Microcytic Hypochromic Anemia Research Articles

Severe Anemia in Sprague-Dawley Rats After Roux-en-Y Gastric Bypass Surgery.

Roux-en-Y gastric bypass (RYGB) surgery is one of the most commonly performed bariatric procedures for weight loss in humans. However, this procedure is not risk-free, and patients may experience complications that include small bowel obstruction, gastrointestinal bleeding, chronic diarrhea, ulcers, malnutrition, and anemia. In particular, anemia is a recognized long-term complication and can be severe. Rats have been used as a model to study the effects of gastric bypass surgeries. They can experience similar complications as people, but the development of severe anemia has not previously been reported in rats. We observed 2 cases of severe anemia in female Sprague-Dawley rats after RYGB surgery. These cases prompted us to further investigate the frequency and severity of anemia after RYGB in rats. Blood work and necropsies were performed on 9 additional female Sprague-Dawley rats (5 with RYGB, 4 with sham surgery). In these 9 rats, only one had signs of clinical anemia. These 3 anemic rats displayed moderate to severe pallor of the eyes and ears. Necropsy findings in anemic RYGB rats included pale internal organs and eccentric heart enlargement, which led to a significantly higher heart:body weight ratio in RYGB rats as compared with sham controls. Anemic rats had either a macrocytic normochromic anemia, consistent with vitamin B12 or folate deficiency, or microcytic hypochromic anemia, indicative of iron deficiency. Researchers who perform RYGB surgery in rats should be aware of the potential complication of severe anemia. Plans for the diagnosis and management of this complication and the development of criteria for humane endpoints for severe anemia are recommended as a refinement to these studies.

CLINICAL & HEMATOLOGICAL PROFILE OF ANEMIA AMONG MALE PATIENTS: A SNAPSHOT STUDY FROM TERTIARY CARE CENTRE OF WESTERN INDIA

Background: In India, the prevalence is 47-50% for all ages while as per NFHS-4, the prevalence of anemia among men 15-49 year age (<13gm/dl) is 18.5% for urban & 25.3% for rural areas. Most of the programs are directed at the Reproductive & Adolescent age group & mainly for females & children. The above data shows 1 in 4 men suffers from anemia & may face complications & consequences. Objective: Thus the present study is aimed to assess the Clinical & Hematological profiles of Male anemic patients admitted to Medical wards. Methodology:100 Male patients admitted to the medical ward for anemia at tertiary care hospital affiliated with the medical college, during the study period, who met inclusion criteria and who were willing to participate in this study were subjected to further evaluation. Along with clinical data, demographic information was also obtained. Results: Severe Anemia was present in 70% of males. Moderate anemia was seen in 30% of males with a Mean age of 43 years. Hence in male patients, anemia should be screened vigilantly so that we can treat it and avoid complications. Nutritional deficiency is the most common etiology found. All patients had pallor. The most common symptom observed were weakness (85%) followed by easy fatigability (82%)and breathlessness on exertion (47%). In peripheral smear examination, 50% of males were having microcytic hypochromic anemia. The most common type of anemia was Iron deficiency anemia observed in 50% of patients. In male anemic patients, a thorough evaluation of the type of anemia will make etiology-specific treatment more effective.

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.

Ancylostomiasis in cats in Yogyakarta, Indonesia, and its causative genetic relations

