Background: Multiple myeloma (MM) is a hematological malignancy characterized by systemic inflammation and frequent renal involvement. The C-reactive protein-to-albumin ratio (CAR) has emerged as a potential inflammation-based biomarker; however, its clinical significance in MM remains incompletely understood. Methods: This retrospective single-center study included 62 patients with MM. Clinical and laboratory data at diagnosis were collected, and CAR was calculated as the ratio of CRP to serum albumin. Patients were stratified into low and high CAR groups based on the median value (0.13). Survival outcomes were assessed using the Kaplan–Meier method. Results: The mean age was 65.9 ± 9.9 years, and 54.8% of patients were male. Higher CAR levels were associated with shorter overall survival (123 vs. 89 months, p = 0.32) and progression-free survival (60 vs. 36 months, p = 0.16), although these differences did not reach statistical significance. An unexpected finding was that the requirement for dialysis was higher in the low-CAR group (21.2% vs. 3.4%, p = 0.04). Other clinical and laboratory parameters were comparable between groups. Conclusions: CAR may reflect systemic inflammatory status in patients with MM; however, its prognostic value for survival remains uncertain in this cohort. The observed findings, particularly regarding renal outcomes, should be interpreted with caution. Larger prospective studies are needed to clarify the clinical utility of CAR in MM.
Pre-hospital use of whole blood is becoming increasingly prevalent in EMS and military medicine. Technologies to store, transport, warm up, and transfuse the blood are now available, and the outcome of whole blood transfusion seems to be superior to infusion of crystalloid solutions or plasma and at least equivalent to packed cells with plasma. The auto-transfusion tourniquet (A-TT®, Oneg HaKarmel Ltd., Tirat Carmel, Israel) is a non-invasive device that shifts the patient’s own blood from the legs to the core and blocks its reentry. The A-TT consists of an elastic ring made of a stainless-steel coil, wrapped by an elastic sleeve and pulling straps. When rolled up the leg(s), it squeezes the soft-tissues’ blood into the central circulation, and the ring stops the return of blood to the leg. The application time of the A-TT is less than 20 s per leg, and the A-TT transfers more than 500 mL of blood from each leg to the core. The auto-transfused blood is of the patient’s own type, has full oxygen carrying capacity, is normothermic, and is not anticoagulated. The device can be applied by a trained first responder, even during transport, and its use can be titrated to avoid overshooting the patient’s blood pressure. The device can be kept on the leg for up to 2 h, and as such, can serve as a bridge to blood or a bridge to definitive care. This paper is a hypothesis-generating review that defines the potential role of the A-TT in settings where blood is not available and is a call for others to help generate more data.
Background: The co-existence of hemophilia and cancer presents one of the most complex clinical scenarios, demanding individualised therapeutic planning to balance oncologic efficacy and hemostatic safety. This study evaluated the ability of two Large Language Models (LLMs)—ChatGPT (GPT-4) and Microsoft Copilot (GPT-4–based)—to generate clinically appropriate recommendations for real cases of hemophilia with concurrent malignancy. Methods: Six consecutive adult cases of hemophilia and cancer, managed at the Hemophilia Centre of Padua, Italy, were selected for evaluation. Identical structured prompts were submitted to both LLMs. Two independent expert clinicians rated the model outputs across five domains (Decision/Rationale, Strategy, Selected Drug, Regimen, and Assessment) using a four-level ordinal scale. Results: LLMs demonstrated uneven performances. Outputs were consistently rated as highly reliable in domains involving high-level synthesis, such as Assessment and Strategy. However, substantial limitations were observed in the clinically demanding domains of Selected Drug and Regimen. Critically, in the Selected Drug domain, there was complete agreement between the two expert raters for neither system. This severe lack of concordance signifies that clinicians assigned different adequacy ratings to the same output in every case, reflecting ambiguity, lack of specificity, and inconsistent clinical interpretability of the drug-related information provided by LLMs. Conclusions: While LLMs possess the capacity for high-level reasoning and strategic planning, their inability to translate principles into precise, consistent, and clinically interpretable therapeutic plans—particularly regarding drug selection and treatment regimens—is a significant constraint. These deficiencies, highlighted by the minimal expert concordance in critical domains, necessitate rigorous clinical validation before the responsible integration of LLMs into the management of this uniquely vulnerable patient population.
