Open Access Original Research Article

Immunophenotypic Characterisation of Blast Crisis in Chronic Myeloid Leukemia : Experience at a Tertiary Care Centre

Monika Gupta, Shivani Singhal, Sunita Singh

Asian Hematology Research Journal, Page 1-5

Aims and Objectives: Chronic myeloid leukemia (CML) is a clonal stem cell disorder that is hallmarked by the presence of a t(9;22), also known as the Philadelphia chromosome. The natural history of CML is typically triphasic: an initial indolent chronic phase, followed by an accelerated phase and usually a terminal, highly aggressive blast phase. Determination of the cell lineage of CML blasts is clinically important for a better response to chemotherapy and longer survival. Hence, it becomes essential to correctly classify the nature of BC preferably by immunophenotyping for further course of management and survival.

Materials and Methods: This study retrospectively analyzed cases of CML-BC for 5 years and lineage of blasts were determined in each case depending upon the expression of markers by comprehensive immunophenotyping on flow cytometry. EDTA peripheral blood samples or bone marrow aspirates were used for immunophenotyping using 19 antibody panels.

Results: 15 cases of CML-BC were reported for 5 years with a male to female ratio of 2:1 and a median age of 38.3 yrs. Flow cytometry revealed 8 cases were of lymphoid BC and 7 cases were of myeloid BC. Blast percentage ranged from 16% to 90%. Aberrant myeloid antigen expression was common in cases with lymphoid BC. Out of 7 cases of myeloid BC, 2 cases of monocytic lineage were seen. CD7 positivity was common in cases with myeloid BC.

Conclusion: Immunophenotyping is important in distinguishing between a myeloid and lymphoid blast crisis, thus providing clinically useful information for further treatment protocols and prognosis.

Open Access Original Research Article

Diagnosis of Dengue NS 1 Antigen with a Finger Prick – Evaluation of New Rapid Diagnostic Test

H. P. Shruthi, H. B. Shobha, K. Thejasvi, K. Tejashwini

Asian Hematology Research Journal, Page 6-11

Introduction: Dengue is one of the most common mosquito borne viral disease of humans and a major contributor to the health burden in the world.There are many reasons why early diagnosis of dengue is important. Hence there is need for Rapid Diagnostic Tests(RDTs) for early diagnosis of Dengue, that yields results within minutes and that can be performed in health centers with little infrastructure or trained personnel, preferably without electricity.

Aims: To identify differences in sensitivity, specificity, and likelihood ratios between the diagnostic assays. To determine the positive and negative predictive value of the Rapid NS1-FP(Finger Prick) test and To correlate platelet counts with expression of NS 1 antigen.

Study Design: Prospective case control study.

Place and Duration of Study: Blood samples were collected from 200 patients clinically suspected of dengue during JUNE – 2017 to AUGUST – 2017 form PADMASHREE DIAGNOSTIC CENTER, BANGALORE.

Methodology: Dengue suspects were evaluated according to WHO criteria for probable dengue infection. Blood samples were collected from 200 patients clinically suspected of dengue were tested for NS 1 antigen using Serum card method and Finger prick method and results were compared with ELISA method ,later the qualitative results of NS 1 antigen were correlated with platelet counts.

Results: Total number of male cases were 113 (56.5%) and female cases were 87 (43.5%). The Sensitivity and specificity rates were on par with serum card method. The performance characteristics of Whole blood finger prick method was as follows.1.Sensivity – 90.9% 2.Specificity – 100%

Conclusion: Further studies are required to assess the potential impact of implementing early laboratory diagnosis of Dengue in terms of prognosis and cost effectiveness.

Open Access Original Research Article

Pattern Analysis of the Hemoglobin Variants in Western India by HPLC: Strategies and Practical Implication for Pursuing Rare Hemoglobins

Kumar Ankur, Gulati Sandhya, Sharma Nidhi, Saini Peeyush Kumar

Asian Hematology Research Journal, Page 12-20

Aims: The aim of the present study was to determine the common Hb disorders in patients of a tertiary care hospital of Rajasthan, India.

Study design: This was a retrospective study which included high performance liquid chromatography (HPLC), clinical history, hematological parameters and family studies to reach an accurate diagnosis.

Place and Duration of Study: This study was conducted in the Advanced Hematology & HLA Laboratory, Department of Pathology of a tertiary care center in rajasthan over a period of 5 years from January 2015 to December 2019.

Methodology: A retrospective study was undertaken in which 2789 patients were included. A detailed clinical history and family history were obtained from each patient. Blood samples were analyzed for complete blood counts. HPLC was performed on the samples with BIORAD VARIANTTM-II using beta thalassemia short program.

