Pregnant women with severe anemia reporting in labor: prevalence, socio-demographic and obstetric determinants

Background: Severely anemic women reporting in labor remains one of the most important challenging situation for the obstetrician as well as for the mother and her family due to its adverse feto-maternal outcome. Various socio-demographic and obstetric conditions need to be explored which are important to tackle them, for primary prevention of anemia. The aim and objectives of the study were to estimate prevalence of severe anemia in pregnant women reporting in labor in a tertiary hospital of Delhi and to evaluate various socio-economic and associated obstetric factors associated.Methods: This is a hospital based, prospective, case contol study. Hemoglobin was estimated at the time of labor room admission. Fifty consecutive antenatal women with severe anemia (Group A) and 50 non-anemic women (Group B) were enrolled in early labor. Socio-demographic and obstetric factors, were recorded and analyzed.Results: Prevalence of severe anemia was estimated to be 2.23%. Determinants of severe anemia were found to be socio-economic status (p value 0.001), education (p value 0.001), rural living (p value 0.016), calorie intake (p value 0.001), BMI (p value 0.046), booking status of pregnancy (p value 0.001), gravida (p value 0.024), inter-conception interval (p value 0.002) and regular iron-folic acid intake (p value 0.001).Conclusions: Primary prevention of anemia by targeting these factors at the community/state/ national level, by the policy makers is important. Early booking and screening for anemia in antenatal clinics, providing iron supplements to anemic women for secondary prevention of severe anemia is recommended so that no woman reports with severe anemia in labor.

A concurrent parallel study to compare the efficacy and safety of oral iron chelators, defrasirox and defriprone in patients of beta thalassaemia major

Background: This study was planned to evaluate all the cases of ? thalassaemia major, already receiving one of the oral iron chelators for a comparison among the efficacy, safety and economy of deferasirox and deferiprone to establish the better option in an Indian scenario.Methods: We identified two groups of patients: 38 treated with deferasirox and 35 treated with deferiprone. Laboratory parameters such as serum ferritin, creatinine, SGPT, Hb, CBC and urine were recorded at the time of inclusion and at 1, 3 and 6 months after the inclusion. The primary outcome variable was serum Ferritin level at the start and at the end of study. Serum ferritin level was carried out by microparticle enzyme linked immunoassay.Results: Before the study, the mean hemoglobin level was 7.32±1.50mg/dL ranged from 4 to 10.8 in deferasirox group and 7.54±1.15mg/dL ranged from 5.5 to 8.8 in deferiprone group. At the time of inclusion, study population was characterized by a mean serum ferritin value of 4735.11±450.01 SE in deferasirox and 4315.97±340.75 SE in deferiprone group. After one month the mean serum ferritin increases to 4578.66±371.96 in deferasirox and 4388.82±316.16 in deferiprone group. After three month the mean serum ferritin reduces to 4295.60±377.37 in deferasirox and 3988.88±349.84 in Deferiprone group.Conclusions: Thus, we conclude that deferasirox and deferiprone are well tolerated, have few adverse effects and almost have a comparable effect in lowering of the patient's serum ferritin level. Deferiprone is more cost effective but needs a strict control on compliance owing to requirement in three divided doses per day.

Prevalence and spectrum of hemoglobinopathies in tertiary care centre in a rural area of Madhya Pradesh.

Background: Haemoglobinopathies like thalassaemia and sickle cell anaemia etc are increasing due to unawareness of rural population. This study indicates type of haemoglobinopathies amongst the patients of a rural based tertiary care hospital in one year and nine months. Methods: Five hundred ten patients were studied during last one year and nine month for all suspected cases of haemolytic anaemia based on Complete Blood Count, Red cell indices and Peripheral blood smear examination. Sickling test, test for Hb F and haemoglobin electrophoresis with quantification of bands are done in all these cases Results: Out of all 510 cases of anaemia 461 cases (90.39%) were confirmed to nonhaemolytic anaemia whereas 49 cases (9.60%) had shown abnormal haemoglobin bands on electrophoresis. Out of these 49 cases 29 (59.18%) were Males and 20 (40.81%) were females. Most common Haemoglobinopathy observed was Sickle cell  Thalassaemia 23 (4.50%) followed by  Thalassaemia Trait 9 (1.76%), Sickle Cell trait 7 (1.37%).  Thalassaemia Major 5 (0.98%) & Sickle Cell Disease 5 (0.98%) have equal prevalence. The onset of disease was most prominent in Neonatal to pediatric age group including early adolescent (0-18 years) followed by reproductive age group (19- 45 years). Few cases of old age (46+ years) were detected. Conclusion: Study provides data on the spectrum & pattern of Haemoglobinopathies in a rural tertiary care centre. Screening of all anemic patients should be done for Haemoglobinopathy and proper Genetic counseling must be given to all cases to prevent incidence of cases in future generation.

