Hemolytic disease of the fetus and newborn caused by anti-D and anti-S alloantibodies: a case report

<p>Abstract</p> <p>Introduction</p> <p>Hemolytic disease of the fetus and newborn is most commonly caused by anti-D alloantibody. It is usually seen in Rhesus D (RhD)-negative mothers that have been previously sensitized. We report here a case of hemolytic disease of the fetus and newborn in a newborn baby caused by anti-D and anti-S alloantibodies, born to a mother who was RhD negative, but with no previous serological evidence of RhD alloimmunization.</p> <p>Case presentation</p> <p>A one-day-old Chinese baby boy was born to a mother who was group A RhD negative. The baby was jaundiced with hyperbilirubinemia, but with no evidence of infection. His blood group was group A RhD positive, his direct Coombs' test result was positive and red cell elution studies demonstrated the presence of anti-D and anti-S alloantibodies. Investigations performed on the maternal blood during the 22 weeks of gestation showed the presence of anti-S antibodies only. Repeat investigations performed post-natally showed the presence of similar antibodies as in the newborn and an anti-D titer of 1:32 (0.25 IU/mL), which was significant. A diagnosis of hemolytic disease of the fetus and newborn secondary to anti-D and anti-S was made. The baby was treated with phototherapy and close monitoring. He was discharged well after five days of phototherapy.</p> <p>Conclusions</p> <p>This case illustrates the possibility of an anamnestic response of allo-anti-D from previous sensitization in a RhD-negative mother, or the development of anti-D in mid-trimester. Thus, it highlights the importance of thorough antenatal ABO, RhD blood grouping and antibody screening, and if necessary, antibody identification and regular monitoring of antibody screening and antibody levels for prevention or early detection of hemolytic disease of the fetus and newborn, especially in cases of mothers with clinically significant red cell alloantibody.</p

A rare occurrence of plasma cell myeloma with biclonal gammopathy

Plasma cell myeloma is known to cause expansion of a single clone of immunoglobulin (Ig) which results in the secretion of a unique homogeneous monoclonal protein (M component). However, there are cases which reported that it can also cause production of two different clones of these monoclonal M proteins. Although it is relatively very rare as the prevalence is only 2% of all plasma cell myeloma cases, the clinical features are said to be similar to monoclonal gammopathy. It is suggested that these biclonal gammopathy results from either one monoclonal cell clone in monoclonal gammopathy or two different monoclonal cell clones. Whichever the mechanism of the disease be, the response to treatment seems to be similar as compared to the monoclonal cases although some reports shows chemoresistant. Here, we report a rare case of plasma cell myeloma with IgG (lambda) and IgA (lambda) type of biclonal gammopathy, the clinical presentation, the haematological and biochemical markers as well as the response to the treatment

The Msi2 protein expression positive correlation with favorable cytogenetics findings in AML

Acute myeloid leukaemia (AML) is the most common subtype of acute leukaemias with a poor outcome. Msi2 protein is a newly discovered prognostic marker and it has been considered as a new target for therapy in AML. The study of Msi2 protein expression in AML cases has not been performed in Malaysia, to date. The main aim of the present study was to observe the expression of Msi2 protein in AML patients by immunohistochemistry (IHC) and to correlate its expression with the well-established prognostic and clinical parameters in AML as well as the overall survival (OS). Sixty four bone marrow trephine biopsy sections were immunostained for Msi2 protein. The percentage of blasts with positive reaction and the intensity of the cytoplasmic and nuclear staining were evaluated. The expression of Msi2 protein was found in 95.3% cases with Msi2 pattern varying between the cases. In 71.9% of cases, the blasts showed total cellular positivity and 23.4% cases showed only cytoplasmic positivity. Majority showed high expression of Msi2 for cytoplasmic staining. Interestingly, there was significant correlation between total cellular staining and the intermediate cytogenetic subgroup (P= 0.04). In conclusion, the results showed that the majority of the patients had high expression of Msi2 but this did not correlate to OS. However, the Msi2 expression correlated to the cytogenetic findings. The results suggest future extensive research to be conducted in order to ascertain the exact role of Msi2 positive blast cells in AML in our population and their association with prognosis and outcome

