Tathagata Chatterjee

Background: Autoimmune hemolytic anemia (AIHA) is a rare immune disorder which occurs when antibodies are directed against self red blood cells (RBCs) leading to hemolysis. AIHA is widely classified as warm autoimmune hemolytic anemia, cold agglutinin syndrome, mixed AIHA, paroxysmal cold hemoglobinuria and rarely drug induced AIHA. The pathogenesis of AIHA is complex interplay between genetic predisposition, immune dysregulation and enviornmental triggers. A direct antiglobulin test can be used to assess the immunological origin of the hemolysis in order to diagnose AIHA after identifying laboratory and clinical symptoms of hemolysis. Objective: The objective is to understand underlying mechanism in AIHAs, and usage of targeted therapies to modulate specific components of the immune response. Materials and Methods: We are hereby presenting a case series of 11 clinically suspected cases of AIHA in collaboration with their clinical features, immuno-hematological and other laboratory parameters, Flow cytometric analysis of lymphocyte subset in relevant cases, underlying etiology as well as serological subtype are also included. Results: Majority of the patients were categorized as secondary AIHA (7/11, 63.63%). Out of 11 cases 7 were serologically subtyped as warm AIHA (7/11, 63.63%) ,2 cases were DaaT negative AIHA (2/11;18.18%), 2 cases were characterized as mixed AIHA subtype (2/11, 18.18%). Conclusion: Accurate subtyping of AIHA requires a systematic immunohematological approach coupled with comprehensive evaluations of clinical, hematological, and biochemical parameters.

Background: Molecular monitoring of chronic myeloid leukemia (CML) patients receiving tyrosine kinase inhibitors at various time points after diagnosis is indispensable for therapeutic stratification. Thus, standardization and reproducibility of these tests to an international scale are of paramount importance. Standard TRUPCR BCR-ABL1 by quantitative real-time reverse transcription–polymerase chain reaction and Xpert BCR-ABL Ultra performed on the Cepheid GeneXpert ^® Instrument Systems (GeneXpert) were used to perform molecular monitoring in CML patients. Materials and Methods: Twenty-six samples (6 diagnostic and 20 monitoring samples) were tested on both platforms, and the BCR-ABL1 transcript ratio was compared. Kappa statistic was applied to calculate the agreement between the two tests, and Chi-square test was used to evaluate the difference in proportions in the two groups. The costs between the two tests were also compared, however, no statistical analysis was done for the same. Results: All six diagnostic samples were detected by TRUPCR, but only four could be detected by GeneXpert. One of these was a minor BCR-ABL1 transcript (p190) which cannot be detected by GeneXpert. Among the 20 monitoring samples, there was moderate agreement between the two tests, with a P = 0.01. The cost of TRUPCR was significantly less compared to GeneXpert. Conclusion: Standard BCR-ABL1 estimation by TRUPCR is superior and much more cost-effective than GeneXpert. GeneXpert inspite being an easy-to-use, fully automated platform lacks the benefit of customization with a high cost making the standard reverse transcription – polymerase chain reaction techniques more feasible and usable for molecular monitoring in CML patients.

Autoimmune Hemolytic Anemia (AIHA) has been rarely reported worldwide as well as from India as the underlying cause of anemia in malaria. We hereby present a case of complicated Plasmodium falciparum malaria with concomitant warm AIHA in a 31 year old male. Direct Antiglobulin Test (DAT) was positive and elution studies showed pan-aggluttination agglutination reaction. Clinico-hematological and serological follow up of the patient was done post artesunate treatment until day 9. We suggest that it is important to establish the immune basis of anemia in malaria patients for guiding the treatment plan for the clinicians and providing packed red blood cell transfusion if required.