Pub Date : 2023-03-20DOI: 10.37545/haematoljbd2023106
S. Afrose
{"title":"Venous Thromboembolism is Still Undermined in Bangladesh","authors":"S. Afrose","doi":"10.37545/haematoljbd2023106","DOIUrl":"https://doi.org/10.37545/haematoljbd2023106","url":null,"abstract":"","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"89 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117314036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd202396
Md. Raiq Raihan Chowdhury, Ishwor Man Singh, N. Akhter, Samim Reza, Md. Maruf Reza Kabir, Kazi Fazlur Rahman, Nishat Mahzabin, Md Salahuddin Shah, Md. Abdul Aziz
Introduction: Chronic Myeloid Leukaemia (CML) is a myeloproliferative neoplasm characterised by uncontrolled proliferation of white blood cells and its precursors. At diagnosis, various risk scoring systems have been formulated for risk stratification. In 2016, European Treatment Outcome Study (EUTOS) Long Term Survival (ELTS) score has been formulated most recently. This score was recommended by European LeukaemiaNet in 2020. Objective: The objective of the study was to estimate the frequency of high-risk patients among Chronic Myeloid Leukaemia patients in chronic phase using ELTS scoring system. Materials and Methods: This observational study was conducted among patients at Bangabandhu Sheikh Mujib Medical University (BSMMU) between September 2020 and October 2021. A total of fifty chronic myeloid leukaemia patients were enrolled using purposive sampling technique. Clinical information and haematological parameters were recorded. Bone marrow study was conducted to confirm phase of the disease. ELTS risk score was calculated, and risk stratification was done. Chi-square test was done to find out statistical association between variables. Results: Among study participants, 14% were identified as high-risk cases using ELTS score. 40% of patients were intermediate-risk and 46% were low-risk disease. Presence of hepatomegaly or splenomegaly were significantly more common among high-risk patients. Significantly increased eosinophil and blast percentages and significantly lower haemoglobin level were found in high-risk patients. Conclusion: A fair proportion of the CML patients were identified as high-risk patients. Hepatomegaly, splenomegaly, lower haemoglobin, higher eosinophil and higher blast percentages were identified to be independently associated with higher risk stratification of patients.
{"title":"Risk Stratification of Chronic Myeloid Leukaemia Patients with ELTS Risk Score at a Tertiary Care Hospital in Bangladesh","authors":"Md. Raiq Raihan Chowdhury, Ishwor Man Singh, N. Akhter, Samim Reza, Md. Maruf Reza Kabir, Kazi Fazlur Rahman, Nishat Mahzabin, Md Salahuddin Shah, Md. Abdul Aziz","doi":"10.37545/haematoljbd202396","DOIUrl":"https://doi.org/10.37545/haematoljbd202396","url":null,"abstract":"Introduction: Chronic Myeloid Leukaemia (CML) is a myeloproliferative neoplasm characterised by uncontrolled proliferation of white blood cells and its precursors. At diagnosis, various risk scoring systems have been formulated for risk stratification. In 2016, European Treatment Outcome Study (EUTOS) Long Term Survival (ELTS) score has been formulated most recently. This score was recommended by European LeukaemiaNet in 2020. Objective: The objective of the study was to estimate the frequency of high-risk patients among Chronic Myeloid Leukaemia patients in chronic phase using ELTS scoring system. Materials and Methods: This observational study was conducted among patients at Bangabandhu Sheikh Mujib Medical University (BSMMU) between September 2020 and October 2021. A total of fifty chronic myeloid leukaemia patients were enrolled using purposive sampling technique. Clinical information and haematological parameters were recorded. Bone marrow study was conducted to confirm phase of the disease. ELTS risk score was calculated, and risk stratification was done. Chi-square test was done to find out statistical association between variables. Results: Among study participants, 14% were identified as high-risk cases using ELTS score. 