Imerslund-Gräsbeck Syndrome: Clinical Case

Introduction: Imerslund-Gräsbeck syndrome (IGS) is a rare congenital disorder characterized by decreased vitamin B12, megaloblastic anemia, and proteinuria. Clinical case: A 58-year-old woman with four episodes of generalized tonic movements whose paraclinical findings showed cyanocobalamin deficiency. The presence of gait disturbances and constitutional syndrome was reported upon questioning, which required further investigation. The extension tests confirmed type 1 IGS, so it was decided to continue the cyanocobalamin management and nutrition evaluation, with which an adequate evolution was achieved. The patient was eventually discharged. Conclusion: This pathology is low prevalence and mainly affects the first decade of life. It prefers the female sex and is characterized by a decrease in vitamin B12, which can predispose to other disorders such as ataxia and growth retardation.

Introducción: el síndrome de Imerslund-Gräsbeck es un trastorno congénito infrecuente caracterizado por disminución de la vitamina B12, anemia megaloblástica y proteinuria. Caso clínico: mujer de 58 años de edad con cuatro episodios de movimientos tónicos generalizados cuyos paraclínicos mostraban deficiencia de cianocobalamina, por lo que en el interrogatorio se reportaba la presencia de alteraciones en la marcha y síndrome constitucional que requería ampliar los estudios. Los exámenes de extensión confirmaron el síndrome de Imerslund-Gräsbeck tipo 1, de modo que se decidió continuar el manejo con cianocobalamina y valoración con nutrición, con lo que se obtuvo una adecuada evolución y se decidió dar egreso a la paciente. Conclusión: esta patología tiene una baja prevalencia y afecta principalmente a la primera década de la vida, tiene predilección por el sexo femenino y se caracteriza por una disminución de la vitamina B12, que puede predisponer a otras alteraciones como ataxia y retraso en el crecimiento.

Effect of megaloblastic anemia on hemoglobin A2 and diagnosis of ?-thalassemia trait

Context: ?-thalassemia trait is usually diagnosed by raised hemoglobin A2 (HbA2). The presence of megaloblastic anemia can cause an increase in HbA2 and create a diagnostic dilemma. Here, we have analyzed the effect of vitamin B12 and folic acid supplementation on HbA2 and diagnosis of ?-thalassemia trait in cases of megaloblastic anemia with raised HbA2. Materials and Methods: Cases of megaloblastic anemia with raised HbA2 on high-performance liquid chromatography (HPLC) were supplemented with vitamin B12 and folic acid. Post-treatment evaluation was done after 2 months. Cases showing adequate hematological response were subjected to statistical analysis. Based on post-treatment HbA2 value, the cases were diagnosed as normal, borderline raised HbA2, or ?-thalassemia trait. Pre- and post-treatment values of red cell parameters and HbA2 were analyzed. Results: There was a significant decrease in HbA2 value after vitamin B12 and folic acid supplementation. The diagnosis was changed in 70.97% of the cases after treatment. The chance of inconclusive diagnosis was decreased from more than 50% to less than 10%. Pre-treatment mean corpuscular volume (MCV) and HbA2% showed a significant difference between the thalassemic and normal groups. Conclusions: Megaloblastic anemia can lead to false-positive diagnosis of ?-thalassemia trait on HPLC. Repeat HPLC should be done after adequate supplementation of vitamin B12 and folic acid in cases of megaloblastic anemia with raised HbA2. Red cell parameters are not helpful to suspect ?-thalassemia trait in presence of megaloblastic anemia. However, HbA2% on HPLC can be a useful parameter to suspect or exclude ?-thalassemia trait in cases of megaloblastic anemia.

