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Naithani R, Seth T, Tandon N, Chandra J, Pati H, Choudhry VP. Safety of Zoledronic Acid in Patients with Thalassemia Associated Low Bone Mineral Density. Indian J Hematol Blood Transfus 2018; 34:345-346. [PMID: 29622881 DOI: 10.1007/s12288-017-0858-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 08/01/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rahul Naithani
- 1Hematology and Bone Marrow Transplantation Unit, Max Superspeciality Hospital, Saket, New Delhi, India.,2Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - Tulika Seth
- 2Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - Nikhil Tandon
- 3Department of Endocrinology and Metabolism, All India Institute of Medical Science, New Delhi, India
| | - Jagdish Chandra
- 4Division of Pediatric Hemato-Oncology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - H Pati
- 2Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - V P Choudhry
- 2Department of Hematology, All India Institute of Medical Science, New Delhi, India
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Naithani R, Seth T, Tandon N, Chandra J, Pati H, Saxena R, Choudhry VP. Fractures and Low Bone Mineral Density in Patients with Beta Thalassemia Major. Indian J Hematol Blood Transfus 2017; 34:163-165. [PMID: 29398822 DOI: 10.1007/s12288-017-0820-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/19/2017] [Indexed: 12/01/2022] Open
Affiliation(s)
- Rahul Naithani
- 1Department of Hematology, All India Institute of Medical Science, New Delhi, India.,4Division of Hematology and Bone Marrow Transplantation, Max Super Speciality Hospital, New Delhi, India
| | - Tulika Seth
- 1Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - Nikhil Tandon
- 2Department of Endocrinology and Metabolism, All India Institute of Medical Science, New Delhi, India
| | - Jagdish Chandra
- 3Division of Pediatric Hematology-Oncology, Department of Pediatrics, Lady Hardinge Medical College and Kalawati Saran Children's Hospital, New Delhi, India
| | - H Pati
- 1Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - Renu Saxena
- 1Department of Hematology, All India Institute of Medical Science, New Delhi, India
| | - V P Choudhry
- 1Department of Hematology, All India Institute of Medical Science, New Delhi, India
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Abstract
The incidence of hereditary hemorrhagic disorders may vary according to the country and ethnic origin. Von Willebrand disease has emerged as the most common hereditary hemorrhagic disease in the industrialized world. In this series of 966 patients diagnosed to have inherited bleeding disorders, hemophilia A was the most common and was seen in 410 (42.4%) of the patients followed by platelet function defects seen in 380 (39.4%) of the patients. It is thus concluded that, similar to the white population, hemophilia A remains the most common bleeding disorder in the Indian population, although this is closely followed by platelet function defects in India, which are quite rare in whites. Von Willebrand disease is relatively rare in the Indian population.
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Affiliation(s)
- Meenal Gupta
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, 110 029, India
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4
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Bhattacharya M, Biswas A, Ahmed RPH, Kannan M, Gupta M, Mahapatra M, Choudhry VP, Saxena R. Clinico-Hematologic Profile of Factor XIII-Deficient Patients. Clin Appl Thromb Hemost 2016; 11:475-80. [PMID: 16244775 DOI: 10.1177/107602960501100416] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A retrospective analysis of clinico-hematologic parameters of 18 factor XIII-deficient patients was carried out. The hematologic tests included activated partial thromboplastin time (APTT), prothrombin time (PT), and clot solubility. Laboratory diagnosis of FXIII deficiency was made where bleeding time, PT, APTT, and thrombin time were normal and the clot solubility test result with 5M urea was positive. Factor XIII level with family screening was performed using commercially available kits. History of prolonged bleeding from the umbilical stump was present in four (22.2%) patients. The most common site of bleeding was the skin (11 of 18 patients). Three patients were given prophylaxis (FFP in two, factor XIII in one). A high prevalence of recurrent abortion in female pa tients with FXIII deficiency (two of the three patients in this study) was observed.
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Affiliation(s)
- M Bhattacharya
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Bhattacharya M, Biswas A, Kannan M, Mishra P, Kumar A, Choudhry VP, Saxena R. Clinicohematologic Spectrum in Patientswith Lupus Anticoagulant. Clin Appl Thromb Hemost 2016; 11:191-5. [PMID: 15821825 DOI: 10.1177/107602960501100208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A retrospective analysis of clinicohematologic parameters of 25 patients with lupus anticoagulant was carried out. The hematologic tests included dilute Russel viper venom test (dRVVT), kaolin clotting time (KCT), activated partial thromboplastin time, and prothrombin time. The diagnosis of lupus anticoagulants was based on the presence of prolonged KCT/dRVVT, its absence of correction with normal plasma and correction by phospholipids. Specific factor assays and platelet aggregation studies were performed wherever required. Ten patients (40%) had thrombosis, which was venous in 5 (50%) and arterial in 4 (40%). One patient (10%) had both arterial and venous thrombosis and presented with catastrophic antiphospholipid syndrome. Eighteen female patients conceived. Four (22%) of these had recurrent first trimester abortion. Five (20%) patients had bleeding manifestations. One (4%) of these had hypoprothrombinemia and was diagnosed to have hypoprothrombinemia lupus anticoagulant syndrome. However in two of these patients, no cause of bleeding could be identified other than the presence of lupus anticoagulants. It is concluded that patients with lupus anticoagulant have a varied spectrum of hemostatic disorders. Bleeding may sometimes occur in these patients due to associated thrombocytopenia or associated factor inhibitors. Rarely, it may occur due to presence of lupus anticoagulants alone.
