Open Access Short Communication

Can Plasmapheresis be Useful in the Treatment of Patients with Covid-19?

Ali Zahit Bolaman, Atakan Turgutkaya, İrfan Yavaşoğlu

Asian Hematology Research Journal, Page 1-4

Severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) has created a pandemic throughout the world, most notably causing death owing to pneumonia and cytokine storm syndrome. The treatment is highly supportive with no definitive antiviral therapy and aims to alleviate hypercytokinemia in addition to prevent further complications during viral clearance. Therapeutic plasma exchange is the separation of plasma from other blood components and have a potential to clear cytokines which causes the “storm”. Double-Filtration Plasmapheresis is effective of removal of particles huger than 55-60 nm and the method stands the rationale of possibly clearing SARS-CoV-2 (60-140 nm) from blood. In this article we would like to highlight the beneficial potential of plasmapheresis although it’ s an unproven strategy.

Open Access Short Communication

Lipid Profile and Other Measures of Cardiovascular Disease Risk among Anemic Individuals with and without Thalassemia in Metro Manila, Philippines

Maria Sofia Amarra, Francisco de los Reyes

Asian Hematology Research Journal, Page 23-34

Objectives: The present study examined biochemical, clinical, and anthropometric factors that influence cardiovascular disease risk among anemic individuals with and without thalassemia. The objectives were to analyze and compare the following conditions in subjects with anemia due to alpha or beta thalassemia and those with anemia due to iron deficiency or other causes: 1) lipid profile, blood pressure, and fasting blood sugar; 2) anthropometric measurements (BMI, waist circumference, waist-hip ratio); and 3) identify significant cardiovascular risk factors that characterize anemic subjects with and without thalassemia.

Methodology: Randomly selected anemic individuals (n=101) were tested for presence of iron deficiency, hemoglobinopathy, or anemia due to other (unidentified) causes. Anemia was determined using cyanmethemoglobin method.  Genetic hemoglobin disorders were examined using capillary electrophoresis. Iron deficiency was determined using immunoradiometric assay for serum ferritin. Differences in mean values of biochemical, clinical, and anthropometric measurements by cause of anemia were analyzed using ANOVA. The same test was used to determine the association of age with these cardiovascular risk factors. The likelihood of adverse biochemical, clinical, and anthropometric measurements among thalassemic and non-thalassemic subjects was examined using logistic regression.

Results: Non-thalassemic subjects were more likely to have reduced HDL-C (OR 0.09; 95% CI 0.02, 0.39; P<0.001) and increased VLDL-C (OR 5.6; 95% CI 1.32, 23.8; P<0.020) compared to thalassemic subjects. Majority of anemic individuals had high blood pressure and central obesity. Older age was associated with high blood pressure and increased total cholesterol and LDL-C.

Conclusion: Thalassemic subjects had better lipid profile than those with anemia due to iron deficiency and other causes, but were similar in terms of blood pressure and central adiposity.  Further investigation using larger sample sizes is needed to confirm these results and determine their impact on CVD development.

Open Access Minireview Article

Venous Thromboembolism in Covid-19 ICU Patients: A Narrative Review

Noun Eltayeb Ahmed Abdulgader, Abdelrahman Hamza Abdelmoneim Hamza, Hiba Awadelkareem Osman Fadl, Rawan Khidir Abdel Galil, Sahar G. Elbager

Asian Hematology Research Journal, Page 35-43

Aim: The purpose of this narrative review is to provide a summarized coverage of evidence-based researches reporting VTE in COVID-19 patients in the ICU. It aims to serve as a contribution to healthcare professionals in designing a comprehensive strategy in managing COVID-19 patients.

Background: SARS-CoV-2 (COVID-19) was declared a global pandemic by the WHO in March 2020, as cases continued to surge since January after its sudden outbreak in China. It commonly presents with respiratory symptoms along with a fever, however, comorbidities requiring ICU admission are documented. Several anecdotal reports of VTE amongst ICU patients have surfaced since the outbreak. There is a noticeably increased risk of what appears to be a COVID-19 induced hypercoagulable state despite prophylactic and therapeutic anticoagulation treatment, consequently emphasizing the importance of systemic screening of VTE amongst ICU patients. This calls for a high level of clinical suspicion and a low diagnostic threshold. Understanding the exact impact of VTE on COVID-19 ICU patients improves our ability to reach a timely diagnosis and initiating optimal management to potentially improve survival.

Methods: Google Scholar and Pub Med were used as sources for searching and obtaining the data, as they were critically appraised for the best evidence. The information collected was overviewed and summarized in this narrative review.

Results: After searching in the previously mentioned database, 21 articles were found, assessed, and then filtered to 11 articles in correlation with the review context. 8 full-text articles, 2 case reports, and 1 clinical investigation research were obtained overall. Even with the evidenced data, efficacy of prophylactic anticoagulants remains uncertain but is nonetheless, a practical preventive approach.

