International Journal of Hematology

International Journal of Hematology | Vol. 3, No. 1, January 2012 | pp. 1–8
DOI: 10.46882/2012/IJH/000025

Original Article

Title: Cytochemical and morphological classification of acute leukemias in a tertiary health facility

Names of Authors: Y. Z. Ibrahim¹, A. B. Okafor², C. D. Danjuma³

Authors’ Affiliations: ¹Department of Haematology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; ²Department of Pathology, University of Ibadan, Ibadan, Nigeria; ³Department of Haematology, University of Maiduguri, Maiduguri, Nigeria

Abstract: Accurate differentiation between acute myeloid leukemia and acute lymphoblastic leukemia is essential for selecting appropriate induction chemotherapy. This descriptive study classified 62 newly diagnosed adult acute leukemia cases using peripheral blood films, bone marrow aspirates, and standard cytochemical stains, including Myeloperoxidase, Sudan Black B, and Periodic Acid-Schiff. Acute myeloid leukemia was diagnosed in 58.1% (36 of 62) of the cases, while acute lymphoblastic leukemia accounted for 41.9% (26 of 62). The acute myeloid leukemia cases were subclassified using the French-American-British system, where the M2 (acute myeloid leukemia with maturation) and M4 (acute myelomonocytic leukemia) variants were the most common, representing 33.3% and 22.2% of myeloid cases, respectively. Myeloperoxidase reactivity showed a high specificity (96.4%) for myeloid lineage determination. Misclassification occurred in 4.8% of cases when evaluating poorly differentiated blastic patterns without cytochemical stains. In resource-limited settings lacking flow cytometry, systematic cytochemical staining remains a reliable and affordable diagnostic protocol for acute leukemia classification.

Keywords: Acute myeloid leukemia, acute lymphoblastic leukemia, cytochemistry, myeloperoxidase, bone marrow aspirate

Manuscript Timeline: Received: October 14, 2011; Revised: November 20, 2011; Accepted: December 08, 2011; Published: January 11, 2012

International Journal of Hematology | Vol. 3, No. 11, November 2012 | pp. 81–88
DOI: 10.46882/2012/IJH/000035

Original Article

Title: Cytogenetic and molecular response kinetics to low-dose hydroxyurea in essential thrombocythemia

Names of Authors: Y. Z. Ibrahim¹, A. B. Okafor², C. D. Danjuma³

Authors’ Affiliations: ¹Department of Haematology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; ²Department of Pathology, University of Ibadan, Ibadan, Nigeria; ³Department of Haematology, University of Maiduguri, Maiduguri, Nigeria

Abstract: Essential thrombocythemia carries a risk of vascular thrombosis and transformation to myelofibrosis. This prospective study evaluated the clinical, hematological, and molecular kinetics of low-dose hydroxyurea (500 mg to 1000 mg daily) in 40 newly diagnosed, high-risk essential thrombocythemia patients harboring the JAK2 V617F mutation. Full blood counts were monitored bi-weekly, and JAK2 mutant allele burdens were quantified via real-time PCR at baseline and 12 months. Complete hematological response, defined by a platelet count below 400 × 10⁹/L and absence of symptoms, was achieved in 85.0% (34 of 40) of patients within a median of 6 weeks. The mean platelet count fell from 842.5 ± 124.0 × 10⁹/L to 354.2 ± 48.0 × 10⁹/L at month 12 (P < 0.001). However, the median JAK2 V617F allele burden showed only a minimal reduction, from 24.5% at baseline to 21.2% at month 12 (P = 0.34). Mild leukopenia occurred in 10.0% of patients. Low-dose hydroxyurea provides rapid and durable hematological control, but its short-term molecular clearance of the JAK2 clone is limited. Long-term studies are needed to determine if molecular non-response influences fibrotic transformation.