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Affiliation(s)
- M Bhattacharya
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Dixit A, Chatterjee T, Mishra P, Kannan M, Choudhry DR, Mahapatra M, Choudhry VP, Saxena R. Disseminated Intravascular Coagulation in Acute Leukemia at Presentation and During Induction Therapy. Clin Appl Thromb Hemost 2016; 13:292-8. [PMID: 17636191 DOI: 10.1177/1076029607302435] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Between January 2001 and December 2003, 67 patients with acute leukemia were evaluated prospectively for hemostatic abnormality at presentation, of which 43 (64.2%) had acute lymphoblastic leukemia and 24 (35.8%) had acute myelogenous leukemia. At presentation, 27 patients (40.3%) had bleeding manifestations. Thrombocytopenia was present in 57 patients (85%), and 33(49.3%) had some abnormality of global coagulation markers. Disseminated intravascular coagulation was defined by International Society of Thrombosis and Hemostasis criteria. Disseminated intravascular coagulation was more often associated with bleeding manifestations in acute myelogenous leukemia cases than in acute lymphoblastic leukemia cases. Two patients presented disseminated intravascular coagulation on day 7 of chemotherapy, without any bleeding manifestations. Four of 15 evaluated cases who had a bleeding or infection complication after day 7 of induction therapy also had disseminated intravascular coagulation. It is recommended that all patients with leukemia be investigated for disseminated intravascular coagulation at presentation.
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Affiliation(s)
- Ashish Dixit
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Panigrahi I, Dixit A, Arora S, Kabra M, Mahapatra M, Choudhry VP, Saxena R. Do alpha deletions influence hydroxyurea response in thalassemia intermedia? Hematology 2013; 10:61-3. [PMID: 16019448 DOI: 10.1080/10245330400020439] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Thalassemia intermedia patients show variable phenotypes. Hydroxyurea (HU) may benefit some of the thalassemia intermedia cases (1), however, the parameters influencing the response to HU have not been reported. In this study, the molecular parameters, alpha-globin and beta-globin genotype and the Xmn I polymorphism, were correlated with the HU response. Twenty patients with thalassemia intermedia were given HU (10-20 mg/kg) and responses were evaluated over a one year period. Twelve patients (60%) showed a good response to therapy with a significant increase in Hb and HbF levels and with elimination of the transfusion requirement in four patients. Four out of the twelve (33%) patients were positive for -alpha(3.7) deletions whereas none of the 8 non-responders were positive for alpha deletions. One each of the responders and non-responders were positive for alpha alpha alpha(anti-3.7) triplication. Three (25%) responsive and one non-responsive patients were homozygous for the IVS1-1 (G-->T) mutation. Three of the responsive patients with alpha deletions were also homozygous positive for Xmn I polymorphism. Thus, in addition to acting in synergy with the XmnI polymorphism, alpha deletions may be an independent factor predicting good response to HU in thalassemia intermedia, although this needs to be confirmation in larger studies.
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Affiliation(s)
- I Panigrahi
- Department of Hematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
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Chatterjee T, Mahapatra M, Dixit A, Naithani R, Tyagi S, Mishra P, Bhattacharya J, Dutta P, Pati HP, Choudhary DR, Kumar R, Choudhry VP, Saxena R. Primary myelodysplastic syndrome in children—clinical, hematological and histomorphological profile from a tertiary care centre in India. Hematology 2013; 10:495-9. [PMID: 16321814 DOI: 10.1080/10245330500155556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
We describe the clinical, hematological and histomorphological features in children of primary myelodysplastic syndrome (MDS) seen at the All India Institute of Medical Sciences over three years (Jan 2001-Jan 2004). Twenty-one patients of primary MDS aged 17 year or less were classified using the latest proposed WHO classification for Pediatric MDS. The median age was 9 years with male predominance (80%). Pallor was present in all the cases while fever and bleeding diathesis was present in more than 50% of the cases. Morphological assessment of the peripheral blood showed macrocytosis in 50%, pancytopenia in 15% and blast cells in 45% of cases. A complete analysis of clinical features in conjunction with the bone marrow profile revealed 8 cases of refractory cytopenia (RC), 3 cases of refractory anemia with excess blasts (RAEB), 5 cases of refractory anemia with excess blasts in transformation (RAEB-T), 4 cases of Juvenile myelomonocytic leukemia (JMML) and a solitary cases of acute myeloid leukemia (AML) in Downs syndrome. These children were followed up from 1-36 months (mean 15 months). Three patients of RAEB-T progressed to AML within 3-4 months. RC had the best prognosis and all are alive and under regular follow up. The solitary case of AML of Downs syndrome died 1.5 months after initial diagnosis. All 3 cases of RAEB are under regular follow-up and doing well. Three cases of RAEB-T died (all had progressed to AML); the remaining 2 cases were lost to follow up. Of the 4 cases of JMML 1 died within 6 months of diagnosis; the other 3 cases are under regular follow up of whom 1 has a progressively increasing blast count. We conclude that the latest proposed WHO classification for Pediatric MDS can be successfully applied to all cases of primary MDS.
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Affiliation(s)
- Tathagata Chatterjee
- All India Institute of Medical Sciences, Department of Hematology, New Delhi, 110029, India
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Abstract
Haemoglobin E beta thalassemia (HbE beta thalassemia) has a remarkable variability in clinical expression ranging from a mild form of thalassemia intermedia to a transfusion dependent condition. An overlap between the mild variety of HbE beta thalassemia and homozygous HbE disease is common, however, differentiation is required for early institution of therapy and for predicting the later clinical course. Fifty cases of Hb E syndrome comprising of 43 cases of Hb E beta thalassemia and 7 cases of homozygous HbE disease were studied. Their clinico- haematological features and results of high performance liquid chromatography (HPLC) were analysed.
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Affiliation(s)
- S Tyagi
- Department of Haematology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi.
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11
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Choudhry VP, Chandra J. Symposium on nutritional anemia. Editorial. Indian J Pediatr 2010; 77:785-6. [PMID: 20582575 DOI: 10.1007/s12098-010-0122-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- V P Choudhry
- Sunflag Pahuja Centre For Blood Disorders, Sunflag Hospital, Faridabad, Haryana, India.
