Advances in Hematology最新文献

Background: Diabetes is a significant worldwide health challenge associated with significant metabolic, cellular, and hematological disturbances. Hematological alterations are well-documented complications of diabetes and play a crucial role in the progression of diabetes related pathology. While extensive data exist globally on hematological parameters in type 2 diabetes mellitus (T2DM), specific insights into these parameters and their local determinants within study area remain limited. Therefore, this study aimed to assess the hematological parameters among adult patients diagnosed with T2DM in JUMC at Jimma, Southwest, Ethiopia, 2024. Methods: A total of 200 medical charts of adults with T2DM who registered for follow-up at Jimma University Medical Center were reviewed from December 2023 to February 2024. Data were collected using a data extraction checklist. Bivariate and multivariate logistic regression analyses were performed to identify factors associated with hematologic abnormalities. A p value less than 0.05 indicates statistical significance. Result: The overall prevalence of anemia and leukocytosis in adults with T2DM was 14.0% and 12.0%, respectively. Neutrophilia was the common white blood cell (WBC) abnormality detected in 9.5% of the patients. Besides, thrombocytopenia and thrombocytosis were observed in 2.5% and 1.5% of the patients, respectively. Increasing age 5.28 (95% CI: 1.07-26.1) and duration of diabetes mellitus (≥ 3 years) (AOD = 3.1 (95% CI: 1.02-9.5)) were significantly associated with anemia and leukocytosis, respectively. Conclusion: This study found a prevalence of hematological abnormalities in adults with T2DM, including anemia, elevated WBC count, increased neutrophils, and thrombocytopenia. Anemia was associated with advanced age, while leukocytosis was associated with a longer diabetes duration. Therefore, it is recommended to start regularly screening T2DM patients for hematological abnormalities to improve clinical practice, guide treatment decisions, and develop targeted interventions.

Introduction: Dental alterations associated with benign odontogenic lesions can alter patients' diet, possibly leading to anaemia. Indeed, cytological studies of fluid contained in benign odontogenic lesions report the presence of blood cells. The aim of this study was, therefore, to investigate anaemia and haemogram parameters in relation to benign odontogenic lesions. Material and Method: We conducted a descriptive cross-sectional study over 24 months in the Odontostomatology Department of the Idrissa Pouye General Hospital in Dakar, Senegal. The selection criteria included all patients who had received treatment for benign odontogenic lesions with an available cell blood count. The collected variables were demographic, clinical and paraclinical, with calculation of inflammation marker ratios. The data were analysed using SPSS 20.0 software, and the Kruskal-Wallis and Fisher tests were also performed for statistical comparison. Results: Of a total of 50 patients, 70% were women. The mean age was 32.6 years, with a mean duration of 41.5 months. Mandibular location was encountered in 76% of the cases. Ameloblastoma and cemento-osseous dysplasia each accounted for 24% of the cases. Anaemia was found in 21 patients, 11 of whom were normocytic normochromic and 8 microcytic hypochromic. Neutropenia was noted in 23 patients. Conclusion: Normocytic normochromic anaemia, microcytic hypochromic anaemia and neutropenia were more common in benign odontogenic lesions. A more detailed study should be undertaken to gain a better understanding of the significance of haemogram parameter variations in benign odontogenic lesions.

