Maitreyee Bhattacharyya

Study of bone marrow changes in antiretroviral naive human immunodeficiency virus-infected anemic patients

BACKGROUND Bone marrow changes are common throughout the course of HIV infection. There is scanty data addressing this issue in Indian subcontinent. The present study was aimed at characterizing the bone marrow changes in the antiretroviral naive HIV-infected Indian patients with anemia. MATERIALS AND METHODS This was a nonrandomized cross-sectional observational study undertaken over a period of 2 years. Forty-six randomly selected patients with documented anemia served as the study population. None of them was on any antiretroviral therapy or suffering from any known causes of anemia. All the patients underwent thorough evaluation, including bone marrow examination. RESULTS Majority of the patients had normocytic-normochromic anemia (63%), in tune with the available data. In most of the cases bone marrow was hypercellular (63.04%), although in a significant proportion it was found to be hypocellular (19.57%). Erythropoiesis was suppressed in 36.96% of patients. Dysplastic changes involving isolated cell lines ranged from 13.04% to 45.65%, dysmegakaryopoiesis being the most common, followed by dyserythropoiesis. Marrow plasmacytosis was detected in 23.91% of patients. No statistically significant correlation was detected in between immunological status (CD4 count) and marrow cellularity, myelodysplastic changes or marrow plasmacytosis. In a fair number of cases bone marrow examination aided in the diagnosis of opportunistic infections. CONCLUSIONS Bone marrow changes are common in Indian HIV-infected anemic population, particularly in the advanced stages of the disease. HIV infection should be considered in the differential diagnosis of patients with secondary myelodysplasia or unexplained bone marrow changes.

Effectiveness of Prenatal Screening for Hemoglobinopathies in a Developing Country.

Abstract The thalassemias are among the most common monogenic diseases worldwide, a national health burden in India. There are estimated 7500–12,000 babies born with β-thalassemia major (β-TM) every year in this country. Couples who are at-risk of having children with hemoglobin (Hb) disorders desired to have the option of avoiding the birth of an affected child by prenatal diagnosis (PND). Thus, the prenatal women are a highly important target group for carrier screening and preventing the birth of thalassemic children in the country. The present study was conducted among 20,883 pregnant women, irrespective of gravida and duration of pregnancy, from the prenatal clinic of Nilratan Sarkar (NRS) Medical College & Hospital, Kolkata, West Bengal, India, from February 2009 to November 2012. Thalassemia carrier status was assessed by high performance liquid chromatography (HPLC) along with red blood cell (RBC) indices. Husbands of all thalassemia carrier women were advised and persuaded to undergo screening for hemoglobinopathies. The couples were counseled to undergo PND if both of them were detected to be thalassemia carriers. The data were statistically analyzed to evaluate the efficacy of this procedure.

Lenalidomide-Induced Pure Red Cell Aplasia

Pure red cell aplasia (PRCA) is a bone marrow failure disorder. Several drugs have been reported as having induced PRCA, but lenalidomide-induced PRCA is rarely reported. Here we present a patient with myelodysplastic syndrome (MDS) who developed PRCA after treatment with lenalidomide.A 47-year-old male presented with a history of weakness with effort intolerance for 5 months. Examination showed pallor and mild splenomegaly. Blood count showed Hb level of 86 g/L, total WBC count of 5.2x10

Interferon λ3 gene (IL28B) is associated with spontaneous or treatment-induced viral clearance in hepatitis C virus-infected multitransfused patients with thalassemia: ROLE OF IL28B IN HCV-INFECTED PATIENTS

Hepatitis C virus (HCV) is the major posttransfusion infection in multitransfused individuals in India with thalassemia major. To our knowledge, this study is the first conducted to correlate and comprehend the effects of the host interleukin (IL)28B gene polymorphism at loci rs12979860 and rs8099917 in spontaneous or interferon (IFN)‐induced treatment response in the HCV‐seroreactive individuals with thalassemia major.

