Asian Hematology Research Journal

Concurrent B Cell Acute Lymphoblastic Leukemia (ALL) and Histiocytic Sarcoma (HS): A Case Report

Arshad Raja — 2026-09-10

Histiocytic sarcoma is a rare haematopoietic neoplasm with aggressive clinical behaviour and limited standardised treatment guidance. Its occurrence in association with acute lymphoblastic leukaemia is uncommon and may create significant diagnostic and therapeutic challenges. This case report describes a 25-year-old woman who was diagnosed with B-cell acute lymphoblastic leukaemia after presenting with fever and generalised tiredness. Initial evaluation showed blast involvement in the peripheral blood and bone marrow, with flow cytometry supporting B-cell lineage disease. Cytogenetic testing by FISH was negative for BCR-ABL, ETV6-RUNX1, KMT2A, and TCF3 rearrangements, and there was no central nervous system involvement at diagnosis. The patient received HyperCVAD chemotherapy and achieved measurable residual disease-negative remission after the first cycle. During subsequent therapy, she developed persistent fever despite negative infectious and haemophagocytic lymphohistiocytosis work-ups. Repeat bone marrow biopsy and PET-CT revealed a multifocal process, including metabolically active breast nodules and skeletal lesions. Core biopsy of the right breast lesion showed large histiocytoid cells with diffuse CD68 and CD4 positivity, weak LCA and TdT expression, absence of other myeloid and lymphoid lineage markers, a Ki-67 index of 15–20%, and negative BRAF V600E staining. These findings supported a diagnosis of histiocytic sarcoma involving the breast and bone marrow. The patient’s condition deteriorated despite further therapy, and palliative care was initiated. This case highlights the need for careful clinicopathological correlation when atypical lesions emerge during treatment for acute lymphoblastic leukaemia.

When the Count Lies: EDTA-dependent Leukoagglutination Unmasked by a Peripheral Smear in Chronic Hepatitis C Infection

Bashir Abdrhman Bashir — 2026-09-24

Automated complete blood count analysers can generate spuriously low cell counts when anticoagulant-dependent aggregation occurs, creating a risk of misclassification as true cytopenia. This case report describes EDTA-dependent leukoagglutination in a 70-year-old man with chronic hepatitis C infection who presented with worsening lethargy, pallor, mild jaundice, and mild hepatosplenomegaly. Initial testing of an EDTA-anticoagulated sample showed severe anaemia, borderline leukopenia, and mild thrombocytopenia. Peripheral blood smear examination demonstrated compact aggregates of morphologically unremarkable segmented neutrophils, associated cytoplasmic debris, and occasional adhering platelets, while free nonaggregated leukocytes were sparse. The red cell population showed anisopoikilocytosis with occasional schistocytes. Recollection into sodium citrate abolished the leukocyte aggregation. Repeat analysis produced a total leukocyte count of 4.4 × 10⁹/L, an absolute neutrophil count of 3.1 × 10⁹/L, and a platelet count of 115 × 10⁹/L before correction for citrate dilution; the corresponding corrected values were 4.84 × 10⁹/L, 3.41 × 10⁹/L, and 126.5 × 10⁹/L. The disappearance of aggregates with normalisation of leukocyte and neutrophil counts confirmed EDTA-dependent leukoagglutination as the cause of pseudoleukopenia. This case highlights the diagnostic value of correlating automated counts with peripheral smear morphology and confirmatory testing using an alternative anticoagulant when an apparent cytopenia is discordant with microscopic findings.

