Blood Picture Research Articles

Mean Platelet Volume (MPV) and Plasma Lactate Level in the Diagnosis and Prognosis of Neonatal Bacteremia

Abstract Background Neonatal sepsis is a life-threatening clinical condition. It is associated with high morbidity and mortality if not treated properly. Blood culture remains the gold standard method diagnosis of sepsis, but it takes at least 24 hours for presumptive diagnosis. Owing to the fact that neonates are vulnerable and can deteriorate easily, rapid diagnosis and management is a must. Aim of the Work Determination of the role of mean platelet volume (MPV) and Blood Lactic acid (BLA) level in the diagnosis and prognosis of neonatal bacteremia. Materials and Methods Study included 108 clinically septic neonates aged 0-28 days, admitted to NICU in Ain Shams University Hospitals. All neonates were subjected to blood culture as gold standard method, complete blood picture (for MPV evaluation), CRP, and BLA, then they were equally divided into two groups bacteremic group, and non-bacteremic group. Results The current study showed that there was a significant difference between bacteremic and nonbacteremic group as regards MPV, CRP, and BLA with higher mean and median values among bacteremic group with P value 0.001, 0.003, and 0.021 respectively. High BLA level was found to be highly significant in non-survived neonates when compared to the survived ones with P value 0.001. Conclusion MPV and BLA tests are simple, rapid, and inexpensive methods to diagnose neonatal bacteremia. The available evidence confirms significantly higher MPV, and BLA in neonates with bacteremia compared to neonates with non-bacteremia causes of sepsis. Therefore, in clinical practice, MPV and BLA could be used as indicators for the early diagnosis of sepsis, while blood lactic acid could be used additionally as a predictor of mortality.

A Research Study of Blood Picture of Both Cows and Buffaloes

Abstract The current study was designed to evaluate the effect of sexual maturity in both male cows and buffaloes on hematological parameters. Blood samples were collected from 20 immature malecows and 20 mature males. In the same way, samples were collected from male buffaloes. The results of the statistical analysis showed a significant increase in the values of the packed cells volume (PCV) and the number of red blood cells of thesexually mature male cows compared with the immature, and a rise in the PCV, the concentration of hemoglobin and the number of red blood cells for the mature male buffaloes compared with the immature, while no effect of sexual maturity was observed on the number of white blood cells for both male cows and buffaloes. In conclusion, the age of sexual maturity in male cows and buffaloes had an effect that would raise the values of red bloodcells count, PCV, and hemoglobin concentration.

Lysinuric protein intolerance presenting as pancytopenia and splenomegaly mimicking acute leukaemia: a case report

BackgroundLysinuric protein intolerance is a rare inherited metabolic disease due to autosomal recessive mutations of the SLC7A7 gene. The affected patients commonly present with protein-rich food intolerance, failure to thrive, hepatosplenomegaly, muscle hypotonia and lung involvement due to impaired intestinal absorption and excessive urinary excretion of dibasic amino acids. Presentation with splenomegaly and cytopenia without other features has not been reported. Here we report a Sri Lankan girl with lysinuric protein intolerance presenting with pancytopenia and splenomegaly mimicking acute leukaemia.Case presentationTwo years and six months old Sri Lankan girl presented with persistent pancytopenia following a viral illness. She was asymptomatic without vomiting, diarrhoea, abdominal pain or irritability. Physical examination revealed pallor and isolated firm splenomegaly of 2 cm. Growth parameters and other system examinations were normal. Full blood count revealed anaemia, leukopenia and thrombocytopenia. The blood picture showed a mixture of hypochromic microcytic and normochromic normocytic red cells with occasional pencil cells and macrocytes. Bone marrow examination was normal except for occasional megaloblasts; however, serum vitamin B12 and red blood cell folate were normal. The metabolic screen showed a high anion gap compensated metabolic acidosis, high lactate and ketosis. Genetic mutation analysis using whole exome sequencing revealed compound heterozygous variants of the SLC7A7 gene, confirming the diagnosis of lysinuric protein intolerance.ConclusionWe report a child with lysinuric protein intolerance presenting with pancytopenia and splenomegaly without other disease features. This case report adds to the heterogenic presentations of lysinuric protein intolerance, which is considered a multifaceted disease.

