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AIMS: To analyze various changes in the red blood cell (RBC) parameters in patients with chronic kidney disease (CKD) and to correlate it with the stage of the disease. MATERIALS AND METHODS: The following parameters were analyzed in 300 diagnosed cases of CKD: RBC count; hemoglobin (Hb); hematocrit; mean corpuscular volume (MCV); mean corpuscular hemoglobin (MCH); MCH concentration (MCHC); serum iron profile (serum total iron, total iron-binding capacity, and serum ferritin levels); and peripheral smear, blood urea, and serum creatinine levels. The data were retrieved from the laboratory information system, and SPSS version 20 was used for statistical analysis. RESULTS: The mean age of presentation was 52 ± 14 years. The male-to-female ratio was 4.3:1. The mean RBC count was 3.29 ± 0.79 × 10⁶/μl, and a significant fall was noticed as the stage of CKD progressed. 74% and 60% of patients with Stage 4 and 5 CKD, respectively, showed Hb of <10 g/dl. Correlation of MCV, MCH, and MCHC values with stages of CKD was statistically not significant. One hundred and six (59%) patients had anemia of chronic disease as per the serum iron profile. 94% of patients showed normocytic normochromic RBC picture on peripheral smear and 21% showed features of hemolysis. CONCLUSION: Anemia is a leading cause of morbidity in patients with CKD and it worsens with the stage of the disease. Evaluation of Hb and RBC parameters in patients with CKD helps in classifying the type of anemia and aids in choosing the correct treatment modalities and avoids unnecessary iron overload in these patients.

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Background: Data on frequency distribution of ABO Rh blood group in pediatric dengue patients are not available. Dengue disease an emerging arthropod borne infection of public health concern belongs to Flaviviridae. The studies defining the relationship between blood groups and dengue disease and its severity are limited. Blood group antigens are generally known to act as receptors for various etiological agents. Hence, we hypothesized there will be an association between blood group and dengue disease and its severity and conducted this case-control study. Study Design: Hospital-based case-control study. Materials and Methods: Study was conducted in department of pediatrics, 244 pediatric subjects (age group 1 - 13 years) were enrolled divided into cases who were admitted cases of dengue (119, 65 males, 64 females) and controls who were attending outpatient department for various other ailments. (125, 67 males, 58 females) and demographic data (age, gender, blood group, and dengue infection status) were collected from them. The risk of acquiring dengue disease and severity and its association with factors such as blood group, gender were analyzed statistically. Results: The data of this study showed a possible association between blood groups of the study population with dengue infection. We observed that dengue infections were higher in individuals with O positive blood group 42.8% when compared with controls 32%. (P = 0.043) But blood groups were not associated with severity of infection. These data present further evidence for the association of the blood groups, gender to susceptibility to dengue infection. Further studies are needed to confirm these findings. Conclusion: Dengue disease is more common with blood group O. But severity of the disease is not associated with any blood groups.

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Dimorphic anemia (DA) is characterized by two different cell populations. One population is of microcytic hypochromic and other being either normocytic or macrocytic. A retrospective study was undertaken to correlate and compare the clinico-hematological parameters in DA done over a period of 6 months. All cases of anemia diagnosed during this period were analyzed and all cases diagnosed as DA in the peripheral blood smear (PBS) were included in the study. In PBS, dual population was seen in 17.5% of cases of anemia (178), comprising microcytic hypochromic with normocytic normochromic red blood cells in 37.1% of cases (66) or macrocytes in 62.9% of cases (112). Pancytopenia was seen in 9.55% (17) cases and bicytopenia in 50.5% (90) patients. Only eight cases had bone marrow correlation. All marrows were hypercellular showing megaloblastic erythropoiesis. DA is one of the common anemia but is an undermined entity. In low-resource settings, clinical and hematological parameters are of paramount importance for diagnosis and guiding treatment.

