Primary Adrenal Lymphoma: When B Symptoms Appear Hand in Hand with Adrenal Masses

Primary adrenal lymphoma (PAL) is a very rare type of non-Hodgkin’s lymphoma (NHL). Herein, we report a case of NHL of both adrenal glands in a 69-year-old man. The patient was admitted because of a 1-month history of B symptoms and symptomatic hypotension. Biochemical analysis showed normocytic normochromic anaemia, hyponatraemia, hyperkalaemia, and elevated lactate dehydrogenase, C-reactive protein and D-dimers. A computed tomography scan revealed bilateral enlargement of the adrenal glands. There was no evidence of endocrine adrenal dysfunction. The mass in the right adrenal gland was biopsied and histopathology identified a diffuse large B-cell lymphoma of the activated B-cell subtype. A positron emission tomography 18F-fluorodeoxyglucose scan showed intensive hypermetabolic lesions involving both adrenal glands, as well as other locations, with higher uptake in the adrenal glands. Taken together, these findings suggested the diagnosis of PAL. The patient responded favourably to debulking therapy and is currently undergoing chemotherapy.

To study and analyze hematological parameters in anaemia in males

Hematological parameters like Hb (haemoglobin), TC (total count), DC (differential count), PCV (packed cell volume), MCV (mean red cell corpuscular volume) done in the automated cell counter and peripheral smear findings were studied. Observational study.Out of 250 cases, 192 i.e. 76.8% cases showed microcytic hypochromic anaemia, 30 cases i.e. 12% had normocytic hypochromic anaemia, 27 cases i.e. 10.6% had normocytic normochromic anaemia and dimorphic anaemia was seen in 02 cases i.e. 0.6% cases.Out of 250 cases, 193 i.e. 77.2% cases showed microcytosis maximally in 0-5 years age group and 57 cases i.e. 22.8% had normocytic picture. The distribution of peripheral smear (RBC size) finding with age varied significantly (p value <0.05). Iron deficiency is almost universal when dealing with this magnitude of anaemia. However, clinically speaking, many technical experts believe that to differentiate severe anaemia, a screening for other causes is desirable, all males are recommended to be screened. In the present study of pediatric cases 0-5 years age group males were most affected and prevalence was more in males as compared to females and the predominant morphological pattern was microcytic hypochromic anaemia.

Structure of anaemic conditions comorbid to alcoholic and non-alcoholic steatohepatitis

The retrospective analysis of 378 medical records of inpatients with steatohepatitis (SH) depending on its etiology was performed to identify and study the type of anaemic conditions (AC). Among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.2% of cases, in patients with alcoholic (ASH) - in 36.3%, in patients with non-alcoholic SH (NASH) - in 22.0 % of cases. Macrocytic, hyperchromic anaemia prevailed in patients with anaemia of all groups: in patients with SH of mixed etiology - in 47.9%, in patients with ASH - 56.8%, NASH - 71.4%. Normocytic, normochromic anaemia was registered in 52.1% with mixed etiology of SH, in patients with ASH - 43.2%, NASH - 28.6%.The prospective study of 125 patients with SH showed that anaemia was found in 40.0% of patients with ASH, among patients with SH of mixed (including alcoholic) etiology anaemia was found in 32.0%, among patients with NASH the result was 21.7%. The following types of anaemia were found in ASH: vitamin B12 - deficient - in 17.5% of cases, anaemia of chronic disease - in 10.0% of cases and Zieve's syndrome - in 12.5% of cases. Three types of anaemia were found in patients with SH of mixed etiology: vitamin B12 - deficient - in 16.0% of cases, anaemia of chronic disease - in 8.0% and Zieve's syndrome - in 8.0% of patients. The structure of anaemias in patients with NASH accompanied by obesity of I-II degrees is as follows: B12 - deficient anaemia - in 15.0% of cases, anaemia of chronic disease - in 6.7% of people. In patients with NASH, H. pylory contamination was present in 84.6% of patients with anaemic syndrome (AS), including 100% of patients with B12-deficient anaemia. With ASH, H. pylory contamination was present in 80.0% with anaemia, including 100% of patients with B12-deficient anaemia. In patients with SH of mixed etiology, H. pylory contamination was present in 100.0% of people with AS.

