Normal MCV Research Articles

Serum ferritin level in children with normal hemoglobin and low MCV and MCH in a hospital in Iraq

Background: Iron deficiency is common around the world, particularly in young people because of their elevated need for iron to grow and develop. Iron deficiency is demonstrated by low levels of serum ferritin. This research will investigate the level of serum ferritin in children with normal hemoglobin but low MCV and MCH, the purpose of this is to determine the degree to which subclinical iron deficiency is present and distinguish it from other causes of microcytosis. Method: 150 children with typical hemoglobin but low MCV and MCH were recruited recognizing subordinate iron deficiency. Blood samples and demographic information regarding sociological aspects were collected and assessed. A computerized hematology analyzer and an ELISA were both used to assess the level of haemoglobin in the blood and the serum level of ferritin. Results: Children with normal hemoglobin but low MCV and MCH had a mean hemoglobin level of 12.7±0.6 mg/ dl and a serum ferritin level of 86.5±7 ng/ ml, according to the study. The levels of serum ferritin and hemoglobin changed significantly, depending on the sociodemographic variables. Among the pediatric population, the levels of serum ferritin and hemoglobin were significantly higher (P-value 0.002). Conclusion: In children with typical hemoglobin, but low MCV and MCH, the sociodemographic factors are strongly associated with the hemoglobin and serum ferritin levels. Gender, birth order, and family size—children under the age of 10 years— had an effect on the serum level of ferritin. The age, birthdate, and the time of supplemental food consumption also had an effect on hemoglobin levels. These findings demonstrate the necessity of recognizing and treating iron deficiency early on in life.

Association between asymptomatic Plasmodium falciparum malaria infection, anemia and mean corpuscular volume of school children in the Volta Region of Ghana

Abstract Introduction/Objective Although several studies have reported abnormal MCV values and anemia associated with malaria infections with a focus on P. falciparum among patients with complicated and uncomplicated malaria. This study assessed the association between asymptomatic P. falciparum malaria infection, anemia, and the MCV values of school children in Ghana. Methods/Case Report We conducted a cross-sectional study using 3 ml of blood samples from 549 children aged 5- 17 years attending 5 schools selected in the Volta Region. Semi-structured questionnaires were administered to the children to obtain demographic data. Blood samples were collected into a K2EDTA tube and then used to estimate the children’s automated full blood count (FBC) and malaria status using microscopy. MCV was classified into low, normal, and high. Data obtained were analyzed using STATA 15 software. P-values less than 0.05 were considered statistically significant. Results (if a Case Study enter NA) Most of the children in this study (49.9%) had normal MCV (81.3-91.3 fL) with an overall malaria prevalence of 55.6 % (95% CI: 51.3-59.8) and anemia prevalence of 48.6% (95% CI 44.4-52.9). The majority of the anemic children had normal MCV (81.3-91.3 fL) (49.8, 95% CI 43.7-56.0). The predicted probability of malaria was highly likely among children whose MCV fell within the first and third quartiles. Conclusion This study shows a reduced predicted probability of malaria among children with low and high MCV, playing a protective function against malaria. Further studies are required to elucidate the association and interaction between MCV, anemia, and asymptomatic Plasmodium falciparum infection.

The frequency of vitamin B12 derangements in females presenting for workup of iron deficiency anemia

Objective: Iron deficiency anemia (IDA) is the most prevalent hematological disorder in women of child-bearing age. IDA poses a threat to feto-maternal wellbeing. It is the leading cause of morbidity and mortality in pregnancy. IDA in young females can coexist with other nutritional deficiencies such as vitamin B12 (Vit B12). An undetected Vit B12 deficiency carries a greater likelihood of development of maternal neuropsychiatric disorders and neural tube defects in the fetus. Materials and methods: Venous blood samples of non-pregnant female population (N=133) from Fauji Foundation Hospital, Rawalpindi were collected and analyzed for complete blood count (CBC), Vit B12 and serum Ferritin. Population was further subdivided into two groups. Group A, included females with low serum Ferritin and low MCV, group B restricted to normal serum Ferritin and low MCV, whereas control group had females with normal serum Ferritin and MCV levels. Results: Demographic data suggested that only height was slightly lower in IDA patients other than reduced serum Ferritin levels. Group A also showed reduced levels of Vit B12 as compared to group B and control group. CBC analysis indicated marked reduction in all hematological parameters except platelet count in group A. Conclusion: Our findings suggest that IDA and Vit B12 deficiency may coexist in young females. Monitoring Vit B12 along with iron deficiency parameters is essential to treat anemia and prevent gynecological complications. Paucity of information on their coexistence in females of childbearing age require further investigation. Keywords: Vitamin B12, Iron deficiency anemia, Microcytosis, Serum Ferritin.