Survivors of primary gastric lymphoma (PGL) face a significantly elevated and persistent risk of developing second primary malignancies (SPMs), with gastric adenocarcinoma representing the most frequent SPM and standardized incidence ratios reaching up to 16-fold above the general population. This excess risk persists for decades after initial treatment and is associated with increased cause-specific mortality compared to matched primary cancers. Among patients with PGL, approximately 5% develop gastric cancer (with two-thirds being metachronous), and nearly 15% harbor precancerous lesions including atrophic gastritis, intestinal metaplasia, and dysplasia. Beyond gastric malignancies, survivors also experience elevated rates of extra-gastric SPMs, particularly digestive system tumors (43%), respiratory cancers (21%), and urinary tract malignancies (13%). Key risk factors include treatment with immunochemotherapy or radiotherapy, advanced age, male sex, advanced stage at diagnosis, ulcerative-type lymphoma morphology, and persistent Helicobacter pylori (HP) infection. Patients receiving combined chemoradiotherapy demonstrate the highest SPM risk, particularly for gastric and pancreatic cancers. These findings underscore the critical importance of lifelong, risk-adapted surveillance strategies integrating both hematology and gastroenterology follow-up. Annual endoscopic surveillance is recommended for high-risk patients, with intervals adjusted according to lymphoma histology, HP status, and the presence of precancerous gastric lesions. Mandatory HP eradication with confirmation of response is essential for reducing gastric cancer risk. Future research priorities include prospective, standardized studies to better quantify SPM risk, validation of molecular and microbiological biomarkers for individualized risk stratification, and development of predictive models to enable personalized surveillance protocols and improve long-term outcomes in this vulnerable population.
Background: Sickle cell disease (SCD) patients have increased susceptibility to infections, particularly encapsulated bacterial pathogens such as Streptococcus pneumoniae and Haemophilus influenzae type b. Hyposplenism as well as immune defects in SCD result in increased risks for infections; these are the most frequent complications in individuals with SCD. This study was performed within the African Research and Innovative initiative for Sickle cell Education (ARISE, EC GA No 824021) project to develop best practices in the clinical management of SCD. In this retrospective study we aimed to determine the most prevalent reported infections among SCD patients’ records during clinic visits at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Methods: The medical records of 1961 paediatric SCD patients from 1998 to 2023 were extracted and reviewed from a pilot electronic registry using a structural query. The data analysed patterns of infections reported during clinic visits at the ABUTH, Zaria, Nigeria. Results: 458 subjects (23.4%) manifesting at least one infection, of whom 392 (19.9%) subjects had a single infection (bacterial or parasitic) and 173 (8.8%) had more than one infection (bacterial and parasitic). Conclusions: Bacterial and parasitic infections are a significant complication of SCD patients attending a tertiary institution in northern Nigeria.
Background: In hematologic malignancies, treatment allocation and outcome prediction are traditionally driven by clinical and biological parameters. However, growing evidence suggests that non-clinical factors—such as psychosocial context, caregiver availability, organizational support, and digital health integration—play a pivotal role in patients’ ability to tolerate and adhere to complex therapeutic pathways. The concept of “resilience” may offer a more comprehensive framework to capture this multidimensional readiness to treatment. Methods: We conducted a narrative review of the literature focusing on patient and caregiver resilience in hematologic settings. PubMed, Scopus, and Web of Science were searched for studies published in English over the last 15 years, addressing clinical, psychosocial, organizational, and contextual determinants influencing treatment tolerance, continuity of care, and outcomes in hematology. Results: the literature highlights resilience as a dynamic construct shaped by clinical fitness, psychological resources, caregiver competence, social and family context, healthcare system organization, and access to supportive technologies such as telemedicine. Several domains emerged as recurrent determinants of resilience, yet no standardized, integrated assessment tool is currently available in routine hematologic practice. Conclusions: Resilience in hematology should be reframed as a multidimensional, context-dependent construct extending beyond traditional clinical fitness. Incorporating resilience-oriented assessment into clinical workflows may improve treatment personalization, optimize resource allocation, and enhance patient- and caregiver-centered care. Future research should focus on developing pragmatic, clinically applicable tools to operationalize resilience in real-world hematologic settings.
