Growth of thalassaemic children in Myanmar

The growth of thalassaemic children was studied at the Day-Care-Room in Yangon Children's Hospital. Most of these patients came to the Day-Care-Room for transfusion only, when their pretransfusion haemoglobin level became very low (range 3-8.2 g/dl, median 5.0 g/dl). Their spleens and livers were moderate to markedly enlarged. The percentage of children who had below median -2SD for weight and height for age were 68.8 percent and 72.9 percent respectively. There was no much difference between growth of boys and girls. The rising trend of percentage of children who had low weitht and height for age was found as they became loder. To get a better growth and a better quality of life, the pretransfusion haemoglobin level should be maintained at > 6 g/dl (probably 6-9 g/dl).

The peripheral lymphocyte mitogenic responses of apparently healthy Myanmar blood donors

The responses of peripheral lymphocytes to mitogens namely, phytohemagglutinin (PHA) and lipopolysaccharide (LPS) were determined in 50 apparently healthy blood donors. The stimulation indexes of PHA and LPS of male and female donos were calculated. Though there was a singificant difference (p < 0.001) between the sexes to PHA response, no significant difference was found in LPS response. Also the mitogen responses had no correlation with the age and the number of T and B lymphocytes in the peripheral blood.

Immunophenotyping of acute leukaemia

Immunophenotyping of peripheral blood mononuclear cells from 36 patients (Male 23, female 13; age range 3-80 yrs) newly diagnosed as acute leukaemia were done during May 1991 to November 1992. All cases were diagnosed as acute leukaemias based on clinical features and peripheral blood and bone marrow findings under light microscopy. Using the indirect immunofluorescent method immunophenotypes of the leukaemic blasts were identified on peripheral blood mononuclear cells using monoclonal antibodies (CD13 as myeloid marker; CD3, CD10 and CD19 as lymphoid markers). Out of 36 patients, 19 were myeloid and 14 were lymphoid leukaemias and 3 were non-reactive with monoclonals used. The study showed a significant positive correlation between morphological diagnosis and immunophenotyping. It had established the diagnosis in 3 cases where morphology alone was unable to do it. Discrepancy between morphological diagnosis and immunophenoltyping was observed in 4 cases. The present study showed that it will be of great diagnostic as well as therapeutic value if an appropriate and wider panel of monoclonal antibodies can be used.

Establishment of staphylococcal clumping test and detection of normal level of fibrin(-ogen) degradation products in Myanmar (Staphylococcal clumping test and normal FDP level in Myanmar)

Staphylococcal clumping test was established using a coagulase positive strain of staphylococci. 10 mg/ml of bacterial cell suspension was used as the optimum concentration for detecting 2 ug/ml of fibrinogen reference solution. The sensitivity of our method is of 2 ug/ml of fibrinogen. Using the staphylococcal clumping test, 150 samples of healthy blood donors were tested. The normal fibrin(-ogen) degradation product levels of Myanmar ranged from zero to 10 ug/ml. The results obtained from the staphylococcal clumping test were comparable to those obtained from Thrombo-Welllco latex agglutination test (Wellcome Divagnostics).

The effect of cobra (Naja naja) venom on blood coagulation/fibrinolysis system and on red blood cells

The effects of cobra (Naja naja) venom on blood coagulation , fibrinolysis and red blood cells were studied in vitro. Cobra venom had dose dependent inhibition effect on both intrinsic and extrinsic coagulation pathways. It also had inhibitive/ destructive effect on the individual clotting factors V, VII and X but on effect on the action of thrombin on fibrinogen. However, cobra venom had neither fibrinolytic nor fibrinogenolytic effect even at high venom concentration (10 mg/ ml). Furthemore, cobra venom had direct haemolytic effect shown by increased red cell fragility and raised plasma haemoglobin level.

Heparin therapy in Russell's viper bite victims with disseminated intravascular coagulation: a controlled trial.

A controlled clinical trial of low dose heparin was carried out in confirmed cases of Russell's viper bite. Twenty patients with systemic envenoming were included in the study. They were randomized to receive low dose heparin in an initial dose of 50 units/kg body weight intravenously immediately after antivenom followed by a continuous infusion of 10 unit 3 kg/hour in isotonic saline for 24 hours, or antivenom alone. Response to treatment was assessed clinically as well as by serial measurements of coagulation factors and biochemical values. No significant difference was observed in the outcome among two groups, the recovery rate from the clotting defect being similar in both. The mean serum creatinine values of the two groups were also not statistically different. The results indicated that there is no beneficial effect of adding heparin to the standard treatment by antivenom.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: knowledge, attitudes and practice in relation to thalassemia.

A maternal knowledge, attitudes and practice (KAP) study concerning the nature and prevention of thalassemia was carried out at the Yangon Children's Hospital in Myanmar. The KAP information was collected using a pretested schedule. Only 18 to 28% of the mothers knew at least one of the statements: thalassemia is a genetic disorder; both parents of thalassemic children carry abnormal genes; there is a 25% chance of recurrence in each subsequent pregnancy. Eighty-two per cent of the respondents decided not to have a further pregnancy for fear of recurrence and of these 62% were currently practising contraception. Oral contraception was the most commonly used method (56%). The median scores as well as the percent responses in favor of the three attitude scales relating to limiting thalassemic children, prenatal diagnosis and termination of pregnancy were high. Although there is a need to increase the community awareness of thalassemia in Myanmar, there is a possibility that prenatal diagnosis and pregnancy termination will be accepted for the prevention of thalassemia.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: basic hematological values of thalassemia traits.

