Publications (39)44.8 Total impact
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Article: Effect of iron deficiency anemia on hemoglobin A1c levels.
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ABSTRACT: Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, P<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, P<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, P<0.01). In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.Annals of laboratory medicine. 01/2012; 32(1):17-22. -
Article: Clinical evaluation of severe anemia in pregnancy with special reference to macrocytic anemia.
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ABSTRACT: Anemia in pregnancy has been almost synonymous with iron-deficiency anemia but there appears to be a changing trend with emerging evidence of macrocytic anemia. The aim of this study was to evaluate the clinical profile of patients having severe anemia in pregnancy. This study included all antenatal patients presenting with severe anemia (hemoglobin<7gm%) over a period of 2years from January 2008 to December 2009 in the Department of Obstetrics and Gynaecology, Maulana Azad Medical College and Lok Nayak Hospital, New Delhi. Although iron-deficiency anemia remains the most important cause of anemia (48.1%) there is also a high prevalence of macrocytic anemia (40%) amongst these cases of severe anemia in pregnancy. The maternal and fetal morbidity and mortality is higher in macrocytic anemia as compared to iron-deficiency anemia. There is an emerging trend of macrocytic anemia among antenatal patients with severe anemia. Both maternal and fetal morbidity appears to be higher in these cases. This has important implications in terms of diagnosis and therapy to optimize both maternal and perinatal outcomes. Once clinicians and health administrators recognize the magnitude of this problem it may be considered relevant to start public health interventions by way of requirement of appropriate food fortification.Journal of Obstetrics and Gynaecology Research 11/2011; 38(1):203-7. · 0.94 Impact Factor -
Article: Hyaline vascular Castleman disease relapsing as T cell rich B cell lymphoma with paraneoplastic pemphigus.
Journal of clinical pathology 01/2011; 64(1):93-4. · 2.43 Impact Factor -
Article: Morphological findings in bone marrow biopsy and aspirate smears of visceral kala azar: A review
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ABSTRACT: Context: Visceral leishmaniasis (VL) is endemic in India and may simulate and cause many hematological disorders like pancytopenia, myelofibrosis, myelodysplasia and hemophagocytosis. Aims: The study aims to investigate the hematological manifestation of Visceral Leishmaniasis and associated changes that may be observed in bone marrow aspirate smears and biopsy which may warn a pathologist of possible infections. Settings and Design: This is a retrospective study of 18 VL cases on B (b) one marrow aspirate and biopsy in the department of Pathology in a tertiary care teaching hospital in New Delhi. Methods and Material: Giemsa stained slides of bone marrow aspirates and hematoxylin and Eosin stained biopsy slides were reviewed in detail by two competent pathologists. All the findings were tabulated and discussed and comparisons made with the previous similar studies. Results: Hyper cellular marrow, increased lymphocytes and plasma cells, marrow granulomas, hemophagocytosis, myelofibrosis, myelodysplasia and gelatinous transformation of the marrow were notable features the presence of which together or individually should caution a pathologist to search for Leishman Donovan (LD) bodies in patients especially in a non-endemic zone in a tropical country.Indian Journal of Pathology and Microbiology. 01/2010; -
Article: An acute myeloid leukemia M6b blast crisis with giant proerythroblasts in chronic myeloid leukemia.
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ABSTRACT: The case of a 12 yr old female with bcr-abl positive chronic myeloid leukemia who subsequently developed a fatal AML-M6b (pure erythroleukemia) blast crisis is presented. The case is unique for its rarity of occurrence and for the striking resemblance that the circulating proerythroblasts showed to the giant cells characteristically seen in Parvovirus B19-induced acute pure red cell aplasia. This is, to the best of our knowledge, the first description of such cells in a blast crisis of chronic myeloid leukemia.Journal of Pediatric Hematology/Oncology 04/2009; 31(3):220-1. · 1.16 Impact Factor -
Article: Bone marrow angiogenesis in aplastic anemia--a study of CD 34 and VEGF expression in bone marrow biopsies.
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ABSTRACT: Bone marrow function and the growth of hemopoietic cells depends on an intact microvasculature. A pivotal regulator of angiogenesis is vascular endothelial growth factor (VEGF). Our study assesses VEGF expression and microvessel density (MVD) in the bone marrow of patients with aplastic anemia (AA). Bone marrow specimens from 25 patients with AA and 15 controls were studied. MVD was calculated on sections stained immunohistochemically for CD34. Subsequently, all the cases were studied for VEGF expression. Bone marrow MVD in patients with AA was significantly lower than that in controls (p < 0.01). There was a significant MVD difference between severe AA and moderate AA (p < 0.05). VEGF expression was also significantly lower in AA cases compared to controls (p < 0.05). Our data show that AA is associated with reduced angiogenesis and reduced VEGF expression. Defective angiogenesis may result in or aggravate bone marrow aplasia in AA patients. There are limited studies on this aspect. More studies to confirm the present hypothesis might pave the way for new treatment options in AA.Hematology (Amsterdam, Netherlands) 02/2009; 14(1):16-21. · 1.33 Impact Factor -
Article: Hypocellular acute myeloid leukemia with bone marrow necrosis in young patients: two case reports.
