Systematic Review Article | Asian Hematology Research Journal. 2023 July 15;6(3):178-191
Role of Bioinformatics based Red Cell Indices in the Diagnosis of Iron Deficiency Anemia and to Differentiate it from Beta Thalassemia and to Assess Its Reliability in Analysing the Level of Prognosis

Saritha Mary Thomas, Kuladeepa Ananda Vaidya

Iron deficiency anemia (IDA) is a prevalent hematological disorder characterized by a deficiency of iron, leading to a reduction in red blood cell production and subsequent impairment of oxygen transport. Accurate and timely diagnosis of IDA is crucial for effective management and prevention of complications. Various red cell indices, including the Mentzer, Shine& Lal, and other emerging indices, have been proposed as practical tools for distinguishing IDA from other types of anemia (7,16,18).

This comprehensive review aims to assess the significance of the Mentzer, Shine& Lal, and other red cell indices in the diagnosis of IDA and their utility in clinical practice. A systematic search was conducted to identify relevant studies and publications that evaluated the diagnostic accuracy of these indices in different patient populations.

In conclusion, the Mentzer, Shine& Lal, and other emerging red cell indices offer valuable tools for screening and differentiating IDA from other forms of anemia. When used in conjunction with a comprehensive clinical evaluation, these indices can aid in the diagnosis of IDA and guide appropriate management strategies. Further research is warranted to validate their performance in diverse patient populations and explore their potential integration with novel diagnostic techniques.

Minireview Article | Asian Hematology Research Journal. 2023 April 15;6(3):112-115
Long-term Outcome of Splenectomy in Immune Thrombocytopenia (ITP)

Tarun Kumar Dutta

ITP is a chronic illness with frequent mucosal bleeding. Though the first line treatment is corticosteroids, relapse is frequent which necessitates splenectomy. Response to splenectomy is usually good initially; however, over the years relapses are frequent.  Drugs then used are azathioprine, mycophenolate mofetil, anti-D globulin, TPO-receptor agonists, rituximab, cyclosporine, etc. Ultimately there is a small subset of patients who may require a small dose of prednisolone lifelong.

Original Research Article | Asian Hematology Research Journal. 2023 March 23;6(3):97-103
Correlation between PT/INR and APTT in Patients on Warfarin: A Study at a Tertiary Care Teaching Hospital

Sasini Attanayake, Ishara Manathunga, Chandima Kulathilake

Background: Warfarin prolongs coagulation by inhibiting the synthesis of biologically active forms of coagulation factors and regulatory factors, which are dependent on vitamin K. The Prothrombin Time (PT) and International Normalized Ratio (INR) are routinely used to monitor warfarin therapy in clinical settings. In addition to PT, APTT is also prolonged by warfarin therapy due to the effect of warfarin on intrinsic pathway. In this study we aimed to evaluate the distribution of PT/INR, distribution of APTT and correlation between INR and APTT in a cohort of patients on long term warfarin.

Materials and Methods: Seventy four (74) patients on long term warfarin therapy were recruited from University Haematology clinic of Colombo South Teaching Hospital. PT and APTT were performed in the routine citrated blood samples during their regular clinic visits using semi-automated 4 channel CA-104 analyzer. Data were analyzed statistically by using SPSS.

Results: Among the recruited 74 patients, 36 were females and 38 were males. In this cohort, PT was normally distributed. The distribution pattern of APTT deviated from the normal standard pattern due to some exceptional cases of females. There was no significant correlation between INR and warfarin dose. The statistical results of the study established that there was a good (strongly positive) linear correlation between the APTT and INR since Pearson correlation coefficient equals to 0.799 (p=0.000).

Conclusion: Our study concluded that in addition to the elevation of PT/INR and APTT by warfarin, there is a good linear correlation between elevation of INR and APTT.

Original Research Article | Asian Hematology Research Journal. 2023 April 6;6(3):104-111
Monocytosis / Monocytic Dysplasia: Testing a New Diagnostic Tool Using Sysmex XN Analyzer Parameters

Houda Kouame, Hanaa Bencharef, Mohammed Benamor-Seghir, Karima Arioua-Mikou, Bouchra Oukkache

Background: In a medical laboratory, monocytosis is very common, often reactive, but may be related to a hematological malignancy, particularly Chronic myelomonocytic leukemia (CMML).

CMML is considered a diagnosis of elimination given the frequency of reactive monocytosis. This increases the number of blood smears (BS) performed without diagnostic interest. The objective of this study is to test and validate on our population a score established from the parameters of SYSMEX XN analyzers, to differentiate patients with monocytic dysplasia - which may suggest a hematological malignancy, in particular CMML -, from patients with reactive monocytosis, and reduce the number of unnecessary BS.

