Medicine
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This repository contains the published and unpublished research of the Faculty of Medicine by the staff members of the faculty
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Item Microcytic anemia in children: Parallel screening for iron deficiency and Thalassemia provides a useful opportunity for Thalassemia prevention in low- and middle-income countries(Hemisphere Pub. Corp., 2020) Mettananda, S.; Paranamana, S.; Fernando, R.; Suranjan, M.; Rodrigo, R.; Perera, L.; Vipulaguna, T.; Fernando, P.; Fernando, M.; Dayanath, B.K.T.P.; Costa, Y.; Premawardhena, A.ABSTRACT:Microcytic anemia in children is commonly attributed to iron deficiency without attempting to find the cause. Inadequate investigations to exclude hemoglobinopathies lead to missed opportunities for identification of thalassemia carriers. Here we aim to describe the relative contribution of iron deficiency and thalassemia to microcytic anemia in children. This hospital-based prospective study was conducted at the Colombo North Teaching Hospital, Ragama, Sri Lanka. All newly diagnosed patients with microcytic anemia were recruited and data were collected using an interviewer-administered questionnaire. Full blood count, blood film, serum ferritin, c-reactive protein, quantification of hemoglobin sub-types and α-globin genotype were performed using 4 ml of venous blood. A total of 104 children (Male- 60.5%) were recruited. Iron deficiency was the cause for anemia in 49% whilst 16% and 10% had α- and β-thalassemia trait respectively. Seven (6.7%) children had co-existing iron deficiency and thalassemia trait while two coinherited α- and β-thalassemia trait. Children with β-thalassemia trait had significantly higher red cell count and lower mean corpuscular volume compared to children with iron deficiency. However, none of the red cell parameters were significantly different between children with α-thalassemia trait and iron deficiency. Iron deficiency contributes only to half of children with microcytic anemia; one-fourth had thalassemia trait. Co-existence of iron deficiency and thalassemia trait or co-inheritance of α- and β-thalassemia trait were found in 9%. Parallel investigation of children with microcytic anemia to diagnose iron deficiency and thalassemia provides an opportunity to identify thalassemia carriers which is beneficial for thalassemia prevention.Item Rational use of FFP at North Colombo Teaching Hospital: An audit(Sri Lanka Medical Association, 2018) Sutharsiny, Y.; Darshani, W. M. N.; Moratuwagama, H. M. D.; Costa, Y.; Williams, H. S. A.; Kularatne, W. M. M .T.INTRODUCTION & OBJECTIVES: The British Committee for Standards in Haematology (BCSH) provides guidelines for use of fresh frozen plasma (FFP). Inappropriate use and non-compliance with guidelines for FFP have been reported.This audit is to reinforce guidelines and avoid inappropriate use. The objectives are to check - l.The indications ofFFP use 2.Calculation of dose according to weight of patient 3.Checking of coagulation (PT/APTT) before and after FFP METHODS: Data was collected from blood bank requests for 4 months. Details were collected from a questionnaire from patients and BHTs following transfusion.RESULTS: Of 50 patients, 11 were neonates and 4 children. Indications were liver disease with abnormal coagulation (40%), DIC and severe sepsis (20%), liver disease with normal coagulation awaiting surgery (10%), and massive bleeding (8%). 14% of neonates required FFP for resuscitation and to treat sepsis.Though weight was measured in 41(82%), adequate dose was administered to 14 (28%), overestimated in 26%, and underestimated in 28%. Pre and post transfusion coagulation was done in 33 (66%) and 17 (34%) respectively. Seven (14%) had coagulation tests within 3 hours. None of the patients had informed consent, risks and benefits informed prior to transfusion. CONCLUSION: All FFP is used according to guidelines. Documentation of volume of FFP used requires improvement as ambiguity of ml or units. Each unit of FFP varies· from 180ml - 230ml. Requirement of post transfusion coagualation within 3 hours is to be emphasized. Requirement of informed consent prior to transfusion of blood products is stressed.Item Microcytic anaemia in children: Do we really know the cause?(Sri Lanka Medical Association, 2018) Paranamanna, S.; Fernando, V. R.; Suranjan, P. D. M.; Rodrigo, R.; Perera, L.; Vipulanayake, U. K. T.; Fernando, A. G. L. N. P.; Fernando, A.M.; Costa, Y.; Dayanath, D.K.T.P.; Premawardhena, A.; Mettananda, S.INTRODUCTION & OBJECTIVES: Microcytic anaemia is common among children and is often attributed to iron deficiency. Other causes are given less priority. We aimed to describe the aetiology of microcytic anaemia among children aged between 6-59 months.METHODS: A descriptive study was conducted at Teaching Hospital, Ragama from March 2016 to February 2017. All newly diagnosed patients with microcytic anaemia (haemoglobin <11 g/dL and mean corpuscular volume <80 Fl) were recruited. Data was collected using an interviewer-administered questionnaire and 5ml of venous blood was obtained for full blood count, serum ferritin, capillary electrophoresis and alpha-globin genotype during a period free from any acute illness. A therapeutic trial with oral iron (6mg/kg/day) was given to all children and response was assessed after one month. Ethical approval was obtained from Ethics Committee of University of Kelaniya and data were analysed using SPSS. RESULTS: Sixty-six children (male-54.5%; mean age-20.5±13.9 months) were recruited. Severity of anaemia was mild-38%, moderate-61% and severe- I%. Reported clinical features were: irritability (26%), loss of appetite (6%), fatigue (5%), pica (3%), brittle hair (26%), dry skin (23%), angular stomatitis (2%) and glossitis (2%). Aetiologically, 28 (42.4%) had iron deficiency (ferritinlg/dl after 1 month) was observed in 27 (40 9%).CONCLUSION: Less than half of children with microcytic anaemia had low serum ferritin and only 41 % of children demonstrated a response to a trial of oral iron Thalassaemia trait, especially alpha-thalassaemia is an important cause for microcytic anaemia in asymptomatic children.