Vitamin B[12] deficiency- a major cause of megaloblastic anaemia in patients attending a tertiary care hospital

Folate and vitamin B[12] deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B[12] deficiencies in causing megalobalstic anaemia in our patient population. In this retrospective cohort study, clinical records of 220 patients [101 females and 119 males with an age range of 1-80 years] who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. Data pertaining to complete blood count and serum levels of folate and vitamin B[12] were analysed. The mean haemoglobin [Hb] level was 6.8 +/- 0.2 gm/dl. Sixty-nine percent of the patients had severe anaemia [Hb<8gm/ dl]. Mean +/- SEM values of haemoglobin, serum folate and serum B[12] were not significantly different between males and females [Hb 6.4 +/- 0.3 gm/dl vs 6.3 +/- 0.3 gm/dl; folate 6.9 +/- 0.8 eta g/ml vs 7.8 +/- 1 eta g/ml; B[12] 259 +/- 65 rho g/ml vs 225 +/- 45 rho g/ml, respectively]. Linear regression analysis showed that serum folate was inversely related with the mean corpuscular volume [MCV, p=0.04]. Spearman's correlation analysis indicated an inverse mild association between MCV and serum folate [correlation coefficient= -0.18]. Folate deficiency was 43.3%, while vitamin B[12] deficiency was 78.5% in these patients. Seventy-one percent of folate-deficient patients had vitamin B[12] deficiency was 78.5% in these patients. Seventy-one percent of folate-deficient patients had vitamin B[12] deficiency as well, while 26.1% of patients with B[12] deficiency had a co-occurrence of folate deficiency. Vitamin B[12] deficiency appears to be the major factor leading to megaloblastic anaemia in our study population. Inadequate dietary intake, over-cooking of our food and poor absorption might be contributing to high prevalence of vitamin B[12] deficiency in this population

Hematologic and cytogenetic findings in eleven chronic myelogenous leukemia patients treated with imatinib mesylate at a Tertiary care hospital

Objective: To evaluate the response of Imatinib mesylate in patients with myeloid leukemia in chronic, accelerated and blast phase

Material and Methods: Eleven patients with established diagnosis of chronic myeloid leukemia were treated with Imatinib mesylate. Adverse events were documented with regular follow ups. Hematological and cytogenetic responses were assessed according to established criteria. Patients with zero percent Philadelphia positive metaphases were labeled as complete cytogenetic response while patients with 1% to 35% Philadelphia positive metaphases were termed as partial responders

Results: Of 11 cases there were 7 males and 4 females with a mean age of 39.5 years and median age 51 years [range 21-69]. Male to female ratio was 7:4. Median follow-up was 34 weeks [range 8-78]. Four patients were in blast crisis, 1 in accelerated phase and remaining six patients were in chronic phase. All patients achieved hematological response. Cytogenetic response was present in six patients, 3 were responders and the remaining were non responders. Two patients achieved complete cytogenetic response and one patient had partial cytogenetic response. Both patients with complete cytogenetic response relapsed in twelve weeks time

Conclusion: Imatinib mesylate is a drug with curative potential and can be used as a first line drug in the management of CML, however at present the cure rate is unknown

Prevalence of Hepatitis C virus in lymphoproliferative disorders

Objective: To study the prevalence of hepatitis C virus in lymphoproliferative disorders

Methods: A case control prospective study was performed on 143 patients with lymphoproliferative disorders and 29 patients with non-hematological malignancies were taken as controls. All the patients in both groups were analyzed for various risk factors for infection with hepatitis C virus and were tested for the presence of hepatitis C virus antibody [anti HCV], cryoglobulins and rheumatoid factor antibody. Hepatitis C viremia was documented by detection of HCV RNA by polymerase chain reaction

Results: There was no significant difference for risk factors for hepatitis C virus infection in both the groups except for the increase in number of surgical procedures being carried out in the control group. There was no significant difference in the presence of rheumatoid factor antibody in both the groups and cryoglobulins were not positive in any individual. Five percent patients with lymphoproliferative disorders and 3.4% with non-hematological malignancies were positive for anti HCV. HCV RNA was detected in 29.2% cases and 31.0% in controls

Conclusion: There was no association between hepatitis C virus infection and lymphoproliferative disorder in our population. However, further studies are required from this region to establish any causal relationship between hepatitis C virus infection and lymphoproliferative disorder

Polycythemia vera and idiopathic eryhrocytosis: comparison of clinical and laboratory parameters

To evaluate the various clinical and laboratory parameters of Polycythemia vera and idiopathic erythrocytosis in order to differentiate between two entities at the Aga Khan University Hospital. Twenty six patients of polycythemia vera and 34 patients of idiopathic erythrocytosis were analyzed with respect to clinical features and laboratory findings. Patients with idiopathic erythrocytosis were males with a mean age of 41 years and no splenomegaly. Patients with polycythemia were older males and females with splenomegaly, red cell count of mor than 6.5 million/cmm, haematocrit 55%, leucocytosis, thrombocytosis and low erythropoietin level. Based on the above-mentioned findings, we suggest that polycythemia vera and idiopathic erythrocytosis are separate entities and the diagnosis of these can be made on the basis of clinical and laboratory parameters

audit of blood cross-match ordering practices at the aga khan University Hospital: first step towards a maximum surgical blood ordering schedule

OBJECTIVE: In the absence of an explicit maximum blood order policy, ordering for blood transfusion is frequently based on subjective anticipation of blood loss instead of evidence based estimates of average requirement in a particular procedure. This study was done to assess current practice and the feasibility of a prospective randomized work to develop practice guidelines. METHOD: We audited transfusion data for elective surgical procedures in our hospital during the last 2 years. Cross-matched to transfused ratio [C/T ratio] and Transfusion Index [Ti] for each of the elective surgical procedures was performed during the study period. C/T ratio is used as a measure of the efficiency of blood ordering practice. It should ideally be between 2 and 2.5. We compared our results with the ideal. Data was analyzed for 32 elective surgical procedures in 2131 patients. Majority [2079] [97.56%] of the patients had C/T ratios higher than 2.5. Only 12 in 450 [21.11%] patients, had a Transfusion Index [Ti] higher than 0.5. There were 13 procedures in which both C/T ratio was greater than 2.5 and Ti less than or equal to 0.5. In vast majority of elective surgical procedures routine cross match is not necessary. We propose a draft Maximum Surgical Blood Ordering Schedule [MSBOS]. It provides guidelines for frequently performed elective surgical procedures by recommending the maximum number of units of blood to be cross-matched preoperatively. Implementation of MSBOS will result in about 60% reduction of cost to the patients