Indian Journal of Hematology and Blood Transfusion最新文献

Critically ill patients often exhibit low ionized calcium levels. This study aimed to investigate the potential of ionized calcium levels in distinguishing between acute and chronic anemia in emergency department patients receiving red blood cell transfusions. A prospective cross-sectional case series involving 472 patients was conducted. Patient data, including demographics, comorbidities, vital signs, units of blood products received, mechanical ventilation, inotropic therapy, emergency transfusion requirement, length of hospital stay, outcome, and mortality, were systematically recorded. Out of the 472 patients, 57.2% (n = 270) were hypocalcemic (I.Ca < 1.10 mmol/L). Chronic anemia was present in 58.9% (n = 278), while 41.1% (n = 194) had acute anemia (trauma + gastrointestinal bleeding). The mean I.Ca level in patients with acute anemia (1.05 ± 0.1) was significantly lower than in those with chronic anemia (1.08 ± 0.12) (p = 0.009). Patients with hypocalcemia had a significantly higher need for inotropic therapy (p = 0.026) and mechanical ventilation (p = 0.036). The ionized calcium level in patients receiving emergency transfusion (O Rh- and cross-match-compatible) was notably lower (1.02 ± 0.12) than in those receiving cross-matched transfusions (1.07 ± 0.11), with statistical significance (p = 0.001). Among hospitalized patients, hypocalcemic patients required recurrent transfusion at a statistically significant level (p = 0.004). The ROC curves comparing the predictive power of blood gas parameters in emergency transfusion patients showed that lactate levels (AUC: 0.819, 95% CI: 0.761-0.877, p < 0.001, cut-off: 3.06) and ionized calcium levels (AUC: 0.619, 95% CI: 0.297-0.464, p = 0.005, cut-off: 0.96) had significant predictive value. Ionized calcium levels are a rapidly available blood gas parameter that assists clinicians in detecting trauma-induced acute anemia and identifying the need for recurrent transfusions. Additionally, both lactate and ionized calcium levels predict the necessity for emergency transfusion.

Abstract: Diffuse large B-cell lymphoma (DLBCL) is the most common and a morphologically, molecularly, and clinically heterogeneous group of non-Hodgkin's lymphoma (NHL) whose outcomes have greatly improved after rituximab-based chemotherapy. The present Indian study is unique as we have analysed the data of DLBCL patients based on cell of origin, clinical features, and outcomes with rituximab-based chemotherapy. In this retrospective observational study from 2016-2023, the medical records of 580 DLBCL patients were analysed. The cell of origin was based on immunohistochemistry using the Hans algorithm. The median age of presentation was 55 years, with the Activated B-cell (ABC) type being the most common. Stage IV disease was observed in 41% of the patients. As per International Prognostic Index (IPI) risk stratification, 38% and 36% of the patients were in the low intermediate (LI) and high intermediate (HI) risk groups, respectively. Extranodal involvement, B symptoms, and bulky disease were seen in 26%, 46%, and 29% of the patients, respectively. R-CHOP chemotherapy was used in 75% of the patients. Complete response was seen in 73% and 43% in the germinal centre B-cell (GCB) type and ABC type, respectively. Other factors associated with lower rates of complete response were female sex, Stage II/IV, IPI-HI/H, Bulky disease, and non-R-CHOP chemotherapy use. The overall two-year PFS rate was 78%, with 87.6% in the GCB and 70.5% in the ABC type, respectively. Two-year overall survival was 81.4% (87.7% for GCB, 73.5% for ABC and 90.1% for others).

Clinical trial registration: Nil.

Bone marrow (BM) sampling guidelines in the evaluation of childhood aplastic anemia (AA) and staging neuroblastomas (NB) are sporadically published in the literature. We aim to the present a retrospective audit on the efficacy of BM sampling in above two diagnoses at our centre. Particle squash smears from BM aspirate (BMA), trephine biopsy (BMBx) touch imprint (BMI) smears, and pre-processing BMBx core length (PBCL) were analysed from cases (< 18 years) of AA and NB diagnosed over last 4 years (2019-2022). Fifty-one AA [median age; 9 years, (2-17)] and 25 NB [1 year (0.7-12)] had median PBCL of 18 (10-40) and 10 (5-25) mm, respectively. BMA, BMI, and BMBx had a higher degree of concordance in stratification of AA (Kohen κ; 0.890-1.000, p = 0.0001) and marrow involvement by NB (κ; 0.610, p < 0.001). The PBCL had positive correlation with age (Spearman r; 0.177, p = 0.213) and number of evaluable marrow spaces (r; 0.551, p = 0.000) in AA. PBCL of 11 mm and 08 mm were optimal in the evaluation of AA (AUC; 0.59, sensitivity; 86.3%, specificity; 75%) and NB (0.673, 61.5%, 75%), respectively. Combination of bone marrow aspirate, trephine touch imprint, and ≥ 08 mm of BMBx are satisfactory in the adequate evaluation of AA and staging NB in children and adolescents.