Congenital Methemoglobinemia Misdiagnosed as COVID-19 in a 20-Year-Old Male: A Case Report

Arshad Raja — 2026-09-24

Congenital methaemoglobinaemia is a rare disorder that may be overlooked when persistent cyanosis and low pulse-oximetry readings are attributed to cardiopulmonary disease. We report a 20-year-old male who presented with fever, peripheral cyanosis, clubbing and mild dizziness during the COVID-19 pandemic. Persistent SpO₂ readings of 86–87% led initially to isolation and treatment for suspected COVID-19, despite two negative RT-PCR tests and normal chest radiography, echocardiography, chest CT and CT pulmonary angiography. Subsequent arterial blood gas analysis showed pO₂ of 113 mmHg, while co-oximetry demonstrated MetHb 35.2%, O₂Hb 60.7%, HHb 4.1% and sO₂ 93.7%, with calculated sO₂(c) 98.4%. Clinical exome sequencing identified a homozygous likely pathogenic CYB5R3 variant, NM_000398.7:c.148C>T (p.Arg50Trp), supporting congenital methaemoglobinaemia. Erythrocyte cytochrome-b5-reductase activity was not measured, so a definitive biochemical subtype could not be established. The combined clinical, co-oximetry and genetic findings supported the final diagnosis. The patient commenced vitamin C tablets in March 2022, and follow-up in April documented improvement in symptoms and cyanosis. This case highlights the diagnostic value of considering methaemoglobinaemia when cyanosis and pulse-oximetry findings remain unexplained by routine cardiopulmonary investigations, particularly when oxygen measurements are discordant.

Turnaround Time in the Haematology Laboratory and Its Impact on Patient Care

E. Wealthy-Emmanuel — 2026-09-25

Background: Turnaround time (TAT) is a visible indicator of laboratory performance because delays in haematology testing can postpone diagnosis, treatment, transfusion decisions, surgery and discharge. However, rapid reporting must not compromise specimen integrity, analytical reliability or communication.

Objective: This narrative review examines the concept, measurement, determinants and clinical implications of TAT in haematology laboratories and outlines practical improvement strategies, including approaches applicable to resource-constrained settings.

Methods: Guidance and literature on laboratory quality, the total testing process, pre-analytical error, automation, critical-result communication, emergency laboratory services and quality indicators were synthesised across pre-analytical, analytical and post-analytical phases.

Results: Avoidable delays commonly arise from interacting failures involving inappropriate requesting, patient identification, specimen collection, transport, specimen quality, batching, equipment downtime, reagent shortages, manual review, repeat or reflex testing, delayed authorisation, information-system failure and unsuccessful critical-result notification. These delays may affect decisions concerning antibiotics, anticoagulant reversal, transfusion, operative management and recognition of severe haematological abnormalities. Improvement requires clear test-specific time points and targets, monitoring of distributions and outliers, workflow mapping, prioritisation of urgent specimens, reliable transport, validated autoverification, equipment and inventory management, and collaboration with clinical teams.

Conclusion: TAT should be managed as a balanced quality indicator within the total testing process. The aim is timely delivery and acknowledgement of an accurate result that supports safe clinical action.

Protective Effects of Telfairia occidentalis and Carica papaya Leaf Extracts on Hematological and Lipid Alterations in Phenylhydrazine-Induced Anemia in Rats

Osuvwe C. Ororoxro — 2026-09-01

Anaemia is a major global health challenge and is commonly associated with oxidative stress, haemolysis and metabolic disturbances, including dyslipidaemia. Phenylhydrazine (PHZ)-induced haemolytic anaemia is a widely used experimental model characterised by erythrocyte destruction and altered lipid metabolism. This study investigated the combined haematoprotective and hypolipidaemic effects of Telfairia occidentalis and Carica papaya leaf extracts in PHZ-induced anaemic Wistar rats. Twenty male albino Wistar rats were randomly assigned to four groups: normal control, PHZ-induced untreated group (negative control), PHZ-induced group treated with the standard drug (Oreifer®) and PHZ-induced group treated with combined ethanolic leaf extracts (200 mg/kg). Anaemia and dyslipidaemia were induced by intraperitoneal administration of PHZ (40 mg/kg) for four consecutive days, followed by seven days of treatment. Haematological parameters and serum lipid profile were assessed. The negative control group (Group B) exhibited marked haematological disruption, with increased WBC count (13.12 ± 2.1) and reduced RBC (2.9 ± 0.82), HGB (131.42 ± 7.0) and PCV (26.14 ± 5.5). This was accompanied by reduced HDL-C and increased LDL-C, TC and TAG levels, confirming the induction of anaemia and dyslipidaemia. Treatment with the combined extracts improved RBC, HGB and PCV, restoring values towards normal and producing effects comparable to the standard drug group. The extracts also significantly increased HDL-C and reduced LDL-C levels (p < 0.05). However, reductions in TAG and TC were not statistically significant. WBC and platelet counts showed normalisation trends after treatment. Overall, the combined leaf extracts of Telfairia occidentalis and Carica papaya exhibited haematoprotective and selective hypolipidaemic effects in PHZ-induced anemia. These findings support their potential as complementary therapeutic agents in managing anemia and associated lipid abnormalities. Further studies are required to elucidate mechanisms, isolate active compounds, and establish safety for clinical use.