40% of patients were intermediate-risk and 46% were low-risk disease. Presence of hepatomegaly or splenomegaly were significantly more common among high-risk patients. Significantly increased eosinophil and blast percentages and significantly lower haemoglobin level were found in high-risk patients. Conclusion: A fair proportion of the CML patients were identified as high-risk patients. Hepatomegaly, splenomegaly, lower haemoglobin, higher eosinophil and higher blast percentages were identified to be independently associated with higher risk stratification of patients.","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128493092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd202397
N. Akhter, A. L. Kabir, M. T. Islam, Md. Abdul Aziz, A. Yunus, M. Begum, Salahuddin Shah, R. Khan, F. Rahman
Background: Haemophilia is a sex-linked bleeding disorder. Affected patients suffer spontaneous or post-traumatic bleeding into various sites of the body, mainly into joints, depending on the level of coagulation factor deficiency. Recurrent joint bleeds lead to progressive disability. Susceptibility to joint haemorrhage in persons with haemophilia suggests that the routine assessment of joint health is an important aspect of clinical management and outcome studies assessing the efficacy of treatment. Aim: The aim of the study was to assess of joint health status in haemophilia patients attending in a tertiary care hospital, Bangladesh. Methodology: A descriptive observational study was carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total number of 45 patients who were attended in OPD and IPD, meeting inclusion and exclusion criteria of enrolled haemophilia patients, were included in the study. Joint assessment or any kind of joint impairment was assessed by the Haemophilia Joint Health Score (HJHS) score 2.1 version (an eight-item scoring tool for assessing joint impairments of the six index joints in boys with haemophilia aged 4–18 years. Clinical and laboratory information was recorded with a semi structured questionnaire. Result: Among 45 haemophilia patients, the mean age was 12.9±3.4 years while males were predominant (91.1%). Majority (80.0%) of the patients (36) were diagnosed as haemophilia A. This study observed that, 48.9% of the patients had moderate and 28.9% had severe haemophilia. Knee joint was the predominant target joint. Left knee joint involved in 80% cases and right knee joint were involved in 55.6% of patients. The mean global gait score was found 1.49±0.66 and mean HJHS score was 15.8±4.4. There was no significant correlation between HJHS score and severity of haemophilia (r= -0.081; p=0.596) while significant correlation between the ages of patient with HJHS score (r=0.536; p=0.001) was observed. Conclusion: Haemophilia is a debilitating and life-threatening disease that affects mostly knee, ankle and elbow joints. The joint evaluation system is of paramount importance in clinical practice which is capable to prevent major haemarthrosis and chronic haemophilic synovitis. Haemophilia Joint Health Score (HJHS) is an effective and reliable tool to detect early and subtle changes in joint health and function. This study finding will help in future to assess early the joint conditions and complications, which will assist to modify the treatment approach on demand and start prophylaxis.
{"title":"Assessment of Joint Health Status of Haemophilia Patients in a Tertiary Care Hospital of Bangladesh","authors":"N. Akhter, A. L. Kabir, M. T. Islam, Md. Abdul Aziz, A. Yunus, M. Begum, Salahuddin Shah, R. Khan, F. Rahman","doi":"10.37545/haematoljbd202397","DOIUrl":"https://doi.org/10.37545/haematoljbd202397","url":null,"abstract":"Background: Haemophilia is a sex-linked bleeding disorder. Affected patients suffer spontaneous or post-traumatic bleeding into various sites of the body, mainly into joints, depending on the level of coagulation factor deficiency. Recurrent joint bleeds lead to progressive