A Bio-Indicator Pilot Study Screening Selected Heavy Metals in Female Hair, Nails, and Serum from Lifestyle Cosmetic, Canned Food, and Manufactured Drink Choices.

Lifestyles, genetic predispositions, environmental factors, and geographical regions are considered key factors of heavy metals initiatives related to health issues. Heavy metals enter the body via the environment, daily lifestyle, foods, beverages, cosmetics, and other products. The accumulation of heavy metals in the human body leads to neurological issues, carcinogenesis, failure of multiple organs in the body, and a reduction in sensitivity to treatment. We screened for Cr, Al, Pb, and Cd in selected foods, beverages, and cosmetics products depending on questionnaire outcomes from female volunteers. We also screened for Cr, Al, Pb, and Cd on hair, nails, and serum samples using inductively coupled plasma mass spectrometry (ICP-MS) from the same volunteers, and we analyzed the serum cholinesterase and complete blood picture (CBC). We performed an AutoDock study on Cr, Al, Pb, and Cd as potential ligands. Our results indicate that the most elevated heavy metal in the cosmetic sample was Al. In addition, in the food and beverages samples, it was Pb and Al, respectively. The results of the questionnaire showed that 71 percent of the female volunteers used the studied cosmetics, food, and beverages, which were contaminated with Cr, Al, Pb, and Cd, reflecting the high concentration of Cr, Al, Cd, and Pb in the three different types of biological samples of sera, nails, and hair of the same females, with 29 percent of the female volunteers not using the products in the studied samples. Our results also show an elevated level of cholinesterase in the serum of group 1 that was greater than group 2, and this result was confirmed by AutoDock. Moreover, the negative variation in the CBC result was compared with the reference ranges. Future studies should concentrate on the actions of these heavy metal contaminations and their potential health consequences for various human organs individually.

MEASUREMENT OF STRESS LEVEL IN BUFFALOES BY THE EFFECT OF REPEATED RECTAL PALPATION IN TEACHING ENVIRONMENT

Livestock contributed 60.1 percent to the agriculture value added and 11.5 % in overall GDP during 2020-21 (Economic Survey 2020-21). Livestock plays a major and vital role in socio economic development of rural region of country. According to economic survey of Pakistan, 42.4 million buffalo population is present in Pakistan. Small holding buffalo farming system is present in rural areas of Pakistan. Rectal palpation is the most useful method for conducting pregnancy diagnosis, artificial inseminations and detection of various reproductive anomalies in large domestic animals like cows and buffaloes. This procedure, however, can prove to be stressful and painful for these animals which raise an animal health and welfare issue. Blood picture in terms of changed levels of cortisol, glucose, cholesterol and blood cells may occur in animals subjected to this procedure. Similarly, behavioral symptoms of elevated heart rate and respiratory rates may also occur. The aim of the current project, therefore, was to study the effects of repeated rectal palpation-related stress response in blood constituents in buffaloes so that the appropriate counter measures could be adapted to save the animals from impending pain and stress. The study was conducted on ten buffaloes divided into two groups each i.e. experimental and control. Buffaloes were subjected to rectal palpation procedure. Blood samples were collected before and after rectal palpation for serum cortisol and complete blood cells count. Blood samples were also collected from buffaloes of control group without rectal palpation. Physical parameters were also noted. No statistically significant difference found in cortisol levels, CBC or physical parameters i.e. TPR that demonstrates that rectal palpation procedure inflicts no harm to buffaloes and can be used for the training of students.

