SARS-2 COVID-19-induced immunity response, a new prognostic marker for the pregnant population correlates inversely with neonatal Apgar score.

BACKGROUND: The COVID-19 infection has impacted pregnancy outcomes; however, few studies have assessed the association between haematological parameters and virus-related pregnancy and neonatal outcomes. We hypothesised differences in routine haematology indices in pregnant and non-pregnant COVID-19 patients as well as COVID-19-negative pregnant subjects and observed neonatal outcomes in all pregnant populations. Further, we tested if pattern identification in the COVID-19 pregnant population would facilitate prediction of neonates with a poor Apgar score. METHODS: We tested our hypothesis in 327 patients (111 COVID-19-positive pregnant females, 169 COVID-19-negative pregnant females and 47 COVID-19-positive non-pregnant females) in whom standard routine laboratory indices were collected on admission. RESULTS: Pregnant COVID-19-positive patients exhibited higher WBC, neutrophil, monocyte counts as well as neutrophil/lymphocyte and neutrophil/eosinophil ratio compared to non-pregnant COVID-19-positive patients (p = 0.00001, p = 0.0023, p = 0.00002, p = 0.0402, p = 0.0161, p = 0.0352, respectively). Preterm delivery was more prevalent in COVID-19-positive pregnant patients accompanied with a significantly lower birth weight (2894.37 (± 67.50) g compared with 3194.16 (± 50.61) g, p = 0.02) in COVID-19-negative pregnant patients. The COVID-19-Induced Immunity Response (CIIR) was defined as (WBC × neutrophil) / eosinophil; Apgar scores were significantly and inversely correlated with the CIIR index (r =-0.162). INTERPRETATION: Pregnancy appears to give rise to an increased immune response to COVID-19 which appears to protect the mother, however may give rise to complications during labour as well as neonatal concerns. CIIR is a simple metric that predicts neonatal distress to aid clinicians in determining the prognosis of COVID-19 and help provide early intensive intervention to reduce complications.

ZAP-70 is highly expressed in most cases of childhood pre-B cell acute lymphoblastic leukemia.

The tyrosine kinase ZAP-70 plays a critical role in signal transduction in T cells and NK cells but has limited expression in primary human B cells. ZAP-70 is, however, expressed in adult B cell chronic lymphocytic leukemia where it correlates with a poor prognosis. We wished to determine if ZAP-70 is also expressed in pediatric B cell malignancy. A quantitative PCR assay for ZAP-70 expression was established and ZAP-70 expression in a range of human B cell lines was compared with expression in the Jurkat T cell line. ZAP-70 expression was then determined in bone marrow lymphoblasts obtained from 12 patients with pre-B cell acute lymphoblastic leukemia (ALL). ZAP-70 expression was not detected in mature B cell lines but was detected in pre-B cell lines at a level comparable to that seen in T cells. ZAP-70 expression was strongly expressed in nine of the 12 cases of primary pre-B cell lymphoblastic leukemia. The T cell-associated protein kinase ZAP-70 is highly expressed in pre-B lineage cells and most cases of pre-B acute lymphoblastic leukemia. ZAP-70 expression may hold prognostic value for pre-B ALL and raises the prospect of a novel therapeutic target.

Aspergillus brain abscess in a patient with acute myeloid leukaemia successfully treated with voriconazole.

Cerebral aspergillosis is associated with very high mortality in immunocompromised hosts. Conventional antifungal agents like amphotericin-B and itraconazole are almost ineffective in cerebral aspergillosis. Newer azoles have been shown to penetrate the blood, cerebrospinal fluid barrier and achieve effective fungicidal concentrations. These newer azoles may change the outlook of this fatal condition. We report here a patient with cerebral aspergillosis who was successfully treated with voriconazole.

Plasma cell leukaemia presenting with polyarthralgia and phalangeal lytic lesions.

We present the case of a patient who presented with small joint polyarthralgia and mild lymphocytosis. The patient was subsequently diagnosed to have plasma cell leukaemia. Skeletal survey showed bony lytic lesions in the hands and feet with no skeletal lesions elsewhere. The most common sites of bony involvement in plasma cell dyscrasia are skull, vertebrae, ribs and long bones. Although it is quite unusual for plasma cell leukaemia or myeloma to involve solely small joints of hands and feet, we suggest plasma cell dyscrasia should be kept in the differential diagnostic list for polyarthralgia in adults if usual causes are ruled out.

Acute myeloid leukaemia presenting as cholestatic hepatitis.

A 40 year old man presented with abdominal pain, jaundice, weight loss, and hepatosplenomegaly. Liver function tests revealed cholestatic jaundice and a computed tomography scan showed an enlarged liver, with a normal biliary tree. Liver biopsy showed diffuse infiltration by neutrophils, monocytoid cells, and blasts. Peripheral blood film and bone marrow were consistent with acute myeloid leukaemia. After treatment with chemotherapy using an acute myeloid leukaemia protocol (UK Medical Research Council AML-12), there was complete resolution of jaundice and the patient went into complete molecular remission.

Chronic myeloid leukaemia occurring in a patient with hairy cell leukaemia.

Occurrences of second malignancies in hairy cell leukaemia are well recognised. Most of these malignancies are either solid tumours or lymphoproliferative disorders. The association of myeloproliferative disorders with hairy cell leukaemia (HCL) is very rare. This report describes a case of a patient with HCL who after remaining in remission developed Philadelphia chromosome positive chronic myeloid leukaemia (CML), which rapidly transformed to acute lymphoblastic leukaemia with further cytogenetic abnormalities.