Dietary effects of Gmelina arborea × Panicum maximum forages on digestibility and haematological characteristics of rams.

Rams' productivity is integrally hinged on their nutrition/nutrients intake, and performance by these animals is predominantly dependent on dry matter intake. Hence, the experiment aims to evaluate the dietary effects of wilted and silages of Gmelina arborea and Panicum maximum forages at different proportions on nutrient digestibility, performance, blood components and ruminal fermentation characteristics of rams. P. maximum was substituted with G. arborea leaves at 100:0, 70:30 and 60:40, respectively and were allowed to wilt overnight, while equal proportions were ensiled for 2 days, designated as 100P(W), 70P:30G(W), 60P:40G(W), 100P(E), 70P:30G(E) and 60P:40G(E). Thereafter, the diets were fed to thirty West African Dwarf rams (5 rams, randomly allocated into each dietary treatment) for 56 days. Parameters measured included nutrients intake, nitrogen utilization, apparent digestibility, weight change, blood components, volatile fatty acids, rumen pH and temperature. From the results, G. arborea leaves and fermentation as a result of the silage significantly (p<0.05) improved nutrient composition, and invariably, all the parameters assessed. Highest CP (14.02%), DMI (765.06 g/day) and nitrogen retention (84.64%) was recorded for rams fed diet 60P:40G(E). The least acetic (23.69 mmol/100ml) and highest propionic (24.97 mmol/100ml) acid production was also recorded for rams fed 60P:40G (E) which suggests richness of the diet and enacted the activities of rumen microbes for efficient feed utilization. Further, their normal PCV (45%), WBC (13.70×109/L), RBC (14.02×109/L), haemoglobin (13.40 g/dL), MCV (32.10 fl/cell) and MCH (9.56 pg/cell) values indicated the diet is not detrimental to their health. Conclusively, P. maximum could suitably be combined with G. arborea leaves at 60:40 when ensiled, for improved ram production, and it's thus recommended.

Analysis of Examination Results of Erythrocyte Index in Pulmonary TB Patients Labuang Baji General Hospital, Makassar City

The high rate of transmission of tuberculosis (TB) in Makassar City is very concerning. Data from the Makassar Health Office (Dinkes) in 2019 there were 5,412 TB cases. The data then decreased during the pandemic to 3,260 cases in 2020. And 3,911 cases in 2021 with a recovery rate of 83% in 2019 and 85% in 2020. The purpose of this study was to determine the value of the erythrocyte index in patients with pulmonary tuberculosis at the Hospital of Labuang Baji, Makassar City. The type of research used is laboratory observation with descriptive method. The population in this study were all patients with pulmonary tuberculosis as many as 11 people with pulmonary tuberculosis. The results obtained are known for the MCV value, 8 tuberculosis patients have a normal MCV value, 2 patients have a low MCV value and one has a high MCV value, for the MCH value, 6 tuberculosis patients have a normal MCH value, 4 patients have a high MCH value. low and one patient had a high MCH value, for the MCHC value 4 people with tuberculosis had a normal MCHC value and 7 patients had a low MCHC value.

TMPRSS6 gene mutations in six Saudi families with iron refractory iron deficiency anemia

Iron-refractory iron deficiency anemia (IRIDA) is considered an autosomal recessive iron deficiency anemia due to mutations in the transmembrane protease serine 6 (TMPRSS6) gene. Variations in iron parameters and a higher risk of iron deficiency have been linked to the TMPRSS6 mutations. Furthermore, human genome-wide association studies (GWAS) identified a common mutation (rs855791) linked to abnormal hematological parameters, highlighting the importance of the TMPRSS6 gene in the regulation of iron homeostasis. This is the first study to investigate TMPRSS6 gene mutation in six Saudi families of probands with iron deficiency anemia unresponsive to oral iron and partially responsive to parenteral iron administration. Each participant provided a vacutainer tube with three blood samples (2.5 ml each) and analyzed based on hematological, biochemical iron profiles, and followed by genotyping by PCR. The TMPRSS6 gene was amplified, sequenced, and analyzed in all probands and family members. Statistical analysis was done using SPSS and SHEsis software. Few functional mutations in these families were suggested (p.W73X, p.E523K and p.V736A). The proband of family 6 presented numerous hematological abnormalities upon initial consultation, including normocytic anemia accompanied by low Hb, normal MCV, low serum iron, low serum ferritin, and normal TIBC. While the p.W73X variant was only found in 2 families, the p.V736A variant was found in all examined Saudi families with IRIDA. Given the evidence outlined for these six cases, future genotype-phenotype correlation studies in a large number of IRIDA patients in Saudi Arabia may be very informative for patient management, in addition to increasing knowledge of TMPRSS6 function during development as well as factors in the regulation of TMPRSS6 and its effect on iron levels in the body.