Anaemia due to chronic kidney disease: A cross-sectional analysis from a tertiary referral centre in Sri Lanka

Introduction: Anaemia is a common complication of chronic kidney disease (CKD) that adversely affects cardiovascular health and quality of life. Data on anaemia in Sri Lankan CKD patients is scarce.Objectives: This study was conducted to assess the prevalence, associations, and treatment response of anaemia in a cohort of patients with CKD.Methodology: A descriptive cross-sectional study was conducted among consecutive, consenting adult patients with stable CKD attending clinics and wards of the University Medical Unit, Colombo North Teaching Hospital, Ragama.Results: Of 149 patients with CKD (males 57.7%), 70.5% had diabetes, 83.9% had hypertension and 37.6% had ischemic heart disease. Anaemia was present in 90.6% of females and 93% of males. The severity of anaemia was significantly (p=<.05) associated with female gender, advancing CKD stage, diabetes, chronic liver cell disease, being on dialysis, and increasing degree of proteinuria.Of 91 patients investigated for the cause of anaemia, 60.4% had iron deficiency with anaemia of chronic disease, while 27.5% had anaemia of chronic disease based on the blood picture. Of 88 patients with haemoglobin <10g/dl, only 45.4% were on erythropoietin and 56.8% had received blood transfusions. 76.1% of the anaemic patients had hemoglobin below 10g/dL at follow-up despite treatment.Conclusions: Anaemia was highly prevalent in the CKD cohort with a significant number requiring transfusions. Patients continued to have anaemia despite being treated with nutritional supplements and erythropoietin.

ANALISIS KETAHANAN IKAN LELE DUMBO (CLARIAS GARIEPENUS) YANG DIINFEKSI BAKTERI AEROMONAS HYDROPHILA DENGAN KONSENTRASI BERBEDA

The purpose of this study was to determine the susceptibility of catfish to Aeromonas hydrophila bacteria, and to know the blood picture of catfish infected with Aeromonas hydrophila bacteria. The method used in this study used an experimental method with a Completely Randomized Design (CRD) or Competely Randomized Design (CRD) (Gomez and Gomez, 1984) with 4 (four) treatments and one control each with 3 replications. The results showed that catfish had a strong susceptibility or resistance to Aeromonas hydrophila bacteria. The Lethal Dose value of 50 was 106 cfu/ml, meaning that Aeromonas hydrophila bacteria was able to kill 50% of the catfish population when it was 5.4 x106 cfu/ml. The lowest average red blood cell count was in treatment A, which was 23.89x106 cells/mm3 and the highest in treatment D, which was around 37.5x106 cells/mm3, while the highest and lowest mean total leukocyte counts were 43.07-82.72x103 cells/mm3, still within the range of values. normal. The average hemoglobin concentration was lower than the normal value range in treatment A, which was 6.52 gr% and in treatment D, it was around 12.42 gr%

Hematological, immuno-antioxidant disruptions, and genes down-regulation induced by Aeromonas veronii challenge in Clarias gariepinus: The ameliorative role of silica nanoparticles.

Aeromonas veronii is a pathogenic bacterium associated with various diseases in aquaculture. However, few studies address the antibacterial activity using nanoparticles (NPs). Hence, the current study is innovative to evaluate the antibacterial efficacy of silica nanoparticles (SiNPs) against A. veronii infection in-vitro with a trial for treatment in-vivo. Primarily, we assessed the in-vitro antibacterial activity against A. veronii. Further, we investigated the hematological profile, immune-antioxidant response, and gene expression of African catfish (Clarias gariepinus) in response to SiNPs exposure and the A. veronii challenge. Fish (N = 120; weight: 90 ± 6.19 g) were distributed into four groups (30 fish/group) for a ten-days-treatment trial. The first (control) and second (SiNPs) groups were treated with 0 mg/L and 20 mg/L SiNPs in water, respectively. The third (A. veronii) and fourth (SiNPs+A. veronii) groups were treated with 0 mg/L and 20 mg/L SiNPs in water, respectively, and infected with A. veronii (1.5×107 CFU/mL). Results demonstrated that SiNPs displayed an in-vitro antibacterial activity against A. veronii with a 21 mm inhibitory zone. A. veronii infection caused a high mortality rate (56.67%) and substantial reductions in hematological indices and immune indicators [nitric oxide (NO) and immunoglobulin M (IgM)]. Additionally, marked decline in the level of antioxidants [superoxide dismutase (SOD), catalase (CAT), and reduced glutathione content (GSH)] as well as down-regulation in the immune-related genes [interleukins (IL-1β and IL-8) and tumor necrosis factor-alpha (TNF-α)] and antioxidant-related genes [SOD1, glutathione peroxidase (GPx), and glutathione-S-transferase (GST)] were the consequences of A. veronii infection. Surprisingly, treatment of A. veronii-infected fish with SiNPs lessened the mortality rate, enhanced the blood picture, modulated the immune-antioxidant parameters, and resulted in gene up-regulation. Overall, this study encompasses the significant role of SiNPs, a new versatile tool for combating hematological, immuno-antioxidant alterations, and gene down-regulation induced by A. veronii infection and sustainable aquaculture production.