Methods: Patients aged ≥18 years with monocytosis>1G/L and>10% leukocyte formula were included. BS were performed manually with the objective of confirming monocytosis and looking for signs of monocytic dysplasia. The calculation of the monodysplasia score (MS) was performed using parameters derived from the SYSMEX XN9100 analyzer.

Results: During the study period 263 patients were collected with a sex-ratio of 1.4. The mean monocyte value was 1.49 G/L. The MS was <0.160 in 242 patients, and >0.160 in 21 patients of which 12 showed signs of monocytic dysplasia on BS. The MS showed 100% sensitivity and 96.41% specificity with a negative predictive value at 100% and a positive predictive value at 57.14%.

Conclusion: Our study demonstrates the effectiveness of MS, having shown high sensitivity and specificity. The diagnosis of CMML remains difficult, so the use of MS helps to select patients most suspected of malignancy and will reduce the number of unnecessary BS.

Original Research Article | Asian Hematology Research Journal. 2022 May 5;6(3):129-142
Clinical Profile of Multiple Myeloma in National Oncology Center, Aden, Yemen

Gamal Abdul Hamid, Rasha Yassin Abbas

Background: Multiple myeloma (MM) is a malignant disorder characterized by the proliferation of a single clone of plasma cells derived from β-cells in the bone marrow. This present study aims to determine the clinical and laboratory features, stages, and outcomes of newly diagnosed adult myeloma patients and to identify the pattern of multiple myeloma distribution according to gender, age, occupations, risk factors, and geographic distribution.

Materials and Methods: This is a descriptive study of 30 patients diagnosed with multiple myeloma carried out at the Hematology Department of National Oncology Center Aden, Yemen, between 2019 – 2020, with history and physical examination, complete blood count, bone marrow aspiration, serum protein electrophoresis, B2 macroglobulin, albumin, creatinine, and calcium were done for all patients.

Results: Of the 30 diagnosed cases of multiple myeloma, 11 were male, and 19 were female; Male to Female ratio was (1:1.7). The age ranged between 43 – 80 years, where (36.7%) were more than 65 years. The mean age was 63.2 years. Bone marrow plasmacytosis was noted in 100% of cases with a mean count was (32.2%). On serum electrophoresis, M-band was noted in all patients. Radio imaging revealed lytic bone lesions in 93.3%. According to ISS: The most common patients presented with stage III (40%). In the study period, (85.6 %) of the patients received bortezomib, cyclophosphamide, thalidomide, and/or lenalidomide with dexamethasone as part of the first-line treatment. The survivors during the research period were (60%) of patients. 

Conclusion: This study shows that multiple myeloma is a disease of the middle and elderly aged population with a female preponderance. Bone pain and low backache were the most common presenting symptoms, along with fatigue and weakness. Most patients were in stage III at presentation with severe anemia, lytic lesions, pathological fractures, and renal insufficiency were most observations findings. Bone marrow aspiration, serum electrophoresis, and related investigations play an essential role in diagnosing and managing multiple myeloma cases.

Original Research Article | Asian Hematology Research Journal. 2023 May 17;6(3):143-149
Evaluation of the Effect of Methanol Seed Extract of Carica papaya (Pawpaw) on the Haematological and Renal Indices of Rats Induced Kidney Damage

Amah Akuma Kalu, Eberechukwu Lolly Mbanaso, Onwuka Kelechi Collins, Ubani Clement Dimgba, Chris Akunne Wariso

The kidney is one of the most important organs of the body saddled with critical physiological functions one of which is the elimination of metabolic waste products from the blood.  Drugs, chemicals, pesticides and pollutants can pose threat to the kidney and often times, collapse its functions. In order to minimize pressure on the already deteriorating organ, treatment should focus more on natural options than the conventionally sourced option of employing synthetics. Thus, the aim of this study was to evaluate the efficacy of pawpaw seed extract in the treatment of experimentally induced kidney damage. Seed obtained from ripe pawpaw fruit was dried at room temperature and afterwards extracted. Twenty five (25) adult male Wistar rats were divided into five groups of five (5) rats per group. Group I was the normal control administered with only distilled water. Group II was administered with 100 mg/kg gentamicin and was not treated with extract. Groups III-V were administered with 100, 200 and 400 mg/kg body weight of Pawpaw Seed Extract respectively for 28 days after which animals were sacrificed and blood samples collected for analysis. Biochemical, haematological and histological parameters were determined using standard procedures. Results obtained from this study revealed that increased serum creatinine and urea levels were observed in Group II. However these were significantly (P<0.05) reduced in treated groups with the effect of treatment being more pronounced in groups administered 200 and 400 mg/kg of PSE. It also revealed that extract did not alter the hematological indices of treated rats. In conclusion, PSE can reverse kidney damage and would not alter haematological indices of treated animal.

