Common Hematological Reference Indices Among Healthy Reproductive Age Indian Women-Data Subset from Nationwide Study.

Despite the negative implications on women's health, pregnancy, and fetal outcomes, population-based studies on hematological indices among reproductive age women in India have received inadequate attention. This study aimed to generate normative ranges for various hematological parameters among these women. After ethics approval, apparently healthy (n = 5884) women (aged 18-40 years) were recruited from six eco-geographic zones of India. After various exclusions (n = 5412), including women having anemia, data of clinically, and biochemically healthy women (n = 472) was analysed to generate centiles (2.5 and 97.5th) and correlations. The mean age and mean BMI of women was 29.3 ± 6.5 years and 23.25 ± 3.26 kg/m2 with BP of 112.26 ± 8.9/74.04 ± 6.7 mmHg. The reference intervals for hemoglobin (12-15.1 gm/dl), RBC (3.68-5.55 millions/µl), WBC (4.1-11.26*109/L), platelet count (1.32-4.42*105/µl), and erythrocyte sedimentation rate (4.35-41.65 mm/hr) were different from currently used reference values (p < 0.05). However, these haematological indices did not vary among various age categories, geographical zones, ethnicities and rural or urban origins. Pearson's correlation revealed a statistically significant association between ESR, WBC, monocytes, and platelets with homeostasis model assessment of insulin resistance (HOMA-IR). Women with HOMA-IR > 2 displayed a statistically significant differences in parameters like MCV, ESR, eosinophil and platelet counts as compared to the women with HOMA-IR < 2. This study provides a pioneering reference data of hematological indices among women of reproductive age in India. Despite the small sample size results can be extrapolated to the national population given the representative sampling of various geographical zones. This may pave way for future comprehensive large-scale studies on the subject. Supplementary Information: The online version contains supplementary material available at 10.1007/s12288-023-01714-6.

Polycythemia vera in patients of beta-thalassemia trait and stress erythropoiesis.

A 70-year-old male with a known case of beta-thalassemia trait and was on yearly follow-up was found to have a hemoglobin of 14.8 g/dL, hematocrit of 47.7%, and RBC count of 6.0 × 1012/L. Total leukocyte count (TLC) was 5 × 109/L and platelet count was 4 × 109/L. Secondary causes of polycythemia were ruled out (e.g., renal or cardiac disease and smoking). He did not have symptoms of hyperviscosity syndrome. The abdominal ultrasound showed no abnormalities. On further investigation, a JAK-2 (Exon 14) mutation was detected in this patient confirming the diagnosis of polycythemia vera (PV).

ATRA-induced bradycardia in a case of acute promyelocytic leukemia: A case report.

A 45-year-old female, a new case of acute promyelocytic leukemia (APL), received induction chemotherapy containing all-trans retinoic acid (ATRA) and idarubicin. On the sixth day of therapy, she developed sinus bradycardia and differentiation syndrome (DS). Electrolytes and cardiac imaging were normal. The patient achieved normal sinus rhythm after ATRA was withheld, and DS was treated.

Visceral leishmaniasis: A leucaemia mimicker: A case report.

Visceral Leishmaniasis (VL) is endemic in the northeast part of India, principally Bihar, Jharkhand, Uttar Pradesh, and West Bengal. We report a case of VL from the non-endemic Himalayan region of Kashmir. A 25-year-old female presented with a history of fever, generalized weakness, loss of appetite for one month. On clinical examination, there was hepatosplenomegaly and pancytopenia. There was no travel history to any VL endemic areas. Bone marrow examination revealed an amastigote form of Leishmania Donovan. Nested polymerase chain reaction (PCR) confirmed diagnosis. The patient was treated with 6 mg/kg liposomal amphotericin B, for ten days and improved clinically. Our case reveals that VL is expanding towards non-endemic regions of India, and physicians should remember the differential diagnosis of VL in a patient presenting with fever, pancytopenia, and hepatosplenomegaly.

Vitamin D toxicity due to self-prescription: A case report.

Apart from maintaining healthy bones, vitamin D is also required for cell differentiation, cell growth inhibition, and immune modulation. Vitamin D deficiency is common in the Indian subcontinent. Vitamin D presenting toxicity, leading to hypercalcemia, acute kidney injury, and altered sensorium is very rare. Here we present a case of a 65-year-old man who presented to emergency with persistent vomiting, altered sensorium, and acute kidney injury. The cause of which was an unchecked intake of vitamin D for non-specific musculoskeletal pain. When treated with intravenous fluid, diuretics, calcitonin, and steroids, the patient improved clinically. Therefore, for any patient presenting with persistent vomiting, altered sensorium, and hypercalcemia, with normal to low parathyroid hormone levels, a diagnosis of an overdose of vitamin D should be considered. Early treatment of this condition not only improves the symptoms but also prevents further kidney damage.

Rare snake bite- A case report.

Snake bite is an acute life threating medical emergency and is included amonst neglected tropical diseases.1 Every year in India 200,000 people bitten by snakes and >25% are fatal.2In Maharashtra, Konkan area, the green pit viper (Trimeresurus gramineus) is uncommon, though this snake has become more common. [ Figure 1].

Varying presentation of type 1 polyglandular failure in India.

Clinical presentation and course of six patients with type 1 autoimmune polyglandular failure are presented. Mean age of the patients was 17.3 +/- 5.2 years and age at presentation was 10.16 +/- 4.35 years. Four out of six had the classic triad. All of the patients first presented with hypoparathyroidism followed by mucocutaneous candidiasis and adrenal failure.