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Context: Manual examination of peripheral blood smear in diagnosis of anemia has taken a backseat with the advent of automated counters. Though a lot of studies have been done to assess the efficacy and significance of red blood cell parameters in different hematological conditions fewer efforts have been made to standardize the visual examination of peripheral blood smears for diagnosing anemias. Aims: Standardization and grading of abnormal red cell morphology in peripheral blood smear and counter based red cell indices in cases of anemia of various etiologies. Settings and Design: Cross-sectional study of one year duration conducted in the Hematology laboratory, in a tertiary care hospital in North India. Materials and Methods: In 60 anemic patients, automated counts and peripheral blood smear were prepared and evaluated by three observers, according to a red cell morphology grading guide. Statistical Analysis Used: ANOVA, Tukey post hoc test were used. Results: Objective grading of peripheral blood smears in cases of anemia have a good inter observer correlation and hence have reduced subjective variation. Manual parameters like microcytosis, macrocytosis and hypochromia expressed as a percentage, have shown significant correlation, with their corresponding automated parameters, and the regression model so generated may provide a novel way for quality control of automated counters, if calculated for different models. Conclusions: Even in the age of molecular analysis, the blood smear remains an important diagnostic tool and sophisticated modern investigations of hematologic disorders should be interpreted in the light of peripheral blood features as well as the clinical context.

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INTRODUCTION: Sickle cell anemia (SCA) is an autosomal recessive illness caused by the formation of abnormal hemoglobin S. Sickle cell disease has many complications such as vaso-occlusive crisis (VOC), gallstones, stroke, acute chest syndrome (ACS), and others. OBJECTIVES: This study aimed to describe the epidemiology and characteristics of sickle cell patients admitted to hospitals in Jazan region. MATERIALS AND METHODS: A cross-sectional study conducted in four hospitals in Jazan region including King Fahad Central Hospital, Prince Mohammed Bin Nasser Hospital, Sabya, and Abu-Arish General Hospital to estimate the prevalence of admitted sickle cell patients and their characteristics. All patients admitted to medicine and pediatric wards from July 15, 2018, to August 15, 2018, were included in the study. Data were collected by interview. RESULTS: Four hundred and two of 446 patients have agreed to participate with a response rate of 90%. Ninety-one (22.6%) were SCA patients, among them, 45 (49.5%) were male and 46 (50.1%) were female, with a mean age of 18.81 ± 11.05 years. Most of them were admitted due to VOC 56% (n = 51) and ACS 12.1% (n = 11). Almost all sickle patients had VOC 91.2% (n = 83), and more than half of them had ACS 58.2% (n = 53) as a complication. CONCLUSIONS: SCA was the number one cause of admissions in this study. Approximately, one out of each four patients admitted to Jazan hospitals is a sickle cell patient. VOC represents the most frequent complication of sickle disease, followed by ACS. Further studies and interventions to reduce this burden and improve sickle cell patients' health status are recommended.

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Glanzmann thrombasthenia is a rare disorder, due to quantitative and/or qualitative abnormalities of the platelet integrin αIIbβ₃ and/or αIIbβ3. Although it is considered a rare disorder with a global incidence of 1/1,000,000 population, the case is different at the Gulf Cooperation Council countries, where prevalence rate as high as 1/40,000 in Madinah, Saudi Arabia. This makes it necessary to develop patient's management guidelines. Due to limited resources in the literature, experts' consensus was important to develop such guidelines. Experts panel elected to use recombinant activated factor VII (rFVIIa) as the first line of treatment of acute bleeds and reserve platelets transfusion for nonresponding patients or severe bleeds, rFVIIa at high dose (270 μg/kg body weight) may tried upfront. rFVIIa may be tried as prophylactic treatment in patients with frequents bleeds. Experts panel elected to allow girls with Glanzmann thrombasthenia to have menstruation and to adapt a special protocol for this purpose (Madinah protocol). Pregnancy should be managed carefully, where normal delivery encouraged under coverage of rFVIIa. Risk of bleeding should be expected in neonates. Minor surgeries and dental workup can be managed under coverage of rFVIIa. Glanzmann thrombasthenia patients with severe disease should be encouraged for hematopoietic stem cell transplant.

