Haematological Profile in Microcytic Hypochromic Anaemia in Children

INTRODUCTION: The most common disorders presenting with microcytic hypochromic anaemia are iron deficiency anaemia (IDA) and β-Thalassemia trait (β-TT), and each of them has different pathogenesis and treatment modality. Here we intend to see the haematological profile in microcytic hypochromic anaemia in children apart from IDA and Thalassemia with respect to age and gender. MATERIAL AND METHODS: A total of 95 pediatric patients between the ages of 2 to 12 years with microcytic hypochromic anaemia were included in the study. Blood samples obtained from each patient were evaluated for various haematological and biochemical profiles along with haemoglobin electrophoresis. It was a hospital based observational cross-sectional study done for a period of 18 months from January 2019 to July 2020. RESULTS: Severe anaemia was seen in 55 (57.89%) cases, followed by 38 (40.00%) cases with moderate anaemia and 2 (2.11%) cases with mild anaemia. Majority of the cases showed IDA, which were 85 (89.5%) cases, followed by 6 (6.3%) cases with β-TT and 4 (4.2%) cases with β-TM. RBC count, hematocrit and RDW showed significant variation between IDA, β-TM and β-TT. Most number of correctly diagnosed cases were shown by Ricerca Index with 90 (94.74 %). CONCLUSION: Our study concludes RBC count and RDW, along with Srivasthava Index, Ricerca Index and RDW Index could be used as reliable indices to differentiate between iron deficiency anaemia and β-Thalassemia. Red cell indices, serum iron profile and haemoglobin electrophoresis complement each other for the precise diagnosis of underlying cause of microcytic hypochromic anaemia.

A STUDY TO EVALUATE THE EFFECT OF ANAEMIA IN TYPE-2 DIABETIC PATIENTS

Introduction: As the tribulation of diabetes escalates, developing countries like India is expected to be the diabetic capital in the world in coming years. Diabetes Mellitus progressively results in various complications including both microvascular and macrovascular disorders. The nephropathy undermines the renal production of erythropoietin, positively contributing to an increased anaemic framework. However, anaemia in type 2 diabetic patients is often untended. Aims And Objectives: • To correlate the levels of haemoglobin with the degree of glycaemic control (HbA1c>6.5% vs HbA1c<6.5%) • To determine the morphology and severity of anaemia in type 2 diabetic patients. • To know prevalence of other comorbidities as a result of anaemia and diabetes. Materials And Methods: A prospective observational study was conducted in 100 type 2 diabetic patients visiting the Out Patient Department in Acs Medical College and Hospital, Chennai. Haemoglobin and red cell indices were estimated. Comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy were recorded. Peripheral blood smear examination was done using leishman's stain. Ion exchange chromatography was used to measure the HbA1c levels. Results: In the poor glycaemic control group, a signicant decrease in the haemoglobin levels was noted especially in females and elderly population. Microcytic Hypochromic Anaemia was the most prevalent which was of mild to moderate severity. Predominantly reduced iron stores in Microcytic Hypochromic Anaemia were attributed to increased HbA1c levels. The poor control of diabetes when associated with anaemia, were also found to have comorbidities like hypertension, chronic kidney disease, arthritis and retinopathy. Conclusion: To conclude, though anaemia is signicantly prevalent in diabetic patients, it is often neglected. In accordance with the study, poor glycaemic control is the result of increased glycation of haemoglobin A1c (HbA1c) due to reduced iron stores. Hence in diabetic patients, it would be benecial to assess haemoglobin levels often, for better quality of life

HAEMATOLOGICAL PROFILE OF SEVERE ACUTE MALNOURISHED CHILDREN ADMITTED AT OUR INSTITUTION

Background: Severe acute malnourished children are prone to deranged pathophysiology. Their haematological profile affected mild to severe degree. Our study was done to observe the haematological profile of severe acute malnourished children admitted at P.B.M. Hospital Bikaner, Rajasthan. Material And Methods: This prospective observational study was designed for severe acute malnourished 178 children. Duration of this study was one year from 01.01.2013 to 31.12.2013. This study was done in special concern of haematological profile of severe acute malnourished children. Results: Our study showed that oedematous malnourished children had anaemia more common than non-oedematous malnourished children.Microcytic hypochromic anaemia and dimorphic anaemia were more common in non- oedematous and oedematous malnourished children. Conclusion: We concluded that Microcytic hypochromic anaemia and dimorphic anaemia is common in severe acute malnourished children. So, our primary target should be prevent malnourishment and secondary should be early diagnosis and management of sequelae by proper monitoring to avoid complications.

