Coagulation profile and Hematological parameters in patients with Alcoholic Liver Disease and its association with the disease severity (A study of 230 cases)

Introduction: Alcoholic liver disease is a term that encompasses the liver manifestation of long-term alcohol consumption, including fatty liver, alcoholic hepatitis, and liver cirrhosis. Abnormalities in hematological parameters are common in patients with alcoholic liver disease. The pathogenesis of abnormal hematological parameters in cirrhosis is multifactorial and includes portal hypertension-induced sequestration, alterations in bone marrow stimulating factors, viral- and toxin-induced bone marrow suppression. Excess alcohol intake itself causes direct bone marrow suppression leading to toxic effects on the cell lineages and cause hematological disturbances causing anemia, leucocytosis, leucopenia, and thrombocytopenia. Abnormalities in hematological parameters are associated with an increased risk of complications, including bleeding and infection. All three parameters determine a greater extent of morbidity and mortality in these patients.Materials and Methods: In the present study, patients were grouped into Group 1 to 5 based on the Model for End-stage Liver Disease scoring, and individual hematological parameters were studied. The onset of anemia, leucocytosis or leucopenia, and thrombocytopenia in the MELD group was studied so that corrective measures can be taken at the earliest.Results: Maximum number of patients fell into Group 2 of MELD score and hemoglobin, total count and platelets were studied in each group. Patients followed a pattern of reduced hemoglobin as the MELD score as well as group increased with significant p value and increase total count with increase in MELD group with significant p value.Concluison: The results obtained from the study have clear implications regarding the prediction of what the hematological spectrum does an individual patient has when he falls into a particular group of MELD score. This speculation could persuade the treating physicians to correct these hematological indices so that further disease progression could be delayed or nullified

The Prevalence of clotting factor inhibitors in patients with hemophilia

Background: Hemophilia A and B are X-linked diseases that predominantly affect male patients. Patients can develop coagulation factor inhibitors, which exponentially increases the treatment cost. Objective: This study aimed to determine the prevalence of factor VIII inhibitors. Materials and methods: This was an observational descriptive study. Clotting factor inhibitor screening was performed by activated partial thromboplastin time mixing studies using normal pooled plasma. Bethesda assay for quantitation of factor VIII inhibitors was performed on samples which were positive with screening tests.Results: Study was performed in total of 62 patients with Hemophillia. Out of 62 patients, Hemophilia A and Hemophilia B was observed in 92% cases and 7% cases respectively and 1 case was with Hemophillia and von willebrand disease(1%). Out of 62 patients, 39(63%) had severe hemophilia A, 18(29%) had moderate hemophilia A, and 5(8%) had mild hemophilia A. Mixing based inhibitor screening was positive in total 14 number of patients. Bethesda assay confirmed 10(16%) cases with presence of inhibitor. 4(40%) out of 10 patients were low responders (<5 BU), with mean BU of 2.88, and 6(60%) patients were high responders (>5 BU), with mean BU of 39.2. Diagnostics of mixing based inhibitor screening showed sensitivity and specificity of 75% & 60% at difference of ≥5 seconds and 60% & 100% for difference of ≥10 seconds.Conclusion: Mixing tests are an important first step in the investigation of inhibitors in cases with hemophilia as the follow up investigations are more costly and time consuming than the basic screening tests