Background: The associations between mean corpuscular volume (MCV) and leukocyte-derived ratios and chronological aging remain poorly understood. We aimed to evaluate the association between MCV and leukocyte-derived ratios and chronological age in U.S. adults. Methods: This cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES, n = 9259) and the Health and Aging Brain Study–Health Disparities (HABS-HD, n = 770). Participants were aged ≥20 years, and individuals with hemoglobin levels outside 12–18 g/dL or C-reactive protein (CRP) > 1 mg/dL were excluded. Associations between age and MCV, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-to-monocyte ratio (NMR), and platelet-to-white blood cell ratio (PWR) were examined using quartile comparisons and multivariable linear regression adjusted for sex, race/ethnicity, CRP, and red cell folate and hemoglobin. Results: In both cohorts, higher quartiles of MCV, NLR, and MLR were associated with older mean age. In adjusted marker-specific models, MCV, NLR, and MLR were each positively associated with chronological age. In composite models, MCV remained independently associated with older age in both NHANES (β = 0.646, 95% CI 0.567–0.725) and HABS–HD (β = 0.300, 95% CI 0.156–0.445). Conclusions: MCV and selected leukocyte-derived ratios are significantly associated with chronological age across two U.S. cohorts, with MCV showing the most consistent independent association.
Acute lymphoblastic leukemia (ALL) is a genetically and epigenetically heterogeneous malignant disease characterized by different subtypes with varying sensitivities to conventional chemotherapy. Despite significant improvements in survival rates, relapse remains the primary cause of treatment failure, often associated with intrinsic or acquired drug resistance. First-line therapy at diagnosis represents a major determinant of relapse in ALL. In this study, we performed a transcriptome and drug response profiling analysis to identify subtype-specific cell surface proteins that are overexpressed in patients with poor response to induction therapy. We summarize the current state of knowledge regarding chemotherapy responses, resistance mechanisms to standard cytostatic drugs and the increasing importance of cell biomarkers as predictors of an adverse disease course and potential therapeutic targets. We discuss the results of clinical and molecular studies linking specific genomic alterations—such as KMT2A-rearrangements, Ph-like, DUX4-rearrangements and T-ALL—to drug resistance and highlight surface antigens like CSPG4, HER2, MCAM and ROR1 that define high-risk leukemia phenotypes. The integration of transcriptomic, immunophenotypic and drug response data could enable a new generation of risk-adapted, surface-directed strategies for relapse treatment in ALL. Our analysis therefore provides subtype-specific predictive therapeutic targets for relapse treatment in ALL.
Blastic plasmocytoid dendritic cell neoplasm (BPDCN) is a rare myeloid malignancy, characterized by the involvement of multiple organs, including the skin, bone marrow and blood, lymph nodes and the central nervous system. According to tumor location, the disease is classified as skin-only, systemic-only, and skin and systemic. The cutaneous manifestations of disease are typical and are represented by violaceous single tumors or multiple plaques present in sun-exposed cutaneous areas. BPDCN is issued from the malignant transformation of dendritic cell progenitors and is diagnosed using the classical immunophenotypes CD123, CD4 and CD56 in addition to specific membrane markers of plasmocytoid dendritic cells. BPDCN is an aggressive disease and is associated with a short survival. Upfront therapies involve either chemotherapy regimens in fit patients and CD123-targeted therapies, including interleukin-3 conjugated with diphtheria toxin (Tagraxofusp, SL-401), or Pivekimab sunirine, an anti-IL-3R-drug conjugate, for both fit and unfit patients. Targeted treatments limit the toxicities of chemotherapy and allow the bridging of a consistent proportion of patients to hematopoietic stem cell transplantation, the only treatment associated with potential long-term survival.