Beta Thalassemia Trait among Antenatal Mothers and Those with Microcytic Anaemia

BACKGROUND Among microcytic hypochromic anaemias, the most common disorders are iron deficiency anaemia (IDA) and co-pathological conditions such as α- or βthalassemia (α- or β- thalassemia) traits. Thalassemia minor is often an asymptomatic carrier state but exhibit marked microcytosis that can be mistaken for iron deficiency. About 1.5 % of the global population (80 to 90 million people) are carriers of thalassemia and more than 200 mutations are described in thalassemia, the only effective way to reduce burden of thalassemia is to prevent birth of homozygotes. The purpose of this study was to estimate the prevalence of beta thalassemia trait (BTT) in adult individuals with microcytic hypochromic anaemia and among antenatal mothers visiting the Obstetric Department of SDMCMSH. METHODS In this prospective descriptive study, 101 adult patients between 18 and 40 years who were in in-patient department (IPD) or attending out-patient department (OPD) from department of general medicine and department of haematology were studied during a period of one year from October 2018 to October 2019 and their blood sample was sent for complete blood count (CBC), iron studies and haemoglobin electrophoresis. All the data was entered in Microsoft Excel software and analysis was done using Minitab software. P value of less than 0.05 was considered statistically significant. RESULTS Out of the 101 microcytic hypochromic anaemia patients analysed, 7 patients have beta thalassemia trait. 4 of the 7 are females. Their haemoglobin electrophoresis report showed high HBA2 value of > 3.8. There were no carriers among the pregnant individuals tested. A regression model was fitted for predicting HBA2 based on values of serum iron, serum ferritin, and mean corpuscular volume (MCV). CONCLUSIONS In conclusion, identification of thalassemia gene mutations in our population is necessary because of the country’s multiracial population. This will prevent unnecessary treatment with iron supplements in thalassaemic patients and also helps in pregnant women to prevent thalassemia major children. Molecular genotyping provides a rapid and reliable method for identification of common, and unknown α - and β - gene mutations, which help to diagnose unexplained microcytosis and thus prevent unnecessary iron supplementation. We conclude that microcytosis due to thalassemia is common in north Karnataka. This illustrates the importance of adequate prenatal and laboratory investigation for these abnormalities. KEYWORDS Beta Thalassemia Trait, Microcytosis, Haemoglobin Electrophoresis, Antenatal Screening, Thalassemia

To study and analyze hematological parameters in anaemia in males

Hematological parameters like Hb (haemoglobin), TC (total count), DC (differential count), PCV (packed cell volume), MCV (mean red cell corpuscular volume) done in the automated cell counter and peripheral smear findings were studied. Observational study.Out of 250 cases, 192 i.e. 76.8% cases showed microcytic hypochromic anaemia, 30 cases i.e. 12% had normocytic hypochromic anaemia, 27 cases i.e. 10.6% had normocytic normochromic anaemia and dimorphic anaemia was seen in 02 cases i.e. 0.6% cases.Out of 250 cases, 193 i.e. 77.2% cases showed microcytosis maximally in 0-5 years age group and 57 cases i.e. 22.8% had normocytic picture. The distribution of peripheral smear (RBC size) finding with age varied significantly (p value &#60;0.05). Iron deficiency is almost universal when dealing with this magnitude of anaemia. However, clinically speaking, many technical experts believe that to differentiate severe anaemia, a screening for other causes is desirable, all males are recommended to be screened. In the present study of pediatric cases 0-5 years age group males were most affected and prevalence was more in males as compared to females and the predominant morphological pattern was microcytic hypochromic anaemia.

