Asian Hematology Research Journal

Haematologic and Haemostatic Profiles of Human Immunodeficiency Virus-positive Subjects on Two Anti-retroviral Regimens in Port Harcourt, Nigeria

Florence Nneka Worlu, Stella Urekweru Ken-Ezihuo, Evelyn Mgbeoma Eze — Sat, 21 Jun 2025 00:00:00 +0000

Introduction: Haematologic and haemostatic abnormalities are common complications of human immunodeficiency virus (HIV) infection. These abnormalities intensify in the course of the disease. In both antiretroviral-treated and naïve individuals, varied types of haematologic and haemostatic abnormalities are common. The human immunodeficiency virus (HIV) is the leading infectious cause of adult death in the world. As HIV disease progresses without treatment, the prevalence and severity of its adverse effects also increase. Antiretroviral treatment (ART) decreases the mortality of HIV positive subjects but increases coagulation disorders.

Aim of the Study: This study is aimed at assessing the Haematologic and Haemostatic Profiles of Human Immunodeficiency Virus- Positive Subjects on Two Anti-Retroviral Regimens in Port Harcourt, Nigeria.

Materials and Methods: A total of one hundred and fifty (150) subjects aged (20-79) were recruited for the study from the Rivers State University Teaching Hospital (RSUTH) and University of Port Harcourt Teaching Hospital (UPTH) out of the which, fifty (50) were those on Abacavir Lamivudine Dolutegravir (Abc/3Tc Dtg) (First-line regimen), fifty (50) on Tenoforvir Lamivudine Dolutegravir(TLD) (Second-line regimen), while the remaining fifty (50) were the Naïve subjects used as control. The 5-part Sysmex XP-300 Automated Haematology Analyser was used to analyse the haematologic parameters. The determination of the D-dimer levels was done using the enzyme-linked immunosorbent assay (ELISA) technique. The generated data was expressed as Mean ± Standard deviation, and analysed using Microsoft Office Excel 2007 and Graph Prism Pad version 6.2. Comparisons of mean and standard deviation values were made for the various parameters for HIV-positive patients on First-line antiretroviral therapy, Second-line therapy and Naïve subjects using the Student’s independent t-test. Comparisons between more than two groups were made using the analysis of variance (ANOVA). Results were considered statistically significant at a 95% confidence interval (p<0.05).

Results: From this study, the WBC value for naïve subjects (5.3 ± 1.0 × 10 9/l) and patients on the First-line drug (5.3 ± 1.5 × 10 9/l) was significantly decreased when compared with (6.0 ± 1.7 × 10 9/l) in subjects on the Second- line (p₌0.0256). The lymphocyte value for naïve subjects (2.1 ± 0.68 × 10 9/l) was found to be significantly decreased when compared with 2.2 ± 0.93 × 10 9/l and 2.7 ± 1.3 × 10 9/l in subjects on the First-line and Second-line, respectively (p= 0.00068). The haemoglobin (HB) values for naïve subjects (10 ± 2.2 g/dl) were found to be significantly decreased when compared with 13 ± 1.5 g/dl in subjects on the First-line drugs and for subjects on the second-line drugs (p= 0.0001). The Neutrophil to lymphocyte ratio (NLR) value for naïve subjects (1.7 ± 1.2) was found to be significantly increased when compared with 1.2 ± 0.68 and 1.1 ± 0.99 for First and Second line, respectively (p= 0.0070). Prothrombin time for naïve subjects (12 ± 2.8 sec) and subjects on the second-line drug (12 ± 2.4 sec) was found to be significantly decreased when compared with 14 ± 3.3 sec in subjects on the First-line drug (p=0.004). The APTT for naïve subjects (28 ± 5.3sec) was significantly decreased when compared with the First-line drug (33 ± 13 sec) and second-line drug (30 ± 7.3 sec) (p= 0.0091). The D-dimer levels for naïve subjects (537 ± 84 mg/dl) were significantly increased when compared to 160± 30 mg/dl for first-line and 308± 98 mg/dl for Second-line drugs (p < 0.0001)

Conclusion: There was a significant decrease in most parameters of the Naïve subjects, due to their immunocompromised state. And also significant differences were noted in the haemostatic parameters between the first-line and second-line when compared to the Naive subject. Inflammatory markers, such as the neutrophil-to-lymphocyte ratio (NLR) and monocyte percentages, demonstrated the influence of ART in reducing systemic inflammation, with first-line treatment leading to improved immune balance. The persistence of elevated inflammatory markers in some second-line patients, however, emphasises the need for continuous monitoring and tailored treatment strategies.

