Evaluation of sodium citrate anticoagulant for the Resolution of edta-dependent pseudo Thrombocytopenia.

BACKGROUND: EDTA-dependent pseudo thrombocytopenia (EDTA-PTCP) refers to a falsely low platelet count occurring in the presence of ethylene diamine tetra-acetic acid (EDTA) anticoagulant during blood sample collection, which results in the formation of platelet clumps in vitro. This phenomenon has significant clinical implications, including unnecessary administration of platelets. Our study aims to evaluate the efficacy of sodium citrate anticoagulant for the resolution of EDTAPTCP. METHODS: This retrospective study was conducted in the haematology laboratory of Shifa International Hospital (SIH), Pakistan. Patients with pseudo thrombocytopenia (i.e. platelet count less than 150,000/ul with platelet clumps seen on peripheral smear) were included in this study if they had blood samples drawn in both EDTA and sodium citrate tubes less than 48 hours apart. Data was analyzed using IBM® SPSS Software Version 22. RESULTS: A total of 151 study participants were included in this study. The mean age was 48.95±20.69 years and the majority were female (52.3%). Wilcoxon signed-rank test showed that there was a statistically significant difference in platelet count measured in both tubes (Z = -3.223, p=0.001). Overall, blood samples processed in sodium citrate tubes showed lower platelet count than EDTA samples. Sodium citrate anticoagulant was able to correct EDTA-PTCP in 47 (31.1%) of the cases. CONCLUSIONS: Sodium citrate anticoagulant was only able to resolve one-third of our EDTA-PTCP cases. Our findings do not support the use of sodium citrate as a suitable alternative for correction of EDTA-PTCP.

A Case Of Precursor B-Acute Lymphoblastic Leukaemia Masquerading As Hypereosinophilia And Space Occupying Lesion In A 14-Year-Old Boy.

Peripheral blood eosinophilia is associated with a variety of benign and neoplastic conditions. Rarely, marked eosinophilia can mask an underlying Acute Leukaemia, delaying the correct diagnosis and treatment. Here, we report a case of 14-year-old boy, who presented with marked eosinophilia and space occupying lesion in the brain. Bone marrow biopsy and biopsy of brain lesion were performed to assess the underlying disorder, revealing the unexpected diagnosis of Precursor B- Acute Lymphoblastic Leukaemia in this patient. Cytogenetic studies revealed a normal male karyotype. This case highlights the significance of considering the rare possibility of Acute Lymphoblastic Leukaemia among the differential diagnosis of persistent eosinophilia in order to facilitate prompt and appropriate treatment.

The Prevalence of Transfusion Transmitted Infections among Blood Donors in Pakistan: A Retrospective Study.

Objectives: This study aimed to determine the prevalence of blood transfusion-transmitted infections (TTIs), among blood donors in Pakistan, specifically HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malaria. Methods: Data records of all registered blood donors (n = 120 968) during 2008-2019, at a blood transfusion center in a tertiary care hospital were assessed. Frequency of the seropositive donors for HIV, HCV, HBV, syphilis, and malaria was analyzed. Results: The overall age range of the donors was 25-65 years. Nearly all were male (99.0%). HCV, syphilis, and malaria were more prevalent among those aged 26-35 years. Most donors (81.1%) were residents of Islamabad city. The infection with the highest prevalence among the screened blood donors was HCV (1.5%; 95% CI: 0.423-0.661) followed by syphilis (0.8%; 95% CI: 1.149-1.432). HCV and syphilis were most frequently observed in blood group B positive (B+) donors while HIV was more common in those who were O+. The frequency of co-infection of syphilis with HCV and HIV was 0.02% and 0.01%, respectively. Conclusions: Among male blood donors, the most prevalent TTI infection was HCV followed by HIV; the latter is on the rise. HCV and syphilis are the most frequent co-infections.

Early hematological indicators of severe COVID-19 disease in hospitalized patients: Data from a South Asian population.