Abstract. Dami JC, Damayanti LPE, Indarjulianto S, Priyowidodo D. 2023. Ancylostomiasis in cats in Yogyakarta, Indonesia, and its causative genetic relations. Biodiversitas 24: 2605-2611. Ancylostomiasis is a zoonotic cat disease caused by one or more species of Ancylostoma spp. This study aims to determine ancylostomiasis in cats in Yogyakarta and its causative genetic relations. This research used ten cats with ancylostomiasis, based on the findings of Ancylostoma spp. eggs in their feces. Cats were examined clinically and laboratory, including blood profile and identification of Ancylostoma spp. eggs. The ITS1-5.8S-ITS2 region of Ancylostoma spp. was amplified by polymerase chain reaction (PCR) and sequenced; the results were compared with the Basic Local Alignment Search Tool (BLAST). As a result, physical examination showed that cats with ancylostomiasis suffered from diarrhea (100%), decreased appetite (70%), weakness (60%), anemia (60%), emaciation, and dull hair (10%). Blood examination showed that 5 (50%) cats had normochromic normocytic anemia, and 1 (10%) cat had hypochromic microcytic anemia. PCR tests, sequencing, and phylogenetic tests found that Ancylostoma spp. isolates had been successfully identified as Ancylostoma braziliense De Faria 1910, identical to A. braziliense from Australian isolate (DQ359149.1). Therefore, it was concluded that ancylostomiasis in cats in Yogyakarta was caused by A. braziliense.

Atypical Cutaneous Viral Infections Reveal an Inborn Error of Immunity in 8 Patients.

Unusual viral skin infections might be the first clinical manifestation in children with an inborn error of immunity (IEI). We performed a prospective study from 1 October 2017 to 30 September 2021, at the Department of Pediatric Infectious Diseases and Clinical Immunity of Ibn Rochd University Hospital-Casablanca. During this period, on 591 patients newly diagnosed with a probable IEI, eight of them (1.3%), from six independent families, had isolated or syndromic unusual viral skin infections, which were either profuse, chronic or recurrent infections, and resistant to any treatment. The median age of disease onset was nine years old and all patients were born from a first-degree consanguineous marriage. By combining clinical, immunological and genetic investigations, we identified GATA2 deficiency in one patient with recalcitrant profuse verrucous lesions and monocytopenia (1/8) and STK4 deficiency in two families with HPV lesions, either flat or common warts, and lymphopenia (2/8), as previously reported. We also identified COPA deficiency in twin sisters with chronic profuse Molluscum contagiosum lesions, pulmonary diseases and microcytic hypochromic anemia (2/8). Finally, we also found one patient with chronic profuse MC lesions and hyper IgE syndrome, (1/8) and two patients with either recalcitrant profuse verrucous lesions or recurrent post-herpetic erythema multiforme and a combined immunodeficiency (2/8) with no genetic defect identified yet. Raising clinicians awareness that infectious skin diseases might be the consequence of an inborn error of immunity would allow for optimized diagnosis, prevention and treatment of patients and their families.

Comparative effects of treatment with ferric carboxymaltose versus ferric derisomaltose in a murine model of iron-deficiency anemia

