International Journal of Hematology

International Journal of Hematology | Vol. 13, No. 9, September 2022 | pp. 65–72
DOI: 10.46882/2022/IJH/000151

Original Article

Title: Serum hepcidin-25 kinetics and iron profiling updates in pregnant women presenting with severe microcytic anemia

Names of Authors: A. I. Ibrahim¹, C. D. Balogun², E. O. Ojo³

Authors’ Affiliations: ¹Department of Haematology, Ahmadu Bello University, Zaria, Nigeria; ²Department of Obstetrics and Gynaecology, University of Ilorin, Ilorin, Nigeria; ³Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Abstract: Managing microcytic anemia during gestation requires distinct differentiation between absolute nutritional iron depletion and functional iron blockades driven by subclinical inflammatory states. This prospective study evaluated serum hepcidin-25 kinetics, soluble transferrin receptor (sTfR) levels, and total hemoglobin variations in 85 pregnant women in their third trimester presenting with severe microcytosis (MCV < 70 fl). Bioactive serum hepcidin-25 concentrations were quantified via a competitive enzyme-linked immunosorbent assay. Pregnant individuals with true iron deficiency anemia exhibited complete suppression of serum hepcidin-25 levels (< 1.5 ng/ml) paired with marked elevation of soluble transferrin receptor levels. Conversely, a sub-population presenting with concurrent chronic infections demonstrated paradoxically elevated hepcidin-25 concentrations (mean 24.5 ± 4.2 ng/ml) despite low serum iron parameters, reflecting an inflammatory iron trap. Hepcidin levels correlated positively with serum ferritin metrics (r = 0.62, P < 0.001). Integrating quantitative hepcidin-25 evaluations into gestational screening algorithms provides superior diagnostic security, allowing clinicians to bypass ineffective oral iron replenishment steps and identify functional anemia variants requiring targeted anti-inflammatory or intravenous management.

Keywords: Hepcidin-25, pregnancy, iron deficiency anemia, anemia of chronic disease, soluble transferrin receptor

Manuscript Timeline: Received: June 15, 2022; Revised: July 24, 2022; Accepted: August 12, 2022; Published: September 15, 2022

International Journal of Hematology | Vol. 13, No. 7, June 2022 | pp. 49–56
DOI: 10.46882/2022/IJH/000149

Original Article

Title: Immunophenotypic profile and clinical stage stratification of B-cell chronic lymphoproliferative disorders utilizing CD200 and CD306 expression markers

Names of Authors: W. A. Adebayo¹, X. Y. Emeka², Z. Z. Salami³

Authors’ Affiliations: ¹Department of Haematology, University of Ibadan, Ibadan, Nigeria; ²Department of Haematology, University of Calabar Teaching Hospital, Calabar, Nigeria; ³Department of Pathology, Lagos University Teaching Hospital, Lagos, Nigeria

Abstract: Multiparameter flow cytometry immunophenotyping plays an important role in separating overlapping mature B-cell malignancies. This prospective study evaluated the diagnostic performance of combining CD200 and CD306 (LAIR2) markers to differentiate chronic lymphocytic leukemia from mantle cell lymphoma and marginal zone lymphoma in 55 adult patients presenting with persistent absolute lymphocytosis. Lineage markers and monoclonal light chain restriction were established using flow cytometry. Chronic lymphocytic leukemia was confirmed in 38 cases, while 17 were diagnosed with non-CLL mature B-cell variants. Strong, uniform surface expression of CD200 paired with positive CD306 was detected in 94.7% (36 of 38) of the chronic lymphocytic leukemia cases. In contrast, mantle cell lymphoma cohorts demonstrated a complete absence of CD200 alongside dim or negative CD306 and bright CD20 expression (P < 0.001). Marginal zone lymphoma variants exhibited variable CD306 paired with negative or dim CD200 parameters. High expression density for CD200 correlated with early clinical presentation (Binet Stage A). Incorporating CD200 and CD306 into standard screening protocols provides excellent diagnostic specificity, reducing borderline scores and helping classify mature B-cell expansions.

