Open Access Original Research Article

Platelet Indices and Antiphospholipid Syndrome in Patients with Recurrent Pregnancy Loss

Soha Abuelela, Hadeer Shawarby

Asian Hematology Research Journal, Page 1-7

Introduction: Spontaneous pregnancy loss is a common occurrence. Recurrent pregnancy loss (RPL) is defined as two or more failed clinical pregnancies as documented by ultrasonography or histopathologic examination before 20 weeks gestation. Ectopic, molar, and biochemical pregnancies are not included.

Aim: To examine the relationship between platelet indices and the presence of antiphospholipid syndrome (APS) in RPL patients.

Methodology: This study was conducted on fifty first-trimester pregnant females with a history of RPL. Control group included fifty first-trimester pregnant females without history of RPL with at least one live birth. Lupus anticoagulant (LA) testing with simplified dilute Russell’s Viper venom test (DRVVT) and anti-cardiolipin (aCL) antibodies detection with Human Anti-Cardiolipin IgG/IgM ELISA. CBC for mean platelet volume (MPV), Platelet distribution width (PDW), and plateletcrit (PCT) was done for all patients.

Results: The age and the gravida number of the patients were significantly higher than of the control. All platelet indices were significantly higher among RPL group compared to control. According to the positivity of LA and aCL antibodies, RPL patients were classified into 2 groups, 25 patients each, positive and negative for APS respectively. Comparing platelet indices between both subgroups, PCT and MPV were significantly higher among APS positive patients, while PDW did not attain any significance. Receiver operating characteristic (ROC) curve analysis was applied to assess the best cut off value for predicting RPL in patients with APS who may benefit from early treatment.

Conclusion: These low-cost and easily measurable indices can be used for prediction of fetal loss and may help clinicians start early management of high-risk RPL cases.

Open Access Original Research Article

Changes in Tissue Erythropoietin and Some Haematological Parameters in Chronic Kidney Disease Subjects on Blood Transfusion in Port-Harcourt

E. M. Eze, B. S. Mbeera, S. Ken-Ezihuo, G. N. Mbeera, S. O. Akwuebu

Asian Hematology Research Journal, Page 1-10

Chronic kidney disease (CKD) is a progressive loss in renal function over a period of time. The kidney chiefly secretes erythropoietin (EPO) which is a glycoprotein hormone that acts on the bone marrow cells resulting in red blood cell formation. Anaemia is a major complication in CKD. The aim of this study was to assess changes in erythropoietin levels in chronic kidney disease patients on blood transfusion attending health care in Port Harcourt. A total of one hundred and fifty two (152) subjects were recruited for this study. One hundred and twenty two (122) subjects were recruited from those confirmed with renal diseases from the Urology Department of the hospital. Thirty eight (38) subjects were non-transfused with blood and eighty four (84) subjects were multitransfused with blood. Thirty subjects were apparently healthy controls. EPO was determined by sandwich ELISA method while the full blood count was determined using haematology autoanalyser, Mindray BC-6800..The results were statistically analyzed using GraphPad prism version 5.0 and statistical significance set at P<0.05. The result showed a significant decreased (p<0.0001) in EPO level in multitransfused and non-transfused subjects with mean values of 4.95±2.95 mIU/Land 6.32±2.66 mIU/L respectively compared to control 10.51±3.05 mIU/L. On assessment of the haematological characteristics, erythropoietin secretions of patients with chronic kidney disease (CKD), the mean haematocrit, haemoglobin, mean cell haemoglobn concentration and red cell count for the multiple transfused CKD were respectively found to be significantly lower compared to that of nontransfused. This could be due to impaired erythropoietin secretion and other factors which suppress marrow erythropoiesis  and shortened red cell survival in CKD which was directly associated with a decrease in red cell count and subsequent reduction in the haematocrit level. Transfusion improves anaemia through the increase in haemoglobin and hepcidin and as well suppresses erythropoiesis with an eventual decrease in erythropoietin and growth differentiation. It is therefore concluded that transfusion does not improve anaemia in CKD subjects.