Effect of syringic acid on steroid and gonadotropic hormones, hematological indices, sperm characteristics and morphologies, and markers of tissue damage in methyl cellosolve-administered rats

Methyl cellosolve (MTC) is an established gonadotoxic and hematotoxic compound that is commonly and universally utilized in herbicide, liquid soap, stain, dye, paint, and brake fluid manufacturing industries as a solvent. Due to its wide range usage, this study therefore investigated the effect of syringic acid (SYAC) on hematological indices, sperm characteristics and morphologies, and markers of tissue damage in MTC administered male Wistar rats. Thirty (30) rats divided into six groups were used. Rats in group 1 served as control, those in group 2 were administered MTC for 30 consecutive days, those in groups 3, 4, and 5 were treated with 25, 50, and 75 mg/kg body weight of SYAC respectively also for 30 consecutive days immediately after each day MTC administrations, while rats in group 6 received 75 mg/kg body weight of SYAC only throughout. Compared with control, administrations of MTC resulted in a significant decrease in spermatozoa count, number of normal and live spermatozoa, Hb count, MCH, MCHC, serum TC, and LH, while number of abnormal spermatozoa, RBC and WBC counts, activities of serum AST, ALT, GGT, LDH, and ADH were significantly increased. Treatments with 25 mg/kg of SYAC significantly reduced the RBC and WBC counts, serum activities of AST, ALT, GGT, and increased TC concentration. Treatments with 50 mg/kg SYAC significantly lowered the number of abnormal spermatozoa, RBC count, activities of serum ALT, AST, LDH, ADH, and increased the number of normal spermatozoa, MCV, MCH, and MCHC, while 75 mg/kg of SYAC significantly decreased the serum activities of AST, ALT, GGT, LDH, ADH, and increased serum TC concentration. Findings from this study have revealed the hepatoprotective effect of SYAC at all doses investigated but did not confer spermatoprotection and hematoprotection against MTC-induced toxicities, and looking at the 3 doses investigated, 50 mg/kg of SYAC yielded the best effect.

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.

How I investigate acquired megaloblastic anemia.

In this review of megaloblastic anemia (MA), an overview of vitamin B12 and folate body requirements, biochemical pathways, and laboratory testing strategies will be provided. However, the focus of this review is the classic and unique features of MA in blood and bone marrow. Acquired MA is a benign disorder for many, but can be detrimental for some. The clinical presentation can vary considerably, and the spectrum of symptoms and signs is diverse and quite broad. Prompt recognition and therapy are critical to prevent potential irreversible damage and clinical sequelae, especially in patients with vitamin B12 deficiency. A delay in diagnosis of vitamin B12 deficiency can result in significant neurologic sequelae that may not fully resolve with treatment, including in neonates and young infants. The blood and bone marrow features in MA can closely mimic thrombocytopenic purpura, myelodysplasia, and other myeloid neoplasms. Both pancytopenia and normal MCV at presentation are common in MA and raise unique challenges for the diagnostician. Partially treated MA is also a significant diagnostic "trap". MA is highly responsive to treatment, and patients tend to improve rapidly upon treatment initiation. However, the broad range of clinical and hematologic features makes the rapid, successful diagnosis of MA a unique challenge for the hematopathologist. Even in the era of state-of-the-art laboratory testing, a high suspicion is required.

