Tuberculous granuloma on bone marrow trephine

Bone marrow examination is a useful tool for diagnosis of many diseases. The utility of bone marrow examination in workup of pyrexia of unknown origin cannot be undermined. Bone trephine of patients presenting with pyrexia of unknown origin must be carefully looked upon for granulomas for evaluation of tuberculosis. In this case, bone marrow trephine aided in timely diagnosis of tuberculosis in a patient

Cold agglutinins in peripheral blood with atypical cells with an owl-eye appearance in bone trephine

Autoimmune hemolytic anemia (AIHA) is a form of hemolytic anemia in which red cells lysis occurs due to presence of an autoantibody. Association of AIHA is well known with lymphoproliferative disorders, especially with non-Hodgkin\u27s lymphoma. However, AIHA in association with Hodgkin\u27s lymphoma is seen occasionally. Of the AIHA associated with Hodgkin\u27s lymphoma, most are of warm type or mixed type. Cold AIHA, as seen in our case, is very rare in Hodgkin\u27s lymphoma

Rhesus and kell phenotyping of voluntary blood donors: foundation of a donor data bank

OBJECTIVE: To assess the Rhesus (Rh) and Kell (K) phenotype of voluntary blood donors and lay foundation of a data bank of voluntary blood donors. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Blood Bank, The Aga Khan University Hospital, Karachi, in the year 2014. METHODOLOGY: Voluntary blood donors were inducted after taking written informed consent. Three -5cc of EDTA anticoagulated blood sample was taken to phenotype red cells for C, c, E, e, and Kell antigens using antisera. [DiaMedSwitzerland]. RESULTS: Hundred blood donors were included in the study. ABO blood groups of the donors were: O [37%], B [31%], A [21%] and AB [11%]. Ninety-seven percent were Rh D positive while 3% were Rh D negative; \u27e\u27 antigen had the highest frequency [99%], while \u27E\u27 antigen was the least frequent [19%]. The most common probable Rh phenotype was R1R1 ((DCe/DCe) in 44 [44%]. In the Kell system, all the donors [100%] had phenotype of K-k+. CONCLUSION: The most common blood group was O +ve. The pattern of Rhesus antigen expression and phenotype found in this study was concordant to that reported previously from Asia. However, there was a much lower frequency of K antigen

Transfusion-related acute lung injury in a paediatric intensive care unit of Pakistan

Background: Transfusion-Related Acute Lung Injury (TRALI) is a major cause of transfusionrelated morbidity and mortality in the intensive care unit setting. There is a paucity of such data from Pakistan. The purpose of this study is to assess the incidence and outcome of TRALI in critically ill children admitted in a pediatric intensive care unit (PICU) of Pakistan.Methods: This is a retrospective cohort study of all critically ill or injured children who developed TRALI or possible TRALI after blood transfusion based on Canadian Conference Consensus criteria in a closed multidisciplinary-cardiothoracic PICU from January 2012 to June 2016. The demographic, pertinent clinical data, transfusion-related variables and outcome of all cases of TRALI were recorded.Results: Of total 2975 admissions in the PICU during study period, 35.8% (1066) received 5124 blood components. Eleven cases developed TRALI in our cohort. The incidence of TRALI was 1.03% per patient transfused and 0.19% (19/100,000 per blood product transfused). Median age was 8 (range 1-14) yr., 70 % (n=8) were male. Mean PRISM-III score was 16.3±6.7. Mean time interval for onset of TRALI was 2.73±1.67 hr. The postoperative cardiac surgical and hematology-oncology patients were most common categories (63.6%). Plasma and platelets were the most commomly identified trigger of TRALI. The case-specific mortality was 63.6% and the overall mortality was 10.7% (p\u3c0.0001).Conclusions: The incidence of TRALI in critically ill children is low, but is associated with high mortality. Critically ill children with high PRISM-III score, postoperative cardiac surgical and hematology-oncology patients are often affected by TRALI

Distribution of chromosomal abnormalities commonly observed in adult acute myeloid leukemia in Pakistan as predictors of prognosis

Objective: The heterogenous response to treatment in acute myeloid leukemia (AML) can be attributed largely to the difference in cytogenetic features identified in between cases. Cytogenetic analysis in acute leukemia is now routinely used to assist patient management, particularly in terms of diagnosis, disease monitoring, prognosis and risk stratification. Knowing about cytogenetic profile at the time of diagnosis is important in order to take critical decisions in management of these patients. The study was conducted to determine the distribution of cytogenetic abnormalities in Pakistani adult patients with AML in order to have insights regarding behavior of the. method: A retrospective analysis of all the cases of AML (≥15years old) diagnosed at Aga Khan University from January 2011 to December 2016 was performed. Cytogenetic analysis was made for all cases using the trypsin-Giemsa banding technique. Karyotypes were interpreted using the International System for Human Cytogenetic Nomenclature (ISCN) criteria. Result: A total of 321 patients were diagnosed with AML during the study period, of which 288 samples successfully yielded metaphase chromosomes. The male to female ratio was 1.7:1. A normal karyotype was present in 61% (n=176) of the cases whereas, 39% (n=112) had an abnormal karyotype. Of the abnormal cases, t (8;21) (q22;q22) and t (15;17) (q22;q12) were identified in 8.3% and 4.9% cases respectively. Adverse prognostic cytogenetic subgroups including complex karyotype, monosomy 7 and t(6;9)(p23;q34) were identified in 9%, 1% and 0.7% patients respectively. Conclusion: This largest cytogenetic data in adult AML from Pakistan showed comparable prevalence of favorable prognostic karyotype to international data. The prevalence of specific adverse prognostic karyotype was low

