Evaluation of hematological causes in cases of nasal bleeding

To find the causes of hematological disorder in patients of epistaxis attending ENT department, Abbasi Shaheed Hospital. This cross sectional study was carried out in ear, nose and throat and hematology departments of Abbasi Shaheed Hospital from Jan 2006 to Dec 2008. Patients of epistaxis attending ENT out patient deptartment and emergency were included. A questionnaire was filled including brief clinical history, general and local examination. Based on history, patients were stratified into two groups. Group 1 included patients with single episode of epistaxis while in group 2 patients with a history of recurrent epistaxis were enrolled. For hematology workup complete blood count with peripheral film examination, bleeding time, prothrombin time and activated partial thromboplastin time were done. Specialized test like platelet aggregation test, VonWillibrand factor Ag, Ristocetin cofactor and factor VIII assay were carried out in selected cases. Bone marrow aspiration and trephine biopsy were done for the workup of cytopenia. The causes of bleeding assayed and recurrent epistaxis were compared with single episode. 10% patients were having various hematological disorders. In majority of cases no cause was found. Recurrent epistaxis or epistaxes with mucocutaneous bleeding were found to be more associated with hematological disorder and in the absence of local pathology it should be thoroughly investigated

Peripheral blood film - an important tool for diagnosing Anaemia, its types and causes

To emphasize the importance of peripheral film and pathologist's comments in diagnosing different types of anaemia and its possible causes in hospitalized patients at Abbasi Shaheed Hospital. It is a descriptive study. The study populations comprised of hospitalized patients in various wards at Abbasi Shaheed Hospital. A month of year is randomly selected for the study. The records of complete blood picture report of the patients were revised for anaemia, its morphologic type and possible cause of anaemia on the basis of blood indices and peripheral blood film. One thousand and eight blood reports of complete blood picture were reviewed. Among the total. 605 were female and 403 were male and 563 patients were found anaemic. Based on blood indices and haemoglobin, 151 showed hypochromic micro-cytic picture. Seven films showed hypochromic microcytic picture, target cells and high red cell count suggestive of thalassemia minor, or iron deficiency anaemia plus thalassemia minor. 87 cases showed dimorphic picture. Normocytic normochromic picture was seen in 134 patients. 59 slides showed target cells. Macrocytes with right shifted neutrophils were seen in 07 patients. Burr cell were seen in 7 patients. Trophozoites and schizonts of Plasmodium vivax were found in 9, while trophozoites of p.falciparam were seen in 2 peripheral slides. Fragmented cells were observed in 2 blood smears. Peripheral film is an old but very important diagnostic tool to reach to final diagnosis. So whenever blood is sent for complete blood picture. one should pay attention on the comments given on peripheral film