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BACKGROUND: In India, hemoglobinopathy screening programs focus on reducing the burden of beta-thalassemia by screening the antenatal females and young adolescents. Although alpha (α)-thalassemia is common in the Mediterranean countries, alpha (α)-thalassemia screening and diagnosis are performed in a few centers in India. HbH disease is an uncommon clinical phenotype of α-thalassemia with variable clinical presentation. The hallmark feature of HbH is the presence of golf ball inclusions in the red cells demonstrated with supravital staining. PATIENTS AND METHODS: Here, we discuss an algorithmic approach to screen hemograms for thalassemic indices, followed by evaluation of reticulocyte preparation after 40 minutes (supravital stain preparation for golf ball inclusions). If golf ball inclusions were positive, Hb analysis on Hb-capillary zone electrophoresis (Hb-CZE)was done. RESULTS: We received 28,000 samples for complete hemogram and blood film examination, over a period of 8 months. Reticulocyte count was required in 11,600 samples out of which 13 cases were positive for golf ball inclusions. Of these, nine were identified as HbH disease on Hb-CZE. These patients presented with pallor and generalized weakness. On examination, jaundice (3/9 patients) and hepatosplenomegaly (4/9 patients) were relatively uncommon. The majority of them (6/9) required infrequent blood transfusions. All patients had microcytic hypochromic red cell indices with median HbA of 89% (range: 68.1%–96.9%), HbA2 of 1.4% (range: 0.8%–1.7%), and fast-moving band in zone 15 (HbH) of 5.6% (range: 1.4%–30.3%) on Hb-CZE. CONCLUSION: We emphasize a systematic screening of hemograms and peripheral smears along with a simple and cost-effective screening test for golf ball inclusions to diagnose HbH disease that often poses a clinical dilemma due to its variable clinical presentation.

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Hemophilia is an X-linked heritable coagulopathy with an overall prevalence of approximately 1 in 10,000 individuals. The most common form is factor VIII deficiency (hemophilia A), which comprises approximately 80% of cases. Factor IX deficiency (hemophilia B), comprises approximately 20% of cases. In patients with hemophilia, regular replacement therapy with clotting factor concentrates (prophylaxis) is effective in preventing recurrent bleeding episodes into joints and muscles. However, despite this success, intra-articular and intramuscular bleeding is still a major clinical manifestation of the disease. Bleeding most commonly occurs in the knees, elbows, and ankles, and is often evident from early childhood. The pathogenesis of hemophilic arthropathy is multifactorial, with changes occurring in the synovium, bone, cartilage and blood vessels. Recurrent joint bleeding causes synovial proliferation and inflammation (hemophilic synovitis) that contribute to end-stage degeneration (hemophilic arthropathy); with pain and limitation of motion severely affecting patients' quality of life. The author conducted a comprehensive review and synthesis of the relevant literature. The author reviewed all compiled reports from computerized searches. Searches were limited to English-language sources and human subjects. Literature citations were generally restricted to published manuscripts appearing in journals listed in Index Medicus and reflected literature published up to July 1, 2013. The aim of this updated paper is to provide comprehensive and timely evidence-based guidelines and recommendations on the treatments of damaged joint among hemophilia patient. Further recommendations included the control of risk factors, interventional approaches for treatment of hemophilia, the use of bypassing factors for the inhibitors, and preventing recurrent bleeding especially in high-risk populations are provided. Prophylaxis by replacement of the missing factor in patients with hemophilia is the optimal way to prevent the occurrence of haemarthrosis and thereby the onset of arthropathy, provided that it is started early in life. Dosing should be individualized and increased in case of bleeding. Prevention of bleeding episodes through early treatment will prevent accumulation of blood in joint and the subsequent inflammation and potential hemophilic arthropathy. Treatment must be maintained until bleeding remission and patients have recovered as much of their ROM and muscular strength as possible. Clinical evaluation of the joints, gait, motion, muscle tone, functional level of disability, pain, and swelling, as well as imaging techniques, must be performed to assist in the diagnosis of chronic synovitis and to guide treatment decisions. The first step to treating synovitis, refractory to medical treatment, is the use of synovectomies, non-surgical or surgical interventions. In many cases, joint deformities have to be treated by open orthopaedic surgery. State-of-the-art treatment of patients with hemophilia requires a multidisciplinary team. Level of evidence: Level III (Systematic Literature review).