Conclusion: COVID-19 infection induces a hypercoagulable state that results in VTE amongst ICU patients. Early prophylactic and therapeutic therapy is deemed essential in the early phases. Further studies are required to develop a better understanding and hence more appropriate management.

Open Access Original Research Article

Qualitative Phytochemical Screening, Anti-inflammatory and Haematological Effects of Alkaloid Extract of Combretum dolichopetalum Leaves

Nwuke P. Chinedu

Asian Hematology Research Journal, Page 5-12

Background: Inflammation has been implicated in a number of wounds and disease conditions, spurring the search for compounds with anti-inflammatory properties.

Aim: The study investigated the anti-inflammatory potentials and effect of alkaloid extract of Combretum dolichopetalum on haematological parameters of Wistar albino rats.

Methodology: Alkaloids in the leaves were extracted using 10% acetic acid as solvent. The anti-inflammatory potential was investigated using egg-albumin paw edema model, while the haematological effects of the extract was observed on plasma.

Results: Phytochemical screening showed the presence of alkaloids, saponins and tannins in moderate concentration. Alkaloid specific test showed the presence of six classes of alkaloids. Result for anti-inflammatory potentials showed a significant (p<0.05) reduction in paw size of extract treated group compared to negative control. The extract also stabilized haematological parameters compared to negative control.

Conclusion: In conclusion, the study confirms the use of the alkaloid extract of Combretum dolichopetalum leaves in pain management and inflammatory conditions.

Open Access Original Research Article

Non-Hodgkin Lymphoma in Nigeria: An Insight into the Clinical, Laboratory Features and Outcomes

Anazoeze Jude Madu, Kaladada Korubo, Ifeoma Clare Ajuba, Ngozi Immaculata Ugwu, Augustine Ejike Okoye, Angela Ogechukwu Ugwu, Augustine Nwakuche Duru, Kenechi Anthony Madu, Ebele Muoghalu, Onyinye Eze, Nneka Amu, Chioma Ugwu, Gladys Ilechukwu, Chiemelie Obiatuegwu, Frances Nwamaka Madu

Asian Hematology Research Journal, Page 13-22

Background: The prevalence of Non-Hodgkin lymphoma (NHL) has waxed and waned with the trends in HIV prevalence over the years. The clinical landscape as well as treatment experience in Africa has not earned the much needed attention.

Aim: This study aimed at giving insight to the clinical and laboratory variations as well as treatment outcomes in NHL in a group of Nigerian patients.

Methods: The clinical and laboratory details were obtained from all patients diagnosed with NHL from October 2015 to December 2018 in 3 tertiary health institutions in Nigeria. These were the patients seen or admitted to the Haemato-Oncology clinics and wards. They were followed-up till the time of this write-up, while those that were lost to follow-up were also noted.

Results: There were 77 patients in the study aged 16 to 81 years with a median age of 50 years. These include 45 males and 32 females. Majority (53.7%, n=36/67) of them had no palpable splenomegaly at diagnosis.  Of 57 patients, 26.3% (n=15/57) had diffuse large B cell lymphoma, 15.8% (n=9/57) small lymphocytic lymphoma while 10.5% (n=6/57) each had intermediate and high grade lymphoma 14% (n=8/57). The other histological types seen were Follicular lymphoma 3.5%, Cutaneous T cell lymphoma 5.3%, maltoma 7% and bone marrow lymphoma 3.5%.

Patients with ≤ stage 2 Ann-Arbor were 16/66, while majority (40/66) were > stage 2 at diagnosis. The median haemoglobin concentration remained stable from 9.8g/dl at diagnosis to 12.3g/dl at 6 months, while the absolute neutrophil count dropped from 2.4 x 109/l to 1.2 x 109/l. The median leucocyte count at diagnosis was 6.8 x 109/l, while the platelet count was 185 x 109/l, both parameters were 5.3 and 187 x 109/L at six months post-diagnosis, respectively. Of the 64 patients who had their HIV status documented 7 were positive, giving prevalence rate of 12.6%.

Only 14 (18%) out of all the patients had immunophenotyping and only 8 of them were CD20 positive. Relapse rate among the cohort was 43.3% (26/60) while 34 (56.7%) were still on remission. 22 (30.6%) patients were lost to follow up, 18 (25%) had died while 32 (44.4%) were alive and had been seen in the clinic out of 72 patients recorded. The median follow-up time was 10 months and ranged from 0 to 45 months and the mean time of remission was 12 months (range 0-125.) Majority of the patients (55.5%, 35/63) received CHOP with or without Rituximab, 7.9% (5/63) received COAP as first line chemotherapy, while 13/63 (20.6%) had their regimen switched either due to relapse or sub-optimal response, while 10/63 (15.8%) received other combinations. Only 7 patients got Rituximab in combination with any regimen.

Conclusion: The management modalities and treatment outcomes for NHL in most resource-poor countries are sub-optimal and need to be adopted to suit the available resources in these areas and optimize survival /response. The use of treatment algorithms with expensive and unavailable chemotherapeutic agents may not suffice and cheaper available combinations maybe advocated for use in situations where the desirable is not available.