Open Access Case Study

Non-Essential Intervention in the Management of Ovarian Burkitt Lymphoma: A Case Report

C. E. Amiwero, E. A. Nelson, H. Idris, A. A. Sule

Asian Hematology Research Journal, Page 27-35

Background: Ovarian involvement by Non-Hodgkins Lymphoma (NHL) may manifest within the four subtypes of lymphoma: diffuse large B-cell lymphoma, Burkitt lymphoma, lymphoblastic lymphoma, or anaplastic large cell lymphoma. Burkitt Lymphoma (BL) rarely manifests as a primary ovarian disease given the various epidemiological studies, putting the incidence at 0.5% of NHL and 1.5% of all ovarian neoplasm.

Objective: This study is intended to highlight necessary intervention in the event of an uncommon manifestation of Burkitt lymphoma in a milieu of diagnostic challenges.

Methods: A comprehensive review, and analysis of diagnosis, intervention and treatment of the index case was conducted by a team of health caregivers of the Federal Medical Centre, Bida, North Central Nigeria.

Results: This review identifies a 15-year old female, with features suggestive of abdominal malignancy. In view of the associated severe abdominal discomfort, and pressure effects arising from the huge abdominal mass, the patient underwent exploratory laparotomy partly as a palliative measure to debulk as well as determining the extent of the local disease spread, and obtain tissue for histology.  Following a histological diagnosis of ovarian Burkitt lymphoma stage IIIB (St. Jude / Murphys staging), the patient was commenced on supportive therapy; a monthly course of intensive multi-agent (cyclophosphamide, Vincristine, Methotrexate) chemotherapy including intrathecal Methotrexate prophylaxis.  Haematologic remission was achieved by the end of the fifth cycle of the scheduled six cycles. Patient is currently well, and on hormone replacement therapy while being followed up at both the haematology and gynaecology clinics.

Conclusion: Burkitt lymphoma (BL) as we have and seen in this case is highly responsive to standard high-dose chemotherapy, but it could be rapidly fatal if treatment is delayed. Although surgery is not considered as first line of treatment, but offers an opportunity for debulking and obtaining tissue biopsy for histological analysis. Standard multi-agent chemotherapeutic management remains the recommended first line choice in established case.

Open Access Minireview Article

Plasma Cell Leukaemia (PCL): A Review

Emmanuel Ifeanyi Obeagu, Ebube Chioma Udemezue, Blessing Oluchi Akalonu, Quratulain Babar

Asian Hematology Research Journal, Page 36-38

Leukemia is a blood and bone marrow malignancy. Chronic lymphocytic leukemia (CLL), acute lymphocytic leukemia (ALL), chronic myelogenous leukemia (CML), and acute myeloid leukemia are the four main kinds of leukemia (AML). The pathological diagnosis of plasma cell leukemia is based on histological, immunophenotypic, and cytogenetic findings in addition to the circulating plasma cell count.

Open Access Original Research Article

Antiretroviral Therapy Immune Function Reinstallation in HIV-Infection in Sub Sahara Africa Population

Precious Nc. Alisi, Edna O. Ibegbulem, Evelyn M. Eze, Chinwe S. Alisi, Zacchaeus A. Jeremiah

Asian Hematology Research Journal, Page 1-11

Aims: To access antiretroviral therapy immune function reinstallation in HIV-infection in a sub-Sahara Africa population.  

Study Design:  The study was carried out in HIV seronegative healthy young (20-35 years) adults (CTRL), HIV Seropositive ART-Naive (20-35 years) young adults (Naïve) and HIV Seropositive on Anti-retroviral therapy (ART) aged 20-35 years old.

Place and Duration of Study: One hundred and fifty subjects were used for the study. One hundred (100) are HIV seropositive individuals, 50 on ART and 50 ART-Naive attending the Federal Medical Centre Owerri between August and December 2020. Fifty (50) healthy younger adults of the same age range served as controls in this study.

Methodology: EDTA and plain vacutainers were used to collect Venous blood from each participant.  The following parameters were determined in the subjects:  Viral load, CD4+, CD8+, CD4+/CD8+ ratio was calculated and CD57+ measured, Erythrocyte Sedimentation rate (ESR), and C-reactive protein (CRP) concentrations were also determined in subjects. The data generated were analysed by a one-way analysis of variances (ANOVA) using Statistical Package for Social Sciences (SPSS) version 21.

Results: The result of the study showed that Naïve individuals had a mean viral load of 41.54±13.39 copies/ml (IQR12-18) while subjects on ART had a significantly (p<0.05) lower mean viral load value of 22.26±11.31 (IQR8-54). CD4+ count obtained was 335.46 ± 76.75, 482.80 ± 88.69 and 846.08 ± 231.47cells/mm3 in NAIVE, ART and Control subjects respectively. CD8+ count obtained was 604.34 ± 126.09, 441.48 ± 94.42 and 376.86 ± 51.17 cells/mm3 in NAÏVE, ART and CTRL,respectively. Our result showed that HIV infection significantly (P<0.05) decreased CD4+/CD8+ ratio. CD57+ counts in ART treated subjects were found to be improved by treatment. CD4+ count correlated positively with viral load in NAÏVE (r = 0.799) and in ART subjects (r = 0.809). ART-NAÏVE, ART and CTRL subjects had IFN-γ concentrations of 186.44 ± 38.67, 161.83 ± 37.34 and 133.73 ± 25.97 pg/ml respectively. ESR was significantly (P<0.05) elevated in HIV seropositive subjects (NAÏVE and ART)(49.16 ± 5.49mm/hr  and 24.12 ±2.88mm/hr) when compared to CTRL (7.66 ± 0.61 mm/hr). ART treatment resulted in a significant (P<0.05) decrease in ESR among seropositives. CRP concentration was significantly (P<0.05) increased in NAÏVE when compared to CTRL and subjects.