Keywords: Chronic lymphocytic leukemia, CD200, CD306, flow cytometry, lymphoproliferative disorders, immunophenotyping

Manuscript Timeline: Received: April 14, 2022; Revised: May 20, 2022; Accepted: June 08, 2022; Published: June 20, 2022

International Journal of Hematology | Vol. 13, No. 4, April 2022 | pp. 25–32
DOI: 10.46882/2022/IJH/000146

Original Article

Title: Evaluation of baseline plasma antithrombin III functional activity as an independent predictor of thromboembolic risk in lupus nephritis

Names of Authors: E. F. Chinedu¹, G. H. Haruna², I. J. Balogun³

Authors’ Affiliations: ¹Department of Haematology, University of Nigeria Teaching Hospital, Enugu, Nigeria; ²Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Nigeria; ³Department of Chemical Pathology, University of Ilorin, Ilorin, Nigeria

Abstract: Nephrotic-range proteinuria in lupus nephritis induces a severe hypercoagulable state due to the heavy urinary loss of natural regulatory elements, but the clinical utility of functional antithrombin III monitoring remains under-studied. This prospective study evaluated baseline plasma antithrombin III functional activity in 54 adult patients with active Class IV lupus nephritis to track its correlation with serum albumin depletion and 1-year thromboembolic complications. Antithrombin III activity was quantified via chromogenic substrate assays prior to starting high-dose immunosuppressive therapy. Severe antithrombin III activity depletion (< 60.0%) was identified in 29.6% (16 of 54) of the patients. Multivariable Cox proportional hazards regression revealed that baseline antithrombin III activity below 60.0% was an independent predictor of acute deep vein thrombosis or pulmonary embolism within a 12-month follow-up window (hazard ratio = 4.12, P < 0.01). Antithrombin III depression correlated strongly with low serum albumin levels (r = -0.68, P < 0.001) and elevated D-dimer values. Screening for functional antithrombin III profiles provides clear prognostic utility, helping identify high-risk autoimmune renal cohorts requiring early prophylactic anticoagulation.

Keywords: Lupus nephritis, antithrombin III, hypercoagulability, albuminuria, thromboembolism

Manuscript Timeline: Received: January 12, 2022; Revised: February 20, 2022; Accepted: March 08, 2022; Published: April 14, 2022

International Journal of Hematology | Vol. 13, No. 2, February 2022 | pp. 9–16
DOI: 10.46882/2022/IJH/000144

Original Article

Title: Impact of systemic hydroxyurea on plasma soluble intercellular adhesion molecule-1 levels and painful crisis patterns in pediatric sickle cell anemia

Names of Authors: S. T. Adeyemi¹, U. V. Okoye², W. X. Salami³

Authors’ Affiliations: ¹Department of Haematology and Blood Transfusion, Obafemi Awolowo University, Ile-Ife, Nigeria; ²Department of Medicine, University of Nigeria Teaching Hospital, Enugu, Nigeria; ³Department of Paediatrics, Ahmadu Bello University, Zaria, Nigeria

Abstract: Microvascular occlusion in sickle cell disease is driven by complex adhesive interactions between sickle erythrocytes, leukocytes, and the vascular wall. This prospective cohort study evaluated the long-term impact of optimized hydroxyurea therapy on plasma soluble intercellular adhesion molecule-1 (sICAM-1) concentrations and clinical pain crisis patterns in 54 pediatric patients (aged 3 to 12 years) with steady-state sickle cell anemia (HbSS). Hydroxyurea was administered at a mean dose of 20 mg/kg/day and monitored over 12 months. Plasma markers were quantified using an enzyme-linked immunosorbent assay at baseline, 6 months, and 12 months. Baseline mean sICAM-1 concentrations fell significantly from 342.5 ± 48.0 ng/ml to 184.2 ± 22.0 ng/ml at month 12 (P < 0.001). Concurrently, the annual frequency of documented vaso-occlusive painful crises fell by 72.4%. Reductions in sICAM-1 values correlated positively with an increase in fetal hemoglobin from 5.2% to 16.5% and a drop in absolute reticulocyte counts. These findings confirm that hydroxyurea successfully downregulates endothelial adhesion molecules, providing a reliable and non-invasive pharmacological pathway for reducing microvascular cellular entrapment in pediatric sickle cell variants.

