Background and objective Acute myeloid leukemia (AML) is a heterogeneous and aggressive blood malignancy prevalent among both children and adults, accounting for a significant proportion of acute leukemia cases worldwide. Our study aimed to shed light on the demographic and clinical profile and risk stratification of newly diagnosed AML cases at a tertiary care government hospital in South India. Methods We conducted a cross-sectional study involving 221 patients with AML in the Department of Clinical Hematology, Rajiv Gandhi Government General Hospital and Madras Medical College, Chennai, Tamil Nadu from January 2020 to December 2022. All data were collected from the hospital database of patients\' medical records. A thorough analysis of clinical history, comorbidities, laboratories, risk stratification, and chemotherapy regimen was performed. The patients included in the study were newly diagnosed cases of AML over the age of 13 years, and we excluded all the relapsed cases. Results The highest proportion of patients were in the age group of 41-50 years (22.2%), and there was a significant male predominance (55.7%) in the cohort. Occupationwise, 31% of the study population were farmers, followed by housewives (16.3%). While no identifiable risk factors for AML were found in 191 cases (86.4%), 4.1% had undergone previous chemotherapy, and 3.6% had myelodysplastic syndrome (MDS). Hyperuricemia was noted in 50 cases (22.6%) while 8.6% had tumor lysis syndrome (TLS). About 53.8% of cases fell in the intermediate risk category of AML. Standard induction chemotherapy was administered in 87.3% of cases of AML. Conclusions Gaining awareness and knowledge about the regional demographic data and clinical presentation of AML will aid in the early detection, prompt referral, and initiation of treatment, thereby further improving patient outcomes in the era of targeted therapy and hematopoietic stem cell transplantation.

UNASSIGNED: Pseudothrombocytopenia is a commonly obtained false negative result when analyzing feline platelet (PLT) count by an automated machine. It is related to ethylenediamine tetra-acetic acid (EDTA), a widely utilized anticoagulant in blood collection tubes, resulting in EDTA-dependent pseudothrombocytopenia (EDTA-PTCP).
UNASSIGNED: To investigate whether treated with kanamycin enhanced the quantity of PLT aggregations in feline blood specimens collected using EDTA-PTCP.
UNASSIGNED: Thirty-one blood samples were obtained using EDTA tubes. The complete blood count was analyzed using an automated Mindray BC-5000Vet. Both Manual cell counts and thin blood smears were performed to estimate the amount of red blood cell, white blood cell, and PLTs as well as to evaluate the severity scores of PLT clumping, respectively. Comparisons were made between those pre-treated and those treated with kanamycin in the EDTA tube.
UNASSIGNED: There were significantly different mean PLT counts in the samples before and after they were treated with kanamycin, both on automated (156.6 ± 76.4 vs. 260.3 ± 115.5; p < 0.001) and manual (168.5 ± 92.1 vs. 262.8 ± 119.6; p < 0.001) readings, with a 95% confidence interval of 0.19 (0.022-0.365).
UNASSIGNED: This study suggests that in clinical laboratory practice, kanamycin should be added to feline blood specimens with EDTA-PTCP.

BACKGROUND: In recent years, extracorporeal membrane oxygenation (ECMO) has been increasingly used in critically ill patients with respiratory or cardiac failure. Heparin is usually used as anticoagulation therapy during ECMO support. However, heparin-induced thrombocytopenia (HIT) in ECMO-supported patients, which results in considerable morbidity and mortality, has not yet been well described. This meta-analysis and systematic review aimed to thoroughly report the incidence of HIT on ECMO, as well as the characteristics and outcomes of HIT patients.
METHODS: We searched the PubMed, Embase, Cochrane Library, and Scopus databases for studies investigating HIT in adult patients supported by ECMO. All studies conforming to the inclusion criteria were screened from 1975 to August 2023. Nineteen studies from a total of 1,625 abstracts were selected. The primary outcomes were the incidence of HIT and suspected HIT.
RESULTS: The pooled incidence of HIT in ECMO-supported patients was 4.2% (95% CI: 2.7-5.6; 18 studies). A total of 15.9% (95% CI: 9.0-22.8; 12 studies) of patients on ECMO were suspected of having HIT. Enzyme-linked immunosorbent assay (ELISA) is the most commonly used immunoassay. The median optical density (OD) of the ELISA in HIT-confirmed patients ranged from 1.08 to 2.10. In most studies, the serotonin release assay (SRA) was performed as a HIT-confirming test. According to the subgroup analysis, the pooled incidence of HIT in ECMO patients was 2.7% in studies whose diagnostic mode was functional assays, which is significantly lower than the incidence in studies in which the patients were diagnosed by immunoassay (14.5%). Argatroban was most commonly used as an alternative anticoagulation agent after the withdrawal of heparin. Among confirmed HIT patients, 45.5% (95% CI: 28.8-62.6) experienced thrombotic events, while 50.1% (95% CI: 24.9-75.4) experienced bleeding events. Overall, 46.6% (95% CI: 30.4-63.1) of patients on ECMO with HIT died.
CONCLUSIONS: According to our study, the pooled incidence of HIT in ECMO-supported patients is 4.2%, and it contributes to adverse outcomes. Inappropriate diagnostic methods can easily lead to misdiagnosis of HIT. Further research and development of diagnostic algorithms and laboratory assays are warranted.