Background: The international cooperation between GATLA and AHOPCA with the support of St. Jude led to the adoption of the OEPA/COPDAC as a strategy to improve outcomes in high risk (HR) patients with HL. This study also includes the ABVD regimen for intermediate risk (IR) and low risk (LR) patients. Methods: Patients were stratified by predefined risk assignment. HR was defined as a disease in stages II B, III B, and IV. Modality treatment: LR: ABVD × 4 ± IFRT (20 Gy); IR: ABVD × 6 ± IFRT (20 Gy); and HR: OEPA-COPDAC + IFRT (20/25 Gy). The staging and response were reviewed in a periodic discussion of presentation of cases in the group. Eligibility for radiotherapy: LR patients in partial response (PR) after 4 ABVD and IR patients in PR after 2 ABVD received IFRT. All HR patients received IFRT at 20 (complete response (CR)) or 25 Gy (PR) depending on the response achieved after the first two OEPA cycles. Results: From November 2012 to June 2022, 203 pediatric patients were enrolled. A total of 171 patients were eligible in this analysis. HR: 98 patients (57.3%), IR: 52 patients (30.4%), and LR: 21 patients (12.3%). More than half of the patients were in stages III and IV and more than half also presented B symptoms. The response evaluation was performed by PET/CT in 147/171 patients (86%). A total of 68/171 patients (40%) did not received radiotherapy. Radiotherapy was omitted in 95% of the LR patients and 70% of the IR patients. The 10-year OS was 95% (90.7-97.6) for the 171 patients and 93% (85.3-96.4) for HR patients. The 10-year EFS was 91% (85.2-94.2) for the 171 patients and 87.8% (79.5-92.9) for HR patients. Conclusion: The international cooperation made it possible to significantly improve the outcomes of patients with advance disease in Argentina compared with our previous experience (7-PHD-96: COPP-ABV × 6 + IFRT Bulky Disease or PR (20/25 Gy): 5yOS: 85%, 5yEFS: 67%), reduce the number of patients who required radiotherapy, and reproduce the European experience for HR patients in a totally different context.

Background: Successfully navigating the transition process has received little attention, especially in sub-Saharan Africa. This study assessed the transition readiness of pediatric sickle cell disease (SCD) patients in the Komfo Anokye Teaching Hospital (KATH), Kumasi-Ghana. Methods: A hospital-based cross-sectional study was conducted using a purposive sampling technique to recruit adolescents who were scheduled to be transitioned from the Pediatric to the Adult SCD Clinic at KATH. Two transition assessment tools were adopted and modified to suit our local setting. Findings: Majority of the patients (90%) scored above median mark for the items under the transition self-care importance and confidence and over 50% for most of the items under the disease knowledge and appointment keeping domains. The internal consistencies of the items were over 70% for all the three domains: disease knowledge, medication management, and appointment keeping. In multivariable regression models, older age, female gender, and higher education were associated with higher scores in all the three domains. Also, the sickle cell disease-SS (SCD-SS) status was associated with higher scores in disease knowledge and appointment keeping. Patients staying with both parents were associated with higher scores for the domains but only appointment keeping was statistically significant. Staying with other relations was associated with a lower score for appointment keeping and had significant association for medication management. Conclusion: The study revealed a high transition readiness among pediatric patients. In general, the patients had high confidence transitioning to an adult clinic and the ability to manage their own healthcare. However, patients were hesitant speaking about their SCD status. Staying with both parents was significantly associated with higher scores for appointment keeping. Also, staying with other relations significantly reduced the scores for medication management. We recommend setting up of an adolescent sickle cell support group to help reduce stigmatization and improve health outcomes.

Background: Bacterial contamination of donated blood has been a major public health problem. It poses grave risks to the recipient. Objective: The objective of this study was to determine bacterial contamination in donated blood for transfusion purposes at Kisii Teaching and Referral Hospital. Methodology: This was a cross-sectional study. Sample collection was performed in BD BACTEC culture bottles and analyzed by BD BACTEC Machine FX40 for the presence of bacteria and thereafter subcultured for the positive vials. Biochemical tests were performed followed by confirmation tests with API-20 to identify bacterial presence. Samples negative for bacteria were not subjected to further analysis, and the results were directly recorded. Quality control procedures were performed using known ATCC microorganisms (Staphylococcus aureus [S. aureus] ATCC 25923). The data were entered into Excel and analyzed by SPSS Version 25. Results: The general prevalence of bacterial contamination was 21.3% (23/108). The blood group A positive had the highest contamination rate (10.2%), while the prevalence by age was also higher in the 21-30 years age group (24%). The most commonly isolated organisms were Staphylococcus epidermidis (S. epidermidis) (56.5%), S. aureus (39.1%), Bacillus spp. (30.4%), and Escherichia coli (E. coli) (17.4%). Logistic regression analysis indicated that blood group A positive individuals (OR = 2.5, p=0.02) and the 21-30 years age group (OR = 1.8, p=0.03) were significantly related to contamination at odds. The association of blood group A positive and age 21-30 further augmented this risk (OR = 3.5, p=0.01). Conclusion: S. epidermidis, S. aureus, Bacillus spp. and E. coli were among the isolated and identified bacteria found in donated blood samples among donors at KTRH.

