case report of thalassemia with cold agglutinin

Thalassemia is the most prevalent hereditary anemia worldwide and in our country. Lifelong blood transfusion is currently the treatment protocol of this disease, but it has some side effects; one of them is alloimmunization. Alloantibodies produce antigens against RBCs which patients do not have. The antigens are transmitted via chronic blood transfusion gradually. One of these RBC antigens is antigen I, and the antibody against it is IgM class and cold antibody. Cold agglutinins are capable of agglutinating RBCs in low temperature and may result in hemolytic anemia which is known as cold agglutinin disease [CDA]. In Iran, data regarding incidence of CAD are not available, but incidence of CAD in USA is approximately 1:300000. An 18-year-old man with beta-thalassemia major referred to the hematology lab for periodic checking of blood smear. He had clumps of RBC and RBC indices were abnormal. In repeated examination, he was known to be asymptomatic for purpose of cold agglutinins. We do not have any records or information about cold agglutinins in thalassemic patients in Iran. This case was detected only through periodic laboratory tests without any special complications on the part of the patient

Bacteriology and prophylactic antibiotic study of biliary tract surgery

During a two-year prospective study [1980-1981], 186 bile specimens were cultured from patients who had undergone surgical operations of the biliary tract. The incidence of infected bile in the operated patients, 84/186 [45.2%], was higher in females, 65/136 [47.8%], than in males, 19/50 [38%]. Of the 84 infected bile cultures, 76 [90.4%] grew aerobic bacteria, and anaerobes were found in eight [9.6%] Septic complications developed in 11/108 [10.2%] of the patients. Prophylactic antibiotics proved useful in patients with infected bile cultures. This study confirms the importance of intraoperative bile cultures. Biliary tract infections are known to be caused by a wide variety of aerobic and anaerobic organisms[1-4]. Recently, polymicrobial biliary infections involving both aerobes and anaerobes had been frequently found in the presence of common duct stones[4-6]. It has been reported that operations on the biliary tract are associated with a 20-33% incidence of wound sepsis, and often occurred in cases with infected bile[2,6,7]. However, a few investigators demonstrated that patients with infected bile would benefit from preoperative prophylactic antibiotics[6,7]. This study describes the bacteriology of biliary tract infection and evaluates antibiotic prophylaxis in high risk patients undergoing biliary tract surgery