disability. Susceptibility to joint haemorrhage in persons with haemophilia suggests that the routine assessment of joint health is an important aspect of clinical management and outcome studies assessing the efficacy of treatment. Aim: The aim of the study was to assess of joint health status in haemophilia patients attending in a tertiary care hospital, Bangladesh. Methodology: A descriptive observational study was carried out in the department of Haematology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. A total number of 45 patients who were attended in OPD and IPD, meeting inclusion and exclusion criteria of enrolled haemophilia patients, were included in the study. Joint assessment or any kind of joint impairment was assessed by the Haemophilia Joint Health Score (HJHS) score 2.1 version (an eight-item scoring tool for assessing joint impairments of the six index joints in boys with haemophilia aged 4–18 years. Clinical and laboratory information was recorded with a semi structured questionnaire. Result: Among 45 haemophilia patients, the mean age was 12.9±3.4 years while males were predominant (91.1%). Majority (80.0%) of the patients (36) were diagnosed as haemophilia A. This study observed that, 48.9% of the patients had moderate and 28.9% had severe haemophilia. Knee joint was the predominant target joint. Left knee joint involved in 80% cases and right knee joint were involved in 55.6% of patients. The mean global gait score was found 1.49±0.66 and mean HJHS score was 15.8±4.4. There was no significant correlation between HJHS score and severity of haemophilia (r= -0.081; p=0.596) while significant correlation between the ages of patient with HJHS score (r=0.536; p=0.001) was observed. Conclusion: Haemophilia is a debilitating and life-threatening disease that affects mostly knee, ankle and elbow joints. The joint evaluation system is of paramount importance in clinical practice which is capable to prevent major haemarthrosis and chronic haemophilic synovitis. Haemophilia Joint Health Score (HJHS) is an effective and reliable tool to detect early and subtle changes in joint health and function. This study finding will help in future to assess early the joint conditions and complications, which will assist to modify the treatment approach on demand and start prophylaxis.","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121199546","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd2023100
A. Haque, S. Nahar, A. Haque, Md. Arif-Ur- Rahman, A. Yunus, T. Afrin, Md. Abdul Aziz, Md. Rafiquzzaman Khan, Md Salahuddin Shah, Nusrat Jahan
Background: Flow cytometry assay for PNH clone is a compulsory routine test for all aplastic anaemia patients. Objective: To estimate the frequency of PNH clone in aplastic anaemia. Method: Twenty-two known cases of aplastic anaemia patients were enrolled for the study. Flow cytometric quantitation of glycosyl phosphatidyl-inositol (GPI)-anchored proteins deficiency using markers CD14, CD24, CD45, CD59, Fluorescent Aerolysin (FLAER), CD235a (6 markers) were performed. Result: PNH clone was identified in 8 (36.4%) of the study population. Among PNH clone positive patients 7 (87.5%) were suffering from non-severe aplastic anaemia. Conclusion: PNH clone is significantly associated with aplastic anaemia and PNH clone assay should be regularly assayed in aplastic anaemia patients for specific management.
{"title":"Prevalence of Paroxysmal Nocturnal Haemoglobinuria Clone in Aplastic Anaemia: A Single Centre Study","authors":"A. Haque, S. Nahar, A. Haque, Md. Arif-Ur- Rahman, A. Yunus, T. Afrin, Md. Abdul Aziz, Md. Rafiquzzaman Khan, Md Salahuddin Shah, Nusrat Jahan","doi":"10.37545/haematoljbd2023100","DOIUrl":"https://doi.org/10.37545/haematoljbd2023100","url":null,"abstract":"Background: Flow cytometry assay for PNH clone is a compulsory routine test for all aplastic anaemia patients. Objective: To estimate the frequency of PNH clone in aplastic anaemia. Method: Twenty-two known cases of aplastic anaemia patients were enrolled for