INTRODUCTION: Outbreak of corona virus disease in 2019 (COVID-19) has resulted in significant morbidity and mortality worldwide. Our aim is to document hematological parameters of patients with COVID-19 during initial stage of diagnosis and to identify early hematological indicators of severe infection. MATERIALS AND METHODS: This retrospective study was conducted at Shifa International Hospital, Pakistan from April to November 2020. Patients hospitalized with COVID-19, diagnosed on RT-PCR and had a complete blood count (CBC) done within 48 hours of diagnosis were included. Data was analyzed using IBM® SPSS Statistics. RESULTS: A total of 425 patients were included in this study out of whom 272(64%) were males. The mean age was 55.61 ± 17.84 years. 95 patients (22.4%) had normal blood counts within 48 hours of COVID-19 diagnosis. Cytopenias were seen in 193(45.4%) patients. There were 75(17.6%) mortalities during the study period. Chi-square test showed that thrombocytopenia, lymphopenia and neutrophilic leucocytosis were significantly associated with mortality (P = .037, P < .001, P < .001 respectively) and need for ventilator (P = .009, P < .001, P < .001, respectively). Neutrophilia was also associated with development of Acute Respiratory Distress Syndrome (P < .001). On ROC analysis, Neutrophil-to-Lymphocyte Ratio yielded an area under the curve (AUC) of 0.693 and 0.660 for the outcomes mortality and need for ventilator, respectively. For a subset of 288 patients who had D-dimer levels checked within 48 hours of COVID-19 diagnosis, the AUC for mortality and ventilator need was 0.708 and 0.671, respectively. CONCLUSION: Hematological indices are vital indicators in the prognosis and risk stratification of COVID-19 during initial stages of disease.

Frequency of true hepatitis B virus positivity in blood donors positive for hepatitis B core antibodies: implications for transfusion practice.

OBJECTIVE: To determine the true positivity of hepatitis b virus in anti-hepatitis B core antigen positive donors, keeping polymerase chain reaction as the gold standard. METHODS: The cross-sectional study was carried out at the Shifa International Hospital, Islamabad, Pakistan, from June 1, 2014, to December 30, 2016, and comprised all blood donors who were positive for hepatitis B core antibody and negative for hepatitis B surface antigenon the basis of by enzyme-linked immunosorbent assay. The smaples were subjected to real-time polymerase chain reaction for hepatitis B deoxyribonucleic acid detection. Data was analysed using SPSS 20. RESULTS: All the 100 samples came from males subjects who had a mean age of 36.8±10.8 years. Only 2(2%) donors showed hepatitis B virus deoxyribonucleic acid reactivity. CONCLUSION: The inclusion of Hepatitis B core antibody screening may make blood transfusions safer for the patients.

Blood Diathesis in a Patient of Rare Blood Group 'Bombay Phenotype'.

Bombay blood group or Oh phenotype is a rare autosomal recessive phenotype within the ABO blood grouping system. It occurs due to a mutation in the H gene that produces H antigen on red blood cells (RBCs). Individuals with two mutant H genes lack H antigen on RBCs and have anti-H antibodies in serum. At the time of blood grouping, this blood group mimics O blood group but it shows incompatibility with O group blood during cross matching. Several studies have reported an association of decreased von Willebrand factor (VWF) levels in plasma with ABO blood groups. Here we report a case of a 19-year-old male, who was labelled as Bombay phenotype and later found to have markedly reduced plasma VWF levels.

Transfusion Transmissible Infections: Maximizing Donor Surveillance.