Panobinostat in combination with bortezomib and dexamethasone in multiply relapsed and refractory myeloma; UK routine care cohort

© 2023 The Authors. Published by PLoS. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: https://doi.org/10.1371/journal.pone.0270854The combination of panobinostat, bortezomib and dexamethasone (PanBorDex) is available as a treatment option for relapsed refractory multiple myeloma (RRMM) based on the PANORAMA-1 trial which investigated this triplet in early relapse. In routine clinical care, PanBorDex is used primarily in later relapses and is commonly administered in attenuated dosing schedules to mitigate the treatment-related toxicity. We set out to evaluate efficacy and safety outcomes with PanBorDex later in the disease course and evaluate the role of attenuated dosing schedules. This was a retrospective evaluation of patients treated in routine clinical practice between 2016–2019 across seven heamatology centres in the UK; patients who received at least one dose of PanBorDex were eligible for inclusion. The dosing schedule of panobinostat (10mg, 15mg or 20mg, twice or three times a week) and bortezomib (0.7mg/m2, 1mg/m2 or 1.3mg/m2 once or twice weekly) was as per treating physician choice. Patients received treatment until disease progression or unacceptable toxicity. The primary outcome is response rates according to IMWG criteria. Key secondary endpoints include progression-free survival (PFS) and overall survival (OS). Other secondary endpoints include rates of adverse events according to CTCAE criteria. In total, 61 patients were eligible for inclusion and received PanBorDex primarily as ≥5th line of treatment. One third of patients received PanBorDex at full dose, for the remaining two thirds, treatment was given in reduced dose intensities. The overall response rate was 44.2%, including 14.7% very good partial response (VGPR) rates; 68.8% of patients derived clinical benefit with stable disease or better. The median PFS was 3.4 months; non-refractory patients and those who achieved VGPR benefited from prolonged PFS of 11.4 months and 17.7 months, respectively. The median OS was 9.5 months. The triplet was associated with 45% and 18% incidence of grade 3–4 thrombocytopenia and diarrhea, respectively.Published versio

COVID-19 in haematology patients: A multi-centre West Midlands clinical outcomes analysis on behalf of West Midlands Research Consortium

This is an accepted manuscript of an article published by Wiley in British Journal of Haematology, available online on 05/11/2020 at: https://doi.org/10.1111/bjh.17136 The accepted version of the publication may differ from the final published version

COVID-19 in hematology patients: real world experience in hospitals in the UK West Midlands

© 2021 The Authors. Published by Hilaris. This is an open access article available under a Creative Commons licence. The published version can be accessed at the following link on the publisher’s website: [DOI/weblink]Objectives: This study aimed to understand the consequences of coronavirus disease 2019 (COVID-19) in patients diagnosed with haematological conditions, malignant and non-malignant. Method: A detailed insight into the first 112 patients with comorbidity of haematological conditions and COVID-19, admitted into nine National Health Services Trusts in the West Midlands Area of the United Kingdom, between 1st of March 2020 and 31st May 2020. Results: In the study cohort, 82% of patients had a malignant haematological disorder whilst 18% had a non-malignant haematological condition. Increasing age, breathlessness, reduction in oxygen saturation under 90% and abnormal chest x-ray were independently associated with higher mortality. Other long term co-morbidities did not present adverse impacts in this population. Survival analysis demonstrated that the COVID-19 severity score had a significant adverse correlation on patient outcome. COVID-19 patients who were classified as low risk, based on their primary haematological condition, showed significantly shorter survival time than those in the high risk category, which might be due to the shielding strategy for high infection risk patients. Conclusion: The 55% overall mortality in this cohort suggests that patients with haematological conditions had a higher mortality rate than patients with other acute, chronic or long term conditions. Significance: Previous studies have suggested poor outcomes for COVID‐19 infection in patients with haematological cancers, with short‐term mortality rates ranging from 32% to 62%. We report here the outcome of COVID-19 infection in patients with haematological conditions with both malignant and non-malignant, admitted to secondary care in acute care hospitals of the UK West Midlands. This study also examined the impact of chemo immunotherapy on outcomes from COVID-19 infection. This will be useful information to guide decision making during this second UK national lockdow