the study. Flow cytometric quantitation of glycosyl phosphatidyl-inositol (GPI)-anchored proteins deficiency using markers CD14, CD24, CD45, CD59, Fluorescent Aerolysin (FLAER), CD235a (6 markers) were performed. Result: PNH clone was identified in 8 (36.4%) of the study population. Among PNH clone positive patients 7 (87.5%) were suffering from non-severe aplastic anaemia. Conclusion: PNH clone is significantly associated with aplastic anaemia and PNH clone assay should be regularly assayed in aplastic anaemia patients for specific management. ","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124324916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd202398
M. Nurunnabi, Mosammath Khadiza Mamdu, A. Siddika
Background: The notorious pandemic coronavirus disease 2019 (COVID-19) has been spread all over the world. Its third pandemic wave has been completed and now a fourth wave is running over many countries. Almost 60 million people have been infected and more than 5.7 million people have died. Till now almost 1.2 million people have been infected and about 30000 people have died in Bangladesh from Covid-19. It has not only taken away human lives but also has put a tremendous impact on our society and economy. So early detection of this virus and isolating the patients have a significant role to control the disease. Henceforth there is an urgent need for simple, accurate and rapid identifications of C0VID -19. Rapid antigen tests can provide timely results, which is of particular importance in a primary setting. So, Performance of the Rapid antigen detection test (RAT) should be evaluated and compared with gold standard real-time reverse transcription-polymerase chain reaction (RT-PCR) test for diagnosis of COVID-19. Methods: Specimens were collected from both naso and oropharyngeal region from 1000 patients who reported to the flu centre in CMH Sylhet with the complaints of fever, cough & headache for detection of COVID virus-2 RNA by rapid antigen (RAT) and RT-PCR test. We used real time RT-PCR kit (Sansure, Biotech china, gene RdRP & N) and COVID-19 Ag Kit (Wondfo, Republic of China) for detection of COVID-19 RNA. Results: Out of 1000 samples 158 were positive and 842 were negative by real-time RT-PCR assay where 154 samples were positive, and 846 cases were negative by rapid antigen test for severe acute respiratory syndrome (SARS) CoV-2. The duration from the onset of symptoms to laboratory test in all suspected cases ranged from 0 to 02 days (with a median of 01 days). The rapid SARS-CoV-2 antigen detection tests sensitivity and specificity were 97.29% (95% CI, 90.06–99.89%) and 97.94% (95% CI, 97.26–98.57%), respectively. Seven samples were found negative in RAT but were found positive in RT-PCR, other three samples were found positive in RAT while they were found negative in RT-PCR. Conclusions: It is observed that most rapid antigen tests for COVID-19 are significantly comparable with RT-PCR tests and had enough sensitivity and specificity for 158 individuals, infected with severe acute respiratory syndrome-CoV-2.
{"title":"Comparative study between gold standard real-time RT-PCR assay and rapid antigen test for detection of COVID-19 in Sylhet CMH","authors":"M. Nurunnabi, Mosammath Khadiza Mamdu, A. Siddika","doi":"10.37545/haematoljbd202398","DOIUrl":"https://doi.org/10.37545/haematoljbd202398","url":null,"abstract":"Background: The notorious pandemic coronavirus disease 2019 (COVID-19) has been spread all over the world. Its third pandemic wave has been completed and now a fourth wave is running over many countries. Almost 60 million people have been infected and more than 5.7 million people have died. Till now almost 1.2 million people have been infected and about 30000 people have died in Bangladesh from Covid-19. It has not only taken away human lives but also has put a tremendous impact on our society and economy. So early detection of this virus and isolating the patients have a significant role to control the disease. Henceforth there is an urgent