EVALUATION OF PANCYTOPENIA WITH BONE MARROW INTERPRETATION

Background: Pancytopenia is one of the most common clinico-haematological entity observed in our day to day clinical practice. It is a disorder in which all the three major elements of blood (i.e. red blood cells, white blood cells and platelets) are decreased in number. The causes of pancytopenia may be due to decrease in hematopoietic cell production in the marrow resulting from infections, toxins, malignant cell in?ltration, post- chemotherapy or post-radiation. Aims and Objectives: 1) To study the etiology and clinical presentation of pancytopenia in all age groups. 2) To correlate with bone marrow interpretation Materials & Methods: This is a prospective study which was conducted among 50 patients of pancytopenia in the Clinical Pathology, Government General Hospital,Kurnool from January 2021 to October 2022 Bone marrow aspiration was done by using Salah's bone marrow puncture needle. Smears were made from bone marrow aspirate (BMA) and stained by Leishman stain and special stains like Perl`s wherever necessary. The smears were assessed for cellularity, differentiation and maturation of erythroid, myeloid and megakaryocytic lineage, M:E ratio, Plasma cells, Lymphocytes and parasites/ abnormal cells. In the present study the commonest cause of Pancytopenia was Megaloblastic anemia (70%) followed by Results: Dimorphic anemia (20%). The less common conditions were Multiple Myeloma (6%),Chronic Myeloid Leukemia(2%),Acute Leukemia(2%). The present study concludes that complete primary hematological Interpretation and Conclusion: investigations along with bone marrow aspiration in pancytopenic patients are helpful for understanding disease process and to diagnose or to the rule out causes of pancytopenia. These are also helpful in planning for further investigations and management

Spectrum-of-haematological-disorders-in-bone-marrow-aspiration-at-tertiary-care-hospital-jorhat

Anemia is a common symptom of haematological disorders in people of all ages .The spectrum of haematological disorders differs significantly between developing and industrialized countries. The primary use of bone marrow aspirate is for cytological examination. It enables study into the cellularity of the bone marrow as a whole, the detection of specific lesions, and the amount of infiltration by various disease entities. The aim of the study is toAims & objective: evaluate the spectrum of haematological disorders reported in bone marrow aspiration and to know the age and sex incidence. This prospective study is an observational study was conducted over a one-yearMaterials and methods: period on 73 patients and the spectrum of hematological disorders was studied on bone marrow aspiration smears. Conclusion: A thorough examination of the bone marrow is essential for diagnosing haematologic disorders. It is a simple and cost effective procedure which can be performed routinely without using any specialized equipment or a need of general anaesthesia

Diferentes formas de presentación de la anemia megaloblástica en el lactante / Different forms of presentation of megaloblastic anemia in the infant

Introducción: La anemia megalobástica es un trastorno madurativo de los precursores eritroides y mieloides causado por déficit de vitamina B12, ácido fólico, o ambos. Es poco común en la infancia y su prevalencia se desconoce por ser una enfermedad poco frecuente. Objetivo: Describir diferentes formas de presentación de la anemia megaloblástica en el lactante. Presentación de casos: Se presentan dos casos de lactantes, en el caso 1 la madre tuvo una alimentación precaria durante el embarazo y la lactancia, prolongó la lactancia materna exclusiva más de 6 meses. La paciente comenzó a perder las habilidades ganadas en el desarrollo psicomotor y presentó trastornos neurológicos graves, por lo que se consideró que se trataba de una enfermedad progresiva del sistema nervioso central. En el caso 2, en el que se prolongó la lactancia materna exclusiva, apareció trombocitopenia, por lo que se sospechó una enfermedad hematológica maligna. Resultados: En ambos casos después de realizar diversas pruebas para descartar enfermedades neurológicas (caso 1) y enfermedades hematológicas (caso 2) se diagnosticó anemia megaloblástica por déficit de vitamina B12 por disminución en la ingesta y una reserva limítrofe en la madre que lacta. En ambos casos los síntomas desaparecieron con el tratamiento vitamínico sustitutivo. Conclusiones: En el lactante la anemia megaloblástica se puede presentar de diferentes formas clínicas a pesar de tener la misma causa, un déficit en la ingesta y una reserva escasa de la madre durante el embarazo y lactancia(AU)