111 CLINICAL IMPORTANCE OF MEAN CORPUSCULAR VOLUME AS A PROGNOSTIC MARKER AFTER ESOPHAGECTOMY FOR ESOPHAGEAL CANCER

Abstract High MCV is suggested to be relevant to the incidence and prognosis of several malignancies. However, few studies investigating the correlation between MCV and survival outcome of esophageal cancer have been conducted. Methods This study included 570 patients with esophageal cancer who underwent radical esophagectomy between April 2005 and December 2017. Patients were divided into two groups according to the standard value of pretreatment MCV: normal (83–99 fL) and high (&amp;gt;99 fL) groups. Clinical backgrounds, short-term outcomes, and prognostic outcomes post-esophagectomy were retrospectively compared between the groups. Results Of all patients, 410 (71.9%) had normal MCV, and 160 (28.1%) had high MCV. High MCV was significantly associated with lower body mass index, higher frequency of habitual alcohol and tobacco use, and higher incidence of multiple primary malignancies other than esophageal cancer. High MCV also correlated with higher incidence of postoperative morbidity of the Clavien–Dindo classification ≥II and pulmonary morbidity. Overall survival was significantly worse in patients with high MCV. Multivariate analysis suggested that high MCV was an independent risk factor for worse survival outcome (hazard ratio, 1.54; 95% confidence interval, 1.098–2.151; p = 0.012). Conclusion Patients with high MCV have various disadvantages in clinical background that can adversely affect both short-term and long-term outcomes after esophagectomy. MCV can become a predictive marker to estimate survival outcome after esophagectomy for esophageal cancer.

HIGH PREVALENCE OF ELEVATED VITAMIN B12 LEVELS AT A TEACHING HOSPITAL

<h3>Introduction</h3> Measurement of serum vitamin B12 and folate levels is an integral part of the laboratory evaluation at our geriatric psychiatry clinic. While B12 testing is typically done to detect abnormally low B12 levels, in our clinic and elsewhere the tests often detect vitamin B12 abnormalities consisting of high rather than low levels of B12. The apparent high frequency of excessively high levels of vitamin B12 at our clinic led us to explore this issue in a more systematic manner. <h3>Methods</h3> This presentation examined all the B12 results completed at Hackensack Meridian Health- Jersey Shore University Medical Center [JSUMC] in 2018 and 2019. The initial query elicited 15833 test results. All cases whose folate was low (n=58) or unavailable (n=3987) were excluded from further analysis resulting in a sample of 11787 tests. Furthermore, duplicate tests for the same individual were excluded, holding on to the earliest performed test, resulting in a sample of 8901 B12 tests across all ages. This presentation examines the interplay between three variables: Vitamin B12 level, Age, and MCV. All three parameters were examined as continuous as well as categorical variables. The three variables were converted from continuous to categorical variables as follows: B12 level (low 0-179 Pg/Ml = 132 pmol/L; normal 180-914 Pg/Ml (that is 133-677 pmol/l); high 915 Pg/Ml (677 pmo/l) and up), Age (young 0– 17 yrs; adult 18-64; senior 65 and up), MCV (low 0-79.9; normal 80-100; high 100.1 and up). The conversion ratio for vitamin B12 is is 1.35 pg/ml = 1 pmol/l. <h3>Results</h3> 1. 22% of the whole sample had above normal Vitamin B12 levels 2. 27% of Seniors (65 and older) had above normal Vitamin B12 levels 3. B12 levels correlated positively with age; Seniors (65 and older) had significantly higher (by about 20%) B12 levels compared to adults (18-64 of age) 4. 8% of Seniors had high MCV despite normal or above normal plasma B12, suggesting possible functional B12 deficiency 5. 3.3% of Seniors had normal MCV despite B12 deficiency. <h3>Discussion</h3> During a two year period over a quarter of all vitamin B12 tested patients at JSUMC in general, and seniors in particular had above normal B12 levels. Oral B12 supplements may contribute to above normal B12 plasma levels, but the literature is equivocal on this issue. Unfortunately because in this sample specific clinical data was not available regarding the B12 intake in this population, the nature of the relation between oral intake of vitamin B12 supplements and abnormal high plasma B12 levels could not be explored. Several studies have reported on the prevalence of abnormal high vitamin B12 levels: Jammal et al., 2013 found it in 12% of cases, Carmel et al.,2001 in 14% and Chiche et al., 2013 in 18% of patients. Using 914 Pg/Ml as a cutoff point resulted in 27.5 % of JSUMC seniors falling in the above normal range category well above the published results. Above normal vitamin b12 levels are known to be associated with a long list of serious conditions including: 1. Hematological malignancies / blood dyscrasias, 2. Liver diseases, 3. solid organ tumors, 4. Autoimmune disorders 5. Renal disease / kidney failure, 6. Infectious diseases 7. Possibly with excessive b12 supplements intake. 8. Increased all-cause mortality Two recent studies have reported on the relationship between serum B12 concentrations. Wolffenbuttel et al., 2020 found, that there was a small but significant increase in cardiovascular mortality in the groups with low or high serum B12. The 2020 Flores-Guerrero et al., study found "that higher levels of plasma concentrations of vitamin B12 were associated with increased risk of all-cause mortality...". <h3>Conclusions</h3> 1. Over a quarter of the seniors tested at JSUMC had abnormally high vitamin B12 levels. The reason for this higher than expected prevalence requires further exploration. 2. In addition, since elevated B12 levels are known to be associated with a long list of serious medical conditions and a higher mortality rate, this project emphasizes the importance of conducting a careful clinical review for possible serious hidden causes for such findings. 3. High vitamin B12 may be the result of oral intake of large amounts of vitamin B12 supplements, but this information is typically not systematically collected. This project also highlights the importance of collecting accurate quantitative information regarding vitamin supplement intake when completing the medication reconciliation process in routine clinical practice. 1. Andrès E, et al., 2013 PMID: 23447660. 2. Arendt JF, et al., 2013 PMID: 23241600. 3. Carmel R, et al., 2001 PMID: 11843883. 4. Jammal M, et al 2013 PMID: 2314212. 5. Chiche L, et al., 2013 PMID: 23708236. 6. Wolffenbuttel BHR, 2020 PMID: 33032595. 7. Flores-Guerrero JL, 2019 PMID: 31940038.