Background: Sepsis remains a leading cause of mortality in the intensive care unit (ICU). Platelets (PLTs) are central to coagulation, inflammation, and the maintenance of endothelial integrity. Although thrombocytopenia is an established prognostic marker in sepsis, alterations in PLT function and morphology may provide additional insight into disease progression. Methods: This retrospective pilot study examined adult ICU patients diagnosed with sepsis or septic shock. Extracted data included demographic characteristics, clinical variables, and laboratory parameters. Platelet function was evaluated using impedance aggregometry and rotational thromboelastometry (ROTEM), while PLT morphology metrics were obtained from complete blood counts. Statistical analyses comprised Spearman’s rank correlation and logistic regression. Results: Twenty patients were included. Platelet aggregation was impaired across ASPI, ADP, and TRAP-6 assays despite normal PLT counts and morphology. ROTEM-derived measure of PLT contribution to clot strength was within normal ranges. No correlations were observed between PLT function and PLT morphology parameters. An inverse correlation was identified between ROTEM-derived PLT contribution to clot strength and SOFA score (r = −0.60, p = 0.03). Neither PLT function nor PLT morphology was associated with ICU mortality. Conclusions: Functional PLT deficits may occur in sepsis in the absence of structural abnormalities. ROTEM-derived PLT contribution to clot strength may inversely reflect sepsis severity. Platelet function parameters appear unlikely to predict short-term mortality in septic patients.
Background: Chronic lymphocytic leukemia (CLL) is a biologically heterogeneous disease characterized by variable clinical outcomes. The introduction of targeted therapies, particularly the BCL-2 inhibitor venetoclax, has significantly improved treatment outcomes in patients with relapsed/refractory (R/R) CLL. However, real-world data on the safety and effectiveness of venetoclax-based regimens remain limited. Methods: In this multicenter retrospective study, 147 adult patients with R/R CLL treated with venetoclax between April 2019 and August 2025 were analyzed. Venetoclax was administered as monotherapy or in combination with rituximab, obinutuzumab, or ibrutinib. Adverse events were graded according to CTCAE v4.0, and treatment responses were assessed based on IWCLL criteria. Survival outcomes, including overall survival (OS) and progression-free survival (PFS), were evaluated using Kaplan–Meier analysis. Results: The median age at venetoclax initiation was 64 years, and patients had received a median of two prior lines of therapy. Combination therapy was administered in 78.9% of patients. The overall response rate was 83.0%, including complete remission in 65.3% of patients. Grade ≥ 3 hematologic adverse events included neutropenia (18.4%), thrombocytopenia (14.3%), and anemia (7.5%). Tumor lysis syndrome (TLS) occurred in 28.6% of patients, predominantly during the dose ramp-up phase. At a median follow-up of 61 months, median OS and PFS were both 60 months. Bulky disease was associated with inferior survival outcomes. Conclusions: Venetoclax-based therapy is effective and well tolerated in patients with R/R CLL in a real-world setting. High response rates and durable survival outcomes were observed despite the inclusion of patients with high-risk clinical and biological features. These findings support the use of venetoclax as a key component of modern CLL treatment strategies and highlight the importance of real-world evidence in optimizing patient management.
Myeloid/lymphoid neoplasms with tyrosine kinase rearrangements (MLN-TKs) are rare clonal eosinophilias driven by PDGFRA, PDGFRB and other kinase fusions, highly sensitive to tyrosine kinase inhibitors. Their detection remains challenging, particularly for cryptic PDGFRA rearrangements. We performed a large multicenter real-world validation of the generic quantitative RT-PCR assay (gPDGFR), which detects 3′ PDGFRA/PDGFRB overexpression independently of fusion partner. A total of 231 consecutive patients with hypereosinophilia from 12 French centers were analyzed, and assay robustness was further assessed in an independent heterogeneous cohort of 102 tyrosine kinase inhibitor (TKI)-treated patients. Twenty-two PDGFR-rearranged cases (14 PDGFRA-r, 8 PDGFRB-r) were identified. The assay demonstrated 100% sensitivity and 100% negative predictive value. For PDGFRA, positive predictive value and specificity reached 100%. In contrast, PDGFRB overexpression showed lower specificity due to borderline false-positive cases, underscoring the need for confirmatory testing. In selected patients, longitudinal gPDGFR kinetics paralleled fusion-specific RT-qPCR, supporting its use for molecular follow-up when dedicated assays are unavailable, although it does not provide quantitative measurable residual disease assessment. Overall, gPDGFR represents a robust, partner-independent first-line screening strategy that can be readily integrated into routine diagnostic workflows to enable timely identification of patients eligible for targeted therapy.