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BACKGROUND: Glucocorticoids (GCs) may cause leukocytosis through several mechanisms. The objective of this study was to examine the impact of a single-GCs dose on total white blood cell (WBC) count, absolute neutrophil count (ANC), and absolute lymphocyte count (ALC) in hospitalized adults without bacterial infections. METHODS: This retrospective cohort study included hospitalized patients ≥18 years of age who received a single dose of a systemic GC (oral or intravenous methylprednisolone and hydrocortisone and oral prednisone). Total WBC count, ANC, and ALC changes over the 72 h after GC administration were evaluated. RESULTS: A total of 99 patients were included. After the administration of a single-GC dose, ALC began to drop significantly as early as the interval of 0–<6 h (median interquartile range, 0.90 [0.60–1.10], P = 0.011). ANC increased significantly as early as the interval of 6–<12 h (6.22 [4.45–7.33], P = 0.049) and continued to be significantly increased from baseline up to 42 h from GC administration. Total WBC counts significantly decreased in the 6–<12 h interval (6.90 [5.15–8.85], P = 0.03) and then increased significantly in the 12–<18 h interval (8.80 [6.50–11.95], P = 0.002). This effect on total WBC count continued to be significant until the 36-<42 h interval (10.55 [7.23–13.03], P < 0.001). CONCLUSIONS: ANC followed by WBC count increased significantly after a single-GC dose in hospitalized patients within 12 h of a single-GC dose, while a decrease in WBC and ALC was seen within the first few hours of GC dose.

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BACKGROUND: Automated hematology analyzers effectively reduce turnaround time and generates scattergrams which can be used to screen for different hematological conditions. AIMS: We wish to study the scattergrams generated by the Sysmex XN-series analyzer for confirmed cases of hematological malignancies and evaluate for the specific patterns to these malignancies. METHODS: Two hundred and ninety-one newly diagnosed cases of various hematological malignancies were included in the study. All these cases were diagnosed and classified in accordance with flow cytometry, bone marrow morphological study, immunohistochemistry, and molecular studies. Forty-eight cases of leukemoid reaction were also included in the study. We retrieved the scattergrams and complete blood count data of all these cases which were processed in the Sysmex XN-analyzer before their diagnosis. Along with scattergrams, the peripheral blood smear findings of all the cases were extracted too. The scattergram patterns in the white blood cell differential (WDF) and white cell nucleated region (WNR) channels were evaluated and correlated with their peripheral blood smear findings. RESULTS: All the scattergrams in the WDF and WNR channels were studied. Patterns seen in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were striking and distinctly separate. After correlating with the peripheral smear and immunophenotyping, AML patterns were subtyped by the French American British classification. Acute promyelocytic leukemia as well as different phases of chronic myeloid leukemia had unique patterns. Scattergram patterns of ALL had minute difference with that of chronic lymphoproliferative disorder. CONCLUSION: In high-volume laboratories, the patterns on Sysmex XN-series analyzer scattergrams can be used as a valuable aid for suspecting and triaging cases of hematological malignancies.

