Open Access Case Study

Multiple Infectious Intracranial Aneurysms in a Child with Acute Lymphoblastic Leukaemia - A Fatal Complication in a Highly Curable Disease

Yamini Krishnan, S. Gazel, Shailaj Kurup, V. P. Muralikrishnan

Asian Hematology Research Journal, Page 11-17

Multiple infectious intracranial aneurysms are rare in the paediatric population. This case report is of a child with acute lymphoblastic leukaemia who developed this fatal complication in induction therapy. The child succumbed despite aggressive medical management and surgical intervention. A high index of suspicion is required in the early diagnosis and treatment when a child presents with febrile neutropenia and intracranial haemorrhage.Lymphoblastic leukaemia

Open Access Case Study

Piperacillin Induced Acute Severe Thrombocytopenia during VV ECMO in COVID19 Pneumonia: Case Report and Review of the Literature

Mohammed K. O. Qandil, Hussam Abdel Rahman S. AL Soub, Tasleem Raza N. Mohd

Asian Hematology Research Journal, Page 39-46

Piperacillin-tazobactam is a frequently used antibiotic that has a broad spectrum of antibacterial activity and a wide safety profile. The development of thrombocytopenia following the use of piperacillin is usually a gradual phenomenon occurring several days following the first exposure, which is usually mild and passed unnoticed However, re-exposure can cause severe rapid thrombocytopenia secondary to pre-existing antibodies. Thrombocytopenia is relatively common during VV ECMO and multifactorial in nature. We present a case of acute severe thrombocytopenia after re-exposure to piperacillin during a prolonged VV ECMO run for COVID 19 respiratory failure leading to diagnostic challenge, after withdrawal of the piperacillin the acute severe thrombocytopenia improved dramatically, also we provide literature review for the similar cases available in the literature. Our case unique in that it had happened in ECMO patient with severe COVID ARDS, and we clinically confirmed that the piperacillin component of TZP is the culprit for the acute severe thrombocytopenia.

Open Access Original Research Article

Hematological Profiles of Naturally Infected Pigs Treated with Bridelia ferruginea Leaf Extracts

Afees Adebayo Oladejo, Olukemi Osukoya

Asian Hematology Research Journal, Page 1-10

Bridelia ferruginea (Benth) Phyllanthaceae called “Kizni” in Hausa, “Iralodan” in Yoruba and “Ola” in Igbo languages are widely used as food and as medicines in traditional medical practice. They are widely found in the Savannah regions especially in the moister regions. This study explores the hematological profiles of pigs naturally infected with gastrointestinal nematodes treated with N-hexane leaf extract of Bridelia ferruginea in three divided doses (125 mg/kg, 250 mg/kg and 500 mg/kg body weight) for twelve days. The hematological assay was carried out using mind Ray hematology auto analyzer (BC 5300). Results showed that leaf extract of B. ferruginea exhibited significant increase (p<0.05) in packed cell volume, total leukocyte, hemoglobin, neutrophil, lymphocyte, monocyte and eosinophil counts. However, no significant difference (p<0.05) was observed on the total erythrocyte and platellet counts of the animals. The results in our findings demonstrated that the leaf extract of B. ferruginea is capable of stimulating blood cell formation and act as active phagocytic agent against foreign compounds, and therefore can be used to formulate new plant-based phyto-medicine in a bid to improve human and animal health.

Open Access Original Research Article

Overview of the Distribution and Presentation of Patients with Sickle Cell Disorders: A Report from a Tertiary Care Centre in Eastern Part of India

Ankita Sen, Tuphan Kanti Dolai, Arnab Chattopadhyay

Asian Hematology Research Journal, Page 18-24

Aims: With globalisation, patients with Sickle cell disorders can be found all over the world. Depending on the original genotype, the disease manifestations vary.

This study aimed to assess the distribution and clinical presentation of patients with Sickle homozygous/ heterozygous diseases in the eastern part of India.

Study Design: Retrospective analysis.

Place and duration of study: Department of Hematology at NRS Medical College, Kolkata, between 1st January 2018 to 31st May 2020 (2 years and 4 months).

