International Journal of Hematology

International Journal of Hematology | Vol. 11, No. 6, June 2020 | pp. 41–48
DOI: 10.46882/2020/IJH/000126

Original Article

Title: Evaluation of baseline plasma protein C functional activity as an independent predictor of thromboembolic recurrence in active nephrotic syndrome

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: Massive renal wasting of natural anticoagulant factors establishes a profound hypercoagulable state in nephrotic disease, yet the clinical utility of functional protein C monitoring remains under-studied. This prospective study evaluated baseline plasma free protein C functional activity in 54 adult patients with active nephrotic syndrome to track its correlation with serum albumin depletion and 1-year thromboembolic recurrence outcomes. Protein C activity was quantified via chromogenic substrate assays prior to initiating immunosuppressive therapy. Severe protein C activity reduction (< 55.0%) was identified in 29.6% (16 of 54) of the nephrotic patients. Multivariable Cox proportional hazards analysis revealed that baseline protein C functional activity below 55.0% was an independent predictor of acute deep vein thrombosis or pulmonary embolism within a 12-month follow-up window (hazard ratio = 3.84, P < 0.01). Protein C depression correlated inversely with serum albumin levels (r = -0.65, P < 0.001) and positively with D-dimer concentrations. Screening for functional protein C profiles provides clear prognostic utility, helping identify high-risk nephrotic populations requiring early prophylactic anticoagulation.

Keywords: Nephrotic syndrome, protein C activity, hypercoagulability, albuminuria, thromboembolism

Manuscript Timeline: Received: March 14, 2020; Revised: April 25, 2020; Accepted: May 12, 2020; Published: June 19, 2020

International Journal of Hematology | Vol. 10, No. 8, August 2019 | pp. 57–64
DOI: 10.46882/2019/IJH/000116

Original Article

Title: Evaluation of baseline plasma protein C functional activity variations as an independent predictor of recurrent macrovascular thrombosis in nephrotic syndrome

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: Excessive renal loss of anticoagulant regulatory elements establishes a profound hypercoagulable state in nephrotic disease, but the predictive utility of functional protein C monitoring remains under-analyzed. This prospective study evaluated baseline plasma free protein C functional activity in 54 adult patients with active nephrotic syndrome to track correlations with serum albumin depletion and 1-year thrombotic recurrence outcomes. Protein C activity was quantified via chromogenic substrate assays prior to initiating standard immunosuppressive therapy. Severe protein C activity reduction (< 55.0%) was identified in 29.6% (16 of 54) of the nephrotic patients. Multivariable Cox proportional hazards analysis revealed that baseline protein C functional activity below 55.0% was an independent predictor of acute deep vein thrombosis or pulmonary embolism within a 12-month observation window (hazard ratio = 3.84, P < 0.01). Protein C depression correlated inversely with serum albumin levels (r = -0.65, P < 0.001) and positively with D-dimer concentrations. Screening for functional protein C profiles provides clear prognostic utility, helping identify high-risk nephrotic populations requiring early prophylactic anticoagulation.

Keywords: Nephrotic syndrome, protein C activity, hypercoagulability, albuminuria, thromboembolism

Manuscript Timeline: Received: May 12, 2019; Revised: June 20, 2019; Accepted: July 10, 2019; Published: August 17, 2019

International Journal of Hematology | Vol. 10, No. 3, March 2019 | pp. 17–24
DOI: 10.46882/2019/IJH/000111

Original Article

Title: Clinical outcomes of low-dose rituximab maintenance in elderly patients with relapsed warm autoimmune hemolytic 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 Medicine, University of Ilorin, Ilorin, Nigeria; ³Department of Chemical Pathology, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Abstract: Elderly individuals face heightened vulnerability to standard high-dose immunosuppressive strategies for managing relapsed warm autoimmune hemolytic anemia. This prospective clinical trial evaluated the therapeutic efficiency and safety profile of an ultra-low-dose rituximab maintenance protocol (100 mg fixed dose monthly for 6 months) in 28 elderly patients (aged ≥ 65 years) who achieved partial remission after initial steroid induction. Full blood counts, reticulocyte percentages, and serum lactate dehydrogenase concentrations tracked metabolic hemolysis. Complete hematological remission was achieved and maintained in 71.4% (20 of 28) of the patients at month 12. The mean hemoglobin concentration rose from a post-induction baseline of 8.4 ± 1.2 g/dl to 12.4 ± 1.4 g/dl at the conclusion of maintenance therapy (P < 0.001). Grade 1 or 2 infusion-related adverse reactions were documented in 14.2% of the cases, and no severe opportunistic infections occurred. These findings confirm that a structured low-dose rituximab maintenance protocol provides durable, safe, and cost-effective clinical control, minimizing the toxicities associated with long-term corticosteroid exposure in older cohorts.

