Correlation between maternal and childhood VitB12, folic acid and ferritin levels

Objective: To determine the correlation between serum folic acid, vitamin B12 and ferritin of mother and child and to study various neonatal risk factors as a cause of anemia in children

Methods: One hundred eighty children two months to two years of age admitted in the department of Pediatric Medicine of The Children's Hospital and The Institute of Child Health Lahore from January 2013 to January 2015 with common medical conditions having anemia were included. Complete blood count [CBC], serum ferritin level, folic acid and Vitamin [Vit] B12 level were sent of children and their mothers. Data was analyzed using SPSS version 20

Results: Out of 180 children with anemia, 66.7% were males. Mean age of children was 7.3months. Fifty-five percent children were malnourished according to z scoring. The mean Hemoglobin [Hb] of children was 8 g/dl. Only 4% children had low ferritin level while 60% had low folic acid and 45% had decreased VitB12. There was significant correlation between Hb of mother and child [p =0.02], Vit B12 deficiency [p=0.008] and iron deficiency [p<0.001]. Premature children had lower folic acid levels [p =0.02], while prematurity, IUGR, previous admission and history of sepsis showed no association with anemia in our study. Both breast-feeding and top feeding showed significant association with anemia with p-value of 0.042 and 0.003 respectively while dilution showed no impact on anemia

Conclusion: Maternal anemia has a significant impact on child's hemoglobin. As compared to previous concept of increased iron deficiency in children we found increased occurrence of folic acid and VitB12 deficiency in children and their mothers

Glanzmann thrombasthenia: a clinicopathological profile

Objective: to describe the clinical presentation of patients with Glanzmann's thrombasthenia [GT] and evaluate their diagnostic, clinical, and laboratory parameters including platelet aggregometry

Study Design: descriptive study

Place and Duration of Study: department of Hematology and Blood Transfusion, the Children Hospital and Institute of Child Health, Lahore, from January 2006 to December 2013

Methodology: patients presenting with mucocutaneous bleeding during study period and evaluated for diagnosis of inherited platelet function disorder, were included. Clinical data and family history were recorded. Laboratory investigations including complete blood count [CBC], peripheral blood smear [PBS], bleeding time [BT], activated partial thromboplastin time [APTT], prothrombin time [PT], and platelet aggregation studies were evaluated

Results: among 796 patients, 163 [20.4%] patients were diagnosed with Glanzmann's thrombasthenia. The male to female ratio was 1.2:1. Their mean age was a 7 +/-2.5 year ranging from 3 months to 35 years. Consanguinity was observed in 65% patients. Common presenting symptoms included easy bruisibility [76.6%], gum bleeding [56.4%], epistaxis [62.5%], and prolonged bleeding after injury [47.2%]. Bleeding time was prolonged in 92%. Platelet aggregation studies showed decreased aggregation with ADP, Collagen and Epinephrine in 100% of these patients and 9.2% showed decreased aggregation with Ristocetin also

Conclusion: glanzmann thrombasthenia was seen in a substantial number of patients [20.4%], possibly due to consanguineous marriages. GT patients presented from early age to adulthood and raised awareness hoping to help in early diagnosis and more appropriate management. Extensive collaborated studies are needed to predict the true incidence of GT in Pakistan

Per oral bleeding: rare presentation of gardner-diamond syndrome

A 10-year boy presented with spontaneous episodes of oral bleeding for the last 6 months. Detailed ENT examination showed no pathology, bleeding profile was normal, endoscopy and dental examination also did not reveal any abnormality. Child abuse or malingering was also ruled out. Initially the child was managed with platelet transfusion and fresh frozen plasma and then put on follow-up treatment with antifibrinolytics, Vitamin C but the episodes became recurrent. Psychiatric evaluation revealed that child was suffering from depression. Antidepressants were prescribed by the psychiatrist that not only cured the depression with time but also the bleeding episodes which were actually related to child's depression [Gardner-Diamond syndrome or psychogenic purpura]. This is a diagnosis by exclusion where the patients bleed due to dysregulated steroid secretion secondary to stress; resulting in development of sensitization to RBC membrane, and dysregulated fibrinolytic system activity

Pediatric myelodysplastic syndrome [MDS] - case series at the childrens hospital and the institute of child health, Lahore

A study was planned to determine the pattren of FAB type distribution of myelodysplastric syndrome in childhood haematological malignancies. It was a cross sectional study carried over a twenty-month period in Haematology and Transfusion Medicine Department of Children Hospital and Institute of Child Health. All patients of age suspected of haematological malignancy were included in the study. All patients underwent a complete blood count, reticulocyte count, peripheral blood film from neonate 15 years examination, bone marrow aspiration and trephine biopsy. During a period of 20 months [from Sep 2000 to May 2002] 195 cases of haematological malignancies were diagnosed. Out of these 9 [4.6%] patients were diagnosed as cases of Paediatric MDS. There were 110 cases of acute lymphoplastic leukemia [ALL], 63 cases of acute myeloid leukemia [AML] and 13 cases of chronic myeloid leukemia [CML]. Out of the 9 MDS cases five were of MDS Type III - Refractory Anemia with Excess of Blasts-[RAEB] and four were of MDS Type I Refractory Anemia [RA]. It can be conducted that paediatric MDS represents 4.6% of all childhood haematological malignancies with nearly equal distribution of REAB and RA