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Abstract
Iron deficiency is the most common micronutrient deficiency in the world. Children, particularly infants living in developing countries are highly vulnerable to infectious diseases. Therefore, understanding the relationship between iron deficiency and infection is of great importance. Iron deficiency is associated with impairment of innate (natural) immunity and cell mediated immunity, thereby contributing to increased risk of infections. The iron acquisition by the microbes and their virulence is determined by various host and microbial mechanisms. Altering these mechanisms might provide modes of future therapy for infectious diseases.
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Affiliation(s)
- Vishal Kumar
- Department of Pediatrics, Chacha Nehru Bal Chikitsalya, Geeta Colony, Delhi, India.
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15
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Abstract
BACKGROUND Glanzmann thrombasthenia (GT) is an autosomal recessive inherited platelet function defect that is characterized by reduction in, or absence of, platelet aggregation in response to multiple physiologic agonists. The defect is caused by mutations in the genes encoding ITGA2B or ITGB3. This results in qualitative or quantitative abnormalities of the platelet receptor, alpha IIb-beta 3. OBJECTIVES The aim of this study was to identify the mutations in GT patients and to correlate these with patient phenotype. SUBJECTS AND METHODS A total of 45 unrelated patients with GT were enrolled in the present study to identify the causative molecular defects, and also to correlate their phenotype with their genotype. Platelet aggregation, flow cytometry, Western blotting, and mutation screening by conformation sensitive gel electrophoresis (CSGE) followed by sequencing were performed in all patients. Novel mutations were analyzed for penetrance in individual families. RESULTS A total of 22 novel mutations were identified in 45 unrelated GT patients. Mutations were identified in 36 of the 45 (80%) patients. Missense mutations were seen in most of the GT patients (59%). The remaining mutations were heterogeneous and were distributed throughout the length of the gene. Analysis of family members showed heterozygous mutations in all families. CONCLUSIONS The severe type I GT was the most common subtype found in this study. Missense mutations were identified as the defects responsible for most GT patients. Carrier detection and genetic counseling in these families is a potentially effective alternative for decreasing the burden of severe type of GT.
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Affiliation(s)
- M Kannan
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Chandra J, Choudhry VP. Stimulating platelet production to raise platelet count in immune thrombocytopenic purpura: A novel approach. Indian J Pediatr 2009; 76:1065-6. [PMID: 19907945 DOI: 10.1007/s12098-009-0206-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Jagdish Chandra
- Department of Pediatrics, Lady Hardinge Medical College, Kalawati Saran Children's Hospital, New Delhi, India.
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Choudhry VP, Upadhyay A. Deep vein thrombosis in air travellers. J Assoc Physicians India 2009; 57:648-650. [PMID: 20214003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- V P Choudhry
- Sunflag Pahuja Centre for Blood Disorders, Sunflag Hospital, Faridabad, Haryana
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Panigrahi I, Mahapatra M, Pati HP, Kumar R, Naithani R, Wadhwa S, Choudhry VP, Saxena R, Chatterjee T. Hairy cell leukemia: Clinical, pathological and ultrastructural findings in Asian-Indians. Indian J Cancer 2008; 45:41-4. [DOI: 10.4103/0019-509x.41768] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Kumar P, Jagannathan NR, Choudhry VP. Assessmrent of iron overload in thalassaemic patients by magnetic resonance imaging: a pilot study. J Indian Med Assoc 2007; 105:561-591. [PMID: 18383951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
The patients of thalassaemia major need repeated blood transfusion which leads to excess iron deposition in various organs like liver, heart, pituitary etc. This iron accumulation causes various complications and ultimately organs' failure. There is no non-invasive, standard and reliable method to know the status of iron overload in various organs of the body. This paper attempts to use magnetic resonance imaging to know the liver iron overload in 8 thalassaemic patients as a pilot study. Eight children suffering with thalassaemia and 3 controls who were the normal siblings of the patient group underwent magnetic resonance imaging of the abdomen using spin-echo T, weighted sequence. Blood serum ferritin levels in the patients' group were also determined on the same day of magnetic resonance imaging examination. It was observed that the ratio of magnetic resonance imaging signal intensity (in spin-echo T1 weighted image) in paraspinous muscle to liver was significantly different in normal control (0.65) compared to that in thalassaemia patients (2.1 to 11.4 depending upon extent of iron deposition). The magnetic resonance signal intensity ratio correlated with the blood serum ferritin level of patients (p = 0.01) which is generally taken as indirect measure of body iron burden. Spin-echo sequence is the simplest imaging sequence and it increases the chance of its routine use. The study concludes that magnetic resonance imaging has good potential to quantify the liver iron deposition non-invasively and may denote the efficacy of iron-chelation therapy which is used to reduce the body iron burden in these patients.
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Affiliation(s)
- Pratik Kumar
- Medical Physics Unit, IRCH, All India Institute of Medical Sciences, New Delhi 110029
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Mishra P, Kumar R, Mahapatra M, Sharma S, Dixit A, Chaterjee T, Choudhry DR, Saxena R, Choudhry VP. Tuberculosis in acute leukemia: a clinico-hematological profile. ACTA ACUST UNITED AC 2007; 11:335-40. [PMID: 17607583 DOI: 10.1080/10245330600915818] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
We studied 130 consecutive cases of acute leukemia over a 2-year period and identified 9 cases (6.9%) with active tuberculosis (TB). Eight patients with TB had acute myeloid leukemia (AML). Patients with AML were more likely to develop TB as compared to patients with acute lymphoblastic leukemia (ALL) despite the wider use of steroids and radiotherapy in ALL protocols {OR 4.41 (CI 0.53-36.44)}. Only 1 patient died of disseminated TB during post induction neutropenia. All other patients were successfully managed using current anti-tuberculous therapy (ATT). On the whole, TB did not cause any undue delay in chemotherapy and did not flare up during subsequent chemotherapy cycles. However it is not a commonly described infection in acute leukemia and a high index of suspicion is warranted especially in areas endemic for TB.