An acute, unilateral othematoma was diagnosed in a 9-year-old mixed-breed dog. There was no clinical or anamnestic evidence for the cause of the othematoma. During diagnostic work-up, marked hyperglobulinemia and marked thrombocytopenia were detected. This was a consequence of a multiple myeloma. This is the first case report of a dog with othematoma secondary to coagulopathy associated with multiple myeloma.
Bei einer 9 Jahre alten Mischlingshündin wurde ein akutes, unilaterales Othämatom diagnostiziert. Es gab weder klinisch noch anamnestisch einen Hinweis auf eine Ursache des Othämatoms. Im Rahmen der diagnostischen Aufarbeitung wurden eine hochgradige Hyperglobulinämie und eine hochgradige Thrombozytopenie nachgewiesen. Ursächlich hierfür war ein multiples Myelom. Dies ist der erste Fallbericht über einen Hund mit Othämatom als Folge einer Koagulopathie bedingt durch ein multiples Myelom.

Dengue, an arboviral illness, is notorious for inducing thrombocytopenia, leading to bleeding and heightened mortality risk. Carica papaya leaf extract has shown efficacy in elevating platelet counts. A 35-year-old male presented with fever, fatigue, and body pain persisting for four days. Additionally, he complained of severe back pain, ocular discomfort, and brief episodes of nosebleeds. Testing revealed a positive NS1 antigen, prompting the initiation of intravenous normal saline, paracetamol, and papaya extract tablets. Despite initial platelet levels of 74,000, a subsequent decline to 30,650 was observed following another nosebleed. Subsequently, the patient\'s spouse administered freshly prepared papaya leaf extract orally three to four times daily, resulting in a platelet count of 120,320 on day 14. Timely recognition of declining platelet levels and the commencement of C. Papaya leaf extract contributed significantly to averting mortality risks.

OBJECTIVE: To describe the response and relapse of severe thrombocytopenia in patients with systemic lupus erythematosus (SLE) with different treatments.
METHODS: We performed a retrospective cohort study, which included SLE patients who were hospitalized for thrombocytopenia of less than 30,000/µL platelets, from January 2012 to December 2021. Demographic and clinical information was obtained from clinical records. Kaplan-Meier and logrank test were performed.
RESULTS: Forty-seven patients, mostly women (83%) with a median age of 31 years, were included in the study. Eight patients (17%) relapsed within a median period of 35.7 weeks. Initial acute treatment with prednisone at 1 mg/kg/day was as effective as glucocorticoid pulses. However, induction treatment with cyclophosphamide (CYC) had the lowest remission rate (43%, p = 0.034). There was no significant difference in relapse-free survival (RFS) among the acute glucocorticoid treatments. CYC induction was associated with lower RFS compared to rituximab (RTX) (CYC 43.6 weeks vs. RTX 51.8 weeks, p = 0.040) or azathioprine (AZA) (CYC 43.6 weeks vs. AZA 51.2 weeks, p = 0.024). Administration of antimalarials was associated with longer RFS (51.6 weeks vs. 45.0 weeks, p = 0.021). Factors such as antiphospholipid syndrome, IgG anti-β2 glycoprotein I positivity, renal and additional hematologic SLE activity during follow-up significantly reduced RFS.
CONCLUSIONS: Despite similar response of acute glucocorticoid regimens, induction therapy with AZA or RTX resulted in a longer RFS compared to CYC. Adding an antimalarial also improved RFS. Our study provides evidence that may help develop better treatment strategies for severe thrombocytopenia in SLE patients. Key Points • Induction therapy with azathioprine or rituximab provided longer relapse-free survival in SLE thrombocytopenia compared with cyclophosphamide. • Antimalarial administration was associated with longer relapse-free survival in SLE thrombocytopenia. • Antiphospholipid syndrome, IgG anti-β2 glycoprotein I positivity, as well as renal and additional hematologic SLE activity during follow-up, decreased relapse-free survival.