Keywords: Essential thrombocythemia, hydroxyurea, JAK2 V617F mutation, platelet count, molecular response

Manuscript Timeline: Received: August 14, 2012; Revised: September 20, 2012; Accepted: October 10, 2012; Published: November 15, 2012

International Journal of Hematology | Vol. 2, No. 9, September 2011 | pp. 65–72
DOI: 10.46882/2011/IJH/000021

Original Article

Title: Diagnostic accuracy of cell counter-derived microcytic anemia indices compared with gold standard bone marrow iron stores

Names of Authors: A. I. Mustapha¹, C. K. Nwosu², E. O. Olayinka³

Authors’ Affiliations: ¹Department of Haematology, University of Ilorin Teaching Hospital, Ilorin, Nigeria; ²Department of Pathology, Enugu State University of Science and Technology, Enugu, Nigeria; ³Department of Biomedical Science, Ladoke Akintola University of Technology, Ogbomoso, Nigeria

Abstract: Differentiating absolute iron deficiency from other microcytic disorders remains critical for targeted therapeutic planning. This prospective study evaluated the diagnostic accuracy of the Green and King index, Mentzer index, and red blood cell distribution width against histological bone marrow iron grading using Perl’s Prussian blue stain. Bone marrow aspirates and peripheral blood counts were obtained from 115 adult patients with microcytic hypochromic anemia (MCV < 80 fl). Histological examination confirmed absent bone marrow iron stores in 58.3% (67 of 115) of the patients. The Mentzer index exhibited a sensitivity of 76.1% and a specificity of 70.8% for diagnosing absolute iron deficiency. The Green and King index demonstrated superior diagnostic performance, yielding a sensitivity of 89.6%, a specificity of 85.4%, and an area under the receiver operating characteristic curve of 0.88 (P < 0.001). Combining automated red blood cell distribution width with the Green and King mathematical model significantly reduced misclassification rates compared to single-parameter indices. These results demonstrate that utilizing refined cell counter-derived mathematical formulas provides an accessible, non-invasive, and reliable screening protocol for iron deficiency in laboratories lacking advanced biochemical profiles.

Keywords: Iron deficiency anemia, bone marrow iron, Mentzer index, Green and King index, microcytosis

Manuscript Timeline: Received: June 10, 2011; Revised: July 15, 2011; Accepted: August 04, 2011; Published: September 12, 2011

International Journal of Hematology | Vol. 2, No. 12, December 2011 | pp. 89–96
DOI: 10.46882/2011/IJH/000024

Original Article

Title: Prevalence and risk factors of alloimmunization to red blood cell antigens in multi-transfused sickle cell anemia patients

Names of Authors: S. T. Adeyemi¹, U. V. Nwachukwu², W. X. Salami³

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

Abstract: Red blood cell alloimmunization complicates long-term transfusion therapy in sickle cell anemia, causing delayed hemolytic transfusion reactions and limiting cross-match availability. This cross-sectional study determined the prevalence and specificity of red blood cell alloantibodies among 112 multi-transfused patients with sickle cell anemia who had received at least 5 lifetime packed red blood cell transfusions. Antibody screening and identification were conducted using a standardized 3-cell and 11-cell panel gel card system. Alloantibodies were detected in 14.3% (16 of 112) of the patients. The antigen specificities identified were directed against the Kell system (anti-K, 37.5%), the Rh system (anti-E, 25.0%; anti-C, 18.7%), and the Kidd system (anti-Jka, 12.5%). The risk of alloimmunization correlated with the total number of transfused units (P < 0.05) and an older age at the first transfusion episode. These findings indicate a significant rate of red blood cell alloimmunization, supporting the implementation of extended phenotype matching for Rh and Kell antigens to prevent immune hemolysis in chronically transfused sickle cell cohorts.