Haematological alterations of mullet Planiliza abu (Heckel, 1843) naturally infected by Ergasilus mosulensis Rahemo, 1982 (Copepoda: Ergaslidae) in a private fish farm from Basrah Province, Iraq

Generally, there is no previous information about haematological parameters of parasitized fish maintained in fish farms in Al- Mashab area, Basrah, Iraq. In this study, the effects of parasitism by the copepod Ergasilus mosulensis. on haemoglobin (Hb), haematocrit (HCT), red blood cells (RBCS), mean corpuscular volume (MCV), mean corpuscular haemoglobin (MCH), mean corpuscular haemoglobin concentration (MCHC), and leucocytes were analysed in infected Planiliza abu. The high level of parasitism found in infected fishes was responsible for alterations in blood picture Hb, HCT, RBCS, MCV, MCH, MCHC, and leucocytes (P > 0.05). This is the first report regarding hematology of cultivated freshwater fish which are infected with parasitic copepods in Basrah Province.

THE PREVALENCE OF THE THALASSEMIA TRAIT AMONG THE EAST MALAYSIAN STUDENTS IN THE FACULTY OF HEALTH SCIENCES, UNIVERSITI TEKNOLOGI MARA, UiTM SELANGOR

The thalassemia trait is an asymptomatic thalassemia syndrome that increases the risk of developing a more severe condition. This study aimed to determine the prevalence of the thalassemia trait among Sabah and Sarawak students enrolled in the Faculty of Health Sciences at Universiti Teknologi MARA, UiTM Selangor. The study was carried out over 3 months following approval from the ethics and research committees of Universiti Teknologi MARA, UiTM Shah Alam. A universal sampling method was used where the blood samples were collected from the 40 students, 16 from Sabah and 24 from Sarawak, of various ethnicities. All subjects were asked to fill out consent forms. A volunteer medical laboratory staff member assisted in taking whole blood samples from the subjects’ venous blood. The blood was then collected in a 3 mL EDTA (ethylenediaminetetraacetic acid) tube and was tested for thalassemia using a Full Blood Count (FBC) and a Full Blood Picture (FBP), as well as a Mentzer Index (MI) calculation, gel electrophoresis, and an H-inclusion test. In conclusion, the prevalence of the thalassemia trait is 7.5% (3) out of 40 volunteers among students from Sabah and Sarawak in the Faculty of Health Sciences at UiTM Selangor.

A study of different treatment modalities in management of liver abscess at tertiary care center

