'Doctor, there is a lump in my heart' - A rare case of a ventricular myxoma.

Myxomas are the commonest primary cardiac tumours. They may be asymptomatic, and picked up incidentally, or be the cause of congestive heart failure, arrhythmias and/or murmurs. Echocardiography is necessary for diagnosis. Surgical resection is recommended to prevent further complications. A rare symptomatic ventricular myxoma is presented in this case report.

Distribution of ABO and Rh-D blood groups among blood donors in a tertiary care centre in South India.

The distribution of ABO and Rh-D blood groups was studied among 150,536 blood donors screened at the Dr John Scudder Memorial Blood Bank, Christian Medical College Hospital, Vellore, over a period of 11 years (April 1988 to March 1999). The most common blood group was found to be group O [58,330 (38.75%)], followed by group B [49,202 (32.69%)], and group A [28,372 (18.85%)]. The least common blood group was AB group [7,930 (5.27%)]. A2 or A2B groups were found in 3.01% and 1.43% of donors, respectively. The prevalence of Rh-D negative group was found in 8,225 (5.47%) donors. Bombay group (H negative non-secretor, genotype hh phenotype Oh) was found in six donors (0.004%). Although the incidence of Rh-D negative group was identical to previously published data from North India, the most common blood group was O group in our study as opposed to B group.

Increasing prevalence of HIV antibody among blood donors monitored over 9 years in one blood bank.

To determine the time trend of HIV infection among non-professional blood donors at the Christian Medical College and Hospital, Vellore, the annual HIV prevalence among them for the years 1993-1997 was compared with that of the previous 5 yr. Since confirmed number of HIV positive blood donors is required for calculation of prevalence, the serum samples which were reactive for HIV 1/2 antibody by ELISA, were confirmed by Western blot. The annual prevalence of HIV antibody gradually increased from 1.6 per 1000 in 1988-1989, to 3.8 per 1000 in 1996-1997. The mean tri-annual prevalences for the years 1988-91, 1991-94 and 1994-97 were 1.3, 2.7 and 3.6 per 1000 respectively, suggesting a slow but steady increase in HIV prevalence over time. Our findings provide an insight into the dynamics of HIV infection in the general population of our country, whom the nonprofessional blood donors at our hospital represent.

Low-dose intermittent factor replacement for post-operative haemostasis in haemophilia.

Recommendations for factor replacement therapy for postoperative haemostasis in haemophilia are often empirical and based on the physiological understanding of haemostatic requirements. This report describes the haemostatic management of patients with severe haemophilia undergoing major surgery using lower than usually recommended levels of factor replacement therapy. Eighteen adults (11 with FVIII and seven with FIX deficiency) with an average weight of 52 kg (range: 27-69) underwent 20 major surgical procedures. Factor concentrates were administered by intermittent bolus infusions. The dose of FVIII infused before surgery was 76 mu kg-1 (range: 51-113) and that of FIX was 77 mu kg-1 (range: 50-104). The preoperative levels achieved were 107% (range: 80-180) and 73% (range: 60-90), respectively. Between days 1 and 3 after surgery, an average of 29 mu kg-1 day-1 (range: 20-46) of FVIII and 23 mu kg-1 day-1 (range: 12-42) of FIX was used resulting in mean trough levels of 36% (range: 12-62) and 34% (range: 11-52), respectively. After day 4, an average of 19 mu kg-1 day-1 (range: 15-25) of FVIII and 18 mu kg-1 day-1 (range: 10-37) of FIX was administered until wound healing. The average duration of factor replacement was 11 days (range: 8-16). The mean dose of factor concentrate per patient was 260 mu kg-1 (range: 179-338) of FVIII and 300 mu kg-1 (range: 183-524) of FIX. The total amount of factor used per patient ranged from 12,380 to 19,980 units of FVIII and 8000 to 23,600 units of FIX. Only one patient had post-operative bleeding which was due to a surgical cause. It is concluded that it may be possible to use much lower than recommended levels of factor replacement therapy for postoperative haemostasis in severe haemophilia.

Low-dose activated factor IX complex concentrates (FEIBA(R) ) for post-operative haemostasis in a patient with high responding factor VIII inhibitors.

Replacement therapy in patients with severe haemophilia A is associated with the development of inhibitory antibodies in about 15% [1,2]. The presence of inhibitors of factor VIII greatly complicates and compromises the treatment of these patients because of the lack of any completely satisfactory product to treat them. Haemostatic management for surgery in patients with inhibitors is very difficult. A product frequently used to treat bleeding episodes in such patients is prothrombin complex concentrate (PCC) [3] or its activated derivative (APCC) [4]. Activated recombinant human factor VII is another option [5]. For both these modalities of treatment, there are no laboratory tests that can be used to monitor clinical efficacy [5, 6]. Porcine factor VII is therefore the preferred product for surgery in patients with high-responding factor VIII inhibitors [7]. Unfortunately, none of these products are readily available in most developing countries, including India. We report the management of a patient with high-responding factor VIII inhibitor using low doses of FEIBA(R) (Immuno, Austria) in the post-operative period.

Glanzmann's thrombasthenia. A review and report of 42 cases from South India.

In the 14 year period from June, 1966 to June, 1980, 42 cases of Glanzmann's thrombasthenia have been diagnosed, all fulfilling the criteria of prolonged bleeding time, with normal venous platelet count, defective clot retraction and decreased platelet aggregation, associated with a lifelong bleeding tendency. Few cases have been reported from India though it is the fourth most common congenital bleeding disorder among the patients seen at the Christian Medical College Hospital, Vellore. The large number of such cases found in South India as compared with reports from other parts of the world may be due to the high degree of consanguinity which is part of the accepted culture in this area. Reliable diagnosis of this condition is possible with fairly simple laboratory procedures.

Essential athrombia. A report on 4 cases from South India.

Four cases of essential athrombia have been diagnosed in the 14 year period from June, 1966 to June, 1980 at the Coagulation Laboratory of the Christian Medical College Hospital, Vellore. All cases fit Inceman's description of the original case and fulfill the diagnostic criteria of prolonged bleeding time, decreased platelet aggregation, normal platelet count, normal morphology and normal clot retraction. No cases have been reported from India in the past 15 years.