The Bombay blood group: are we out of risk?

The Bombay blood group is a rare blood group, phenotypes of this group lacking H antigen on the red cell membrane and have anti-H in the serum. It fails to express any A, B or H antigen on their red cells or other tissues. The existence of a human H/h genetic polymorphism was first established by Bhende et al. As first discovery in Bombay (Mumbai), in India in 1952, so the name of this rare blood group is known as Bombay blood group. People having Bombay phenotype are mostly confined to the Southeast Asia. Around 179 persons in India with a frequency of 1 in 10,000 have "Bombay Blood group". A high level of consanguinity present among the parents of the Bombay phenotype. The classic Bombay phenotype has been reported in those of Indian descendent. It is quite rare in Caucasian with an incidence of 1 in 250,000. As because in our country there is routine practice of "only forward or cell type grouping" using finger prick method by voluntary blood donors organization and various blood banks; so there is tremendous chance of misinterpretation or unexploration of this Bombay blood group. When misdiagnosed, this Bombay group can cause fatal haemolytic transfusion reaction. For this reason our suggestion is to incorporate "routine serum typing or reverse grouping confirmation" along with 'O' cell control in reverse grouping procedure in every Transfusion Medicine Department or Blood Bank or Blood Donor Centers and this practice should be mandatory to reduce the risk of fatal haemolytic transfusion reaction. In this view we will highlight the incidence, molecular biology and clinical significance of this rare and fatal blood group.

Holmium laser urethrotomy for urethral stricture.

A prospective cross-sectional study was carried-out in the department of urology, Dhaka Medical College Hospital (DMCH) to evaluate the outcome of Laser urethrotomy for the treatment of urethral stricture. For this purpose, 30 male patients aged 15 to 60 years with short segment anterior urethral stricture (>2cm) were treated by HO:YAG Laser. The energy used for this purpose was 0.8 to 1.5 joules by LISA 80 Watt Holmium Laser machine. All patients were catheterized for less than 24 hours and were followed up for 6 to 12 months postoperatively by uroflowmetry and by retrograde with voiding cystourethrogram 3 monthly. The study revealed that out of 30 patients, 27(90%) showed good flow of urine (Qave>16.0 ml/sec) and adequate caliber urethra in retrograde urethrogram (RGU). Only 3(10%) patients showed narrow stream of urine (Qave<8.0 ml/sec) and recurrent stricture in RGU which were managed by optical internal urethrotomy (OIU) and clean intermittent self catheterization (CISC). The study showed satisfactory results in 90% cases with short term follow up. The study concludes that HO:YAG Laser urethrotomy for the treatment of short segment urethral stricture is highly effective. The study further reveals that the method is simple, safe and thus, it can be considered favorably as a new therapeutic option for the treatment of urethral stricture. However, long term follow up is necessary for making a final comment on this issue.

In hydronephrosis less than 10 % kidney function is not an indication for nephrectomy in children.

PURPOSE: To reduce the incidence of nephrectomy or hydronephrosis in children. MATERIALS AND METHODS: From September 1998 to October 2000, we treated 58 patients with hydronephrosis; their ages ranged from 35 days to 11 years (mean age 4 years 7 months). All patients were subjected to a DTPA renogram with split function. In 12 patients (study group), kidney function was less than 10 % (range 0 - 10 %). Initially, nephrostomy was carried out in all 12 patients followed by Anderson-Hyne's pyeloplasty after 4 - 6 weeks. Postoperatively renal USG, urine r/m/e & c/s (routine and microscopic examination and culture and sensitivity test), blood urea, serum creatinine were assessed and DMSA scan and DTPA renogram with split functions were carried out in all patients. RESULTS: In the study group, all 12 patients showed improvement of renal function (more than 10 %) after nephrostomy and in all of them pyeloplasty was subsequently carried out within 4 - 6 weeks. There were no significant pre-, peri- or postoperative complications. CONCLUSIONS: Contrary to common practice we do not recommend nephrectomy for hydronephrotic kidneys which show < 10 % of renal function on renogram. The renal functional status improves significantly after a preliminary nephrostomy, thus avoiding the need for a straightforward nephrectomy in children along with all the possible long-term effects of a single kidney.