Chronic myeloid leukemia (CML) complicated by mixed malaria infection - an unusual presentation

Objective: To report an unusual case of Chronic Myeloid Leukemia [CML] undergoing chemotherapy complicated by co- infection with Plasmodium vivax and Plasmodium falciparum

Case presentation: A 31 years Kashmiri male who was a known case of Philadelphia positive Chronic Myeloid Leukemia and on chemotherapy for last1 year, presented with high grade fever, left flank pain, vomiting and one episode of epistaxis. The oncologist suspected CML progressing to Accelerated phase or chemotherapeutic drug [Tasigna] associated adverse effects leading to thrombocytopenia. He was diagnosed with mixed malarial infection based on positive blood smear and bone marrow aspirate showing gametocytes of both Plasmodium Vivax and Plasmodium Falciparum. Patient was treated successfully with anti malarial drugs and showed marked improvement in platelet count

Conclusion: It is suggested that malaria should be considered as a complicating factor in the patients of hematological malignancies or those on chemotherapy in form of fever or thrombocytopenia, especially in malaria- endemic areas

Clinical features and hematological investigations pattern in Acute Promyelocytic Leukaemia patients

Acute Promyelocytic Leukemia [AML-M3] patients, though amenable to treatment, present with early and sometimes severe bleeding manifestations. In our setup, for various reasons, patients are diagnosed rather late and therefore these bleeding manifestations are a limiting factor in the early and effective treatment of leukemia in such cases. To look into the clinical, peripheral blood and bone marrow features of AML-M3 patients in our setup. A total of 40 consecutive cases of AML-M3 diagnosed on bone marrow biopsy over a period of 10 years were analyzed for clinico-morphological features. Majority of patients [75%] were <30 years of age. The male: female ratio was 3:2. The mean duration of symptoms was 4.2 weeks [Range 1-10 weeks]. Commonest clinical features were fever, pallor and bleeding manifestations. The spleen and liver were variably enlarged in 25% and 45.5% of cases, respectively. The hemoglobin levels ranged from 3.1 to 12.8 g/dl with a mean of 6.6 g/dl. The WBC count ranged from 0.5 to 142 x 10[9]/l with a mean of 28.3 x 10[9]/l. Platelet counts ranged from 5-150 x 10[9]/l with a mean of 28.8 x 10[9]/l. Morphologically 36 patients had hypergranular and 4 had hypogranular promyelocytic leukemia. The features identified in our study can help in early diagnosis of APL, which is known to be extremely important in effective management of patients

Red cell alloimmunization in repeatedly transfused thalassemia major patients

Thalassemia major patients managed by regular transfusion regimen may develop anti-red cell alloimmunization. If the alloantibodies are hemolyzing in nature, transfusion reaction may occur, and provision of blood thereafter requires matching of the relevant blood group in addition to "ABO" and Rh 'D' matching. We investigated 75 cases of multiply transfused thalassemia major patients for development of alloantibodies against red cells by indirect antiglobulin test, using 3-red cell panel, and when required 11-red cell panel. Anti-red cell alloantibodies were detected in 17 [22.7%] patients. Anti-Kp[a] antibodies were the commonest, followed by Anti-e, anti-E and anti-K antibodies, respectively. Anti-k, -C[W], -Fy[b], -Kp[b], -Rh 'D' and -c were detected in one patient each. It is concluded that in multiply transfused patients, alloantibodies develop in a significant number of patients. The hemolyzing nature of antibodies should be determined in patients who develop these antibodies, and transfusion should be arranged accordingly

Hepatitis C virus seropositivity in repeatedly transfused thalassemia major patients

Multiple transfusions in patients of thalassemia major who are conventionally treated by a regular transfusion regimen, are at a risk of developing Transfusion Transmitted Infections [TTIs], including HCV-hepatitis. Strict criteria of safe donor selection have to be adopted in order to minimize the risk of TTIs. The present study was conducted to evaluate the seropositivity of anti-HCV antibodies in multiply transfused thalassemia major patients. A total of 75 patients of thalassemia major who had received at least 10 transfusions were tested for anti-HCV antibodies, using third generation ELISA kits. Amongst these patients, 42% were seropositive for anti-HCV antibodies. This is a high prevalence rate and calls for a critical look into the prevailing transfusion practices and adoption of stricter donor selection criteria