ABSTRACT
Background and Objective: Blood transfusion is an essential and life-saving medical intervention. Despite multiple preventive measures transfusion-transmitted hepatitis C virus [HCV] infection continues to be a major healthcare issue in Pakistan. This study was conducted at National Institute of Blood Diseases and Bone Marrow Transplantation to evaluate the frequency of active HCV infection with or without co-infection in blood donors and also to determine comparative efficacy of Multisure HCV antibody assay [MHAA]; a new serological device
Methods: A total of 14652 blood donors visiting National Institute of Blood Diseases and Bone Marrow Transplantation [NIBD] Blood Bank from January 2013 to July 2014 were enrolled and screened for a range of blood borne infections such as HBV, HCV, HIV, malaria and syphilis. The HCV was screened simultaneously by Abbot Architect anti-HCV assay [CLIA] and MHAA. The active HCV infection was confirmed by nucleic acid testing [NAT] in reactive donors. Later; for determination of comparative efficacy of MHAA; all NAT positive samples were further tested using Monolis[TM], HCV blot 3.0, Anti-HCV plus V2 and Anti-HCV-MPBIO-EIA
Results: The HCV reactive sera were observed in 1.563 percent [226] donors. The NAT confirmed active HCV infection in 138 donors. Overall 27.84 percent of HCV positive donors exhibited co-infection either with HBV [2.57 percent], syphilis [22.78 percent]. Triple infection was not observed in any donor. The efficacy of MHAA is comparable to all the serological tests with a sensitivity of about 96.89 percent
Conclusion: Active HCV infection was present in 0.94 percent donors. With a sensitivity of 96.89 percent [95 percent CI: 95.66-98.12] the multi-parametric device MHAA can effectively detect HCV infection in donors. Thus, it can be used in limited health care settings for HCV screening
ABSTRACT
Background and Objective: Alpha [alpha] thalassemia is a hereditary disorder and is caused by deletions or mutations in globin genes. It is present in two clinically significant forms: hemoglobin Bart hydrops fetalis [Hb Bart] syndrome and hemoglobin H [HbH] disease. It is highly prevalent in South-East Asia or Mediterranean countries. The most common deletion reported in alpha thalassemia in Pakistani population was -alpha[3.7] with a frequency of 8.3%, and the rare forms were -alpha[4.2] [0.2%] and alphaalphaalpha[anti3.7] [0.9%]. In our study, diagnosis of severe anemia cases without any alpha and beta mutations or deletions were made by using extended alpha thalassemia deletions panel. The main objective of this study was to determine the prevalence and to study the spectra of alpha thalassemia gene deletions in beta thalassemia patients with the use of an extended panel including -[SEA], --[FIL], --[MED], --[20.5], --[THAI] in addition to -alpha [3.7], -alpha [4.2] and - alphaalphaalpha[anti3.7]
Methods: The samples were collected in ethylenediaminetetraacetic acid [EDTA] vacutainers. A total of 156 samples were analyzed for alpha thalassemia mutations. This cohort included 121 samples of beta thalassemia major, nine samples of beta thalassemia minor and 26 without any evidence of beta thalassemia mutations. DNA was extracted with Qiagen extraction kit. The primers for determination of different subsets of alpha thalassemia deletions were included. PCR amplification was performed and result interpreted on agarose gel
Results: Co-inheritance of alpha thalassemia [-alpha [3.7], -alpha [4.2]] with homozygous beta thalassemia was detected in 30% cases of studied cohort [37 out of 121]. The most common found was -alpha[3.7] deletion [35/37] as single/double deletions or in combination with -alphaalphaalpha[anti3.7]. In undiagnosed cases screened for beta thalassemia major, we found Mediterranean [-alpha [MED]] deletion at specifically 875 bp on agarose gel. This is distinctive finding in case of detecting -alpha [MED] instead of any other deletion from Pakistan
Conclusion: Alpha thalassemia deletions [-alpha[3.7], -alpha[4.2]] are the common co-inherited deletions found in beta thalassemia major patients. On the basis of results, we propose an extended alpha thalassemia genetic mutation panel should be used for screening of children presenting with anemia with suspicion of haemoglobinopathy
ABSTRACT
Uncontrolled bleeding is the leading cause of mortality in the trauma victims. Massive bleeding after traumatic injury is a result of surgical and coagulopathic bleeding. We describe a case of gun shot injury brought to the hospital in a collapsed state because of massive blood loss in the abdominal cavity. Surgical intervention secured the surgical bleeding but coagulopathic bleeding continued which was controlled with Recombinant activated factor VII [rFVIIa]. Guidelines of the use of factor VII in trauma are presented
Subject(s)
Humans , Male , Wounds, Gunshot/drug therapy , Hemostatics , Hemostatic TechniquesABSTRACT
To determine the association between adverse pregnancy outcomes and thrombophilia. This is a descriptive study, incorporating retrospective analysis of patients with recurrent pregnancy losses, intrauterine deaths, abruptio placenta and early onset pre eclampsia. Patients with adverse pregnancy outcomes in whom co-morbid factors were excluded underwent screening for both acquired and inherited thrombophilia. A total of 40 patients were screened for acquired and inherited thrombophilia with adverse pregnancy outcomes. Anticardiolipin antibodies were found positive in 55% of patients and 45% of patients were found deficient for natural anticoagulants protein C and S. Two patients were found positive for both acquired and inherited thrombophilia. Thrombophilia, both acquired and inherited are associated with adverse pregnancy outcomes. Patients in whom other co-morbid factors are excluded, should be offered screening for thrombophilia. Liaison between hematologist and obstetrician is the corner stone for success