Malaysian Journal of Pathology最新文献

Introduction: The treatment of Plasmodium vivax malaria with 8-aminoquinolines is contraindicated in glucose-6-phosphate dehydrogenase (G6PD) deficient individuals due to the risk of acute haemolytic anaemia. Effective G6PD screening is paramount to avoid adverse drug reactions. This study aimed to evaluate the performance of novel quantitative point-of-care (POC) tests as a new screening method for G6PD deficiency in Malaysia.

Materials and methods: A total of 153 neonatal cord blood, 99 peripheral blood of older children aged between 1 month to 12-years old, and 62 peripheral adult blood were screened for G6PD deficiency using two quantitative POC tests, CareStartTM biosensor (Carestart) and CareStartTM Biosensor 1 (S1). The results were compared with OSMMR2000D kit as a reference assay. Two statistical analyses were performed in this study to evaluate the POC test performances, the Spearman's correlation test and the Cohen's kappa method.

Results: Both Carestart and S1 tests showed significant positive correlations to OSMMRS000D with r² = 0.7916 and r² = 0.7467. Their measurement of agreement showed a kappa (κ) value of 0.805 (p<0.001, 95% CI), and 0.795 (p<0.001, 95% CI), respectively. Analysis of the area under the Receiver Operating Curve (ROC) at 60% cut-off illustrated that the Carestart had 90.2% sensitivity, 98.9% specificity, 98.3% positive predictive value (PPV), and 93.8% negative predictive value (NPV). The corresponding values for the S1 were 95.2%, 100%, 100%, and 96.8%, respectively.

Conclusion: This study showed that the Carestart and S1 biosensors have high-performance reliability for screening of G6PD deficiency, which can guide safe prescriptions of anti-malaria medications and hence, eradication of Plasmodium vivax malaria.

Introduction: Mixed warm and cold autoimmune haemolytic anaemia (AIHA) secondary to COVID-19 is rarely reported.

Case report: We present a case of a 65-year-old Malay lady with no known medical illness, who was admitted for COVID-19 category 3 and mixed warm and cold AIHA. She presented with lethargy, productive cough and on and off fever. Blood investigations showed severe anaemia with spurious macrocytosis, increased lactate dehydrogenase (LDH) and total bilirubin with indirect bilirubin predominance. On full blood picture (FBP), there was normocytic normochromic anaemia with reticulocytosis, red blood cells clumping and NRBC's were seen. Both anti-IgG and anti-C3d were positive for monospecific Coombs test. For indirect Coombs test, auto-IgG and cold agglutinin were detected.

Discussion: These findings were consistent with mixed warm and cold AIHA. She was treated with intravenous methylprednisolone, before being changed to high dose oral prednisolone. A total of 3 units packed cells were transfused.

Introduction: The objective of this study was to investigate the effect of convalescent plasma (CP) transfusion on clinical and serial laboratory parameters in severe COVID-19 patients. The Coronavirus Disease 2019 (COVID-19) pandemic presents a challenge to the healthcare system worldwide due to the limited treatment options available. The body of evidence reported that CP containing anti- COVID-19 antibodies could be effective against the infection.

Materials and methods: This was a cross-sectional study that involved retrospective data collection of severe COVID-19 adult patients who received CP transfusion along with the best-of-care (CP group, n: 53) and best-of-care only (control group, n: 53). An age, gender, and comorbidity were manually matched approximately at a 1:1 ratio.

Results: The prevalence of adverse transfusion reactions was 5.7%. A shorter duration of oxygen support (median: 12 days vs 14 days, P=0.030) and a shorter duration of mechanical ventilation (median: 6 days vs 10 days, P=0.048) were found in the CP group. The laboratory parameters were also improved. However, there was no significant difference in the mechanical ventilation rate, length of hospital stay, length of intensive care unit (ICU) stay, and mortality rate across both groups (P = 0.492, 0.614, 0.793, 0.374).

Conclusion: CP transfusion is safe and effective in the treatment of severe COVID-19 patients. However, a revision of our approaches such as early CP transfusion and use of a high-titre anti-COVID-19 neutralising antibody (nAb) unit is necessary to unlock the full potential benefits of CP transfusion among COVID-19 patients.