The influence of clinical and chronic forms of magnesium deficiency on the haematological parameters of dairy cows

The aim of the study was to determine the influence of hypomagnesaemia on the haematological status and predictive values of haematological tests in the diagnosis of magnesium (Mg) deficiency in dairy cow herds. The study was carried out on 100 dairy HF cows, divided into two experimental groups and a control one.The two experimental groups (I - clinical form of hypomagnesaemia, II - chronic form of hypomagnesaemia) consisted of 40 cows and the control group consisted of 20 healthy cows. Blood samples were collected twice: before the commencement of the therapy and after three months. In both hypomagnesaemic groups, low erythrocyte count, haemoglobin (Hgb) concentration and hematocrit (Ht) index values were observed. The indirect parameters of the erythrocyte system were within the standard reference range, with the exception of the mean corpuscular hemoglobin (MCH) index, which, in approx. 45% of animals, was below the lower limit of the normal range. Haemolytic normocytic normochromic anaemia was detected through the hypomagnesaemia of the cows. In the first and second group, at the first blood sampling an increase in the eosinophil count was observed, which was statistically significant in relation to the second sampling. In the blood smear test, a variety of erythrocyte sizes (anisocytosis), polychromasia and Howell-Jolly bodies were detected in the affected cows. After supplementation with magnesium, the concentration of Mg in the serum of the treated animals returned to normal more rapidly than the haematological parameters. The authors assumed that these in the haematological parameters may be helpful in indicating the need for Mg supplementation.

An unusual large polythene bezoar in the rumen of a fallow deer (Dama dama)

Ingestion of indigestible foreign bodies in both domestic and wild ruminants are very common. Indigestible foreign materials can be ingested during free range grazing or under captivity in zoos or game parks. There are different types of bezoars in literature. The most common in animals are phytobezoars, trichobezoars, lactobezoars, phytotrichobezoars, lithobezoars or pharmacobezoars. This is a case study of an adult (4 years old), 40 kg body weight female Fallow Deer (Dama dama) which was reared with other four more Fallow Deer does at Riyadh Zoological Garden. The doe was found sluggish and weak. On presentation the veterinarian of the zoo noticed the anorexia, pale mucous membranes and dullness. There was Normocytic Normochromic anaemia, low RBCs and Haematocrit level, high neutrophil count and leucocytosis. The doe was subjected to medicinal and supportive therapy but she could not recover and found dead on very next day. On post-mortem examination, an unusual large polythene bezoar along with calcified stony mass recovered from the rumen. The results suggested that the rumen impaction in the Fallow Deer might be due scavenging on refused Plastic dumps in the premises left over by visitors to the zoo and that the blood biochemical alterations, alongside clinical signs, might be of some diagnostic assistance.

COMPARATIVE STUDY OF ANAEMIA CASES BASED ON PERIPHERAL BLOOD SMEARS AND CELL COUNTER GENERATED RED CELL INDICES

Background: Analyzing peripheral blood smears routinely has facilitated interpretation of various hematological disorders and has been a major diagnostic tool. The advent of automated hematology cell counter has improved accuracy, precision and safety. There is still a need to depend on manual techniques for primary calibration. This highlights the importance of maintaining the manual technical skills, Thus, the present study was undertaken to compare anaemia cases based on peripheral blood smears and cell counter generated Red blood cell (RBC) Indices. Material and Methods: The peripheral blood smears in anaemia were evaluated and compared it with cell counter generated red cell indices of 500 anemic patients. The automated analyzer SYSMEX XP-100 was used.Simultaneously, a peripheral smear was prepared according to standard operating procedures and stained by Leishman stain. Results: The cases consisted of normocytic normochromic anaemia (14%), microcytic hypochromic anaemia (76.2%), macrocytic anaemia (0.4%) and dimorphic anaemia (13.4%). In normocytic normochromic anaemia on peripheral smears 65.7% showed normal curve. In microcytic hypochromic anaemia 81.1% showed left shift. In cases of macrocytic anaemia 100% histogram showed right shift. Majority of the curves in dimorphic anaemia showed broad based curve (46.26%). Discussion: The relationship between histogram patterns and peripheral smear diagnosis in dimorphic anaemia posed queries regarding the validity of histocytograms. Hence, peripheral smear examination along with clinical history is an important diagnostic tool while handling the patients with hematological conditions.

