PURE RED CELL APLASIA : A CASE REPORT

Pure cell aplasia is a rare bone marrow failure that affects erythroid lineage characterized by normocytic normochromic anemia with reticulocytopenia in the peripheral blood and absent or infrequent erythroblasts in the bone marrow. It can be congenital or acquired. Acquired can be primary when no cause is identied or secondary-due to underlying or associated pathology. Herein we report a case of a 28 year old female with Primary Acquired Pure Red cell aplasia. The patient presented with severe anemia (Hb-1.9gm%) and low reticulocyte count 0.1%. Bone marrow aspiration shows normocellular marrow with Decreased erythropoiesis with M:E ratio of 20:1..Patient was started on oral prednisolone and improvement was seen and the patient became transfusion independent.

STUDY AND ANALYSIS OF MORPHOLOGICAL PATTERNS OF ANEMIA IN GERIATRIC PATIENTS

INTRODUCTION:Anemia in elderly population is a frequently diagnosed problem and if it is untreated ,it can lead to impaired functional capacity, poor quality of life and increased morbidity and mortality. In view of high prevelance of anemia in geriatric population,the study was conducted to evaluate the morphological patterns of anemia in elderly population. METHODS:A Prospective observational study was conducted on 100 geriatric patients above 60 years of age,for a period of 3 months.Routine haematological investigations and peripheral smear study was done. RESULTS: In the present study, females were found to be more affected than males and patients in the age group of 60-69 years were affected the most. Normocytic normochromic anemia was the most common morphological type of anemia observed. CONCLUSION: Despite recent diagnostic advances, geriatric anemia remains under reported and inadequately investigated. Determining the morphological type of anemia can help in nding out the etiology and there by aid in proper diagnosis and better patient management.

Normocytic Normochromic Anemia Revealed an Early Onset Hashimoto’s Hypothyroidism in an Infant: A Case Report

Autoimmune thyroiditis is very rare etiology of primary hypothyroidism in infancy. Hypothyroidism has a wide range of clinical presentation, from subclinical hypothyroidism to overt type. It is unclear what pathological mechanisms connect thyroid function and erythropoiesis or how thyroid disease can contribute to anemia. We report a 12-month-old infant who presented with anemia associated with early onset of overt autoimmune thyroiditis. The peculiarity of our case enables us to draw attention of physician to consider acquired hypothyroidism in the differential diagnosis of unexplained anemia even if the neonatal screening is normal and congenital hypothyroidism is a remote possibility.

Two Individuals with Rare Blocked Antigen Phenomenon and Coinciding Warm Autoantibody Mimicking Alloanti-Jk3 Resolved with JK Analysis

Introduction/Objective Kidd antigens can bind complement (C3) as well as Kidd specific warm autoantibodies (WAAb). An 838G>A single nucleotide variant (SNV) defines JK*01 and JK*02 which codes the antithetical Jka and Jk b, respectively. Both alleles translate the high prevalence (>99%) Jk3 (JK3). The 130G>A is associated with weak Jka and weak Jkb expression. In vivo binding of non-agglutinating globulins can cause false-negative phenotypes by means of the blocked antigen phenomenon (BAP). Methods/Case Report Transfusions were requested for a 74-year-old Caucasian (CA) female with Evan’s Syndrome, and an 85-year-old African American (AA) female with metastatic uterine cancer. Both had a history of nonspecific WAAb. Direct antiglobulin testing (DAT) detected moderate in vivo sensitization of IgG and C3. They phenotyped Jk(a- b-) with untreated and EDTA glycine-acid (EGA) treated IgG DAT-negative cells. Their serum contained anti-Jk3 reactivity, while a panreactive WAAb in the eluate reacted with Jk3- donor and EGA treated DAT-negative autologous cells. Weak anti-Jka and anti-Jkb reactivity remained in the alloadsorbed serum of the antithetical adsorbing cells. Genetic testing of the CA revealed JK*01W.01(130A)/02 alleles, while cDNA confirmed the alleles would be transcribed into mRNA. Sequencing of the AA detected 130G/A, and 838G/A as well as other silent mutations predicting either a Jk(a+wb+) or Jk(a+b+w) phenotype. The CA received one compatible JK:-3 transfusion, and both individuals benefited from multiple least incompatible transfusions of Jk a+ and/or Jk b+ donors with expected hemoglobin increases (1 g/dL per transfusion). The CA serologically phenotyped Jk(a-b+) 132 days later following prolonged immunosuppressive therapy while a normocytic normochromic anemia and the WAAb persisted. No follow up evaluations of the AA are available. Results (if a Case Study enter NA) NA Conclusion Unexpected BAP can confound immunohematology testing and lead WAAbs mimicking alloanti-Jk3 to be mischaracterized as allogeneic. By predicting phenotypes, genetic analysis can aid serological techniques in antibody characterization and help circumvent complications searching for rare JK:-3 donors.