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OBJECTIVES: This study's objectives are to (1) determine the current prevalence of iron-deficiency anemia (IDA) and risk factors for female college students at Prince Sultan Military College of Health Sciences (PSMCHS) in the Eastern Province of Saudi Arabia and (2) address the gap in the current literature. A written survey in both Arabic and English was administrated to 214 female students, and only 201 students completed the survey. It was randomly selected from all registered female students. A number of factors possibly associated with IDA were examined using the Chi-square test. CONTEXT: Globally, iron deficiency is known to be the most common nutritional disorder. About 30% of the world's population are iron deficient (ID). Women seem to be more affected with IDA than men, which constitute an epidemic public health issue. AIMS: The aim of the study was to determine the prevalence of IDA and the risk factors among healthy Saudi undergraduate female college students studying at PSMCHS in Dhahran. SETTINGS AND DESIGN: A cross-sectional study on 201 female students (18–25 years) was conducted between January and March 2019. SUBJECTS AND METHODS: A questionnaire which contains sociodemographic data was completed by each participant. Two blood samples were collected from each participant to estimate the iron profile and to analyze the complete blood counts. STATISTICAL ANALYSIS: The statistical analysis was carried out using the Statistical Packages for the Social Sciences software. RESULTS: The overall prevalence of IDA was 35.3%. The questionnaire analysis of the dietary habit and clinical characteristics revealed that family history of hereditary disease and physical activity have a significant effect on the development of IDA. Statistical analysis showed that having breakfast regularly significantly reduced the development of IDA compared with irregularly having breakfast. CONCLUSIONS: The prevalence of IDA in this study was moderately high, and our results suggest that further education regarding IDA is highly encouraged. This is the first study that demonstrated the prevalence and risk factors of IDA among undergraduate female college students in PSMCHS, and the data generated will provide a database for further studies.

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In recent years, numerous alternatives to VKAs have been developed, the first competitors to warfarin are the novel oral anticoagulants (NOAC) or better referred to as Direct Oral Anti-Coagulant (DOAC) or Target Specific Oral Anti-coagulant (TSOAC): These drugs have definite advantages and disadvantages that should be clear to the physicians before prescribing any of them for patients. Many clinical trials, which involved thousands of patients provided definite information about the efficacy and the safety of DOACs, yet, many physicians remain reluctant to prescribe these drugs due to lack of answers to real world questions. The concerns are directed towards appropriate patient selection (The choice should be made according to age, renal function, compliance, cost, clinical condition, intake of other drugs), the mechanism of switching between agents. How to manage regarding any procedural measurement? How these drugs affect routine laboratory tests and when do we need monitoring? Knowledge of other drugs that interact with the DOAC and management of severe bleeding will be reviewed and recommendations will be given to all these concerns.

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Recent advances in prenatal diagnosis and multidisciplinary management has improved the reproductive outlook for carriers of hemophilia and their offspring. Pre-pregnancy planning allows the woman and her partner to explore reproductive options and prepares the family for the potential delivery of an affected male infant. Non-invasive methods of prenatal diagnosis are advancing, with the aim of providing a definitive test for hemophilia. Carriers of hemophilia have an increased risk of primary and secondary postpartum hemorrhage. The affected male offspring is potentially at risk of cranial bleeding during delivery. A multidisciplinary approach provides advanced planning for the optimum mode of delivery and provision of appropriate haemostatic cover to reduce the risk of bleeding complications. This review summarises current recommendations for pregnancy management in carriers of hemophilia, from the initial pre-pregnancy counseling through to delivery and care of the neonate.

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Context : Various hemoglobinopathies are one of the major public health problems of India. Aims: High performance liquid chromatography (HPLC) is a speedy and accurate tool for diagnosis of various hemoglobinopathies. In present study about 7,000 cases have been studied for identification of various hemoglobin (Hb) disorders in western India. Settings and Design : Study is conducted from May 2010 till April 2013 for various hemoglobinopathies and variants. The geographical distribution of all cases included states of western India. Materials and Methods: Complete blood count (CBC) is done on CELL DYN 3700 analyzer and then HPLC is performed on BIO-RAD 'VARIANT II' (beta thalassemia short program) in samples received in our laboratory. Simple Statistical analysis is done with help of Microsoft Office Excel 2007. Results: A total of 7,261 cases were included in our study, out of these 1,615 (22.24%) cases showed abnormal Hb fractions. The major abnormality observed was of high HbA2, a cutoff value of > 3.9% was considered for diagnosis of beta thalassemia trait (BTT). A total of 839 cases (11.55%) of BTT were diagnosed. Other hemoglobinopathies were also identified in varying proportions. Conclusions: HPLC is simple, accurate, and superior technique combined with complete automation makes it an ideal method for diagnosis of hemoglobinopathies.