Kasabach-Merritt phenomenon with cellulitis in infant

Kasabach-Merritt phenomenon (KMP) is consumptive coagulopathy in large vascular lesion. This condition is specific in kaposiform haemangioendothelioma (KHE) and tufted angioma, associated with high mortality rate. This condition often involves the limbs, trunk and retroperitoneum. The clinical features that are usually found are purpura, oedema, induration and ecchymosis. A boy baby aged 9 months presented with a history of violaceous tumour that appeared on his left leg at birth that became enlarged since 6 months ago that caused discrepancy between both of his legs. The patient has his left leg massaged through alternative treatment, causing it became bruised and wounded. Blood examination showed normocytic normochromic anaemia with severe thrombocytopenia and high D-dimer. The patient was diagnosed with KMP with cellulitis and treated with oral corticosteroid, propranolol and antibiotics. Diagnosis of KMP can be made through clinical and laboratory findings. Combination therapy with corticosteroid and propranolol can be considered for KMP treatment.

UNUSUAL CASE OF ANAEMIA IN ADULT MALE

A case of Anaemia which was investigated and found to be a case of Acquired Pure Red Cell Aplasia. Pure red cell aplasia (PRCA) is a syndrome defined by a normocytic normochromic anaemia with severe reticulocytopenia and marked reduction or absence of erythroid precursors from the bone marrow. It is commonly due to primary autoimmune or infection and secondary to myeloproliferative disorder. In this discussion we are presenting a case of normocytic normochromic anaemia which was admitted to our hospital after being investigated and treated several times outside. On extensive workup, we diagnosed the case as PRCA secondary to Thymoma and initiated the appropriate management.

Detection of a novel haemoplasma species in fattening pigs with skin alterations, fever and anaemia

BackgroundIn a fattening farm in Southern Germany, skin alterations (urticaria, haemorrhagic diathesis) and high fever were observed in 30% of the pigs 2 weeks after arrival. Feed intake was severely compromised in affected pigs.MethodsAfter detailed clinical observation, blood samples from affected pigs were collected for haematological, PCR and serological investigations. In addition, pathological investigations were performed on one pig.Results and conclusionAnalysis of blood parameters revealed a normocytic, normochromic anaemia. A novel porcine haemoplasma species was detected in blood samples of affected pigs and spleen sample of the necropsied pig by PCR. Phylogenetic analyses based on the 16S rDNA showed 99% identity to a novel porcine haemoplasma (‘Candidatus (Ca.) M. haemosuis’) species which has recently been described in China. Interestingly, this is the first report of ‘Ca. M. haemosuis’ in pigs with clinical signs resembling those of Mycoplasma (M) suis and the first description of this novel haemoplasma species outside Asia. On-farm affected pigs were treated with oxytetracycline and non-steroidal anti-inflammatory drugs. Clinical signs improved after implementation of treatment and optimisation of management procedures. This case might indicate that other porcine haemoplasma species than M suis can induce fever and skin alterations and may have an economic impact on affected farms.

Haematological changes associated with porcine haemoparasitic infections in Ibadan, Oyo State, Nigeria

The study was carried out between January and July 2016. Blood samples were obtained from 153 pigs by venipuncture and jugular severance at slaughter. The blood samples were examined for all known hemoparasites detectable by light microscopic examination. Haematimetric indices, complete blood cell count and leukocyte differentials were determined. The level of parasitaemia and changes in blood indices were subjected to statistical analysis across seasons. Trypanosoma brucei and Eperythrozoon suis were the only hemoparasites detected in the blood of pigs during the period of sampling. The prevalence of haemoparasitic infections in sampled pigs was 5.23%. T. brucei contributed 3.9% while E. suis contributed 1.31% to the prevalence. Anaemia (PCV<32) was a consistent and significant finding in all parasitemic samples. Eperythrozoon suis caused more severe anaemia (20±9.89) when compared with Trypanosoma brucei (27±3.03). The anaemia caused by E. suis was mostly microcytic normochromic while T. brucei mostly caused normocytic normochromic anaemia. Mild leucopenia was observed in eperythrozoonosis while a moderate lymphocytosis was observed in T. brucei infections. It was observed that in spite of intense chemoprophylaxis and other control measures employed, we still have persistent infections with Eperythrozoon sp and Trypanosomes in our pig population. Further studies should be carried out to detect the possibility of drug resistance by some of these circulating hemoparasites in the pig industry. Attempts should also be made to control the vectors of these parasites which are usually abundant during the rainy season and may be responsible for the higher prevalence recorded during this period.Keywords: Porcine, Infection, Haemoparasites, Haematological changes, Nigeria