Probability Predicting Tool for Identifying Incidence and Severity of Pancytopenia as a Result of Megaloblastic Anemia

Background: One of the most common etiology in the diagnosis of pancytopenia in physician practice is megaloblastic anemia. However there is significant confusion associated with marrow megaloblastic features, which need not always because of pancytopenia. They may be just co-incidental findings. Its often difficult to establish that the peripheral pancytopenia is related to marrow megaloblastic features, as Vitamin B12 and folate are often normal in these cases [because of prior treatment] Aim: This study was conducted to develop a probability predicting system for possible incidence and severity of pancytopenia as a result of megaloblastic anemia. Materials and Methods: This is a retrospective analysis conducted at a tertiary care center with approximately 2,000 new cases of megaloblastic anemia. We Hypothesized age, duration of symptoms, Mean Corpuscular Volume [MCV], nutritional status, B12 and folate levels, underlying illness and response to therapy as possible factors associated with pancytopenia of megaloblastic anemia. Receiver operating characteristic (ROC) curves were drawn to predict the cutoff values for risk factors, and a final scoring system was developed with sensitivity and specificity data. Results: A total of 458 patients with pancytopenia and marrow findings of megaloblastic anemia were analyzed. Based on ROC analysis, following cutoff values were selected: age > 40 years or <20, Folate <30% lower limit, B12 any value close to lower limit of reference laboratory value, Mean Corpuscular Volume>110 fl, duration of symptoms more than 18 weeks, Serum Albumin <2.5 gm/dl [taken as marker for nutrition]. The remaining factors were indicated as present or absent. A score of 1 was assigned for the above factors if they were present. For patients, the final score of 2 or less there is 22% probability of having pancytopenia while patients having score of 6 or more have 89% probability. Similarly when the Mean Corpuscular Volume recovered/reduced by 8 fl at week 3, patients have positive predictable recovery pattern. Those who does not have such recovery by week 3, the etiology of pancytopenia is unlikely to be megaloblastic anemia. And they need further evaluation Conclusion: The current tool is fairly accurate in predicting development of pancytopenia in patients with low B12 and folate/megaloblastic anemia. This will further help clinicians to look for other reasons of pancytopenia in case, where MCV does not recover beyond week 3 of therapy, so that valuable time of patient is not lost in resource constraints nations like India

Approach to Aplastic Anemia- An Overview and Practical Approach

Despite the fact that cytopenia has been a common hematological entity seen in clinical practice for decades, the understanding of its etiopathogenesis has been changing, which in turn impacts on the management strategies. The current review focuses on the understanding of the current concepts and a brief overview of the management of aplastic anemia. As the spectrum of stem cell biology, etiology, and treatment from transplantation to graft-versus-host disease cannot be covered in few paragraphs, the most concise form is presented here

Retrospective Evaluation of Anemia in Relation to Body Mass Index [BMI] in Women Presenting to Tertiary Care Hospital from Telangana

Objective: This is a retrospective analysis to investigate the prevalence, nature [Like megaloblastic vs Iron deficiency vs blood loss vs hemolytic etc.] and determinants of anemia among women in a tertiary care hospital during the period 2011-2014. We examined differences in anemia related to, urban/rural location, nutrition status as reflected by body mass index (BMI) and serum albumin levels and hemogram values Methods: The Hb values of all women presenting to the OPD was captured along with the details of the Haemogram, Iron profile, as well as other clinical examination findings. Wherever the complete work up was performed, the details were also captured. The standard definitions were used for entering the data and MEDCALC version 7.0 was used for the statistical analysis. Results: A total of 463 women aged 15–59 were analyzed. (Elderly were not included as the etiologic of the anemia will be different in them as well as multiple co-morbidities confounding the analysis) Prevalence of anemia was high among all women, however as compared to national statistics; this is slightly less in the current study. In all 28.4% of women had mild, 12.6% had moderate, and 5.2% had severe anemia. Both high and low BMI were associated with anemia, though very low BMI had mixed picture, Low BMI had Iron deficiency and high BMI had Megaloblstic variants of anemia. Conclusion: Anemia still is an important health burden in women of both urban and rural origin, even-though the prevalence compared to a decade ago appears to be slightly less. New differential and tailored program strategies are needed for improving the hemoglobin for those with very low BMI [Iron supplements alone may not be enough and they need both Iron and B12 with folic acid]. Similarly in urban women, its essential to sensitize regarding the balanced diet, [especially if the BMI is high] with focus on the B12 and folate supplements [besides other dietary modifications]

Retroperitoneal inflammatory myofibroblastic tumor

BACKGROUND: Inflammatory myofibroblastic tumor (IMT) is a neoplasm of unknown etiology occurring at various sites. By definition, it is composed of spindle cells (myofibroblasts) with variable inflammatory component, hence the name is IMT. CASE PRESENTATION: The present case is of a 46 years old woman presented with a history of flank pain, abdominal mass and intermittent hematuria for last 6 months. The initial diagnosis was kept as renal cell carcinoma. Finally, it turned out to be a case of retroperitoneal IMT. The patient was managed by complete surgical resection of the tumor. CONCLUSION: IMT is a rare neoplasm of uncertain biological potential. Complete surgical resection remains the mainstay of the treatment

Case Report-Malignant adenomyoepithelioma of the breast

Malignant adenomyoepithelioma of the breast is a rare tumor characterized by biphasic proliferation of both epithelial and myothelial cells. Here we report a 20-year-old female presented to us with recurrence of a breast lump shortly following lumpectomy. Histopathological examination suggested malignant adenomyoepithelioma. She had undergone modified radical mastectomy, received local radiation to the chest wall and six courses of adriamycin and cyclophosphamide. She remains in complete remission at 18 months follow-up. The present case is rare in several respects. The age of presentation was 20 years, much less than what has been reported. Mammography showed micro-calcifications, thus far not described. In addition, our patient had an exceptionally aggressive tumor that recurred within two months of lumpectomy. This tumor also showed good chemo sensitivity