Background: Iron deficiency anemia (IDA) is the most common form of pediatric anemia, with first-line treatment focusing on iron repletion through oral and/or intravenous iron. The American Society of Hematology (ASH)/the American Society of Pediatric Hematology and Oncology (ASPHO) Choosing Wisely Campaign recommends against packed red blood cell (PRBC) transfusion for asymptomatic IDA. PRBCs are a finite resource and carry treatment associated risk compared to iron therapies. The use of oral and intravenous iron is an effective, tolerated therapy modality for IDA which can be overlooked based on the degree of anemia. Study Design and Methods: Plan, Do, Study, Act methodology was used for this single institution quality improvement initiative. The objective was to decrease the percentage of PRBC transfusions in all admitted IDA patients from a baseline of 72% to a target of 50% by December 2022 and to sustain for 12 months. Interventions consisted of multidisciplinary, evidence-based didactic education sessions and development of a single institution clinical practice guideline for the treatment of IDA. Results: In the pre-education/baseline group, 72% (n = 57/79) of patients received PRBC transfusion for the treatment of IDA, compared to the posteducation/intervention group where 38% (n = 29/76) of patients received PRBC transfusion for the treatment of IDA (p value < 0.0001). In the pre-education/baseline group, 19% (n = 11/57) of patients received PRBC transfusions not indicated based on the developed CPG, compared to 6.9% (n = 2/18) in the posteducation/intervention group (p value = 0.20). Discussion: This work demonstrates how multidisciplinary, education- and evidence-based interventions lead to clinically and statistically significant reductions in PRBC transfusion for admitted patients with IDA.

Transfusion-dependent thalassemia (TDT) is a severe inherited anemia characterized by impaired synthesis of hemoglobin chains. Disease progression and TDT severity are potentially linked to oxidative stress and protein damage. This study aimed to explore the expression patterns of ceruloplasmin (CP), α2-macroglobulin (A2M), and alpha-2-HS-glycoprotein (AHSG) in TDT serum through quantitative proteomic profiling. The results were validated using enzyme-linked immunosorbent assays (ELISA). The study participants were divided into three groups based on the duration of blood transfusion. Age and gender-matched normal individuals served as controls. The results revealed the downregulation of these proteins. The reduced levels of these proteins may contribute to tissue damage in TDT patients, primarily due to increased oxidative stress. For example, decreased CP levels can disrupt iron and copper metabolism, leading to heightened oxidative stress and rendering red blood cell membranes more susceptible to rupture due to active oxygen radicals. In summary, CP, A2M, and AHSG association with iron metabolism, inflammation, and oxidative stress underscores their potential relevance in understanding TDT's pathogenesis and progression. These findings may pave the way for improved diagnostic and therapeutic strategies for TDT patients.

In Ghana, prevalence of anaemia is higher than the worldwide average and contributes to deferral of blood donors. A cross-sectional study was carried out as part of a pilot study aimed at improving haemoglobin levels and promoting repeat donations to retain donors who were deferred due to low haemoglobin. The copper sulphate test was used to determine low haemoglobin and anaemia assessed by the World Health Organization (WHO) gender-specific criteria. Over sixteen months, 1213 donors were eligible, of which 826 (68%) were male and 78 (6.4%) were deferred for low haemoglobin. Among these 78 deferrals, 71 (91%) were female, 77 (99%) were first-time donors and 77 (99%) were voluntary nonremunerated blood donors (VNRBDs). A total of 337 donors consented to provide a blood specimen out of which 325 donors met eligibility criteria and had complete FBC results. Of those, 189 (N = 39 males; N = 150 females), or 58%, were classified as anaemic. Model-based estimates which correct for selection bias in the enrolment process found that 61.6% of female donors (95% credible interval: [53.4%, 70.8%]) and 19.7% of male donors (95% credible interval: [11.5%, 33.8%]) were anaemic by WHO criteria. Among the 252 consenting donors with completed blood specimen analyses and haemoglobin levels meeting the threshold for blood donation, 118 (47%) were classified as anaemic according to WHO criteria. Population-level estimates of anaemia using WHO criteria suggest anaemia is highly prevalent and the results generally matched donor deferral using the copper sulphate test among women blood donors. Trial Registration: ClinicalTrials.gov identifier: NCT04949165.