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Abstract
A large number of complications in thalassemia major are due mainly to iron overload. Deferoxamine in iron-overloaded patients has established that chelation therapy, when given at an adequate dose, reduces iron-related complications. Parenteral administration and the daily nuisance of an infusion pump hinder the optimal compliance. Deferiprone is moderately effective oral iron chelator. Arthralgia and cytopenias constitute the main side effects. Deferasirox is a new orally effective iron chelator which has been shown to be non-inferior to deferoxamine in clinical trials. Further clinical trials especially in Indian children will tell if it stands the test of time.
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Affiliation(s)
- V P Choudhry
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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Biswas A, Choudhry P, Mittal A, Meena A, Ranjan R, Choudhry VP, Saxena R. Inherited Warfarin Resistance in Indian Patients: Does It Occur? Clin Appl Thromb Hemost 2007; 13:338-9. [PMID: 17636200 DOI: 10.1177/1076029607302446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
The clinical and hematological profile and treatment outcome of children with warm autoimmune hemolytic anemia (AIHA) were assessed using retrospective case record analysis. There were 26 (17 idiopathic; 9 secondary) patients with a median age of 11 years. Pallor (100%), fever (39%), and jaundice (59%) were the main presenting complaints. Jaundice was much more common in idiopathic (70%) compared to secondary (44%). Direct antiglobulin test was negative in 3 patients. Oral prednisolone produced remission in 81% patients. Four patients relapsed after a median period of 7 months (2 months to 2 year) after response. All responded to a second course of steroids in median 14 days. One child required cyclosporin A in addition. No correlation was found between response and parameters such as age, sex, jaundice, low pretreatment hemoglobin, reticulocyte count, total leukocyte count, platelet count, subtype of AIHA, and hepatosplenomegaly. Relapse correlated with increased duration between the onset of symptoms and treatment. This study indicates that oral prednisolone is an effective therapy for autoimmune hemolytic anemia. In refractory cases cyclosporine A may be useful.
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Abstract
Two children with suspected ITP are described. One child was treated outside with corticosteroids and was diagnosed acute lymphoblastic leukemia. Another child was fresh and diagnosed as acute myeloid leukemia on bone marrow aspirate examination. Both the children had no physical or peripheral smear finding suggestive of leukemia. We suggest that a bone marrow examination is required in developing countries for evaluation of thrombocytopenia before labeling it an immune thrombocytopenic purpura.
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Affiliation(s)
- Rahul Naithani
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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25
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Gupta PK, Kannan M, Chatterjee T, Dixit A, Mahapatra M, Choudhry VP, Saxena R. Acquired von Willebrand's disease associated with gastrointestinal angiodysplasia: a case report. Haemophilia 2006; 12:452-5. [PMID: 16834752 DOI: 10.1111/j.1365-2516.2006.01301.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acquired von Willebrand syndrome (AVWS) is a rare and probably underestimated bleeding disorder which mimics most of the clinical symptoms and laboratory features of hereditary von Willebrand disease (VWD) in patients devoid of both personal and family history of bleeding diathesis. In this study, we present a case of 55 yrs male patient, presented with gastrointestinal bleeds since three years, diagnosed to have AVWS with inhibitors. From this study it is concluded that AVWS is rare and it is important to diagnose this bleeding disorder so that appropriate treatment with plasmapheresis and IV:Ig can effectively correct the haemostatic defect and manage severe bleeding in these patients.
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Affiliation(s)
- P K Gupta
- Department of Haematoloy, All India Institute of Medical Sciences, New Delhi, India
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26
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Kumar R, Prem S, Mahapatra M, Seth T, Chowdhary DR, Mishra P, Pillai L, Narendra AMVR, Mehra NK, Saxena R, Choudhry VP. Fludarabine, cyclophosphamide and horse antithymocyte globulin conditioning regimen for allogeneic peripheral blood stem cell transplantation performed in non-HEPA filter rooms for multiply transfused patients with severe aplastic anemia. Bone Marrow Transplant 2006; 37:745-9. [PMID: 16518427 DOI: 10.1038/sj.bmt.1705321] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Multiply transfused patients of severe aplastic anemia are at increased risk of graft rejection. Five such patients underwent peripheral blood stem cell transplantation from HLA-identical siblings with a fludarabine-based protocol. The conditioning consisted of fludarabine 30 mg/m(2)/day x 6 days, cyclophosphamide 60 mg/kg/day x 2 days and horse antithymocyte globulin (ATG) x 4 days. Two different ATG preparations were used: ATGAM (dose 30 mg/kg/day x 4 days) or Thymogam (dose 40 mg/kg/day x 4 days). Engraftment: median time to absolute neutrophil count (ANC) >0.5 x 10(9)/l was 11 days (range: 8-17) and median time to platelet count >20 x 10(9)/l was 11 days (range: 9-17). At a median follow-up of 171 days (range: 47-389), there has been no graft rejection and all patients are in complete remission. Acute GVHD (grade 1) occurred in one patient only. Chronic GVHD developed in two patients (extensive in one and limited in another). The transplants were performed in non-HEPA filter rooms. In only one patient, systemic antifungal therapy (voriconazole) was used. The use of Thymogam brand of ATG for conditioning is being reported for the first time. Our experience suggests that this fludarabine-based protocol allows rapid sustained engraftment in high-risk patients without significant immediate toxicity.
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Affiliation(s)
- R Kumar
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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Abstract
Autoimmune hemolytic anemia (AIHA) associated with giant cell hepatitis (GCH) is a rare disorder in infants. AIHA usually precedes the development of liver disease by months to years. Early recognition of the disease and prompt institution of immunosuppressive therapy results in clinical remission and prevents liver disease progression.