Introduction: Megaloblastic anemia is a maturing disorder of the erythroid and myeloid precursors caused by deficiency of vitamin B12, folic acid, or both. It is uncommon in childhood and its prevalence is unknown because it is a rare disease. Objective: To describe different forms of presentation of megaloblastic anemia in infants. Presentation of cases: Two cases of infants are presented, in case 1 the mother had a precarious diet during pregnancy and lactation, and prolonged exclusive breastfeeding more than 6 months. The patient began to lose the skills gained in psychomotor development and presented severe neurological disorders, so it was considered that it was a progressive disease of the central nervous system. In case 2, in which exclusive breastfeeding was prolonged, thrombocytopenia appeared, so a malignant hematological disease was suspected. Results: In both cases, after performing various tests to rule out neurological diseases (case 1) and hematological diseases (case 2), megaloblastic anemia was diagnosed due to vitamin B12 deficiency due to a decrease in intake and a borderline reserve in the breastfeeding mother. In both cases the symptoms disappeared with vitamin replacement therapy. Conclusions: In the infant, megaloblastic anemia can occur in different clinical ways despite having the same cause, a deficit in intake and a low reserve of the mother during pregnancy and lactation(AU)

Síndrome de Imerslund-Gränsbeck: revisión sistemática de casos clínicos / Imerslund-Gränsbeck Syndrome: systematic review of clinical cases

Resumen Introducción: el Síndrome de Imerslund-Gränsbeck es un trastorno congénito inusual que cursa con disminución de la Vitamina B12, anemia megaloblástica y proteinuria sin afección renal que cual se produce por una mutación de los cromosomas 10 y 14, que condicionan un defecto en el receptor del complejo vitamina B12-factor intrínseco del enterocito ileal. Fue descrita por Olga Imerslund y Armas Gransbeck. Objetivo: caracterizar a la población que ha padecido el Síndrome de Imerslund-Gränsbeck. Metodología: revisión sistemática de la literatura de casos clínicos. Resultados: se incluyeron 68 casos, en la mayoría de los casos el diagnostico en los primeros 10 años de vida, en el que se evidenció una mayor frecuencia en mujeres, y se encontró asociado con antecedentes familiares como consanguinidad entre padres (14,6%). La manifestación más frecuente fue palidez (20,9%), seguido de vomito (10,5%) y anorexia (9,8%). La anemia megaloblástica (66,2%) fue el hallazgo más frecuente y el tratamiento se dio con cianocobalamina (intramuscular u oral) para regular las concentraciones plasmáticas de esta vitamina. Conclusión: el Síndrome de Imerslund Gränsbeck tiene una baja prevalencia y se presenta con mayor frecuencia en el continente europeo, tiene predilección por el sexo femenino y se caracteriza por una disminución de la vitamina B12 que pueden que puede predisponer a otras alteraciones como ataxia y retraso en el crecimiento.

Abstract Introduction: Imerslund-Gränsbeck Syndrome is an unusual congenital disorder that causes a decrease in vitamin B12, megaloblastic anemia and proteinuria without kidney involvement that is caused by a mutation of chromosomes 10 and 14, which determine a defect in the complex receptor vitamin B12-ileal enterocyte intrinsic factor. It was described by Olga Imerslund and Armas Gransbeck. Objective: to characterize the population that has suffered from Imerslund Gränsbeck syndrome. Methodology: systematic review of the clinical case literature. Results: 68 cases were included, in most cases the diagnosis in the first 10 years of life, in which a higher frequency was found in women, and was found to be associated with family history such as consanguinity between parents (14.6%). The most frequent manifestation was paleness (20.9%), followed by vomiting (10.5%) and anorexia (9.8%). Megaloblastic anemia (66.2%) was the most frequent finding and treatment was given with cyanocobalamin (intramuscular or oral) to regulate plasma concentrations of this vitamin. Conclusion: Imerslund-Gränsbeck Syndrome has a low prevalence and occurs more frequently in the European continent, has a predilection for females and is characterized by a decrease in vitamin B12 that may predispose to other disorders such as ataxia and retardation in growth.