The paediatric iron deficiency assessment with reticulocyte haemoglobin equivalent (Ret-He) in comparison with biochemical markers of serum ferritin and transferrin saturation

Diagnosis of iron deficiency anaemia (IDA) is a challenge as the conventional methods often diagnose the disease at the later stage. Haemoglobin content of reticulocytes is useful to identify IDA at earlier stage. The objective of this study was to evaluate reticulocyte-haemoglobin equivalent (Ret-He) in diagnosing IDA in children and to compare it with other conventional methods. This prospective study was conducted on 120 paediatric patients aged 12 years and below, who attended Hospital Sultanah Aminah Johor Bahru, Malaysia with haemoglobin <12 g/dL. Ret-He and serum iron, ferritin and transferrin saturation were measured. Using a cut-off point of 20% for transferrin saturation, 81 out of 120 subjects (67.5%) were found as iron deficient. Based on the diagnosis of IDA, cut-off value for Ret-He using the Receiver Operating Characteristics (ROC) curve analysis was found as 22.65 pg. Ret-He showed a good sensitivity and specificity of 77.8% and 66.7%, respectively. As compared with Ret-He, serum ferritin showed a sensitivity of only 18.9%. However, a good specificity of 100% suggest it is useful for ruling in the disease but not suitable for screening. Transferrin saturation showed a good sensitivity and specificity, but it is biologically variable and not cost effective as a screening tool. Correlation study showed serum iron and transferrin saturation have significant positive correlation with Ret-He (r=0.415 to 0.518). However, there was no correlation between Ret-He and serum ferritin (r=0.051, p=0.578). This study shows that Ret-He at a cut-off point of 22.65 pg has a better sensitivity and potentially be useful as a screening tool in the paediatric population

Idiopathic hypereosinophilic syndrome with unusual presentation : two case reports and review of literature

Idiopathic hypereosinophilic syndrome (HES) is an uncommon disorder which usually presents with prolonged and significant primary eosinophilia with end-organ dysfunction. Damaging proteins released by the eosinophilic granules are responsible for the tissues and organ system damage. Here we report two cases of idiopathic HES. Both the patients were young lady presented with high grade fever and concomitant symptoms. Laboratory findings showed leucocytosis with predominant neutrophilia and marked eosinophilia. A diagnosis of idiopathic HES was made after excluding secondary causes of eosinophilia. However, the first patient was complicated with multiple venous thrombosis and intravenous heparin was started which was later changed to subcutaneous low molecular weight heparin (LMWH). The patient developed pleural effusion and consolidation. Intravenous Tazoscin, tablet Prednisolone and tablet Hydroxyurea was started and the patient responded well. Despite treatment, two weeks later, suddenly the patient collapsed and unfortunately succumbed. On the other hand, the second patient was complicated with fever, thrombocytopenia, haemolytic anaemia, acute renal failure and neurological deficit which were part and parcel of thrombotic thrombocytopenic purpura (TTP). Plasma exchange was commenced and patient’s condition had slowly improved. Nevertheless, the hypoxia which she sustained during the multiple episodes of fits had resulted in permanent brain injury and thus requiring a tracheostomy for prolonged ventilatory support. Currently, there is no cure for HES. The main aim of treatment is to minimise the tissue damage caused by the hypereosinophilia. Early diagnosis and intervention are therefore crucial in preventing the spread of the disease and the end-organ damage

