ABSTRACT
Background: The aim was to study the effect of ultra-short course of injectable steroid followed by oral steroid therapy for cumulative 14 days on clinical and hematologic parameters of secondary hemophagocytic lymphohistiocytosis in children.Method: A retrospective longitudinal study was conducted by collecting data from case records. Cases diagnosed with secondary hemophagocytic lymphohistiocytosis had been included. The cases with malignancy were excluded. Remaining cases had been given injectable methyprednisolone (30 mg/kg/day) for three days followed by oral prednisolone (1 mg/kg/day) for 11 days. The time' to cessation of fever and organomegaly were noted. The changes in mean hematologic parameters, ferritin and triglycerides were noted at the time of suspicion of HLH or MAS, after therapy and on follow up.Results: About 96% of children were afebrile within five days of therapy. There was regression of hepatospleenomegaly in all 100% surviving children by day seven of therapy. Improvement in hemoglobin (mean value 8.1 mg/dl to 8.7 mg/dl) and platelet count (mean value 0.89 lakh to 1.47 lakh) was seen by day seven of therapy. Fall in serum ferritn (mean value 1419 ng/ml to 298 ng/ml) and serum triglycerides (mean value 307 mg/dl to 176 mg/dl) was seen at one-month follow-up. 96% survival was observed. None of the survivors had any recurrence at 6 months follow up.Conclusion: Ultra short course of injectable methyprednisolone for 3 days followed by oral prednisolone for 11 days was successful in 95% survival in our study. This cost-effective regimen, with use of less toxic drugs leading to a shorter hospital stay maybe helpful in resource limited settings.
ABSTRACT
Iron deficiency anemia is the most common form of anemia in pregnancy. The present study was carried out to determine the prevalence of antenatal anemia and iron deficiency in the Malaysian population and its correlation with sociodemographic and obstetric profile. It was a cross-sectional study conducted at an urban health clinic over a period of six months. A single blood sample was drawn from apparently healthy pregnant mothers at antenatal booking and sent for laboratory assessment of full blood count and serum ferritin as screening tools for anemia and iron status. SPSS version 19.0 was used for statistical analyses. The results showed that out of 250 subjects, 43.6% had anemia and 31.6% had iron deficiency. Whilst 47.7% of subjects with anemia were iron deficient, 19.1% of subjects without anemia were also iron deficient. Serum ferritin correlated negatively with period of gestation at booking (p<0.001), with 77.6% of these women not having prior iron supplements. Serum ferritin was also significantly lower among grandmultiparae (p=0.01). Iron deficiency was significantly (p=0.024) more common among Indians (42.5%) compared to Malays (33.5%) and Chinese (13.0%). In conclusion, continuation of the current practice of routine antenatal iron supplementation is still warranted and justifiable in Malaysia as there is high prevalence of iron deficiency in pregnancy not only in the presence of anemia but also in the presence of normal hemoglobin values.