Beneficial effects of empagliflozin on hematocrit levels in a patient with severe anemia

Introduction Sodium-glucose cotransporter (SGLT2) inhibitors may additionally benefit patients with diabetes by improving their erythropoiesis followed by the elevation of hemoglobin and hematocrit levels. Reason for the report In the case described, severe normocytic normochromic anemia was resolved when empagliflozin had been introduced to the therapy. Case summary A 78-year-old male patient was admitted to our hospital with a non-ST-segment elevation myocardial infarction. His past medical history included diabetes, right coronary artery angioplasty, myocardial infarction and paroxysmal atrial fibrillation which required anticoagulant treatment. When examined, severe normocytic normochromic anemia was also diagnosed. About two years prior to his admission, the patient began suffering from persistent anemia despite the modification of his anticoagulant therapy with warfarin, rivaroxaban and dabigatran. An extensive evaluation failed to provide an explanation for his anemia. Outcome Eventually, only the introduction of empagliflozin successfully increased the values of hemoglobin and hematocrit. Therefore, it transpires that SGLT2 enhances erythropoietin (EPO) secretion which subsequently raises hematocrit levels in patients with severe anemia. Graphic abstract

Study of Spectrum of anemia in various age groups

: Anemia is major health problem world-wide especially in developing countries. Globally 1.62 billion persons are affected. It has grave consequences on human health. The present study evaluates the severity and morphology of anemia in various age groups in rural population. : 1): To study degree and severity of anemia in study population; 2): To study distribution of anemia in various age groups; 3): To study morphological spectrum of anemia in study population. s: The study includes 792 patients having low concentration of hemoglobin for their age & sex. The other hematological parameters and morphology were analyzed. : In our study, females constituted 72.6% (575/792) of study population and male constituted 27.4% (217/792) of population. Pediatric patients (up to 15 years of age) constituted 10% of study population. Out of 792 anemic patients, 439 (55.4%) were having moderate anemia, 228 (28.7%) were having mild anemia & 125 (15.78%) were having severe anemia. Out of 792 anemic patients, 384 (48.4%) were having microcytic hypochromic anemia, 296 (37.37%) were having normocytic normochromic anemia, 84 (10.6%) were having macrocytic anemia and 3.5% were having hemolytic anemia. Out of 792 anemic patients, 439 (55.4%) were having moderate anemia, 228 (28.7%) were having mild anemia & 125 (15.78%) were having severe anemia. In our study anemia was more common in females as compared to males constituting majority of study population which is in concordance with other studies also. Moderate anemia was more common in study population as well as in various sub-groups being in concordance with other studies too. Morphologically microcytic hypochromic anemia was the most common type of anemia especially in adult females. Pregnant females were found to have normocytic normochromic anemia predominantly. Most of the cases of hemolytic anemia was found in children <15years. Similarly macrocytic anemia was found more commonly in adult males. Anemia is the most hematological abnormality found in daily practice, though found in all age groups but quite higher in females. The main objective for diagnosing anemia is to make clinician aware so that they can take measures to prevent and control anemia.

Haemobartonellosis in a Domestic Cat in Indonesia: a Case Study

Haemobartonellosis is a disease caused by Haemobartonella felis or Mycoplasma haemofelis, which attacks red blood cells. Ctenocephalides felis could transmit Haemobartonellosis. Further, vertical transmission from mother to offspring and blood transfusion from infected animals could transfer the disease to other animals. This report aimed to describe the diagnosis and medical treatment of haemobartonellosis in a domestic cat in Indonesia. Physical examinations and blood analysis were carried out. The cat weighed 1,4 kg with 39,3°C temperature, CRT was three seconds, mucosa looked pale, and many Ctenocephalides felis fleas were found. The clinical symptoms detected were weakness, loss of appetite, and hair loss. A blood test indicated normocytic normochromic anemia. The rod-like formation within erythrocytes in blood smear was observed. Infection with Hemobartonella felis was diagnosed based on the blood test and the presence of numerous Ctenocephalides felis. Doxycycline was administrated at 10 mg/kg BW once a day for 21 days. The cat recovered clinically after 21 days, with a good appetite, normal mucosal color, and normal temperature

Association and correlation of thyroid dysfunction with anemia types in pregnant women of northern Andhra Pradesh, India

Background: Thyroid dysfunction is a common disorder in pregnancy along with anemia. But no study has evaluated the association between them. To estimate the prevalence of thyroid dysfunction and its association with anemia types in pregnant women during 1st trimester.Methods: Three hundred and eighty pregnant women with <12 weeks of gestational age were selected for the study with no history of thyroid dysfunction and anemia. All the pregnant women were classified into A, euthyroid and B, thyroid dysfunction groups. The B group was again subdivided into hypothyroid, subclinical hypothyroid (SCH), hyperthyroid according to nature of dysfunction. 5 ml of blood sample was collected from all subjects to analyse thyroid hormones and erythrocyte indices.Results: Out of 380 subjects, euthyroid was found to be 77.9%, and rest 22.1% were with thyroid dysfunction. Out of 84 thyroid dysfunction, hypothyroid was found to be 7.9%, SCH 13.9% and hyperthyroid was 0.3%. Out of 296 euthyroid women, anemia was identified in 97 pregnant women (32.8%) whereas in thyroid dysfunction women it was 43 women out of 84 (51.2%) which is a statistically significant. Significantly higher frequency of microcytic hypochromic anemia and normocytic normochromic anemia types were also found in thyroid dysfunction groups compared to euthyroid group (p<0.05). However, no significance between the thyroid dysfunction groups, Statistically significant difference was observed in the Hb concentration, RBC count, MCV, MCH and PCV between euthyroid and different thyroid dysfunction conditions (p<0.05). A statistically significant positive correlation was found between fT4 and erythrocyte indices.Conclusions: As fT4 and TSH correlated with erythrocyte indices, it is advisable to screen for thyroid dysfunction and vice versa so as to prevent the complications associated with anemia and thyroid dysfunction.