Haemoglobin D Trait-An Uncommon Haemoglobinopathy in Chattogram: A Case Report

This case presents haemoglobin D Trait (Hb-D) which is a rare disease in Bangladesh. It is a heterozygous state for haemoglobin D who came to Laboratory Medicine Department of Chattogram Maa Shishu-O-General Hospital (CMSOGH) for heamoglobin electrophoresis. Our patient was 9 years old girl from Noakhali, Bangladesh. She was clinically silent with no splenomegaly. Her peripheral blood film was microcytic hypochromic anaemia and Capillary Electrophoresis (CE) of Hb revealed Hb D Trait. On family screening her father was Hb E trait, mother was Hb D trait and younger sister turned out normal Hb study. Compound heterozygosity for haemoglobin D and haemoglobin E may be present in subsequent pregnancy of her mother. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 81-83

Reticulocyte Parameters in Microcytic Hypochromic Anaemias Using Beckman Coulter DxH800 – A Study from Kerala, India

BACKGROUND Microcytic hypochromic anaemia is commonly due to iron deficiency, anaemia of chronic disorder [ACD] and thalassaemic syndromes. Reticulocyte count reflects the erythropoietic activity of bone marrow and is thus useful in both diagnosing anaemias and monitoring bone marrow response to therapy METHODS All samples were selected from routine blood counts, and sent for investigation of anaemia, over a period of two years. These samples were run on the DxH800 (Beckman Coulter). 385 cases were selected for the study. Blood analysis for all these cases had been requested by general practitioners to investigate anaemia. These blood samples had been collected in ethylenediaminetetraacetic acid (EDTA) anticoagulant vacutainers and processed within 2 hours of collection. Determination of red cell and reticulocyte parameters in all blood samples, was performed using the Beckman Coulter 7-part analyser [Unicell DxH 800]. RESULTS Of the 156 cases of microcytic hypochromic anaemia studied, iron deficiency anaemia (IDA) was present in 91 cases, anaemia of chronic disorder (ACD) in 50 cases, beta thalassemia trait (BTT) in 15 cases. Of the 50 ACD cases, 37 were associated with IDA. The control group comprised of 229 adult medical students (143 women and 103 men) with a median age of 18.84 ± 0.98 years. We also had 4 cases of other haemoglobinopathies, which were microcytic hypochromic, but were not included in our study as the number of cases was too less to be analysed. CONCLUSIONS New reticulocyte parameters are useful for evaluation of iron status and diagnosing iron deficiency anaemias. They also are reliable parameters for recognising subsets of anaemic patients thereby improving the management of anaemia. KEYWORDS Reticulocyte, Microcytic, Hypochromic, Anaemia, Beckman Coulter

Anaemia Types and Severity in Patients Aged 1 to 14 Years at the Children’s Hospital of the University Teaching Hospitals in Zambia

Anaemia is a condition in which either the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. The global estimate of childhood anaemia indicates that 293.1 million children are anaemic, and 28.5% of these children reside in sub-Sahara Africa. Also,anaemia is a significant public health problem with a high age-standardised death rate of 11.18 per 100,000 in Zambia. We conducted a cross-sectional study involving 392 anaemic children aged one year to 14 years. The study was conducted at the Children Hospital, University Teaching Hospitals, which is a third-level referral Hospital in Lusaka, Zambia. The aim was to determine the most common type of anaemia, it’s severity, and the most affected age groups among children aged 1–14 years.Out of392 participants, 219 (56%) were female. Maximum haemoglobinrecorded was 10.9g/dl, a minimum of 2.0 g/dl, a mean of 7.8g/dl and a standard deviation of 1.86g/dl. 200 (51%) participants had severe anaemia, and 192 (49%) had moderate anaemia with none having mild anaemia. Microcytic hypochromic anaemia was the commonest (60%), followed by normochromic normocytic anaemia (26%) and the least was macrocytic anaemia in 14% of the participants. An analysis of variance showed that the difference in mean haemoglobin concentration between age groups was not significant, F (7.94) = 0.83, p > 0.57. A Chi-squared test was used to determine the relationship between anaemia types (microcytic, hypochromic) and age groups.The interaction was not significant (Chi-Square (1) = 1.28, p-value = 0.73. Microcytic hypochromic anaemia was the most prevalent and all age groups were equally affected.We recommend the country’s National Food and Nutrition Commission to revisit the Zambian National Strategy and Plan of Action for the Prevention and Control of Vitamin A Deficiency and Anaemia of1999 to 2004 and implement the measures stated in the strategic plan