need for simple, accurate and rapid identifications of C0VID -19. Rapid antigen tests can provide timely results, which is of particular importance in a primary setting. So, Performance of the Rapid antigen detection test (RAT) should be evaluated and compared with gold standard real-time reverse transcription-polymerase chain reaction (RT-PCR) test for diagnosis of COVID-19. Methods: Specimens were collected from both naso and oropharyngeal region from 1000 patients who reported to the flu centre in CMH Sylhet with the complaints of fever, cough & headache for detection of COVID virus-2 RNA by rapid antigen (RAT) and RT-PCR test. We used real time RT-PCR kit (Sansure, Biotech china, gene RdRP & N) and COVID-19 Ag Kit (Wondfo, Republic of China) for detection of COVID-19 RNA. Results: Out of 1000 samples 158 were positive and 842 were negative by real-time RT-PCR assay where 154 samples were positive, and 846 cases were negative by rapid antigen test for severe acute respiratory syndrome (SARS) CoV-2. The duration from the onset of symptoms to laboratory test in all suspected cases ranged from 0 to 02 days (with a median of 01 days). The rapid SARS-CoV-2 antigen detection tests sensitivity and specificity were 97.29% (95% CI, 90.06–99.89%) and 97.94% (95% CI, 97.26–98.57%), respectively. Seven samples were found negative in RAT but were found positive in RT-PCR, other three samples were found positive in RAT while they were found negative in RT-PCR. Conclusions: It is observed that most rapid antigen tests for COVID-19 are significantly comparable with RT-PCR tests and had enough sensitivity and specificity for 158 individuals, infected with severe acute respiratory syndrome-CoV-2. ","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"45 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115851593","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd2023101
M. Rahman, M. Doha, S. Miah, Mahbuba Sharmin
Chronic idiopathic urticaria (CIU) is a troublesome condition which affect the patient’s quality of life adversely. Conventional treatment of this condition comprises of antihistamines, steroids and sometimes monoclonal antibodies with varying degree of outcomes. Recently, autologous blood and serum used by some researcher to treat CIU with promising result. Here we present a case of chronic idiopathic urticaria that was treated successfully with autologous serum in Bangladesh.
{"title":"Autologous Serum Therapy in the Management of Chronic Idiopathic Urticaria, Does It Really Work?","authors":"M. Rahman, M. Doha, S. Miah, Mahbuba Sharmin","doi":"10.37545/haematoljbd2023101","DOIUrl":"https://doi.org/10.37545/haematoljbd2023101","url":null,"abstract":"Chronic idiopathic urticaria (CIU) is a troublesome condition which affect the patient’s quality of life adversely. Conventional treatment of this condition comprises of antihistamines, steroids and sometimes monoclonal antibodies with varying degree of outcomes. Recently, autologous blood and serum used by some researcher to treat CIU with promising result. Here we present a case of chronic idiopathic urticaria that was treated successfully with autologous serum in Bangladesh.","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130481609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd202391
Fatima- Tuz- Zohra, Abu Hasan Rubel, M. Islam, Md. Sirazul Islam
Autoimmune haemolytic anaemia (AIHA) and paroxysmal nocturnal haemoglobinuria (PNH) are two distinct causes of haemolytic anaemia. They have different mechanisms that underpin their pathogenesis and, therefore, require different treatment strategies. The direct antiglobulin test (DAT) or Coombs’ test is positive in cases of immune-mediated haemolytic anaemia and, thus, is positive in AIHA but negative in PNH. We report a case of a man presenting with a haemolytic anaemia who was found to have concomitant evidence of AIHA and PNH. The case highlights the importance of carrying out a comprehensive haemolysis work-up in patients who present with haemolytic anaemia.