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Affiliation(s)
- Rajesh Kashyap
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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Bhattacharyya J, Dutta P, Mishra P, Dixit A, Srinivas U, Kannan M, Kumar R, Choudhry VP, Saxena R. Congenital vitamin K-dependent coagulation factor deficiency: a case report. Blood Coagul Fibrinolysis 2006; 16:525-7. [PMID: 16175013 DOI: 10.1097/01.mbc.0000183634.68071.3b] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Congenital vitamin K-dependent coagulation factor deficiency is a very rare bleeding disorder, which usually presents with episodes of intracerebral bleed in the first few weeks of life, sometimes leading to a fatal outcome. We report a case of combined factor deficiency of vitamin K-dependent factors in which the patient presented with both intracerebral bleeding, and possibly also thrombosis, and responded to a vitamin K supplement along with fresh frozen plasma.
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Affiliation(s)
- Jina Bhattacharyya
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Sazawal S, Hasan SK, Dutta P, Kumar B, Kumar R, Kumar L, Choudhry VP, Saxena R. Over-representation of bcr3 subtype of PML/RARalpha fusion gene in APL in Indian patients. Ann Hematol 2005; 84:781-4. [PMID: 16132910 DOI: 10.1007/s00277-005-1095-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2005] [Accepted: 07/20/2005] [Indexed: 12/01/2022]
Abstract
Thirty six patients with acute promyelocytic leukemia were studied by reverse transcriptase-polymerase chain reaction (RT-PCR) and real-time PCR. There was concordance between the results achieved by both the methods except in one case, which was negative by RT-PCR but positive by real-time PCR. The prevalence of bcr3 (short isoform) was found to be significantly higher than that of bcr1 (long isoform) (64 vs. 36%, P=0.03). No correlation was found between age, sex, and white blood cell (WBC) count at diagnosis. Molecular remission was achieved in 66.6% of patients with bcr3 isoform. Median WBC count at presentation was found to be higher than that in the West.
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Affiliation(s)
- Sudha Sazawal
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, 110 029, India
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Mishra P, Mahapatra M, Kumar R, Dixit A, Chatterjee T, Tyagi S, Choudhry DR, Sazawal S, Choudhry VP. Philadelphia-chromosome positive thrombocythemia in a child. Eur J Haematol 2005; 75:262-3. [PMID: 16104885 DOI: 10.1111/j.1600-0609.2005.00499.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Philadelphia-chromosome positive thrombocythemia without features of chronic myeloid leukemia in peripheral blood has been described in adults. It is rare in children. We present a case of Philadelphia positive thrombocythemia in a child who was managed with a combination of imatinib and hydroxyurea. Although a reduction in the BCR-ABL transcript was documented, the thrombocytosis was refractory to imatinib alone and required the addition of hydroxyurea.
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Saxena R, Gupta M, Gupta S, Kannan M, Ahmed RPH, Choudhry VP. Inherited heterogenous defect in platelet aggregation selectively with ADP and epinephrine--a series of 25 cases. INDIAN J PATHOL MICR 2005; 48:345-8. [PMID: 16761747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Inherited heterogeneous defects of platelet function caused by impairment of platelet responses to weak agonists as ADP, epinephrine and others as low concentration collagen and platelet activating factor (PAF) have been described, though quite rarely. We describe here 25 cases of this defect with impairment in response to ADP and epinephrine. Subjects with a history of generalized bleeding and a prolonged bleeding time, PF3 availability or prothrombin consumption index and a normal platelet count, prothrombin time, activated partial thromboplastin time and clot solubility were subjected to platelet aggregation. Those of these which showed a normal aggregation with collagen and arachidonic acid and an absent or reduced aggregation with ADP and epinephrine were included in our study group. Subjects with history or findings suggestive of antiplatelet drug intake or any acquired condition affecting platelet functions were excluded from this study. 76% of the patients had onset of recurrent bleeding manifestations since childhood with a mean age at onset of 9.2 years. A positive family history was present in 36% of the patients. Majority of the patients (88%) presented with mild bleeding manifestations, the commonest symptom being appearance of recurrent ecchymotic spots. We present here a series of patients with a hereditary platelet aggregation defect selectively with ADP and epinephrine.
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Affiliation(s)
- Renu Saxena
- Department of Haematology, All India Institute of Medical Sciences, New Delhi.
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Mishra P, Pati HP, Chatterjee T, Dixit A, Choudhary DR, Srinivas MU, Mahapatra M, Choudhry VP. Hb SE disease: a clinico-hematological profile. Ann Hematol 2005; 84:667-70. [PMID: 15947927 DOI: 10.1007/s00277-005-1044-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2004] [Accepted: 03/17/2005] [Indexed: 10/25/2022]
Abstract
Hb S and Hb E are globally common hemoglobinopathies. However, Hb SE double heterozygous state is uncommon, with only 25 cases reported so far in literature. We present two more cases. One presented with gallstones, and the other was asymptomatic. This type of disorder was previously described as a relatively asymptomatic condition compared to HbSS. A review of the 25 reported cases in literature shows that 40.7% (11/27) of these cases are symptomatic. Gender, hematological parameters and levels of Hb S, E or F do not predict clinical severity.
