Bone marrow infiltration and patterns in previously diagnosed patients of non hodgkin lymphoma [a single centre study]

Objective: The objective of this study was to determine the frequency of bone marrow infiltration along with various histological patterns of bone marrow infiltration in previously diagnosed patients of Non Hodgkin Lymphoma

Study Design: Cross sectional study

Place and Duration of Study: Department of Haematology, Armed Forces Institute of Pathology Rawalpindi. Six months, from Nov 2013 to May 2014

Material and Methods: This study involved 70 patients diagnosed of Non-Hodgkin Lymphoma

Results: The mean age of the patients was 51.40 +/- 16.50 years and 78.6% of the patients were males and 21.4% were females. Diffuse Large B-Cell lymphoma was the most frequently observed variant [DLBCL, 60%], followed by Follicular [22.9%] and small lymphocytic lymphoma [SLL, 14.3%]. Most of the patients were suffering from Stage-IV disease [51.4%], followed by Stage-III [25.7%] and Stage-II disease [22.9%]. Bone marrow infiltration was observed in 51.4% patients. The most common pattern of infiltration was recorded as diffuse, observed in 33.3% of patients. The second most common pattern was interstitial which was recorded in 25% cases followed by mix [22.2%] and focal [16.7%] patterns. The frequency of bone marrow infiltration was unaffected by age [p=0.497], gender [p=0.868] and type of the disease [p=0.486]

Conclusion: The most common pattern of diffuse large B-cell Non Hodgkin lymphoma infiltration was bone marrow followed by interstitial tissue

Assessment of status of thyroid functions in patients of beta thalassemia major, reporting to OPD of military hospital, Rawalpindi

Objective: To determine the status of thyroid functions in patients of beta Thalassemia Major, reporting to OPD of Military Hospital, Rawalpindi

Study Design: Descriptive cross sectional study

Place and Duration of Study: Paediatric Outpatients Department of Military Hospital, Rawalpindi from 1st Jan to 30th Jun 2012

Material and Methods: After taking informed consent from the parents of all the children fulfilling the inclusion criteria, detailed history was taken and blood samples were drawn by strict aseptic means. Samples taken from these patients included complete blood and thyroid profile [serum thyroxine T4, triiodothyronine T3 and thyroid stimulating hormone TSH]. These blood samples were labeled and sent to Armed Forces Institute of Pathology [AFIP], Rawalpindi for analysis by enzyme-linked immunosorbent assay [ELISA]. Primary hypothyroidism was defined by TSH levels >4IU/ml. Statistical analysis was done at the end of study using SPSS version 10. Significance for association was calculated using student t-test

Results: Sixty patients fulfilled the inclusion criteria out of these sixty four patients lost the follow up while 56 patients completed the study. Out of 56 patients, 21 [37.5%] had biochemical evidence of hypothyroidism. Mean Ferritin level was 3924 +/- 1247ng/ml in hypothyroid and 3136 +/- 1387ng/ml in euthyroid patients indicating a significant difference in mean serum ferritin levels between hypothyroid patients and others

Conclusion: The study demonstrates hypothyroidism in a significant number of hyper transfused beta- thalassemic patients, emphasizing the importance of monitoring thyroid functions in thalassemic patients, particularly in those receiving suboptimal chelation

Methylmalonic acidemia

Methylmalonic Acidemia [MMA] is an inborn error of metabolism that results in accumulation of methylmalonic acid in blood and increased excretion in urine. The effects of MMA vary from mild to life threatening and it usually presents in early infancy. Affected infants can have vomiting, dehydration, hypotonia, developmental delay and failure to thrive. The emergency treatment of the newborn with MMA mainly comprises rehydration and promotion of anabolism, followed by long-term dietary management by both the restriction of precursor amino acids using a low protein diet and avoidance of prolonged fasting. Prognosis depends on the type of MMA and whether the condition is well controlled in general and during episodes of metabolic decompensation. We report here the presentation and management of a 2-year boy with MMA who failed to achieve expected milestones for age. To the best of our knowledge, only one case of MMA has been reported from Pakistan