Case of lymphadenopathy with lytic bone lesions

Plasmablastic lymphoma, a rare highly aggressive non-Hodgkins lymphoma subtype, often associated with HIV infection, is a close differential diagnosis of plasmablastic myeloma. The 2 conditions may be morphologically and immunophenotypically identical. However, differentiating between the 2 conditions is critical for adequate patient management. Herein, we describe an unusual case of plasmablastic myeloma with biclonal gammopathy which was initially diagnosed as plasmablastic lymphoma based on lymph node biopsy and immunohistochemistry (IHC) results. The incidental finding of lytic bone lesion on imaging prompted further investigations. The presence of multiple osteolytic lesions, biclonal gammopathy on serum protein electrophoresis and immunofixation, negative Epstein-Barr virus-encoded small RNAs on IHC led to revision of the diagnosis to plasmablastic variant of multiple myeloma. The patient was initially started on bortezomib plus dose-adjusted EPOCH chemotherapy for plasmablastic lymphoma. Subsequently, he was treated with RVD (lenalidomide, bortezomib, dexamethasone) regimen for plasmablastic myeloma and he achieved stringent complete response after 4 cycles.

Isolated third nerve palsy: a rare neurological presentation of Burkitt's lymphoma

Lymphoma patient presenting with isolated third nerve palsy is relatively rare, and diagnosis of underlying disease may be challenging. Until this date, less than 20 cases have been described in the literature. This is the case of a 3-year-old boy who presented to neurologist with ptosis of left eye for 8 days. On examination, abdominal mass was detected, and the child was referred to paediatric surgery department. Laparotomy and excision of the mass was done. Histopathology and immunohistochemistry of the mass confirmed it to be a case of Burkitts lymphoma. At this point, the patient was referred to haematology department. Contrast-enhanced CT brain showed infiltration around left cavernous sinus. Patient was treated with two cycles of R-CODOX-M/R-IVAC. Ptosis improved completely within few days of starting chemotherapy. Follow-up positron emission tomography CT scan done after the second cycle of chemotherapy revealed no metabolically active disease.

Loss of CD20 expression in relapsed diffuse large b-cell lymphoma: Clinical significance of an uncommon pathological finding

I n d I a n J o u r n a l o f P a t h o l o g y a n d M I c r o b I o l o g y 5 9 ( 2 ) , a P r I l J u n e 2 0 1 6 263 3. Madan N, Sikka M, Sharma S, Rusia U, Kela K. Red cell indices and discriminant functions in the detection of beta‐thalassaemia trait in a population with high prevalence of iron deficiency anaemia. Indian J Pathol Microbiol 1999;42:55‐61. 4. Urrechaga E, Borque L, Escanero JF. The role of automated measurement of RBC subpopulations in differential diagnosis of microcytic anemia and ß‐thalassemia screening. Am J Clin Pathol 2011;135:374‐9. 5. Yeo GS, Tan KH, Liu TC. The role of discriminant functions in screening for beta‐thalassaemia traits during pregnancy. Singapore Med J 1995;36:615‐8. This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

Concomitant occurrence of multiple myeloma with diffuse large B-cell lymphoma

Editor, Diffuse large B-cell lymphoma (DLBCL) is the most prevalent subtype of non-Hodgkin lymphoma (NHL), with a diverse pathobiology while multiple myeloma (MM), a neoplastic disease involving the clonal proliferation of terminally differentiated plasma cells, is the second most common hematologic neoplasm.[1] The simultaneous presentation of these neoplasms is exceedingly rare, and we present such a case of synchronous DLBCL and MM in a male patient.[2]

Thyroid abscess in case of Pre B acute lymphoblastic leukaemia: a rare presentation

Thyroid abscess is a very rare clinical condition. It usually occurs in immunocompromised individuals or those with underlying malignancy. We report a case of multiple thyroid abscesses in the patient with Pre B acute lymphoblastic leukaemia which developed secondary to hematogenous spread from pyomyositis of right calf muscle. The patient developed sepsis-associated disseminated intravascular coagulation, which got resolved after thyroidectomy. He became afebrile after surgical intervention. Unfortunately, all the cultures were negative. Since there are few case series and reports, there are no clear guidelines for management of thyroid abscess. We conclude that though rare, thyroid abscess may be the cause of persistent fever in immunocompromised patients.

Rituximab-containing chemotherapy in pregnancy with malignancy

Non-Hodgkin lymphoma diagnosed during pregnancy often has an aggressive histology, with diffuse large B-cell or peripheral T-cell lymphomas being most common in this context. Aggressive lymphomas during pregnancy present a difficult challenge in diagnosis, especially in staging by means of radiological evaluation. The aim of the treatment is to give the mother the best chance for cure but at the same time with minimal harm to the fetus. Most cytotoxic agents, including rituximab, cross the human placenta and reach the fetus. Rituximab-based chemotherapy (R-CHOP) is now considered the standard of care and generally considered safe for the treatment of aggressive lymphomas during pregnancy except during the first trimester.