Objective: The aim of this study is to investigate the relationship of leukocytes DNA methylation in targeted sites and thrombophilia.

Methods: Eight thrombophilia patients and their kin-related individuals as the healthy control. Targeted DNA methylation from peripheral leukocytes were examined with MassArray. Multivariate correlation analysis was used to estimate targeted gene methylation as an independent risk factor of thrombophilia. Receiver operating characteristic curve analysis was used to calculate the accuracy of biomarkers in the prediction of thrombophilia.

Results: The age of thrombophilia group was higher than control group (P < 0.001). F5.24.CpG.10 and Protein S.44.CpG.29-33 methylation were significantly associated with thrombophilia negatively and positively (r = -0.7289, P < 0.01 and r = 0.5667, P < 0.05). F5.24.CpG.10 methylation was higher in control group (P < 0.01), but Protein S.44.CpG.29-33 methylation increased in thrombophilia group (P < 0.05). The areas under curve of ROC were 0.9297 and 0.8437, respectively.

Conclusion: Target DNA methylation in Protein S.44.CpG.29-33 island is associated with an elevated risk of thrombophilia.

Purpose: Daratumumab-induction regimen has benefitted the multiple myeloma patients with long-lasting effective response. However, studies have showed daratumumab induction therapy reduced CD34+ stem cell yield and increased dependence on plerixafor use during mobilization therapy for subsequent autologous stem cell transplantation (ASCT). Here, we aim to explore the influence of daratumumab-based induction therapy on CD34+ stem cell yield in Indian multiple myeloma patients.

Methods: In this retrospective study, electronic medical records of transplant eligible multiple myeloma patients (n = 91) between December 2015 and February 2023 were considered. Clinical information about induction therapy, mobilization therapy, stem cell collection and transplant status were collected. Data analysis was done using SPSS v.26, with statistical significance at p < 0.05.

Results: Among the 91 patients, 8 received daratumumab induction regimen. The CD34+ stem cell yield among daratumumab and non-daratumumab induction groups did not show significant difference (5.29 ± 1.64 × 10⁶ versus 6.08 ± 3.11 × 10⁶ CD34+ cells/kg; p = 0.101). Patients on daratumumab induction regimen exhibited an increased use of plerixafor when compared to non-daratumumab induction regimen (p < 0.001).

Conclusion: The addition of daratumumab in induction therapy of multiple myeloma did not affect stem cell yield but increased dependence on plerixafor during mobilization therapy.

Polycythemia vera (PV) is a myeloproliferative disease characterized by hemoglobin/hematocrit levels above 16.5 g/dL or 49% in men, and 16 g/dL or 48% in women and accompanied by JAK2 mutations. It is aimed to prevent false negative and false positive results with simultaneous serum erythropoietin (EPO) measurements. The importance of sensitivity and specificity of low EPO level for PV is known; determining a more sensitive cut-off may reduce the need for further analyzes and invasive procedures. In our study, we aimed to reveal the sensitivity and specificity of serum EPO level in patients diagnosed with PV and to determine a new cut-off value that would show higher diagnostic performance instead of low serum EPO level. In this study, patients who were examined because of polycythemia between 01.01.2018-01.01.2022 at the hematology clinics of 5 different centers from xxx were included. A total of 468 patients (90 females, 378 males) were included in the study. One hundred seventy-five (37.4%) patients met the criteria for PV. In the ROC analysis performed to reveal the effectiveness of serum EPO level for predicting the diagnosis of PV, the sensitivity for ≤ 4.68 cut-off value was 89%, specificity 92%, AUC = 0.934 (95% CI: 0.91-0.96, p < 0.05), positive predictive value 87% and negative predictive value was 93.1%. Serum EPO level is an effective and easy method for predicting the diagnosis of PV, and it would be more predictive for the new cut-off level in this study.

Supplementary information: The online version contains supplementary material available at 10.1007/s12288-025-01990-4.