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Affiliation(s)
- Pravas Mishra
- Department of Hematology, All-India Institute of Medical Sciences, New Delhi, India
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Gupta PK, Ahmed RPH, Sazawal S, Choudhry VP, Saxena R. Relatively high frequency of VWD types 3 and 2 in a cohort of Indian patients: the role of multimeric analysis. J Thromb Haemost 2005; 3:1321-2. [PMID: 15946229 DOI: 10.1111/j.1538-7836.2005.01336.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Dixit A, Chatterjee TC, Mishra P, Choudhry DR, Mahapatra M, Tyagi S, Kabra M, Saxena R, Choudhry VP. Hydroxyurea in thalassemia intermedia—a promising therapy. Ann Hematol 2005; 84:441-6. [PMID: 15838670 DOI: 10.1007/s00277-005-1026-4] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2004] [Accepted: 02/13/2005] [Indexed: 10/25/2022]
Abstract
Pharmacological agents such as hydroxyurea (HU) have been known to cause induction of fetal hemoglobin and possibly may alleviate the symptoms in thalassemia intermedia patients. Thirty-seven patients with beta-thalassemia intermedia were enrolled to assess response to HU therapy. Major response was defined as transfusion independence or hemoglobin rise of more than 20 g/l and minor response as rise in hemoglobin of 10-20 g/l or reduction in transfusion frequency by 50%. The median age was 10 years (range: 4-50 years) and median follow-up was 12 months (range: 4-36 months). Twenty-six patients (70.2%) showed response to HU therapy. Seventeen patients (45.9%) were major responders, and nine patients (24.3%) showed minor response. There was no correlation of response with beta-thalassemia mutation or XmnI polymorphism; however, the presence of alpha(3.7) deletion was associated with major response in three patients. Mean fetal hemoglobin (HbF) levels rose on HU therapy. Older age, low baseline F cell percent, and low baseline HbF levels (below 10%) were predictors of poor response. Response was evident within 1 month of starting HU therapy in the majority of responders. Thus, a short trial of HU therapy can predict durable response.
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Affiliation(s)
- Ashish Dixit
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Dixit A, Chatterjee T, Mishra P, Choudhary DR, Mahapatra M, Saxena R, Choudhry VP. Cyclosporin A in myelodysplastic syndrome: a preliminary report. Ann Hematol 2005; 84:565-8. [PMID: 15809884 DOI: 10.1007/s00277-005-1016-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2004] [Accepted: 01/25/2005] [Indexed: 11/28/2022]
Abstract
Therapeutic approaches are not well established in patients with myelodysplastic syndrome (MDS). We evaluated response to cyclosporin A (CyA) in 19 cases with MDS who were enrolled for the study [13 refractory anemia (RA), 5 refractory anemia with excess of blasts (RAEB), and 1 refractory anemia with ringed sideroblasts (RARS)]. Bone marrow was normocellular in ten, hypercellular in five, and hypocellular in four cases. Fifteen patients were transfusion dependent and the rest were not transfusion dependent but with a hemoglobin range of 6.4-8.8 g% with a mean of 7.4 g%. CyA was given at a dose of 3-5 mg/kg per day. A major response was observed in seven patients with RA, which was sustained on follow-up. Four cases of RA showed minor response and two cases of RA did not respond to CyA therapy. A minor response was also seen in one RAEB and one RARS case, while one RAEB case that initially showed a major response relapsed on therapy. The first effect of therapy was evident after a mean period of 2.5 months. A rise in platelets and leukocyte count was seen in three and two cases, respectively. One case developed renal failure on therapy and later died of septicemia. Response to CyA was independent of bone marrow cellularity. CyA could be an effective mode of therapy in patients with MDS especially those having RA.
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Affiliation(s)
- Ashish Dixit
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Bhattacharyya J, Kumar R, Tyagi S, Kishore J, Mahapatra M, Choudhry VP. Human parvovirus B19-induced acquired pure amegakaryocytic thrombocytopenia. Br J Haematol 2005; 128:128-9. [PMID: 15606559 DOI: 10.1111/j.1365-2141.2004.05252.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Mohanty S, Kapil A, Mohapatra M, Das B, Dhawan B, Choudhry VP. Group C streptococcal bacteremia: a case report from India. Southeast Asian J Trop Med Public Health 2004; 35:877-8. [PMID: 15916084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Group C streptococci are a common cause of infection in animals and a rare cause of bacteremia in human beings. The entity is often seen in elderly people with a severe underlying illness. We report here the only case of Group C streptococcal bacteremia reported in our hospital, caused by Streptococcus equisimilis, a beta-hemolytic Group C streptococcus. The patient was a 10-year old male with a known history of aplastic anemia. In spite of specific therapy with penicillin, the outcome was fatal.
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Affiliation(s)
- Srujana Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India
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Phom H, Kumar A, Tripathi M, Chandrashekar N, Choudhry VP, Malhotra A, Bal CS. Comparative evaluation of Tc-99m-heat-denatured RBC and Tc-99m-anti-D IgG opsonized RBC spleen planar and SPECT scintigraphy in the detection of accessory spleen in postsplenectomy patients with chronic idiopathic thrombocytopenic purpura. Clin Nucl Med 2004; 29:403-9. [PMID: 15192463 DOI: 10.1097/01.rlu.0000129117.55170.fd] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Radionuclide imaging specific for functioning splenic tissue is considered the method of choice to detect an accessory spleen in patients of chronic idiopathic thrombocytopenia purpura (ITP), who present with relapse after splenectomy. Radioimmunospleen scintigraphy with Tc-99m-labeled autologous RBC opsonized with anti-D IgG (RIS) is claimed to be more sensitive and specific than Tc-99m heat-denatured RBC spleen scintigraphy (HDRS) in the detection of an accessory spleen. We compared the efficacy of RIS with HDRBC for the detection of accessory spleens METHODS A total of 45 patients (male:female = 17:28, age range: 6-58 years) who presented with relapse of ITP after splenectomy underwent scintigraphy with both methods. An average of 3 years had passed since surgery. All patients were imaged by a dual-head gamma camera with high-resolution collimators; planar static images and SPECT of abdomen were acquired. RESULTS Accessory spleens were detected in 31% (14 of 45) of patients, 6 had 1 each and 8 had more than 1 (including 1 patient who had 13 accessory spleens). Both methods were concordant in all the patients. There was no difference in the scintigraphic picture (planar and SPECT) or in the size and number of accessory spleens detected. CONCLUSION Tc-99m-labeled anti-D IgG opsonized autologous RBC spleen scintigraphy provides no additional diagnostic information over heat-denatured RBC spleen scintigraphy. Heat-denatured RBC scintigraphy thus remains the procedure of choice in the detection of accessory spleens.