{"title":"A Case Report: Autoimmune Haemolytic Anaemia & Paroxysmal Nocturnal Haemoglobinuria Association","authors":"Fatima- Tuz- Zohra, Abu Hasan Rubel, M. Islam, Md. Sirazul Islam","doi":"10.37545/haematoljbd202391","DOIUrl":"https://doi.org/10.37545/haematoljbd202391","url":null,"abstract":"Autoimmune haemolytic anaemia (AIHA) and paroxysmal nocturnal haemoglobinuria (PNH) are two distinct causes of haemolytic anaemia. They have different mechanisms that underpin their pathogenesis and, therefore, require different treatment strategies. The direct antiglobulin test (DAT) or Coombs’ test is positive in cases of immune-mediated haemolytic anaemia and, thus, is positive in AIHA but negative in PNH. We report a case of a man presenting with a haemolytic anaemia who was found to have concomitant evidence of AIHA and PNH. The case highlights the importance of carrying out a comprehensive haemolysis work-up in patients who present with haemolytic anaemia. ","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121192052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd2023102
A. Habib, A. Zaman, S. Jebunnahar, A. Kabir, Mohammad Shahbaz Hossain
Background: Pregnancy itself is one of the most provoking factors for the development of venous thromboembolism (VTE) with an incidence of 5-12 per 10 000 pregnancies (from conception to delivery, i.e., 40 weeks) and 3-7 per 10 000 deliveries postpartum (6 weeks).1 Moreover, certain clinical conditions and individual patient profile make each pregnant women more susceptible to develop symptomatic VTE comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no denial of the fact that risk stratification based upon individual risk factors (both clinical and biochemical) during antenatal period will rationalize the implementation of precise antenatal care/ personalized prophylaxis tailored to each pregnant women, ultimately leading to safe and healthy maternal and perinatal outcome. Objective: The objective of this study is to apply the documented assessment scoring system according to the RCOG Guideline 37a mainly based on clinical risk factors to detect and stratify antenatal patient risk of VTE and institute appropriate preventive treatment/advice. Method: This is a prospective cross-sectional study involving 50 antenatal/pregnant women randomly selected over a period of 6 months undergoing antenatal care in Bangladesh Medical College. For the assessment of risk of VTE in these patients, RCOG guideline 37a risk assessment tool was used. (Appendix 1) A score ranging from 0 to 4 or more was objectively found among these patients. Based upon the score, each patient was categorized as high risk, intermediate risk, and lower risk. Then thromboprophylaxis with LMWH (Enoxaparin)/mobilization was advised for variable durations depending upon the timing of presentation and scores. The patients were reassessed after admission and post-delivery using the same tool for change in transient factors and advised according to the score. Implementation of this risk stratification tool resulted in improved patient care and counselling; the pregnancy outcome of each case was followed up. Results: Among the fifty antenatal patients, RCOG guideline 37a risk assessment tool revealed the following scores: one patient scored zero. Eighteen patients scored one. Sixteen patients scored two. Nine patients scored three. Six patients scored four. Those who scored 0 and 1 (19 patients) required no thromboprophylaxis. The sixteen patients with a score of two were advised for post-natal thromboprophylaxis with low molecular weight heparin/ Enoxaparin (LMWH) for 10 days. They were reassessed/ re-scored in the postnatal period for VTE risk and 5 of these patients down scored to one. Thereby they were judged as not to require post-natal thromboprophylaxis and were advised early mobilization and avoidance of dehydration. The remaining 11 patients with a score of two on postnatal review were put on LMWH (Enoxaparin) at a dose of 20 mg daily subcutaneous (s.c.) (<50 kg), 40 mg daily (50-90 kg), 60 mg daily in 2 divided dose (91-130 kg) for 10 days. Conclusion: Pulmo
{"title":"Assessment of Risk Factors and Risk Stratification for Venous Thromboembolism (VTE) in Pregnancy: A Study Conducted in A Tertiary Level Hospital","authors":"A. Habib, A. Zaman, S. Jebunnahar, A. Kabir, Mohammad Shahbaz Hossain","doi":"10.37545/haematoljbd2023102","DOIUrl":"https://doi.org/10.37545/haematoljbd2023102","url":null,"abstract":"Background: Pregnancy itself is one of the most provoking factors for the development of venous thromboembolism (VTE) with an incidence of 5-12 per 10 000 pregnancies (from conception to delivery, i.e., 40 weeks) and 3-7 per 10 000 deliveries postpartum (6 weeks).1 Moreover, certain clinical conditions and individual patient profile make each pregnant women more susceptible to develop symptomatic VTE comprising deep vein thrombosis (DVT) and pulmonary embolism (PE). There is no denial of the fact that risk stratification based upon individual risk factors (both clinical and biochemical) during antenatal period will rationalize the implementation of precise antenatal care/ personalized prophylaxis tailored to each pregnant women, ultimately leading to safe and healthy maternal and perinatal outcome. Objective: The objective of this study is to apply the documented assessment scoring system according to the RCOG Guideline 37a mainly based on clinical risk factors to detect and stratify antenatal patient risk