Keywords: Sickle cell anemia, hydroxyurea, ICAM-1, cellular adhesion, pediatric vaso-occlusion

Manuscript Timeline: Received: November 05, 2021; Revised: December 14, 2021; Accepted: January 08, 2022; Published: February 18, 2022

International Journal of Hematology | Vol. 12, No. 8, August 2021 | pp. 57–64
DOI: 10.46882/2021/IJH/000138

Original Article

Title: Evaluation of automated immature reticulocyte fraction and red blood cell fragmentation flags in separating iron deficiency from thrombotic thrombocytopenic purpura

Names of Authors: Q. S. Abubakar¹, U. T. Maina²

Authors’ Affiliations: ¹Department of Haematology, National Hospital, Abuja, Nigeria; ²Department of Pathology, Bayero University, Kano, Nigeria

Abstract: Severe microcytic anemia fragments can mimic schistocytes on automated counters, requiring robust laboratory separation parameters to prevent inappropriate therapeutic decisions. This prospective diagnostic study evaluated the performance of automated immature reticulocyte fractions (IRF) and fragmented red blood cell (FRC) flags for separating absolute iron deficiency anemia from thrombotic thrombocytopenic purpura variants. Evaluations were conducted on 125 adult patients presenting with thrombocytopenia and microcytosis, and diagnoses were validated via serum ferritin, ADAMTS13 activity, and manual visual blood film schistocyte counts. Thrombotic thrombocytopenic purpura was confirmed in 50 cases (ADAMTS13 < 10%), while 75 presented with severe iron deficiency. The mean immature reticulocyte fraction was significantly higher in the thrombotic thrombocytopenic purpura cohort compared to the iron-deficient group (0.36 ± 0.08 versus 0.12 ± 0.03, P < 0.001), reflecting an intense bone marrow response. Conversely, automated fragmentation flags were elevated in both groups. Receiver operating characteristic analysis established a combined IRF and FRC model that achieved a diagnostic sensitivity of 92.8% and a specificity of 89.1% for identifying true microangiopathic processes. Utilizing automated reticulocyte maturity indices provides an efficient, low-cost asset for screening destructive hemolytic conditions.

Keywords: Immature reticulocyte fraction, fragmented red cells, iron deficiency anemia, schistocytes, cell counter indices

Manuscript Timeline: Received: May 12, 2021; Revised: June 20, 2021; Accepted: July 09, 2021; Published: August 14, 2021

International Journal of Hematology | Vol. 12, No. 3, March 2021 | pp. 17–24
DOI: 10.46882/2021/IJH/000133

Review Article

Title: Targeting the Wnt/beta-catenin Signaling Pathway in Acute Myeloid Leukemia Stem Cells: Mechanisms and Inhibition

Names of Authors: M. A. Bello¹, O. R. Eze²

Authors’ Affiliations: ¹Department of Haematology, Aminu Kano Teaching Hospital, Kano, Nigeria; ²Department of Pathology, University of Benin, Benin City, Nigeria

Abstract: Quiescent leukemia stem cells escape standard cytotoxic chemotherapy, driving disease relapse and resistance in acute myeloid leukemia. This comprehensive review examines the cellular mechanisms of the evolutionary conserved Wnt/beta-catenin signaling pathway in sustaining leukemia stem cell self-renewal and marrow niche interactions. Accumulation of beta-catenin in the nucleus complexes with TCF/LEF transcription factors, upregulating critical cell-survival and proliferative genes. Traditional intensive chemotherapy regimens fail to eliminate these slow-cycling progenitors. Evolving management models emphasize the therapeutic deployment of small-molecule Wnt/beta-catenin inhibitors. Combining targeted catenin path inhibitors with low-dose cytarabine or hypomethylating backbones has shown clinical efficacy in expanding overall survival in elderly or frail acute myeloid leukemia populations unsuited for standard induction. However, secondary drug resistance can emerge via alternative microenvironmental niche overrides or signaling crosstalk. This review outlines clear biomarker tracking networks, beta-catenin expression monitoring, and combination protocols designed to bypass intrinsic resistance pathways and optimize clonal eradication in myeloid leukemias.

Keywords: Acute myeloid leukemia, leukemia stem cells, Wnt/beta-catenin pathway, molecular inhibitors, clonal resistance

Manuscript Timeline: Received: December 01, 2020; Revised: January 12, 2021; Accepted: February 04, 2021; Published: March 15, 2021