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Affiliation(s)
- Hentok Phom
- Department of Nuclear Medicine, All India Institute of Medical Sciences, New Delhi, India
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Chatterjee T, Dixit A, Mohapatra M, Tyagi S, Gupta PK, Mishra P, Bhattacharya M, Karan AS, Pati HP, Saxena R, Choudhry VP. Clinical, haematological and histomorphological profile of adult myelodysplastic syndrome. Study of 96 cases in a single institute. Eur J Haematol 2004; 73:93-7. [PMID: 15245507 DOI: 10.1111/j.1600-0609.2004.00271.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Myelodysplastic syndromes (MDS) are clonal haematopoietic stem cell disorders characterised by ineffective and dyspoietic haematopoiesis. The natural history of these disorders is variable and ranges from a chronic to a rapid course towards leukaemic progression. Certain shortcomings have been encountered in the French-American-British (FAB) classification over the years, and therefore there is a need for an alternative method of classification. In 1999, the WHO published a revised classification of MDS. In the present study, we have analysed the clinical, haematological and histomorphological features in 96 cases of primary MDS seen in the department of haematology at the All India Institute of Medical Sciences (AIIMS) over a 6-yr period (1996-2001). Both FAB and WHO classifications have been incorporated and the Bournemouth scoring system applied in each case at presentation. The Bournemouth scoring system, in the absence of a cytogenetic study, offers a good prognostication and long-term survival estimate.
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Affiliation(s)
- T Chatterjee
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Mishra P, Chatterjee T, Dixit A, Choudhry VP, Kumar R, Saxena R. Secondary severe factor X deficiency associated with antiphospholipid syndrome. Am J Hematol 2004; 76:311. [PMID: 15224378 DOI: 10.1002/ajh.20085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Gupta PK, Ahmed R, Kannan M, Chatterjee T, Choudhry VP, Saxena R. Platelet factor 3 availability test: an effective screening test for types 1 and 2 von Willebrand disease. Ann Hematol 2004; 83:489-90. [PMID: 15052373 DOI: 10.1007/s00277-004-0872-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2003] [Accepted: 11/27/2003] [Indexed: 10/26/2022]
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Panigrahi I, Rafeeq PHA, Choudhry VP, Saxena R. High frequency of deletional alpha-thalassemia in beta-thalassemia trait: implications for genetic counseling. Am J Hematol 2004; 76:297-9. [PMID: 15224373 DOI: 10.1002/ajh.20083] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Thalassemias are a group of genetic hemolytic disorders with varying phenotypes. In this study, the frequency of alpha globin gene deletions was studied in the beta-thalassemia trait, the mildest form of the disorder. Eleven out of 33 (33%) individuals were positive for alpha(-3.7 kb) deletions. None of the subjects was positive for the Southeast Asian deletion. Such a high frequency for alpha deletions has not been reported earlier in thalassemia minor. Hematological parameters are compared, and implications of this finding for genetic counseling are discussed.
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Affiliation(s)
- I Panigrahi
- Department of Hematology, All India Institute of Medical Sciences, IRCH Building 1st Floor, Ansari Nagar, New Delhi 110 029, India
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Talwar R, Choudhry VP, Kucheria K. Differentiation of Fanconi anemia from idiopathic aplastic anemia by induced chromosomal breakage study using mitomycin-C (MMC). Indian Pediatr 2004; 41:473-7. [PMID: 15181297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
This study was conducted to differentiate between Fanconi anemia (FA) and "idiopathic" aplastic anemia on the basis of induced chromosomal breakage study with mitomycin C (MMC). MMC-stress test was conducted on peripheral blood lymphocytes from 29 patients with aplastic anemia. Ten patients with very high percentage of chromosomal breakage and four patients exhibiting somatic mosaicism were diagnosed as FA on the basis of chromosomal breakage study. Six of these patients exhibited congenital anomalies at presentation while another eight lacked such anomalies or had minor physical problems. The present study illustrates that MMC stress test provides an unequivocal means of differentiation between Fanconi anemia and 'idiopathic' aplastic anemia. Further, the study, first of its kind from India, stresses on the need for conducting this test in all aplastic anemia cases, even those without congenital anomalies, for accurate and timely diagnosis of Fanconi anemia to implement appropriate therapy.
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Affiliation(s)
- Rashmi Talwar
- Department of Anatomy, All India Institute of Medical Sciences, New Delhi 110 029, India
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Ahmed RPH, Gupta PK, Kannan M, Suresh K, Kashyap R, Choudhry VP, Saxena R. Hemophilia A: role of FVIIIC/vWF Ag in assisting linkage analysis for carrier detection. Clin Appl Thromb Hemost 2004; 10:127-31. [PMID: 15094932 DOI: 10.1177/107602960401000202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Carrier detection for hemophilia A was carried out in 52 females from 30 families presenting to the Haematology Department AIIMS, using linkage analysis and factor VIIIC (FVIIIC)-von Willebrand factor (vWF) antigen assay. The allelic frequency for the marker Bcl 1 and Xba 1 was 0.58 and 0.54, respectively, for the positive alleles and 0.42 and 0.46, respectively, for the negative alleles. The heterozygosity frequency of Bcl I and Xba 1 was 0.65 and 0.55, respectively. Of the 52 females, 30 were mothers of hemophilic patients and 22 were sisters of hemophilic patients. Of the 30 mothers, positive family history was present in 14. In these patients, the defective X chromosome was tracked in 10, and in four the defective X chromosome could not be tracked because the mothers were homozygous for the marker used. Of the 16 mothers without a family history of disease, three were observed to be carriers based on linkage analysis and reduced factor VIII levels in mother/sister. Possible defective X chromosome was tracked in 11 mothers and five were noninformative because they did not show heterozygosity for the markers used. Using linkage analysis, nine of the 22 sisters were found to be definite carriers, 10 noncarriers, and three were noninformative. It is thus concluded that using Bcl 1 and Xba 1 linkage analysis, carrier status can be definitely ascertained in 50% females and this level of information can be increased to 61.5% by measuring FVIIIC/vWF antigen levels in them.