Intravenous (IV) iron preparations like ferric carboxymaltose (FCM) and ferric derisomaltose (FDI) are used to treat iron deficiency anemia (IDA) due to heavy uterine bleeding, inflammatory bowel disease, and chronic kidney disease. These preparations greatly differ in terms of their side-effect profiles (e.g, hypophosphatemia). However, studies that directly compare FCM and FDI are limited. The objective of this study was to compare the effects of FCM and FDI in a mouse model of IDA and investigate changes in blood parameters and mineral homeostasis. Female C57Bl/6J mice were fed iron-deficient diet for 5 weeks followed by IV bleeding (0.7% of body weight [b.w.]) for 3 consecutive days. On day 0 (last day of bleeding), baseline blood and urine were analyzed for hematocrit, CBC, P i and Ca 2+ . Mice were randomized to vehicle (saline, 2 μl/g b.w.; n=16), FCM (20 mg/kg; n=12), or FDI (20 mg/kg; n=12) treatment via retroorbital injection on day 0 and 7. On day 14, terminal blood, urine, spleen, and heart were collected. At baseline, compared with pre-bleeding, all mice had low hematocrit (22±1 vs 48±0.3%; P<0.05) and microcytic hypochromic anemia. After 14 days, mice treated with FCM and FDI had higher hematocrit compared with vehicle (47±0.4 and 46±0.3 vs 25±1%; P<0.05). WBC were similar on day 14 compared with day 0 for mice treated with FCM (8±1 vs 7±1 x10 9 /L; NS) or FDI (7±1 vs 7±1 x10 9 /L; NS); however, WBC were decreased in vehicle-treated mice (4±1 vs 6±1 x10 9 /L; P<0.05). Thrombocytes were increased in vehicle-treated mice on day 14 compared with day 0 (1405±55 vs 795±23 x10 9 /L; P<0.05); while there was no change in thrombocytes in mice treated with FDI (706±16 vs 831±29 x10 9 /L; NS), they were decreased in FCM-treated mice (583±41 vs 771±30 x10 9 /L; P<0.05). Both FCM and FDI prevented splenomegaly that was seen in vehicle-treated mice (88±3 and 87±20 vs 263±40 mg; P<0.05). Similarly, FCM and FDI prevented greater heart weight that was seen in vehicle-treated mice (0.43±0.01 and 0.45±0.01 vs 0.48±0.01 g/b.w. %; P<0.05). After 14 days, mice treated with FCM and FDI had lower plasma P i compared with vehicle (1.9±0.1 and 2.1±0.1 vs 2.4±0.1 mmol; P<0.05); although FCM-treated mice showed greater hypophosphatemia compared with FDI ( P<0.05). There were no differences between groups for urinary P i . Plasma Ca 2+ was similar between groups on day 14; but compared with day 0, it was higher in vehicle (2.7±0.1 vs 2.5±0.1 mmol; P<0.05) and FCM-treated mice (2.8±0.1 vs 2.5±0.1 mmol; P<0.05). Urinary Ca 2+ /creatinine was higher in mice treated with vehicle compared with day 0 (0.4±0.04 vs 0.1±0.01 mmol/mmol; P<0.05) but was lower with FCM (0.09±0.03 vs 0.14±0.04 mmol/mmol; P<0.05) and FDI (0.08±0.01 vs 0.3±0.06 mmol/mmol; P<0.05). In summary, our study shows that both iron preparations have similar effects on blood parameters, but mice were more hypophosphatemic when treated with FCM vs FDI. We speculate this may be due to variations in PTH and FGF23 levels. This work was supported by 1R01DK110621, VA Merit Award IBX004968A, NIDDK Diabetic Complications Consortium RRID:SCR_001415, DK076169 and DK115255 (all to TR). LT was supported by an AHA Postdoctoral Fellowship (828731). This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Beta Thalassemia Carrier Rate: Problem Burden among High School Children.

A cross-sectional multicenter study was carried out on 4320 randomly selected students from four governorates of the Nile Delta region, Egypt. All patients were to be tested for their complete blood count. Those with microcytic hypochromic anemia not caused by iron deficiency were tested for βT carrier status using high-performance liquid chromatography. The total prevalence of βT carrier rate was 6.13%. The highest prevalence was detected in Al-Sharkia Governorate, reaching 7.89%, followed by 6.90% in Al-Gharbia Governorate. Al- Dakahilia and Al-Menoufia showed lower rates of 4.86% and 3.73%, respectively. Despite the premarital national screening program for βT in Egypt, the carrier rate is still high. More effort should be done into the proper implementation of national prevention programs.

Association between Patients' Self-Judgement, Coagulated Menstrual Blood, and Menorrhagia: Results from a Questionnaire Survey and Blood Test Analysis.

