Phlebotomy consent: ethical concerns.

Phlebotomy is one of the common invasive procedures carried out all round the globe. The practice of phlebotomy varies widely. In terms of the technique, the procedure may involve the use of a syringe or a vacutainer, and as for the technicians, some are not specifically trained to perform the procedure and others are qualified phlebotomists. Finally, some may receive training on the job, while others undergo formal, focused training. However, the underlying ethical principles of respect for autonomy and informed consent do not change. This commentary, which is supported by data collected during training in phlebotomy, reflects on the ethical issue of obtaining consent for the procedure.

ABO blood groups and malaria related clinical outcome.

Objectives: The study was undertaken to correlate the blood groups and clinical presentations in malaria patients and to understand the differential host susceptibility in malaria. Methods: From October 2007 to September 2008, malaria positive patients’ samples were evaluated in this study. Hemoglobin, total leukocyte count, and platelet count of each patient were done on an automated cell counter. After determining the blood groups, malarial species and the severity of clinical course were correlated. Results: A total of 100 patients were included in the study, of which 63 cases were positive for Plasmodium falciparum and 37 cases were positive for P. vivax infection and 11 patients had mixed infection. The results of the blood groups showed 22 – ‘A’ group, 42 – ‘B’ group, 35 – ‘O’ group and 1 was ‘AB’ group. When the clinical courses between different groups were compared using the following parameters for severe infection—a parasitic load of >10/1000 RBCs, severe anemia with hemoglobin < 6 g%, platelet count of <10,000/mm3, hepato or splenomegaly or clinical signs of severe malaria such as fever >101oF and other organ involvement, it was observed that ‘O’ group had an advantage over other the groups. The difference in rosetting ability between red blood cells of different ‘ABO’ blood groups with a diminished rosetting potential in blood group ‘O’ red blood cells was due to the differential host susceptibility. Conclusion: ‘O’ group had an advantage over the other three blood groups. Based on literature and the results of this study, the diminished rosetting potential in blood group ‘O’ red blood cells is suggested as the basis for the differential host susceptibility.

Significance of preoperative thrombocytosis in epithelial ovarian cancer.

Background: Reactive thrombocytosis is reported in a variety of solid tumors. A few studies have documented preoperative thrombocytosis in ovarian cancer and identified it as a marker of aggressive tumor biology. Aim: To study the incidence of preoperative thrombocytosis (platelets greater than 400x10) in epithelial ovarian cancer and its association with other clinicopathologic factors. Materials and Methods: Sixty-five patients with invasive ovarian epithelial cancer were retrospectively reviewed and analyzed for the association preoperative thrombocytosis with other clinical and histopathological prognostic factors. Means were analyzed by Student's t test; proportions were determined by Chi-square analysis. Results: Twenty of 65 (37.5%) patients had thrombocytosis at primary diagnosis. Patients with preoperative thrombocytosis were found to have lower hemoglobin (P < 0.0002), more advanced stage disease (P < 0.05) and higher grade tumors (P < 0.02). Patients with thrombocytosis had greater likelihood of subpotimal cytoreduction. Conclusions: Preoperative thrombocytosis is a frequent finding in ovarian carcinomas and their association with advanced stage disease and higher grade denotes that platelets play a role in the tumor growth and progression.

Impact of vascular abnormalities in neoplastic and non-neoplastic lung disease.

BACKGROUND: Vascular abnormalities of the pulmonary circulation in the setting of destructive lung diseases caused by inflammation or neoplasia has been scantily researched. A need was felt to document the spectrum of pathological alterations in the vasculature and thus permit speculation into both their pathogenesis and possible clinical significance. METHODS: Between January 1999 and June 2001, 21 patients (male:female 3:4) who had chest disease exceeding a duration of six months and later underwent lobectomy were included in the study. The histopathological material was analysed for vascular changes such as arterial intimal fibrosis, muscularisation of intima and pericapillary fibrosis. The study included a detailed morphometric analysis. RESULTS: The lesions included 15 non-neoplastic diseases and six neoplastic diseases. The striking vasculopathic changes observed in the absence of pulmonary hypertension were pulmonary artery medial hypertropy (100%), intimal fibrosis (62%) and muscularisation of the neo-intima (3%). Pericapillary fibrosis was seen in 83% of the neoplastic lesions and 67% of the non-neoplastic lesions. CONCLUSION: This study highlights the impact of chronic lung disease on pulmonary vasculature. The role that neoplastic and non-neoplastic lung disease have to play in the evolution of the documented vascular changes have been postulated, and the need to design effective therapeutic strategies to modulate hypoxia, reverse the inflammatory process and stabilise the fibroblastic process is also highlighted.

Cutaneous vasculitis--a dynamic process posing diagnostic challenge.

AIM: To characterize the clinicopathologic features and to assess the therapeutic outcome in cutaneous vasculitis. MATERIAL AND METHODS: Fifty biopsy proven cases of cutaneous vasculitis seen between January 1998 and July 1999 were studied. RESULTS: The commonest presentation was palpable purpura. The site most commonly affected was the extremity, irrespective of the age (adults - 40 and children - 10) and sex. The histopathologic picture ranged from an acute to chronic process, which besides the classic picture included bullous presentation, granulomatous histology and nonspecific features. Clinical correlation and investigations including direct immunofluorescence (DIF) were required to differentiate primary from secondary vasculitis (SLE-4, dermatomyositis-2, rheumatoid artritis-1, HIV-1, septicaemia-1 and drug reaction 2). DIF was diagnostic in 13 out of 21 cases providing evidence of an immune-mediated pathogenesis. Drugs used in the treatment included dapsone, colchicine, pentoxyphiline and steroids. CONCLUSIONS: The clinical picture and outcome of primary cutaneous vasculitis were benign while the prognosis of secondary vasculitis depended on the primary disease, irrespective of the histopathological picture.