Microcytic Hypochromic Blood Picture Research Articles

Serum Iron and Ferritin Levels in Beta Thalassemia Carriers in Duhok Governorate, Iraq.

Background Thalassemia and iron deficiency anemia (IDA) account for most cases of microcytic hypochromic anemia. It is a common misconception that iron deficiency does not occur in thalassemia. However, studies have found that iron deficiency can coexist in carriers of beta thalassemia. Objective The aim of this study was to determine the prevalence of iron deficiency and iron overload in carriers of beta thalassemia in Duhok, Iraq. Patients and methods This prospective cross-sectional study included 250 patients with beta thalassemia carriers attending Kurdistan Private Hospital Laboratory Department from July 2021 to June 2023. Patients with microcytic hypochromic blood picture were tested for HbA2 levels, and those with a level >3.7% were included in the study and were tested for serum iron and serum ferritin levels. Results The age range was 15-80 years, with a mean of 25 years, and the male-to-female ratio was 1.5:1. The prevalence of iron deficiency in beta thalassemia carriers was 16% (N = 40). The prevalence of iron overload was 8.4% (N = 21). There was a significant statistical difference among those with iron deficiency, normal iron status, and iron overload in terms of hemoglobin level (P=0.001), RBC count (P=0.012), HbA2 (P=0.015), and serum ferritin (P < 0.0001). Conclusion Iron deficiency is more prevalent in beta thalassemia carriers than iron overload, necessitating proper assessment of iron status in patients with beta thalassemia carriers. Those with abnormal iron status need effective treatment to optimize the overall outcomes in patients with beta thalassemia carriers.

To evaluate the hematological markers in patients having nutritional anemia attending National Institute of Medical Sciences Hospital of Jaipur, Rajasthan

Abstract Background: Nutritional anemia is the most common preventable cause of anemia. Anemia of nutritional origin is an acquired problem caused by consumption of diets that lack sufficient quantity of vitamin B12 levels and serum iron and other components. As per World Health Organization guidelines, hemoglobin (Hb) of &lt;10 g/dL concentration treated as anemia. Nutritional anemia is identified by determining Hb concentrations, evaluating red cell indices and examining peripheral blood picture accompanying serum iron parameters and serum vitamin B12 level. Objectives: To study complete blood count indices with different serum vitamin B12 levels and serum iron profile among nutritional anemia patients attending NIMS Hospital, Jaipur. Materials and Methods: An observation study was conducted among 274 patients having nutritional anemia from General medicine out patients between 15 and 60 years. Two blood samples were collected from each participant to estimate the complete blood counts and red blood cells (RBCs) morphology and to analyze the iron profile and vitamin B12. Results: This presence study shows nutritional anemia in 55% of women than men. 15.6% of patients were from age group 15–20 years. 56.57% patients had moderate anemia, 29.92% patients had severe anemia, and 13.56% patients had mild anemia. Study shows 55% population were nonvegetarians and 45% had vegetarian diet. Microcytic hypochromic blood picture was found in 59.49% patients. Conclusions: Nutritional deficiency anemia was the most prevalent anemia. Peripheral smear is in concordance with serum iron parameters and serum vitamin B12 level. Our study suggests RBC morphology along with red cell indices in diagnosis and management of nutritional anemia which can be cured by dietary adjustment and fortification of food with iron and other micronutrients.

