Histopathological outcome of pancytopenia cases on bone marrow trephine biopsy

Objective: To determine the histological outcome of pancytopenia cases on bone marrow trephine biopsy and to see the frequency of various causes of pancytopenia in our population

Study Design: Descriptive study

Place and Duration of Study: Pathology department, Combined Military Hospital [CMH], Kharian [Pakistan]. One year [Jan 2015-Dec 2015]

Material and Methods: Two hundred bone marrow trephine biopsies were done in one year [2015], out of which 40 were done for evaluation of pancytopenia. The criteria for diagnosis of pancytopenia were; haemoglobin less than 10 g/dl, total leukocyte count [TLC] less than 4.0 x 109/1 and platelet count less than 100,000 x 109/1. Patients with pancytopenia secondary to drugs, chemotherapy and radiotherapy were excluded from the study

Trephine biopsies showing marked crushing and having inadequate material were also excluded from the study. Biopsies were processed, slides made and examined under light microscope by haematologist and histopathologist. Frequencies of various causes of pancytopenia diagnosed on histopathology were calculated. The findings were analyzed by using SPSS version 10.0

Result: Out of 40 cases of pancytopenia, male to female ratio was 3:2. The age range was between 1 year to 75 years. Histopathological analysis of bone marrow trephine biopsies revealed megaloblastic anaemia as the most common cause of pancytopenia [30%], followed by aplastic anaemia [25%] and hypersplenism [15%]

Conclusion: Megaloblastic anaemia is the most common cause of pancytopenia in our population as compared to aplastic anaemia mentioned in most of the international studies. This indicates prevalence of nutritional deficiency in our population and megaloblastic anaemia must be kept at top of list while evaluating pancytopenia cases. Early diagnosis and treatment of megaloblastic anaemia will prevent any further complication of this disease

Hepatitis B leading to megaloblastic anemia and catastrophic peripheral thrombocytopenia

Hepatitis B virus [HBV] typically causes chronic hepatitis, cirrhosis, and hepatocellular carcinoma. It is associated with a variety of extrahepatic complications. We herein, present a rare extrahepatic complication of HBV infection. A 32-year man presented with melena, bleeding from gums and fever. Peripheral blood examination revealed anemia, macrocytosis and severe thrombocytopenia. His hepatitis B surface antigen [HBsAg] was positive but deoxyribonucleic acid [HBV DNA] by polymerase chain reaction [PCR] was negative. Other hepatitis, human immune deficiency virus [HIV], dengue, and autoimmune serology were negative. Bone marrow examination revealed megaloblastic erythropoiesis. There was mild to moderate reduction of megakaryocytes in bone marrow, which was not compatible with severe peripheral thrombocytopenia. His response to cyanocobalamin and folic acid was remarkable for myeloid cell lines and moderate for erythroid cell lines, but poor to platelet counts. Platelet counts gradually improved to safe limits with eltrombopag, likely reflecting autoimmune pathogenesis for thrombocytopenia. This case report highlights multiple targets of HBV infection with associated multiple pathogenetic mechanisms

Histopathological analysis of gastric mucosal biopsies in non ulcer dyspepsia

Objective: To find out the pattern of gastric mucosal histopathological findings in gastric biopsies of patients with non ulcer dyspepsia

Study Design: Prospective descriptive study

Place and Duration of Study: Histopathology department Combined Military Hospital [CMH] Kharian Pakistan from Jan to Dec 2015

Material and Methods: One hundred patients presenting at outpatient gastroenterology department with dyspepsia having no endoscopic lesion were included in the study. Two gastric mucosal biopsies from antrum and two from corpus were taken. The specimens were processed and examined histologically to see the changes

Results: Gastric biopsies of 100 patients including 65 males and 35 females presenting with non ulcer dyspepsia were studied. Most of the patients were between the age group of 31-50 years. Histological examination of gastric biopsies revealed 70% of patients having histological features of gastritis, while 30% having no significant histological finding. Chronic inflammation was seen in 70 cases [70%], activity in 15 cases [15%], glandular atrophy in 2 cases [2%] and intestinal metaplasia in 2 cases [2%]. H.Pylori were identified in 25 cases [25%] based on haematoxylin and eosin [H and E] staining and modified giemsa staining

