ABSTRACT
Objectives: The detection of maternal alloimmunization against red cell antigens is vital in the management of hemolytic disease of the fetus and newborn. We sought to measure the presence of allosensitization to Rhesus D [RhD] antibodies in antenatal women attending a tertiary care hospital and assess the fetal outcome in sensitized women
Methods: We conducted a retrospective review of pregnant Omani women who registered at the Sultan Qaboos University Hospital between June 2011 and June 2013. Pregnant women were tested for ABO blood type and were screened for RhD antigen and antibodies at their first antenatal clinic visit. In women who tested positive for the RhD antibodies, an antibody titer was performed to evaluate the severity of their case
Results: Data was available on 1,251 pregnant women who were managed and delivered at Sultan Qaboos University Hospital. The prevalence of RhD negative pregnant women was 7.3%. Blood group O was the most common followed by A, B, and AB. The rate of RhD negative alloimmunization was 10%, and anti-D was the most common antibody detected. There were no stillbirths or neonatal deaths. Postnatal transfusion was necessary for only one baby
Conclusions: The prevalence of RhD negativity was comparable to other Asian countries. Previous RhD alloimmunization and history of miscarriages were the most common maternal medical history
ABSTRACT
Natural killer [NK] cell lymphoproliferative disorders are uncommon and the Epstein-Barr virus [EBV] plays an important aetiological role in their pathogenesis. We report a 20-year-old male with a chronic active EBV infection associated with a NK cell lymphoproliferative disorder which had an unusual indolent course. He presented to the Sultan Qaboos University Hospital in Muscat, Oman, in December 2011 with a history of intermittent fever and coughing. Examinations revealed generalised lymphadenopathy, hepatosplenomegaly, leukocytosis, transaminitis, diffuse bilateral lung infiltrates and bone marrow lymphocyte involvement. A polymerase chain reaction [PCR] test revealed a high EBV viral load in the peripheral blood cells. The patient received a course of piperacillin-tazobactam for Klebsiella pneumoniae, but no active treatment for the lymphoproliferative disorder. However, his lymphocyte count, serum lactate dehydrogenase and liver enzymes dropped spontaneously. In addition, EBV PCR copies fluctuated and then decreased significantly. He remained clinically asymptomatic over the following four years
ABSTRACT
Objectives: transfusions are a common medical intervention. Discussion of the benefits, risks and alternatives with the patient is mandated by many legislations prior to planned transfusions. At the Sultan Qaboos University Hospital [SQUH], Muscat, Oman, a written transfusion consent policy was introduced in March 2014. This was the first time such a policy was implemented in Oman. This study therefore aimed to assess adherence to this policy among different specialties within SQUH
Methods: the medical records of patients who underwent elective transfusions between June and August 2014 were reviewed to assess the presence of transfusion consent forms. If present, the consent forms were examined for completeness of patient, physician and witness information
Results: in total, the records of 446 transfused patients [299 adult and 147 paediatric patients] were assessed. Haematology patients accounted for 50% of adult patients and 71% of paediatric patients. Consent was obtained for 75% of adult and 91% of paediatric patients. The highest adherence rate was observed among adult and paediatric haematology specialists [95% and 97%, respectively]. Consent forms were correctly filled out with all details provided for 51% and 52% of adult and paediatric patients, respectively. Among inadequately completed forms, the most common error was a lack of witness details [20-25%]
Conclusion: in most cases, the pre-transfusion consent policy was successfully adhered to at SQUH. However, further work is required to ensure full compliance with the consent procedure within different specialties. Implementation of transfusion consent in other hospitals in the country is recommended
ABSTRACT
Objectives: Manual platelet estimation is one of the methods used when automated platelet estimates are very low. However, the reproducibility of manual platelet estimation has not been adequately studied. We sought to assess the reproducibility of manual platelet estimation following automated low platelet counts and to evaluate the impact of the level of experience of the person counting on the reproducibility of manual platelet estimates
Methods: In this cross-sectional study, peripheral blood films of patients with platelet counts less than 100 × 109 /L were retrieved and given to four raters to perform manual platelet estimation independently using a predefined method [average of platelet counts in 10 fields using 100× objective multiplied by 20]. Data were analyzed using intraclass correlation coefficient [ICC] as a method of reproducibility assessment
Results: The ICC across the four raters was 0.840, indicating excellent agreement. The median difference of the two most experienced raters was 0 [range: -64 to 78]. The level of platelet estimate by the least-experienced rater predicted the disagreement [p = 0.037]. When assessing the difference between pairs of raters, there was no significant difference in the ICC [p = 0.420]
Conclusions: The agreement between different raters using manual platelet estimation was excellent. Further confirmation is necessary, with a prospective study using a gold standard method of platelet counts
ABSTRACT
Glucose-6-phosphate dehydrogenase [G6PD] deficiency is an X-linked genetic disorder characterized by low levels of the G6PD enzyme. It is present worldwide but with more prevalence in the Middle East and the Mediterranean areas. We report a case of severe hemolysis due to G6PD deficiency manifesting as methemoglobinemia in a 70 year old Omani male never known to have any previous hemolytic episodes or previously diagnosed of G6PD deficiency.
ABSTRACT
The recognition and management of transfusion reactions [TRs] are critical to ensure patient safety during and after a blood transfusion. Transfusion reactions are classified into acute transfusion reactions [ATRs] or delayed transfusion reactions, and each category includes different subtypes. Different ATRs share common signs and symptoms which can make categorisation difficult at the beginning of the reaction. Moreover, TRs are often under-recognised and under-reported. To ensure uniform practice and safety, it is necessary to implement a national haemovigilance system and a set of national guidelines establishing policies for blood transfusion and for the detection and management of TRs. In Oman, there are currently no local TR guidelines to guide physicians and hospital blood banks. This paper summarises the available literature and provides consensus guidelines to be used in the recognition, management and reporting of ATRs
ABSTRACT
This study aimed to validate pulse CO-oximetry-based haemoglobin [Hb] estimation in children and adults with thalassaemia major [TM] and to determine the impact of different baseline variables on the accuracy of the estimation. This observational study was conducted over a five-week period from March to April 2012. A total of 108 patients with TM attending the daycare thalassaemia centre of a tertiary care hospital in Muscat, Oman, were enrolled. Spot [Sp] Hb measurements were estimated using a Pronto-7 [Registered Sign] pulse CO-oximetry device [Masimo Corp., Irvine, California, USA]. These were compared to venous samples of Hb using the CELL-DYN Sapphire Hematology Analyzer [Abbott Diagnostics, Abbott Park, Illinois, USA] to determine the reference [Ref] Hb levels. A multivariable linear regression model was used to assess the impact of baseline variables such as age, gender, weight, height, Ref Hb and blood pressure on the Hb estimations. Of the 108 enrolled patients, there were 54 males and 54 females with a mean age of 21.6 years [standard deviation [SD] = 7.3 years; range: 2.5-38 years]. The mean Ref Hb and Sp Hb were 9.4 g/dL [SD - 0.9 g/dL; range: 7.5-12.3 g/dL] and 11.1 g/dL [SD = 1.2 g/dL; range: 7.5-14.7 g/dL], respectively. The coefficient of determination [R[2]] was 21% with a mean difference of 1.7 g/dL [SD = 1.1 g/dL; range: -0.9-4.3 g/dL]. In the multivariable model, the Ref Hb level [P = 0.001] was the only statistically significant predictor. The Pronto-7 [Registered Sign] pulse CO-oximetry device was found to overestimate Hb levels in patients with TM and therefore cannot be recommended. Further larger studies are needed to confirm these results