Red cell transfusion; triggers used in operating room

The purpose of this study was to determine and quantify those factors that anesthetist's use when deciding to transfuse blood in operating room. CMH abbottabad Nov to Dec 2008. Survey report. Prospective cross-sectional descriptive from operation theatre of Combined Military Hospital Abbottabad a tertiary care hospital. With consent from the local ethics committee, an audit was carried out using a questionnaire designed to examine some of the factors that could be important in the decision-making process surrounding blood transfusion during intermediate and major surgery. Anesthetists were asked to fill in the audit forms and to indicate whether they were going to give blood or not. Fifty two audit forms, completed during intermediate or major surgery, were analyzed to determine the strengths of certain factors in the decision-making process related to transfusion. Fifty one forms had a satisfactorily complete data set with hemoglobin concentrations Hb between 6.6 and 15.0 g/dL. This study demonstrates that, of the physiological factors, the hemoglobin concentration was the most important factor used for red cell transfusion, and the presence of ongoing bleeding an important contextual factor. Peer pressure to transfuse became apparent at a [Hb] of about 8.5 g/dL. The patients were transfused at the average Hb value of 10.8 g/dL. This average Hb of transfused patients is much higher than current Hb trigger thresholds of 7.0-8.0 g/dL

Efficacy of interferon therapy in patients of chronic hepatitis B viral infection treated at MH Rawalpindi

The consequences of acute and chronic HBV infection are major public health problems. These infections may progress to cirrhosis, liver failure, and Hepatocellular carcinoma Treatment of chronic replicative hepatitis B virus [HBV] infection is aimed at stopping viral replication and preventing the development of chronic liver disease. To determine the efficacy of Interferon therapy in patients of chronic Hepatitis B treated at MH Rawalpindi, by comparison of PCR for HBV DNA before and after Interferon therapy. Quasi-experimental study. Military Hospital, Rawalpindi from July 2003 to December 2005. The efficacy of a 4-month course of subcutaneously administered human recombinant interferon Alfa was studied. A total of 50 patients of proven chronic viral hepatitis B with presence of hepatitis B surface antigen and hepatitis B virus DNA [HBV DNA] in the serum were enrolled over the span of 30 months. All patients were treated with 5 mega units of recombinant interferon alfa-2b subcutaneously once daily for 4 months. PCR for HBV DNA was performed at the end of fourth month in treated patients as a predictor of response to interferon therapy. The treatment was well tolerated, only in three patients treatment was ceased due to severe depression while none of the other patient required dosage reduction or cessation of treatment because of side effects. In 22 treated persons [44.0%] PCR for HBV DNA becomes negative showed response to treatment. This finding is statistically significant [p less than 0.05]. Interferon Alfa has significant efficacy in chronic Hepatitis B. Patients of chronic Hepatitis B in whom Interferon therapy is not contraindicated should be treated with Interferon Alfa to avoid long term complication of infection

Reactive lymphocytosis; an enigma of diagnosis

A case of reactive lymphocytosis is described who despite all the relevant investigations and clinical evaluation eluded a conclusive diagnosis