28 October 2020 (Wednesday) - Pseudo Pelger Huet

The nice people at Lablogatory sent a rather interesting article about pseudo-Pelger-Huet anomaly today. You can read it here.

From the article was a link to its original source – I’ve signed up with them. I wonder if Medscape will be of any use to me? I hope so, but something for nothing is always worth having.

27 October 2020 (Tuesday) - A New Treatment

The American Society of Hematology sent an update today. In amongst some of the less relevant bits and pieces was an article about a new treatment for AML in the older patient.


27 October 2020 (Tuesday) - Leishmaniasis

Here’s something that made me sit up and take notice… a case study that a colleague shared with me:

A one-year-old infant was hospitalised with a general deterioration and few weeks of fever. On examination she showed splenomegaly and pale skin and mucosae but no hepatomegaly or palpable lymphadenopathy. No other family member had any of the same symptoms.

The child frequently stayed with family in southern France where she was in contact with numerous animals (mainly dogs and cats). 

Biochemical laboratory test results were

urea 2.4 mmol/l (normal range (NR) 1.43-6.78)
creatinine 15 µmol/l (NR 14-35)

aspartate aminotransferase (ASAT) 76 U/l (NR 0-96)

alanine aminotransferase (ALAT) 56 U/l (NR 0-45)

C-reactive protein (CRP) 80.6 mg/l (normal <5).

Serological tests for hepatitis B (HBV) and C (HCV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), rubella, chickenpox (varicella zoster virus, VZV), human immunodeficiency virus (HIV), herpes simplex virus 1 and 2 (HSV-1, HSV-2) and parvovirus B19 were all negative.

The blood film confirmed the severe normocytic anaemia, thrombocytopenia (genuine) and neutropenia with most of the nucleated cells being abnormal lymphocytes, but nothing really diagnostic was evident.

Examination of the bone marrow showed a hypocellular marrow, without excess blasts or marked abnormality of any cell lines. However examination of the macrophages showed numerous amastigote forms of Leishmania parasites.

What really made me sit up and take notice was that the important bit here was the mention of frequent stays in southern France and of close contacts with dogs. I didn’t know that dogs are the main reservoir host of the parasite in the Mediterranean basin.

Some References:

Faucher B, Piarroux R. Actualités sur les leishmanioses viscérales. Revue de Médecine Interne 2011;32(9):544–551.

Control of the leishmaniases: report of a meeting of the WHO Expert Committee on the Control of Leishmaniases, Geneva, 22-26 March 2010. (https://apps.who.int/iris/handle/10665/44412)

Haute Autorité de Santé. Actualisation des actes de biologie médicale relatifs au diagnostic de la leishmaniose. Juillet 2017 (https://www.has-sante.fr/jcms/c_2751691/fr/actualisation-des-actes-de-biologie-medicale-relatifs-au-diagnostic-de-la-leishmaniose)

World Health Organisation. Newsroom/Fact sheets/Detail/Leishmaniasis. March 2019 (https://www.who.int/news-room/fact-sheets/detail/leishmaniasis)

Pine M, Walter AW. Pancytopenia in hospitalized children: a five-year review. J Pediatr Hematol Oncol 2010;32:e192-4