Browsing by Author "Dilhani, M.N."

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    An assessment on foeto-maternal haemorrhage
    (Sri Lanka Medical Association, 2018) Dilhani, M.N.; Wijesinghe, P.S.; Ranasinghe, H.R.P.; Williams, H.S.A.
    INTRODUCTION AND OBJECTIVES: Foeto-maternal haemorrhage leading to maternal sensitization against foetal antigens occurs predominantly during delivery. This leads to rhesus haemolytic disease of the newborn and foetus in subsequent pregnancies. Accurate estimation of volume of such haemorrhage is important to provide the correct dose of anti-D for the prevention of haemolysis in subsequent pregnancies. Objective was to assess the volume and determinants offoeto-maternal haemorrhage at delivery. METHODS: A prospective descriptive study was conducted among 625 mothers admitted to the Professorial Obstetric unit for delivery from 2006 June. 2cc of Ethylene Diamine Tetra Acetic acid anticoagulated blood was taken within 2 hours of partus. Volume of foeto-maternal haemorrhage was assessed using the Keilhauer test.A minimum of 6000 adult red cells was counted to achieve a reasonable precision and to narrow 95% confidence limits to 95%. The volume of the haemorrhage was reported to the ward for necessary action An interviewer-administered questionnaire was filled at the time ofvenepuncture. RESULTS: Only 1.76% (n=l l ) mothers had more than 4ml hemorrhage (Range 6ml-52ml) to be qualified as a large bleeder, requiring additional doses ofanti-D. The toal number oflarge bleeders identified were too small to make inferences on determinants of large haemorrhages but still, some important observations were made: None of the mothers were multiparous but most were primi (n=6). All were single cephalic presentations (n=l l) delivered vaginally (n=9) or by a caesarean section (n=2). One had a placenta praevia, but none of the pregnancies were . complicated with antepartum or postpartum haemorrhage, polyhydramnios, manual removal of placenta or external cephalic versions or asssisted by instruments which are already known factors for such large bleeds. CONCLUSION: Clinically significant foeto-maternal haemorrhage requiring additional anti-D was <2% in our study population. Prospective epidemiological study including a larger study population will help to identify factors associated with increasing volume of foetal haemorrhage
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    A woman with unilateral thigh pain, moderate leukocytosis and extreme thrombocytosis (Case report 2)
    (The Sri Lanka College of Haematologists, 2019) Dilhani, M.N.; Jayaweera, W.M.N.M.; Williams, H.S.A.; Premawardhena, A.P.
    ABSTRACT: Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm (MPN) of hematopoietic stem cells characterized by the presence of the Philadelphia (Ph) chromosome (t (9;22) (q34.1;qll.2), in which granulocytes are the major proliferative component. Atypical presentations of chronic phase CML reported include extreme thrombocytosis with or without leukocytosis, marked megakaryocytic proliferation or significant marrow fibrosis. We describe a middle-aged woman who presented with nonspecific leg pain and abnormal FBC parameters. Moderate leukocytosis (WBC 55 x 103/ pl), mild anemia and marked thrombocytosis (1,615 xl03/pl) were noted without clinical or laboratory features of ongoing infection or inflammation. Clinical examination revealed mild pallor only. A prominent spleen was noted ultrasonically (13.5 cm). A leucoerythroblastic blood picture was seen with moderate neutrophil leukocytosis, tear drop poikilocytes and one percent blast cells. No characteristic myelocytes and neutrophil peaks were present, and dysplasia was absent. Mild eosinophilia was observed however basophilia was absent. Platelets were markedly increased with anisocytosis. An underlying MPN suspected. JAK2V617 F mutation was absent and BCR-ABL (transcript type- b3a2) mutation detected. Her bone marrow biopsy revealed markedly hyper- cellular fragments with suppressed erythropoiesis, markedly hypercellular granulopoiesis (blasts <5%) with prominent eosinophil precursors. Megakaryocyte numbers were markedly increased with numerous micro megakaryocytes. The trephine biopsy displayed a few loose clusters of megakaryocytes. A marked background fibrosis noted (Grade (3/3). The diagnosis of chronic phase- CML was made. She was commenced on Imatinib 400mg daily and she achieved and maintained all the desired milestones since diagnosis.