In vitro resistance of leukaemic blasts to prednisolone in bcr-abl positive childhood acute lymphoblastic leukaemia.

BACKGROUND & OBJECTIVES: Although the outcome of children with acute lymphoblastic leukaemia (ALL) has improved dramatically over the last decade, some children still fare poorly and relapses are seen. The sensitivity of leukaemic cells to corticosteroids has emerged as an important prognostic factor in ALL. The t(9,22) translocation, resulting in the bcr-abl fusion gene, is a non-random translocation found in B-lineage acute lymphoblastic leukaemia. It is also known to be an independent poor prognostic factor for long-term disease free survival. We studied the association between the presence of bcr-abl fusion gene and in vitro prednisolone resistance in children with B-lineage acute lymphoblastic leukaemia at diagnosis. METHODS: A total of 23 children (aged 1-16 yr, median age: 12 yr) with B-lineage acute lymphoblastic leukaemia at diagnosis were included in the study. The presence of bcr-abl fusion gene was determined by reverse transcriptase-polymerase chain reaction (RT-PCR) and the in-vitro resistance to prednisolone was measured by short term colorimetric methyl thiazol tetrazolium (MTT) assay. RESULTS: A median LD50 (lethal dose for 50% cells) for prednisolone in bcr-abl positive children (n=7) was 1.6 mg/ml (range: 0.25-5.0 mg/ml) and that of bcr-abl negative children (n=16) was 0.35 mg/ml (range 0.62-1.0 mg/ml). The median LD50 for prednisolone differed significantly between the bcr-abl positive and negative groups of children with acute lymphoblastic leukaemia (P<0.005). INTERPRETATION & CONCLUSION: This is probably the first report to show that leukaemic blasts of bcr-abl positive children with ALL are about four-fold resistant to prednisolone as compared to blasts from bcr-abl negative children. This suggests that one of the reasons for the poor prognosis of bcr-abl positive ALL could be a lower steroid sensitivity.

Drug sensitivity assay for leukaemic cells by flow cytometry.

BACKGROUND & OBJECTIVES: Drug sensitivity assays are useful in oncology practice for evaluating the sensitivity of malignant cells to anti-cancer drugs. The usefulness of such assays for the prediction of clinical response to therapy has also been demonstrated. The existing methods used for this purpose are time consuming and labour intensive. Here we report a simplified flow cytometry based assay for evaluating the in vitro drug sensitivity of leukaemic cells. METHODS: The chemo-sensitivity of three human leukaemic cell lines (a lymphoblastoid cell line, Jurkat; an erythroleukaemic cell line, K 562 and a myelomonocytic cell line HL-60) was investigated by flow cytometry. Flow cytometry was used to determine LD50 (50% inhibitory concentration) for prednisolone on Jurkat and daunorubicin on HL 60 and K 562 cell lines respectively. Per cent cell death could directly be assessed on a flow cytometer by measuring the fluorescence after staining with propidium iodide (PI). For comparison MTT assay was also performed using prednisolone on Jurkat and daunorubicin on HL-60. RESULTS: Cytotoxic effect of drugs was found to be dose dependent. Mean LD50 of prednisolone for Jurkat cells by flow cytometry was 0.805 +/- 0.058 mg/ml and by MTT assay 0.866 +/- 0.115 mg/ml. Mean LD50 of daunorubicin for HL-60 was 1.96 +/- 0.05 micrograms/ml by flow cytometry and 1.90 +/- 0.282 micrograms/ml by MTT assay. The mean LD50 of daunorubicin to K 562 was 0.49 +/- 0.049 mg/ml by the flow cytometry method. The inter-assay variation for the LD50 by flow cytometry based assay was found to be 6, 14 and 10 per cent for Jurkat, HL-60 and K 562 respectively. INTERPRETATION & CONCLUSION: We report a flow cytometry based drug-sensitivity assay for leukaemic cells, which uses a single dye staining and is rapid, technically simple and reproducible. The results compare well with the more commonly used MTT assay, which is labour intensive and time consuming. The limitation of our method is that it can only be used for studying cells in suspension and is therefore not suitable for adherent cell lines.