Haematological response in experimental human Plasmodium falciparum and Plasmodium vivax malaria

Background Malaria-associated anaemia, arising from symptomatic, asymptomatic and submicroscopic infections, is a significant cause of morbidity worldwide. Induced blood stage malaria volunteer infection studies (IBSM-VIS) provide a unique opportunity to evaluate the haematological response to early Plasmodium falciparum and Plasmodium vivax infection. Methods This study was an analysis of the haemoglobin, red cell counts, and parasitaemia data from 315 participants enrolled in IBSM-VIS between 2012 and 2019, including 269 participants inoculated with the 3D7 strain of P. falciparum (Pf3D7), 15 with an artemisinin-resistant P. falciparum strain (PfK13) and 46 with P. vivax. Factors associated with the fractional fall in haemoglobin (Hb-FF) were evaluated, and the malaria-attributable erythrocyte loss after accounting for phlebotomy-related losses was estimated. The relative contribution of parasitized erythrocytes to the malaria-attributable erythrocyte loss was also estimated. Results The median peak parasitaemia prior to treatment was 10,277 parasites/ml (IQR 3566–27,815), 71,427 parasites/ml [IQR 33,236–180,213], and 34,840 parasites/ml (IQR 13,302–77,064) in participants inoculated with Pf3D7, PfK13, and P. vivax, respectively. The median Hb-FF was 10.3% (IQR 7.8–13.3), 14.8% (IQR 11.8–15.9) and 11.7% (IQR 8.9–14.5) in those inoculated with Pf3D7, PfK13 and P. vivax, respectively, with the haemoglobin nadir occurring a median 12 (IQR 5–21), 15 (IQR 7–22), and 8 (IQR 7–15) days following inoculation. In participants inoculated with P. falciparum, recrudescence was associated with a greater Hb-FF, while in those with P. vivax, the Hb-FF was associated with a higher pre-treatment parasitaemia and later day of anti-malarial treatment. After accounting for phlebotomy-related blood losses, the estimated Hb-FF was 4.1% (IQR 3.1–5.3), 7.2% (IQR 5.8–7.8), and 4.9% (IQR 3.7–6.1) in participants inoculated with Pf3D7, PfK13, and P. vivax, respectively. Parasitized erythrocytes were estimated to account for 0.015% (IQR 0.006–0.06), 0.128% (IQR 0.068–0.616) and 0.022% (IQR 0.008–0.082) of the malaria-attributable erythrocyte loss in participants inoculated with Pf3D7, PfK13, and P. vivax, respectively. Conclusion Early experimental P. falciparum and P. vivax infection resulted in a small but significant fall in haemoglobin despite parasitaemia only just at the level of microscopic detection. Loss of parasitized erythrocytes accounted for < 0.2% of the total malaria-attributable haemoglobin loss.

Pregnancy‐associated haemolytic anaemia: A cause not to be forgotten

Anaemia in pregnancy is common, however, only a few cases of pregnancy-associated autoimmune haemolytic anaemia have been documented. Typically, such cases involve a positive direct antiglobulin test and have the potential to cause haemolytic disease of the fetus and newborn. Rarely, no autoantibodies are detected. We report two cases of direct antiglobulin test negative haemolytic anaemia occurring in multiparous women with no cause found. Both women had a haematological response to corticosteroid therapy and delivery.