A study of anemia profile in a research hospital in Telangana, South India

Background: Anemia is widespread public health problem with 1.62 billion people affected globally. In India, Anemia is considered a major health problem. Children, women of child bearing age and pregnant women are more prone to develop anemia. Anemia affects the physical and mental growth of children, associated with increase maternal and fetal mortality, leads to reduced work productivity in adults. The present study was undertaken to determine prevalence and severity of anemia among patients who attended the outpatient clinics of a Unani research hospital in Telangana.Methods: This hospital based retrospective observational study was conducted from January 2020 to December 2020 to investigate the prevalence, type, and determinants of anemia. The complete haemogram values of all the patients who underwent haemogram investigation were noted, information was compiled, tabulated, and analysed. Descriptive statistics were computed with percentages, mean, standard deviation, and student’s t-test was used find the significance of study parameters.Results: Prevalence of anemia was 26.2% (872/3326), high prevalence of anemia was observed in females (44.04%) compared to males (5.72%) (p&lt;0.0001). The prevalence was more in reproductive age group (58.6%). Moderate anemia (58.6%) was more prevalent followed by mild anemia (36.6%). Microcytic hypochromic blood picture predominates with the incidence of 53.6% followed by normocytic blood picture 42.2%.Conclusions: Results confirmed high prevalence of anemia in females and moderate anemia being more prevalent followed by mild anemia and majority of anemia cases were microcytic, suggesting iron deficiency as the main cause of anemia.

Iron Deficiency in Anemic Patients: Study in a Tertiary Care Centre

Introduction Anemia is a clinical abnormality characterized by a reduction in hemoglobin concentration below the normal for age and sex. It can be of different types, the most common being iron deficiency anemia which affects mostly pregnant and lactating females and growing children in the developing world. Materials and Methods This was a hospital-based observational study conducted at National Medical College and Teaching Hospital, Pathology Department, Birgunj, Nepal. Patients above the age of 10 years of both sexes (male and females) having anemia ( males having hemoglobin level &lt; 13 gm/dl and females having hemoglobin level &lt; 12 gm/dl ) were included. After a detailed history, preliminary blood tests including complete blood counts, peripheral smear, and reticulocytes count were done. In patients suspected (microcytic hypochromic blood picture and normal reticulocytes count ) to have iron deficiency anemia, serum ferritin was done to confirm the diagnosis. Patients under the age of 10 years and those patients having blood malignancies (acute or chronic leukemia) were excluded from the study. Results Sixty anemic patients were found to have iron deficiency. Females were affected more (66%) with iron deficiency anemia than males (34%). There were two peaks (30% and 21%) in age groups 10 – 20 years and 61 – 70 years. Complete blood counts revealed a significant decrease in the value of red cell indices like mean corpuscular volume in 70% patients (Normal MCV 80 to 100 fl) and mean corpuscular hemoglobin in 72% patients (Normal MCH 27 to 33 pg ). On peripheral smear, it was seen that most of the patients (72%) had microcytic hypochromic blood pictures. Iron deficiency anemia was more common in rural areas. Conclusion Iron deficiency anemia was the most common type of anemia. It is more common in females and the prevalence is more in rural areas.

Common nutritional deficiency with unusual site of presentation

BackgroundPellagra is a nutritional disorder due to deficiency of vitamin B3 (niacin) which is characterized by dermatitis, dementia, diarrhea, and death. The most common site of dermatitis in pellagra is the Casal necklace; however, in this case, the presentation of dermatitis is in unusual sites. Therefore, mucocutaneous signs play a major role in diagnosing the condition. The clinical features of pellagra begin with gastrointestinal symptoms followed by neurological symptoms which are subtle and non-specific. But if misdiagnosed and untreated, it can progress to death from multiorgan failure.Case presentationA 46-year-old Indian farmer, chronic alcoholic of 20 years duration, presented to the hospital with the complaints of darkening and thickening of the skin over the left upper chest and shoulder, epigastric region, left arm and forearm, and right arm and forearm for a period of 4 months with mild cognitive decline. His blood parameters revealed moderate anemia with microcytic hypochromic blood picture and decreased MCV, MCH, and MCHC values. A diagnosis of pellagra was built clinically after exclusion of other causes and has been treated with nicotinamide and had drastic improvement on follow-up.ConclusionThe unusual site of pellagra presentation is rare; however, the uncommon presentation of a common disease is always to be considered for diagnosing the disease at the early stage. The neuropsychiatric symptoms of the pellagra in a known case of chronic alcoholic are not well defined, and if untreated, it may progress to stupor and coma and ultimately death. Hence, appropriate diagnosis and earlier management helps in the prevention of various life-threatening complications of any disease.

