ABSTRACT
Non-Transfusion Dependent Thalassemia (NTDT) is a term used to label patients who do not require lifelong transfusions for survival. The common conditions traditionally described as NTDT are beta thalassemia intermedia, haemoglobin H disease and haemoglobin E beta thalassemia. The major problem with NTDT patients remains that, as they do not require regular transfusions, so they often do not seek medical attention until they develop serious complications such as anaemia due to ineffective erythropoiesis, iron overload, hypercoagulability and hormonal imbalances like hypogonadism, hypoparathyroidism, renal dysfunction etc.METHODSOur study was conducted in the Thalassemia Out Patient Department, Institute of Haematology & Transfusion Medicine at Medical College, Kolkata, over a span of 1 year 6 months. It was a cross sectional observational study of 30 patients of Non-Transfusion Dependant Thalassemia (NTDT) selected randomly as per the inclusion criteria. Thorough history taking and clinical examination were performed. Blood samples were tested for haemoglobin levels, RBC indices, fasting glucose, serum calcium, serum phosphate, SGPT, serum creatinine, TSH, FT4, FSH and LH (3 pooled samples at 30-minute-intervals), serum testosterone (in males) and serum ferritin. Ultrasonography and echocardiography were done. The data was analysed by standard statistical methods, using MedCalc (version 3.0) software. The correlation of different complications of NTDT with serum ferritin levels was done using Mann-Whitney U test. An alpha level of 5% has been taken i.e. any p value < 0.05 has been taken as significantRESULTSSerum ferritin levels were found to be quite high in the NTDT patients, with a range of 335.1 (min.) - 1300 (max.) ng/mL, with a mean serum ferritin level of 568.78 ng/mL and SD of 224.9, despite the fact that nearly 87% (26 out of 30) of the patients had received less than 10 transfusions in their lifetime. Our study showed that, delayed puberty, renal dysfunction, liver dysfunction and pulmonary hypertension were found to be significantly related to the serum ferritin levels (serving as a marker of liver iron concentration).CONCLUSIONSThus, we conclude that despite requiring much fewer transfusions than transfusion dependant thalassemia patients, the NTDT patients do develop iron overload as well as different complications, some of which are significantly related to the liver iron overload. Knowledge of such complications could help to initiate chelation therapy at the appropriate time for NTDT patients, thereby reducing morbidity and improving their quality of life.
ABSTRACT
Background & objectives: Newly diagnosed HIV patients may be asymptomatic or present with a wide range of symptoms related to opportunistic infections, acute seroconversion illness or other medical illnesses. This study was designed to evaluate the socio-demographic parameters, spectrum of the presenting clinical conditions and concurrent immunological status of newly diagnosed HIV patients and document the WHO clinical stages at the time of HIV diagnosis. Methods: This cross-sectional, observational study was undertaken over a 12 month period at a tertiary referral hospital in eastern India. Three hundred sixty consecutive newly diagnosed HIV patients were selected for the study from the HIV clinic and medicine wards of this hospital. Demographic and clinical data and relevant laboratory investigations of the patients were recorded and analyzed. Results: Mean age of patients was 36.38 ± 10.62 yr, while 63.89 per cent were males. The main mode of transmission of HIV for males and females were unprotected exposure to commercial sex (139, 60.44%) and intercourse with HIV seropositive spouses (89, 68.46%), respectively. Fever (104, 28.89%), weight loss (103, 28.61%) and generalized weakness (80, 22.22%) were the predominant symptoms. Overall mean CD4 count was 176.04 ± 163.49 cells/μl (males 142.19 ± 139.33 cells/μl; females 235.92 ± 185.11 cells/μl). Overall, 224 opportunistic infections were documented in 160 patients, opportunistic diarrhoea (44, 12.22%) and pulmonary tuberculosis (39, 10.83%) being the commonest. There were 83 and 133 patients in WHO clinical stages 3 and 4, respectively; 291 (80.83%) patients were eligible for initiation of first-line antiretrovirals at presentation. Interpretation & conclusions: Advanced immunodeficiency and burden of opportunistic infections characterize newly diagnosed HIV patients in eastern India. The physicians should keep in mind that these patients may have more than one clinical condition at presentation.