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Objective: The aim was to evaluate the efficacy and safety profile of dapsone as a cheap second-line treatment for chronic immune thrombocytopenia (ITP) in developing countries. Materials and Methods: A prospective study on 100 chronic ITP patients. These patients were put on dapsone after ruling out glucose 6 phosphate dehydrogenase deficiency and secondary causes of ITP. Results: The basic work up for secondary causes of ITP was negative. All these patients had been treated with steroids in the past. Anti-D had been given acutely in 20 patients, and intravenous immunoglobulin G had been given in 10 patients. Vincristine had been given to 20 of these patients. Dapsone was started in these patients, and 44% patients showed a response to treatment. The mean time to onset of response was 21 days. Out of these 44 patients, 21 (47.7%) went into remission and had platelet count >100,000/μl at 2 years post tapering of the treatment. Remaining 23 patients were kept on low dose dapsone and maintained their platelet counts. Adverse drug reactions included mild skin eruptions in 5% of patients, pruritus in 10% of patients, dose-related hemolysis in 1% of patients, methemoglobinemia in 1% of patients and Stevens Johnson syndrome in 1% of patients. 56 patients were nonresponders to the available, affordable conventional medical treatment and were referred to the surgical department for splenectomy, with a cure rate of 86% postsurgery. Conclusions: Dapsone is a safe, cheap and effective treatment option for patients with chronic ITP, who cannot afford the usual costlier second-line drugs.

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Tuberculosis (TB) is a mycobacterial infectious disease that can affect any organ system. The wide varieties of manifestations that TB can present with make the disease a challenge for treating physicians. Anemia is commonly seen in patients with TB, and it is usually anemia of chronic disease. However, the occurrence of autoimmune hemolytic anemia in the setting of TB infection is rare.

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Introduction: Standard guidelines assert that any vacutainer, which is 10% less under-filled should be rejected as it may affect the results. These guidelines refer to the studies using liquid K ₃ -ethylene diamine tetra acetic acid (EDTA). Although the new guidelines recommend K ₂ -EDTA instead of earlier K ₃ -EDTA but has not clearly commented upon whether the same holds true for the new anticoagulant K ₂ -EDTA. Materials and Methods: Blood samples from 100 healthy blood donors were included. We took 7-8 ml of blood and was then transferred to three 3 ml capacity vacutainers-up to 3 ml, 2.5 ml, 1 ml (marked a, b, c respectively) containing spray-dried K ₂ -EDTA as anti-coagulant. Thus, b and c vacutainers were under-filled. Hematological parameters in all the samples were analyzed immediately using automatic analyzer (Cell Dyn). Statistical analysis was done with the help of SPSS v. 17.0 (Chicago, IL, USA) using one-way ANOVA. Results: The results showed that three groups were comparable with respects to hemoglobin, hematocrit, total leukocyte count, differential leukocyte counts, total platelets, mean corpuscular volume, mean hemoglobin concentration, mean cellular hemoglobin concentration along with red cell distribution width. Conclusion: Our study suggested that under-filling till 67% (1 ml in 3 ml standard capacity) of the recommended volume in a spray-dried K ₂ -EDTA vacutainers did not affect hematological parameters in healthy people. In view of these results, there is need to further investigate the same in diseased. If further studies done on under filling of the pathological samples also give similar results as in our study then only the present guidelines related to under filling could be revised when K ₂ -EDTA is used as an anticoagulant.