Dissecting Splenic B Cell Lymphoma/Leukaemia with Prominent Nucleoli (SBLPN) by Flow Cytometry: Experience from a Stand-Alone Reference Laboratory

Abena Hidangmayum — 2026-09-02

Background: Splenic B-cell lymphoma/leukaemia with prominent nucleoli (SBLPN) is a rare chronic B-cell lymphoproliferative malignancy, comprising approximately 0.4% of all chronic lymphoid malignancies, with a reported annual incidence of 0.03 per million. Although prominent nucleoli with polar cytoplasmic projections are considered distinctive features of SBLPN, their assessment is often subjective and requires an experienced observer, which may lead to an imprecise diagnosis. Molecular studies are limited and inconclusive. Flow cytometry is often indispensable for the accurate characterisation of such atypical lymphoid cells.

Method: The study was an observational study of 10 cases diagnosed as SBLPN. The samples were processed using the stain-lyse-wash procedure and analysed using the BD FACSCANTO II analyser with BD FACS Diva software v9.0. A gating strategy using bright CD19 versus low side scatter was employed to analyse the lymphocyte population. A Matutes-based scoring system incorporating the HCL markers CD11c, CD103, CD123, and CD25 was used.

Result: SBLPN is a CD5-, CD10-, and CD25-negative B-cell lymphoproliferative disorder with positivity for CD11c and CD103. Of the 10 cases, eight had a score of 2 out of 4, while two had a score of 3 out of 4. None of the cases had a score of 0, 1, or 4.

Conclusion: SBLPN is a CD5-, CD10-, and CD25-negative B-cell lymphoproliferative disorder with positivity for CD11c and CD103. The Matutes immunophenotypic score using the four markers remains relevant and usually yields a lower score in SBLPN.

Serum Ferritin and Plasma Fibrinogen Levels among Pregnant Women Attending Antenatal Clinic at Federal Teaching Hospital, Owerri, Imo State, Nigeria

C. Okoro Blessing — 2026-09-10

Background: Pregnancy is accompanied by substantial physiological changes in iron metabolism and haemostasis. Although many of these changes are normal adaptations to pregnancy, marked alterations may contribute to maternal anaemia and thrombotic complications. Ferritin provides an indirect assessment of body iron stores, while fibrinogen is an important coagulation protein whose concentration increases during pregnancy as part of the physiological hypercoagulable state.

Objectives: This study evaluated serum ferritin and plasma fibrinogen levels among pregnant women attending antenatal clinics at Federal Teaching Hospital, Owerri, Imo State, Nigeria.

Methods: The study comprised 120 women, consisting of 60 apparently healthy non-pregnant women who served as controls and 60 pregnant women distributed across the first, second and third trimesters. Five millilitres of venous blood were collected from each participant. Two millilitres were dispensed into a sodium citrate container for fibrinogen estimation, while the remaining 3 mL were dispensed into a plain container for serum ferritin estimation. Data generated were analysed using analysis of variance (ANOVA) and Student's t-test.

Results: Ferritin levels among pregnant women showed a progressive decline across pregnancy, from (65.64 ± 4.25)ng/ml in the first trimester to (56.59 ± 3.56)ng/ml in the second trimester and (45.69 ± 5.39)ng/ml in the third trimester. Compared to non-pregnant women (64.05 ± 2.34), the difference was not statistically significant in the first trimester (p = 0.737) or second trimester (p = 0.105), but was significantly lower in the third trimester (p = 0.001). In contrast, fibrinogen levels were significantly higher among pregnant women in all trimesters compared to non-pregnant controls (187.29 ± 8.62)mg/dl, with values of (347.29 ± 19.47)mg/dl, (390.21 ± 17.23)mg/dl and (359.79 ± 18.44)mg/dl in the first, second and third trimesters, respectively (p < 0.001 for all comparisons).