Pregnancy-related Autoimmune Hemolytic Anemia in a Sickle Cell and Beta-thalassemia Trait Patient: A Rare Case Report

Niranjhana Sree, Aakriti Puri, Babita Raghuwanshi, Devesh Dubey — Fri, 13 Jun 2025 00:00:00 +0000

The presence of autoimmune hemolytic anemia (AIHA) further complicates the clinical landscape. The coexistence of sickle cell anemia and AIHA during pregnancy poses significant risks, including severe anemia, increased likelihood of crises, and heightened maternal and fetal morbidity. We report a case of 29-year-old pregnant patient with sickle cell anemia (sca) and β-thalassemia trait, complicated by autoimmune hemolytic anemia (aiha). She presented with severe anemia and jaundice at 36 weeks, requiring transfusions, plasma exchange, and hemodialysis due to inadequate response to transfusions. The interplay of oxidative stress, immune dysregulation, and pregnancy-related changes exacerbated aiha. This case highlights the challenges of managing AIHA in SCA during pregnancy and the need for coordinated care to optimize maternal and fetal outcomes. Ongoing research is vital to improve management strategies and outcomes, enabling better care for affected patients and their infants. Through coordinated multidisciplinary efforts, healthcare providers can enhance the health and well-being of mothers and their children.

Adapting to Newer Hemostatic Agent Emicizumab for Major Surgery in Hemophilia A: An Experience in Neurosurgery for an Infant

Malavika Prakash P, Nimsha Rajesh, Narmadha MP, Suhas Udayakumaran, Rema G — Thu, 19 Jun 2025 00:00:00 +0000

Background: Perioperative hemostasis for major surgery in Hemophilia A has been cumbersome with clotting factor concentrate (CFC) administration based on half-life and factor activity to minimize fluctuation. Availability of newer agents like FVIII mimetic Emicizumab with steady state levels in blood and long half-life as an adjunct has helped to reduce fluctuations of hemostasis.

Case report: A 11-month-old male with Moderate Hemophilia A, a previously untreated patient with sagittal craniosynostosis was started on Emicizumab prophylaxis. Elective anterior 2/3^rd calvarial remodeling surgery was undertaken while continuing Emicizumab prophylaxis with additional FVIII clotting factor concentrate.Chromogenic assays were used to confirm factor activity levels for hemostasis. The patient underwent surgery without perioperative bleeding complications, with FVIII support continued for eight days postoperatively. Emicizumab prophylaxis was continued subsequently, with ongoing monitoring to ensure optimal surgical wound healing.

Conclusion: This case highlights the complexity of managing moderate hemophilia A in a pediatric patient requiring major surgery while using Emicizumab, which, along with FVIII CFC, ensured adequate hemostasis and reduced hospitalization by allowing Factor VIII infusion to stop after Day 8. Limited data exist on Emicizumab use in congenital hemophilia A patient undergoing neurosurgery, emphasizing the importance of careful preoperative planning, including arranging factor products and laboratory reagents. Unlike traditional prophylaxis with CFCs, which requires frequent monitoring and venous access, Emicizumab offers advantages of subcutaneous administration, reduced hospital visits, and effective hemostasis with a lower risk of spontaneous or recurrent bleeding.

High-dose Methotrexate (HDMTX)-Induced Generalised Tonic-clonic Seizures in a Relapsed B-ALL Patient: Challenges in Management and Continuation of HDMTX

Wed, 25 Jun 2025 00:00:00 +0000

Background: Acute Lymphoblastic Leukaemia (ALL) is the most common childhood cancer. Methotrexate (MTX) is an important drug used in the treatment of ALL patients to eliminate clinically evident CNS disease at diagnosis as well as to prevent CNS relapse for both CNS-involved and non-involved groups at diagnosis. MTX is also responsible for neurotoxicity in some cases. Management of MTX-induced neurotoxicity and further continuation of MTX in such cases is a very challenging issue for physicians.

Aim: Here, a case was described that developed MTX-induced neurotoxicity, the use of levetiracetam, and the successful continuation of all the remaining HDMTX and ITMTX without any further neurotoxic events.

Case: A six-year-old boy was diagnosed with B-ALL, treated with the MRC-11 protocol, and faced an event of generalised tonic-clonic seizures while receiving high-dose methotrexate (HDMTX), then rescued with intravenous diazepam. Following this, the MRC-11 protocol continued to use intrathecal (IT) and oral methotrexate (MTX), but HDMTX was taken out of the other treatments. After completing MRC-11 maintenance five years later at the age of fourteen, the patient experienced a relapse of B-ALL, with no involvement in the CNS or both testicles. We treated this relapsed case using the BFM 2002 protocol. Once again, the patient experienced generalised tonic-clonic seizures while receiving folic acid rescue following the completion of Day+8 HDMTX and IT MTX in the consolidation phase. The seizures subsided immediately, within three minutes of their onset, with the assistance of intravenous diazepam. Clinically, there was no focal sign of any neurological deficit and no abnormal enhancement in the brain's MRI. We kept the patient on regular oral levetiracetam. No further seizures were observed. The patient then received the remaining days (Day+22, Day+36, and Day+50) of HDMTX and ITMTX, as well as the intensification and maintenance phases, according to protocol, without any seizures. Anti-convulsant oral levetiracetam was continued for three (3) months more after the completion of the maintenance phase (total of two years and three months since starting); within this period, no seizure was reported, and then oral levetiracetam was discontinued.

Conclusion: MTX-related clinical neurotoxicity is transient, and most patients can receive subsequent MTX without recurrence of acute or subacute symptoms. In addition to this, levetiracetam can be an alternative drug for the long-term management and prevention of HDMTX-related neurotoxicity.