The present study was conducted in the Outpatient Department (OPD) of Yangon Children's Hospital (YCH) during June to November 1990 to determine the hematological data of 133 Myanmar patients with thalassemia trait who were the parents of patients with known beta-thalassemia major or hemoglobin E (Hb E)/beta-thalassemia. The mean values of hemoglobin (Hb) concentration, packed cell volume (PCV), mean cell hemoglobin (MCH) and mean cell volume (MCV) were significantly lower than normal controls but the mean cell hemoglobin concentration (MCHC) was the same as controls. Increased osmotic resistance tested in 0.36% buffered saline was detected in 81-97% of cases depending on the cut-off point. High levels of Hb A2 (> 3.5%) were found in 93% of cases whereas Hb F was increased (> 0.8%) only in 23% of cases. Although the mean red cell count (RBC) was significantly higher than normal, only 79% of thalassemia traits were detected if the RBC count of > 5.0 x 10(12)/1 was taken as the discrimination limit. Other discrimination functions such as MCH/RBC, MCV/RBC, (MCV)2 x MCH x 0.01 and MCV-(RBC/10(12)/1)-(5 x Hb) - 3.4 or - 8.4 were tested for their utility in diagnosing thalassemia traits. All of them were found not to be superior to each of the simple tests (MCV, MCH, Hb A2 or osmotic fragility) in diagnosing thalassemia traits. The one tube osmotic fragility test is a the suitable test to be used in future thalassemia screening programs in Myanmar.

Thalassemia in the outpatient department of the Yangon Children's Hospital in Myanmar: cost analysis of the day-care-room services for thalassemia.

A cost analysis study for the fiscal year 1989-1990 was conducted in the day care room (DCR) for thalassemia patients at the Yangon Children's Hospital in Myanmar to provide a basis for future cost-effectiveness, cost-benefit and efficiency analyses. Two types of costs, hospital costs and costs borne by the patients' families were studied by reviewing hospital records and by interviewing family members of patients. Of the total cost of DCR services for thalassemia 74 to 75% was contributed by material costs most of which were for imported items. The cost of each transfusion visit and the annual cost per patient were Kyats 166.5 to 173.3 and Kyats 1,108.6 to 1,208.7, respectively. The median cost (range) per treatment visit and the averaged annual median cost (range) borne by the patients' families were Kyats 21 (0-302) and Kyats 107 (0-1,509), respectively.

Haemolytic effect of Russell's viper venom on red blood cells

The red blood cells (RBC) of human and Wistar rats were incubated with 300 ng of Russell's viper venom (RVV) at 37 degree C. At different incubation times, there haemolytic effect of RVV was tested by estimating plasma haemoglobin (Hb) level and by performing osmotic fragility test. Five cases of human Russell's viper bite (RVB) victims with non-clotted blood were also studied. No significant haemolytic effect was observed on RBC obtained from Wistar rats. These results suggested that action of RVV may be species specific.

Platelet Aggregation Studies in Russell's Viper Bite Victims

Platelet aggregation study was performed in Russell's viper bite victims with a view to study the contribution of plateletaggregation component of the venom to the coagulopathy manifested in the bite victims. Results showed poor platelet aggregation responses in general. It is conclude that platelet aggregating component of the venom may not play a major role to the coagulopathy manifested in the bite victims.

The evaluation of whole blood prothrombin time in Russell's Viper Bite Cases

The Evalution of whole blood prothrombin time was done in 3 groups of Russell's viper bite wictims: 20 with incoagulable blood on admission, 19 with coagulable blood only on admission and 16 with coagulable blood throughout. The laboratory results suggest that the whole blood prothrombin time is as useful as 20 minutes whole blood clotting time test in indicating for starting antivenom therapy in patients with incoagulable blood on admission but not for the need to repeat the therapy. It is also not as useful as serial monitoring of fibrin (ogen) degradation products in discrimnating patients with and without progressive defibrination.

Effect of heprin on Russell's viper venom envenomated experimental rabbits

Effects of heparin were studied on 20 Russell's Viper Venom (RVV) envenomated rabbits. After injection with LD 100 dose of RVV, the experimental animals were divided into four groups. Group 1 rabbits were left untreated; in Group II antivenom treatment was given; in Group III antivenom plus heparin was administered intravenously and in Group IV heparin alone was given. Effectiveness of heparin therapy was assessed by comparing the changes in the blood screening tests of haemostasis such as prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT), survival rate, degree of congestion and haemorrhage in the kidneys, presence or abscence of fibrin deposition and acute tublar necrosis in the kidneys of different groups of animals. Results showed no significant differences in the blood tests and fibrin deposition in the kidneys. However, there is an increase in the survival rate, as well as reduction in the severity of congestion, haemorrhage and acute tubular necrosis of the kidneys in the rabbits treated with specific antivenoms (ASV) plus heparin (Group III) over that treated with antivenom alone (Group II) and heparin alone (Group IV).

The evaluation of whole blood prothrombin time in Russell's Viper Bite cases

The Evaluation of whole blood prothrombin time was done in 3 groups of Russell's viper bite victims: 20 with incoagulable blood on admission, 19 with coagulable blood only on admission and 16 with coagulable blood throughout. The laboratory results suggest that the whole blood prothrombin time is as useful as 20 minutes whole blood clotting time test in indicating for starting antivenom therapy in patients with incoagulable blood on admission but not for the need to repeat the therapy. It is also not as useful as serial monitoring of fibrin (ogen) degradation products in discriminating patients with (or) without progressive defibrination.