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

Frequency of factor V leiden mutation

To determine the frequency of factor V leiden mutation. Observational study. One-year, January 2001 to December 2001 at the Armed Forces Institute of Pathology, Rawalpindi, Pakistan. Two hundred subjects each of apparently healthy and unrelated Punjabi and Pathan origins were included in the study. Peripheral blood samples were collected in EDTA and DNA extracted by phenolchloroform extraction method. DNA analysis was done by PCR for restriction fragment length polymorphism. The product was digested overnight with Mn/1 and electrophoresed on acrylamide gel to detect 67 and 153 base pair fragments of factor V leiden against 37, 67 and 116 base pair fragments of normal factor V. In the 400 subjects studied, only 5 cases of heterozygotes for factor V leiden were detected. The overall carrier rate was 1.3% [95% Cl 0.2-2.2%]. The carrier rate in Punjabis and Pathans was 1% and 1.5% respectively. This study confirms that the prevalence of factor V leiden is low in Asians and Africans as compared to the European population

Diagnosis of B-thalassaemia major in previously transfused patients

The study was conducted to evaluate the effects of blood transfusion[s] on the haematological picture of b-thalassaemia major. Design: Retrospective case control study. Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology, Rawalpindi from January1999 to December 2000. Subjects and A total of 280 consecutive patients of b-thalassaemia major were studied. They were diagnosed by haematological parameters, and Hb-F estimation. Parent's study and PCR was also used when required. Out of the 280 patients 109 [39%] had received one or more blood transfusions [cases]. The remaining 171 patients who did not receive any transfusion served as controls. The mean MCV, MCH and Hb-F in cases were significantly higher than in the controls [p<0.05]. The mean Hb-F in 95 cases, which had received occasional [<4] transfusions, was higher [33%] than in the 14 cases who had received >4 transfusions [17%] [p=0.016]. In the occasionally transfused patients Hb-F level was directly related to the time since last transfusion. In 44/109 [40%] transfused patients [Hb-F >30%] the diagnosis of thalassaemia was not difficult. In 54/109 [50%] patients [Hb-F: 5-30%] the diagnosis was aided by parent's study, while PCR for thalassaemia mutations was required in 11/109 [10%] patients [Hb-F <5%]. In most transfused patients of thalassaemia major MCV and MCH were significantly higher while Hb-F was lower than in the un-transfused patients. There was a linear correlation between Hb-F level and time since last transfusion in the occasionally transfused patients. However, the reduction in Hb-F level was more marked and sustained in multipally transfused patients. Parent's study and PCR are useful aids in establishing the correct diagnosis in these patients

Clinical spectrum of thrombocytopenia in adult population of Karachi

To determine the etiology and clinical features of patients presenting with bleeding due to thrombocytopenia. Design: A cross sectional study. Place and Duration of Study: The study was carried out at PNS Shifa Hospital, karachi during the period from 1994-1996. Subjects and A total of 500 consecutive patients of 15 years or more age with a platelet count of less than 150 x 109/l were included in the study. Complete blood count including platelets count was carried out by using electronic coulter counter model T-890 for each patient. Very low platelet count was also confirmed by manual method. Among 500 patients of thrombocytopenia the commonest cause was malaria consisting of 216 [43.2%] cases. Megaloblastic anemia was the leading hematological cause, comprising of 31 [6.2%] patients. Other miscellaneous causes like dengue hemorrhagic fever, idiopathic thrombocytopenic purpura, aplastic anemia and leukemias were responsible for the rest of cases of thrombocytopenia. Epistaxis followed by gum bleeding was the leading clinical manifestation. We conclude that malaria and viral infections are common causes of transient thrombocytopenia. Epistaxis and gum bleeding are the leading clinical manifestations in various disease processes in adult population

Prevalence of hepatitis b-core antibodies amongst health care workers

Health care workers [HCWs] are at high risk of acquiring Hepatitis 'B' virus infection due to their frequent exposure to blood and body fluids of the infected patients. Medical and paramedical staff of PNS SHIFA Karachi was tested for the presence of Anti-HBc antibodies as a pre vaccination-screening programme. A total of 310 HCWs were included in the study. These included the medical officers [n=42], nursing officers [n=38] and medical assistants [n=230]. Anti-HBc antibodies were detected in 24.5 percent [n=76] of HCWs. The medical assistants were having the highest prevalence [26.06 percent] followed by the nursing officers [23.08 percent] and the medical officers the least [16.66 percent]. Early screening and vaccination programmes in addition to the proper precautions in exposure prone procedures can only prevent the HCWs from this serious infection