Hepatitis C Liver dysfunction and relationship with hemostatic disorders

Objectives: HCV liver disease is associated with abnormal liver functions and often results in various haematological disorders. This study was conducted on 100 HCV positive patients in Mayo Hospital, Lahore

Material and Method: The objective of this study was to establish a relationship between severity of liver disease and subsequent haemostatic disorders. The severity of liver disease was assessed by ALT, AST, Albumin, AST/ALT ratio and APRI Score and Hemostatic disorder was evaluated by Platelet Count, PT, APTT and D-Dimers which showed a significant positive correlation between the severity of liver disease and the increasing hemostatic derangements

Results: The results of the study showed that mean age was 41.29 +/- 11.15 years with minimum and maximum ages being 21 and 66 respectively. There were 63% male and 37% female pts and male to female ratio was 1.70: 1. In this study the mean PLT count was 202.870 x109/L +/- 66.779 x109/Lwith minimum count being 35.000 x 109/L. The PLT count was lower than normal in 21% of the pts. The distribution of D. Dimers was < 0.5 in 42%, 0.5 1 in 55% and it was > 1 in 3% of the pts. The mean PT and APTT were 16 seconds +/- 1.81 seconds and 37 seconds +/- 4.28 seconds respectively. The PT was prolonged in 48% and APTTin 5% of the patients

Conclusion: The severity of liver disease was assessed by ALT, AST, Albumin, AST/ALT Ratio and APRI Score while the Hemostatic abnormality was checked by Platelet count, PT, APTT and D-Dimers. The results of liver function tests and the coagulation profile along with the levels of AST/ALT Ratio and APRI Score in this study have proved that as the liver disease advances, the hemostatic derangement also increases

Antigen expression on blast cells and hematological parameters at presentation in acute lymphoblastic leukemia patients

To analyze the expression of various antigens on the leukemic blasts and to determine the hematological parameters, in Acute Lymphoblastic Leukemia [ALL] patients at presentation. Observational study. King Edward Medical University, Lahore and Hameed Latif Hospital, Lahore, from February 2013 to March 2014. A total of 50 newly diagnosed and untreated patients of ALL were selected from Mayo Hospital and Hameed Latif Hospital. These patients included both genders and all age groups. Hemoglobin, total leukocyte count and platelet count were determined on hematology analyser-Sysmex-Kx-2I. Blast cell percentage was estimated on Giemsa stained blood smears. Immunophenotyping was done on bone marrow samples by 5 colour flowcytometery on Beckman Coulter Navious Flowcytometer. An acute leukemia panel of 23 antibodies was used. The data was entered and analyzed in SPSS version 22. Of the 50 ALL patients, 36 [72%] were B-ALL and 14 [28%] T-ALL. There were 18 [36%] children and 32 [64%] adults. T-ALL included 22% of the childhood and 31% of the adult cases. Immunophenotypic analysis showed that CD19, CD79a and CD20 were B-lineage specific markers whereas cCD3, CD3 and CD5 were T-lineage specific. CD10 was the most sensitive marker for B-ALL and CD7 was the most sensitive marker of T-ALL. TdT was expressed in 92% B-ALL and 71% T-ALL cases, CD34 in 58% and 43% cases and CD45 in 83% and 100% respectively. High leukocyte count [> 50 x 10[9]/L] was present in 58% cases. Hemoglobin was < 10 g/dl in 74% patients and platelet count was below 20 x 10[9]/L in 12% patients. Leukocyte count, hemoglobin, platelet count and blast cell% did not show a significant difference in the two ALL immunotypes. The frequency of T-ALL is higher in childhood as well as adult ALL in our population compared to the Western literature. Antigenic expression of the blast cells also shows some interesting differences. A large number of our patients present with high leukocyte count which is a known factor associated with poor prognosis

Frequency and pattern of bone marrow infiltration in Hodgkin's lymphoma

Lymphomas are malignant neoplasms arising from lymphoid tissue. They are divided into two groups i.e Hodgkin's Lymphoma and Non-Hodgkin's Lymphoma. Staging of Hodgkin's Lymphoma is important for the management and treatment of the patient. This study was carried out to determine the frequency of bone marrow infiltration at the time of diagnosis as well as various patterns of bone marrow involvement. Clinical history and physical findings were recorded in the proforma. Investigations were carried out. Bone marrow aspirate and trephine biopsies were performed from posterior iliac crest. Aspirates and trephine biopsies were evaluated and assessed for cytology, marrow architecture, haemopoietic tissue and any lymphomatous infiltration. In cases with infiltration, the infiltration pattern was studied. Fifty Hodgkin's lymphoma patients were studied. Bone marrow infiltration was found in 19 [38%] cases. Among these 19 patients with infiltration 17 [89.4%] patients were of Hodgkin's Lymphoma mixed cellularity and 2 [10.5%] had Hodgkin's Lymphoma Nodular Sclerosis. Pattern of infiltrate was interstitial in majority of cases followed by diffuse type of infiltration. Bone marrow involvement in Hodgkin's Lymphoma is more common in our setup as patients present at a later stage. It is recommended that bone marrow examination should be performed as a part of staging investigations in patients with Hodgkin's Lymphoma

Bone metastasis: a comparison between bone scan and bone marrow aspiration biopsy

Background: all cancer involves the production of abnormal cells are capable of irregular and independent growth that invades health body tissues. Metastases are a characteristic feature of all malignant tumors, which spread to distant areas of body via lymphatic system and blood stream