Conclusion: The reduction in ferritin with advancing gestation suggests progressive utilisation of maternal iron stores, while the increase in fibrinogen reflects the haemostatic adaptation of pregnancy. These findings demonstrate that ferritin and fibrinogen may provide useful complementary information during antenatal assessment. Routine monitoring of iron stores and haemostatic status, particularly in women at increased risk of anaemia or thrombotic complications, may improve maternal care.

Haematological Parameters and Alkaline Phosphatase Levels among Men with Benign Prostatic Hyperplasia in Owerri, Nigeria

C. Okechukwu Faith — 2026-09-25

Background: Benign prostatic hyperplasia (BPH) is a common non-malignant enlargement of the prostate in older men and is frequently associated with lower urinary tract symptoms. Systemic haematological and biochemical findings may coexist with BPH, but evidence from local Nigerian populations remains limited.

Objective: This study compared red blood cell (RBC) count, total white blood cell (TWBC) count, and serum alkaline phosphatase (ALP) activity between men with BPH and apparently healthy controls and examined the relationships of ALP with RBC and TWBC counts among men with BPH.

Methods: A comparative cross-sectional study included 60 adult men: 30 with BPH and 30 age-matched apparently healthy controls. RBC count was measured using a Mindray BC-5180 automated haematology analyser, TWBC count was determined manually with Turk's solution and an improved Neubauer counting chamber, and serum ALP activity was measured using a Randox reagent kit. Group means were compared using an independent-samples Student's t test, and Pearson correlation was used to examine associations within the BPH group.

Results: Mean RBC count was lower in the BPH group (2.51 ± 0.64 × 10¹²/L) than in controls (3.91 ± 0.65 × 10¹²/L; t = 8.41, p < .001). Mean TWBC count was also lower in the BPH group (5.60 ± 1.57 × 10⁹/L) than in controls (8.38 ± 1.65 × 10⁹/L; t = 6.69, p < .001). Mean ALP activity was higher in men with BPH (81.39 ± 22.11 U/L) than in controls (51.10 ± 16.65 U/L; t = 5.99, p < .001). ALP was not significantly correlated with RBC count (r = .01, p = .972) or TWBC count (r = -.07, p = .724).

Conclusion: Men with BPH in this study had lower mean RBC and TWBC counts and higher mean serum ALP activity than controls. These nonspecific laboratory differences should be interpreted alongside clinical findings and should not be used independently for the diagnosis or monitoring of BPH.

Antinutrient, Biochemical and Histopathological Study of Hunteria umbellata Seed Extract on the Blood, Liver and Kidney of Wistar Albino Rats