Keywords: Sickle cell anemia, alloimmunization, red blood cell antigens, blood transfusion, alloantibodies

Manuscript Timeline: Received: September 15, 2011; Revised: October 24, 2011; Accepted: November 12, 2011; Published: December 15, 2011

International Journal of Hematology | Vol. 2, No. 10, October 2011 | pp. 73–80
DOI: 10.46882/2011/IJH/000022

Original Article

Title: Hematological changes and myelosuppression kinetics in HIV-positive patients initiating zidovudine-based highly active antiretroviral therapy

Names of Authors: G. M. Babalola¹, I. N. Okoye², 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: Zidovudine-induced bone marrow suppression limits the therapeutic durability of first-line antiretroviral regimens. This prospective cohort study investigated the timeline, severity, and hematological predictors of myelosuppression in 150 treatment-naive HIV-infected adults initiating highly active antiretroviral therapy containing zidovudine (300 mg twice daily). Full blood counts and CD4 lymphocyte counts were monitored at baseline, 2 weeks, 4 weeks, 8 weeks, and 24 weeks. The prevalence of treatment-emergent anemia (hemoglobin < 10.0 g/dl) was 28.7% (43 of 150) within the first 8 weeks, with severe anemia (< 7.0 g/dl) developing in 6.7% of patients. Concurrently, absolute neutrophil counts declined by a mean of 34.5% from baseline values, whereas mean corpuscular volume values increased progressively from 82.4 fl to 104.6 fl by week 24, acting as an index of therapeutic adherence. Multivariable logistic regression identified a baseline CD4 count below 100 cells/μl and a baseline hemoglobin below 11.0 g/dl as independent risk factors for severe macrocytic anemia (odds ratio = 3.42, P < 0.01). Early, intensive hematological monitoring during the initial 8 weeks of zidovudine therapy is critical to safely managing severe cytopenias.

Keywords: HIV, antiretroviral therapy, zidovudine, anemia, myelosuppression

Manuscript Timeline: Received: July 05, 2011; Revised: August 20, 2011; Accepted: September 10, 2011; Published: October 14, 2011

International Journal of Hematology | Vol. 2, No. 3, March 2011 | pp. 17–24
DOI: 10.46882/2011/IJH/000015

Original Article

Title: Bone marrow morphological patterns in adult patients with unexplained cytopenias: A 5-year retrospective audit

Names of Authors: F. K. Yusuf¹, G. O. Eze², H. A. Maina³

Authors’ Affiliations: ¹Department of Haematology, Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria; ²Department of Pathology, University of Benin Teaching Hospital, Benin City, Nigeria; ³Department of Haematology, University of Maiduguri, Maiduguri, Nigeria

Abstract: Unexplained peripheral blood cytopenias present diagnostic challenges requiring bone marrow aspirate and trephine biopsy evaluations. This 5-year retrospective audit reviewed 164 adult patients who underwent bone marrow examinations for isolated anemia, bicytopenia, or pancytopenia of uncertain etiology. Hyperplastic marrow with megaloblastic erythropoiesis was the most common morphological finding, occurring in 34.1% of cases (56 of 164), primarily due to nutritional vitamin B12 or folate deficiencies. Aplastic anemia was diagnosed in 15.2% of patients, characterized by marked hypocellularity and fatty replacement. Hematological malignancies, including acute myeloid leukemia, multiple myeloma, and myelodysplastic syndromes, accounted for 26.8% of cases. Granulomatous inflammation secondary to disseminated tuberculosis was found in 7.3% of biopsies. Trephine biopsies provided a superior diagnostic yield over aspirates alone for aplastic anemia and myelofibrosis. The findings demonstrate that nutritional deficiencies and preventable infections remain major causes of marrow failure, highlighting the diagnostic necessity of early bone marrow histology.

Keywords: Bone marrow biopsy, cytopenia, pancytopenia, megaloblastic anemia, aplastic anemia

Manuscript Timeline: Received: December 04, 2010; Revised: January 15, 2011; Accepted: February 10, 2011; Published: March 18, 2011