ABSTRACT
Background: Chronic Kidney Disease (CKD) with its high prevalence, morbidity and mortality, has become an important public health problem. The incidence and prevalence of CKD is increasing worldwide, including India. CKD is associated with a variety of hematological abnormalities, include anaemia, infections and bleeding diathesis. Anaemia is the most consistent hematological abnormality and is associated with poor quality of life and poor cardiovascular outcomes.Methods: A hospital based cross-sectional observational study was done to detect the prevalence of haematological abnormalities, correlation of anaemia with CKD stage and evaluation of iron deficiency. Newly diagnosed CKD (stages 3 to 5) patients were included in this study. Presence of anaemia (Hb%, haematocrit, MCV, peripheral smear), iron deficiency (TSAT, serum ferritin), thrombocytopenia, leucocyte count and coagulation abnormalities (PT, APTT) in different stages of CKD were studied.Results: All the subjects in study group had anaemia which was normocytic and normochromic and of moderate degree in most patients. The severity of anaemia progressed with stage of the disease. Iron deficiency was significantly prevalent (52% in the study population, with transferrin saturation (TSAT) <20%). WBC count was not significantly altered. There was mild thrombocytopenia in a few patients. Bleeding time or other in vitro tests of platelet function were not measured. The coagulation parameters, PT and APTT, were not significantly altered.Conclusions: All CKD patients should be screened for iron deficiency anaemia for its early treatment and to decrease morbidity.
ABSTRACT
Multiple primary malignancies involving papillary thyroid carcinoma and non-Hodgkin’s lymphoma (NHL) is an extremely unusual event. Here, we report the case of a 70-year-old man presented with high-grade fevers and abdominal discomfort and were found to have pancytopenia. He had generalized lymphadenopathy, hepatosplenomegaly, goiter, and tracheal shift. Biopsy of the left cervical lymph node was positive for papillary carcinoma of the thyroid. He underwent excision biopsy of axillary lymph node which was suggestive of high-grade NHL. The patient was started on chemotherapy (R-CHOP) and his fevers resolved promptly. He then underwent total thyroidectomy and the histopathology of the thyroid gland post-operative showed papillary carcinoma. The second primary malignancy is a second malignant neoplasm occurring in a patient with known cancer. This case highlights the unusual synchronous occurrence of the papillary carcinoma of thyroid and NHL and the diagnostic challenges involved in such cases.