ABSTRACT
Context: ?-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ?-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ?-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ?-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ?-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ?-thalassemia trait in cases of megaloblastic anemia.
ABSTRACT
In Odisha, Kalahandi is one of the most exposed and vulnerable districts to malaria incidences due to its poor socioeconomic condition and extreme climate. The study aimed to explore the temporal characteristics of malaria incidences in Kalahandi and to identify its relationship with rainfall for the period from 2011 to 2018. Out of the total blood films examined, 8.84% were found positive in Kalahandi between 2011 and 2018. Plasmodium falciparum is the most dominant species accounted 88.3% of the total cases. Very high mean annual parasitic index (API) >15 is recorded throughout the study years. The highest incidences are recorded in the monsoon season followed by postmonsoon. The correlation value of the annual blood examination rate with P. falciparum, Plasmodium vivax, and API has shown a very high positive correlation. Rainfall shows a (+) correlation with malaria incidences in the cold (0.47) and hot seasons (0.01) and (−) correlation in the monsoon (−0.54) and postmonsoon season (−0.54).