Anemia megaloblástica. A propósito de un caso / Megaloblastic anemia

La OMS reporta anemia en 24,8% de la población con predominio en países en desarrollo. La anemia megaloblástica, es una causa frecuente en la población adulta mayor. Se caracteriza por alteración en la síntesis de ácido desoxirribonucleico por deficiencia de vitamina B12 y/o folatos. Presentamos el caso de una mujer con manifestaciones clínicas y alteraciones de laboratorio características. Recibió tratamiento combinado con cianocobalamina y ácido fólico. Paulatinamente presentó reversión clínica y laboratorial. A pesar del nombre, la anemia megaloblástica, suele cursar con anemia, bicitopenia o ancitopenia y alteraciones sistémicas. Es obligatorio buscar la causa desencadenante para instaurar el tratamiento completo.

The WHO reports anemia in 24.8% of the population mainly in developing countries. Megaloblastic anemia is a frequent cause in the elderly population and it is due to an impaired synthesis of deoxyribonucleic acid. A deficiency of vitamin B12 and / or folic acid are the main causes. We present the case of a woman with characteristic clinical manifestations and laboratory abnormalities. She was treated with cyanocobalamin and folic acid. She improved and her laboratory tests got to normal gradually. Despite the name, megaloblastic anemia usually presents anemia, bicytopenia or pancytopenia and systemic manifestations. It is mandatory to search for the etiologic cause to make a complete treatment.

New progress in the diagnosis and treatment of thiamine responsive megaloblastic anemia syndrome / 中华实用儿科临床杂志

Thiamine responsive megaloblastic anemia syndrome is a rare autosomal recessive disease caused by mutations of the SLC19A2 gene that encodes the high-affinity thiamine transporter-1.Thiamine responsive megaloblastic anemia syndrome involves extensive organs and systems with various clinical manifestations.The typical triad is megaloblastic anemia, non-autoimmune diabetes, and sensorineural deafness.The diagnosis of thiamine responsive megaloblastic anemia syndrome depends on the detection of the pathogenic gene SLC19A2.Thiamine replacement therapy is the first-line treatment.Blood glucose of patients with thiamine responsive megaloblastic anemia syndrome should be comprehensively managed, and hearing aids and cochlear implants can be used to improve the hearing.

Lithium Toxicity Associated with Pancytopenia And Megaloblastic Anaemia.

A 29-year-old male was treated for Bipolar Affective Disorder since 5 months with Lithium 400 mg per day which was gradually up titrated to 800 mg in 10 days of start of treatment in view of minimal improvement in symptoms. After 2 months of treatment patient started experiencing weakness and fatiguability. During third month of treatment patent had complaints of 3 episodes of vomiting associated with nausea, mild abdominal pain, diarrhea, dyspnea on exertion, restlessness, tremors, dry mouth and decreased sleep. Patient was brought to emergency department and all baseline investigations were done which were suggestive of Pancytopenia. Hematology reference was done, and lithium toxicity was considered as contributing factor for above symptoms and results. Short-term lithium administration may be life-threatening and should thus be prescribed cautiously in hematological disorders as in other conditions

Consideraciones generales para estudiar el síndrome anémico Revisión descriptiva / General considerations for studying anemia syndrome. Descriptive review

Introducción: la anemia es un problema de salud pública en países desarrollados y no desarrollados; esta entidad tiene repercusiones en el desarrollo socioeconómico de las comunidades y, especialmente, en la salud de embarazadas, niños y jóvenes. Objetivo: describir los aspectos generales del síndrome anémico, sus presentaciones más frecuentes y el estado del arte de dicha problemática en el suroccidente colombiano. Método: se realizó una búsqueda bibliográfica con un lapso de 30 años (1990-2020) en Medline, Google Scholar, Lilacs y Redalyc, para revisar los conceptos generales del síndrome anémico, anemia por déficit de hierro, anemia megaloblástica, anemia hemolítica y anemia de células falciformes, en función de la etiología, epidemiología, manifestaciones clínicas, diagnóstico y pronóstico. Resultados: el síndrome anémico es una entidad frecuente en varias regiones de Colombia, con alta carga epidemiológica, complicaciones y pronóstico importantes. Se realizó la descripción general de las presentaciones más frecuentes del síndrome anémico. Conclusión: hacen falta estudios para todas las regiones del país, particularmente, en el suroccidente colombiano..Au

