Differentiation between Anemia of Chronic Disease and Iron Deficiency Anemia Using Newer Erythrocyte Parameters.

Both Iron deficiency anemia (IDA) and anemia of chronic disease (ACD) can present as microcytic anemia. It is important to differentiate between the two, because the treatment is different. In patients presenting with microcytic anemia, bone marrow is often required for differentiation between IDA and ACD. But since bone marrow is an invasive and cumbersome procedure, newer erythrocytic parameters and reticulocyte indices are being studied in differentiation of these two entities. Life span of Reticulocyte is just 1-2 days compared to 120 days of that of an RBC. Therefore, the decrease in reticulocyte hemoglobin content occurs much earlier than an erythrocyte. This makes reticulocyte indices early and reliable indicators of IDA. We explored the value of reticulocyte hemoglobin (Ret Hb) and percentage microcytic RBCs (%Micro R) in the differentiation of both these conditions with bone marrow iron studies being the gold standard. MATERIAL: Overall 130 patients with iron deficiency anemia and anemia of chronic disease were recruited and they underwent detailed evaluation including RBC indices, Ret Hb, %Micro R, serum iron studies, bone marrow examination including estimation of bone marrow iron. The diagnostic accuracy of Ret Hb and %Micro in differentiation between the two conditions was determined. OBSERVATION: Ret Hb was found to be positively correlated to serum iron, ferritin and TIBC in diagnosing IDA. At a cut-off value of RET HB of 27 pg/mL, the diagnosis of IDA could be made at a sensitivity of 93.4% and a specificity of 95.83%. Positive predicitive value for Ret Hb was 99% and negative predicitive value was 76.6%. RET HB was found to have best diagnostic efficiency (area under the curve 0.96) on ROC analysis in the differentiation of these two conditions. MICRO R was found to be inferior to other parameters (AUC of 0.39) in the differentiation of these two conditions. CONCLUSION: Ret Hb differentiates iron deficiency anemia from anemia of chronic disease with a high accuracy rate of 96%. It can be used as a marker of IDA across all situations.

The QT dispersion and QTc dispersion in patients presenting with acute neurological events and its impact on early prognosis.

AIMS: To find out and investigate whether the QT dispersion and QTc dispersion is related to type and prognosis of the acute stroke in patients presenting within 24 h of the onset of stroke. SETTINGS AND DESIGN: This was a observational study conducted at Mahatma Gandhi Hospital, Dr. SN. Medical College, Jodhpur, during January 2014 to January 2015. SUBJECTS AND METHODS: The patients presented within 24 h of onset of acute stroke (hemorrhagic, infarction, or transient ischemic event) were included in the study. The stroke was confirmed by computed tomography scan and magnetic resonance imaging. Patients with (i) altered sensorium because of metabolic, infective, seizures, trauma, or tumor; (ii) prior history of cardiovascular disease, electrocardiographic abnormalities' because of dyselectrolytemia; and (iii) and patients who were on drugs (antiarrhythmic drugs, antipsychotic drugs, erythromycin, theophylline, etc.,) which known to cause electrocardiogram changes, were excluded from the study. National Institute of Health Stroke Score (NIHSS) was calculated at the time of admission and Modified Rankin Scale (MRS) at the time of discharge. Fifty age- and sex-matched healthy controls included. STATISTICAL ANALYSIS USED: Student's t-test, ANOVA, and area under curve for sensitivity and specificity for the test. RESULTS: We included 52 patients (male/female: 27/25) and 50 controls (26/24). The mean age of patients was 63.17 ± 08.90 years. Of total patients, infarct was found in 32 (61.53%), hemorrhage in 18 (34.61%), transient ischemic attack (TIA) in 1 (1.9%), and subarachnoid hemorrhage in 1 (1.9%) patient. The QT dispersion and QTc dispersion were significantly higher in cases as compare to controls. (87.30 ± 24.42 vs. 49.60 ± 08.79 ms; P < 0.001) and (97.53 ± 27.36 vs. 56.28 ± 09.86 ms; P < 0.001). Among various types of stroke, the mean QT dispersion and QTc dispersion were maximum and significantly higher in hemorrhagic stroke as compared to infarct and TIA (P < 0.001). The mean QT dispersion and QTc dispersion was found significantly high in nonsurvivors (n = 16) as compared to survivors group (n = 36) (P < 0.05). The mean QT dispersion was directly correlated with the NIHSS and functional outcome score MRS. Patients with greater QT and QTc dispersion having high NIHSS had poor prognosis. CONCLUSION: We concluded that patients presenting with acute neurological events having increased QT dispersion and QTc dispersion is related to high mortality and poor functional outcomes on hospital discharge and if the values of dispersion score are very high we can predict for hemorrhagic stroke.