Material and Methods: this cross-sectional study included 50 patients with different Malignancies. The diagnosis of these patients had been established on the basis of Histopathology. These patients were taken from Oncology Department of lnmol Jinnah, Shaikh Zayed and Mayo Hospitals. Lahore. These patients underwent bone scan which was performed with technetium 99m methldipbosphonate. [99.m Tc-:-MDP]. Twenty five patients with positive bone scan findings were taken as group A and the other 25 patients with negative bone scan were marked as group-B. The metastatic involvement of these patients was found by performing bone marrow aspiration and trephine biopsy

Results: in our study, 9 out of 50 cases were positive for bone marrow infiltration. Out of these 5 cases [20%] were positive for bone marrow metastases in positive bone scan patients. Whereas 4 patients [16%] were positive for bone marrow metastases in negative bone scan patients

Conclusion: the study hence reveals that bone scan is a superior method for detection of bone marrow infiltration in patients with · malignant metastatic disease but bone marrow aspiration /trephine biopsy is also mandatory as it picked 4 patients [16%] out of 25 patients with negative bone scan

Use of AgNOR index in grading and differential diagnosis of astrocytic lesions of brain

This study was conducted to see the importance of AgNOR staining in grading and differential diagnosis of Astrocytic lesions. It was a descriptive and prospective study conducted in Department of Pathology King Edward Medical University, from June-December 2002. AgNOR staining was performed on 60 randomly selected brain specimens of Astrocytic lesions including Astrogliosis and Astrocytoma. AgNOR count, size and dispersion were normal in Astrogliosis, low in Pilocytic Astrocytoma, high in grade II, higher in grade III and highest in grade IV. AgNOR counts of different grades of astrocytoma [2.97 +/- 0.96, 3.97 +/- 0.43, 6.01 +/- 2.74 and 8.01 +/- 3.56] were significantly [P< 0.01] greater as compared with counts of normal brain [0.40 +/- 0.01], and reactive gliosis [0.60"0.01]. There was no statistical difference in normal brain tissues and inflammatory lesions of the brain. AgNOR size and dispersion were of higher grade in significantly greater proportion in malignancy as compared to benign conditions. [P <0.05]. AgNOR size and dispersion were normal in Astrogliosis. Typing of AgNOR count, size and dispersion was found to be an important marker in grading and differential diagnosis of Astrocytic lesions, especially in Astrogliosis and low grade Astrocytoma

assessment of coagulation parameters in liver cirrhosis

This study was carried out to assess the haemostatic defects in patients of liver cirrhosis by estimating prothrombin time [PT], activated partial thromboplastin time [APTT], plasma fibrinogen level, fibrinogen degradation products [D-dimer], and platelet count. It was carried out at the Department of Pathology, King Edward Medical College, Lahore. A total of 50 patients from all age groups of both gender with cirrhosis of liver were selected from Mayo Hospital, Lahore. All the investigations were carried out by standard procedures. Results were analyzed statistically with appropriate tests of significance. The mean values of PT and APTT were 14 second and 19 seconds longer than the control values respectively. These prolongations were highly significant statistically [p<0.0001]. Thirty-four out of fifty patients showed a serum fibrinogen level lower than normal with the mean value of 1.90 +/- 1.30 g/L The difference from normal value was not significant statistically. All but one patient of cirrhosis, sho wed raised level of D-dimer i.e.>250 ng/ml. Mean platelet count in patients was significantly lower than normal value [p<0.05]. Prolongation of PT and APTT indicates plasma clotting factors deficiency due to impaired hepatic synthesis. Derangements of other coagulation parameters indicate that multiple factors like fibrinolysis, hypofibrinogenaemia, thrombocytopenia, and low grade DIC, all play a role in liver cirrhosis

Clinics hematologic study of adult AML, A retrospective analysis

This retrospective study was carried out from the cases of adult acute myeloid leukemia diagnosed at Haematology Department of King Edward Medical College, Lahore, over a period of five years, from 1994-1999. M1 was the commonest subtype. Common presenting features were anemia, bleeding and infections along with some uncommon symptoms in individual cases

Prevalence of methicillin resistant staphylococcus aureus [mrsa] infection laboratory study at mayo hospital lahore

To study the prevalence of methicillin resistant Staphylococcus aureus [MRSA] so that recommendation can be made for their prevention and control. Design: 350 Staphylococcus MINUS strains were isolated from Swvab/pus and other specimens randomly. Place and Duration: The samples were processed in the Department of pathology King Edward Medical Lahore College, during June 2000 to December 2000. Subject/The specimens from various types of infection sites suspected on clinical ground were processed by Standard methods and antibiotic susceptibility testing of all the isolates was done by using modified Kirby Bauer Disc diffusion technique. Result: Of these 350 positive cultures for Staphylococcus aureus, 135 were found to be methicillin resistant [38.5%]. This study shows a high prevalence of MRSA, which is of serious concern in Pakistan, In addition to the economic burden for antibiotic treatment MRSA Infections are serious threat to patients and a challenge for doctors

Acute lymphoblastic leukaemia: a study of immunophenotypes

Immunological characteristics of leukaemic blast cells from 55 patients of acute lymphoblastic leukaemia were analysed using a panel of monoclonal antibodies and immunoperoxidase technique. Among 36 children the percentage of Common-ALL was found to be low [39%] as compared to western reports, whereas that of T-ALL was high [36%]. Out of 19 adults, 52.6% were Common-ALL, 21.1% Early-B-ALL and 16% T-ALL; the findings being consistent with western studies. The T-ALL cases [13] were subclassified according to the stage of thymic maturation depending upon the expression of CD8 and CD4 antigens. Six were identified as early, 3 as common and 4 as late thymocyte stage