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Paroxysmal nocturnal hemoglobinuria (PNH) is an acquired, rare clonal blood disorder, characterized by chronic intravascular hemolysis, bone marrow failure, renal failure and pulmonary hypertension, and a heightened risk of thrombotic complications. PNH etiology is an Υ-linked gene somatic mutation of the phosphatidylinositol glycan class ΐ (PIG-A ), that results in deficiency of the glycosylphosphatidylinositol anchor structure responsible for fixing a wide spectrum of proteins on blood cell membranes, absence of these proteins, particularly CD55 and CD59, dysregulates the complement on cell membranes and results in significant chronic complement-mediated hemolysis. Early diagnosis of PNH is crucial for effective disease management. However, the heterogeneity of clinical symptoms and rarity of this disease usually results in untimely diagnosis, severe disability of patients, and increased risk of fatal complication. These recommendations are formulated by a panel of experts from the gulf cooperation countries. This information reflects their experience and to assist specialists looking after PNH patients, including hematologists, nephrologists, dialysis specialists, gastroenterologists, cardiologists, and surgeons.

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Primary familial and congenital polycythemia (PFCP) is a rare autosomal dominant disorder caused by hypersensitivity of erythropoietin receptor of erythroid progenitors leading to increased rate of erythropoiesis at any given serum erythropoietin level. The hallmark of this disorder is isolated erythrocytosis with the absence of splenomegaly and lack of secondary causes of polycythemia. In this short review, we will shed light on various aspects of PFCP with special focus on molecular pathogenesis and diagnostic approach.

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Context: Pancytopenia is not a disease but a clinico-hematological entity encountered in clinical practice. A prompt intervention is required to avoid complications, which can occur in these patients. The relevant clinical history and complete hematological workup is required to treat patient of pancytopenia. The severity of pancytopenia and the underlying pathology determines the management and prognosis. Aims: To diagnose different conditions producing pancytopenia on the basis of clinical, hematological and bone marrow studies. To estimate the frequency of different diseases producing pancytopenia. Subjects and Methods: The study was conducted in Department of Hematology of our college in capital city of India. A prospective study was carried out among 100 consecutive patients with pancytopenia. Blood samples of the patients were analyzed for red cells, white cells and platelets morphology along with presence and absence of immature cells and abnormal cells. In bone marrow examination, morphology of all cells lineage, cellularity, parasite and abnormal cells were scrutinized. Trephine biopsy was done where ever indicated. Results: The age of patients ranged from 5 to 80 years. 74% of patients in this study were vegetarian. The most common cause of pancytopenia was megaloblastic anemia (66%) followed by aplastic anemia (18%), malaria (6%), kala-azar (4%), acute myeloid leukemia (2%), multiple myeloma (2%), myelodysplastic syndrome (1%), and tuberculosis (1%). Conclusions: The present study concludes that detailed primary hematological investigations along with bone marrow examination in cytopenic patients is helpful for understanding disease process, to diagnose or to rule out the causes of pancytopenia. It is also useful in planning further investigations and management.

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Myelodysplastic syndromes (MDSs) constitute a heterogeneous group of clonal hematopoietic disorders. A panel of Saudi hematologists representing the Saudi MDS Working Group convened with two international experts to develop the guidelines for MDS diagnosis and treatment. The recommendations were formulated on the basis of a list of real cases and therapy-related questions. The diagnostic procedures should help distinguish MDS from other causes of cytopenia and dysplasia and other clonal stem cell disorders. Blood smear, bone marrow aspirate and biopsy, and cytogenetic testing are among the mandatory diagnostic tests in MDS. Higher resolution genetic testing like mutational analysis and single nucleotide polymorphisms can be suggested for the workup depending on the clinical condition and availability of these technologies. The Working Group stressed that the heterogeneity of MDS strongly withstands a risk-adapted treatment strategy based on the international prognostic scoring system risk group of patients.