COMPARATIVE STUDY OF ANAEMIA CASES BASED ON PERIPHERAL BLOOD SMEARS AND CELL COUNTER GENERATED RED CELL INDICES

Background: Analyzing peripheral blood smears routinely has facilitated interpretation of various hematological disorders and has been a major diagnostic tool. The advent of automated hematology cell counter has improved accuracy, precision and safety. There is still a need to depend on manual techniques for primary calibration. This highlights the importance of maintaining the manual technical skills, Thus, the present study was undertaken to compare anaemia cases based on peripheral blood smears and cell counter generated Red blood cell (RBC) Indices. Material and Methods: The peripheral blood smears in anaemia were evaluated and compared it with cell counter generated red cell indices of 500 anemic patients. The automated analyzer SYSMEX XP-100 was used.Simultaneously, a peripheral smear was prepared according to standard operating procedures and stained by Leishman stain. Results: The cases consisted of normocytic normochromic anaemia (14%), microcytic hypochromic anaemia (76.2%), macrocytic anaemia (0.4%) and dimorphic anaemia (13.4%). In normocytic normochromic anaemia on peripheral smears 65.7% showed normal curve. In microcytic hypochromic anaemia 81.1% showed left shift. In cases of macrocytic anaemia 100% histogram showed right shift. Majority of the curves in dimorphic anaemia showed broad based curve (46.26%). Discussion: The relationship between histogram patterns and peripheral smear diagnosis in dimorphic anaemia posed queries regarding the validity of histocytograms. Hence, peripheral smear examination along with clinical history is an important diagnostic tool while handling the patients with hematological conditions.

Anaemia Types and Severity in Patients aged 1 to 14 years at the Childrens Hospital of the University Teaching Hospitals in Zambia

Anaemia is a condition in which either the number of red blood cells or their oxygen-carrying capacity is insufficient to meet physiologic needs, which vary by age, sex, altitude, smoking and pregnancy status. The global estimate of childhood anaemia indicates that 293.1 million children are anaemic, and 28.5% of these children reside in sub-Sahara Africa. Also, anaemia is a significant public health problem with a high age standardised death rate of 11.18 per 100,000 in Zambia. We conducted a cross-sectional study involving 392 anaemic children aged one year to 14 years. The study was conducted at the Childrens Hospital, University Teaching Hospitals, which is a third-level referral Hospital in Lusaka, Zambia. The aim was to determine the most common type of anaemia, its severity, and the most affected age groups among children aged 1-14 years. Out of 392 participants, 219 (56%) were female. Maximum haemoglobin recorded was 10.9g/dl, a minimum of 2.0 g/dl, a mean of 7.8g/dl and a standard deviation of 1.86g/dl. 200 (51%) participants had severe anaemia, and 192 (49%) had moderate anaemia with none having mild anaemia. Microcytic hypochromic anaemia was the commonest (60%), followed by normochromic normocytic anaemia (26%) and the least was macrocytic anaemia in 14% of the participants. An analysis of variance (ANOVA) showed that the difference in mean haemoglobin concentration between age groups was not significant, F (7.94) = 0.83, p > 0.57. A Chi-squared test was used to determine the relationship between anaemia types (microcytic, hypochromic) and age groups. The interaction was not significant (Chi-Square (1) = 1.28, p-value = 0.73. Microcytic hypochromic anaemia was the most prevalent and all age groups were equally affected. We recommend the countrys National Food and Nutrition Commission to revisit the Zambian National Strategy and Plan of Action for the Prevention and Control of Vitamin A Deficiency and Anaemia of 1999 to 2004 and implement the measures stated in the strategic plan.