Background and Objectives: Menorrhagia is defined as a blood loss of more than 80 mL, which is significant enough to cause anemia. Previously known methods for evaluating menorrhagia, such as the alkalin-hematin method, pictograms, and measuring the weight of sanitary products, were all impractical, complex, and time-consuming. Therefore, this study aimed to determine which item among menstrual history taking was most associated with menorrhagia and devised a simple evaluating method for menorrhagia through history taking that can be applied clinically. Materials and Methods: The study was conducted from June 2019 to December 2021. A survey was conducted on premenopausal women who underwent outpatient treatment or surgery and those who underwent a gynecologic screening test, and their blood tests were analyzed. The presence of iron deficiency anemia was identified with a Hb level of less than 10 g/dL with microcytic hypochromic anemia on a complete blood count performed within one month of the survey. A questionnaire survey was conducted on six items related to menorrhagia to investigate whether each item was related to "significant menorrhagia". Results: There were 301 participants in the survey during the period. In univariate analysis, the results revealed a statistically significant association between significant menorrhagia and the following items: self-judgement of menorrhagia; menstruation lasting over 7 days; total pad counts in a single menstrual period; Number of sanitary products changed per day; and leakaging of menstrual blood and presence of coagulated menstrual blood. In multivariate analysis, only the "self-judgement of menorrhagia" item showed a statistically significant result (p-value = 0.035; an odds ratio = 2.217). When the "self-judgement of menorrhagia" item was excluded, the "passage of clots larger than one inch in diameter" item showed a statistically significant result (p-value = 0.023; an odds ratio = 2.113). Conclusions: "Patient self-judgement of menorrhagia" is a reliable item for evaluating menorrhagia. Among several symptoms indicating menorrhagia, determining the presence of the "passage of clots larger than one inch in diameter" during the menstrual period is the most useful item for evaluating menorrhagia in clinical history taking. This study suggested using these simple menstrual history taking items to evaluate menorrhagia in real clinical practice.

Hemoglobin Variants in Patients With Microcytic Hypochromic Anemia: A Review of Indian Studies.

Microcytic hypochromic (MCHC) anemia with hemolytic components is common in clinical practice. Hemoglobinopathies and variants are one of the important underlying causes of MCHC anemia. The Indian population, by large, as various studies reported, showed a plethora of hemoglobinopathies with regional predilections for its types. The present systematic review is carried out for the evaluation of MCHC anemia for its underlying causes of hemoglobinopathies and their loco regional comparisons. The review was carried out by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method with selected keywords through the Google advanced search matchable to the objectives of the present systematic review. Upon the systematic review, it was observed that β thalassemia trait (βTT) remained the highest reported hemoglobinopathy. The other abnormal hemoglobin variants, though rare, also have been reported in the reviewed articles. It is concluded that patients with MCHCrefractory to its regular treatment should be subjected to high-performance liquid chromatography (HPLC) in exclusion of underlying hemoglobinopathy and abnormal hemoglobin variants.

Beta thalassemia revealing hypothyroidism: A case report

Thalassemia is a condition that affects hemoglobin synthesis and is one of the most Common hereditary illnesses in the world. Patients with thalassemia major require several blood transfusions. Multiple blood transfusions cause thyroid dysfunction, which leads to iron excess. We report the case of 35-year-old, followed in hematology for deep iron deficiency anemia who has benefited from a transfusion repeatedly diagnosed with beta thalassemia. At the interrogation, the patient reports a moderate gain of weight not quantified, hair loss and sensations of chills, chronic constipation, without other associated signs including no other signs of hypersecretion or anterior pituitary hyposecretion, no tumor SD. The physical examination finds a conscious patient, Normocardium, normal build, dysmorphic SD, palpable thyroid not increased in size. Microcytic hypochromic anemia, TSH at 10 mIU/l (0.35 -5.1) mIU / l, T4 at 10.6 pmol / l (10.6-19.4) pmol / l T3 to 2.88 pmol / l (3.8-8.4) pmol / l. Objective cervical ultrasound thyroid gland increased in size at the expense of the thyroid lobe with thyroid nodules classified EU-TIRADS 2 and 3. The patient was put on levothyrox 75ug/d. Thyroid disorders are common in β-thalassemia patients who have been transfused multiple times.

