Essential thrombocythaemia presenting as recurrent headaches in a young patient: a case report

Essential thrombocythemia is a rare hematological disorder which mostly presents in elderly. Its clinical picture is dominated by predisposition to vascular occlusive events and hemorrhage. Headache, visual disturbances and light headedness are some of the neurological manifestations of essential thrombocythemia. In middle aged or elderly patients these findings are suggestive of essential thrombocythemia, however in young patients; one usually is not suspecting essential thrombocythemia to be the cause of headache. Here, we report a case of young male who presented as outdoor patient with severe headache since 3 months. On blood complete picture his platelet count was raised. All the causes of reactive thrombocytosis were ruled out. After bone marrow examination, diagnosis of essential thrombocythemia was made. It is unusual for essential thrombocythemia as a cause of headache in young patients and has not been documented in the literature

Frequency of intrinsic factor antibody in megaloblastic anaemia

To evaluate the presence of intrinsic factor antibody in vitamin B12 deficient patients. Cross-sectional, observational study. Fauji Foundation Hospital, Foundation University Medical College and Armed Forces Institute of Pathology, Rawalpindi, from January 2011 to June 2012. A total of 120 patients of megaloblastic anaemia were selected on the basis of low serum vitamin B12 level. The intrinsic factor antibody tests were performed by ELISA method. The patients were considered positive or negative on the basis of presence or absence of intrinsic factor antibody respectively. The data was analyzed by using SPSS version 14. Pernicious anaemia with intrinsic factor deficiency was found in 13.3% in 120 vitamin B12 deficient patients. The mean age of patients of pernicious anaemia was 41.5 years, with a male to female ratio of 1:2.5. It was relatively more common in older age [17% in age more than 60 years] as compared to other age groups. Frequency of pernicious anaemia in megaloblastic anaemia was 13.3%. The male to female ratio was 1:2.5 and it was relatively more common in age group of more than 60 years

Chediak-higashi syndrome presenting in accelerated phase

Chediak-Higashi Syndrome [CHS] is a rare autosomal recessive disorder, characterized by silver hair, recurrent infections, partial oculo-cutaneous albinism, mild coagulation defect and progressive neuropathy. The characteristic feature of CHS is the presence of huge lysosomes and cytoplasmic inclusions within different body cells like the white blood cells. The disease has an early onset but usually presents in an accelerated phase. We present a case of a 2 years old boy with high grade fever, bilateral cervical lymphadenopathy, hepatosplenomegaly, abdominal distention of 28 days duration. He was diagnosed with Chediak-Higashi syndrome in accelerated phase on the basis of clinical presentation, morphological findings on peripheral blood film and bone marrow aspirate

Myeloid sarcoma in a child with acute myeloblastic leukaemia

We report a rare occurrence of myeloid sarcoma in a 7 years old child with acute myeloblastic leukaemia [AML - FAB type M[2]]. He presented with fever, generalized weakness, bilateral proptosis and left parotid swelling. CT scan revealed a mass in paranasal sinuses extending into brain and retro-orbital region. Diagnosis of AML M[2] was made on bone marrow aspiration and special stains. Induction therapy for AML was given according to standard protocol. The extramedullary lesion as well as the acute leukaemia went into complete remission