Keywords: Autoimmune hemolytic anemia, rituximab, elderly patients, maintenance therapy, hemolysis

Manuscript Timeline: Received: December 14, 2018; Revised: January 20, 2019; Accepted: February 10, 2019; Published: March 15, 2019

International Journal of Hematology | Vol. 10, No. 2, February 2019 | pp. 9–16
DOI: 10.46882/2019/IJH/000110

Short Communication

Title: Evaluation of automated microcytic cell screening formulas in predicting latent iron deficiency in high-yield blood donors

Names of Authors: B. C. Akpan¹, D. E. Usman²

Authors’ Affiliations: ¹Department of Haematology, University of Calabar, Calabar, Nigeria; ²Department of Clinical Pharmacology, Ahmadu Bello University, Zaria, Nigeria

Abstract: Frequent blood donations deplete storage iron pools, often inducing pre-anemic iron deficiency before total hemoglobin screening tests fall below acceptable donation thresholds. This diagnostic study evaluated the predictive performance of the Mentzer index and the Green and King mathematical cell counter formulas for identifying latent iron depletion in 120 regular male blood donors presenting with normal total hemoglobin levels (≥ 12.5 g/dl). Calculated indices were cross-validated against biochemical serum ferritin reference parameters. Latent iron deficiency, defined by a serum ferritin below 25 ng/ml, was confirmed in 22.5% (27 of 120) of the blood donor cohort. The Green and King formula achieved an isolated sensitivity of 88.8% and a positive predictive value of 75.0% for predicting depleted iron reserves, significantly outperforming the Mentzer index model (P < 0.05). Utilizing automated cell counter mathematical formulas offers an efficient, low-cost screening protocol to detect latent iron-restricted erythropoiesis and improve donor safety.

Keywords: Blood donors, latent iron deficiency, Mentzer index, Green and King formula, donor selection

Manuscript Timeline: Received: November 18, 2018; Revised: December 22, 2018; Accepted: January 12, 2019; Published: February 15, 2019

International Journal of Hematology | Vol. 10, No. 11, November 2019 | pp. 81–88
DOI: 10.46882/2019/IJH/000119

Original Article

Title: Immunophenotypic profile and clinical stage stratification of mature B-cell lymphoproliferative disorders utilizing CD200 and CD27 expression variations

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 panels play an important role in separating overlapping mature B-cell malignancies. This prospective study evaluated the diagnostic performance of combining CD200 and CD27 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 co-expression of CD200 and CD27 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 both markers alongside bright CD20 expression (P < 0.001). Marginal zone lymphoma variants exhibited positive CD27 paired with negative or dim CD200 parameters. High expression density for both markers correlated with early clinical presentation (Binet Stage A). Incorporating CD200 and CD27 into standard screening protocols provides excellent diagnostic specificity, reducing borderline scores and helping classify mature B-cell expansions.

Keywords: Chronic lymphocytic leukemia, CD200, CD27, flow cytometry, lymphoproliferative disorders, immunophenotyping

Manuscript Timeline: Received: August 20, 2019; Revised: September 25, 2019; Accepted: October 12, 2019; Published: November 15, 2019

International Journal of Hematology | Vol. 10, No. 4, April 2019 | pp. 25–32
DOI: 10.46882/2019/IJH/000112

Original Article

Title: Prevalence and molecular characteristics of CALR exon 9 Type 1 and Type 2 variants in essential thrombocythemia

Names of Authors: G. M. Babalola¹, I. N. Nwosu², K. S. Abubakar³

Authors’ Affiliations: ¹Department of Haematology and Blood Transfusion, Lagos University Teaching Hospital, Lagos, Nigeria; ²Department of Medicine, University of Nigeria, Nsukka, Nigeria; ³Department of Pathology, Bayero University, Kano, Nigeria

Abstract: Identifying specific calreticulin (CALR) mutation sub-types helps refine clinical risk evaluation in Janus kinase 2 (JAK2)-negative myeloproliferative malignancies. This cross-sectional study investigated the prevalence, hematological profiles, and thromboembolic rates linked to CALR exon 9 Type 1 (52-bp deletion) and Type 2 (5-bp insertion) variants in 54 adult patients diagnosed with essential thrombocythemia. Genomic DNA was isolated from peripheral blood leucocytes, followed by fragment analysis and direct Sanger sequencing. CALR mutations were detected in 33.3% (18 of 54) of the patients. Type 1 deletion variants were identified in 61.1% (11 of 18) of positive cases, while Type 2 insertion variants accounted for 38.9% (7 of 18). Patients with Type 1 mutations exhibited significantly higher baseline platelet counts (mean 942.5 ± 124.0 × 10⁹/L) compared to Type 2 variants (mean 612.4 ± 84.0 × 10⁹/L, P < 0.05). However, Type 2 insertion variants correlated with a higher risk of transformation into secondary myelofibrosis over a 24-month observation window. Screening for these distinct calreticulin subclasses provides essential prognostic utility for guiding individualized maintenance therapies.

Keywords: Essential thrombocythemia, Calreticulin mutation, deletion variants, insertion variants, molecular genetics

Manuscript Timeline: Received: January 10, 2019; Revised: February 18, 2019; Accepted: March 12, 2019; Published: April 14, 2019