TT@MHA: A machine learning-based webpage tool for discriminating thalassemia trait from microcytic hypochromic anemia patients

BackgroundIron deficiency anemia (IDA) and thalassemia trait (TT) are the most common causes of microcytic hypochromic anemia (MHA) and are endemic in lower resource settings and rural areas with poor medical infrastructure. Accurate discrimination between IDA and TT is an essential issue for MHA patients. Although various discriminant formulas have been reported, distinguishing between IDA and TT is still a challenging problem due to the diversity of anemic populations. MethodsWe retrospectively collected laboratory data from 798 MHA patients. High proportions of α-TT (43.33 %) and TT concomitant with IDA (TT&IDA) patients (14.04 %) were found among TT patients. Five machine learning (ML) approaches, including Liner SVC (L-SVC), support vector machine learning (SVM), Extreme gradient boosting (XGB), Logistic Regression (LR), and Random Forest (RF), were applied to develop a discriminant model. Performance was assessed and compared with six existing discriminant formulas. ResultsThe RF model was chosen as the discriminant algorithm, namely TT@MHA. TT@MHA was tested in an interlaboratory cohort with a sensitivity, specificity, accuracy, and AUC of 91.91 %, 91.00 %, 91.53 %, and 0.942, respectively. A webpage tool of TT@MHA (https://dxonline.deepwise.com/prediction/index.html?baseUrl=%2Fapi%2F&id=26408&topicName=undefined&from=share&platformType=wisdom) was developed to facilitate the healthcare providers in rural areas. ConclusionThe ML-based TT@MHA algorithm, with high sensitivity and specificity, could help discriminate TT patients from MHA patients, especially in populations with high proportions of α-TT patients and TT&IDA patients. Moreover, a user-friendly webpage tool for TT@MHA could facilitate healthcare providers in rural areas where advanced technologies are not accessible.

Analisa Perbandingan Hasil Trombosit Pada Alat Hematologi Analyzer Metode Impedance dan Metode Optik Pada Kasus Anemia Hipokrom Mikrositer (Berdasarkan Indeks Eritrosit)

Platelets have an important role in hemostasis, namely the formation and stabilization of platelet plugs. There are several methods in the counting of platelets. They can be carried out in a direct and an indirect manner. The direct method can be carried out in an automatic and automatic way. The automatic method uses an hematology analyzer which functions to measure and examine blood cells in blood samples. Counting the number of platelets is done automatically by two methods, namely optical and impedance which have different principles. The optical method is based on cell size and morphology, while impedance is based on cell size only. Hypochrome is a condition where the Hb concentration is less than normal so that the central achromia widens (> 1/3 of the cell) and there is a decrease in the color of the erythrocytes, namely an increase in the diameter of the central pallor above normal so that it looks paler. Microcyte is a condition where the cell size is smaller than normal. The purpose of this study was to determine the difference in the number of platelets in the hematology analyzer using the impedance method and the optical method in the case of microcytic hypochromic anemia (based on erythrocyte index) with a descriptive analytical research design. The test used is the paired t-test with a total sample of 30 samples. The results of platelets using the impedance method have an average of 339.37 * 103 / uL with a standard deviation of 120.294. The results of platelets using the optical method have an average of 314.70 * 103 / uL with a standard deviation of 113.569. A significant value of 0.000 significant value of (sig. < 0.05) can be concluded that there is a difference between the results of platelets on the hematology analyzer using the impedance method and the optical method in cases of microcytic hypochromic anemia (based on erythrocyte index). Keywords : Trombosit, Hipokrom Mikrositer, Hematology analyzer, Impedance, Optik.

Applications of Artificial Intelligence in Thalassemia: A Comprehensive Review.

Thalassemia is an autosomal recessive genetic disorder that affects the beta or alpha subunits of the hemoglobin structure. Thalassemia is classified as a hypochromic microcytic anemia and a definitive diagnosis of thalassemia is made by genetic testing of the alpha and beta genes. Thalassemia carries similar features to the other diseases that lead to microcytic hypochromic anemia, particularly iron deficiency anemia (IDA). Therefore, distinguishing between thalassemia and other causes of microcytic anemia is important to help in the treatment of the patients. Different indices and algorithms are used based on the complete blood count (CBC) parameters to diagnose thalassemia. In this article, we review how effective artificial intelligence is in aiding in the diagnosis and classification of thalassemia.

