Browsing by Author "Thilakarathne, S."

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Comparison of Sebia capillary electrophoresis with the Bio-Rad VARIANT II HPLC in the evaluation of HbA2 in diagnosing beta thalassemia
(Faculty of Graduate Studies, University of Kelaniya Sri Lanka, 2022) Thilakarathne, S.; Wickramasinghe, M. G. C. N.; Perera, H. L.; Premawardhena, A. P.
The guideline for diagnosis of beta thalassemia trait in Sri Lanka defines low red cell indices (MCV<80 fl, MCH<27 pg) in FBC and HbA2>3.5% by quantification. Different cutoffs for HbA2 value are used in other countries (i.e. in India >4%). Thus, the precision of the HbA2 value is crucial for labelling a person as beta thalassemia trait. High-Performance Liquid Chromatography (HPLC) and capillary electrophoresis (CE) are two different techniques for quantifying HbA2 levels. This study aims to compare the HbA2 results of these two systems in individuals with varying HbA2 values and to assess the consistency when repeated of the two systems. The Bio-Rad VARIANT II HPLC (Bio-Rad, Hercules, USA) and the Sebia Capillarys CE (software version 9.3) analyzers were used as directed by the manufacturer. Using normal and pathological quality control materials, we determined the quality parameter, "between day precision", of both analyzers as per CLSI guidelines (EP15-A2 document). EDTA anticoagulated blood samples of patients (203) were analyzed by both methods during a 3- months period. Subjects (100) with HbA2 values between 1.8-3.3% were considered non-beta thalassemic, i.e. normal, while individuals (50) with HbA2 values >4.1% were categorized as beta thalassemia trait. We defined HbA2 levels as borderline (53) if they were between 3.4 and 4.0%. Incompatible FBC patterns and iron deficiency anemia was excluded from each group. Data analysis was performed using SPSS statistical software. HbA2 values by the CE method were slightly but significantly lower than those of the HPLC method, with a mean difference of 0.24 (Paired t-test; p <0.001). Also, HbA2 results by HPLC and CE methods showed a good relationship between each other (Pearson coefficient correlation; r was 0.98). We statistically analyzed this variation and relationship separately among normal, beta thalassemia trait and borderline groups. The variation in HbA2 value was high (mean difference; 0.27) among the normal group, while it was less (mean difference; 0.15) among beta thalassemia traits. The beta thalassemia trait group showed the highest positive relationship (r=0.92). The borderline group showed the least positive relationship (r=0.76). However, both analytical systems showed very close results (CV< 10%) when repeating the same sample between different days. This confirmed the excellent repeatability and acceptability of generated results by both analyzers. In conclusion, HbA2 values obtained from the two methods have a consistent and significant difference in normal, beta thalassemia trait and borderline samples. The variation in HbA2 values between CE and HPLC methods will make the accurate diagnosis of beta thalassemia traits more difficult based on a single reference cutoff value in the borderline group. Therefore, when issuing a diagnosis of beta thalassemia trait in borderline values, this machinerelated variation of the HbA2 level should be borne in mind.
First paediatric live donor liver transplant in Sri Lanka with 1 year outcome : challenges for the future
(The College of Surgeons of Sri Lanka, 2021) Siriwardana, R.; Thilakarathne, S.; Fernando, M.; Gunetilleke, M.B.; Weerasooriya, A.; Appuhamy, C.
INTRODUCTION: Liver transplantation in the paediatric age group is demanding due to smaller body proportions and physiology. This paper describes the first successful paediatric liver transplant in Sri Lanka along with its one-year outcome. Describing the challenges faced during the process, we highlight the factors that need to be considered for a sustainable programme in the future. METHODOLOGY: A 9-year-old girl who had progressive familial intra hepatic cholestasis type 3 was referred to us with features of end stage liver disease. She was identified as a suitable candidate for liver transplantation. Her 38-year-old mother was selected as the donor, who was evaluated for suitability of a left lateral segment donation. RESULTS: The first paediatric liver transplantation was performed in July 2020. The child's mother donated the left lateral segment weighing 325g. During the postoperative period the child developed outflow tract obstruction at the hepatic venous anastomosis. This was managed with a percutaneously placed stent. Six months after transplant, she developed an acute rejection that required steroids. Treatment of rejection was complicated with multiple liver abscesses caused byAspergillus. The infection was treated with systemic antifungals and drainage. At one-year post transplant, the recipient had recovered from the trauma of surgery and had normal liver biochemistry, a patent hepatic venous stented anastomosis and complete resolution of the abscesses. We faced dual challenges in dealing with a live liver transplant donor and a young child who was the recipient. Our success, on this occasion, was underscored by the multidisciplinary contribution from specialists scattered across the island combined with state-public partnership. CONCLUSION: To offer a sustainable live donor liver transplant service for the future, many other aspects, beyond surgery itself, need to be addressed.