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ABSTRACT: Hypocellular variants of acute myeloid leukemia are very rare and almost always occur in old aged patients. In contrast, hypocellular acute lymphoblastic leukemia usually occurs in children. We report two Indian patients with hypocellular acute myeloid leukemia, a 32-year-old woman and a 13-year-old boy. Interestingly, one of the patients also showed bone marrow necrosis. Hypocellular acute myeloid leukemia is a rare entity and can affect young individuals. It can be considered as a rare cause of bone marrow necrosis.Journal of Medical Case Reports 02/2009; 3:27. -
Article: Langerhans cell histiocytosis masquerading as tuberculosis: a diagnostic dilemma resulting in inappropriate anti-tubercular therapy.
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ABSTRACT: Langerhans cell histiocytosis is known to mimic many other conditions. We present two patients where anti-tubercular therapy was instituted when clinical and radiological features suggested tuberculosis. The correct diagnosis of histiocytosis was reached only on further work-up including immunohistochemistry following un-responsiveness to treatment. In retrospect it was felt that an inordinately high index of suspicion for tuberculosis, clinical and radiological overlap between the two entities, an urgency to start empirical therapy in a rapidly deteriorating patient and pathological similarities between epithelioid histiocytes and pathologic Langerhans cells led to the diagnostic and therapeutic errors.Pediatric Blood & Cancer 02/2009; 53(1):111-3. · 1.89 Impact Factor -
Article: Pseudogaucher cells obscuring multiple myeloma: a case report.
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ABSTRACT: Gaucher-like or pseudo-Gaucher cells have been noted in a variety of conditions including acute lymphoblastic leukemia, Hodgkin's disease, thalassemia, and multiple myeloma. They have an eccentric, lobulated nucleus, foamy cytoplasm but lack the tubular inclusions seen in Gaucher cells. The pseudo-Gaucher cells have distinct appearances on electron microscopy which distinguish them from true Gaucher cells.Increased pseudo-Gaucher cells probably reflects the increased load of leukocyte membrane derived glucosylceramide presented to macrophages under conditions of high cell turnover when the normal pathways for its removal may be saturated.We present a case of a 72-year-old Indian Aryan female, in which the bone marrow contained sheets of histiocytes with features mimicking gaucher cells. These pseudo-Gaucher cells obscured neoplastic plasma cells causing diagnostic difficulty.Cases Journal 01/2009; 2:9147. -
Article: Evans syndrome: a study of six cases with review of literature.
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ABSTRACT: Evans syndrome is an uncommon condition characterised by simultaneous or sequential development of immune thrombocytopenia (ITP) and autoimmune haemolytic anaemia (AIHA) with a positive direct antiglobulin test (DAT) in the absence of a known underlying aetiology. The great majority of patients with Evans syndrome have a chronic relapsing course despite treatment, which is associated with significant morbidity and mortality. We reviewed the clinical and laboratory features of six patients with Evans syndrome. All patients had thrombocytopenia, bleeding symptoms and haemolytic anaemia with positive direct Coombs test at presentation. We discuss the aetiopathogenic, clinical, therapeutic and natural history of Evans syndrome.Hematology (Amsterdam, Netherlands) 01/2009; 13(6):356-60. · 1.33 Impact Factor -
Article: Metastatic signet ring cell adenocarcinoma of bone marrow with bilateral ovarian masses: a case report.
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ABSTRACT: We present a case of metastatic signet ring cell adenocarcinoma of bone marrow with radiologically proven bilateral ovarian masses in a 50 year old Asian Indian female. Even after thorough search no extraovarian primary site could be found. Based on overall clinicopathologic correlation, a diagnosis of metastatic signet ring cell adenocarcinoma of bone marrow with uncertain primary was established.Cases Journal 12/2008; 1(1):332. -
Article: Dengue virus related hemophagocytosis: a rare case report.
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ABSTRACT: We describe a patient with bone marrow hemophagocytosis who had classic dengue fever associated with nasal bleeding and pancytopenia. The patient recovered with appropriate supportive care. A literature search shows fewer than 20 case reports of dengue related hemophagocytosis in the English literature. Our patient is an interesting case of dengue related hemophagocytic syndrome and adds an additional case to the literature. Clinicians should consider that the occurrence of hemophagocytosis in the appropriate geographical area could be due to dengue virus infection and present with pancytopenia.Hematology (Amsterdam, Netherlands) 11/2008; 13(5):286-8. · 1.33 Impact Factor -
Article: Hematological profile in pyrexia of unknown origin: role of bone marrow trephine biopsy vis-à-vis aspiration.