Introduction: anemia is a public health problem both in developed and undeveloped countries; this entity has repercussions in socioeconomic development of communities and, especially, compromises pregnant women, children and young people health. Objective: to describe the general aspects of anemia syndrome, its most frequent presentations and the state of the art of this problem in southwestern Colombia. Methods: a literature search with a span of 30 years (1990-2020) was performed in Medline, Google Scholar, Lilacs and Redalyc databases, in order to describe the general concepts of anemic syndrome, iron deficiency anemia, megaloblastic anemia, hemolytic anemia and sickle cell anemia, regarding on its etiology, epidemiology, clinical manifestations, diagnosis and prognosis. Results: anemic syndrome is a frequent entity in several Colombian regions, with high epidemiological burden, complications and important prognoses. The general description of the most frequent presentations of anemia syndrome was made. Conclusion: additional studies are required for each region, particularly in southwestern Colombia..Au

A study of aetiology and clinical profile of 50 patients presenting with pancytopenia

Background: Pancytopenia is reduction of all the three cellular components which includes anemia, leukopenia and thrombocytopenia. Pancytopenia is striking feature of many serious and life threatening illness ranging from simple drug induced bone marrow hypoplasia, megaloblastic marrow to fatal bone marrow aplasia and leukemias. Pancytopenia has variety of etiologies but most common and reversible is Vitamin B12 deficiency, so early and accurate diagnosis may be lifesaving.Methods: Study conducted prospectively in 50 patients of pancytopenia with age >12 years, who were admitted to department of medicine in Dr. M.K. Shah Medical College between 2018 to 2020. A complete clinical history and examination was carried out. They were evaluated for complete blood count with peripheral smear, liver function test, renal function test, vitamin B12 level, radiological imaging and bone marrow examination in selected patients.Results: The etiological causes of pancytopenia were recorded as vitamin B12 deficiency (n 30,60%), Infections (n11,22%),Hypersplenism (n 4;8%), aplastic anemia (n 3; 6%), Drug induced (n 1; 2%) and SLE (n1; 2%). Presenting symptoms in these patients were lethargy, malaise, generalized weakness, dyspnoea on exertion and fever while signs were pallor, splenomegaly and hyperpigmentation. All patients of megaloblastic anemia had macrocytic picture in peripheral smear and all of them were improved after treatment with vitamin B12 supplement.Conclusions: Pancytopenia is not an uncommon clinical entity and has various etiologies. Most common cause of pancytopenia was B12 deficiency and most common symptoms and signs were generalized weakness and pallor respectively. Most of the etiological causes could be diagnosed with laboratory analysis and radiological imaging without the need of a bone marrow examination.

Megaloblastic anemia and non-vegetarian diet – Is there a changing trend?

Background: According to various studies, non-vegetarians are not at an inherent risk of developing megaloblastic anemia, a common deficiency of Vitamin B12. However, recent trends of the consumption of non-vegetarian food in the processed form as well as changes in cooking methods may gradually change the trend of the occurrence of megaloblastic anemia in nonvegetarians. Very few studies have been conducted on the same in a non-vegetarian population. Objectives: The objective of this study was to study the prevalence of megaloblastic anemia in a non-vegetarian population. Materials and Methods: The study was conducted on 100 non-vegetarian adults after due approval of the institutional ethics committee. The patients were evaluated on the basis of their hematological profile including peripheral smear examination and indices. Results: About 29% of total patients presented with features suggestive of megaloblastic anemia, of which 72% of patients agreed to predominantly be consuming non-vegetarian food from processed sources such as fast-food outlets at an average frequency of 3 weeks. Conclusion: There is a changing trend of megaloblastic anemia in the non-vegetarian population. Processing of food and change in conventional cooking practices along with the recent decline in home cooking of meat seem to be the major factors putting the non-vegetarians at a risk of developing megaloblastic anemia.

