Ratna Sharma

Rational use of blood components - an audit.

ObjectivesThe present study was designed to study appropriateness of use of the blood components in pediatric and neonatal wards.DesignIt was an observational study conducted in a tertiary care institute. The patients were selected from various pediatric subsections over a period of six months.Materials and methodsAll the patients below 12 years of age, who received blood components in any of the pediatric subsections including general pediatric wards, pediatric intensive care unit, pediatric hematology section, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed to decide whether it satisfied the predetermined criteria.ResultsOf the total 184 episodes of blood component transfusions, 153 (83.1%) episodes were appropriate and 31 (16.9%) episodes were inappropriate. Among these, fresh frozen plasma transfusions had highest inappropriate [18/41 (58%)] episodes followed by packed red cell transfusions [11/110 (35.5%)] and platelet transfusions [2/5 (6.45%)]. There was no inappropriate episode of cryoprecipitate transfusion.ConclusionsThe present study reinforces the importance of blood audit in the clinical setting. Judicious implementation of guidelines for use of various blood products may help decrease the inappropriate use of blood components.

Immunoglobulin levels and CD4 / CD8 counts in β — Thalassemia major

ObjectiveThis cross-sectional study determined the CD4, CD8 counts and serum immunoglobulins in transfusion dependent β-thalassemic patients, and correlated them with anti-HIV, anti-HCV and HBsAg status, number of transfusions, iron overload and splenectomy.MethodsPatients with acute or chronic diseases (except HIV, Hepatitis B and C), on immunosuppressive drugs or vaccinated within one month prior to study were excluded. CD4, CD8 counts and serum Immunoglobulins were documented.ResultsIncreasing transfusions led to higher IgA and IgM as well as a decline in CD4 and CD8 levels. Higher ferritin correlated with high IgM. CD4, CD8 and IgA were significantly higher in splenectomized subjects. HCV correlated significantly with lower IgA values.ConclusionHigher transfusion requirement, iron overload, splenectomy and HCV infection correlated with alterations in different immunological parameters.

Isolated conjunctival mass presenting as acute myeloid leukemia in an infant.

Ophthalmic manifestations of acute leukemia are commonly seen in the choroid and retina; however, conjunctival leukemic lesions are uncommon. We report a case of a 7-month-old female child presented with a fleshy conjunctival mass seen growing in the left eye since 1-month [Figure 1A]. The mass was deep pink in colour, painless and the conjunctiva appeared chemotic [Figure 1B]. There was no proptosis and ophthalmic examination was otherwise normal. The mass was soft-to-firm in consistency and showed prominent corkscrew vessels. A computed tomography scan showed an ill-defined, isodense mass [Figure 2] in the anterior orbit infiltrating the left medial rectus muscle (yellow arrow). An incisional biopsy was planned to ascertain the diagnosis. However, during the preoperative work-up, deranged blood counts prompted a peripheral blood smear to be performed, which showed the presence of blast cells in a background of hypochromic microcytic anaemia. A bone marrow aspirate confirmed the diagnosis of acute myeloid leukemia. The child was initiated on chemotherapy but succumbed to sepsis within 2 months of treatment.