Common hematological disorders in children

Appropriateness of Hospital Admission and Length of Stay in the Pediatric Department of a Tertiary Care Hospital in West Bengal

Background

Appropriateness of admissions and inpatient length of stay (LOS) are important factors controlling health-care expenditure. The current study was conducted to assess the proportion of appropriate admissions among 29-day to 12-year--old aged patients admitted to pediatric wards of a tertiary health-care center in one month and evaluate inappropriate LOS among them.

Materials and Methods

An observational longitudinal study was carried out for two months among patients admitted to the pediatric inpatient department using Pediatric Appropriateness Evaluation Protocol (PAEP)-II tool. All patients admitted to the institution during the study period were included in the study.

Results

Among 495 children, 438 (88.5%) were appropriately admitted. Inappropriate admission was mostly found in children aged 1 to 5 years (29, 16.6%), those who lived >5 km from the hospital (45, 15.2%), and those who presented with other systemic illnesses (13, 31.7%). Among the appropriately admitted children, 333 (76%) met the criteria of appropriate LOS during their hospital stays. Multivariable logistic regression showed that the age of the children (AOR = 0.99; 95% CI = 0.98, 0.99), age-appropriate feeding (AOR = 2.12;95% CI = 1.30,3.47), and hematological disorder (AOR = 0.16; 95% CI = 0.05, 0.52) were found to be associated with the children being kept at the hospital inappropriately.

Conclusions

The current study observed a high proportion of appropriate admission in children. However, a higher proportion of inappropriate LOS among them was seen. The younger age group, age-appropriate feeding, and type of illness were found as the primary predictors for inappropriate LOS.

Occult HBV infection in multi transfused thalassemia patients

OBJECTIVE

To determine the prevalence of Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection in multitransfused thalassemic patients, with an aim to further highlight the need for donor screening strategy with supplementary molecular diagnostic tools for high risk population.

METHODS

The study was conducted in 174 thalassemic subjects from Thalassemia unit of Central Red Cross Blood Bank, Cuttack, Odisha, India. Sero molecular diagnosis was followed to detect antigen, antibody and DNA in the study subjects.

RESULTS

Prevalence of antibody to Hepatitis C, HBsAg, Anti HBs and Anti HBc were found to be 3.4 %, 0.5 %, 30.4 % and 21.8 % respectively. HBV seropositivity increased with increase in number of transfusions. Anti HBc was 12 %, 26.8 % and 71.4 % in subjects who received <40, 40-80 and >80 units of transfusions respectively. HBV DNA was detected in 50 % (3/6) of subjects having anti HBc as the only marker (Occult HBV infection). More so, it was detected in 16.12 % (5/31) of cases who were sero positive for both Anti HBs and Anti HBc.

CONCLUSIONS

These results indicate that thalassemic subjects need detailed screening of transfusion products. Fifty percent of occult HBV infection is a major concern suggesting inclusion of viral DNA amplification test along with antigen/antibody detection.