Background: Of all the visceral abscesses, the liver accounts for 48%. When a purulent substance collects in the liver parenchyma as a result of bacterial, parasite, fungal, or combination infections, it is called liver abscess. It is prevalent in India, accounting for the second largest prevalence, owing to insufficient sanitation, overcrowding, and malnutrition. As the liver is a susceptible organ to producing abscesses, whereas amoebic liver abscess is the utmost frequent kind of abscess in the developing world’s tropical regions, pyogenic abscess is more prevalent in affluent nations. The aims and objectives were to study the etiology, clinical manifestation, and predisposing factors of liver abscess; to compare the conservative and surgical treatment modalities of liver abscess; and to find out the outcome of these patients. Methods: After matching inclusion and exclusion criteria, 100 clinically diagnosed liver abscess patients were enrolled for this retrospective and prospective observational study. Patients were analysed for ultrasonography whole abdomen, complete blood picture and liver function test and subjected to conservative or surgical management. Results: The study group of 100 patients consisted of 83 (83%) male and 17 (17%) female with mean age of 40 years (18-70). 89 (89%) patients managed conservatively and 11 (11%) patients underwent for surgery. Patients with conservative management were found to have significant differences between outcome. Conclusions: This study concludes that conservative management has significantly better outcomes as compared to surgical management.

A Case of Compound Heterozygous HbS and HbD Disease in Premarital Screening

Introduction: Among the inherited disorders of blood, haemoglobinopathy and thalassaemia constitute a major bulk of non-communicable genetic diseases in India. They cause a high degree of morbidity in affected individuals. Moderate to severe haemolytic anaemia among vulnerable segments of the society like infants and children, adolescent girls, pregnant women, etc. may result in many deaths in India. Hemoglobinopathies are a vast group of inherited disorders of hemoglobin production and function. Compound heterozygous HbSD-Punjab is an uncommon hemoglobinopathy encountered in Indians. In premarital screening, molecular testing is mostly inconvenient and diagnosis often relies on the abnormal hemoglobin analysis, family studies and epidemiological facts. We present the clinical and laboratory characteristics of hemoglobin D-Punjab with sickle cell disease found on premarital screening. Case Report: Blood sample of a 22 year old patient for high-performance liquid chromatography was received. A complete blood count (CBC) showed mild anemia with Hb of 8.3 g/dl with mild microcytic hypochromic red cell indices.The HPLC showed HbD and S-window on BIO RAD D10 machine. The high-performance liquid chromatography showed normal hemoglobin Hb F and Hb A2, which indicates presence of a Compound heterozygous for HbSD-Punjab. Conclusion: Compound heterozygous state for HbD-Punjab with S-window is a rare disorder. HbSD-Punjab has a heterogeneous clinical presentation. Anemia and sickle crises are quite common. The data obtained from the clinical findings, blood picture and electrophoresis or HPLC will help in diagnosis. Genetic counseling is advisable in patients with presence of a Compound heterozygous HbSD-Punjab.

#6917 IMPACT OF FUNCTIONAL IRON DEFICIENCY IN NON-ANEMIC HEMODIALYSIS PATIENT ON NEUROCOGNITIVE AND QUALITY OF LIFE: A SINGLE CENTER CROSS-SECTION STUDY

Abstract Background and Aims The clinical paradox of high ferritin levels and low TSAT is a condition known as "functional iron deficiency." This occurs when the body has adequate iron stores, as indicated by high ferritin levels, but the iron is not available for use in the body, as indicated by low TSAT levels. This can be caused by inflammation, chronic disease, or other conditions that interfere with the body's ability to absorb and utilize iron. Hemodialysis patients may suffer from both absolute and functional iron deficiency. Most studies was directed to study effect of absolute iron deficiency even without anemia, and the important of supplementing with oral or intravenous iron ; however, impact of functional iron deficiency without anemia and subsequently decision of iron supplementation especially in presence of high ferritin is still undetermined. Our aim is to assess the impact of functional iron deficiency without anemia in neurocognitive function and quality of life among hemodialysis patients in dialysis unit in urology and nephrology center Mansoura University. Method Patients on regular haemodialysis were screened using complete blood picture, transferrin saturation (TSAT) and serum ferritin to determine iron status. The Saint Louis University Mental Status assessed cognitive function. (SLUMS) Examination used for detecting mild cognitive impairment and dementia. Quality of life was assessed by 36-item short-form (SF-36). The SF-36 measures eight scales: physical functioning (PF), role physical (RP), bodily pain (BP), general health (GH), vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH). Results Among 70 patients maintained on regular hemodialysis, A 42 patients have normal hemoglobin level (above 12 mg/dl with high serum ferritin >300 ng/mL). They classified into two group: A 26 patients with high ferritin, high TSAT >20%, and normochromic red blood cells, A 16 patients with high ferritin level,low TSAT<20% and hypochromic red blood cells. Among the 26 patients, 17 male and 9 female, and among the 16 patients, 11 male and 5 female. The 26 patients have mean age of (41 +/- 13) and the 16 patients have mean age of (39 +/- 10). No significant difference between the two groups regarding sex and age with p value (0.5 and 0.1 respectively). Assessment of cognitive function by SLUM score revealed regarding normal group (4 have normal score, 18 have mild impairment of cognitive function and 4 have dementia score) and the iron deficient group (4 have normal score, 9 have mild impairment of cognitive function and 3 have dementia score) with no statistically different between the two group (P = .6).requarding quality of life, no statistically difference was fond between the two group regarding : physical functioning (p= 0.18), role physical (P = .11), bodily pain (p = 0.33), general health (p= 0.5), vitality (P = .41), social functioning (P = .2), role emotional (P = .4), and mental health (P = .21 ). Conclusion Non-anemic hemodialysis Patients with Functional iron deficiency has no statistically difference regarding neurocognitive function and quality of life from normal iron non-anemic patients.

