Hematological Disorders during Chronic Kidney Disease Stages 3 to 5 Non-Dialysed in Cameroon

Introduction: Haematological disorders are common complications of chronic kidney disease (CKD) leading by anemia which increase with the severity of the disease. Objective: Assess the haematological profile of CKD patients stages 3 to 5 non-dialysed seen at the first nephrology consultation in Cameroon. Patients and Methods: A hospital-based cross-sectional study was conducted from February to July 2018 at the nephrology unit of the Yaounde University Teaching Hospital and Douala General Hospital. All adults’ (≥18 years old) patients who provided a written informed consent and attended their first nephrology consultation with a nephrologist diagnosis of CKD stages 3 to 5 non-dialysed were included. Clinical and paraclinical data (serum creatinine, full blood count, reticulocytes count, iron status, vitamin B12 and folates count, and bleeding time) were collected. Parametric, non-parametric and correlations tests were used to compare variables. Results: We included 105 (59% males) participants with a mean age of 55.2 ± 13.6 years divided into 20 (19%), 36 (34.3%) and 49 (46.7%) respectively in stage G3, G4 and G5 of CKD. The profile of hematological abnormalities was anemia (86.7%), leucopenia (15.2%), hyperleucocytosis (6.7%), thrombopenia (23.8%), thrombocytosis (3.8%) and prolonged bleeding time (13.3%) without any association with the stage of CKD (p > 0.05). The pattern of anemia was mainly normocytic and normochromic (59.3%) and aregenerative (92.3%) with iron deficiency found in 23 (21.9%) participants. There was no case of vitamin B12 and folates deficiency. Prolonged bleeding time was observed in 14 (13.3%) participants with a weak correlation between platelets count and bleeding time (r = 0.122). Conclusion: We observed that aregenerative normocytic normochromic anemia is the leading haematological abnormality during CKD in this setting. None of the full blood count parameters was associated with CKD stages and there was a week correlation between bleeding time and platelet count.

Molecular genetic evidence of Y chromosome loss in male patients with hematological disorders

Background There has been continuous debate as to whether Y chromosome loss is an age related phenomenon or a cytogenetic marker indicating a malignant change. This study aimed to investigate the frequency of Y chromosome loss in the specific patients in order to determine whether it is an age related phenomena or a cytogenetic marker indicating a malignant change. Methods Five hundred and ninety-two male patients with a median age of 59 years old （22-95 years） were included in this study. These patients were divided into two groups： the study group, including 237 patients who had hematological disorders included myeloproliferative disorder （MPD）, myelodysplastic syndrome （MDS）, acute myeloid leukemia （AML）, chronic myeloid leukemia （CML）, multiple myeloma （MM）, and lymphoma and the control group including 355 patients with no evidence of hematological disease. Both conventional cytogenetics and fluorescence in situ hybridization using DNA probes specific for the centromere of chromosomes X or Y were performed according to our standard laboratory protocols. Results Twenty-four out of 237 patients with hematological disorders （10.1%） had Y chromosome loss. Of these 24 patients, 2 patients had AML （5.0% of all AML patients）, 2 patients had CML （5.7% of all CML patients）, 2 patients had MPD （8.0% of all MPD patients）, 3 patients had MM （10.0% of all MM patients）, 5 patients had lymphoma （10.6% of all lymphoma patients） and 10 patients had MDS （16.7% of all MDS patients）. Twenty-one out of these 24 patients had a loss of Y chromosome as the sole anomaly and the remaining three had a loss of Y chromosome accompanied with other structural changes detected by conventional cytogenetic analysis. Fluorescence in situ hybridization （FISH） analysis confirmed the routine cytogenetic results. All 24 patients had a loss of Y chromosome with a range of 17.5%-98.5% of cells. Two of the patients, one with AML and another with CML, had karyotype and FISH testing done both at the initial diagnosis and during remission. The results showed a loss of Y chromosome at initial diagnosis but a normal 46,XY karyotype dunng remission. Only 9 out of 355 patients （2.5%） without evidence of hematological disease had Y chromosome loss, among them 7 patients had cardiovascular diseases and 2 patients had kidney diseases. Comparison of the incidence of Y chromosome loss in patients with hematological disorders or without evidence of hematological disease using statistical analysis showed a statistically significance difference （P〈0.05）. Conclusions The present study demonstrated that the frequency of Y chromosome loss is significantly higher in patients with hematological disorders than in patients without hematological disorders, which indicates that the loss of Y chromosome is associated with a neoplastic change.

Post-hematopoietic stem cell transplantation in patients with hematologic disorders:Chinese herbal medicine for an unmet need

While much progress has been made in the field of hematopoietic stem cell transplantation （HSCT）, headway in the promotion of recovery following this procedure has been limited. Data regarding the potential of Chinese herbal medicine （CHM） for patients with hematologic disorders who received HSCT are gradually increasing; however, these data are mostly in Chinese. Therefore, we set out to summarize the existing data. We searched PubMed, the Cochrane Library and the China National Knowledge Infrastructure and retrieved 9 clinical studies related to this group of patients, in whom CHM was used as an intervention. Of the 9 papers, 6 were published by the same group of researchers. The focus of the reviewed studies was heterogeneous, and the objectives varied widely. With the exception of one randomized control trial, all of the studies were retrospective and observational; the median number of patients was 11.5, with the largest study containing 104 patients. CHM treatment was largely divided into two stages： （1） pre-HSCT, which was initiated as soon as conditioning chemotherapy was administered and aimed to counterbalance the adverse effects of these potent agents; （2） post-HSCT, which began immediately after transplantation and was intended to promote engraftment, control graft- versus-host disease and prolong survival. In addition, the 9 Chinese materia medica most commonly prescribed （appearing in four studies） were： Shengdihuang （Rehmannia glutinosa）, Baizhu （Atractylodes macrocephala）, Renshen （Panax ginseng）, Dangshen （ Codonopsis pilosula）, Maimendong （ Ophiopogon japonicus）, Danggui （Angelica sinensis）, Taizishen （Pseudostellaria heterophylla）, Huangqi （Astragalus membranaceus） and Ejiao （Equus asinus）.