Study of lipid profile in β thalassemia major pediatric patients with multiple blood transfusion and its correlation with serum ferritin level in tertiary care hospital in Kolkata

Background: β-Thalassemia major is associated with iron overload toxicity. This study was done to investigate lipid profile abnormality in β-Thalassemia major patients and to establish their correlation with serum ferritin. Another motto of this study was to signify deleterious effect of multiple blood transfusion and facilitate to understand how it will affect the lipid profile parameters changes so that we can also prevent early dyslipidemia induced complications like atherogenesis by early detection of lipid profile abnormality and also to establish derangement of lipid profile as an indirect evidence of iron overload.Methods: 102 nos. β-Thalassemia major paediatric patients with multiple blood transfusion (≥10) in age group of 6 to12 years admitted in pediatric ward of tertiary care hospital (NRSMCH) were enrolled. Serum ferritin level and lipid profile were investigated and their correlation were assessed.Results: Among 102 β-Thalassemia major pediatric (6 to 12 years) patients 55.88% were male and 66.67% were Hindu by religion and 69.61% children came from lower socio-economic class. The average value of number of previous blood transfusion was 42.79±7.510. The mean value of serum ferritin was 2263.53±833.904 ng/ml. The average value of serum total cholesterol, LDL and HDL were 153.84±5.428 mg/dl and 97.16±3.982 mg/dl and 29.45±4.445 mg/dl respectively and their correlation with serum ferritin were negative (r=-0.941 and r=-0.964 and r=-0.751 respectively). Average value of serum triglyceride and VLDL were 206.22±67.407 mg/dl and 36.16±3.385 mg/dl respectively and their correlation with serum ferritin were positive (r=+0.606 and r=+0.973 respectively).Conclusions: There was significant lipid profile derangement. As the serum ferritin level increases, serum total cholesterol, HDL, LDL decreases and serum triglyceride, VLDL level increases.

Retinopathy of prematurity in India: incidence, risk factors, outcome and the applicability of current screening criteria

Background: To study the incidence, risk factors and outcome of retinopathy of prematurity (ROP) in at-risk newborns at tertiary care hospital in Vadodara.Methods: Preterm infants with birth weight ≤2000 gm and gestation ≤34 weeks were screened for ROP at 4 weeks of birth for first screening or if <28 week or <1200 grams then at 3 weeks after delivery. Infants with birth weight >2000 gm and gestation >34 weeks were screened only if they had additional risk factors. Those found to have high risk ROP were treated.Results: The incidence of ROP in 286 infants who were screened was 24.1%, 12 ROP positive cases were having birth weight >2000 gm. On multivariate analysis risk factors predisposing to ROP (P<0.05) were birth asphyxia, Sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and Phototherapy. Out of 69 infants who developed ROP, 6(8.7%) needed invasive management.Conclusions: Risk factors predisposing to ROP were gestational age and birth weight alone and along with the various risk factors like birth asphyxia, sepsis, multiple blood transfusion, respiratory distress syndrome, multiple birth, antenatal steroid use and phototherapy. The occurrence of ROP is trending towards a rise including newborns with higher birth weight and gestational age in developing countries; hence necessitating to use different guideline for Screening of Newborns in these developing countries.

Analysis of presurgical uterine artery embolization (PUAE) for very large uterus myomatosus; patient’s desire to preserve the uterus; case series and literature review

Purpose Purpose of this paper to present results of a group of 21 consecutive patients who underwent uterine artery embolization (UAE) immediately before myomectomy. Surgical myomectomy can lead to a substantial blood loss in case of large or multiple tumors due to the hypervascularization of the tumors. This may lead to multiple blood transfusion or hysterectomy. In cases were the preservation of the uterus is demanded, pre-operative embolization could reduce the risk of substantial bleeding. Materials and Methods Between January 2011 and March 2016, 21 patients underwent UAE 24 hours before myomectomy. All patients were asked by questionnaire about post-surgical follow-up, complications, the length of the scar, satisfaction and improvement of symptoms. Data of the operation and embolization were retrospectively assessed. Results UAE could be performed in all patients without complications. Mean diameter of the largest myoma was 12.7 ± 3.2 cm, primary preservation of the uterus succeeded in all cases. In none of the cases a perioperative blood transfusion was necessary. One patient underwent hysterectomy in another hospital after primary successful resection, one patient received transfusion of 2 bags of red blood cell concentrate during her stay in hospital.11 of 21 patients responded to the questionnaire. 10 of 11 had subjective symptom improvement. Mean inability to work was 31 days, the mean self-measured length was 12 cm. 9 of 11 patients would recommend the procedure, one patient was in the second trimester of pregnancy. Conclusion Preoperative uterine artery embolization facilitates a safe and uterus-preserving myomectomy in patients with very large or multiple fibroids. Key Points Citation Format

MRI signal changes in the liver following multiple transfusions.

Diffuse signal changes in the liver on MRI often represent a depositional process with decreased signal when iron or copper is deposited or increased signal with fatty deposition. We present a 68y male with myelodysplasia requiring multiple blood transfusion, resulting in such signal changes.