Introduction: Respiratory syncytial virus (RSV) is one of the most common causes of acute lower respiratory infection in infants and young children. Mucolytic agents, such as acetylcysteine and carbocysteine have reported benefits in alleviating acute upper or lower respiratory infections. Among these, N-acetylcysteine (NAC) has cyto-protective effects when cells are infected with the RSV.

Materials and methods: Our study investigated primarily the dose-dependent effects of NAC on respiratory alveolar epithelial (A549) cells when co-cultured with RSV in vitro. Three different concentrations of NAC were used, 0.1 mM, 1 mM, and 10 mM. The cytotoxicity of RSV-infected cells was measured by lactate dehydrogenase and antiviral activity of NAC on cell cultures was evaluated by immunofluorescence.

Results: Pre-treatment with the highest dose, 10 mM NAC, resulted in features of cell injury even without RSV infection. The proportion of cells infected by RSV and RSV-induced cell death decreased by more than 3-fold when cells were pre-treated with 1 mM NAC. Pre-treatment at the lowest dose, 0.1 mM, did not show any significant changes.

Conclusion: A moderate dose of NAC (1 mM) appeared protective of RSV infection to lung alveolar epithelial cells. However, a higher dose of NAC (10 mM) may be relatively toxic and injurious to these cells.

Introduction: M-protein secreted by myeloma cells do not only contribute to myeloma-related complications but is also a well-recognised source of interference in laboratory assays. We describe a case of a 62-year-old woman whose blood sample showed improper serum separation even after resampling.

Case report: Centrifugation of a biochemistry specimen in a serum-separator tube received by the laboratory failed to separate any serum, nor did repeating the process at a longer duration. Repeat sampling only yielded a small volume of serum from which highly elevated total protein was noted upon analysis. Additional history from the treating clinician unveiled a diagnosis of multiple myeloma in this patient.

Discussion: This case represents one of the rare, but significant pre-analytical interferences caused by M-proteins.

No abstract available.

Introduction: The eosinophil counts in colonic biopsies are affected by geographical and possibly seasonal variations. This study aims to investigate the significance of seasonal variations of eosinophil counts in histologically normal colonic mucosal biopsies.

Materials and methods: This is a retrospective, cross sectional study that included 337 cases of normal colonic biopsies. The number of eosinophils per high power field was counted in the most densely populated area. The eosinophilic counts were compared among genders, age groups, biopsy sites and in various months and seasons. Two tailed T-test was used to compare means and a p value < 0.05 was considered significant.

Results: 173 (51%) of cases were from males. The age range was between 18-82 with the mean being 51.7 years (SD= 17.5). 181 (54%) biopsies were from the right colon and 156 (46%) from the left colon. There was a statistically significant difference between eosinophil counts in the right colon (mean 20.2, SD 13.2) and left colon (mean 13.8, SD10.1); p value <0.001. The mean eosinophil counts was highest in autumn (21.1) followed by spring (18.3). The counts in winter and summer were close (15.2 and 15.1 respectively). There was a statistically significant difference between counts in autumn and summer (p=0.013) and between autumn and winter (p=0.008). However, there was no statistically significant differences between autumn and spring counts (p=0.183). When stratified according to site, this pattern of statistical significance was observed in the right colon but not the left colonic mucosal biopsies.

Conclusion: There are significant seasonal variations of eosinophil counts in normal colonic biopsies which are more pronounced in the right colon. Pathologists and gastroenterologists need to be aware of these variations and to take them into account when determining if a patient has tissue eosinophilia.

Introduction: PMCT is superior to autopsy for identification of intravascular or extravascular gas pockets and their distribution. However, differentiation between air embolism and putrefactive gas can prove challenging due to overlapping imaging findings.

Case report: We report a case of a healthy young man who was involved in a fight, sustained a slash wound to the right side of his head by a kitchen knife and died at the scene. Pre-autopsy PMCT demonstrated complex fractures of the right mastoid bone extending to the right petrous apex and jugular bulb, exposing the right sigmoid sinus. There was also asymmetric intravascular air distribution suspicious of air embolism with ancillary findings of traumatic carotid-jugular pseudoaneurysm and arteriovenous fistulous formation. Post-mortem examination revealed a slash wound measuring 12x2 cm at the right side of the head, cutting through the scalp, right temporal bone, right temporal meninges, right sigmoid venous sinus and part of the right occipital lobe. No intracranial haemorrhage was found on both PMCT and autopsy.