audit of length of bone marrow trephine biopsies at a tertiary care hospital

Bone marrow trephine biopsy is a well established minor surgical procedure for the inspection of bone marrow usually done along with bone marrow aspiration. The objective of this study was to evaluate the length of trephine biopsies and the rate of positivity for diagnosis as well as unfit biopsies in various length ranges. This retrospective study was conducted at Fauji Foundation Hospital and Foundation University Medical College Rawalpindi from Jan 2007 to Dec 2009. A total of 394 trephine biopsy reports were collected and reviewed. The criterion for adequate trephine biopsy was >/= 1.5 Cm. The biopsies were divided into four groups according to length, i.e., group-1: >/= 1.5 Cm, group-2: 1-1.4 Cm, group-3: 0.5-0.9 Cm, and group-4: <0.5 Cm. The adequacy of trephine biopsy length and rate of positive diagnosis as well as unfit biopsies were compared. Total 394 trephine biopsies were reviewed. Group-1 included 88 biopsies and 87 [98.9%] had positive diagnosis. Group-2 included 137 biopsies and 133 [97.1%] had positive diagnosis. Group-3 included 99 biopsies and 91 [92%] had positive diagnosis. Group-4 included 70 biopsies and 57 [81.4%] had positive diagnosis. There was no significant difference between group-1 and group-2 for the rate of positivity of diagnosis [p=0.65]. In group-1, 1 [1.1%] was unfit for evaluation, in group-2, 4 [2.9%] were unfit, in group-3, 8 [8%] were unfit, and in group-4, 13 [18.5%] were unfit for evaluation. Total 26 trephine biopsies were unfit for evaluation, out of which 13 [50%] belonged to group-4. Trephine biopsies that were unfit for evaluation were 4 [4.9%] in 2007, 17 [10.5%] in 2008, and 5 [3.3%] in 2009. Although 22.3% biopsies were of recommended length there was no significant difference in rate of positive diagnosis between biopsies of >/= 1.5 Cm and 1-1.4 Cm

Significance of bone marrow Trephine biopsy in the diagnosis of haematological and non-haematological disorders

To evaluate the frequency and document the histological pattern of various haematologic and non 'haematologic malignancies and infections, which can be diagnosed by Bone marrow trephine biopsy. A retrospective, cross sectional study was carried out at Histopathology department of Army Medical College Rawalpindi from January 2000 to December 2004. The bone marrow trephine biopsies were taken with Jamshidi's - type needle. The tissues were fixed in 10% formal- saline and then decalcified in 5% nitric acid. These were processed under standard conditions. A total of 789 cases with age range of 9 years to 75 years were studied during a period of five years. Majority of the cases showed male preponderance [69.83%] as compared to females [30.16%]. The most common histological findings in order of frequency were reactive changes [22.43%], unremarkable marrow [16.09%], inadequate biopsy [9.63%], megaloblastic anaemia [7.73%], acute leukaemia [6.21%], erythroid hyperplasia [5.95%]. The less common lesions were multiple myeloma [3.92%], lymphoproliferative disorders [3.80%], hypoplastic marrow [3.54%], chronic granulomatous inflammation [2.53%] and myelofibrosis [2.40%]. The miscellaneous group [5.70%] comprises rare diseases. Bone marrow trephine biopsy is a valuable diagnostic tool in the diagnosis of various types of infections and hematologic and non'hematologic malignancies. Majority of our patients showed reactive changes followed by acute leukaemia and erythroid hyperplasia. It has also been proved useful in detecting micrometastases when primary is not known with the other available diagnostic modalities

Microalbuminuria and associated risk factors in type II diabetics

To determine the frequency of microalbuminuria [MA] and its associated medical risk factors in type II diabetic patients. Place and Duration of Study: This cross-sectional analytical study was conducted during Ist half of 2003 at Combined Military Hospital, Lahore. Non-probability purposive sampling was employed. Materials and Study population included 150 type II diabetic patients [70 women, 80 men] attending outpatient department of the hospital. Patients having clinical albuminuria and with other causes of proteinuria were excluded. Women and men were of comparable ages. Women [26.4 kg/m2] had higher body mass index [BMI] than men [24.3 kg/m2]. The frequency of MA was 46.7%, higher in males [50.6%] than females [41.5%]. Fasting plasma glucose and HbA1c levels were significantly higher in patients with MA compared to those with normoalbuminuria [p < 0.001]. The microalbuminuric patients had significantly decreased HDL-c levels compared to normoalbuminuric subjects [p< 0.001]. However, no relation of MA with age, gender, known duration of diabetes, BMI, history of smoking, hypertension and serum: total cholesterol, LDL-c, triglyceride, urea and creatinine was found. There is a strong association of poor glycaemic control and decreased HDL-c levels with the presence of microalbuminuria