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BACKGROUND: HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome occurs in about 0.5%-0.9% of all pregnancies, but its prevalence is higher in patients with severe preeclampsia, accounting for a substantial maternal and perinatal morbidity and mortality. According to the latest American Society for Apheresis guidelines, Therapeutic plasma exchange (TPE) performed for postpartum cases and antepartum HELLP syndrome cases fall in Categories III and IV, respectively. MATERIALS AND METHODS: Retrospective analysis was done at our tertiary care center from January 2014 to June 2019 for patients diagnosed with HELLP syndrome. Clinical data for age, gestational age at the time of diagnosis, type of delivery, outcome of pregnancy, history of preeclampsia /eclampsia, hemoglobin levels, AST, ALT, LDH, platelet counts, prothrombin time, activated partial thromboplastin time, international normalised ratio, complete blood count, was obtained from patients' electronic medical records. The TPE was initiated within 24 hrs of diagnosis. All TPE was done on Spectra Optia apheresis system (Terumo BCT, Inc, USA). Statistical testing was conducted with the statistical package for the social science system version SPSS 20.0 and R-3.2.0. Continuous variables were expressed as mean±SD and were compared between Pre and Post TPE records of patients by using the paired T test. RESULTS: Nine patients fulfilled the criteria of HELLP syndrome. Seven (77.8%) were diagnosed in the postpartum period and 2 (22.2%) during the second trimester. Out of the total nine patients, two patients (22.2%) recovered completely and were discharged on day 15 ± 7 days, whereas 4 (44.4%) patients were discharged on day 21 ± 7 days with the advice of hemodialysis. Two (22.2%) patients had an intrauterine death and were discharged 3-4 days after the demise. In all these patients (except one), the TPE was initiated within 24 h of the diagnosis. A significant increase in platelet count and decrease in the lactate dehydrogenase levels (P < 0.05) was observed post TPE. CONCLUSION: Our data showed that TPE improved the treatment outcome in patients with HELLP syndrome despite being a Category III and IV indication among postpartum and antenatal females, respectively. However, a timely diagnosis and management are of paramount importance for a favorable outcome. TPE needs to be performed within 24 h of the diagnosis postdelivery when the patient is not responsive to the usual therapies, especially in class I HELLP syndrome.
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Introduction The distribution of ABO and Rh (D) blood groups and their allele frequencies vary from one population to another worldwide. The objective of the study is to estimate the distribution of ABO & Rh (D) blood groups among all the blood donors in a tertiary care hospital in Chengalpattu district of Tamilnadu in South India and to determine their allele frequencies. Methods This was a retrospective observational study carried out in the blood bank of Karpaga Vinayaga Institute of Medical Sciences and Research Centre from January 2015 to December 2021. ABO and Rh (D) blood grouping of all the blood donors were carried out by tube agglutination method. Allele frequency of the blood group genes was calculated based on Hardy-Weinberg equilibrium. Results Out of total a of 7598 blood donors, 7576 (99.71%) were males and 22 (0.29%) were females. The most common blood group was O positive (37.67%) while AB negative (0.18%) was the least common blood group. The phenotypic frequency of blood group O (39.17%) was the highest and that of blood group AB (7.88%) was the least. A majority (95.96%) of the blood donors were Rh (D) positive. The allele frequencies of ABO and Rh (D) blood groups were 0.1628 for IA, 0.2177 for IB, 0.6259 for IO, 0.7991 for ID, and 0.2009 for Id. Conclusions The distribution of the two major blood group systems namely ABO and Rh (D) systems show considerable heterogeneity in different populations of the world. Information about allele frequencies of blood groups among different populations worldwide will help in framing policy decisions to face future challenges in healthcare services.
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INTRODUCTION: Neurological syndromes associated with voltage-gated potassium channels (VGKC) affect the nerve and muscle physiology. Presence of antibodies to VGKC are associated with three main neurologic syndromes namely neuromyotonia (NMT), limbic encephalitis (LE) and Morvan's syndrome(MVS) LE is a variably treatable neurologic syndrome associated with high levels of antibodies to the voltage-gated potassium channel (VGKC) complex. These antibodies are directed against protein antigens that bind to the VGKC complex. These antigens are usually leucine-rich, glioma inactivated 1 (LGI1), and contactin associated protein-like 2 (CASPR2). CASE DESCRIPTION: A 58-year-old female and with a known case of auto immune encephalitis (voltage gated potassium channel) and steroid induced diabetes mellitus presented with progressive worsening of vertigo, recurrent myoclonic jerks and post ictal confusion for last 7 days. She had memory impairment since last few months. She was on treatment with steroids which were gradually tapered off 11 months back. CSF was tested for presence of VGKC antibodies and the test was positive for LGI (leucine-rich glioma inactivated 1) antibody. Therapeutic plasma exchange (TPE) was scheduled every day for 6 consecutive days based upon the recommendations from the ASFA guidelines for the treatment of neurologic syndromes. CONCLUSION: TPE done every day in patient diagnosed LE with VGKC antibodies had shown rapid improvement in controlling the symptoms.