Experience of Danaparoid to Treat Vaccine-Induced Immune Thrombocytopenia and Thrombosis, VITT

Background: Vaccine-induced immune thrombocytopenia and thrombosis (VITT) is triggered by nCOV-19 adenovirus-vectored vaccines against SARS-CoV2. Pathogenesis has been mainly related to platelet activation via PF4-reactive antibodies that activate platelets and cross-react with heparin. Data concerning optimal anticoagulation are anecdotal, and so far, there are scattered reports of danaparoid use in VITT management. Danaparoid has good efficacy and safety in treatment of heparin-induced thrombocytopenia. We report here our experience of the administration and monitoring danaparoid in VITT. Methods: We diagnosed six hospitalized cases of definite or probable VITT, based on the international diagnostic guidance. All VITT-related data were from the local electronic medical and laboratory record system and were analyzed with IBM SPSS Statistics. Results: Predominately women in their late forties developed VITT on average 24 days (range 9-59) after the first ChAdOx1 dose. Clinical presentation included single or multiple venous and/or arterial thrombosis, moderate thrombocytopenia and high D-dimer levels. After detecting PF4 antibodies subcutaneous danaparoid was our first-line antithrombotic treatment with an average duration of three weeks. The median plasma anti-FXa activity was in the lower part of the therapeutic range and during the first week of danaparoid administration clinical symptoms, platelet counts and fibrin turnover resolved or significantly improved. The average duration of hospital admission was 10 days (2-18). One patient died but the other five recovered completely. Conclusions: The clinical outcomes of our small cohort align with the earlier published reports, and support danaparoid as a rational option for the initial anticoagulation of VITT patients.

RETROSPECTIVE STUDY OF MALARIA PREVALENCE IN SELECTED HOSPITALS IN ZARIA, NIGERIA

A retrospective study of laboratory records in selected hospitals in Zaria was carried out to determine the trend of malaria prevalence between 2001 and 2005. Data was obtained from the following selected hospitals: St Luke’s Anglican Hospital, Wusasa, Salama Infirmary, Saidu Dange railway Hospital and Sick Bay, Ahmadu Bello University, Main campus, Samaru. The selection of the hospitals was based on their geographical location and sizes. The prevalence was consistently high over the years; 2001–44.1%, 2002–59.45%, 2003–59.35%, 2004–58.30% and 2005–64.25%. There was no significant difference (P>0.05) between malaria infection in males and females. Infection rates were significantly higher in children than adults (P<0.05) in all hospitals sampled except Salama Infirmary. Sick Bay in the main campus, Samaru had the least prevalence consistently over the five years period – 2001-27.0%, 2002-26.3%, 2003-21.8%, 2004-25.9% and 2005-33.2%. No clear seasonal variation over the years was observed. The study clearly showed consistent high prevalence over the five years period. Record keeping was useful as it provided data bur devoid of specific ages of attendees. Specific ages of hospital attendees rather than “children” or “adults” should be recorded and other demographic variables such as occupation and other socio-economic proxies should be included in laboratory record books

THE POTENTIAL OF RETICULOCYTE HAEMOGLOBIN EQUIVALENT (RET-HE) IN IRON DEFICIENCY ANAEMIA SCREENING AT BETHESDA HOSPITAL, YOGYAKARTA

Background: Traditionally, iron deficiency anaemia (IDA) is diagnosed with iron and ferritin status. Ret-He measurement is a promising parameter to detect iron depletion in earlier stages. Previous studies recommended Ret-He examination as IDA screening. Objective: Compare the Ret-He level and iron status of patients with and without IDA at Bethesda Hospital, Yogyakarta. Method: This is a cross-sectional study using laboratory record of haematological examination at Bethesda Hospital from march to August 2019. Erythrocyte indices, iron status and Ret-He measurement was further examined between IDA and non-IDA group by ANOVA, t-test or non-parametric tests. Results: There were 105 samples, where 22 (20.95%) had complete result of Ret-He and iron status, and 10 (45.45%) diagnosed with IDA. The Ret-He level in IDA group is significantly lower than non-IDA group (17.53 ± 2.43 vs 31.50 ± 4.03, p < 0.001). Conclusion: Ret-He level is lower in IDA group, consistent with other biochemical parameters (Serum iron, Serum ferritin, TIBC, and TSAT). This finding might lead to future research on the potential of Ret-He for early detection of IDA in high-risk populations.

Distribution of Hemoglobinopathy in Nepalese Population

Background: Sickle cell and thalassemia are the inherited disorders of globin chain synthesis, and are the most common monogenic disease worldwide. This study aims to find the distribution of hemoglobinopathies (sickle cell and thalassemia) cases in Nepal using laboratory based data.Methods: A retrospective study was carried out at five different sites of Nepal Government that uses capillary electrophoresis for screening of hemoglobin disorders from January 2019 to March 2019. All the cases diagnosed positive for hemoglobinopathy till December 2018 were collected from laboratory record at each sites, and analyzed using Statistical Package for Social Sciences (SPSS version 20.0).Results: Out of total 4018 patients tested during the period in all five different sites, 1470 were diagnosed positive for hemoglobinopathy. Sickling disorder was the most predominant hemoglobinopathy followed by ?-thalassemia. Province 5, province 6 and province 7 were mostly affected by sickling disorder while the other provinces by ?-thalassemia.Conclusions: Sickle cell is the commonest cause of hemoglobinopathy followed by B thallesmias in Nepalese population. Sickle cell is more concentrated towards western part of Nepal and especially in Tharu ethnic population. In contrast, the distribution of ?-thalassemia is found throughout the country and among all ethnic groups of population.Keywords: Hemoglobinopathy; Nepal; sickle cell; thalassemia

Seroprevalance of ToRCH Infection –A Laboratory Profile

Background: ToRCH infection (Toxoplasma gondii, Rubella virus, Cytomegalovirus, Herpes simplex virus) causes severe consequences in child in ongoing pregnancy. Screening for ToRCH etiologies are sought for those females who have had bad obstetrics history and in children born with birth defects. Such screening helps the couple and the clinicians to develop a consensus for preparedness of adverse fetal outcome, future prevention and planning for next conception.Objectives: This retrospective study was conducted to have an understanding on the burden of ToRCH infection in various clinically suspected cases encountered in BPKIHS.Methods: Laboratory record of 52 serum samples submitted from August 2012 to July 2013 for screening of ToRCH infections was analyzed.Result: Among 52 adult female serums, most (50) were positive for Cytomegalovirus (CMV) IgG, but none were reactive for Rubella IgM. Both IgG and IgM were positive for CMV in 10 cases, Herpes Simplex Virus (HSV) in 1 case and Toxoplasma in 1 case.Conclusion: This study shows, CMV as the most common and Toxoplasma as the least common etiology among the ToRCH profile, in our setup.