Introduction: The concomitant occurrence of myeloproliferative neoplasms (MPNs) and plasma cell dyscrasias is rare and presents significant diagnostic challenges. Accurate distinction between overlapping features is essential, particularly when bone marrow fibrosis (BMF) is present. Case Description: We report a 57-year-old female, with a 10-year history of thrombocytosis managed with antiplatelet therapy, who presented with anemia and severe lumbar pain. Bone marrow biopsy revealed marked fibrosis, and imaging revealed multiple vertebral lesions. Diagnostic workup identified features consistent with myelofibrosis (MF) and coexisting IgG-Kappa multiple myeloma (MM). Although the patient initially fulfilled WHO criteria for MF, the rapid resolution of fibrosis following first-line plasma-cell-directed therapy suggested a secondary, cytokine-mediated process rather than a true concomitant MPN. Conclusions: This case highlights the importance of an integrated diagnostic approach in patients with overlapping features of hematologic malignancies. Differentiating between MM-associated fibrosis and true concurrent MPN and MM is critical, as misclassification may alter both prognosis and therapeutic strategy. In triple-negative cases, the histologic response to plasma-cell-directed therapy can serve as a key discriminating criterion. Awareness of the potential association between MM with fibrosis and extramedullary disease is also essential for clinical management. This case underscores the importance of an integrated diagnostic approach in patients with overlapping hematologic features.
We report a female in her late 80s with high-risk pleomorphic mantle cell lymphoma (MCL) harboring germline ATM mutation and 17p deletion who achieved complete metabolic response with zanubrutinib plus rituximab. Serial peripheral blood next-generation sequencing (NGS) during remission revealed emergence of a molecularly distinct pre-leukemic clone characterized by DNMT3A, TET2, and a TP53 point mutation (p.Tyr220Cys)—distinct from the original 17p deletion. Approximately 20 months after MCL diagnosis, she developed acute myeloid leukemia (AML) with FLT3-TKD and NPM1 mutations, confirming transformation of the pre-leukemic clone. Longitudinal VAF tracking demonstrated complete eradication of MCL-associated mutations (ID3, BIRC3) while the myeloid clone expanded. This case provides direct molecular evidence that AML arose from clonal evolution of a pre-existing hematopoietic clone rather than direct MCL transformation, with implications for understanding second malignancies in BTK inhibitor-treated patients.
Background/objectives. Clostridioides difficile infection (CDI) remains a major cause of healthcare-associated infectious colitis, particularly among elderly and multimorbid patients. Disease severity and clinical evolution are influenced by the host’s systemic inflammatory response. This study aimed to evaluate the hematological and inflammatory profile of hospitalized CDI patients and to explore the prognostic value of routine laboratory parameters for prolonged hospitalization. Methods. A retrospective observational study was conducted on 50 adult patients hospitalized with laboratory-confirmed CDI (positive glutamate dehydrogenase, antigen and toxins A/B). Hematological parameters (WBC, hemoglobin, RDW) and inflammatory markers (CRP, fibrinogen) were analyzed at admission and discharge. Prolonged hospitalization was defined as length of stay (LOS) > 8 days (cohort median). Multivariable logistic regression was performed to assess admission predictors of prolonged hospitalization, and model discrimination was evaluated using leave-one-out cross-validation (LOOCV). Results. At admission, patients exhibited marked inflammatory activation accompanied by reduced hemoglobin and elevated RDW. Significant correlations were observed between inflammatory markers. All inflammatory and hematologic parameters improved at discharge. In multivariable analysis, lower admission hemoglobin and higher log-transformed CRP showed exploratory associations with prolonged hospitalization. The internally validated model demonstrated moderate discriminative performance (AUC = 0.65). Conclusions. CDI is associated with substantial systemic inflammatory activation and hematologic alterations. While no individual predictor reached statistical significance, the observed effect sizes provide hypothesis-generating estimates to inform future prospective validation studies.
