G6PD deficiency; glucose 6 phosphate dehydrogenase deficiency; the case for mass screening in Pakistan

Hyperbilirubinemia due to glucose 6 phosphate dehydrogenase [G6PD] deficiency can cause permanent neurological damage and death in neonates. Screening for the enzyme enables timely diagnosis and treatment in cases of G6PD related kernicterus. Knowledge of patient G6PD status is also important in treatment of malaria, a disease endemic in Pakistan. World Health Organization recommends mandatoryuse of primaquine for radical cure and eradication of malaria. Since, Primaquine, causes hemolysis in G6PD deficient cases, widespread adoption of the drug is viewed with caution. This study assessed frequency of G6PD deficiency in Pakistani noenates and examines the need for its screening based on local disease prevalence and malaria endemicity. A cross sectional study was carried at Hematology Department, Army Medical College [MUST], in collaboration with Military Hospital, Rawalpindi, Pakistan.[January - August, 2011]. The frequency of G6PD deficiency in newborn population was determined by quantitative [spectrophotometric] method. Cord blood [2.5 ml blood in K3EDTA bottle] samples were obtained from 240 newborns [male: female 1.2:1] after informed consent from parents. Data obtained was analyzed using SPSS Windows version 17. Frequency of G6PD deficient cases was 4.2%. Among the ten G6PD deficient patients, six had severe enzyme deficiency [<10% enzyme activity]. The local prevalence of G6PD deficiency and its potential complications qualify it as a disease that must be screened for. Also, prior knowledge of patient G6PD status enables the physician to revert to modified treatment regimen for malaria only in enzyme deficient cases and not otherwise

Efficacy of disposable spinal needle in diagnostic bone marrow aspiration

To see the efficacy of disposable spinal needle in diagnostic bone marrow aspiration. Observational study. Department of Haematology, Military Hospital and Army Medical College, Rawalpindi from 1st October 2008 to 31st September 2009. A total of 324 bone marrow aspirations were performed after obtaining informed consent. The study included both male and female subjects and was not restricted to a particular age group. After detailed clinical history and physical examination, blood counts were performed on Sysmex KX-21 hematology analyzer. Smears were examined to assess the indications for bone marrow aspiration. The procedure was conducted at posterior iliac spine in all cases except children under 2 years of age, for which tibia was the preferred site. A 16-gauge spinal needle was used, under sterile conditions using Lignocaine 2% as a local anesthetic. Leishman Stain was used to stain the slides. Pearls reaction and cytochemical stains were used where required. Once prepared, the slides were examined under light microscope and the diagnosis was made in light of both the clinical presentation and microscopic findings. The results were analyzed on SPSS version 17.0. Out of 324 bone marrow aspirations diagnosis was possible in 295 cases. The most frequently diagnosed conditions were anaemia [Megaloblastic, Iron deficiency, Anaemia of chronic disorder], Leukemias [Acute Leukemias and Chronic Leukaemias] and reactive changes in bone marrow secondary to infection. Disposable spinal needles are convenient, user-friendly, readily available [even in remote areas] and ensure sterilization in bone marrow aspiration