Identification of four novel large deletions and complex variants in the α-globin locus in Chinese population

BackgroundAt present, the methods generally used to detect α-thalassemia mutations are confined to detecting common mutations, which may lead to misdiagnosis or missed diagnosis. The single-molecule real-time (SMRT) sequencing enables long-read single-molecule sequencing with high detection accuracy, and long-length DNA chain reads in high-fidelity read mode. This study aimed to identify novel large deletions and complex variants in the α-globin locus in Chinese population.MethodsWe used SMRT sequencing to detect rare and complex variants in the α-globin locus in four individuals whose hematological data indicated microcytic hypochromic anemia. However, the conventional thalassemia detection result was negative. Multiplex ligation-dependent probe amplification and droplet digital polymerase chain reaction were used to confirm SMRT sequencing results.ResultsFour novel large deletions were observed ranging from 23 to 81 kb in the α-globin locus. One patient also had a duplication of upstream of HBZ in the deletional region, while another, with a 27.31-kb deletion on chromosome 16 (hg 38), had abnormal hemoglobin Siriraj (Hb Siriraj).ConclusionWe first identified the four novel deletions in the α-globin locus using SMRT sequencing. Considering that the conventional methods might lead to misdiagnosis or missed diagnosis, SMRT sequencing proved to be an excellent method to discover rare and complex variants in thalassemia, especially in prenatal diagnosis.

PREGNANT WOMEN WITH SEVERE ANAEMIA IN LABOUR: PREVELENCE, SOCIODEMOGRAPHIC DETERMINANT AND OBSTETRICS OUTCOME

Background: Anaemia is most common hematological issue encountered during pregnancy and one of the major cause for maternal and perinatal morbidity due to disturbed physiological milieu. Our objective was to study the pregnancy outcome in women with severe anaemia in labour. Method: A Prospective observational study was conducted by collecting data from medical records of around 100 consecutive consenting women with severe anaemia in labour with >28weeks of pregnancy which admitted in a labour room of a tertiary health care center of south Gujarat over a period of one year after HREC approval. Results: In our study Majority of the subjects (73 %) were in the age group of 19 – 29 years, Majority (70%) subjects were unbooked. 75% subjects were with severe anaemia (Hb = 4 – 7 gm/dl) and 25% subjects were of very severe anaemia (Hb < 4 gm/dl). Majority of the (69 %) subjects were multipara and (31%) subjects were primipara. In multipara, majority (73.91%) subjects were having < 2 years of birth spacing interval. 84% subjects had microcytic hypochromic anaemia. 62% subjects had vaginal delivery and 36% subjects were undergone for Emergency LSCS. Conclusion: Increasing utilization of healthcare facility at every step(rural/urban) by needy women can improve obstetric & perinatal outcome associated with maternal anaemia. To overcome complications of anemia during pregnancy & in labour early detection of cases & early catching of mild to moderate cases of anaemia & their timely management required. All these can improve our clinical & Reproductive outcome

STUDY OF URIC ACID LEVELS IN PATIENTS WITH HYPOTHYROIDISM AND ITS CORRELATION WITH SERUM THYROID STIMULATION HORMONE LEVELS