Flow cytometry is an essential diagnostic method in hematology, and one of its main applications is the assessment of the clonality of mature B cells. We present a case report of a patient referred for the investigation of absolute lymphocytosis. The flow cytometry study revealed an increased percentage of B cells, but it could not establish B-cell clonality, based on the study of surface light chains in combination with the pattern of expression of mature B-cell markers. The diagnosis of Persistent Polyclonal B-cell Lymphocytosis (PPBL) was considered in the differential diagnosis as the mature B cells were found to be immunophenotypically memory B cells. However, due to the markedly elevated count of B cells, molecular testing with Polymerase Chain Reaction (PCR) for B-cell clonality based on IGH (Immunoglobulin Heavy Chain) gene rearrangements was performed, and it revealed the presence of two clones of B cells. Approximately one year later, the same work-up was repeated in the patient’s bone marrow aspirate. By flow cytometry, a distinct clonal B-cell population was isolated, while the molecular testing with PCR for B cell clonality based on IGH heavy-chain gene rearrangements revealed the presence of three clones of B cells. In addition, evaluation of the sample with high-dimensional mass cytometry showed the presence of four major immunophenotypically abnormal B-cell subsets.
Marginal zone lymphomas (MZLs) are indolent mature B-cell neoplasms. Approximately 3.4% of gastrointestinal mucosa-associated lymphoid tissue (MALT) lymphomas involve the small bowel. Pseudoaneurysmal dilation has been reported in up to 35% of patients with small bowel MALT lymphoma. We report the case of a 73-year-old woman with ulcerative colitis in remission who presented with hematuria, constitutional symptoms, and progressive respiratory distress. Imaging incidentally revealed pseudoaneurysmal dilation of the small bowel and thoracic findings suggestive of pulmonary lymphangitic dissemination. A PET scan showed lung, nodal, and small bowel infiltration. Histopathological and flow cytometry examinations confirmed small bowel MZL, and bone marrow biopsy excluded marrow involvement. The patient was treated with R-CHOP chemotherapy and then R-Bendamustine, achieving complete clinical and radiological remission. This case illustrates a rare presentation of intestinal MALT lymphoma and emphasizes the diagnostic significance of correlating imaging and clinical findings in identifying pseudoaneurysmal dilatation and distinguishing it from other potential causes.
Background: Feto-maternal hemorrhages (FMHs) due to placenta disruption and bleeding from fetal maternal circulation can lead to life-threatening fetal anemia. These hemorrhages are more often of small volume and remain unreported. Sensitization to fetal red blood cell (RBC) antigens can occur during pregnancy, at delivery, or after invasive procedures. The sensitized mother produces IgG antibodies (abs) that cross the placenta and cause the hemolysis of fetal RBCs, release of hemoglobin, and increased levels of unconjugated bilirubin in the fetus or neonate. The result is hemolytic disease of the fetus and newborn (HDFN). Methods: In this study, we aim to provide a structured overview of RBC alloimmunization in pregnancy. A literature search was conducted using PubMed. English articles published from January 2010 to October 2025 were selected by the authors. The contributing manuscripts focused on managing RBC alloimmunization in pregnancy, FMH screening and quantification, antenatal and postnatal testing, Rh immune globulin (Rh Ig or Anti-D) prophylaxis, and national registry data. Results: Frequencies of RBC abs vary among American, Caucasian, and Asian populations because of genetic diversity, different antibody detection and antibody identification methods, and FMH tests. More specifically, the erythrocyte rosette is a simple screening test for FMH. A positive rosette must be quantified by the Kleihauer–Betke (KB) or flow cytometry (FC). The KB results may be overestimated or underestimated. The advantages of FC include high accuracy, specificity, and repeatability. Ultimately, anti-D prophylaxis protocol varies from country to country. Conclusion: Maternal alloimmunization is an uncommon and highly variable event. Although introducing anti-D prophylaxis has decreased the Rh immunization rate, it is still an unmet medical need. In brief, mitigation strategies for RBC alloimmunization risk include accurate maternal and neonatal testing at different time points, adequate Rh immune globulin prophylaxis in D-negative pregnant women, preventing sensitizing events, adopting a conservative transfusion policy, and upfront ABO and Rh (C/c, E/e) and Kell matching in females under 50 years of age.
