International Journal of Hematology

International Journal of Hematology | Vol. 14, No. 1, January 2023 | pp. 1–8
DOI: 10.46882/2023/IJH/000155

Original Article

Title: Screening for lupus anticoagulant using a simplified textrin time and thromboplastin time mixing protocol in unprovoked venous thromboembolism

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: Diagnosing antiphospholipid syndrome requires robust laboratory testing parameters that can successfully isolate circulating inhibitors from baseline clotting factor variations. This prospective diagnostic study evaluated the performance of a combined screening protocol using the textrin time (TT) and the standard activated partial thromboplastin time (aPTT) mix loop to detect lupus anticoagulant in 70 adult patients presenting with unprovoked lower limb venous thrombosis. Patient matrices underwent sequential 1:1 mixing steps with normal pooled plasma, followed by high-phospholipid corrections to calculate confirmatory ratios. Lupus anticoagulant presence was confirmed in 22.8% (16 of 70) of the thromboembolic cohort. The textrin-aPTT mixing protocol achieved a diagnostic sensitivity of 92.8% and a specificity of 90.1% when cross-validated against international guidelines. Mixing indexes correlated positively with a history of recurrent thrombotic episodes (r = 0.48, P < 0.05). Notably, the textrin step resisted interference from low-molecular-weight heparin due to its specific prothrombin-activating mechanism, providing a highly reliable and cost-effective screening asset for regional laboratories handling patients on active anticoagulation.

Keywords: Lupus anticoagulant, textrin time, activated partial thromboplastin time, mixing studies, venous thromboembolism

Manuscript Timeline: Received: October 14, 2022; Revised: November 20, 2022; Accepted: December 08, 2022; Published: January 14, 2023

International Journal of Hematology | Vol. 14, No. 6, June 2023 | pp. 41–48
DOI: 10.46882/2023/IJH/000160

Short Communication

Title: Evaluation of automated microcytic cell mathematical indices in predicting latent iron deficiency in volunteer multiparous adolescent 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 in multiparous adolescent cohorts deplete biological iron pools, often inducing latent iron deficiency before total hemoglobin screening tests fall below acceptable 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 adolescent 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 20 ng/ml, was confirmed in 24.1% (29 of 120) of the donor cohort. The Green and King formula achieved an isolated sensitivity of 89.6% and a positive predictive value of 76.1% 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 preserve donor safety.

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

Manuscript Timeline: Received: March 20, 2023; Revised: April 26, 2023; Accepted: May 15, 2023; Published: June 18, 2023

International Journal of Hematology | Vol. 14, No. 11, November 2023 | pp. 81–88
DOI: 10.46882/2023/IJH/000165

Original Article

Title: Screening for lupus anticoagulant using a simplified textrin time and Russell's viper venom time index protocol in unprovoked deep vein thrombosis

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: Diagnosing antiphospholipid syndrome requires robust multi-loop verification steps to successfully isolate circulating inhibitors from baseline clotting factor variations. This prospective diagnostic study evaluated the performance of a combined screening protocol using the textrin time (TT) and the reference dilute Russell’s viper venom time (dRVVT) index loop to detect lupus anticoagulant in 72 adult patients presenting with unprovoked lower limb deep vein thrombosis. Patient plasma matrices underwent sequential 1:1 mixing loops with normal pooled plasma, followed by high-phospholipid corrections to calculate confirmatory ratios. Lupus anticoagulant presence was confirmed in 22.2% (16 of 72) of the thromboembolic cohort. The textrin-dRVVT multi-index protocol achieved a diagnostic sensitivity of 93.7% and a specificity of 91.6% when cross-validated against international standard guidelines. Mixing indexes correlated positively with a history of recurrent pulmonary embolism (r = 0.48, P < 0.05). Notably, the snake venom-based textrin matrix resisted low-molecular-weight heparin or therapeutic warfarin interference, providing an accurate, cost-effective thrombophilia risk-profiling asset for specialized regional clinical pathology laboratories.