Role of intensive method of bone marrow iron assessment and serum Ferritin in prediction of iron deficiency: a study of 143 patients

Introduction: Iron deficiency anemia is a major health problem in developing countries like India. The situation is even more grim in economically backward areas of our country like Bundelkhand region. The increasing prevalence of co-existence of iron deficiency anemia with chronic diseases makes the use of biochemical markers like serum ferritin, challenging in diagnosing cases of inflammation and functional iron deficiency. Microscopic evaluation is the “gold standard” method for assessment of iron stores. In this study, we tried to correlate the marrow iron stores with serum ferritin so as to facilitate the distinction of iron store deficiency from functional iron deficiency. Materials and Methods: We selected 143 adult patients with anemia. In all the patients diagnostic bone marrow examination was done. Serum ferritin assay, CBC and peripheral blood smear examination was also performed. Assessment of bone marrow iron was done by both Gale’s method and the intensive method and was correlated with serum ferritin. Results: The Conventional Gale’s grading revealed hypoferremic state in 46.85% cases and normal iron stores in 53.15% cases. The new Intensive method of grading, classifies anemias according to iron status. It showed that most common was combined deficiency (functional & iron stores) (43.36%), followed by normal stores, functional iron deficiency and lastly iron stores deficiency in Bundelkhand region. We also found a positive correlation of microcytic hypochromic blood picture with S.Ferritin and iron deficiency anemia (Spearman’s Rho correlation, p value=0.0001). The proposed cutoff value of S.ferritin as a surrogate marker for iron deficiency used in our study is Conclusion: The new Intensive Bone Marrow Grading Method has greatly improved iron assessment because it provides a useful iron status classification which is of high clinical importance, especially in areas with high prevalence of inflammatory conditions co-existing with iron deficiency anemia, like Bundelkhand region and remains the gold standard method. Keywords: Anemia, Ferritin, Iron, Bone marrow.

Study of anemia pattern and its correlation with hematological parameters in a tertiary care centre

Introduction: WHO defines anemia as decrease in total red blood cell count or haemoglobin level below the normal percentage for that age. Decrease in the haemoglobin results in reduced oxygen delivery to the tissue resulting in hypoxia. The aims and objectives of this study is to detect the prevalence and type of anemia by evaluating the haematological parameters of all the samples that were received. Materials and Methods: Using EDTA vacutainer tubes, blood samples were collected from inpatients of all age groups. Total RBC count, hemoglobin concentration, packed cell volume and red blood cell indices such as mean corpuscular volume, mean corpuscular haemoglobin, mean corpuscular haemoglobin concentration and red cell distribution width were analysed and correlated with peripheral smear. Results: Out of 4350 samples, 45.5% patients were diagnosed as anemic. Microcytic hypochromic blood picture accounts for 48% which is the predominant type followed by other types such as normocytic anemia, dimorphic smear and macrocytic anemia. Males were commonly affected when compared to females. Conclusion: Etiopathogenesis of anemia varies according to the age group. The frequency of anemia increases as age advances. Anemia is associated with various conditions such as nutritional deficiency, blood loss, infections and chronic diseases the predominant cause being iron deficiency. Keywords: Anemia, Iron deficiency, Red cell indices, Peripheral smear.

A Study of clinical and laboratory profile of children presenting with febrile seizures in a teaching hospital

