REFERENCE HAEMATOLOGICAL VALUES FOR FULL TERM HEALTHY NEWBORNS FROM RURAL SINDH, PAKISTAN.

BACKGROUND: Normal values of complete blood counts show variation from region to region and between different ethnic groups. It is important to establish reference range for these values in our population for clinical use by our physicians. This descriptive cross sectional study aimed at establishing the normal reference values of complete blood counts in physically normal full term new-borns of Panu Aqil, Rural Sind, Pakistan. METHODS: The study was conducted at Combined Military Hospital, Panu Aqil Cantonment, from January 2010 to March 2011, on 316 term normal neonates selected on the basis of gestational age of 37 weeks or more with uneventful antenatal period. During the initial 12 hours of delivery, 2 ml Cord blood was collected in bottle containing tripotassium ethylene diamine tetra acetic acid (K3EDTA) as the anticoagulant and Complete blood counts were performed by Sysmex KX-21 automated haematology analyser. Blood films were prepared and stained by Leishman stain. RESULTS: The haemoglobin was mean +/- SD 15.4 +/- 1.9 g/dL. The Mean Corpuscular Volume (MCV) was 103.4 +/- 4.6 fL, while Mean Corpuscular haemoglobin (MCH) was 33.8 +/- 1.6 pg. The Red cell Distribution Width-CV (RDW-CV) was 18.5 +/- 1.8%. The total leukocyte count (TLC) was mean +/- SD 13.7 +/- 4.0 x 10(9) /L. The Absolute Neutrophil count (ANC) was mean +/- SD 7.7 +/- 3.0 x 109 /L. The Absolute Lymphocyte count (ALC) was mean +/- SD 5.1 +/- 1.8 x 10(9)/L. Platelet count was mean +/- SD 285 +/- 62 x 10(9) /L. CONCLUSION: Our values provide reference range for haematological values in healthy newborns of Panu Aqil, Rural Sindh, for clinical use by our physicians.

SCHMIDT'S SYNDROME IN A 32 YEARS OLD FEMALE.

In polyglandular autoimmune (PGA) syndromes, there is immune dysfunction of two or more endocrine glands. Immunity mediated disorders of non-endocrine organs may also be seen. These syndromes are of two main types: type I and type II. We are reporting this case of a 32 years old lady who presented initially with hypothyroidism for many years and received thyroid replacement therapy. After that she was married and had children. After an interval of about seven years of the initial diagnosis of hypothyroidism, she was hospitalized in first trimester of pregnancy for severe vertigo, syncopal episodes and hypotension. She responded well to intravenous fluids and steroids. Further endocrine related, investigations revealed Addison's disease and the above episode were retrospectively diagnosed as Addisonian crisis. Thus the patient was diagnosed as Schmidt's Syndrome (Autoimmune polyendocrine syndrome type 2) since 2009.

Complicated plasmodium falciparum malaria initially presenting as myocardites.

Despite recent advancements in diagnostic and treatment modalities, malaria is still one of the most prevalent human diseases with high mortality and morbidity. We described a case of 45 years old man with Plasmodium falciparum malaria primarily presenting with myocarditis. The possibility of malaria was Subsequently considered when he developed fever followed by signs of cerebral involvement. This happens to be a distinctly unusual presentation and we highlighted various features of this case. Thus in hyperendemic areas complicated Plasomdium falciparum malaria may present initially With atypical features and high index of suspicion may lead to prompt early aggressive antimalarial therapy and reduce the complications.

Response of plasmodium vivax malaria induced thrombocytopenia to antimalarial treatment.

BACKGROUND: Thrombocytopenia is often seen in the patients of malaria infected with Plasmodium vivax. We studied patients admitted in hospital having coexisting thrombocytopenia and malaria, and recorded the response to anti-malarial therapy. METHODS: In this cross-sectional descriptive study, a total of 120 patients admitted in medical ward with Plasmodium vivax malaria and co-existing thrombocytopenia were studied. RESULTS: Out of total 120 slide positive Malaria patients who had low platelet count (<150x10(9) /L), platelet count increased to ≥150x10(9) /L in 73 (60.8%) patients after five days of anti-malarial therapy while in 47 (39.2%) patients thrombocytopenia persisted. After ten days of anti-malarial therapy, platelet count in all the patients recovered to ≥ 150x10(9) L. None of the patients required platelet transfusion. CONCLUSION: In majority of the patients of Plasmodium vivax malaria having thrombocytopenia, platelet count returns to normal within five to ten days of start of anti-malarial treatment and nlatelet transfusion is not required.