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

Megaloblastic anaemia, seen in 48 cases of pancytopenia

To assess megaloblastic anaemia in patients presenting with pancytopenia. Descriptive study. Hospitalized patients referred for bone marrow examination for the work up of pancytopenia were selected. Complete blood count was done on haematology auto analyzer. Bone marrow aspiration was done for cytology. Perl's iron staining was done in patients showing low blood indices. Forty eight [48] patients underwent bone marrow aspiration for cytology for the work up of pancytopenia. Nineteen [19] patients [39%] showed megaloblastic anaemia. Macrocytosis and hypersegmented neutrophils were the most common finding on peripheral blood smear. Fregmented red cells were seen in 13 patients showing classical finding of megaloblastic anaemia. Megaloblastic anaemia was found to be the most common cause of pancytopenia. Diagnosis of megaloblastic anaemia requires only complete blood count, peripheral blood smear and bone marrow cytology, which is cost effective. Nutritional factors and recurrent infection seem to be associated strongly with megaloblastic anemia