Clinical profile and etiological causes of pancytopenia: a study in a tertiary care hospital

Background: Pancytopenia is a condition which involves the presence of anemia, leucopenia and thrombocytopenia. Symptoms of pancytopenia include fatigue, bleeding, dyspnea, and increased tendency to infections. The evaluation of pancytopenia is by complete blood picture and peripheral blood smear including that of reticulocytes. Bone marrow examination is extremely helpful.Methods: Demographic details were collected from all the patients and physical examination was done. The patients were asked to undergo biochemical investigations, chest X rays and USG of abdomen. Smears were taken from peripheral blood as well as bone marrow biopsy and stained. Invasive procedure such as bone marrow biopsy is done if needed.Results: A predominance of males was seen over females and 11-30 years age group was the most affected. The most common cause was megaloblastic anemia followed by aplastic anemia and tuberculosis. The most common symptom were fatigue, dyspnea, fever and bleeding.Conclusion: Early identification of this disease would help in early planning for management thereby improving the survival rates.

A case report on hyperpigmentation in vitamin B12 deficiency

Cobalamin (Vitamin B12) is a water-soluble vitamin. Cobalamin is synthesized only by microorganisms. The only source of vitamin B12 for humans is food of animal origin. Hyperpigmentation of skin has been reported only rarely as the presenting manifestation of vitamin B12 deficiency. We report a patient who had hyperpigmentation as her presenting medical complaint and in whom Vitamin B12 deficiency was the cause.  A 36-year-old female presented with generalised weakness and progressive and asymptomatic hyperpigmentation of hand and feet for 5 months. She is vegetarian by diet. On examination, hyperpigmentation was present over dorsal aspect of metacarpophalangeal, proximal and distal interphalangeal joints. Hyperpigmentation were present over dorsum of the foot and over the joints. The tongue was depaillated, and hyperpigmentation was present. Her serum level of vitamin B12 was diminished (83pg/ml). Megaloblastic anemia presents with protean manifestations. The association between vitamin B12 deficiency and hyperpigmentation, although unusual, has been described. Cutaneous manifestations associated with B12 deficiency include characteristic mucocutaneous hyperpigmentation (most common), vitiligo, angular cheilitis, and hair-nail changes. It mainly affects knuckle pads and oral mucosa. It is an under-recognized sign of megaloblastic anemia and should always be looked for in the setting of pallor. Hyperpigmentation could be the earliest manifestation of vitamin B12 deficiency before anemia sets in. It is worthwhile to consider the possibility of vitamin B12 or folate deficiency in a patient with unexplained pigmentary changes. Early detection and adequate treatment will prevent anemia and various neurological manifestations.

Bone marrow evaluation of patients having pancytopenia at tertiary care center, M. Y. hospital, Indore, India: one-year study

Background: Pancytopenia is reduction of all three formed elements of blood below the normal reference range leading to anemia, leucopenia, thrombocytopenia. Bone marrow aspiration is extremely helpful in evaluating the cause of pancytopenia by cellularity and cytology in order to prevent grave complications and mortality as the underlying pathology determines the management and prognosis of the patients. Aim of research study was to evaluate the patients having pancytopenia at tertiary care center, M.Y.H. Hospital, Indore, India.Methods: The present study was carried out over a period of one year from 2017 to 2018, in the Department of Pathology, M. Y. Hospital, Indore. During this period, a total of 109 bone marrow smears were examined. Out of these, 42 cases had the clinical presentation of pancytopenia. A detailed study was done regarding clinical examination and hematological and radiological investigations.Results: In this study 42 cases of pancytopenia were examined over a period of one year. The commonest cause of pancytopenia was megaloblastic anemia (33.34%) followed by aplastic anemia (19.05%). Others includes myelodysplastic syndrome (MDS), acute leukemia, erythroid hyperplasia and plasmacytosis.Conclusions: Bone marrow aspiration can diagnose majority of the cases of pancytopenia. Megaloblastic anemia and aplastic anemia are the commonest causes of pancytopenia.