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Context: Role of youngsters in voluntary blood donation (VBD) is crucial to meet the demand of safe blood. Therefore understanding the various factors contributing to knowledge, attitude, and practice of VBD among college students is important. Aims: The present study aims to assess the level of knowledge, attitude, and practice regarding blood donation among the health care students. Settings and Design: Cross-sectional study done at Anand from July 2012 to December 2013. Subjects and Methods: A cross-sectional study was conducted among 1000 health care medical students at Anand, Gujarat, India using a structured survey questionnaire. Statistical Analysis Used: The data were tabulated, and master chart was prepared. Analysis was performed by using the percentage. Results: Overall knowledge on blood donation among respondents was 37.3%, majority of the participants (78.7%) never donated blood in which 43.7% of the nondonors had negative attitude like blood donation leads to weakness (10.2%), anemia (25.5%), and 8.0% of nondonors felt that blood donation leads to reduced immunity. Majority of nondonors showed a positive attitude (53.1%) by expressing their willingness to donate blood if they were asked to donate blood (35.3%), about 9.8% of the nondonors don't know the importance of blood donation and 11.2% of nondonors don't know where to donate blood. In this study, 11.5% of students had donated blood only once, in which 38.8% of blood donors said no privacy was provided while donation, few (12.2%) had experienced some discomfort after donation and 50.4% of respondent said that they have not tried again. Conclusions: The present study recommends that even health care students' needs to be educated about the importance, awareness and motivation of blood donation on a regular basis and addressing the problems faced, while blood donation will strengthen the recruitment and retention of blood donors to donate blood on a regular basis.

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Background: Donor reaction has the most negative impact on the blood donor return rate. Amelioration of some adverse events has the potential to improve return rate. This study was initiated with the aim to determine the frequency of various adverse reactions. Materials and Methods: The study was conducted over a period of 7 years and 1 month, from July 1, 2007, to August 31, 2014. The donor population analyzed consisted of 27,664 donors (26,557 males and 1107 females). Results: Only 195 donors (0.7%) suffered some adverse reactions. One hundred and fifty-eight (0.57% of the subjects) had mild reactions (agitation, sweating, giddiness, pallor, cold feeling, sense of weakness, nausea), and only 37 (0.13% with 10 females and 27 males) had more severe reactions (including vomiting, fainting, loss of consciousness, and convulsive syncope). Conclusions: Although the number of donors who developed adverse reactions during or immediately after the blood donation was very low, still it is very important to reduce risks to a minimum so that donor return rate could be maintained.

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BACKGROUND: Prolonged use of pentazocine in sickle cell disease (SCD) because of chronic pain may result in mental dependence (addiction) and/or physical dependence leading to withdrawal symptoms on suddenly stopping its use. This study was aimed at determining the prevalence of pentazocine addiction among SCD patients and health-care worker (HCW) perception on its use. MATERIALS AND METHODS: This was an interviewer-administered, questionnaire-based, cross-sectional study. The study involved clients attending the Lagos State University Teaching Hospital sickle cell clinic and the hospital HCWs. Consenting participants filled a World Health Organization structured questionnaire developed and extracted from ASSIST which is A - Alcohol, S - Smoking and S - Substance, I - Involvement, S - Screening, and T - Test. The HCWs were evaluated using a pretested, validated questionnaire. RESULTS: A total of 350 participants were recruited consisting of 169 (48.3%) males and 181 (51.7%) females. ASSIST report showed 88% of them had low score of 0–3, 10% had moderate score of 4–26, while 2% (7 of 350) had high score of >27. A total of 61 HCWs were interviewed, and 18% and 8.2% of them believed 40%–60% and more than 60%, respectively, of the SCD patients were addictive to pentazocine. CONCLUSION: While the issue of drug addiction should not be ignored, the appropriate treatment of SCD patients in Nigeria who are prevented from getting high-quality care should be appropriately addressed. The risk of addiction is overestimated among HCW.

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