Studi Indeks Eritrosit Pada Pasien Diagnosis Positif Malaria

Malaria is a contagious disease caused by parasites (protozoa) of the genus Plasmodium, which can be transmitted through the bite of a female Anopheles mosquito. There are 4 species of Plasmodium that cause malaria in humans, namely Plasmodium Vivax, Plasmodium Falciparum, Plasmodium Malariae and Plasmodium Ovale. Malaria is an infectious disease that is found in many tropical and sub-tropical countries. This study aims to determine the description of the erythrocyte index in patients diagnosed with malaria positive at the Kotaratu Public Health Center, Ende Utara District. Erythrocyte index examination functions in determining the type of anemia. This research method is laboratory observation with a descriptive approach. The research sample was 20 patients with positive diagnosis of malaria in Kotaratu Public Health Center, Ende Utara District. The results of this study were 20 samples, for normal MCV values 10 samples (50%), 10 samples (50%) less than normal and 0 samples (0%) more than normal. The MCH value was less than normal for 7 samples (35%), 13 samples (65%) normal and 100% normal MCHC value. The conclusion is that in malaria parasite infection there is a low MCV is 50% and 50% normal, low MCH is 35%, and normal is 65, while normal MCHC is 100%. Keywords: Erythrocyte Index (MCV, MCH, MCHC), Malaria

Maternal Hemoglobin Concentration and Pregnancy Outcome in a Sample of Iraqi Women

Aim of study: To analyze the maternal and perinatal outcome in varying degree of anemia and assess whichlevel of hemoglobin concentration has best pregnancy outcome in Iraqi women.Patients and Method: A cohort study that was conducted at Al-Elwiya Maternity Teaching Hospital duringthe period from 1st of Dec 2017 till end of Dec 2019. It included 500 pregnant women who were followedup in labor until delivery and their maternal and perinatal outcome were noted. Hemoglobin and MCV ofeach pregnant woman were measured at late second and third trimester. Hemoglobin groups were relatedto the maternal characteristics, delivery characteristics and pregnancy outcome. The patients underwent acomplete blood count, blood film examination and hematocrit estimation.Results: In this study, 33.4 % of study participants had mild anemia and 22% of them had normal hemoglobinand MCV. Incidence of adverse perinatal outcome was 32.6% and adverse maternal outcome was 11.8%.Maternal hemoglobin and MCV levels are significantly affected by mother’s age. Hemoglobin level is alsoaffected by parity while MCV level doesn’t. Low maternal hemoglobin was associated with increased riskof poor birth outcomes including LBW, preterm birth and adverse maternal health outcomes, includingcesarean section and induction of labor.Conclusion: Maternal anemia is strongly associated with several different types of maternal morbidity andperinatal morbidity.