Clinical and hematological profile of pancytopenia in a tertiary care hospital of Southern Odisha, India

Background: Pancytopenia (anemia, thrombocytopenia and leukopenia) is a common haematological condition with various etiologies like ineffective haematopoiesis, bone marrow suppression, bone marrow infiltration and peripheral destruction of blood cells. The present study was done to see the clinical features and etiologies of pancytopenia in this geographical region.Methods: About 150 patients above 15 years of age after fulfilling the inclusion criteria were included in the study. They were evaluated with appropriate laboratory tests including bone marrow study, if indicated to find out the underlying etiology.Results: Common symptoms were generalized weakness (93.3%), fever (75.3%) and dyspnoea (54%). Common physical findings were pallor (100%), lymphadenopathy (43.6%) and hepatosplenomegaly (32%). Most common causes were aplastic anemia (28%), megaloblastic anemia (20%) followed by infections like malaria (13.3%), dengue (5.3%) and sepsis (1.3%). Bone marrow was hypocellular in 50 patients (41.7%), hypercellular in 45 patients (37.5%) and normocellular in 25 patients (20.8%).Conclusions: There are some reversible causes of pancytopenia like megaloblastic anemia, malaria, dengue and sepsis. Conditions like disseminated TB, collagen vascular diseases also can be treated with specific treatment if diagnosed early to avoid further complications.

Evaluation of Bone Marrow Examination in Cases of Pancytopenia in Tertiary Health Center in North-West Rajasthan

Introduction: Pancytopenia is a very common consequenceof many haematological diseases with extensive differentialdiagnosis. It is described as the deficiency of all three cellularelements of blood resulting in anemia and leucopenia andthrombocytopenia. The severity and underlying pathologydetermines the management and prognosis. Bone marrowexamination is an effective way of evaluating various causesof pancytopenia along with other clinical, haematologicalfindings.Material and methods: In this prospective study, a total60 patients presenting with pancytopenia on initial work uprequiring bone marrow examination were studied along withtheir relevant clinical history, examination findings, routinehaematological findings.Results: Among 60 cases studied, age of patients ranged from1-85 years with slight male predominance. Most commonage group involve was 11-30 years. Most of the patientspresented with generalised weakness, pallor, fever. Dimorphicanemia was the predominant blood picture. The commonestmarrow finding was hypercellularity with megaloblasticerythropoiesis. The commonest cause of pancytopenia wasmegaloblastic anemia 62.79% followed by sub/aleukemicleukemia 25.57%.Conclusions: Bone marrow examination can diagnosedmajority of cases of pancytopenia along with comprehensiveclinical and haematological study. It is also helpful in planningfurther investigations and management.

Evaluation of clinical, biochemical and hematological parameters in macrocytic anemia