Background: Sickle cell disease (SCD) is a hereditary blood disorder marked by the production of abnormally shaped, rigid red blood cells that obstruct blood flow, resulting in pain, organ damage, and increased infection risk. SCD poses a significant public health challenge in Nigeria, which has the highest global burden, with about 150,000 affected children born annually. The high prevalence is exacerbated by limited healthcare infrastructure, low public awareness, and socio-economic barriers, making effective disease management difficult. Understanding the knowledge of home-based caregivers is essential to identify gaps that may impact care quality. This study was performed within the African Research and Innovative Initiative for Sickle Cell Education (ARISE, EC GA No 824021) project to develop best practice in the clinical management of SCD. Aim: This study explores the knowledge, experiences, and educational needs of home-based caregivers of children with SCD attending the Paediatric Haematology Clinic, ABUTH, Zaria. Methods: A qualitative case study design was used, involving in-depth interviews with ten purposively selected caregivers. Interviews were conducted in Hausa, transcribed, and translated into English. Thematic analysis was performed. Results: Four themes emerged: 1. Understanding of SCD aetiology 2. Knowledge of symptoms 3. Awareness of complications and 4. Knowledge of SCD type. Conclusions: Home-based caregivers had limited knowledge of the genetic basis of the disease, but possess some knowledge of SCD key symptoms, enabling basic disease management and healthcare seeking. However, there is a need to enhance caregiver education to improve care quality and health-seeking behaviour for children with SCD.
Objective: This study aimed to investigate erythrocyte morphological alterations in hematological malignancies, with particular emphasis on structural differences among leukemia subtypes and anemia. Materials and Methods: Peripheral blood samples were obtained from 60 patients, including individuals with anemia (n = 10), acute lymphoblastic leukemia (ALL, n = 15), acute myeloid leukemia (AML, n = 15), chronic lymphocytic leukemia (CLL, n = 15), and chronic myeloid leukemia (CML, n = 5), as well as 10 healthy controls. Erythrocyte morphology was evaluated using light microscopy and scanning electron microscopy. Morphological abnormalities, including loss of biconcavity, poikilocytosis, echinocyte transformation, burr cells, and stomatocytes, were assessed in accordance with International Council for Standardization in Haematology (ICSH)-based morphological definitions. Results: Distinct erythrocyte morphological alterations were observed across disease groups. AML cases demonstrated pronounced central depression-like or perforation-like structures and hypochromasia. Lymphoid malignancies, particularly ALL and CLL, exhibited increased echinocyte formation, whereas chronic leukemias showed a higher prevalence of stomatocytes and cup-shaped cells. Quantitative scoring indicated that loss of biconcavity was most prominent in anemia, followed by AML, CML, ALL, and CLL. Poikilocytosis was most frequent in anemia, followed by ALL, CLL, AML, and CML. Conclusions: The findings indicate that erythrocyte shape alterations are more heterogeneous and prominent in lymphoid leukemias, whereas myeloid leukemias exhibit distinct ultrastructural membrane abnormalities. Although studies focusing on erythrocyte morphology in leukemia remain limited, the present results provide a foundational morphological reference dataset that may support the development and validation of artificial intelligence-based diagnostic approaches. Further studies involving larger cohorts and expanded imaging analyses are warranted to improve diagnostic accuracy and translational applicability.