S1741 Diffuse Colitis After an Exacerbation of Lupus Nephritis

INTRODUCTION: Mycophenolate mofetil (MMF) is an immunosuppressive drug widely used in organ and bone marrow transplant recipients as well as in autoimmune disorders like systemic lupus erythematosus(SLE). Gastrointestinal side effects occur in about 45% of patients using MMF, manifesting as nausea, vomiting, diarrhea, and abdominal pain. Here we illustrate a case of diffuse colitis induced by MMF diagnosed by colonoscopy and histology. CASE DESCRIPTION/METHODS: 55-year old woman presented to hospital due to asymptomatic severe anemia. She reported having increased flatus and abdominal bloating for the past three weeks but denied any abdominal pain, weight changes, hematochezia, melena or hematuria. Past medical history were hypertension, diabetes mellitus, SLE and lupus nephritis requiring hemodialysis. One month prior to her presentation she experienced a flare of lupus nephritis that was managed with prednisone and MMF. Vital signs and physical exams were unremarkable. Complete blood count showed severe anemia with hemoglobin at 4.6 g/dL, normal MCV 86.9 fL and increased RDW 16.4% and normal white cells and platelet counts, indicative of normocytic anemia. Comprehensive metabolic panel were significant for increased BUN 41 mg/dL and creatinine 6.12 mg/dL with decreased total bilirubin level 0.2 mg/dL. Fecal occult blood test was negative and no blood in urine. Upper endoscopy showed chronic gastric ulcer and duodenitis without hemorrhage or perforation. Colonoscopy demonstrated the entire colon appeared inflamed, edematous and erythematous mucosa with loss of vascularity. Histopathologic exam revealed pan-colonic crypt architectural distortion with increased apoptotic bodies with endocrine cell hyperplasia and focal cryptitis (Figure A-B), which were indicative of MMF induced colitis. Subsequently, MMF was discontinued resulting in improvement and resolution of the patient’s symptoms. DISCUSSION: MMF-induced colitis is an uncommon however debilitating complication with only few case reports and no current guidelines in the literature. Histologic features of MMF-induced colitis include crypt architectural distortion, inflammatory cell infiltration, lamina propria edema and increased crypt epithelial apoptosis, which can mimic ischemic colitis, inflammatory bowel disease or graft-versus-host disease. Colitis is seen in around 9% of patients on MMF. Discontinuing MMF leads to spontaneous resolution of symptoms.Figure 1.: Colonoscopy images showing the entire colon appeared inflamed; the mucosa was edematous and erythematous with loss of vascularity (A). Hematoxylin and eosin stain (original magnification ×400) showing crypt architectural distortion with increased apoptotic bodies (B: red arrows).

Screening for Toxic and Haematological Effect of Ethanol Extract of Azadirachta Indica in Wistar Rats Using Some Serum Enzymes as Markers

The leaves of Azadirachta indica plant was screened for haematological, toxic and serum enzyme activities in rats. Twenty rats were used and were grouped into 4 of 5 rats each. Group 1 was the negative control group administered distilled water. Groups 2, 3, and 4 were the treatment groups received 200, 400 and 800 mg/kg body weight of the A. indica extract respectively. The rats were dosed for 14 days, thereafter were sacrificed and blood collected by cardiac puncture for analysis. The effect of A. indica extract was checked on haematological parameters and serum enzymes activities. All results in treatment groups were compared with the normal control at statistical confidence of 95% (p&lt;0.05). There was progressive reduction of haematological parameters as the dose of the extract increased from 200, 400, to 800 mg/kg body weight. Haematological parameters, PCV, RBC, Haemoglobin showed decrease value which was not statistically significant at (p&lt;0.05). Total leukocyte count, showed progressively elevation by the extract though not statistically significant. Differential leukocyte count indicated very mild lymphocytosis neutropeania, monocytopeania and eosinopeania which were not statistically significant. Clinical biochemical parameters, A. indica extract demonstrated normal levels of the serum enzymes (AST, ALT and ALP) though there was slight decrease in a dose dependent fashion.Total protein was within normal range. The normal MCV, MCH and MCHC values suggests normocytic normochromic anaemic condition. The extract of A. indica is safe to blood cells, liver and kidney marker enzymes at dose &lt; 800 mg/kg body weight.

Vitamin B12 deficiency in children from Northern India: Time to reconsider nutritional handicaps.