A Cross-Sectional Study of the Haematological Profile of Patients With Chronic Liver Disease (CLD).

The liver keeps haematological parameters normal and preserves haemostasis by storing iron, vitamin B-12, and, folic acid, necessary for healthy haematopoiesis. Anaemia of various aetiologies affects approximately 75% of chronic liver disease (CLD) patients, specifically caused by iron deficiency, hypersplenism, chronic diseases, autoimmune haemolysis, folic acid deficiency, aplasticity, and as a side effect of antiviral drugs. This study sought to observe the derangements in haematological parameters in patients with CLD, analyse the spectrum of anaemia in patients with CLD, and predict CLD outcomes utilizing Child-Pugh Score. This cross-sectional observational research was carried out in the Department of General Medicine, Himalayan Institute of Medical Sciences (HIMS), Dehradun, India over the course of a year. The patients with CLD who were admitted to the ward participated in the study. Most patient's blood pictures reported normocytic normochromic with thrombocytopenia (TCP) (28.7%), macrocytic hypochromic with TCP (26%), microcytic hypochromic with TCP (13.3%) and macrocytic normochromic with TCP (9.3%). The incidence of anaemia was 85.3%: mild in 12.7% patients, moderate in 55.3% patients, and severe in 17.3% patients. Interestingly, this study also builds upon others suggesting that 85.9% of CLD patients have Class C Child-Pugh Score.

Investigations on some indicators in the blood of cattle with orosthenic activity tongue rolling.

Hematological studies were carried out in cattle with tongue-rolling hyperactivity in order to establish the etiopathogenetic mechanisms of this behavioral disorder. Cattle were divided into two groups: Group 1 (n = 12), control animals that did not demonstrate the tongue-rolling orosthenic activity, and Group 2 (n = 12), cattle that manifested this stereotyped behavior. Blood samples were collected from all cattle twice at 10-day intervals from Vena jugularis for analysis of red blood cell counts, hemoglobin (HGB) content, mean corpuscular volume (MCV), mean corpuscular HGB (MCH), mean corpuscular HGB concentration (MCHC), hematocrit (HCT), white blood cell counts (WBC), and differential white cell counts [lymphocytes (LYM), monocytes (MON), and granulocytes (GRAs)]. Some blood biochemical constituents were assayed: calcium, inorganic phosphorus, magnesium, plasma total protein, blood glucose, total bilirubin, urea, creatinine, chlorides, cholesterol, triglycerides, and albumin, as well as the enzyme activities of aspartate amino-transferase (AST), alanine amino-transferase (ALT), alkaline phosphatase (ALP), gamma-glutamyltransferase (γ-GT), lactate dehydrogenase (LDH), and creatine kinase (CK). Blood concentrations of the hormones adrenaline, noradrenaline, cortisol, adrenocorticotropic hormone (ACTH), dopamine, serotonin, free thyroxine, thyroid-stimulating hormone, and trace elements manganese, copper, and iron were determined. It was found out that the cattle with tongue-rolling hyperactivity did not demonstrate changes in red blood picture (HGB, HCT, MCV, MCH, MCHC), white blood picture (WBC, LYM, MON, GRA), blood biochemistry (Ca, P, Mg, TP, Glu, TB, urea, creatine, Cl, Chole, TG, and Alb), AST, ALT, ALP, γ-GT, LDH, and CK activities, Cu, and Fe levels. In the study, increased concentrations of adrenaline, noradrenaline, cortisol, ACTH, and serotonin were established. The data demonstrating increased levels of adrenaline, noradrenaline, cortisol, and ACTH confirmed the etiological role of environmental stressors in the emergence of oral hyperactivity. Increased serotonin concentrations in the blood suggest that cattle with the stereotype are probably "happy" with tongue rolling. The lack of changes in blood trace elements manganese, copper, and iron allowed excluding their deficiency as a probable cause in the etiology of the disorder.