Discussion: PMCT findings of air embolism versus putrefactive air on PMCT are discussed in this case. Detailed history on mechanism, circumstances, time of death and careful analysis of intravascular and extravascular air distribution patterns on PMCT are essential in guiding differentiation of true fatal air embolism and "normal" post-mortem putrefactive air. Needless to say, it is recommended that PMCT be performed as early as possible after death to reduce the chances and presence of artifactual decomposition changes.

Introduction: Acute myeloid leukaemia (AML) is a heterogeneous malignant disease with a high degree of treatment failure using chemotherapy. Leukaemia stem cells (LSCs) are CD34+CD38- early progenitors associated with poor prognosis in AML. A unique LSC phenotype that excludes rare normal haematopoietic stem cells (HSC) is still elusive. This study aimed to determine expression of selected potential LSC markers in normal and leukaemic myeloid cells and correlate prognosis in AML patients.

Materials and methods: Flow cytometry and RT-qPCR measured expressions of ALDH, IL3RA/CD123, CLEC12A/CLL-1/CD371, HOXA3 and ENPP4. Normal cord blood (n=3) and blood monocytes (n=5) represented HSC and mature cells, respectively. Myeloid leukaemia cell lines (THP-1, KG-1a, K562 and HL-60) represented progenitor cells at various stages of maturation. AML samples included chemo-resistant (n=8), early relapse (n=2) and late relapse (n=18).

Results: Combining protein/gene expressions, CD34+CD38- was a feature of immature cells seen in cord blood, KG-1a, and K562 but not more mature cells (blood monocytes and HL-60). Normal cells expressed CD371 while mature cells (blood monocytes and HL-60) lacked CD123. ENPP4 was not expressed on normal cells while HOXA3 was expressed only on cord blood and THP-1. In AML, CD123, HOXA3, ENPP4 (but not CD371) were significantly increased in the CD34+CD38- fraction of chemo-resistant patients while ALDH was associated with chemo-resistance.

Conclusion: CD34+CD38- presented an immature phenotype and with ALDH were associated with poor prognosis. CD123, HOXA3 and ENPP4 further enriched the LSC population. ENPP4 has not been reported and has the advantage of not being expressed on HSC and normal monocytes.

Introduction: Mean neutrophil volume (MNV) and immature to total neutrophil ratio (IT Ratio) has been found to support the detection of sepsis in elderly and neonates. This study aimed to assess the diagnostic significance of MNV and IT ratio in adult sepsis population.

Materials and methods: Sixty-four adult patients presented with suspected bacterial sepsis were included in this study. Relevant cultures and/or pertinent serology tests were performed. Full blood counts were analysed for MNV and IT ratio.

Results: Fifty-one patients out of 64 recruited subjects were confirmed sepsis. Twentyfour patients had confirmed bacterial infection by cultivation and two were positive for leptospiral serology. MNV was very good in distinguishing sepsis from non-sepsis group (AUC = 0.80, 95% confidence interval (CI) = 0.69-0.91, Accuracy = 0.72, Kappa = 0.40) with a cut-off value of 153.5 (sensitivity = 67%, specificity = 92%). There was no significant difference in IT ratio between sepsis and non-sepsis group (p-value > 0.05). MNV was superior over IT ratio (AUC = 0.85, 95%CI = 0.76-0.95, and AUC = 0.70, 95% CI = 0.56-0.85, respectively) in diagnosing bacterial infection. The optimum cut-off value for MNV in bacterial infection was 154.5 (sensitivity = 67%, specificity = 89%) and for IT ratio was 0.035 (sensitivity = 45%, specificity = 67%).

Conclusion: MNV appears to be a very good marker for diagnosing sepsis and bacterial infection. We recommend including MNV into sepsis workup in ED setting, since it can be determined without additional specimen.