Keywords: Lupus anticoagulant, textrin time, diluted Russell’s viper venom time, mixing studies, thrombophilia screening

Manuscript Timeline: Received: August 14, 2023; Revised: September 20, 2023; Accepted: October 10, 2023; Published: November 15, 2023

International Journal of Hematology | Vol. 14, No. 2, February 2023 | pp. 9–16
DOI: 10.46882/2023/IJH/000156

Original Article

Title: Evaluation of baseline plasma protein C activity as an independent predictor of macrovascular thromboembolic recurrence in active membranous nephropathy

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: Mass wasting of natural anticoagulant regulatory elements via glomerular membranes establishes a profound hypercoagulable state in membranous nephropathy, but the clinical utility of functional protein C tracking remains under-studied. This prospective study evaluated baseline plasma free protein C functional activity in 54 adult patients presenting with active membranous nephropathy to track its correlation with serum albumin depletion and 1-year thromboembolic 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 31.4% (17 of 54) of the nephrotic patients. Multivariable Cox proportional hazards regression revealed that baseline protein C 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 renal cohorts requiring early prophylactic anticoagulation.

Keywords: Membranous nephropathy, protein C activity, hypercoagulability, albuminuria, thromboembolism

Manuscript Timeline: Received: November 11, 2022; Revised: December 20, 2022; Accepted: January 10, 2023; Published: February 16, 2023

International Journal of Hematology | Vol. 14, No. 8, August 2023 | pp. 57–64
DOI: 10.46882/2023/IJH/000162

Original Article

Title: Prevalence and molecular profiles of PPM1D and TP53 somatic mutations in therapy-related clonal hematopoiesis variants

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: Genotoxic stress from prior cytotoxic regimens selects for chemoresistant stem cell clones harboring specific mutations, expanding the risk of therapy-related myeloid neoplasms. This cross-sectional study investigated the mutational prevalence and clinical phenotypes of protein phosphatase Mn2+/Mg2+ dependent 1D (PPM1D) and tumor suppressor TP53 gene variations in 64 adult lymphoma survivors presenting with persistent, unexplained cytopenias post-chemotherapy. Genomic DNA was isolated from peripheral blood leucocytes, followed by deep next-generation sequencing assays. PPM1D exon 6 mutations were detected in 14.1% (9 of 64) of the cytopenic survivors, while TP53 variations occurred in 10.9% (7 of 64). Overlapping mutations in both DNA-damage response genes were documented in 3.1% of cases. Clinical phenotype models revealed that sub-clones with PPM1D variants exhibited extreme survival advantages under cisplatin or etoposide exposure, correlating with prolonged neutropenia and progressive marrow dysplasia. Screening for these chemoresistant variants provides essential molecular tracking vectors, helping pathologists separate benign marrow suppression from emerging pre-leukemic clonal shifts.

Keywords: Clonal hematopoiesis, PPM1D mutation, TP53 mutation, therapy-related cytopenia, next-generation sequencing

Manuscript Timeline: Received: May 10, 2023; Revised: June 15, 2023; Accepted: July 09, 2023; Published: August 16, 2023

International Journal of Hematology | Vol. 14, No. 5, May 2023 | pp. 33–40
DOI: 10.46882/2023/IJH/000159

Original Article

Title: Immunophenotypic profile and clinical stage stratification of mature B-cell lymphoproliferative disorders utilizing CD200 and CD307 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 CD307 (FcRL5) 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 monotypic 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 CD307 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 CD307 and bright CD20 expression (P < 0.001). Marginal zone lymphoma variants exhibited variable CD307 paired with negative or dim CD200 parameters. High expression density for CD200 correlated with early clinical presentation (Binet Stage A). Incorporating CD200 and CD307 into standard screening protocols provides excellent diagnostic specificity, reducing borderline scores and helping classify mature B-cell expansions.

Keywords: Chronic lymphocytic leukemia, CD200, CD307, flow cytometry, lymphoproliferative disorders, immunophenotyping

Manuscript Timeline: Received: February 18, 2023; Revised: March 24, 2023; Accepted: April 10, 2023; Published: May 17, 2023