Aim: we aimed to investigate whether there is a correlation between uric acid levels and TSH levels in the patients with hypothyroidism. This observational cross-sectional study was Material and method: conducted on patients attending OPD/ IPD of Hospitals afliated to Bangalore Medical College and Research Institute, Bangalore from November 2019 to May 2021. Data of all the patients satisfying the inclusion and exclusion criteria was collected. Data was analyzed by descriptive statistics. Pearson correlational analysis/Spearman's rank correlation was used to assess the correlation between Uric acid and TSH levels. A total of 90 cases were taken up Results: for the study. The mean age of the subjects was found to be 32±8 years, 82(91%) were females and only 8(9%) were males. The average height of the subjects was 158.67±9.31 cm. The average weight was 63.94±9.72 kg. The mean pulse rate of the subjects was 75.62±5.66, mean RR was 18.63±1.83, mean BP was 111±7/75±5. The average T3 was observed to be 1.59±0.96, average T4 was 3.83±3.73 and average TSH was 30.89±20.93. The mean serum uric acid of the subjects was 6.3±1.28 mg/dl, mean serum creatinine was 0.87±0.15 mg/dl and mean eGFR was 85.44±16.45, mean HB was 11.58±1.69, MCV was 79.81±6.76. Platate count was 2.92±1.35. The average Ferritin was found to be 185.21±359.03. The average LDH was 296.46±106.35, microcytic hypochromic anemia was present in 21(23%) subjects and normocytic normochromic anemia was present in 69(77%) subjects. Pearson correlation analysis showed that there was positive association between TSH and serum uric acid, among the subjects. However, the association was not found to be statistically signicant as p>0.05. Although not statistically Conclusion: signicant, a positive correlation was observed between the uric acid and thyroid stimulating hormone.

Diagnostic Value of Upper and Lower Endoscopy in Assessment of Patients with Microcytic Hypochromic Anaemia without Site-specific Gastrointestinal Manifestations

Diagnostic Value of Upper and Lower Endoscopy in Assessment of Patients with Microcytic Hypochromic Anaemia without Site-specific Gastrointestinal Manifestations

Clinico-Etiological and Clinico-Haematological Study of Patients with Pancytopenia in Rural Area

Abstract Background Pancytopenia is a manifestation of other underlying conditions, commonly associated with multiple benign and malignant conditions. Any patient presenting with pancytopenia requires a thorough evaluation to identify the underlying aetiology. Aim This current evaluates various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia in adult group. Study also correlates clinico-haematological profile. Method Fifty patients with a hematological diagnosis of pancytopenia were studied during the period August 2020 to August 2022. The study included adult patients of both sexes having the age of 18 years and above. Tests for complete blood count, reticulocyte count, peripheral smear, bone marrow aspiration, and trephine biopsy were done. Results Various etiological factors were identified in which majority were of megaloblastic anaemia (48.9%), followed by mixed nutritional anaemia (22.2%), hypersplenism (13.3%), aplastic anaemia (8.9%), malignant conditions (6.7%), myelodysplastic syndromes (2%), and others (4%) respectively. Megaloblastic anaemia cases observed in the age group of 31–50 years with male preponderance. Hemoglobin, TLC, Platelet count, and Reticulocyte count ranged from 2 g% - 10g%, 500–4000 cells/cumm, 24,000–1.5 lakh cells/cumm, and 0.1% – 2%. MCV was higher than 100 fl in 57.5% of cases. Majority of the patients had macrocytic and dimorphic anaemia. Hypersegmented neutrophils were present in all the patients. Bone marrow of Megaloblastic anaemia was hypercellular. Megaloblastic erythropoiesis with giant meta- myelocytes and band forms were seen. Nutritional anaemia seen in the age group of 51-60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 2.3 g%–7.8 g%, 1000–4000 cells/cumm, 5000–1.4 lakh cells/cumm, and 0.1–8%. Two cases had microcytic hypochromic anaemia in Nutritional anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 93.8% of cases. In hypersplenism seen in the age group of 51–60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.8 g% – 10 g%, 1700–3800 cells/cumm, 26000-1.4 lakh cells/cumm, and 0.6–2% respectilvey in hypersplenism. 40% of hypersplenism patients had microcytic hypochromic anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 70% of hypersplenism cases. Aplastic anaemia seen in the age group of 41–50 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.1–10 g%, 1100–4000 cells/cumm, 51000–1.5lakh cells/cumm, and 0.2%–1.8%. Aplastic anaemia (35.8%) cases showed macrocytosis. Bone marrow was hypocellular with an increase in marrow fat and Lymphocytes and plasma cells were prominent in Aplastic anaemia cases. Leukaemia commonly seen in the age group of 31–40 years with male predominance. Hemoglobin, TLC, and Reticulocyte count ranges from 5.1–9.8%, 1100–4000 cells/cumm, and 0.6–2% respectively. Bone marrow was hypercellular with a reversal of M:E ratio in 80%. Conclusion Megaloblastic anaemia was the commonest cause of pancytopenia. Most other studies have reported aplastic anaemia as the commonest cause. This seems to reflect the higher prevalence of nutritional anaemia in the Indian subjects. The haematological parameters and bone marrow morphological features in patients with megaloblastic anaemia, aplastic anaemia, and malignant diseases including MDS in the present study were comparable to the findings by other authors. Uncommon etiological factors like dengue fever and hemolytic anaemia were identified in this study. A comprehensive clinical, haematological, and bone marrow study of patients with pancytopenia usually helps in identification of the underlying cause. However, in view of a wide array of etiological factors, pancytopenia continues to be a challenge for hematologists.