Genetic Variations in Haematological Indices of Local and Exotic Turkeys Inoculated with Attenuated Salmonella typhimurium Vaccine

Infection due to Salmonella spp is one of the threatening diseases to poultry industry because it can cause economic losses through mortality, morbidity and reduction in egg production. One hundred and sixty poults comprising 80 local and 80 exotic (Nicholas white) were used to examine the variations in haematological response to Salmonella spp in local and exotic turkeys inoculated with attenuated Salmonella spp. Both genotypes were reared separately on deep litter, under the same management practices and wing tagged for proper identification. At 7th week of age, 1ml of blood sample was collected from each turkey into anticoagulant tubes and labeled accordingly for base-line haematological analysis. The turkeys were inoculated at 8th week by subcutaneous injection of attenuated Salmonella vaccine at 0.5ml per turkey. On the 2nd and 7th days after inoculation, 1ml of blood samples was collected from each turkey for haematological analyses. The un-coagulated blood was used to determine packed cell volume (PCV), red blood cell (RBC), white blood cell (WBC) and its differential counts, and haemoglobin (Hb). The mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH) and mean corpuscular haemoglobin concentration (MCHC) were calculated. The haematological data collected were analyzed using General Linear Model of SAS 9.0 software. The exotic turkey had higher (p<0.05) values of PCV (38.13±1.01), Hb (12.77±0.33gd/l), MCV (133.39±0.14fL) and MCH (43.35±1.27pg/cell) before inoculation. On 2nd day post inoculation, the local turkey had higher (P<0.05) values of PCV (43.93±1.40%), RBC (3.98±0.12 106µl-1) and Hb (14.56±0.47gd/l). Also, on the seventh day post inoculation, the local turkey had higher (P<0.05) values of PCV (42.13±1.20%), WBC (11.94±0.62 103.µ-1), Hb (14.09±0.38 gd/l) and MCH (40.65±0.34pg/cell). The mean values of PCV, Hb, MCV, MCH and MCHC of local turkeys were higher (p<0.05) on the 7th day than on the 2nd day post inoculation, while the RBC was higher (P<0.05) on the 2nd day post inoculation. The WBC, MCV and MCH values were higher (p<0.05) in exotic turkey on the 2nd day post inoculation. The local turkey showed quick haematological response to Salmonella vaccine especially post inoculation. Therefore, the local turkey could be said to have stronger potential to survive under disease prevailing environment than the exotic turkey.

Resolution of primary hepatic marginal zone lymphoma in a hepatitis C virus-infected patient treated with a direct-acting antiviral

ABSTRACT The favorable impact of antiviral therapy on low-grade hepatitis C virus (HCV)-related non-Hodgkin lymphoma manifesting as marginal zone lymphoma (MZL) has been reported in some clinical studies. However, primary HCV-related marginal zone lymphomas (MZLs) confined to the liver have not been described in the literature nor have the resolution of liver lymphoma through anti-HCV eradication treatment. The authors report a genotype 1b HCV-positive patient with chronic hepatitis who exhibited lesions involving both hepatic lobes resembling hepatocellular carcinoma. Liver biopsy revealed an MZL of the liver. Antiviral treatment using sofosbuvir associated with simeprevir as unique treatment was started and resulted in complete haematological response. In HCV-related MZL isolated to the liver, antiviral treatment has led to the eradication of viral infection and a complete haematological response. Antiviral therapy should be considered as a first-line treatment for HCV-related primary MZLs of the liver.

Response of factor X deficiency to darutumumab in the treatment of AL amyloidosis: a novel finding

We report a case of progressive light-chain amyloidosis (otherwise known as AL amyloidosis) with acquired factor X (aFX) deficiency with a complete haematological response and rapid normalisation of FX levels following daratumumab monotherapy. To our knowledge, this is the first case report documenting successful treatment with daratumumab of aFX deficiency secondary to AL amyloidosis. The patient responded well to this therapy, with excellent symptomatic and quality of life improvements as well as a reduction in bleeding manifestations. This case highlights the value in considering daratumumab treatment when AL amyloidosis is complicated by FX deficiency.

