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

Early diagnosis and treatment of hydatidiform mole in adolescent pregnant woman

Hydatidiform mole belongs to the spectrum of gestational trophoblastic disorders in which abnormal conception leads to excess placental tissue formation in the absence of fetal development. The incidence of hydatidiform mole is quite rare so that not all experienced clinicians handle this case in clinical experience. Therefore, we present a case of hydatidiform mole in an adolescent patient. A 14-year-old primigravida woman, unemployed, with elementary school education, with a gestational age of 16 weeks went to the ER with complaints of vaginal bleeding for 2 days. Physical examination found the fundal height at umbilicus, abdominal tenderness, accompanied by vaginal bloody discharge. Complete blood count found mild normochromic anemia with increased levels of T3 and decreased TSH. Ultrasound imaging found a typical vesicular pattern of a hydatidiform mole. Treatment of molar evacuation by curettage and drainage was carried out one day after presentation and obtained 600 grams of molar tissue. The patient underwent 24 hours of post-operative observation before being discharged in a stable state. The patient presented with a typical clinical appearance of hydatidiform mole. Ultrasound imaging reveals a typical complete hydatidiform mole accompanied by anemia and hyperthyroxinemic which may accompany hydatidiform mole. Evacuation was carried out according to clinical guidelines and the patient was discharged in a good condition.

Immunophenotype of Erythroid Precursors in Patient with Pure Red Cell Aplasia (PRCA): Utility of Analysis of Erythroid Maturation

Pure Red Cell Aplasia (PRCA) is an infrequent disease [1,2], which usually presents as hypogenerative normochromic anemia, and is characterized by a significant decrease (including absence) of erythroid precursors [3]. Its etiology can be congenital or acquired, and its correct diagnosis requires exclusion of alternative cases of refractory anemia, so the bone marrow histology plays a crucial role. Myelodisplastic Syndromes (MDS) should always be considered in its differential diagnosis. The use of laboratory tools, specifically Flow Cytometry (FCM) is gained importance in the study of malignant and benign hematology pathologies. In MDS, FCM is not yet considered a standard of care, however it provides valuable information [4,5] and there are numerous publications and scores for its usual clinical use (for example Ogata score and RED-score [6,7]). In relation to the rise of FCM in MDS, enormous progress has been made in the description of the erythroid precursors immunophenotype [8-10]. An example of normal erythroid maturation is presented in Figure 1, showing proerythroblasts with immunophenotype CD71+ CD105+ CD117+, basophilic erythroblasts CD71+ CD105+ CD117-, polychromatophilic and orthochromatophilic erythroblasts CD71+ CD105- CD117- distinguishing by size in Forward Scatter (FSC) versus CD36 respectively. Characteristic maturation curve in CD117 versus CD105 analysis evidenced a predominance towards more mature erythroblasts.

Lymphoplasmacytic hemorrhagic cystitis in dog: case report

Hematuria is a relatively common manifestation in dogs and cats secondary to disorders of the urinary tract, such as bacterial cystitis and urolithiasis, with its treatment being limited to the elimination of the primary cause. However, when hematuria is persistent or capable of causing significant hematological disorders, other less common causes should be investigated. A dog, pit bull, male, 12 years old, was admitted in the Hospital Veterinário da Universidade de Uberlândia (Veterinary Hospital of the Federal University of Uberlândia) with a major complaint of severe urinary bleeding 10 days ago. Laboratory tests showed normocytic and normochromic anemia, associated to intense hematuria. Ultrasound images revealed alterations compatible with chronic cystitis. Based on the results of the laboratory and imaging tests, treatments with antibiotic therapy associated to blood transfusions were started and the animal was referred for bladder biopsy. The histopathologic examination revealed lymphoplasmacytic hemorrhagic cystitis, a rare and very aggressive disease, which presents similar descriptions in human beings, but not yet described in dogs.