Background: Preanalytical variability in haematological testing due to anticoagulant choice remains poorly characterized in resource-limited tropical settings. Objectives: To compare K2EDTA and K3EDTA effects on CBC parameters in Yemeni laboratories as a model for resource-limited tropical settings. Methods: We conducted a prospective study of 100 venous blood samples from healthy adult male volunteers in Ad'Dla Governorate, Yemen, between January and March 2025. Samples were collected in duplicate using K2EDTA and K3EDTA tubes, analysed using a Sysmex KX-21N haematology analyser at baseline (T0) and after six hours of storage at 22 ± 2℃ (T6). Data were analysed using repeated-measures ANOVA and paired t-tests. Results: Fresh samples showed high inter-anticoagulant concordance (ICC > 0.90). After 6-hour storage, K2EDTA exhibited significant MCV reduction (Δ = -2.33 FL, p < 0.001), while K3EDTA showed greater RBC instability (Δ = -0.16 × 1012/L, p = 0.008). Platelet activation markers increased in both anticoagulants (p < 0.01). A novel bidirectional RDW-SD pattern emerged: K2EDTA increased values (+1.71%) while K3EDTA decreased them (-2.20%, both p < 0.01). Conclusion: K2EDTA demonstrates superior stability for delayed processing (> 2 hours), while K3EDTA is preferable for immediate analysis. What This Study Adds": First Yemeni data demonstrating K2EDTA’s superior stability for delayed processing in tropical climates, supporting WHO standardization efforts. These findings support protocol adjustments for African and Middle Eastern laboratories.
Introduction: Glanzmann's thrombasthenia (GT) is a rare bleeding disorder caused by quantitative or qualitative deficiencies of the αIIbβ3 fibrinogen receptor on platelets. Platelet count and morphology are typically normal, but there is dysfunction in platelet aggregation. The global incidence is approximately 1 in 1,000,000 individuals. GT can lead to severe hemorrhages, particularly in post-traumatic or perioperative settings. Objective: To describe the management of a case of GT diagnosed following intraoperative bleeding during mammoplasty and dermolipectomy. Methodology: The study presents an epidemiological design of the descriptive observational type, involving analysis of the patient's medical records. Approval was obtained from the Human Research Ethics Committee. The case description adhered to the precepts outlined in the CARE Guideline. Case description: A 33-year-old female Caucasian with non-consanguineous parents presented to a specialized hematology consultation with complaints of bleeding during mammoplasty and dermolipectomy. Laboratory tests, including a detailed coagulogram and platelet aggregometry, were performed. The results were conclusive for GT, leading to targeted management. Discussion: The platelet light transmission aggregometry test serves as the gold standard for diagnosing GT. Early recognition of the condition is crucial to prevent severe bleeding episodes. Currently, there is no cure for GT, and treatment strategies vary based on the severity of the case. Platelet transfusion remains the most commonly employed method, while the use of activated recombinant factor VII (rFVIIa) shows promise in reducing both the frequency and severity of bleeding episodes.
Pulmonary embolism is a well known culprit in the medical world with a mortality as high as 30% for untreated population [1]. Multiple risk factors have been described including, but not limited to immobility, trauma, oral contraceptive use, drugs, and malignancy. One of the most common risk factors widely recognized is oral contraceptive use in females. However, there are only limited case reports of pulmonary embolism associated with hormone use therapy in males [2-4]. Here, we describe a case of a middle aged male with hypogonadism treated with clomiphene that developed pulmonary embolism. After recognizing Clomiphene as a plausible cause, the drug was discontinued, and the patient was treated with intravenous heparin while in the hospital and subsequently discharged on a direct oral anticoagulant. His workup was negative for malignancy, thrombophilia, and infection. He did not have other known risk factors for pulmonary embolism including trauma, recent surgery, or immobilization. Pulmonary embolism (PE) is a common occurrence resulting in significant morbidity and mortality. Clinical pictures of pulmonary embolism can vary ranging from asymptomatic incidental findings to sudden cardiac death [5]. Pulmonary embolism can be categorized as provoked or unprovoked. Common causes of provoked pulmonary embolism are recent trauma, surgery, immobilization, longair travel, autoimmune disease, and inherited thrombophilia [6]. Medications such as hormonal contraceptives, other hormonal therapy, and glucocorticoids can increase the risk for pulmonary embolism. While less common, there are a few cases reported for Clomiphene citrate associated with pulmonary embolism. Clomiphene citrate has also been associated with other thromboembolic complications like central retinal vein occlusion and intracranial venous thrombosis [7,8].
Background: Long-term storage of whole blood results in lesions, alterations in the biophysical, biochemical, and immunological characteristics of the cells. Each year, in Nigeria, about 1.5 million units of blood are used for blood transfusions as treatment intervention to a variety of medical conditions. This cross-sectional study evaluated changes in the levels of P-selectin, C-reactive protein and Hematological indices with respect to long-time storage of whole blood meant for transfusion in Port Harcourt. Materials and methods: Blood Samples free of hepatitis B and C, syphilis and human immunodeficiency viruses 1 and 2 were randomly withdrawn from eligible 52 healthy donors aged 18-54 years who were at the Rivers State University Teaching Hospital for blood donation. From the 450 milliliters blood withdrawn into Citrate Phosphate Dextrose Adenine -1 (CPDA-1) containing blood bag, 30 ml was taken and stored at 2 °C - 8 °C for 35 days, 5 ml was used each day for Full blood count analysis with HM - 200x autoanalyzer on days 0, 7, 14, 21, 28, and 35. P-selectin and C-reactive Proteins were assayed using Enzyme Linked Immunosorbent Assay sandwich kit from Ela science. A well-structured questionnaire served for medication history, smoking and alcohol intake. Results were analyzed using Statistical Analysis Software version 9.4 and expressed as (mean ± SEM). Comparison of means was done with One-way analysis of variance (ANOVA), significance level set at P < 0.05 and results were represented in tables. Results: During the 35 days of blood storage, the study observed a consistent statistically significant increase (p < 0.0001) in P-selectin, reduced C-reactive protein concentration though not statistically significant (p > 0.05), significant decrease (p < 0.0001) in White blood cells indices, significant increase (p < 0.0001) in red blood cell, hemoglobin, hematocrit and mean cell hemoglobin. Significantly decreased (p < 0.0001) in Mean cell volume and mean cell hemoglobin concentration and statistically significant reduction (p < 0.0001) in Platelets Indies. Conclusion: This study concludes that Storage of whole blood collected in CPDA-1 for duration of 35 days caused significant upregulation in P-selectin concentration, while the hematological constituents of the blood also showed depleted viability.
