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Objective: To assess the spectrum and clinico-haematological profile of chronic lymphoproliferative disorders in patients presenting with lymphocytosis. Method: The cross-sectional, retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data related to cases of bone marrow aspirate and trephine from January to November 2020. Patients for whom the bone marrow was done for lymphocytosis were studied for the presence of lymphoproliferative disorders, sub-types and patients’ characteristics. The diagnosis and classification were based on the World Health Organisation criteria for tumours of haematopoietic and lymphoid tissues. Data was analysed using SPSS 21. Results: Of the 3,334 bone marrow specimens tested, 103(3%) were related to lymphocytosis. Of these, 84(82%) were diagnosed with lymphoproliferative disorders, while diagnosis remained undetermined in 19(18%) cases. Male:female ratio was 3.6:1 and median age was 60 years (range: 21-85 years). Constitutional symptoms were found in 61(73%) patients. Median absolute lymphocyte count was 45x109/L (range: 5.3-480). All 84(100%) patients were classified as B-cell lymphoproliferative disorder. Chronic lymphocytic leukaemia was the most common form, 61(73%), and 31(51%) of them presented with advanced stage disease. Conclusion: A huge majority of patients presenting with lymphocytosis had underlying lymphoproliferative disorders of which B-cell chronic lymphocytic leukaemia was found to be the most common. Key Words: Lymphoproliferative disorder, Lymphocytosis, Chronic lymphocytic leukaemia, Bone marrow, Pakistan.

Dengue virus belongs to flavivirus family which gains entry into the host organism through skin following an infected mosquito bite. Humoral, cellular, and innate host immune responses are involved in the progression of the disease. Dengue fever is getting common in Pakistan, and at times shows high mortality, but there is limited literature available. Therefore, this study was designed to evaluate hematological parameters in patients with dengue fever. This was a retrospective cross-sectional study conducted in the Department of Microbiology, Dow Diagnostic Reference and Research Laboratory, Karachi, Pakistan from 1 January 2021 till December 2021. A total of 6140 were collected, out of which 1746 were found positive. Dengue infection was confirmed by rapid screening NS1 antigen by ICT method. IgM antibodies were detected by Enzyme linked immunosorbent assay (ELISA). Hematological analysis was performed on Sysmex analyzer. Among the 1746 positive samples, 1036 (60%) were males and 710 (40%) were females. More than 10 hemoglobin and 45 hematocrits were found in greater than 40% of cases. Leucopenia less than 4000 was observed mostly in age group 0-20 years. Eosinophilia, basophilia, lymphocytosis and atypical lymphocytosis were shown equally in all age groups. Our study found greater incidence of Dengue fever among 21-40 years of age group with male predominance. Hematological spectrum revealed thrombocytopenia, lymphocytosis, high hematocrit, eosinophilia, basophilia and monocytosis at the time of diagnosis.

Background:Diagnosis of fever of unidentified cause remains challenging despite the availability of modern diagnostic techniques. Pyrexia of Unknown Origin (PUO)may result from various etiologies, among which infectious diseases are largely responsible. Many diagnostic approaches are currently applied. A detailed history with a complete general physical examination followed by baseline investigations with other specific tests like imaging, microbiological tests, and biopsies is employed to diagnose PUO. This study was designed for the evaluation and effectiveness of bone marrow biopsy in the identification of PUO and highlighted the existing spectrum of diseases involved in PUO.Methodology:This Cross-sectional study was conductedatDow University of Health Sciences, Karachi from 2015 to 2018 evaluated the records of patients who had bone marrow aspiration and biopsy Patients included in this study had a history of fever due to an Unfamiliar cause and met the Peters Dorf and Beeson criteria for PUO, i.e. fever for more than 3 weeks before diagnosis. Informed consent was taken from all patients. Results:We analyzed the medical histories of 67 patients (48 males and 19 females) who were recommended bone marrow biopsy and aspiration for the assessment of PUO. The mean age was 38 years. The most common clinical symptoms found in patients of PUO were fever, hepato-splenomegalyfollowed by abdominal pain and weight loss. Anemia was the most common hematological parameter found in this study. The most frequent diagnosis in biopsies of PUO patients was Non-Hodgkins Lymphoma in about 25% of patients.Conclusion:Certain laboratory and clinical parameters can detect major hematological diseases like malignancies when bone marrow biopsy is used for the workup of pyrexia of unknown origin. Bone marrow biopsy should be regarded as a constitutive part of the workup and diagnosis of pyrexia of unknown origin in conjunction with clinical findings.