Background: Febrile seizures are the most common cause of convulsions in children. Although most febrile seizures are benign, the child must be evaluated immediately to reduce parental anxiety, to identify the cause of fever and preventable risk factors if any. It is essential to exclude underlying pyogenic meningitis, either clinically or if any doubt remains, by lumbar puncture. The present study evaluated the common risk factors associated with febrile seizures and the conditions causing fever commonly associated with febrile seizures, the morbidity profile and laboratory profile in children presenting with febrile seizures to identify preventable risk factors if any. Methods : n=50 Children in the age group of 6 months to 5 years admitted to the Department of Pediatrics, Prathima Institute of Medical Sciences, Nagunoor, Karimnagar with Febrile Seizures diagnosed as per AAP (American Academy of Pediatrics) guidelines, taken up for the study and compared with 50 other children in the same group with fever but without seizures. Both the study group and control were examined, investigated and compared against each other concerning the clinical and laboratory profile. RESULTS: In the present observational prospective study, the incidence of febrile seizures was more in children less than 24 months of age (78%), with a Male children Preponderance (58%). There were more children with Pallor (70%), Family History of Seizure Disorder (30%), and Consanguinity (38%) in children with Febrile Seizures. URI &amp; Viral fever (44%) were the most common etiological factors for fever among the study group. On investigation, many children with Febrile Seizures had low Haemoglobin levels (60%) and Microcytic Hypochromic blood picture (58%). There was no significant abnormality in Total &amp; Differential Leucocyte Count, Serum Calcium, Electrolyte, Random Blood Sugar levels among the Cases and Controls. Conclusion: Young age (&lt;24 months), family history of febrile seizures and family history of epilepsy are risk factors for febrile seizures. Consanguinity among parents was an incidental finding in children with febrile seizures. Many children with febrile seizures had Microcytic Hypochromic anemia pointing towards iron deficiency thus iron supplementation to prevent anemia may lead to decreased incidence of development and recurrence of febrile seizures. Association of serious infectious diseases with febrile seizures is rare. Laboratory investigations should be directed towards the identification of the cause of fever and not an evaluation of seizure.

Study of morphological types of anemia in pregnant women with low socioeconomic status attending antenatal care at rural tertiary care hospital

Introduction: Anemia is a major public health problem affecting both the developed(14%) as well as the developing(51%) countries. India became the first developing country to take up a National Nutritional Anemia Prophylaxis Program (NNAPP) to prevent anemia among pregnant women. Aims and objectives: 1.To find out the prevalence of anemia in ANC patients with low socioeconomic status2. To find out morphological types of anemia in this ANC patients 3.To study the various factors causing anemia in this group. Material and Methods: The type of this study is the Cross-Sectional Study, it was conducted on the ANC patients attending OPD and IPD of OBGY department at BhausahebSardesai Talegaon Rural Hospital, Maharashtra.The written consent of the pregnant women was obtained prior to the collection of the blood sample. Data was collected with the help of proforma.The blood sample was collected in the anticoagulant bulb. The diagnosis of anemia done by Hb estimation and estimation of blood indices. Morphological typing is done with the help of Peripheral blood smear stained with Leishman stain. Results: In the present study prevalence of anemia was found to be 72.58%. 15.32% of women found to be mildly anemic, 52.42% moderately anemic and 4.84% severely anemic followed by 27.42% not anemic. PBS examination of anemic women shows microcytic hypochromic anemia (74.44%), microcytic normochromic (3.33%), normocytic normochromic (20%), and normocytic hypochromic (2.22%). Conclusion: Microcytic hypochromic blood picture is predominant in the present study, it indicates there are deficient iron intake and lack of awareness about proper diet. Proper interaction, information, medication, proper diet containing all nutrients, cooking in iron utensils, fortification of food and salt with iron and birth control for proper spacing of pregnancies; such measures will go long way in improving maternal and fetal outcome.