Introduction The World Health Organization (WHO) recommends that all blood transfusion services must screen donated blood for human immunodeficiency virus (HIV) one and two, hepatitis B, hepatitis C and syphilis. A mandatory screening for malaria is also warranted in malaria endemic areas. Our study aimed at analyzing the prevalence and different diagnostic methods of screening transfusion transmitted infections (TTIs) in replacement and voluntary, non-remunerated donors in the blood bank of a tertiary care hospital in Islamabad, Pakistan. Methods The cross-sectional, descriptive study was conducted on 30,470 blood donors from July 2015 to October 2017, in the blood bank of a 500-bed teaching hospital in Islamabad. Initially all blood donors were screened for HIV one, HIV two, hepatitis B and hepatitis C by serological testing. The seronegative samples were further tested by nucleic acid amplification test (NAT). Malaria was screened using immuno-chromatographic antigen-detection tests, while treponema pallidum was screened by electrochemiluminescence immunoassay to detect treponema pallidum (TP) antibodies. All infected blood and blood products were discarded and donors were contacted. The donors were deferred from blood donation according to WHO guidelines. They were also counselled and referred to the infectious diseases clinic. The collected data was analyzed on IBM's statistical package for the social sciences (SPSS) version 21. Results The results revealed that amongst the 30,470 donors, 997 (3.27%) donors were found infected with one or more TTI while 29,473 (96.73%) donors were found safe. Individuals who tested positive on serology for hepatitis B were 322 (1.06%), hepatitis C were 392 (1.29%) and HIV were 49 (0.16%). The seronegative donors were tested by NAT. NAT on seronegative samples showed that 10 (0.03%) donors tested positive for hepatitis B virus deoxyribonucleic acid, while only three (0.01%) were positive for hepatitis C ribonucleic acid. No donor was found positive for HIV by NAT testing. Syphilis testing revealed a frequency of 228 (0.75%) positive results while only five (0.02%) donors were found infected with malaria. Conclusion The results testify that standardized blood component screening can save transmission of infections through blood transfusion. They also establish the superiority of NAT screening over serological tests in decreasing the residual risk of transfusion transmitted infections.

A study into the genetic basis of aspirin resistance in Pakistani patients with coronary artery disease.

Aspirin is a key player in the management and prevention of stroke and myocardial infarction in patients with atherothrombosis. About 12% of Pakistanis suffering from coronary artery disease are resistant to aspirin's effects. Clinical, biochemical and genetic factors are known to be responsible for this phenomenon. We conducted this study to investigate whether previously studied polymorphisms in COX-1, GPIIIa, GPIa and P2RYI genes could be the cause of aspirin resistance in our population. Blood samples were collected from 29 aspirin non-responders and 60 ethnically matched responders. Aspirin response assay was performed on IMPACT-R and DNA prepared from blood using the phenol: chloroform method. Genotyping was carried out for four SNPS including COX-1 C50T (rs3842787), GPIIIA PIA1/A2 polymorphism (rs5918), GPIA C807T (rs1126643) and p2RY1 C893T (rs1065776). No statistically significant differences were observed in the allele or genotype frequencies between the aspirin non responders and responders indicating the possible involvement of different genetic determinants of aspirin resistance in our population. This study paves the way for further research into the field of aspirin resistance in Pakistan.

Chromosomal study for prognostic grouping in chronic lymphocytic leukemia.

OBJECTIVE: To determine the frequency of various cytogenetic aberrations in newly diagnosed chronic lymphocytic leukemia (CLL) patients, and their detection rate by cytogenetic and fluorescent In situ hybridization (FISH) technique separately. STUDY DESIGN: A case series. PLACE AND DURATION OF STUDY: Clinical and Molecular Cytogenetics Laboratories, University of California, Los Angeles, USA, from November 2007 to July 2008. METHODOLOGY: Analysis was made on 100 diagnosed chronic lymphocytic leukemia patients. Cytogenetics and FISH technique were performed on blood or bone marrow samples. RESULTS: Nineteen out of 100 cases (19%) showed karyotype abnormalities; whereas 55 showed abnormalities using the CLL-specific FISH probes. The most frequent abnormality detected by standard cytogenetics was trisomy 12. The most common abnormality detected by FISH was a deletion of 13q14 (40 out of 55 cases; 72% of the abnormal). CONCLUSION: For prognostic grouping of CLL patients, FISH must always be requested which may even replace standard karyotyping. These chromosomal markers help in choosing the therapeutic options.

Report: frequency of aspirin resistance in patients with coronory artery disease in Pakistan.