Methodology: Patients having hemoglobinopathies with any type of Sickle haemoglobin (HbS), such as, Sickle cell anemia/homozygous Sickle cell disorders(SCA); compound heterozygous diseases, like Sickle cell/β thalassemia(HbS/β), Sickle cell/Delta thalassemia (HbS/D), Sickle cell Haemoglobin/E thalassemia(HbS/E); or Sickle cell trait(HbS trait), have been included.

Thorough history was elicited and every patient was clinically examined. Published literature was analysed to assess the differences in disease presentation.

Results: Total 95 patients with a component of HbS were assessed and HbS/β (53.7%) patients comprised the majority, followed by SCA (30.5%). Median age of presentation to our clinic was 17years (range 2-50years). HbS/β and SCA patients had a median age of presentation of 17.5years and 12years, respectively.

Commonest clinical presentation was pain crisis (32,33.7%) - abdominal (11,11.6%) or bone pain (13,13.7%). Other presentations were pallor (26,27.4%), jaundice (12,12.6%) and fever (4,4.2%). Most patients had more than one complaint. Occasional patients required hospital admission for pain, fever or convulsions. HbS trait (5,5.3%) was diagnosed incidentally.

Most patients who attended our center hailed from the nearby district of North 24 Parganas (26,27.4%), and fewer patients came from distant districts and neighbouring states.

Patients were treated with Hydroxyurea, with/without blood transfusions or chelation.

Conclusion: Most studies conducted in India have highlighted the prevalence of Sickle cell disorders among specific endemic populations, unlike in our analysis.

HbS/β was more common than SCA, and, median age of disease presentation was later than that in published literature. There is a variation in the severity of disease manifestation in our cohort. Commonest painful crisis was bone pain, followed by abdominal pain. Stroke, a common manifestation of SCA in other countries, was rare in our cohort.

Open Access Original Research Article

Comparative Study of Erythrocyte Sedimentation Rate (ESR) three Sampling Techniques: Whole Blood in Tri-Sodium Citrate, Whole Blood in Ethylene Di Amine Tetra Acetic Acid (EDTA) , EDTA Blood Diluted with Tri–Sodium Citrate

H. P. A. Gunathilaka, A. W. G. M Sameera, K. H. B. P Fernandopulle, K. S. Pathirage, R. S. Lokupitiya

Asian Hematology Research Journal, Page 25-38

Background: ESR is a simple, inexpensive test commonly used for screening of infective, inflammatory and neoplastic processes. The recommended standard method for ESR by  the International Committee for Standardization in Hematology(ICSH) is the Westergren method where blood is allowed to sediment under optimum conditions in a westergren tube for a given period of time Recommended samples to be used for the test by ICSH are citrate,EDTA diluted in citrate and direct EDTA. When direct EDTA is used ICSH gives a formula to calculate a value that corresponds to citrate values.

Aim: In our study we compared ESR values done on three different samples. Whole blood collected into 3.8% Trisodium-citrate(4:1)(Method1) , EDTA(Method 2), EDTA anticoagulated blood later diluted with 3.8% Tri sodium citrate(4:1)(Method 3)

Methodology: 194 patients’ samples were analyzed irrespective of clinical conditions and gender. Samples were taken into citrate (in a ratio of 1:4, Citrate to blood) and EDTA anticoagulants. Citrate and EDTA samples were mounted directly into the westergren tubes and a third tube was mounted with EDTA blood from the EDTA tube diluted 1:4 with citrate in the laboratory.

Results: 194 results were grouped on HCT as 67 samples with HCT 0.35 and 127 with HCT > 0.35. Mean, SD and range of ESR for methods 1,2 and 3 were (33.81, 22.48,2-118) ,(46.53, 25.02 ,3-122) (32.31, 22.02,2-121)There was no significant difference between(P=0.23) method 1 and method 3. EDTA values were higher than citrated samples and difference was statistically significant (P=0.00). However when the values given by ICSH were substituted for EDTA values (method 2) they were comparable to methods 1 and 3(P=0.59; P=0.98) in patients with HCT<0.35. When HCT was >0.35 the difference was significant with the citrate samples (P=0.00) but not with the samples later diluted with citrate (P=0.103).All tests were conducted at 5% significance level.

Conclusion: ESR gives comparable values when samples are collected into citrate and when collected into EDTA and later diluted with citrate. When EDTA samples are directly mounted the corresponding value given by ICSH is valid when HCT is <0.35