DIAGNOSTIC ACCURACY OF RDWI TO DIFFERENTIATE IRON DEFICIENCY ANEMIA AND THALASSEMIA TRAIT IN BORDERLINE HBA2

Background: Thalassemia is an inherited hemoglobin disorders in which there is reduction or absence of α or β chains due to mutations in α or β genes. Microcytic hypochromic anemia is hallmark of beta thalassemia trait and the patient is usually asymptomatic. It is important to differentiate it from iron deficiency anemia (IDA) which also shows similar peripheral blood picture. The diagnosis is based on quantification of HbA2 and serum ferritin. If the level of HbA2 is more than 3. 5%, then diagnosis of beta thalassemia trait is made. The problem arises with borderline HbA2 i. e 3.1% - 3.4%. There is also diagnostic difficulty when concomitant iron deficiency anemia is present.
 Objectives: To determine the diagnostic accuracy of RDWI in borderline HbA2 to distinguish the beta thalassemia trait from IDA and to diagnose beta thalassemia trait when genetic analysis is not easily available.
 Methods: It was a cross sectional validation study. A total of 90 patients were included in this study, having HbA2 between 3.1-3.4%. Tests for serum ferritin, serum iron and total iron binding capacity (TIBC) were done on all samples. RBC morphology, RBC count, mean cell volume (MCV), mean cell hemoglobin (MCH), mean cell hemoglobin concentration (MCHC) and RDW of all samples were noted. RDWI of all samples was calculated. Mutational analysis by ARMS- PCR was done for confirmation of β thalassemia trait.
 Results: Out of 90 samples with borderline HbA2, 30 cases were diagnosed as β thalassemia trait. Out of these, 15(50 %) had concomitant IDA along with beta thalassemia trait and 15 were non iron deficient beta thalassemia carriers. 43 samples were not iron deficient and were also negative for β thalassemia trait, whereas 17 samples had only IDA without beta thalassemia trait. The sensitivity of RDWI was 76.6% and specificity was 56.6% in borderline HbA2.
 Conclusion: RDWI is a good indicator to differentiate between IDA and beta thalassemia trait (sensitivity 76.6% specificity 56.6%). But in all cases of borderline HbA2 genetic analysis should be done to see the mutation and to confirm the diagnosis.

Pancytopenia as the initial presenting feature in multiple myeloma: a case series

Multiple myeloma is a plasma cell neoplasm characterized by abnormal proliferation of clonal cells in the bone marrow. Anaemia is generally the most common feature from hematologic aspect and bone pain being the other important symptom, but pancytopenia as the presenting feature is unusual. Here, we shared our experience of 3 cases with non-specific symptoms with pancytopenia which on through evaluation revealed our diagnosis. A hospital based observational descriptive case series was conducted wherein all the cases of multiple myeloma presenting with pancytopenia were included. Complete blood picture, peripheral smear, bone marrow aspirate and serum protein electrophoresis were reviewed and analysed. Pancytopenia as the initial presenting feature of multiple myeloma is an unique manifestation and diagnosing such cases require high degree of suspicion to avoid delay in the initiation of treatment.