Oluwagbenle Henry Niyi — 2026-09-29

The antinutritional composition, mineral bioavailability, and subacute toxicological effects of the methanolic seed extract of Hunteria umbellata on Wistar albino rats were determined using standard analytical methods. Mineral bioavailability was assessed using phytate-mineral and oxalate-mineral molar ratios, while the toxicological evaluation involved oral administration of the extract at doses of 100, 200, and 400 mg/kg body weight for 21 days, followed by biochemical, haematological, and histopathological assessments. The results showed low concentrations of phytate (2.72 ± 0.02 mg/100g), oxalate (1.09 ± 0.05 mg/100g), tannin (5.28 ± 0.16 mg/100g), and saponin (2.57 ± 0.09 mg/100g), while alkaloid was the predominant antinutrient (8.45 ± 0.01 mg/100g). Mineral bioavailability indices, including phytate/zinc (0.068), phytate/iron (0.026), calcium/phytate (66.61), and oxalate/calcium (0.003), were below the critical values, indicating minimal interference with mineral absorption and high bioavailability of essential minerals. Biochemical analysis revealed serum alanine aminotransferase (ALT) activities ranging from 80.11 ± 1.46 to 94.97 ± 1.46 Units/litre, aspartate aminotransferase (AST) activities ranging from 60.47 ± 2.91 to 70.13 ± 2.50 Units/litre, and alkaline phosphatase (ALP) activities ranging from 33.60 ± 1.41 to 39.30 ± 0.71 Units/litre, respectively, suggesting preservation of hepatic function. Kidney function indices showed reduced serum urea levels ranging from 41.93 ± 3.93 to 51.86 ± 4.76 mmol/litre, with a moderate increase in creatinine concentration at higher doses, ranging from 72.41 ± 3.08 to 85.31 ± 2.01 mmol/litre; severe renal impairment was not evident, while chloride ion levels ranged from 59.92 ± 0.59 to 77.50 ± 0.94 mg/dL. Haematological evaluation demonstrated an increase in red blood cell count, ranging from 3.60 ± 0.46 to 6.45 ± 0.50 cells/µL, and haemoglobin concentration (4.10 ± 0.28-9.05 ± 1.06 g/dL), indicating a possible haematopoietic effect of the extract. Histopathological examination revealed moderate alterations in renal and hepatic tissues at higher doses. However, the findings suggest that Hunteria umbellata seeds possess low levels of antinutritional factors, favourable mineral bioavailability, and relatively low toxicity at the tested doses, supporting their nutritional potential and suggesting no detrimental effects on the major organs studied when consumed at these doses.

Rheumatoid Arthritis and Sickle Cell Disease: A Study of 18 Cases

Fatou Sow Diouck — 2026-09-30

Background: The coexistence of rheumatoid arthritis and sickle cell trait or disease has seldom been documented in reports from sub-Saharan Africa. This study aimed to characterise the epidemiological, diagnostic and prognostic features of this coexistence within a Senegalese rheumatology department.

Patients and Methods: A retrospective case-control investigation was undertaken between March 2012 and June 2024 within the rheumatology department at Aristide Le Dantec University Hospital, Dakar (currently relocated to the COUD hospital). Patients with concurrent rheumatoid arthritis and sickle cell disease were compared with those who had rheumatoid arthritis alone.

Results: Out of a total of 867 cases of rheumatoid arthritis, 18 cases were associated with sickle cell disease, representing a prevalence of 2.07%. The sickle cell group comprised 13 women and 5 men, with a mean age of 44.1 years. The genotype was AS in 14 cases, SS in 3 cases, and SC in 1 case. Rheumatoid arthritis activity was numerically greater in the combined-disease group (DAS28: 5.62 vs. 5.01 in controls; p = 0.14). The mean HAQ score was 1.6 and 1.4, respectively (p = 0.16). Two cases of aseptic necrosis of the femoral head and one case of diffuse interstitial lung disease were observed in patients with sickle cell disease, but not in controls. Mean haemoglobin was 9.9 g/dL in the control group and 8.6 g/dL among the sickle cell cases.

Conclusion: Although our series is limited, it shows that this association primarily involves predominantly women, whose mean age was 44.1 years. Heterozygous sickle cell trait (AS) accounted for 77.8% of cases. The association showed numerically greater rheumatoid arthritis activity together with greater functional impairment.

Prevalence of Anaemia, Fasting Hyperglycaemia and Hepatitis B Surface Antigenaemia among Pregnant Women Attending a Tertiary Hospital in Owerri, South-East Nigeria

C. Aloy-Amadi Oluchi — 2026-09-30

Background: Anaemia, hyperglycaemia first detected in pregnancy and hepatitis B virus infection are important, largely detectable conditions that can adversely affect maternal and neonatal health. Evidence describing their burden within the same antenatal population in South-East Nigeria remains limited.

Objective: This study determined the prevalence of anaemia, fasting hyperglycaemia meeting the World Health Organization gestational diabetes threshold, and hepatitis B surface antigenaemia among pregnant women attending the Federal University Teaching Hospital, Owerri, Imo State, Nigeria, and compared prevalence across trimesters.