Original Research Article | Asian Hematology Research Journal. 2022 June 17;6(3):150-164
Predictors of Outcome in Pediatric Immune Thrombocytopenia: Relation to Thrombopoietin Levels

Amira Abdel Moneim Adly, Eman Abdel Rahman Ismail, Gina Gergis Abd Elsayed, Fatma Soliman Elsayed Ebeid

Background: It is not easy to predict the course of immune thrombocytopenia (ITP) at the time of diagnosis.

Aim: This prospective study investigated the possible predictors of ITP outcome in children and adolescents including the diagnostic potential of thrombopoietin (TPO).

Methods: Seventy pediatric patients with ITP were studied; 45 had chronic ITP and 25 were newly diagnosed and were followed-up for 3 months. Complete blood count and TPO levels were assessed.

Results: Chronic ITP patients were older (p<0.001), presented more frequently at age >5 years (p=0.027), had higher initial platelet count (p=0.005) but less likely to have platelet count >100 x 109/L after 4 weeks from diagnosis (p=0.017) and frequently used a third line of treatment (p=0.007). After 3 months follow-up of the 25 newly diagnosed ITP patients, 16 entered in a complete remission and they were younger than 5 years and had lower initial platelet count, higher platelet count after 4 weeks from diagnosis, and less frequently used corticosteroid as a second line of therapy compared with the 9 patients who developed persistent ITP. Increased TPO levels were found among patients with persistent ITP and those who experienced relapse. TPO levels were inversely related to platelets count.

Conclusions: The predictors of progression to persistent ITP and chronicity among our pediatric patients were age of onset > 5 years old, high initial platelet count, low platelets count 4 weeks after diagnosis and higher baseline TPO levels which could be used as a serum biomarker of megakaryopoiesis to predict therapeutic response.

Original Research Article | Asian Hematology Research Journal. 2023 July 1;6(3):165-169
Estimation of Protein C and Measurement of Coagulation Changes among Sudanese Patients with Solid Malignancy

Awad Omer Ahmed, Khalid Mohammed Khalid, Mohammed Abdulgader Albasheer

Background: Activation of the coagulation cascade frequently occurs in cancer by a number of mechanisms, including the generation of tumor necrosis factor, tumor pro-coagulant and tissue factor.

Aim: The purpose of this study was to investigate the plasma level of PC, FIB, DD and evaluate the PT, INR, APTT, and platelets count in Sudanese patients with some solid malignant tumors.

Methods: A total of 165 individuals (both sex 52% male and 48% female) of Sudan origin 125 patients diagnosed as solid malignant tumors (40% Breast, 24.8% Prostate, 10.4% uterine cervix, 7.2% rectum, 5.6% ovarian, 4,8%esophageal, 4.8% lungs and 2.4% colon) and 40 apparently healthy control subjects were prospectively enrolled in the study. The exclusion criteria of the study were the presence of a medical history of hematological malignancies or coagulation-related diseases, severe hepatic and/or renal insufficiency, significant cardiovascular disease, or receiving any anticoagulant therapy. Platelets were count by Sysmex Kx21, XRC used for PT, PTT, FIB, Snibe maglumi 2000 was used for D-dimer and ELISA was used for PC.

Results: There were significant statistical differences between the study parameters in the patients compared with apparently healthy controls. The mean of (platelets count, PT, INR and APTT) was (295±125)cell/L, (22.9±2.82)sec, (1.49±0.206)% and (45.3±5.74) sec, in patients with solid malignant tumors vs (350±80.0) cell/L, (17.4±1.48)sec,(1.13±0.104)% and (38.0±5.28)sec in control group p-value (0.011), (0.000), (0.000) and( 0.000) respectively. Then mean of PC, FIB and D-dimer (8.20±2.81)pg/ml, (297.9±75.1)mg/dl, and (1.08±1.26) µg /ml in patients with solid malignant tumors vs (9.57±3.40) pg/ml, (288.6±57.2) mg/dl, and (0.482±0.223) µg /ml in control group p-value (0.011), (0.409), and (0.000) respectively.

Conclusion: In this study, the study variables (Platelets count, PT, INR, APTT, PC, and DD) showed significant statistical difference between the patients with solid malignant tumors and apparently healthy controls, but the FIB level results show insignificant different, our finding suggest that these study variables can play important role in pathogenesis of the hypercoagulable state in cancer patients and the significant difference in platelets count, PT and APTT may early indication of bleeding tendency, further investigations (platelets function tests and coagulation factors assay) should be done to avoid risk of bleeding.