Bile duct injury during laparoscopic cholecystectomy

Background and Aim: Bile duct injuries (BDIs) are complex complications developed during laparoscopic cholecystectomy leading to the postoperative morbidity and mortality. Auxiliary bile duct injury, vascular structures injuries, portal vein, cyst duct leakage and damage to right hepatic artery are caused by bile duct injuries. The purpose of the present study was to investigate the incidence, clinical presentation, and treatment modality of bile duct injuries during laparoscopic cholecystectomy. Patients and Methods: This descriptive case series was conducted on 96 extra hepatic biliary injuries in the Department of General Surgery, Rehman Medical Institute, Peshawar from April 2022 to March 2023. Patients with extra hepatic biliary injuries of either gender were enrolled. Abdominal ultrasonography, ERCP, and MRCP were the different investigating modalities performed on each individual. Complete blood picture, activated Partial thromboplastin time (APTT), liver function tests, blood sugar, prothrombin time (PT), Creatinine, serum electrolytes, and Urea were thoroughly performed on each patient. HIV, HBs, and HCV were various screening tests performed. SPSS version 27 was used for data analysis. Results: Of the total 96 patients, there were 26 (27.1%) male and 70 (72.9%) females.

ETIOLOGICAL PROFILE OF PANCYTOPENIA

Objective: The objective of the study was to describe the etiological profile of pancytopenia. Methods: This was an observational study done in 85 patients who presented with pancytopenia to the Department of General Medicine, Government Medical College, Kottayam. The study was carried out over a period of 1 year. The data were collected in a structured pro forma and analyzed using SPSS version 24. Results: The most common age group was 21–30 years, 29 (34.1%) of the 85 patients. 48 (56.5%) were males and 37 (43.5%) were females. Megaloblastic anemia was the most common etiology constituting 60 (70.6%). The most common presenting complaint was generalized weakness in 74 (87.1%). The most common clinical finding was pallor 77 (90.6%). The mean hemoglobin level was 6.81±1.51 g/dl, the mean total WBC count was 2768.39±791.2, and the mean platelet count was 0.87±0.43. Macrocytic anemia was the predominant blood picture in cytopenic patients. Hypercellular marrow was the most common marrow finding in 78.1%. Conclusion: Megaloblastic anemia was the most common cause of pancytopenia followed by aplastic anemia in the present study. Clinical alertness and suspicion can assure early diagnosis and treatment.

Metformin as a Fetal Hemoglobin Inducer in Non-transfusion Dependent Thalassemia Patients

Non-transfusion dependent thalassemia (NTDT) refers to a group of thalassemic disorders who do not need regular transfusions for survival, however it may be needed in certain conditions. Metformin was reported as a potential fetal hemoglobin (HbF) inducing agent in vitro but its efficacy and safety in vivo was not fully studied. This is a prospective interventional study aimed at studying the effect of metformin on HbF change in NTDT. Methods: Patients with established diagnosis of NTDT were enrolled. They were receiving a stable fixed dose of Hydroxyurea over the last 3 months. Patients were divided into two groups: a group that received Metformin for 6 months (Metformin group) and a control group. Complete blood picture, reticulocytic count, hemoglobin electrophoresis, liver enzymes, bilirubin, kidney functions, LDH and random blood sugar were performed at onset, 3 and 6 months of the study. All adverse events were recorded. Results: Forty two patients aged 12–23 years were enrolled. Metformin intake over 6 months did not show any statistically significant difference in clinical or the laboratory variables of efficacy when compared to the control group apart from reticulocytic count which was higher in Metformin group throughout the study. Conclusion: Metformin intake, in addition to hydroxyurea, did not yield any extra benefit among patients with NTDT.