Introduction: Acute febrile illness contributes to significant morbidity and death particularly in tropical country such as Indonesia. The symptoms are nonspecific, therefore distinguishing these pathogens is difficult without additional laboratory tests. The extended white blood cell parameters indicate cell activities induced by immune response to infection. The study aims to explore the profile of extended white blood cell parameters in acute febrile illnesses and evaluate their diagnostic power to differentiate etiologies of acute febrile illnesses. Methods: This study was a cross-sectional analytical study with a total of 473 samples, conducted between October 2022 and 2023 at Siloam Hospitals Lippo Village, Banten, Indonesia. Acute febrile illnesses are included in this study, including dengue infection, chikungunya infection, typhoid infection, and other bacterial infections. The extended white blood cell parameters including high fluorescence lymphocyte count (HFLC), immature granulocyte (IG), neutrophil-to-lymphocyte ratio (NLR), and cell population data (CPD) which were NE-SSC, NE-SFL, NE-WY, LY-X, LY-Y, and LY-WY. These parameters were integrated in a routine hematology test as research parameters, performed by Sysmex XN2000. Data were analyzed using SPSS Version 25. Results: The value of extended white blood cell parameters was found to be significantly different in viral and bacterial infection (HFLC 1.10% (0.30%-3.85%) vs. 0.20% (0.10%-0.70%), p < 0.001; IG 0.4% (0.2%-0.6%) vs. 0.5% (0.3%-1.1%), p < 0.001; NLR 1.93 (1.10-3.47) vs. 5.21 (2.20-12.26), p < 0.001; NE-SFL 47.7 (45.95-50.10) vs. 48.6 (45.82-52.57), p=0.020; NE-WY 622 (585-653) vs. 653 (615-747), p < 0.001; LY-Y 66.4 (63.85-69.75) vs. 64.05 (60.52-67.17), p < 0.001). HFLC and LY-Y had statistically significant AUC 0.753 and 0.646, respectively, (p < 0.001) in the dengue infection group. IG, NLR, NE-WY, and NE-SFL had statistically significant AUC in bacteremia (0.806, 0.876, 0.783, and 0.656, respectively). Conclusion: HFLC was a useful diagnostic tool to identify viral infection, particularly dengue infection, while IG, NLR, NE-SFL, and NE-WY can be useful to differentiate bacteremia from other acute febrile illnesses.

Unexpected antibodies can cause hemolytic conditions. Therefore, screening for unexpected antibodies is essential for safe transfusion. The study was conducted at Rwanda Blood Transfusion Division and University Teaching Hospital of Kigali to assess unexpected antibodies with their associated clinical conditions. 8693 blood donors and 834 patients were screened for unexpected antibodies. Among 834 patients, 23 patients (2.75%) developed alloantibodies among which two of them had mixed alloantibodies. Five patients developed antibodies of uncertain specificities. Among 8693 blood donors, only 4 blood donors (0.046%) had clinically significant alloantibodies, whereas 6 blood donors (0.069%) had antibodies of uncertain specificities. Moreover, 3 patients (0.35%) had autoantibodies in their plasma. Different types of anemia were presented with patients who developed unexpected alloantibodies. History of transfusion and pregnancy were predictors of alloimmunization among patients (p < 0.01). Antibody screening and antibody identification are important for safe blood transfusion practices.