Aspirin resistance is an emerging clinical entity. However the data available on aspirin resistance in Asian population is scarce. This study was initiated to prospectively evaluate the frequency of aspirin resistance in patients with stable coronary artery disease (CAD) in Pakistan. A cross sectional prospective study was conducted in cardiology and hematology departments at Shifa International Hospital, Islamabad from January to December 2007. Two hundred and fifty patients were enrolled from cardiology out patient department having met the specific inclusion criteria. Details were entered on a pre-designed questionnaire and aspirin response assay was performed on IMPACT-R (Dia Med AG 1785 Cressier Morat, Switzerland). Data was analyzed using SPSS V12. Aspirin resistance was observed in 12% of patients. 73.2% of study population were male and 26.8% were female, with a mean age of 57.2 years. There was no significant correlation of aspirin resistance with traditional risk factors like diabetes mellitus (DM), hypertension or dyslipidemia. 84% of aspirin non responders were taking 75 mg per day and 16% were on 150 mg per day. A positive trend was noted between aspirin resistance and cigarette smoking. Aspirin resistance is a real phenomenon in Pakistani population with an estimated frequency of 12%. Large scale prospective randomized trials with long term follow up are needed to assess the impact of different doses and the clinical significance of this biochemical entity.

Efficacy and safety of total dose infusion of low molecular weight iron dextran in the treatment of iron deficiency anemia during pregnancy.

OBJECTIVE: To determine the efficacy and safety of Total Dose Infusion (TDI) of low molecular weight iron dextran for the treatment of iron deficiency anemia compared to oral iron replacement during pregnancy through improvement in hemoglobin (Hb) after intervention. STUDY DESIGN: Non-randomized control trial. PLACE AND DURATION OF STUDY: Section of Gynaecology and Obstetrics, Shifa International Hospital and Shifa Community Health Centre, Islamabad during January 2005 to January 2006. PATIENTS AND METHODS: A group of 100 pregnant women with gestational age greater than 12 weeks with confirmed diagnosis of iron deficiency anemia attending the antenatal clinics were enrolled in this study. Total dose iron infusion of low molecular iron dextran was given to these patients after calculating iron deficit, in a monitored in-patient setting. Control comprised of a second group of 50 pregnant females matched for age, parity and baseline hemoglobin, tolerant to oral iron supplementation (ferrous sulphate 200 mg three times a day) attending the antenatal clinics during the same period. Post-treatment hemoglobin levels of study group as well as the oral control group were determined between 3 to 4 weeks. RESULTS: In the intervention group, mean pre-infusion hemoglobin level was 8.57 +/- 0.9 gm/dl (range 5-10.5 gm/dl) and mean post-infusion Hb was 11.0 +/- 1.1 (range 8.4-14.3 gm/dl). In control group, mean pre-oral intake Hb level was 9.5 +/- 0.9 gm/dl (range 7-10.5 gm/dl) and mean post-oral intake Hb was 10.2 +/- 1.2 gm/dl (range 6.4-12.8 gm/dl). Mean increase of Hb in intervention group was 2.43 gm/dl (95% CI 2.4 - 3.8) and for controls it was 0.7 gm/dl (95% CI 0.6-2.3). Flushing and palpitations were observed in 4% of interventional group patients and none in the control group. No significant adverse reactions were observed in either group. CONCLUSION: We conclude that the total parenteral iron replacement with low molecular weight iron dextran is an effective and safe method for the treatment of iron deficiency anemia in a selected group of pregnant women.

Non-secretory myeloma: a rare variant of multiple myeloma.

The spectrum of plasma cell neoplasm represents indolent conditions like Monoclonal Gammopathy of Undetermined Significance (MGUS) to more aggressive multiple myeloma and plasma cell leukemia. Non-secretory myeloma comprises less than 01% of this spectrum where serum protein electrophoresis and quantitative immunoglobulins remain essentially normal. We are presenting a case report of this rare variant involving the sternum of an adult male.

Imatinib-related bone marrow aplasia after complete cytogenetic response in chronic myeloid leukemia.

Imatinib mesylate is a BCR-ABL tyrosine kinase inhibitor used in the management of chronic myeloid leukemia. It is a safe and well-tolerated agent with a few manageable side effects. We are reporting a case of imatinib-related fatal bone marrow aplasia after complete cytogenetic response.