Background and Aims:Subclinical Vitamin B12 deficiency is a very common entity in the Indian subcontinent with devastating clinical and socio-economic consequences. The objective of this study was to estimate the proportion of vitamin B12 deficient children and to evaluate their clinical profile.Setting and Design:This prospective analytical study was conducted in a tertiary level care institute in Northern India.Materials and Methods:Children with clinical pallor, were included in this study. Detailed history, height, weight percentiles and characteristic features of vitamin B12 deficiency were recorded and complete blood counts, mean corpuscular volume and vitamin B12 levels were done.Statistics:For Qualitative data was analyzed using Pearson Chi square tests and quantitative data was analyzed using two sided independent samples t tests.Results:A total of 111 children were included. 64.8% (n = 72) had vitamin B12 deficiency. Lethargy (63.9%) and weight loss (62.1%), Knuckle pigmentation were common features. One-fourth of the children were on vegetarian diet. Neurological manifestations were significantly associated with fragile hair (p 0.056) and knuckle pigmentation (p 0.027). Younger children had more weight loss (p 0.001), knuckle pigmentation (p 0.019) and hypotonia (p 0.045). One fifth of children presented with neurological manifestations.Conclusions:Two-thirds of the anemic children had vitamin B12 deficiency. There was a bimodal age distribution with regard to B12 deficiency. Neurological manifestations were predominant in younger children [<6] and hematological abnormalities were more frequent in older children [≥6 years]. Estimation of vitamin B12 levels forms an essential component while evaluating children with anemia, despite mixed dietary habits and normal MCV.

P1301 Opposite outcomes of two equally destructive forms of infective endocarditis

Abstract Introduction Infective Endocarditis is a complex entity with great variability of clinical manifestations and a broad spectrum of complications. The prognosis depends not only on the baseline characteristics of the patient, but also on the agent and the complications, both local and systemic, with clinical repercussion. Two clinical cases are presented. A 67-year-old woman with history of uncharacterized aortic valve disease, presented in the emergency department with a 3-month evolution of asthenia and anorexia, and ocasional fever. She presented pallor, with a systolic murmur II/VI audible throughout the precordium and no other abnormalities in physical examination. Blood tests showed Hb 9g/dL with normal MCV and MCH, no leucocytosis, CRP 132mg/L, mild elevation of troponin I (0.32ng/ml; N &amp;lt;0.04ng / ml) and erythrocyturia. Transthoracic and transesophageal echocardiograms (TTE and TEE) showed a mass on the aortic valve suggestive of vegetation, conditioning a moderate aortic regurgitation (AoR) and mitroaortic pseudoaneurysm. Another 49-year-old female patient, submitted during childhood to a subaortic aneurysm, intraventricular comunication, AoR and aortic coarctation repair, presented with deterioration of functional and neurological status, associated with fever and lower limb edema. At examination she had tachypnea, tachycardia, pallor, aortic systolic murmur and signs of pulmonary congestion. Blood tests had leukocytosis and neutrophilia, CRP 174mg/L, Hb 9.6g/dL, elevation of liver enzymes, spontaneous INR 1.4 and no renal damage. TTE and TEE showed a mobile vegetation attached to the ventricular face of the aortic valve with major AoR and perivalvular abscess fistulized to the left ventricle. Both patients were treated with empirical therapy with gentamicin, ampicillin, and flucloxacillin. The first case evolved with hemodynamic stability, without heart failure or distant embolization. It was isolated a multisensitive Strept. gordonii and antibiotic therapy was de-escalated to ampicillin alone. In the second case, the patient showed rapidly progressive clinical deterioration with hypoxemic respiratory failure and cardiogenic shock requiring vasopressor support, and was urgently presented to a surgical center. No microorganism was isolated and broad-spectrum antibiotic therapy was maintained. She eventually died before she underwent valve surgery. On the other hand, in the first case, 6 weeks of antibiotic therapy were completed and aortic valve replacement surgery was performed without complications. She was discharged without cardiovascular symptoms and has an unremarkable follow-up of 6 months. With these cases it was possible to demonstrate the variability of presentations and prognosis of the same entity, even if ab initio with equally severe local complications. The initial stratification of the prognosis, the initiation of early treatment and the adequacy of the surgical time for intervention are of importance. Abstract P1301 Figure. Imaging study of endocarditis

Profil Kadar Hemoglobin dan Indeks Eritrosit pada Penjual Ikan Bakar di Kota Palangkaraya