Conclusion: Most the cases of non ulcer dyspepsia show histological evidence of gastritis, however a significant number of patients showed no gastric mucosal histological abnormality. A significantly low frequency of H. Pylori in gastric biopsies noted in non ulcer dyspepsia cases may be due to more frequent use of antibiotics and acid suppressant drugs used by general practitioners at some stage of disease

comparative analysis of hyperhomocysteinemia in hemodialysis patients versus normal controls

To compare the mean homocysteine level of ESRD patients undergoing regular hemodialysis with normal age and gender matched controls. This observational study was conducted at Dialysis Unit of Fauji Foundation Hospital, from January 2011 to October 2012. Cases included patients from 12-65 years age of either gender who were on regular hemodialysis for more than three months at a frequency of three times a week. Controls were chosen from the healthy relatives and hospital employees who had normal renal functions and were matched for age and gender. Total homocysteine in plasma was measured by HPLC and fluorescence detection. We included 55 hemodialysis patients and 55 controls. The mean age of cases and controls was 45.67 +/- 10.68 and 45.94 +/- 10.50 years respectively. There were a total of 24 [21.8%] males. The two groups were similar in respect to age and gender distribution. The mean homocysteine level of cases and controls was 17.69 +/- 5.17 and 12.85 +/- 3.27 micro mol/L respectively [p =0.00]. Plasma homocysteine levels are significantly higher among homodialysis subjects as compared to normal controls

Efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children

To compare the efficacy of parenteral iron as compared to oral iron in the treatment of iron deficiency anemia in children presenting at CMH Murree. Randomized control trail [RCT] Departments of Paediatrics and Pathology CMH Murree from August 2009 to March 2010. Forty one children diagnosed with iron deficiency anemia on the basis of hemoglobin, red cell indices and morphology and serum iron levels were included. Patients were randomized into two groups with group I of 18 receiving oral ferrous sulphate and group II of 23 receiving parenteral iron sorbitol therapy. Response was assessed by reticulocyte count at 1 week, change in hemoglobin, MCV and serum iron levels at 4 weeks post treatment. The reticulocyte response at 1 week time was significantly more with intramuscular iron as compared to oral iron. Mean hemoglobin change and serum iron level increase were also significantly more with intramuscular iron therapy. Mean MCV level change was insignificant between the two modalities. Parenteral intramuscular iron sorbitol treatment with better compliance shows early improved responses in children with iron deficiency anemia as compared to oral ferrous sulphate therapy and should be used as a preferred modality for treatment

Frequency of bleeding disorders diagnosed at armed forces institute of pathology Rawalpindi

To determine the frequency of bleeding disorders diagnosed at Armed Forces Institute of Pathology, Rawalpindi [AFIP Rwp]. Descriptive study. Department of Hematology, AFIP Rwp from January 2006 to June 2009. A total of 1836 patients of bleeding diathesis were included in the study. Hess test was done to investigate the vascular defects. Bleeding Time [BT] was done to screen platelet function defects. The 'clotting screen' and mixing studies were done to detect coagulation protein defects. Clot solubility test was performed to screen factor XIII deficiency. Out of 1836 patietns of bleeding diathesis 435 [23.7%] were diagnosed as having haemostatic defects. Out of these 435 patients 273 [62.8%] had coagulation factor deficiency, 81 [18.6%] had platelet function defects and 81 [18.6%] had vWF deficiency. Among the 273 coagulation factor deficiency patients, factor VIII deficiency was in 121 [44.3%], factor IX deficiency in 32 [11.7%], factor V deficiency in 18 [6.6%], factor XIII deficiency in 15 [5.5%], factor VII deficiency in 12 [4.4%], factor X deficiency in 9 [3.3%], factor I deficiency in 8 [2.9%] and factor II deficiency was in 3 [1.1%]. Multiple factor deficiency was 55 [20.1%]. No defects of vasculature were identified. Coagulation factor deficiencies, with factor VII deficiency being the commonest are the most frequent bleeding disorders. Platelet function defects and vWF deficiency also comprise significant proportion of the bleeding disorders

Homozygous beta° thalassaemia presenting with warm antibody immune haemolytic anaemia in an adult male

Beta thalassaemia major in certain genetic mutations may present as thalassaemia intermedia or, its diagnosis may be missed. The management of such patients requires special consideration. We present such a case of beta thalassaemia major who developed warm antibody type of immune haemolytic anaemia