Covid-19 associated coagulopathy with comparison of platelet parameters, PT, aPTT and D-Dimer in ICU and Ward patients

Background: SARS-COV2 is the third known corona virus responsible for fatal respiratory illness in humans. Emerging evidence suggested that severe COVID-19 may be complicated with coagulopathy. These coagulation parameters help in assisting the prognosis of the disease and in optimization of its clinical monitoring. Aims: To assess and compare the coagulation parameters (platelet parameters, PT, aPTT, D-dimer) amongst ward and ICU patients of COVID-19 disease. Settings and Design: The present study was Analytical Cross-Sectional Study. Materials and Methods: This study included 220 COVID-19 positive cases (110 ICU and 110 Ward) at a tertiary care hospital. Tests were done for platelet parameters, PT, aPTT and D-Dimer in ICU and Ward patients. Statistical analysis used: The presentation of the Categorical variables was done in the form of number and percentage (%). The quantitative data were presented as means ± SD and as median with 25th and 75th percentiles (interquartile range). Results: In this study, we compared coagulation parameters (Platelet count, PT, aPTT, D dimer) of 110 ICU and 110 Ward covid-19 patients. We found that PT, aPTT, platelets, PDW cv and PCT between Covid ICU and ward patients had no significant difference (p value>0.05). Patients admitted to ICU had higher D-dimer level and decreased platelet count. There was clear significant difference in levels of D- dimer, platelet count and MPV between two groups (ICU and ward, p value<0.05). Conclusion: It is clear that alterations in the coagulation parameters in COVID-19 patients are strongly disturbed and signify the disease progression, severity and mortality

Diagnostic accuracy of Lung Biopsy and Bronchoalveolar Lavage (BAL) in Lung Malignancy

Objective: The study was designed to correlate histopathology of lung biopsy and bronchoalveolar lavage (BAL) cytology in the diagnosis of lung malignancy and to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and diagnostic accuracy of bronchoalveolar lavage cytology using histopathology of lung biopsy as gold standard. Study Design: The retrospective and prospective study was conducted at Pathology Department of Tertiary care centre from October 2017 to October 2019, to investigate a total of 54 patients who were clinically/radiologically suspected of lung malignancy and who underwent both bronchial biopsy and bronchoalveolar lavage. Results: On histopathological examination of biopsies, 29 cases (53.7%) were malignant whereas on cytological examination of BAL 19 cases (35.18%) were correctly diagnosed as malignant and 4 cases (7.4%) as suspicious/atypical. The sensitivity, specificity, PPV, NPV and overall diagnostic accuracy of BAL was 79.3%, 100%, 100%, 86.2% and 88.9% respectively. Conclusion: It was observed that BAL cytology is sensitive and specific for the diagnosis of lung cancer. Cytopathological examination complements histopathology in both diagnosing and typing of lung tumours

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