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This study can be a useful guide to neonatologists, hematopoietic stem cells transplant hematologists and future analysis.

We report the first case of haemophagocytic lymphohistiocytosis (HLH) in a neonate secondary to primary Dengue virus infection. This neonate presented in the third week of life with fever, shock and hepatosplenomegaly and was diagnosed to have Dengue infection by serology and HLH was confirmed on bone marrow.

Context:Acute lymphoblastic leukemia (ALL) ranks first among pediatric malignancies. 8–12% of ALL present with pancytopenia and 2% with hypocellular marrow a. Diagnosis of ALL in the background of pancytopenia and aplastic bone marrow is difficult.Aims:This study was aimed to compare the clinicopathologic, genetic, and outcome of paediatric ALL patients with and without pancytopenia.Settings and Design:This is a retrospective cross-sectional study.Subjects and Methods:The study included all ALL patients presenting with pancytopenia. The control group included equal number of randomly selected patients with ALL without pancytopenia treated during the same period. Ethics committee approved this study. The demographic, laboratory, and treatment-related details were retrieved from the records and entered in an Excel sheet.Statistical Analysis Used:Data was analyzed with Chi-square test with IBM SPSS statistics 16 software.Results:Diagnosis by peripheral smear is significantly lower (P = 0.015) in comparison with the control group. There is no significant difference in diagnosis between the groups by bone marrow aspirate (P = 0.731) and biopsy (P = 0.849). The diagnosis of leukemia is misdiagnosed as hypo cellular/aplastic marrow in 10% of the pancytopenic patients. Flow cytometry yielded the diagnosis in all the pancytopenic patients. Though cytogenetic abnormalities are more common in pancytopenic group, it is not statistically significant (P = 0.106). There is no significant difference in treatment outcome between the groups (P = 0.0827%).Conclusions:Clinical expertise is highly essential to evaluate a case of pancytopenia to diagnose leukemia. Pancytopenia is an obstacle in the diagnosis of ALL without immunophenotyping. There is no significant difference in the outcome between the two groups.

IntroductionThe extracellular matrix protein hyaluronan acid plays an active in role in tumor cell proliferation and invasion. Hyaluronan acid receptors, namely CD168 or the receptor for hyaluronan acid-mediated motility (RHAMM) and CD44 have been implicated in promoting malignancy. There is a lacuna in data on the expression of the receptor in pediatric leukemias.MethodsPediatric patients with acute leukemia who were diagnosed, treated and followed up in our center were enrolled. The bone marrow biopsies performed prior to treatment were subjected to immunohistochemical staining (54 biopsies: acute lymphoblastic leukemia – 45, acute myeloid leukemia – 9). Blast counts were carried out at diagnosis, end of the induction phase and end of chemotherapy, the minimal residual disease was assessed and follow up details were collected. Positivity was correlated with initial blast count, post-induction blast count, minimal residual disease and patient survival.ResultsThere was no correlation between the initial blast count and the percentage of blasts with RHAMM expression. The positive correlation between percentage of blasts expressing RHAMM and the post-induction blast count was moderate in acute myeloid leukemia (0.74) and mild in acute lymphoblastic leukemia (0.48). There was a statistically significant difference in RHAMM expression between the two minimal residual disease risk groups (p-value = 0.012) with a negative prognostic effect of RHAMM expression. Moreover, a negative prognostic effect of RHAMM expression was noted when patient survival was considered.ConclusionThis study shows that blasts in acute myeloid leukemia show more RHAMM positivity than those of acute lymphoblastic leukemia indicating the aggressive nature of this type of leukemia. In acute leukemias, patients with high percentages of RHAMM-positive blasts had more post-induction blasts, blasts in minimal residual disease and poorer prognosis.

Background:In India, screening of blood for human immunodeficiency virus (HIV), hepatitis B surface antigen (HBsAg), and hepatitis C virus (HCV) is mandatory before issue, but the donors are often not informed of their positive status.[1] The positive donors are always kept in dark. Is it essential to inform the positive donor? It is a debate still.Materials and Methods:Sri Ramachandra Blood Bank, Chennai, took the challenge of posttest counseling of blood donors from June 2008. Blood collected from donors were screened for HIV, HBsAg, and HCV. The donors of the blood, which are positive by two different enzyme-linked immunosorbent assay for any of the above tests, were sent a letter of calling respecting their rights and maintaining confidentiality. Responded donors were given counseling and offered information about confirmation, evaluation, consultation, early treatment, follow-up, contact testing, and transmission prevention. The results were analyzed for a period of 2 years from June 2008 to May 2010.Results:Among the 22,573 donors, 355 (1.7%) were found to be positive in the screening tests. Letters of calling were sent to 310 (87.04%) donors. In all, 218 (70.3%) donors with 7 (87.5%) HIV, 199 (68.85%) HBsAg, and 12 (92.31%) HCV positivity responded. None of the responded donors knew their status earlier. In all, 82 (35%) of them were repeat donors with 201 earlier donations at various blood banks.Conclusion:Posttest counseling of positive donors is essential for the health of the donor and his family, prevention of diseases, improving blood bank economy, and reducing exposure to healthcare workers.

Fig. 1. Child presented with silvery hair and patchy areas of skin hypopigmentation. Fig. 2. Peripheral smear showing giant intracellular granules (arrow).

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