Co-existence of Iron Deficiency in Beta Thalassaemia Trait

Background: Beta-Thalassaemia Trait (β-TT) is common in this subcontinent as well as Bangladesh. 3% of our total population is documented to have β-TT. Iron deficiency anemia (IDA), remains one of the most severe and important nutritional disorder in the world especially in Bangladesh. Microcytic hypochromic blood picture is common manifestation of both disorders. Purpose of the present study was to see whether both can co-exist.Methods: This was a cross sectional study carried out in Department of Internal Medicine, Bangabandu Sheikh Mujib Medical University (BSMMU), Dhaka from January-2014 to August-2015. Total 54 participants were selected from Haematology outpatient department (OPD), BSMMU. All of them had β-TT confirmed by Capillary Haemoglobin Electrophoresis. Proper counseling was done and informed consent was taken. Relevant history was taken and examination was done. Five ml of venous blood was collected and sent to Biochemistry department to measure serum iron, ferritin and tissue iron binding capacity (TIBC). Transferrin saturation (T.Sat) was calculated by formula (iron/TIBC) X100.Results: Total 54 patients who fulfilled the recruitment criteria were finally analyzed. Among them 85% (46) patients were females and 15% (8) were males. Median age was 30 years (range11-80 yrs). Most of the patients 78 % (42) belong to the age group between 15 to 44 years. Mean (±SD) HbA2 (%) was 5.35 (±1.39), Hb (%) 9.04± (1.39), MCV (fl)- 67.02 (±10.39), MCH (pg)- 21.06 (±3.99), RDW (%)- 17.77 (±3.85). Among them 44.4% (24) had low iron (&lt;40μg/dl), 29.6 % (16) had low ferritin (15μgm/L), 33.3% (18) had high TIBC (&gt;407μg/dl), and 50% (27) had low transferrin saturation (&lt;16%). 13% (7) patients were found to be iron deficiency considering all parameters and 63% (34) patients were iron deficient in at least one parameter.Conclusions: The present study shows the frequent occurrence of iron deficiency (29.6%) in subjects with β-TT which is a potentially correctable clinical condition. Proper assessment of iron level among the β-TT should be done and those who are iron deficient, should be treated promptly which may improve their general wellbeing.J MEDICINE Jan 2018; 19 (1) : 44-48

Clinical and haematological parameters associated with patients of visceral leishmaniasis in a district of North Bihar

Background: Visceral leishmaniasis is highly endemic in West Champaran district of Bihar. This endemicity is supposed to be due to poor hygiene and sanitation and poor control of vectors. This study was done to study clinical and haematological parameters of Kala-azar patients in this area.Methods: A retrospective data collection was done in a medical college of north Bihar. Study duration was one year from January 2016 to December 2016. 43 cases, rk-39 positive from 13 blocks of W. Champaran admitted at medical college were studied for clinical and haematological parameters.Results: Bhitha was the highest affected block (25.58%) followed by Manjhaulia (23.25%) Fever was the commonest presentation whereas splenomegaly was the most common sign. Pallor was seen in 90 % cases and hepatomegaly in 60 % cases. Patients presented with bleeding manifestation in 9.3% cases and lymphadenopathy in 6.9% cases. Among blood parameters anaemia was seen in 93% cases and thrombocytopenia in 83%. Microcytic hypochromic blood picture was the most common peripheral blood picture.Conclusions: Extensive epidemiological investigation is needed to find out hidden cases in this area.

English

In India, There Are Around 20 Million Carrier Cases Of -Thalassaemia And Around 8000-10,000 Children Are Born Every Year With -Thalassaemia Major, Lokeshwar M.R. Shah N, Kanakia N. Et.Al 2006. The Birth Of A Thalassaemia Child Places Considerable Health And Economic Strain Not Only On The Affected Child And His/Her Family But Also On The Community. Since, Thalassaemia Is A Severe And Incurable Disease, Emphasis Has To Be Shifted From The Treatment Of An Affected Child To The Prevention Of Such Births In Future. Identifying Carriers For - Thalassaemia Patients, Thus Plays An Important Role In Preventing This, Verma IC Et.Al (1992). - Thalassaemia Trait Presents With Microcytic Hypochromic Blood Picture Similar To The Picture Of Iron Deficiency Anemia And Anemia Of Chronic Diseases. The Differentiation Between These Conditions Becomes Mandatory Which Usually Relies On The Measurement Of Serum Ferritin, Serum Iron, Total Iron Binding Capacity And Hb A2 Levels. These Diagnostic Methods Are Costly And Hence Constitute A Significant Burden On Public Health Economy Particularly In Developing Countries Like India. This Made The Way For Developing A Simple And Economic Screening Test For The Detection Of Carriers Of - Thalassemia. In 1988 Mehta BC Et Al Developed A Simple Cost Effective Screening Test For The Detection Of Cases Of -Thalassemia Trait Based On Reduced Osmotic Fragility. This Is Called NESTROFT (Naked Eye Single Tube Red Cell Osmotic Fragility Test). We Have Tried To Assess The Usefulness Of This Screening Test In Our Paediatric Cases Presenting With Anemia.