Methods: A hospital-based descriptive cross-sectional study enrolled 300 consenting pregnant women by consecutive sampling, with 100 women in each trimester. Venous blood was collected into ethylenediaminetetraacetic acid, fluoride-oxalate and plain tubes. Packed cell volume was measured by the microhaematocrit method and haemoglobin concentration was estimated as packed cell volume divided by three. Fasting plasma glucose was determined by the glucose oxidase method. Hepatitis B surface antigen was screened by immunochromatography, with reactive specimens confirmed by enzyme-linked immunosorbent assay. Anaemia was defined as haemoglobin <11.0 g/dL, while fasting hyperglycaemia was defined as glucose ≥92 mg/dL. Prevalence estimates were reported with 95% Wilson confidence intervals; trimester differences were examined using Pearson's chi-square test.

Results: Anaemia occurred in 111 women (37.0%; 95% CI: 31.7-42.6), fasting hyperglycaemia in 78 (26.0%; 95% CI: 21.4-31.2), and confirmed hepatitis B surface antigenaemia in 48 (16.0%; 95% CI: 12.3-20.6). Anaemia prevalence was 36.0%, 41.0% and 34.0% in the first, second and third trimesters, respectively (χ²=1.115, p=0.573). Corresponding proportions were 28.0%, 23.0% and 27.0% for fasting hyperglycaemia (χ²=0.728, p=0.695), and 17.0%, 16.0% and 15.0% for hepatitis B surface antigenaemia (χ²=0.149, p=0.928).

Conclusion: The antenatal population carried a substantial burden of all three conditions, with anaemia being most frequent. Prevalence did not differ significantly by trimester. Integrated testing at antenatal entry, followed by guideline-based confirmation and treatment, may improve opportunities for timely maternal care and prevention of perinatal hepatitis B transmission.

Genetic Variation of Ribosomal Protein S20 (RPS20) among Sudanese Women with Recurrent Pregnancy Loss 2020

Nosiba Adli Hassan — 2026-10-07

Thrombophilia comprises a group of genetic disorders that cause abnormal blood clotting and are linked to recurrent pregnancy loss (RPL). Thrombophilic gene polymorphisms are known risk factors for RPL. This study was conducted to investigate the relationship between mutations in thrombophilia-associated gene polymorphisms and RPL. This descriptive cross-sectional study was carried out from July 2022 to December 2022 to identify ribosomal protein S20 genetic variants in Sudanese women experiencing recurrent pregnancy loss in Khartoum State. Fifty females were included in this study. Their average age was 34.5 years, ranging from 19 to 50 years, and they were divided into three groups: 19-30, 31-40, and >40 years. Of the females with a history of RPL, 8% had diabetes mellitus (DM), 18% had hypertension (HTN), and 74% had no chronic disease. Thirty per cent had a family history of thrombophilia, whereas 70% had no family history. The frequency distribution of blood groups among females with RPL was A+ve (16%), B+ve (10%), AB+ve (8%), O+ve (56%), A-ve (2%), and O-ve (8%). According to the number of previous abortions, 2% had two, 62% had three, 26% had four, 2% had five, 4% had six, and 4% had seven previous abortions. After completion of the questionnaire, blood samples were collected from each female under sterile conditions into EDTA containers. DNA was isolated by the salting-out procedure, and genetic variants were assessed by restriction fragment length polymorphism analysis. Following PCR amplification and restriction-enzyme digestion, the resulting fragments were electrophoresed through a 1.5% agarose gel containing ethidium bromide and examined under ultraviolet light. Either one band, representing the dominant gene AA at 290 bp, or two bands, representing the mutated gene AT at 250 + 40 bp, were produced. The results were analysed using SPSS version 25. Genetic analysis showed that the RPS20 mutation was found in 4 (8%) females with a history of RPL, while 46 (92%) had the normal gene. No correlation was observed between RPS20 mutation and age group (p = 0.498), associated chronic diseases (p = 0.206), family history of thrombophilia (p = 0.363), or number of previous abortions (p = 0.751). A statistically significant association was identified between RPS20 mutation status and blood group among females with RPL (p = 0.025). Overall, an RPS20 mutation was identified in a few females with RPL, while most had the normal RPS20 gene.