Background: Macrocytosis can be seen in many hematological and non-hematological disorders and more than one cause may co-exist in an individual. Serum vitamin B12 and folic acid tests are routinely ordered but they are limited by their low sensitivity and specificity. This study is done to analyze the clinical, hematological and biochemical parameters in macrocytic anemia and to study the difference between megaloblastic and non-megaloblastic anemia in these parameters.Methods: There were 100 patients presenting with macrocytosis were taken in to study. A detailed clinical history and physical examination was done in all cases. CBC, biochemical investigations, peripheral blood examination, Vitamin B12, folate levels, bone marrow aspiration and reticulocyte count was done in all cases.Results: Primary bone marrow disorders were the most common cause of macrocytosis (45%). The other causes in decreasing order of frequency were megaloblastic anemia (36%), alcoholism and liver disease (15%), drug induced (2%) and idiopathic thrombocytopenic purpura (1%). There was a significant difference in the mean values of MCV and serum LDH between megaloblastic and non-megaloblastic macrocytosis. When serum LDH >1124.5IU/L or MCV>120.5fl (criterion values of ROC curve) with reticulocyte count <2% was taken as criteria, the sensitivity was 94.4% and specificity was 93% for diagnosing megaloblastic anemia.Conclusions: Systematic evaluation of macrocytosis will help us to distinguish megaloblastic and non-megaloblastic macrocytosis. The blood and biochemical parameters especially CBC, RC, and serum LDH along with supporting clinical features help us in diagnosing megaloblastic anemia in a setup where vitamin and metabolite levels are difficult to obtain.

Clinicopathological Study Of Pancytopenia

Background and Objectives: Pancytopenia is an important hematological entity. It is a disorder in which all three major formedelements of blood are decreased in number. The present study has been undertaken to find out various causes of pancytopeniaby evaluation of bone marrow findings so that the data will help the clinician in better management of patients.Materials and Methods: It was a prospective study conducted in the Department of Pathology in King George Hospital,Visakhapatnam, a teaching institute and tertiary hospital in over a period of 1 year. Patients were referred to pathology from thedepartments of medicine and pediatrics for investigations on suspicion of pancytopenia. The patients were evaluated clinicallyalong with hematological parameters and bone marrow aspiration biopsy. It was carried out in 68 patients from November 2016to December 2017. Hemogram was obtained using five-part automated analyzer. Bone marrow aspiration was performed usingSalah needle from the posterior superior iliac crest and from the medial aspect of tibial tuberosity in children <4 years. Bonemarrow aspiration smears were stained using Leishman’s stain and Giemsa stain.Results: Among the 68 patients studied, the age of the patients varied from 3 years to 76 years with a male predominance. Most ofthe patients presented with fever and generalized weakness. The most common physical finding was pallor. Dimorphic anemia wasthe predominant blood picture. The most common bone marrow finding was erythroid hyperplasia with megaloblastic maturation. Themost common cause of pancytopenia was megaloblastic anemia (64.7% of cases) followed by hypersplenism (10.2% of cases). Othercauses include aplastic anemia, leukemia, idiopathic thrombocytopenic purpura, tuberculosis, lymphoma, and multiple myeloma.Conclusion: Detailed clinical history and physical examination along with hematological investigations and bone marrowaspiration biopsy are helpful for understanding the disease process and to diagnose the cause of pancytopenia. Identificationof correct cause will help in implementing appropriate therapy. This study helps in identifying the incidence of various causesof pancytopenia.

Identification Of Megaloblastic Anemia Cells Through The Use Of Image Processing Techniques

Objective:Ouraimistoshowthepossibility ofusingdifferentimageprocessingtechniquesfor bloodsmearanaly-sis.Alsoouraimistodeterminethesequenceofimageprocessing techniquesto identifymegaloblastic anemiacells. Methods:Weconsiderbloodsmearimage.Weuseavariety ofimageprocessingtechniquesto identify meg-aloblasticanemiacells.Amongthesemethods,wedistinguishthemodificationofthe color spaceand the useof wavelets. Results:Wedevelopedasequenceofimageprocessing techniquesforbloodsmearimageanalysis andmegaloblasticanemiacellsidentification.Asacharacteristicfeature formegaloblasticanemia cellsidentification,we considerneutrophilimagestructure.We alsouse the morphologicalmethods of imageanalysisin order to re-veal thenuclear lobes inneutrophilstructure. Conclusion:Wecanidentify themegaloblasticanemiacells.Todothis,weusethefollowing sequenceofbloodsmearimageprocessing:color imagemodification,changeof theim-age contrast, useof wavelets and morphologicalanalysisof thecellstructure.