Risk of maternal alloimmunization in Southern Pakistan - a study in a cohort of 1000 pregnant women.

BACKGROUND: Haemolytic disease of the fetus and the newborn [HDFN] is caused by incompatibility of maternal and fetal erythrocytes. Red blood cell alloimmunization is a well-known cause of HDFN. Due to heterogeneity of populations, the spectrum of alloimmunization varies around the world. This study aimed to determine the frequency of alloimmunization in pregnant women and to determine the risk of HDFN in our population. STUDY DESIGN AND METHODS: This was a descriptive study conducted at Aga Khan University Hospital Karachi. Blood type and red cell antibody screening was determined on every pregnant woman at her first antenatal visit. Red cell antibody identification was performed on positive screening results. RESULTS: A total of 1000 pregnant females including 633 (63.3%) multigravida were studied. Blood type B was predominant (n = 374 or 37.4%) and D negative was observed in 136 women (13.6%). No red cell antibody was detected in 982 females (98.2%). 20 red cell antibodies were detected in 18 women (1.8%). The incidence of non-anti-D was 16/1000 [1.6%] in all pregnant females. The non-anti-D alloantibodies included anti-M (n = 3; 15%), anti-Lewis(a) (n = 3; 15%), anti C ( n = 1; 5%), anti-E (n = 1; 5%), anti-e (n = 1; 5%), anti-Lewis(b) (n = 1; 5%) and nonspecific antibodies (n = 6; 30%). The incidence of anti-D was 4/136 or 2.9% in D negative blood type. After excluding prior sensitization due to blood transfusions, risk remained was 2.2%. Antibodies of clinical significance were identified in 9 (0.9%) females. CONCLUSIONS: In our cohort, frequency of red cell alloimmunization during pregnancy was 1. 8% out of which 0.9% were clinically significant antibodies posing a risk for HDFN. Despite prenatal and post natal prophylaxis, risk of sensitization with D antigen in D negative women was high at 2.2%. We recommend that all pregnant women should be screened for irregular antibodies irrespective of the rhesus type.

Therapeutic outcomes of older patients with acute myeloid leukemia.

OBJECTIVE: To evaluate the therapeutic outcomes of acute myeloid leukemia (AML) in elderly patients. METHODS: This study was conducted at the Aga Khan University Hospital, Karachi, Pakistan over 11 years from January 1997 to August 2008. This was a descriptive case series study. We investigated the impact of disease biology and various treatment protocols on the outcome in this population. RESULTS: A total of 55 evaluable patients (>60 years of age) were diagnosed with AML including 34 (61.8%) males and 21 (38.2%) females. The median age was 67 years (range 60-86 years) at the time of presentation. The AML was preceded by myelodysplastic syndrome in 15 (27.2%) patients. High-risk cytogenetics were observed in 3 (5.4%) patients. Forty patients received palliative treatment while only 15 received chemotherapy. Of the last group with primary AML (n=10), there were 2 remitters, one showed resistant disease while 8 had induction death. The overall mean survival was 75.1 days (95% confidence interval: 46.7-103.5 days) in all patients. There was no survival advantage in patients treated with chemotherapy versus those conservatively treated. CONCLUSION: We found high mortality among aged patients with AML in our setting. Patients receiving chemotherapy were extremely intolerant to toxic drugs and succumbed earlier than patients receiving palliative care only.

Metastatic signet ring gastric adenocarcinoma presenting with microangiopathic hemolytic anemia.

Metastatic adenocarcinoma presenting as microangiopathic hemolytic anemia (MAHA) and leukoerythroblastic blood picture is rare. We report three patients who presented with MAHA as the initial symptom of metastatic signet ring cell gastric adenocarcinoma. One patient had past history of gastric ulcer. In all these patients the initial diagnosis was based on peripheral blood smear followed by bone marrow biopsy; upper GI endoscopy showed presence of gastric ulcers with focally scattered neo-plastic signet ring cells on histopathology. All patients died within a week of diagnosis.