelerated phase or blast crisis). All patients had previously received tyrosine kinase inhibitors (TKIs), and 56 (93.3%) switched because of treatment failure or a suboptimal response. The T315I mutation was detected in 15 patients (25.0%). Among 59 patients with evaluable response data, the overall response rate was 78.0% (46/59), and 26 patients (43.3%) achieved at least a major molecular response. Dose reduction from 45 mg to 30 mg once daily occurred in 28 patients (46.7%) because of adverse events, including vascular complications. Median failure-free survival and overall survival were 18 and 24 months, respectively.

Conclusion: In routine clinical practice in Bangladesh, ponatinib was used mainly as salvage therapy in a relatively young cohort with multi-TKI failure, irrespective of T315I status. Despite frequent dose reductions for safety, clinically meaningful responses were observed in this high-risk population.