Background: Transfusion-related acute lung injury (TRALI) is a rare but potentially fatal complication of blood product transfusion. It is felt worldwide that TRALI is an underrecognized and underreported entity because of lack of awareness. Aim: The purpose of this study was to report all cases of TRALI diagnosed in a tertiary care hospital over a 5-year period. Materials and Methods: This is a retrospective review of all TRALI cases reported from January 2011 to December 2015. All TRALI cases were identified from a manual review of reported transfusion reaction forms. For detailed information of all TRALI cases, medical record charts of patients were reviewed. The record of donors implicated in TRALI cases was derived from blood bank system. Statistical Analysis Used: The rate of TRALI cases per 1000 blood products transfused was computed by dividing the transfusion reactions by total number of all blood units transfused. Results: Total number of transfusions during the study was 291,041. Six cases of TRALI were reported during this period. Rate of TRALI per 1000 units transfused was 0.02%. The mortality associated with TRALI was 33.3%. TRALI occurred following the transfusion of fresh-frozen plasma in one patient, packed red blood cells in two patients, and a mixture of blood components in three patients. In all cases, the donors were male. Conclusion: The rate of TRALI reported to our blood bank was found to be 0.02%, which is very low as compared to international data. This is the first comprehensive study on TRALI from the country and a step forward to create awareness about the importance of diagnosing and reporting TRALI.

Iron overload-associated organ damage in transfusion-dependent anemias is a well-known phenomenon. Here, we discuss a case of 28-year-old, poorly chelated thalassemia major patient, whose blood workup revealed pancytopenia and moderately raised serum ferritin levels. His bone marrow examination was performed which revealed massive iron overload. Aggressive iron chelation led to successful recovery of peripheral blood counts in his patient. This case focuses on the importance of early detection and timely management of reversible iron overload toxicities. Serum ferritin although is convenient marker to asses iron overload, but it should not be relied upon to assess the severity of iron overload. Hence, organ-specific diagnostic modalities must be used along with serum ferritin to assess the severity of iron overload to prevent long-term complications in patients with regular blood transfusions.

Abstract Objective:To ascertain the frequency of markers of transfusion-transmitted infections. among blood donors in a blood bank at a tertiary care hospital Material and Methods:The study was a retrospective cross-sectional descriptive study, covering from 1stJanuary 2013- October 2018 and was conducted in the blood bank section, in the Department of Pathology at Dow University of HealthSciences, Hospital. All blood donors were screened for hepatitis B, hepatitis C, HIV (I & II), syphilis through electrochemiluminescence and malaria (immunochromatography).Data was entered and subsequently analyzed by statistical package for social sciences (SPSS) version 21. The frequency of infectious disease markers (HbsAg, Anti HCV, HIV, syphilis, and malaria) was calculated among blood donors. Results:The total number of donors in our study was 29732, out of which 2587 donors were positive for an infectious disease.Out of the total donors, 29712 were male and 20 were female. There were 12 volunteer donors and 29720 exchange donors. The mean prevalence of donors with positive infectious markers was as follows; Anti HCV was 3 %, HbsAg was 2.9%, Syphilis was 2.0%, HIV was 0.5% and Malaria was 0.02 %. Conclusion:HbsAg and Anti HCV were the most frequent infections (3%) found in our blood donors, followed by syphilis with a frequency of 2%. Keywords: Blood transfusion, transfusion-transmitted infections, blood donors.

Introduction: Superwarfarins are highly lethal rodenticides which are much more potent than the warfarin owing to various structural changes in the parent compound that confers high half-life and increase affinity to vitamin K epoxide. Case Presentation: We report a case of a 19 years old female who presented bleeding prolonged PT and APTT. Factor assay showed significantly lower levels vitamin K dependent coagulation factors. She was given conventional doses of FFP and vitamin K for two consecutive days, although she responded clinically but her coagulation profile failed to show any improvement. Hence superwarfarin poisoning was considered. Based on this assumption patient was cross questioned repeatedly, and subsequently she admitted that she had ingested rodenticide with the suicidal intent. Hence she was given higher doses of vitamin K and FFP for several days after which her PT and APTT shortened significantly. Discussion: Superwarfarin toxicity clinically presents with bleeding and deranged coagulation profile. Differentiating it from other causes is challenging but very crucial, as it does not responds to usual doses of vitamin K and plasma. Conclusion: This case highlights the importance of maintaining high index of suspicion of superwarfarin toxicity in coagulopathy of unknown etiology that fails to respond to conventional doses of treatment. Detailed history with interrogation of leading questions in such cases is of integral importance.