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Affiliation(s)
- R P H Ahmed
- Department of Haematology, All India Institute of Medical Sciences, New Delhi 110 029, India
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Abstract
OBJECTIVE Deferiprone (L1), the new oral iron chelator has been studied in several countries for its efficacy and toxicity with some conflicting observations. Toxicity involving joints has been reported more frequently in Indian patients. The authors planned to include larger number of Indian thalassemics in studying safety and efficacy of Deferiprone. METHODS Seventy five thalassemic children (4-14 yr) were studied for one year with various investigations done periodically. Thirty patients (group A) received 50 mg/kg dose and 21 others (group B) received 75 mg/kg dose of Deferiprone. Rest of the patients were followed up without any chelator. RESULTS The serum ferritin levels reduced significantly in both groups (P < 0.01 each); more in 75 mg/kg than the 50 mg/kg group. Arthropathy appeared in 15 (50%) patients in Group A and 6 (28.6%) of Group B after 1-12 (mean 6) months of L1 treatment; however, only one patient needed withdrawal of L1. Eleven patients needed indomethacin for pain relief. Seropositivity for antinuclear factor and rheumatoid factor had no relation to dose or duration of L1 therapy, arthropathy or the serum ferritin level. Twelve patients developed leucopenia (< 3.0 x 10(9)/L) and neutropenia (0-1.8 x 10(9)/L) after 2-11 months of L1 therapy and was not related to the dose or duration of therapy. The drug was restarted in 10 patients and only one of them developed a second episode of neutropenia. CONCLUSION Deferiprone is an effective iron chelator, but arthropathy and neutropenia are very frequent side effects and need strict monitoring during therapy. Most of the neutropenia are neither very severe nor recur with re-challenge with the drug. Similarly, arthropathy does not need withdrawal of drug in majority of patients.
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Affiliation(s)
- V P Choudhry
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India
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Dixit A, Chatterjee TC, Papneja M, Mishra P, Mahapatra M, Pati HP, Saxena R, Choudhry VP. Sickle beta-thalassemia presenting as orbital compression syndrome. Ann Hematol 2004; 83:536-40. [PMID: 14986068 DOI: 10.1007/s00277-004-0851-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2003] [Accepted: 01/07/2004] [Indexed: 11/28/2022]
Abstract
Orbital compression syndrome is caused by disorders of varying etiologies involving the orbit and presents with ocular and extraocular dysfunction. Ocular involvement of sickle cell disease is uncommon. A 17-year-old male presented with low backache and proptosis of both eyes of 5 days duration without past history of pain crisis or transfusion. Examination revealed pallor, icterus, bilateral proptosis, conjuctival chemosis, and symmetrical restriction of ocular movements with preserved visual acuity. He was drowsy with no other focal deficits. The fundus showed macular edema, venous engorgement, and no hemorrhage. His peripheral smear showed presence of sickle cells. Computed tomography (CT) scan of the orbit revealed orbital subperiosteal hematomas. CT head images showed epidural hematoma in the frontal lobe. High-performance liquid chromatography (HPLC) and mutation studies revealed sickle beta-thalassemia in the patient. He was managed with supportive care, transfusions to keep hemoglobin above 10 g/dl, and hydroxyurea. The patient recovered fully and remained well during follow-up of 12 months. Our case was unique for presenting as orbital compression syndrome without any history of vaso-occlusive crisis.
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Affiliation(s)
- Ashish Dixit
- Department of Haematology, All India Institute of Medical Sciences, New Delhi, India
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Mishra PP, Mahapatra M, Choudhry VP, Saxena R, Pati H, Dixit A, Anupama R, Bhattacharya J, Chatterjee T, Dutta P. Synchronous occurrence of breast carcinoma and acute myeloid leukemia: case report and review of the literature. Ann Hematol 2004; 83:541-3. [PMID: 14963697 DOI: 10.1007/s00277-004-0852-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2003] [Accepted: 01/15/2004] [Indexed: 10/26/2022]
Abstract
We present a case of breast carcinoma, which was followed by acute leukemia within 1 month of diagnosis of the former. She had undergone a modified radical mastectomy for her breast cancer and had not received chemotherapy or radiotherapy. Acute leukemia as a result of chemotherapy for breast carcinoma is well known. However, patients developing synchronous breast carcinoma and acute leukemia, in the absence of any chemotherapy or radiotherapy, are rare.
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Affiliation(s)
- P P Mishra
- Department of Haematology, All India Institute of Medical Sciences, Ansarinagar, New Delhi, India
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Abstract
A case of hemophilic pseudotumor of the thumb in a child is reported. Combined treatment with radiation therapy and factor VIII replacement resulted in complete resolution of the lesion with no recurrence at the 6-month follow-up. The combination of radiotherapy and factor replacement should be strongly considered in the treatment of bone pseudotumors in children.
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Affiliation(s)
- M Issaivanan
- Department of Hematology, All India Institute of Medical Sciences, New Delhi, India.
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Choudhry M, Choudhry VP. Prevention and control of HIV/AIDS. Indian J Pediatr 2003; 70:975-81. [PMID: 14719787 DOI: 10.1007/bf02723824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HIV/AIDS in children has emerged during third phase of HIV epidemic as a result of high level of infection in women of child bearing age. Now it is being detected at an alarming rate. Various methods of HIV/AIDS transmission, prevalence of HIV in multitransfused, modes of prevention and control of HIV infection in children, antenatal care of HIV positive women, infant feeding options, safe blood along with other intervention have been reviewed.
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