Optimizing intraoperative haemodynamics and haemostasis to enhance recovery after liver transplantation for cirrhosis in adults
(College of Anaesthesiologists of Sri Lanka, 2022) Gunetilleke, B.; Welikala, N.; Ranamuni, R.; Jayaweera, D.; de Silva, T.; Amerasinghe, O.; Liyanage, C.; Dissanayake, J.; Appuhamy, C.; Fernando, M.; Thilakarathne, S.; Dassanayake, A.; Niriella, M.; Siriwardana, R.; Gilbert-Kawai, E.
Cirrhosis with end stage liver disease is a leading cause of non-communicable disease related deaths in Sri Lanka. Liver transplantation remains the only curative treatment for such patients. Multi-organ dysfunction characteristic of end stage liver disease, surgical and anaesthetic factors, quality of the graft, coagulopathy and haemodynamic instability, all lead to the complexity of the perioperative care for liver transplant. Aggressive management focused particularly on maintaining intra-operative haemodynamic stability and optimizing haemostasis, directly impacts successful patient outcomes and forms the core of the anaesthetic strategy.
Pre-treatment alphafeto protein in hepatocellular carcinoma with non-viral aetiology - a prospective study
(BioMed Central, 2017) Siriwardana, R.C.; Thilakarathne, S.; Niriella, M.A.; Dassanayake, A.S.; Gunetilleke, M.B.; Habarakada, L.C.A.; de Silva, H.J.
BACKGROUND: Alpha-fetoprotein (AFP) is a biomarker for hepatocellular carcinoma (HCC). The significance of pre-treatment AFP (pt-AFP) in non-viral HCC (nvHCC) is not clear. METHODS: Patients with nvHCC, referred to a Hepatobiliary Clinic from September 2011-2015 were screened. HCC was diagnosed using American Association for the Study of Liver Disease guidelines, and TNM staged. nvHCC was diagnosed when HBsAg and anti-HCVAb was negative. Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD) scores were calculated. AFP level was evaluated against patient characteristics, tumour characteristics and survival. RESULTS: Three hundred eighty-nine patients with nvHCC [age 64(12-88) years; 344(88.4%) males] were screened. Median AFP was 25.46 ng/ml (1.16-100,000). 41.2% (n = 160) Of patients had normal AFP level. 22.9% (n = 89) had AFP over 400 ng/ml. Female gender (P < 0.05), vascular invasion (P < 0.001), tumours over 5 cm (P < 0.05), late TNM stage (P < 0.001) and non-surgical candidates had higher AFP levels. Diffuse type (P < 0.001), macro vascular invasion (P < 0.001) and late stage tumours (P < 0.001) had AFP over 400 ng/ml. Having AFP below 400 ng/ml was associated with longer survival (16 vs. 7 months, P < 0.001). CONCLUSION: Pre treatment AFP has a limited value In diagnosing nvHCC, Having a AFP value over 400 ng/ml was associated with aggressive tumour behaviour and poor prognosis.
Unresolved laboratory issues of the heterozygous state of β-thalassemia: a literature review
(Ferrata Storti Foundation, 2024) Thilakarathne, S.; Jayaweera, U.P.; Premawardhena, A.
Although considered a mild clinical condition, many laboratory issues of the carrier state of beta-thalassaemia remain unresolved. Accurate laboratory screening of beta-thalassaemia traits is crucial for preventing the birth of a beta-thalassaemia major child. Identification of carriers in the laboratory is affected by factors that influence red cell indices and HbA2 quantification. Silent mutations and co-inheriting genetic and non-genetic factors affect red cell indices which decreases the effectiveness of the conventional approach. Similarly, the type of beta mutation, co-inheriting genetic and non-genetic factors, and technical aspects, including the analytical method used and variations in the HbA2 cutoff values, affect the HbA2 results leading to further confusion. However, the combination of MCV, MCH and haemoglobin analysis increases the diagnostic accuracy. Diagnostic problems arising from non-genetic factors can be eliminated by carefully screening the patient's clinical history. Still, issues due to certain genetic factors, such as Krüppel-like factor 1 gene mutations and alpha triplication remain unresolved. Each laboratory should determine the populationspecific reference ranges and be wary of machine-related variations of HbA2 levels, the prevalence of silent mutations in the community.