Open Access Original Research Article

Post-transplant Cyclophosphamide is a Valid Option for GVHD Prophylaxis in Both HLA-matched and Mismatched Allogeneic Transplants

Nahla A. M. Hamed, Dalia A. Nafea, Essam A. Abdel-Mohsen, Omar M. Ghalab, Abdel-Salam A. Adam

Asian Hematology Research Journal, Page 1-9

Despite improvement in transplantation techniques and supportive care, graft versus host disease (GVHD) remains a major cause of post-transplant morbidity and mortality. Advances in immunosuppressive regimens have reduced the incidence and severity of acute GVHD; with no such impact on chronic GVHD. In addition to the considerable toxicity of calcineurin inhibitors (CNI)-based regimens [1]. We compared the safety and efficacy of post allogeneic transplant cyclophosphamide as GVHD prophylaxis versus CNI prophylaxis. This study included 63 patients (2 groups) admitted to Hematology unit, Maadi Armed Forces Medical Compound, Cairo for allogeneic stem cell transplantation for hematological malignancies. Group I received post-transplant cyclophosphamide prophylaxis (50 mg /kg/day), while group II received CNI based prophylaxis. Patients were followed for 6 months for acute and chronic GVHD, infections, and drug toxicities. Most patients successfully underwent hematopoietic reconstitution with no significant difference between both groups in time to hematological recovery. Hepatic and renal toxicities were more common in group II than group I (78.6% vs. 30.8%, P=0.002) and (60% vs. 20.5%, P=0.022) respectively. No significant difference between both groups in the incidence of CMV reactivation or acute and chronic GVHD. Disease free survival and overall survival were not significantly different between both groups either in matched or mismatched transplants, with a trend for better survival in group I than group II (4 vs. 1.4 months, P=0.087). We concluded that post-transplant cyclophosphamide for GVHD prophylaxis is safe, effective and valid option in allogeneic stem cell transplantation, with a different toxicity profile compared with CNI regimens [2].

Open Access Original Research Article

FV, FVIII and Fibrinogen Activity in Fresh Frozen Plasma, Frozen Plasma and Cryoprecipitate: Observational Cross-sectional Study

Ibrahim Youssef, Soha Abuelela, Walaa Hamza

Asian Hematology Research Journal, Page 1-7

Objective: Studies proved that storing whole blood overnight at 4°C resulted in a decrease in the activity of coagulation factor FVIII, without significant loss of activity of coagulation factors FV or fibrinogen. This study is conducted to compare the activity of labile factors V and VIII as well as fibrinogen level in FFP with that of FP24 and to assess their levels in cryoprecipitate and cryosupernatant bags as well.

Materials and Methods: FFP bags separated from whole blood within 8 hours were compared to FP24 bags separated within 24 hours, cryoprecipitate and cryosupernatant after phlebotomy in terms of coagulation factors V and VIII activity and level of fibrinogen by standard methods using (automated coagulometer STA Compact, Stago, France).

Results: A statistically significant loss of factor VIII activity in FP24 compared to FFP was detected; while, the fall in activity of factor V and fibrinogen level was not statistically significant. A highly statistically significant difference was elicited regarding factor VIII, factor V and fibrinogen when comparing cryoprecipitate and cryosupernatant samples. On comparing FFP and cryoprecipitate regarding factor VIII, factor V and fibrinogen a highly statistically significant difference was elicited.

Conclusion: The retention in factor activities, in particular factor V, in FP, indicates the lack of relevant adverse changes when extending the hold period for plasma units. The reduction in factor VIII activity doesn’t reduce the quality of FP.

Open Access Original Research Article

Haematological Response to One-month Varying Doses Treatment of Wistar Rats with Desmodium adscendens

S. A. Seriki, I. K. Nyoro

Asian Hematology Research Journal, Page 1-15

Increasing consumption of traditional medicinal plants to manage medical conditions in recent times is driven by the belief that herbal products are generally safe and efficient. This has been proven wrong as several patients have come down with side effects of some of these herbs in the course of, or after their use. Desmodium adscendens is one of these herbs notably used to manage medical conditions. The current study aimed at determining the haematological response to the use of this herb in low, median and high doses, with the aim to generate data (evidence) as per safety profile (ADR) and the use of Desmodium adscendens in humans. The study which was carried out using 24 Wistar rats lasted for one month. Low, median and high doses of aqueous leave extract of the herb were administered on three groups of rats (n=6). And the responses in these groups were compared to one another and also to a control group. Desmodium adscendens did not have any significant effect on Red blood cell (RBC) count, Haematocrit (PCV), Haemoglobin (Hb) concentration, Mean corpuscular volume (MCV), Mean corpuscular haemoglobin concentration (MCHC), Mean corpuscular haemoglobin (MCH), White blood cell (WBC) count; (Total WBC count, Differential WBC), Platelet count, Platelet indices (PDW, MPV, P-LCR, Plateletcrit). However, the extract caused a significant decrease in the Red-cell Distribution Width (RDW). The leaf extract of D. adscendens also significantly reduced total protein and globulin concentrations in the blood plasma, but caused a significant (p < 0.05) increase in plasma albumin concentration. Desmodium adscendens did not cause significant effect on RBC, WBC and PLT indices. Its use in treatment and management of disease conditions is therefore not likely to have any adverse effect on the body’s blood parameters.