ABSTRACT
Background: Polycythaemia is defined as an increase in the hemoglobin above normal. This increase may be real or only apparent because of a decrease in plasma volume (spurious or relative polycythaemia) and the real polycythaemia can be because of primary due to genetic mutations or secondary due to increased erythropoietin production. The dominant symptoms from an increased red cell mass are related to hyper viscosity and thrombosis (both venous and arterial), because the blood viscosity increases logarithmically at hematocrits >55%. The present study aimed to characterize the different clinical presentations and to find out the complications associated with polycythaemia. Aim and objectives: To identify different clinical presentations of polycythaemia and to evaluate various etiologies of polycythaemia. Materials and methods: Patients with polycythaemia presented to OPD or in patient in the Department of General Medicine in Malllareddy Institute of Medical Sciences, Suraram from June 2020 to January 2022 were included. This was a descriptive observational study in which total of 24 patients were analyzed. Patients with polycythaemia (male Hb >16.5g/dl and females Hb>16.0g/dl) were included. Patients admitted with acute dehydration, sepsis and shock and other conditions leading to spurious polycythaemia and patient on diuretics were excluded. All the patients includedwho were found to have increased RBC mass not including patients from exclusion criteria. A detailed clinical history and physical examination was performed to identify clinical patterns of presentation and look for any complications, and necessary lab investigations were sent accordingly, to evaluate for the cause of polycythaemia. Results: A total of 24 patients were included in the study out of which 16 were males .and 8 were females. Polycythaemia Vera was found in 33% while secondary causes were seen in 67%, patients with polycythaemia vera were found to have more thrombotic complications and the mean age of presentation was in between 30- 40 years. Amongst the secondary causes COPD was the most common cause and smoking was the most common risk factor. Conclusion: Polycythaemia presents wide and varied clinical manifestations. polycythaemia rubra vera is a not an uncommon finding in patients presenting with symptoms of arterial or venous thrombosis, polycythaemia rubra vera is more commonly associated with thrombotic tendencies when compared to secondary causes of polycythaemia, when evaluating a case of polycythaemia it is necessary to look for signs and symptoms of secondary causes, to especially look for erythropoietin secreting tumors an high index clinical suspicion is required in such cases.
ABSTRACT
Background: The major cause of morbidity and mortality in patients with portal hypertension is due to oesophageal varices. Upper gastrointestinal endoscopy is considered best to detect varices earlier. It’s an invasive tool which is expensive and increased financial burden among patients. Hence this study is undertaken to find non-invasive indicators of oesophageal varices in cirrhosis patients with portal hypertension and to establish the role of portal vein diameter determined by ultrasonography in predicting the oesophageal varices. Aim and objectives: To detect non-invasive indicators of oesophageal varices in chronic liver disease, to determine the relation between oesophageal varices on upper gastrointestinal endoscopy and portal vein diameter, to determine other non-invasive parameters to identify oesophageal varices. Materials and methods: A cross sectional study on 45 patients, who were diagnosed to have chronic liver disease and are being presented to outpatient department and were admitted in Malla Reddy Institute of Medical Sciences, Suraram over a period of one year under department of general medicine. All the patients with chronic liver disease who underwent upper gastrointestinal endoscopy are included in the study. Results: 45 patients with cirrhosis of liver were included in the study, among which 32 were males and 13 were females with a mean age group of 46 years. On upper gastrointestinal endoscopy 87% of patients had oesophageal varices while other 13% of patients were normal. Mean portal vein diameterwas 13.8 mm and has a positive linear correlation with p<0.01 and positive predictive value of 95.25%. Majority of patients belonged to the platelet count group of 50,000 to 1lakh and its inversely co related to the severity of varices. Majority of patients with oesophageal varices had moderate splenomegaly. Conclusion: Ultrasonography of portal vein diameter and spleen size along with thrombocytopenia are reliable, inexpensive and easily reproducible non-invasive tool in predicting the presence of oesophageal varices and hence can identify the patients who require endoscopy on a prophylactic basis.