Role of Haematological Changes in Predicting Occurrence of Leishmaniasis- A Study in Kumaon Region of Uttarakhand.

A number of cases of Leishmaniasis have been reported from non-endemic sub-himalayan regions of India. Due to low clinical suspicion and atypical presentation, cases may go undetected or there may be a delay in diagnosis. The aim of the study was to evaluate clinico-haematological parameters and bone marrow findings so that a high degree of suspicion could be made in unsuspected cases of Visceral Leishmaniasis (VL) and Leishman Donovan (LD) body negative bone marrow smears. A retrospective study was conducted at a tertiary care centre serving the kumaon region of Uttarakhand from 2010 to 2014. Forty bone marrow aspirates were included, which were sent on clinical suspicion of VL. Twenty cases were positive for LD bodies. Their clinico-haematological features including bone marrow findings were studied in detail and compared with rest of the 20 LD negative cases. Five LD negative cases were also positive for rk39. Twenty LD positive cases were evaluated. Splenomegaly was the most common sign present in 17 cases (85%). Anaemia, leucopenia and lymphocytosis were present in all the cases (100%). Pancytopenia was seen in 17 cases (85%). Microcytic hypochromic blood picture was the most common finding in 11 cases (55%). Bone marrow was normocellular in 7 cases (35%), hypercellular in 7 cases (35%). Erythropoesis was micro-normoblastic in 11 cases (55%). Overall, there were 25 cases of VL (20 LD positive, 5 LD negative). Increased plasma cells, lymphocytes and histiocytes were seen in 17 cases (68%) of VL. In non-endemic region where clinical suspicion is low, bone marrow findings can be a strong indicator for VL even though marrow is negative for LD bodies. If required other ancillary investigations can also be ordered. This study also emphasizes the need for epidemiological work up in this region.

English

AIMS AND OBJECTIVE: To investigate possible association between Anemia and Gestational Diabetes Mellitus (GDM). DESIGN, SETTING & PARTICIPANTS: A cross sectional study comprising of 100 GDM patients attending as outpatients or In-patients at Vani Vilas hospital and Bowring & Lady Curzon hospital, BMC & RI, Bangalore. MAIN MEASUREMENTS: GDM patients either newly diagnosed or on follow up were selected and complete blood counts including the peripheral smear, blood sugar levels and HbA1c were done. RESULTS: Anemia was diagnosed in 6 patients (6%) who are considerably less compared to Non-GDM pregnancy (40-50%). Out of which only 1 patient's peripheral smear showed Microcytic hypochromic blood picture whereas rest showed Normocytic Normochromic picture. CONCLUSION: Our study suggests that incidence of Anemia especially Microcytic Hypochromic Anemia is considerably lower in GDM. These finding suggests that routine supplementation of Iron irrespective of Hemoglobin (Hb) levels should be reconsidered in risk group

In Tuberculosis -Uncommon Presentation of a Common Disease

We present here a case report of a 27 year old man, who presented with high grade fever and swelling in the neck region. Peripheral blood smear showed both normocytic normochomic as well as microcytic hypochromic blood picture. Hemoglobin was 6.2 g%, TLC was 2100/mm3, DLC was: L65, N30, E05, platelet count was 69000 (i.e. pancytopenia was documented). FNAC of the cervical lymph nodes revealed reactive hyperplasia, with no evidence of caseating or non-caseating granulomas. A differential diagnosis of aplastic anemia was made. However, bone marrow examination revealed acid fast bacilli (AFB) on ZN staining. A revised diagnosis of bone marrow tuberculosis was made and the patient was put on ATT. There was a dramatic response clinically and thepancytopenia reverted after treatment.