Analysis of road accident fatality in malaysia: body part injury

Over the decade, the number of road crashes in Malaysia has kept increasing whilst the number of fatalities has not experienced any dramatic increase, hovering over 6,700 cases yearly. Speeding while driving, fatigue, and reckless driving are the causes of car accidents in Malaysia. The fatality rate of car accidents in this country is high as cars are a means of family transport. This becomes a challenge for this country to reduce the likelihood of road deaths and injuries due to reliance on these vehicles. Moreover, the causes of death in relation to bodily injuries are vaguely discussed. This hampers the vehicles safety programme initiatives meant to prevent accident fatalities. One of the established road safety programmes that highlights the above issue is ASEAN New Car Assessment Programme (NCAP) for verifying compliance with vehicle standards by implementing the NCAP star rating for Malaysian-produced cars. Accordingly, this study was commissioned to evaluate body regions that are the most vulnerable in frontal and/or side collisions. Results showed that head, neck, and chest are the most severely-affected body regions in frontal collisions. As for side collisions, chest is leading the overall results. In line with NCAP, all the above body regions are covered under Adult Occupant Protection (AOP) domain with three main assessments: Offset Frontal Test (OFT); Side Impact Test (SIT); and Head Protection Technology (HPT). Based on the findings, ASEAN NCAP star rating program could ensure manufacturing of safer cars, suitable to current need

Smart Teaching and Learning Strategies in Pre-writing Activities in Bahasa Melayu (Malay Language)

This is a qualitative case study of four smart schools’ teachers using purposive sampling. The study unveils the implementation of smart teaching and learning strategies in pre-writing activities in Bahasa Melayu (Malay Language). Pre-writing activities include reading, free writing, brainstorming, mind mapping, and listening. These activities revolve around student centered learning, thoughtful learning, group work, and also media in the implementation of teaching and learning. There is Integration of Learning Theories based on Brain Based Learning Theory in the prewriting activities. Qualitative data are derived from triangulation of data from non-participant observation, interviews, document analysis as well as vignette and concept maps. Validity is documented through six segments: triangulation from multisources, experts’ review, long-term observation, peer checking, investigator’s position, and collaborative ties with participants. Reliability is determined by the researcher, who uses triangulation and an audit trail. The key findings of the study are as follows: First, prewriting activities include brainstorming activities and mind mapping, reading and interpreting data from print and electronic media. The ability to convey information helps to develop critical thinking. Second, the efforts of smart teachers strengthen learning and teaching which inculcate analytical and critical skills to solve problems. Third, a cyclical model is created from the interviews and observations made during the prewriting activities. Efforts to make smart teaching and learning a success require teachers as well as students to think creatively. Fourth, smart characteristics are related to the integration of brain-based learning theory

Evaluation of Adult Occupant Protection on Body Region using Analytical Hierarchy Process: Side Impact Test

ASEAN NCAP is a well-known automobile safety rating program in evaluating new cars for performance against various safety threats on the road. For the Southeast Asian countries, Adult Occupant Protection (AOP), Child Occupant Protection (COP) and Safety Assist Technology (SAT) are domains used in the ASEAN NCAP assessment. In a recent rating protocol, the AOP domain contributes 50 percent of the overall rating system with a maximum 36 points from three main elements consisting of Offset Frontal Test (OFT), Side Impact Test (SIT) and Head Protection Technology (HPT). Frontal crashes resulted in a severe injury that comes from contact with frontal components and ejection; however, side crashes are also reported to have high rates of serious injury and fatality as compared to other crash types. However, in the ASEAN NCAP assessment programme, to what extent side impact test helps to reduce the severity of injury to the car driver and passenger when the collision happened need to be explored. Therefore, the injury of body region on the side impact due to AOP failure were evaluated and reported in this paper to strengthen this program where the recommendation for performing side impact test could be proposed to ensure successful performance. The elements on the side impact test were extracted and decomposed from the existing structure. Next, input from the expert panels of various related backgrounds regarding the injury of body region on side impact test was gathered and evaluated using the Analytical Hierarchy Process (AHP). The result shows that the head, neck, and chest have the highest rank, followed by an abdomen with a Consistency Ratio (CR) of 0.0079. The finding of this paper will help to evaluate the existing side impact test in the AOP assessment