Original Research Article | Asian Hematology Research Journal. 2023 July 6;6(3):170-177
Characteristics of Cytopenia in HIV Positive Individuals

Md. Sazzad Zayed Chowdhury, Masuda Begum, Muhammad Shahidul Islam Sikder Rumi, Mohammed Wasim, Mohammed Murad Hossain, Md. Shafiur Rahman, Niraj Kumar Singh, Fatema Khatun

Background: HIV infection is an emerging issue all over the world. Bangladesh also experiencing increasing trend of infection over the time. Around 9500 infected individuals were in 2014 and it were only 500 individuals in 2000. Haematological manifestations are very common among those individuals whereas cytopenia is the commonest. Cytopenia may develop due to HIV itself or its sequel or due to drugs used for treatment. In Bangladesh, there is no available data regarding cytopenia and its association in HIV positive individuals till date. So, in our study, we tried to focus about the frequency of cytopenia and its associated factor.

Objective: The objective of this study was to assess the characteristics of cytopenia in HIV positive individuals.

Methods: This was a cross sectional analytical study where 100 of HIV positive individuals were enrolled. The study was conducted in the Department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh with collaboration of Ashar Alo Society, Dhaka, a renowned NGO from January 2014 to December 2015. Cytopenia was identified by automated cell counter and re-evaluated by manual examination of peripheral blood film. CD4 count measured by flow cytometry. Multiple regression analysis was done to assess correlation of different variable. A p value of <0.05 was taken as significant.

Results: Among total participants, 56% had at least one type of cytopenia. Anaemia was observed in 45% whereas leucopenia and thrombocytopenia were found in 10% and 17% respectively. Among all anaemic individual’s, mild anemia was the commonest which was in 64.4%, 22% was moderately anemic and severe anemia was observed in 13.3 % cases. The most common type of anaemia was microcytic anaemia 51.1%, then normocytic anaemia was found in 44.4% while macrocytic variety were seen in only 4.4%. Bicytopenia was observed in 14% and only 1% had pancytopenia. Cytopenia were more prevalent in subjects aged between 20 and 40 years. Multiple regression analysis shows anemia was associated with gender (p <0.05) and CD4 count (p<0.0001). Thrombocytopenia was associated with CD4 count (p<0.05), leukopenia was correlated with the CD4 count (p<0.05) and age (p<0.05) among the variables observed. According to proportion of cytopenia after HAART, neutropenia was at baseline 46.6%, at 6 months 18.0%, at 12 months 15.1%. and at 24 months 11.3%. Anemia at baseline 57.1%, at 6 months 14.9%. after 12 months 9.2% and at 24 months 7.9%. Thrombocytopenia at baseline 19.3%, at 6 months 4.4%, at 12 months 4.3% and at 24 months 2.5%. Cytopenia at baseline 79.1%, at 6 months 25.4%, at 12 months 21.8% and at 24 months 17.7%. Finally, of bi-cytopenia baseline 18.2%, at 6 months 3.4%, at 12 months 2.6% and after 24 2% respectively.

Conclusion: Anemia is the commonest cytopenia related to HIV infected individuals. Mild anemia and microcytic type are very common in Bangladesh. CD4 count is a unique variable for development of cytopenia.

Review Article | Asian Hematology Research Journal. 2022 April 29;6(3):116-128
Hematological and Lipid Profile in Gestational Diabetes Patients: A Systematic Review Analysis of Effect of Gestational Diabetes Mellitus on Different Parameters and Its Association to Maternal and Foetal Outcome

C. K. Nusrin, Kuladeepa Ananda Vaidya

Study was done to analyze various hematological parameters and lipid profiles in gestational diabetes mellitus and also focused on risk factors and outcome at term and effect on childbirth.

The study was a systematic review analysis .it was able to conclude that there are so many blood parameters to find out the risk and relationship to the complications of the condition gestational diabetes mellitus patients.

Platelet parameters and White Blood Cells parameters are varying in Gestational Diabetes Mellitus:- a higher prevalence of Gestational Diabetes Mellitus was associated with maternal age, pregnancy weight, prior spontaneous or induced abortion, prior stillbirth, prior low birth weight infant, prior high birth weight infant, and chronic hypertension. Gestational Diabetes Mellitus -affected mothers were more likely than Gestational Diabetes Mellitus -unaffected mothers to produce babies with HBW. Women with Gestational Diabetes Mellitus had a more than two fold increase in caesarean deliveries. The risk of Gestational Diabetes Mellitus increases with age.

The lipid profile is another key sign in Gestational Diabetes Mellitus. Higher Triglyceride, TOTAL CHOLESTEROL, Low density Lipoprotein (LDL), and very Low density Lipoprotein (VLDL) values as well as low High density lipoprotein (HDL) levels were revealed to be significant with Gestational Diabetes Mellitus.