English

BACKGROUND: More than one-third of world's women are anaemic with majority residing in developing countries and that too in rural areas. The most highly affected population in the decreasing order is pregnant women, school age children, non-pregnant women and preschool children. Nutritional anaemia has recently been ranked as the third leading problem among the women of reproductive age group. Most of the studies conducted so far have focused on pregnant ladies only so it was decided to take all the females in the reproductive age group as the study subjects. AIMS: To find out the prevalence of nutritional anaemia among married females of reproductive age group i.e., 15-49 years of age in a rural area of Jammu District. SETTINGS AND DESIGN: Across-sectional study was undertaken in rural settings. METHODS AND MATERIAL: House to house visits were made and288married females in the reproductive age group were interviewed and their blood samples were taken for necessary haematological investigations which were done at GMC Jammu. STATISTICAL ANALYSIS: Percentages and chi-square test. RESULTS AND CONCLUSION: More than 90% of the females were suffering from anaemia. Majority of them were having microcytic hypochromic blood picture. More than 50% of the subjects were having moderate anaemia as per WHO classification. Nutritional anaemia was seen in 70.47% of the study subjects while the remaining females were having either no anaemia or anaemia due to other medical reasons. The prevalence of nutritional anaemia was even more among pregnant and lactating females and this finding was found to be statistically significant.

Iron Status In Beta Thalassaemia Trait In Adult

Microcytic hypochromic anaemia is one of the commonest blood picture in Bangladeshi population. A vast majority of such cases have iron deficiency. In Bangladesh about 3% of total population that is about 3.6 million people with a microcytic hypochromic blood picture are beta thalassaemia trait. However iron deficiency may be associated with beta thalassaemia trait. Such patients are treated with iron to improve their anaemia. But the subjects of beta thalassaemia trait often have normal iron level. So, by observing microcytic hypochromic blood picture, supplementation of iron to that cases produce iron overload and may produce organ dysfunction. The study of serum ferritin was carried out on 50 confirmed cases of beta thalassaemia trait and 50 cases of healthy individuals. Estimation of serum ferritin level was done by Dimension RxL Max (Automatic Biochemistry Analyzer). The results show that serum iron level was normal in beta thalassaemia trait as like as healthy individuals. DOI: http://dx.doi.org/10.3329/jdnmch.v17i2.12211 J. Dhaka National Med. Coll. Hos. 2011; 17 (02): 21-24

Hemoglobin E Syndromes: Emerging Diagnostic Challenge in North India

Hemoglobin E (HbE) is one of the world's most common and important mutations. HbE disorders may be found in heterozygous (AE), homozygous (EE) and compound heterozygous state. It is important to distinguish HbE disorders diagnostically because of marked differences in clinical course among different genotypes. To find out whether RBC indices as obtained from automated cell counter can provide a clue to the diagnosis of HbE disease. This study was carried out in the Department of Clinical Pathology, PGIMER, Dr. Ram Manohar Lohia Hospital, New Delhi. It included antenatal pregnant females brought for routine check-up as well as referred patients suspected of having hemoglobinopathies. High Performance liquid chromatography was used as a confirmatory test for identification of hemoglobinopathy. Total 20 cases of subtype homozygous HbE (3), HbE trait (12) and Eβ-thalassemia (5) were identified. Statistical analysis was done to find out correlation between levels of HBA2, HBF with RBC indices. (a) There was negative correlation between HbA2/E peak values and RBC indices (Mean corpuscular volume (MCV) and Mean corpuscular hemoglobin) among all the three groups taken together. (b) There was positive correlation between HbA2/E and Red cell distribution width (RDW). (c) There was positive correlation between HbF values with MCV. The finding of positive correlation between HbA2/E and RDW may help in differentiating βthal (RDW normal) from HbE/βthal. In a patient with microcytic hypochromic blood picture and increased RDW, diagnosis of HbE/βthal should also be considered along with the more common Iron deficiency anemia. Thus, new insights into the knowledge of these diseases are important because they impart diagnostic challenges to all the experts involved in the treatment of anemic patients.