Conclusion: We conclude that Antiretroviral therapy in HIV-seropositive individuals acts to reinstall immune function and normalize fuction. Although immune function was not completely normalized, it was closer to normal than ART-naïve person whose immune function was largely compromised.

Open Access Original Research Article

Haematological Indices of HIV-1 Infected Subjects on Antiretroviral Therapy from Selected Tertiary Hospitals in Port Harcourt, Nigeria

U. U. Aaron, I. O. Okonko, N. Frank-Peterside

Asian Hematology Research Journal, Page 12-19

Introduction: Changes in haematological indices could result from so many underlining factors, one of which could be an autoimmune response, defect in hemopoiesis, infection, cancer, and so on. Cytopenia is a common illness observable in the blood of people infected with HIV.  

Materials and Methods: This is a cross-sectional study involving two hundred patients. The blood samples of recruited subjects were collected aseptically before analysis for Haematology indices using Mindray BC-6800. 

Results: Results showed that the lowest and highest count/L for haematological indices were; WBC 1.3-11.9 x109/L, Lymphocyte 0.3-6.4 x109/L, Monocyte 0.2-2.6 x109/L, Granulocyte 0.1-5.1 x109/L and Platelet 30-550 x109/L. White blood cell indices showed a significant difference in distribution of relative lymphocytes (Mean+SD 50.78+15.69) (P=0.000), Monocytes (Mean+SD 15.929+8.68) (P=0.000), Granulocytes (Neutrophils, Basophil and Eosinophil) (Mean+SD 33.287+18.05) (P=0.000), and absolute counts of lymphocytes (Mean+SD 2.742+1.14) (P=0.000), Monocytes (Mean+SD 0.838+0.48) (P=0.000), Granulocytes (Neutrophils, Basophil and Eosinophil) (Mean+SD 1.943+1.31) (P=0.000). Red blood cell indices showed a significant difference in their distribution across all ages in this study. Haemoglobin concentration (Mean+SD 10.491+2.30) (P=0.000), Haemoglobin crit (Mean+SD 40.52+6.98) (P=0.000), MCV (Mean+SD 92.03+6.68) (P=0.000), MCH (Mean+SD 23.43+2.32) (P=0.001), PLT x109/L (Mean+SD 223.10+84.52) (P=0.000), PDW (Mean+SD 13.04+5.23) (P=0.000). Similarly, age was a significant factor in the distribution of haematological parameters across all blood cell lines as it showed significant differences in white blood cell count, relative and absolute counts for Lymphocytes, monocytes, and granulocytes. 

Conclusion: The study showed a substantial change in the WBC differential counts of study participants based on the duration of antiviral drug intake.

Open Access Original Research Article

Clinical, Hematological Profile and Status of Iron Overload in Children with Transfusion Dependent Thalassemia : A Study from Rural Northern India

G. K. Verma, Astitva Singh, C. B. Chauhan, M. V. Singh

Asian Hematology Research Journal, Page 20-26

Thalassemias are one of most common type of haemolytic anaemia caused due to ineffective erythropoiesis requiring lifelong blood transfusions leading to chronic iron overload resulting in vasrious complications restricting the life span of most patients to 3rd-4th decade.

Objective: To evaluate clinical, haematological profile and status of iron overload in patients of transfusion dependent thalassemia.

Methods: We have enrolled 42 patients presenting to our centre for regular blood transfusion, the participants were followed up for a period of 1 year and samples were send at 3 monthly interval for CBC, Serum ferritin(S.F) , Serum Iron(S.I) and TIBC.

Results: The most frequent presenting complaints was pallor, incidence of malnourishment was 45.2%,the mean haemoglobin at time of presentation was 6.8± 2.9 g/dl, the mean S.F(ng/ml) and S.I(mcg/dl) at commencement of study was 2059.45 ± 2082.92 and 248.99 ± 92.95 while these values increased to 2610.57 ± 2245.64 and 349.05 ± 110 respectively after 1 year follow-up. All patients received chelation therapy either in form of Deferasirox (mean S.F=1639 ± 962 mean S.I=274.5 ± 76.7) or a combination of Deferasirox and Deferiprone (mean S.F= 5350 ± 3349.7 mean S.I=397.9 ± 128.2).

Conclusion: Majority of participants are inadequately transfused and chelation therapy was not effective in preventing iron overload which mandates a need of better and more effective chelators, revision of transfusion guidelines as well as proper counselling regarding attitude and behaviour of caregivers.