Results: Out of 2789 patients (1538 males and 1251 females), normal hemoglobin (Hb) pattern was observed in 1931 (69.2%) cases and abnormalities were detected in 858 (30.8%) patients. β (beta) thalassemia heterozygous was the most common abnormality found in 586 (21%) patients, thalassemia homozygous in 149 (5.3%) cases followed by HbE heterozygous in 21 (0.7%) & Sickle cell trait in 20 (0.7%) patients. Other variants detected included Eβ thalassemia, Hb D Punjab trait, HbE disease, sickle cell disease, Hb lepore, hereditary persistence of fetal hemoglobin (HPFH), sickle‑β thalassemia, double Heterozygous for Beta Thalassemia & Hb D Punjab, Sickle cell Trait & Hb D Punjab and many more. One (0.04%) rare case of Hb Burke was also detected.

Conclusion: In India, where β thalassemia trait is so rampant, premarital and antenatal screening should be mandatory to prevent birth of off springs with β thalassemia major. HPLC is a rapid and reproducible technique for determination of different Hb variants.

Open Access Original Research Article

Frequency of Induction-Related Mortality in Patients of Acute Myeloid Leukemia - Experience from a Resource Limited Country

Rija Tariq, Nadia Sajid, Misbah Masood, Abubaker Shahid

Asian Hematology Research Journal, Page 21-30

Aim: Treatment-related mortality during remission induction (also known as induction-related mortality) is a significant contributing factor to poor outcome of acute myeloid leukemia (AML) patients. This is true especially for resource limited countries where there is dearth of adequate supportive care. This study is carried to analyze the frequency of induction mortality in AML patients in Pakistan and the factors that contribute to it.    

Methodology: This descriptive case series was conducted in AML patients admitted in INMOL Hospital, Lahore from November 2017 to April 2018. 80 Patients aged 5-50 years of age with de-novo AML were included in the study. Their progress over 28 days following start of induction chemotherapy, including complications experienced and the outcome at end of 28 days was observed. All patients received prophylactic anti-fungal therapy as part of supportive care.

Results: The progress and outcomes of 80 patients were analyzed including 8 patients less than 15 years of age and 4 patients of acute promyelocytic leukemia. The induction-related mortality was 27.5% (n=22). Of the patients alive at the end of 28 days of start of induction, 38 achieved complete morphological remission (65.5%). Poor performance status was associated with higher induction mortality (P = .01). The cause of death in 90% of the patients was sepsis and fulminant infections.

Conclusion: The frequency of induction mortality in our population was 27.5%. This is a significantly high number when compared with data from the developed resource abundant countries. Thus it highlights the importance of allocation of increased resources to provide adequate supportive measures and infection control for this population.

Open Access Original Research Article

Reference Ranges of Haematological Parameters in Apparently Healthy Elderly Persons in Nnewi Metropolis, Nigeria

Onuigwe, Festus Uchechukwu, Amilo, Grace Ifechukwudebelu, Ibeh, Nancy Chitogu

Asian Hematology Research Journal, Page 31-42

Backgorund: Haematological parameters are important constituent of blood used to monitor immune system, disease progression and therapeutic response. This can be achieved through porper reference values in clinical laboratory.

Aim: This study was aimed at determining reference values of haematological parameters in apparently healthy elderly persons in Nnewi and compared with the local reference values.

Study Design: This was a comparative study

Duration of Study: The study lasted for a period of one year between Januray to December, 2020.

Methodology: This study involved a total of 105 apparently healthy elderly persons aged 60 years. Full blood counts (FBC) were determined using five part haematological analyser by Mindray, Germany. Data were expressed as percentiles, mean and standard deviation. The differneces in gender was determined using using independent t-test and one way ANOVA was used to compare the means between different age groups and BMI

Results: The study established reference ranges of WBC, lymphocyte, neutrophil, eosinophil, monocyte, basophil, RBC, Hb, HCT, MCHC, MCH, MCV, RDW-CV RDW-SD, Platelet count, MPV, PDW and Plateletcrit for the elderly in the Nnewi metropolise. Neutrophil, monocyte, HCT, MCH and MCV were lower than the local used reference ranges used in Nnewi. Lymphocyte, monocyte, RBC, MCHC, MCH, RDW-CV, RDW-SD MPV and PCT were higher than the local used reference ranges in Nnewi. PCV and Hb were significantly higher in males than females (p=<0.001). Monocyte increased with increase in BMI (p=<0.001).

Conclusion: In conclusion, normal reference values obtained in this study notably vary with the local reference ranges used in Nnewi. There is need for each locality to have separate reference ranges for the elderly for their proper diagnosis and management.