Aetiological considerations of acquired aplastic anaemia

Acquired aplastic anaemia is one of the important causes of pancytopenia. This study was conducted to observe the mode of presentation of acquired aplastic anaemia and to find out its possible etiological factors. It is a hospital based descriptive study of 100 patients of acquired aplastic anaemia. Out of 100 patients 60 were male and 40 female. Majority [44%] of the patients were between 12-20 years of age. Patient presented with variable symptoms majority [40%] with fever. Most of the patients had haemoglobin levels between 4-6 gm/dl. [53%. Seventy percent of the cases had no obvious cause, while in 30% some known causative factors were found. Chloramphenicol was found to be the most common causative drug. Mortality was 35%. Thirty patients were partially treated and 15 were lost to follow up. Twenty patients showed improvement with treatment. Acquired aplastic anaemia is common among males and more prevalent in younger age group. It is idiopathic in 70% cases while 30% had some cause. It has very high mortality. Doctors need to keep in mind this fatal condition in patients presenting with anaemia and should properly investigate before prescribing antibiotics and haematinics

Routine blood transfusion should not be [routine] in cardiac surgery

To determine if open-heart surgery can be performed in a public hospital in Pakistan without the use of routine blood transfusions. Considering the high prevalence of Hepatitis B and C in the donor population, decreased use of donated blood is the best protection against these and other transfusion transmitted infections. Cross sectional observational study. This study was conducted at cardiac surgery department, Mayo Hospital Lahore. It included patients operated from January 2006 to September 2006. Duration of study was 9 months. Total of 106 patients undergoing open-heart surgery were included in the study. These were all adult patients operated during the first nine months of 2006 by a single group of surgeons. Patients who were re explored for bleeding or had complicated postoperative course or who did not survive the operation were excluded. All the pump blood after cessation of cardiopulmonary bypass was transfused to the patient. Intra and post-operative allogeneic blood transfusions were given based upon strict transfusion criterion. Any patient who received 1 unit of blood[1] or 2 units of blood with post operative haemoglobin of 11 gram per 100 ml or more than 11 gram per 100 ml or more than 2 units of blood with post operative haemoglobin of 12 gram per 100 ml or more than 12 gram per 100 ml was considered to have received unnecessary transfusion[2]. 67 patients [63.21%] did not receive any blood transfusion. 32 patients, [30.19%] were transfused 2 units of blood. 7 [6.60%] patients received more than two units of blood. 8 [7.55%] patients received unnecessary transfusion. Blood transfusions can be eliminated in most routine cardiac operations. As appropriate drugs and technology like cell savers and in pump haemo-cocentration devices become available to us, the number of patients receiving blood transfusions can most likely be decreased further