Effect of mineral deficiencies on the red blood cell parameters in cattle

Mineral deficiencies are a common problem in dairy herds around the world. Currently, they most often occur in a subclinical form or with atypical symptoms, which makes their diagnosis difficult. New methods and possibilities of identifying mineral deficiencies are being sought. Hematological changes may occur in the early stages of the development of deficiency diseases, and their detection may be helpful in the early diagnosis of diseases. The aim of the article is to present the most important information on disorders in the red blood cell system in the course of mineral deficiencies in dairy cattle. Hematological tests should become one of the most important elements facilitating the determination of the health condition of cows and enabling the correct diagnosis and therapy of cattle diseases. Copper, iron, magnesium and phosphorus deficiencies cause changes in hematological parameters. In iron and copper deficiency, there are microcytic, hypochromatic or normocytic, normochromic anemia. On the other hand, in the deficiency of magnesium and phosphorus, there is normocytic, normochromic anemia.

Causal-Investigative Analysis of the Formation of Anemia in Children

The purpose of the study was to determine the main causal factors in the formation of anemia in children of Ukraine, depending on the morphometric changes in erythrocytes of blood, indicators of iron metabolism for the formation of a risk group for oncohematological diseases. Material and methods. 770 children were examined: 724 with anemia, 46 with acute lymphoblastic leukemia. We studied the parameters of the erythrocyte lineage of hematopoiesis, morphometric parameters of erythrocytes, indicators of iron metabolism (serum iron, ferritin, transferrin, the transferrin saturation with iron, hematocrit, the content of δ-aminolevulinic acid and coproporphyrin in urine, pituitary thyroid stimulating hormone depending on the type of somatic pathology. Anemic states were distributed taking into account the average erythrocyte volume and the average hemoglobin content in the erythrocyte, and dividing diagnoses microcytic-hypochromic or normocytic-normochromic anemia, respectively. Results and discussion. The study showed that in children with normocytic-normochromic anemia, the number of erythrocytes and hematocrit were lower than in patients with microcytic-hypochromic anemia, while average erythrocyte volume, average hemoglobin content, serum iron, serum ferritin and transferrin saturation with iron were higher. The number of reticulocytes in the peripheral blood in all the examined subjects was standard. That is, the anemic conditions in children differed in ferrokinetic parameters, in particular, with and without iron deficiency. Taking into account the age of the children and the reasons for the development of anemia, a third of the girls of puberty with microcytic-hypochromic anemia had menorrhagias. In children under 6 years of age with normocytic-normochromic anemia, diseases of the gastrointestinal tract were more often registered; in the older 6 years – gastrointestinal diseases, helminthiasis and allergic reactions compared with patients with microcytic-hypochromic anemia. The development of normocytic-normochromic anemia in children and the functioning of the gastrointestinal tract were influenced by drug treatment for chronic pathology in the body. All children with anemia had an irrational diet. Porphyria was diagnosed in 3.8% of children with microcytic-hypochromic anemia. In 12.7% of children with normocytic-normochromic anemia, the serum thyroid stimulating hormone level was at the upper limit of the reference value (mean 3.3±0.6) mU/L), which correlated with a reduced number of erythrocytes in blood (r = -0.65) and increased values of average erythrocyte volume (r = 0.41) and average hemoglobin content (r = 0.35), and indicates changes in the erythrocyte lineage of hematopoiesis associated with the initial manifestations of thyroid hypofunction. An excess of iron was observed in 7.1% of older boys with normocytic-normochromic anemia, which requires additional examination. In patients with acute lymphoblastic leukemia were diagnosed with normocytic-normochromic anemia of varying severity. The serum ferritin level was (272.1±28.4) ng/ml and was significantly higher than in children with normocytic-normochromic anemia. In 12 of 46 patients, transferrin saturation with iron was increased and amounted to (70.2±2.3)%. Moreover, the higher the level of serum iron and serum ferritin, the higher was the transferrin saturation with iron (rs = 0.5; rs = 0.85). An inverse correlation was established between transferrin saturation with iron, patient survival (rs = -0.45) and a higher probability of death (rs = -0.46). Conclusion. Children with normocytic-normochromic anemia require in-depth examination and constitute a risk group for the development of myelodysplastic syndrome and leukemia