Background Chronic liver disease (CLD) is associated with a variety of consequences, including thrombocytopenia and esophageal varices, which significantly impact patient prognosis and management. Thrombocytopenia, frequently observed in patients with CLD, may correlate with the severity of esophageal varices, a critical complication leading to variceal bleeding. Methodology A cross-sectional study was carried out in the Department of Medicine and Gastroenterology, Pak Emirates Military Hospital, Rawalpindi, from October 2021 to March 2022. The study enrolled 94 patients, aged 18-70 years, diagnosed with CLD, regardless of the cause. These patients were categorized into four groups based on platelet count: <50,000/uL, 50,000-99,999/uL, 100,000-150,000/uL, and >150,000/uL. Pearson\'s correlation was utilized to evaluate the association between the severity of thrombocytopenia and the grading of esophageal varices. Results A total of 94 patients were enrolled in the study, with 53 (56.4%) males and 41 (43.6%) females. The mean age of patients was 51.06 ±11.09 years. Seventeen (18.1%) had no esophageal varices, 16 (17.0%) were diagnosed with Grade I varices, 35 (37.2%) with Grade II varices, and 26 (27.7%) had Grade III varices. Most patients without varices had a platelet count above 150 x 103 (17, 18.1%). Conversely, most patients with Grade III varices (19, 20.2%) had platelet counts below 50 x 103. Patients with no esophageal varices had a mean platelet count of 173.70 ± 37.48 x 103. Among the patients, those with Grade III esophageal varices exhibited the lowest mean platelet count, recorded at 78.54 ± 24.14 x 103. These findings indicate a statistically significant difference in mean platelet counts across the various esophageal varices grades (P = 0.000). There was an inverse correlation of platelet count with the grading of esophageal varices (r = -0.645, P < 0.000). Conclusions A negative correlation was observed between the platelet count and the grading of esophageal varices, implying that as the severity of esophageal varices increased, the platelet counts proportionally decreased.

Splenic sequestration crisis is a life-threatening complication of sickle cell disease (SCD), characterized by a sudden and huge accumulation of blood in the spleen, leading to rapid enlargement and may lead to organ failure. This case report discusses an unusual case of a splenic sequestration crisis in an adult with SCD. The patient\'s age, Parvovirus B19 infection, and concurrent retrocardiac pneumonia are all things that differentiate this case from our usual presentation. We will be discussing the clinical presentation, diagnostic methods, and management.

Vitamin B12 deficiency is a common condition that is often asymptomatic, though in severe cases may cause megaloblastic anemia and even neurologic symptoms. Occasionally, the clinical presentation can include pancytopenia and thus mimic a more concerning myelodysplastic syndrome (MDS) until corrected by B12 supplementation. In this unusual case, we present a patient with B12 deficiency who presents with severe macrocytic anemia, neutropenia, lymphocytosis, and a bone marrow morphology consistent with MDS.

BACKGROUND: Thrombocytopenia is common for patients in the intensive care unit (ICU) and is associated with adverse outcomes. ICU thrombocytopenia in pediatric patients who underwent cardiac surgeries with cardiopulmonary bypass (CPB) is inadequately studied.
OBJECTIVE: We aimed to investigate the incidence, risk factors, and prognostic role of ICU thrombocytopenia after congenital cardiac surgeries with CPB.
METHODS: A retrospective study involving 11761 patients was conducted. Patients were categorized into four groups of thrombocytopenia based on platelet counts tested during ICU: non (> 150×109/L), mild (100-150×109/L), moderate (50-100×109/L), and severe (< 50×109/L). Logistic and Cox regression analyses were utilized to explore the risk factors of thrombocytopenia and the association of ICU thrombocytopenia with 30-day mortality.
RESULTS: ICU thrombocytopenia was observed in 4007 patients (34.1%), with mild, moderate, and severe thrombocytopenia occurring in 2773 (23.6%), 987 (8.4%), and 247 (2.1%) patients, respectively. Younger age, cyanotic CHD, CPB duration, and preoperative laboratory findings (red blood cell, thrombocytopenia, red cell distribution width, hematocrit, coagulation disorder) were identified as independent risk factors of ICU thrombocytopenia. Patients with moderate [HR: 11.38 (3.02-42.87), p<0.001] and severe thrombocytopenia [HR: 49.54 (13.11-187.14), p<0.001] had a significantly higher risk of 30-day mortality. Furthermore, with the increase in the severity of ICU thrombocytopenia, there was an incremental increase in the incidence of postoperative critical bleeding and thrombosis, perioperative blood transfusions, length of ICU stays, and duration of mechanical ventilation.
CONCLUSIONS: ICU thrombocytopenia occurred in one-third of children after congenital cardiac surgery with CPB, and it was associated with multiple adverse outcomes.