The process of fish by baking or burning using charcoal can produce toxic chemical compounds, one of which is a carbon monoxide (CO) compound. CO compounds can be inhaled into the lungs through the respiratory system in humans, thereby replacing the position of oxygen to bind to hemoglobin and consequently, the level of oxygen in the blood becomes reduced. The purpose of this study was to determine the profile of hemoglobin and erythrocyte indices of the grilled fish seller selling around Pahandut District, Palangka Raya City. The study was conducted with a purposive sampling technique and the number of samples in this study was 25 people. The results showed normal hemoglobin levels of 24 people and below the normal value of 1 person. Normal MCV values were 16 people, MCV below normal values were 9 people (36%). Normal MCH 21 people (84%), MCH under normal values 2 people (8%), normal MCHC 19 people (68%), MCHC below normal values 1 person (1%), MCHC more than normal values 5 people (20%). Profile and erythrocyte indices of 25 samples obtained normal hemoglobin levels of 24 people (96%) and hemoglobin levels below normal values of 1 person (4%). The results of 1 person (4%) cytitrocyte index were suspected of having microcytic hypochromic anemia which could be caused by iron deficiency, and 1 person (4%) of the type was suspected of having microcytichipchromic anemia.

Microcytosis in children and adolescents with the sickle cell trait in Basra, Iraq

BackgroundMicrocytic anemia, the most common form of anemia in children and adolescents, is a heterogeneous group of diseases that is acquired or inherited. We assessed the frequency and causes of microcytosis in children and adolescents with the sickle cell trait (SCT).MethodsThis descriptive study included 95 subjects (49 males and 46 females) with SCT who attended Basra Center for Hereditary Blood Diseases for evaluation. Investigations included complete blood count, high performance liquid chromatography, capillary electrophoresis, and measurement of serum ferritin and transferrin levels.ResultsSCT subjects had a low hemoglobin (Hb) concentration (9.79±1.75 g/dL), low mean corpuscular volume (MCV, 67.43±9.22), low mean corpuscular Hb (21.15±3.64), and a normal red cell distribution width (RDW, 14.00±2.30). Among 95 SCT subjects, 81 (85.26%) had microcytosis, 12 (12.63%) had normal MCV, and 2 (2.11%) exhibited macrocytosis. Sixty-three (77.78%) SCT subjects with microcytosis were iron deficient, and 18 (22.22%) had normal iron levels. The mean serum ferritin and HbA2 levels were significantly lower, while the RDW, sickle Hb, and serum transferrin levels were significantly higher in patients with microcytosis and iron deficiency compared to non-iron deficient subjects (P<0.05). Correlation coefficients did not reveal a significant association between the MCV and iron status of SCT subjects (P>0.05).ConclusionDespite the frequent occurrence of iron deficiency in SCT subjects, co-inheritance of alpha-thalassemia seemed to be the cause of low MCV in non-iron deficient individuals with microcytosis. Genetic analysis is required to understand the genetic basis of this phenomenon.

Evaluation of role of mean corpuscular volume and RBC-histogram in analysing anaemias as a rapid method in comparison to peripheral smear evaluation

Objective: From ages, Peripheral smear evaluation is being considered as the gold standard for evaluation of anaemias. Various other parameters have been assessed for their role as a substitute for peripheral smear. The present study evaluates Mean Corpuscular Volume (hereby referred to as MCV) and RBC-histograms if they are reliable as substitutes for the smear evaluation. Materials &amp; Methods: This is a prospective study conducted at the department of Clinical Pathology, Bhaskar Medical College. A total of 129 cases diagnosed as having anaemia were included in the study. Initially each case was analysed based upon the cell counter values, RBC indices &amp; RBC histogram. A detailed peripheral smear evaluation was done later for each case. The results were compared and analysed statistically. Sensitivity, Specificity and Positive, Negative predictive values were calculated. Results: Female cases outnumbered the male patients. Microcytic hypochromic anaemia was the most common type (61%); MCV was able to detect 75% of cases of macrocytic anaemia and 76% of cases of microcytic hypochromic anaemia. In contrast, 65% of cases of dimorphicanaemia had MCV values in the normal range. RBC-histograms were able to detect 63% of cases, 83% of cases with macrocytic anaemia, only 41% of patients had the characteristic double-peak on histograms. Conclusion: Though MCV and RBC histograms can detect most of the cases of macrocytic anaemia and microcytic anaemias with accuracy, a case with normal MCV and increased RDW requires a peripheral smear examination as the findings were variable in dimorphic anaemia.