of VTE and institute appropriate preventive treatment/advice. Method: This is a prospective cross-sectional study involving 50 antenatal/pregnant women randomly selected over a period of 6 months undergoing antenatal care in Bangladesh Medical College. For the assessment of risk of VTE in these patients, RCOG guideline 37a risk assessment tool was used. (Appendix 1) A score ranging from 0 to 4 or more was objectively found among these patients. Based upon the score, each patient was categorized as high risk, intermediate risk, and lower risk. Then thromboprophylaxis with LMWH (Enoxaparin)/mobilization was advised for variable durations depending upon the timing of presentation and scores. The patients were reassessed after admission and post-delivery using the same tool for change in transient factors and advised according to the score. Implementation of this risk stratification tool resulted in improved patient care and counselling; the pregnancy outcome of each case was followed up. Results: Among the fifty antenatal patients, RCOG guideline 37a risk assessment tool revealed the following scores: one patient scored zero. Eighteen patients scored one. Sixteen patients scored two. Nine patients scored three. Six patients scored four. Those who scored 0 and 1 (19 patients) required no thromboprophylaxis. The sixteen patients with a score of two were advised for post-natal thromboprophylaxis with low molecular weight heparin/ Enoxaparin (LMWH) for 10 days. They were reassessed/ re-scored in the postnatal period for VTE risk and 5 of these patients down scored to one. Thereby they were judged as not to require post-natal thromboprophylaxis and were advised early mobilization and avoidance of dehydration. The remaining 11 patients with a score of two on postnatal review were put on LMWH (Enoxaparin) at a dose of 20 mg daily subcutaneous (s.c.) (<50 kg), 40 mg daily (50-90 kg), 60 mg daily in 2 divided dose (91-130 kg) for 10 days. Conclusion: Pulmo","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130216359","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.37545/haematoljbd2023109
Md. Manirul Islam, Gazi Yeasinul Islam
{"title":"Overview of venous thromboembolism (VTE) in patients with haematological malignancy","authors":"Md. Manirul Islam, Gazi Yeasinul Islam","doi":"10.37545/haematoljbd2023109","DOIUrl":"https://doi.org/10.37545/haematoljbd2023109","url":null,"abstract":"","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114695670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-25DOI: 10.37545/haematoljbd202293
M. Wasim, Md. Abdul Aziz, Ashraful Haque Chowdhury, Gazi Yeasinul Islam, Md Nazmul Islam, Muhammad Nurul Farhad, M. S. I. Sikdar, N. M. Irshadullah, Md. Shafiur Rahman
Background: Even after significant improvement of management of haematological malignancy, post chemotherapy infection is still causing significant mortality and morbidity. Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunocompromised patients. This study was designed to assess prospectively the status of CMV IgM seropositivity in patients with haematological malignancy at diagnosis and after starting chemotherapy by serology test. In Bangladesh the prevalence IgG is high and IgM is low in general population but in patients with chemotherapy due to haematological malignancy status of CMV infection is not known. By finding out the infection rate we will be able to provide supportive care more effectively to patients of chemotherapy due to haematological malignancy. Methodology: This was a prospective type of observational study and patients were selected by purposive sampling. Assessment of CMV IgG and IgM antibody test had been done at the time of 1st diagnosis and IgM antibody for CMV reassessed 6 weeks after initial chemotherapy. Antibodies were detected by Chemiluminescence method from Virology department of BSMMU. Statistical analysis was done both manually and Windows based software device with Statistical Package for Social Science (SPSS). A p-value of <0.05 was taken as significant during data calculation. Result: During 12 months study period a total 45 patients with haematological malignancy were included in the study. Out of 45 patients, 28 were male (62%) and 17 were female (38%), male female ratio was 1.65:1. The youngest of the participants was 15 and oldest was 70 years old. The mean age of the participants was 35.77 years with SD of 16.93. Among 45 patients of the study, ALL patients were 20 (44.4%), AML patients were 17 (37.8%), NHL patients were 5 (11.1%) and HD patients were 3 (6.7%). Before chemotherapy all participants were CMV IgG positive (100%) no one was CMV IgM Positive (0%). Six weeks after chemotherapy, 42 (93.3%) cases were CMV IgM antibody negative and only 3 (6.7%) cases were positive for CMV IgM antibody. McNemar test was done to measure the level of significance and p-value was 0.250, which was not significant statistically. Conclusion: This small study found that all participants were CMV IgG seropositive (100%). It indicates that higher percentages of haematological malignancy patients are previously infected with CMV so there is more risk of reactivation after chemotherapy or BMT. Post chemotherapy CMV IgM seropositivity (new infection or reactivation of CMV) was low 6.7% in this study. This percentage is low in comparison with other studies. Percentage could be high if the tests were carried out with more sensitive and specific tests for CMV like PCR, pp65 antigenaemia or CMV DNA.