Comparative evaluation of haematological profile of the Nigerian indigenous and Large White x Landrace crossbred pigs vaccinated with sheep RBC

This study was designed to evaluate haematological response between Nigerian indigenous pigs (NIP) and Large White x Landrace crossbred pigs (LWL) when vaccinated with sheep RBC. Twenty male pigs with average age of 42±3 days and weighed 3.10±0.29 kg (NIP) and 6.90±0.43 kg (LWL), were used. They were assigned to groups A (10 NIP) and B (10 LWL); each was further divided into two with five animals in each replicate. Processing of sheep RBC followed standard procedures; feed and animal management were similar. All the pigs were vaccinated with 1 ml of 10 % sheep RBC per pig at week 4 and revaccinated 3 weeks later. Their haematological profiles were determined using standard procedures and the study lasted ten weeks. There was a rise in WBC count of both groups after initial vaccination. Mean WBC count of LWL was significantly (p ≤ 0.05) higher at weeks 0, 1, 4 and 6, respectively. Lymphocyte count of the two groups also increased sharply after initial vaccination; values recorded for LWL showed a slight but a continuous rise while those of the NIP generally decreased and increased in value. A significant differences in mean values of neutrophil were recorded prior to initial vaccination (p = 0.011, t = 8), on weeks 1 (p = 0.013, t = 8) and 3(p = 0.005, t = 8) with NIP maintaining higher values than LWL. There was no significance (p ≥0.05) difference in the mean values of eosinophil, basophil and monocytes for both groups.

The not so innocent bystander: an unusual cause of progressive breathlessness

This case report discusses a 76-year-old man who presented with symptomatic diffuse alveolar-septal and tracheobronchial amyloidosis with a low-grade monoclonal gammopathy. This patient had a combination of both symptomatic diffuse alveolar-septal interstitial disease and tracheobronchial amyloidosis, features that contradict the widely accepted presentations seen in this disease. First, tracheobronchial amyloidosis has been documented as localised disease without systemic involvement. Second, diffuse alveolar-septal interstitial disease is rarely identified with clinical symptoms unless there is significant cardiac involvement. This case highlights a number learning points in the diagnosis and management of systemic amyloid light chain amyloidosis;(1) There is a need for a high index of suspicion for diagnosis due to the potential subtlety of a plasma cell clone underlying AL amyloidosis, requiring serum-free light chain assays to increase sensitivity; (2) Haematological response and recovery of organ dysfunction are not a linear relationship due to the slower reversal of amyloid deposition; therefore, ongoing monitoring is required to identify those in need of repeated therapy. However, haematological response is a marker of overall survival and (3) Multisystem assessment and multidisciplinary collaboration are critical in optimising the care of patients with systemic AL amyloidosis.

Comparative evaluation of haematological profile of the Nigerian indigenous and Large White x Landrace crossbred pigs vaccinated with sheep RBC

This study was designed to evaluate haematological response between Nigerian indigenous pigs (NIP) and Large White x Landrace crossbred pigs (LWL) when vaccinated with sheep RBC. Twenty male pigs with average age of 42 ± 3 days and weighed 3.10 ± 0.29 kg (NIP) and 6.90 ± 0.43 kg (LWL), were used. They were assigned to groups A (10 NIP) and B (10 LWL); each was further divided into two with five animals in each replicate. Processing of sheep RBC followed standard procedures; feed and animal management were similar. All the pigs were vaccinated with1 ml of 10 % sheep RBC per pig at week 4 and revaccinated 3 weeks later. Their haematological profiles were determined using standard procedures and the study lasted ten weeks. There was a rise in WBC count of both groups after initial vaccination. Mean WBC count of LWL was significantly (p ≤ 0.05) higher at weeks 0, 1, 4 and 6, respectively. Lymphocyte count of the two groups also increased sharply after initial vaccination; values recorded for LWL showed a slight but a continuous rise while those of the NIP generally decreased and increased in value. A significant differences in mean values of neutrophil were recorded prior to initial vaccination (p = 0.011, t = 8), on weeks 1 (p = 0.013, t = 8) and 3(p = 0.005, t = 8) with NIP maintaining higher values than LWL. There was no significance (p ≥0.05) difference in the mean values of eosinophil, basophil and monocytes for both groups.