DIAGNOSTIC IMPORTANCE OF BONE MARROW EXAMINATION IN HAEMATOLOGICAL MALIGNANT AND NON-MALIGNANT DISORDERS.

BACKGROUND: Bone marrow examination is regarded as one of the most important diagnostic procedure to assess various haematological disorders. The uses and advantages of bone marrow aspiration are numerous. This study was conducted with the aim to evaluate the frequency of involvement of bone marrow with malignant and non-malignant haematological and other clinical disorders and to observe the significance of bone marrow in establishing primary diagnosis of the same condition. METHODS: This was descriptive carried out at the Department of Pathology, Women Medical College, Abbottabad. A total of 570 successful bone marrow examinations were performed. Patients of all age groups and genders were included in the study. After history, clinical examination and blood complete counts, bone marrow was aspirated from posterior superior iliac spine, sternum or tibia. Smears were made, stained and examined under microscope. RESULTS: Total numbers of cases were 570. Ages ranged from 6 months to 70 years. Male to female ratio was 2:1. The common clinical presentation for bone marrow examination were progressive pallor, fever of unknown origin and bleeding. Total numbers of non-malignant haematological conditions were 417 (73.2%) while the numbers of malignant conditions were 153 (27.8%). CONCLUSION: Bone marrow examination remains a simple, reliable and effective technique in the diagnosis of many important clinical conditions. It is a reliable accessible tool for diagnosing various haematological malignant and non-haematological conditions. The importance of bone marrow examination is further highlighted in cases where routine investigations fail to reach a conclusive diagnosis. Treatable conditions like visceral leishmaniasis and malaria are diagnosed and the result is decreased mortality from these diseases.

Effects of smoking on length of hospital stay in patients surviving an orthotopic liver transplant.

BACKGROUND: Smoking in orthotopic liver transplant (OLT) recipients has been associated with increased risk of vascular complications, cardiac events, graft failure and oesophegeal cancer. The aim of this study was to determine the effect of smoking on length of hospital stay post OLT and also to audit support provided to these patients. METHODS: This was a retrospective study carried out in the Liver Transplant Unit, St James University Hospital, UK from 1979 to 2005. One hundred seventy-four 174 adult patients who had undergone OLT in this hospital during this time with a follow-up of at least 2 years after transplantation were included. RESULTS: One hundred seventy-four 174 patients (mean age 52.2 years) responded by answering the questionnaire. Answers were analysed using relevant statistical methods. Eighty 80 patients had a smoking history (ever-smoked) while 94 were non-smokers (never-smoked). Out of 56 patients with a smoking history, 46% (n = 26) were offered advice and only 18% (n = 10) were offered any support. Of the 26 patients smoking at the time of OLT, 58% (n = 15) were offered advice and only 19% (n = 5) had been offered support. There was no significant difference in length of hospital stay post OLT between patients who had never-smoked and ever-smoked (p = 0.780). In addition, smoking at the time of OLT had no significant impact on length of hospital stay (p = 0.922). CONCLUSIONS: Smoking per se does not seem to increase hospital stay post OLT. Patients should be adequately counselled about smoking post OLT. Support mechanisms, including better awareness among doctors and allied healthcare workers should be made available to tackle this problem.

Serum transferrin receptor, serum ferritin and serum transferrin receptor-ferritin index in adults with iron deficiency anaemia.

BACKGROUND: Serum Ferritin (SF) and iron both show acute phase responses to inflammation, so iron may fall and ferritin rise independent of the marrow iron store. Bone marrow iron store has been considered the gold standard, but is invasive, painful and expensive and not suitable for everyone. Serum transferrin receptor (sTfR) which is the concentration of the soluble fragment of transferrin receptor in serum, is an important new haematological parameter. The ratio of sTfR to log SF is known as sTfR-SF index. This study was conducted to evaluate sTfR, Ferritin and sTfR-F Index in diagnosing and differentiating iron deficiency anaemia (IDA) from anaemia of chronic disease (ACD). METHODS: One hundred and sixteen (116) adult subjects (80 anaemic and 36 controls) who already had their bone marrow examination done for various reasons were included in the study. sTfR, SF, and their index were measured and compared with bone marrow iron stores. Absence of iron stores denoted IDA whereas increased macrophage iron with decreased siderocytes and sideroblasts was diagnostic of ACD. RESULTS: Out of 80 anaemic patients, 47 were diagnosed as IDA while 33 were diagnosed as ACD. In case of IDA the diagnostic accuracy of index was 91.57%, sTfR had accuracy of 85.54% while SF had accuracy of 75.90%. In case of ACD, the diagnostic accuracy of sTfR was 91.30%, index 89.86%, while SF had accuracy of 79.71%. CONCLUSION: sTfR-SF index is a better parameter than sTfR or ferritin alone but should only be used when the results of these parameters seem altered or a bone marrow aspiration is mandatory for diagnosis of ACD. The estimation of sTfR or index may offer a simple non invasive method that may enable more accurate assessments of iron status in such patients.

Frequency of visceral leishmaniasis in Abbottabad from 2005 to 2009.

BACKGROUND: Leishmaniasis is a parasitic disease caused by a haemoflagellate Leishmania, transmitted to humans through bites of female sand fly. The objective of this study was to assess the frequency of leishmaniasis in Abbottabad and nearby areas including villages of Nawanshehr, Dhodial, Gamavan, Sheikhulbandi, Kakul and Malikpura. METHOD: This was a retrospective study carried out in Pathology Department, Women Medical College and Benazir Bhutto Teaching Hospital Abbottabad from 2005 to 2009. The diagnosis was based on intracellular and extracellular amastigote forms of Leishmania donovani in the bone marrow aspirates. RESULTS: We diagnosed 61 cases of visceral leishmaniasis, mostly from Nawanshehr (32.78%), in children below 5 years of age with febrile splenomegaly. CONCLUSION: The disease is gradually spreading southwards in the country. A high index of suspicion should be kept in mind for all cases coming from Northern Areas of the country where the frequency is quite high. Local health authorities should take drastic action against this spreading disease.