COMPARATIVE STUDY OF AUTOMATED CELL COUNTER HISTOGRAM AND PERIPHERAL BLOOD SMEAR IN DIAGNOSIS OF ANAEMIA AT TERTIARY CARE HOSPITAL

Introduction: In recent years, complete blood count, red blood cell histogram and peripheral blood smear have become important diagnostic tools for diagnosing various blood diseases. Anemia is a major public health problem worldwide, with high prevalence in developing countries like India1. Red blood cell count and histograms are essential for the diagnosis and management of anemia2. The most important diagnostic tool for testing in most commercial laboratories is the periodic analysis of blood lms. AIM: the aim of this study was to compare the role of automated cell count histograms and peripheral blood smear results in the diagnosis of anemia.. Material and method:A prospective comparative study of RBC histogram and peripheral blood smear in diagnosis of anemia was done on 900 patients of HB<14gm%, over two month time span(September 2022-October 2022) in the central laboratory lab, Department of pathology, Gajra Raja Medical College, Gwalior, Madhya Pradesh. All cases of anemia who received blood transfusions were excluded from this study. Result:It was observed in our study that on peripheral blood smears, the most common type of anemia was microcytic hypochromic anemia, followed by normochromic normocytic anemias. When we compared with the histogram generated by the automated cell counter, the most common type of anemia was hypochromic microcytic anemia, followed by normochromic normocytic anemia. In our study, the female population was more numerous than the males. The average age is (23 years old). Conclusion:CBC histograms and peripheral blood smears generated by automated cell counters play an important role in the diagnosis and management of red blood cell disorders. Our study observed that the histogram pattern and its conrmation by the peripheral blood smear along with the clinical medical history allow an accurate and conrmed diagnosis of various blood disorders. Accuracy and precision have been greatly improved resulting in reducing the subjective error3 .

"STUDY TO DETERMINE USEFULNESS OF RDWI IN DIAGNOSIS OF IRON DEFICIENCY ANAEMIA."

Introduction Iron deciency is the most common nutritional deciency in both developing and developeds countries. In era of rising cost consciousness, efcient diagnostic approaches, which can rule in or rule out diseases with sufcient accuracy so testing is minimized. RDWI has more specicity for IDAthan RDW. So it can rule out IDAbetter than RDW. RDWI appears to be a reliable and useful index for initial screening of microcytic hypochromic anemia and is better than RDW in differentiating iron deciency anemia and beta thalassemia trait. Material And Methods Total 400 patients were included who were suspected for anemia during OPD visit. We have calculated RDWI of all patients using automated hematology analyzer using blood collection in EDTA vacutainer. Serum ferritin levels were also estimated using automated biochemistry using ELISA as principle method Result: There was total 66 patients having <220 RDWI and 7 patients of these 66 patients were having <15 ng/ml serum ferritin. Sensitivity of RDWI to diagnose IDAwas as good as 92.78 % in this study. The specicity and positive predictive value were 19.47% and 26.94% respectively. Negative Predictive Value (NPV) of RDWI to diagnose IDAwas 89.39 %.were having S.ferritin <15 ng/ml.