{"title":"Status of CMV IgM Seropositivity Before and After Starting Chemotherapy in Patients with Haematological Malignancies","authors":"M. Wasim, Md. Abdul Aziz, Ashraful Haque Chowdhury, Gazi Yeasinul Islam, Md Nazmul Islam, Muhammad Nurul Farhad, M. S. I. Sikdar, N. M. Irshadullah, Md. Shafiur Rahman","doi":"10.37545/haematoljbd202293","DOIUrl":"https://doi.org/10.37545/haematoljbd202293","url":null,"abstract":"Background: Even after significant improvement of management of haematological malignancy, post chemotherapy infection is still causing significant mortality and morbidity. Cytomegalovirus (CMV) is an important cause of morbidity and mortality in immunocompromised patients. This study was designed to assess prospectively the status of CMV IgM seropositivity in patients with haematological malignancy at diagnosis and after starting chemotherapy by serology test. In Bangladesh the prevalence IgG is high and IgM is low in general population but in patients with chemotherapy due to haematological malignancy status of CMV infection is not known. By finding out the infection rate we will be able to provide supportive care more effectively to patients of chemotherapy due to haematological malignancy. \u0000Methodology: This was a prospective type of observational study and patients were selected by purposive sampling. Assessment of CMV IgG and IgM antibody test had been done at the time of 1st diagnosis and IgM antibody for CMV reassessed 6 weeks after initial chemotherapy. Antibodies were detected by Chemiluminescence method from Virology department of BSMMU. Statistical analysis was done both manually and Windows based software device with Statistical Package for Social Science (SPSS). A p-value of <0.05 was taken as significant during data calculation. Result: During 12 months study period a total 45 patients with haematological malignancy were included in the study. Out of 45 patients, 28 were male (62%) and 17 were female (38%), male female ratio was 1.65:1. The youngest of the participants was 15 and oldest was 70 years old. The mean age of the participants was 35.77 years with SD of 16.93. Among 45 patients of the study, ALL patients were 20 (44.4%), AML patients were 17 (37.8%), NHL patients were 5 (11.1%) and HD patients were 3 (6.7%). Before chemotherapy all participants were CMV IgG positive (100%) no one was CMV IgM Positive (0%). Six weeks after chemotherapy, 42 (93.3%) cases were CMV IgM antibody negative and only 3 (6.7%) cases were positive for CMV IgM antibody. McNemar test was done to measure the level of significance and p-value was 0.250, which was not significant statistically. Conclusion: This small study found that all participants were CMV IgG seropositive (100%). It indicates that higher percentages of haematological malignancy patients are previously infected with CMV so there is more risk of reactivation after chemotherapy or BMT. Post chemotherapy CMV IgM seropositivity (new infection or reactivation of CMV) was low 6.7% in this study. This percentage is low in comparison with other studies. Percentage could be high if the tests were carried out with more sensitive and specific tests for CMV like PCR, pp65 antigenaemia or CMV DNA.","PeriodicalId":137283,"journal":{"name":"Haematology Journal of Bangladesh","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134287119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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