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ABSTRACT: Bone marrow examination, by aspiration and/or trephine biopsy, is an important procedure in arriving at a diagnosis for long-duration febrile illness. The role of trephine biopsy in immunocompromised host, especially HIV-positive patients, has been well studied in the literature. However, its utility in immunocompetent patients is still shrouded by controversy. Thus, the authors attempted to evaluate the utility of marrow aspirate vis-à-vis trephine biopsy in establishing a diagnosis in cases of pyrexia of unknown origin in immunocompetent individuals, along with an analysis of haematological alterations in these patients. Over a period of 8 years, 121 patients with pyrexia of unknown origin underwent both bone marrow aspiration and trephine biopsy as a part of diagnostic work-up. These cases were reviewed for their clinical data and hematological findings, including detailed morphological features in aspiration smears and trephine biopsies. Bone marrow aspiration and biopsy were compared for their diagnostic efficacy in these patients. A wide age range (2-65 years) was noted with a slight male predominance (2 : 1). Anemia was the most common feature in peripheral blood findings, seen in 97.5% of patients. Bone marrow aspiration was diagnostic in only 16.5% of cases, which revealed leishmaniasis or pure red cell aplasia. Granulomas were infrequent in marrow aspiration smears, as only two cases (1.6%) showed ill defined epithelioid cell collections. Compared to this, trephine biopsy offered a diagnosis in 76% of the cases. Granulomas were a frequent finding in the trephine biopsy, being present in 70% of the cases included. Additional cases diagnosed on biopsy (over those diagnosed with aspiration smears) included lymphoma, tuberculosis, fungal infection, sarcoidosis and hypocellular marrow. Bone marrow trephine biopsy is an important adjunct to aspiration in arriving at an aetiological diagnosis of patient with long-duration febrile illness, and should be routinely performed in such cases. The presence of granulomas in trephine biopsy increases the likelihood of an etiologic diagnosis in these patients.Hematology (Amsterdam, Netherlands) 11/2008; 13(5):307-12. · 1.33 Impact Factor -
Article: Plasmodium falciparum in trephine biopsy.
American Journal of Hematology 08/2008; 83(7):602. · 4.67 Impact Factor -
Article: Osteomyelosclerosis with thalassemia trait: report of a rare association, study of platelet function tests and review of literature.
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ABSTRACT: Idiopathic myelofibrosis is a chronic myeloproliferative disorder characterized by excessive connective tissue deposition in the bone marrow. It presents with leucoerythroblastic anemia and massive splenomegaly. It is termed osteomyelosclerosis in the presence of primitive bone formation in the bone marrow and radiological presence of osteosclerosis. A 40-year-old male, known case of thalassemia trait presented with fatigue and lump in the abdomen for two months. Physical examination showed splenomegaly 8.5 cm below costal margin. X-ray examination revealed multiple osteosclerotic lesions involving the pelvis and long bones. Hemogram showed: hemoglobin 7.8 gm/dl, TLC 47,500/mm(3); DLC was polymorphs 49%, lymphocytes 7%, eosinophils 4%, basophils 4%, blasts 5%, promyelocytes 2%, myelocytes 14%, metamyelocytes 10%. Platelet count was 60,000/mm(3). Peripheral blood film showed leucoerythroblastic blood picture with features of dysmyelopoiesis. Bone marrow aspiration was diluted with peripheral blood. Bone marrow biopsy showed replacement of marrow by grade III reticulin fibrosis. Bony trabaculae were wide and thick. Platelet function studies were abnormal. The clinical, radiological and hematological features suggested a diagnosis of osteomyelosclerosis. We present this case because no similar association of osteomyelosclerosis with thalassemia trait has been described in English literature to date. This is the first study from India, which describes platelet function tests in a patient with osteomyelosclerosis.Hematology (Amsterdam, Netherlands) 05/2008; 13(2):83-7. · 1.33 Impact Factor -
Article: Richter syndrome in CLL - an aspiration cytologic diagnosis.
Indian Journal of Hematology and Blood Transfusion 03/2008; 24(1):39. · 0.06 Impact Factor -
Article: Hemoglobin E disease with concomitant tuberculosis
Indian Journal of Pathology and Microbiology. 01/2008; -
Article: Coomb′s negative autoimmune hemolytic anemia: A diagnostic dilemma for the hematologist
Indian Journal of Pathology and Microbiology. 01/2008; -
Article: Pseudo-Gaucher cells in Hb E disease and thalassemia intermedia.
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ABSTRACT: Pseudo-Gaucher cells are morphologic curiosities described in a number of conditions. We report their presence in a bone marrow biopsy and a spleen from 2 patients with hemoglobin E disease and thalassemia intermedia, respectively. The pathogenesis of these cells and their multiple known associations are discussed.Hematology (Amsterdam, Netherlands) 11/2007; 12(5):457-9. · 1.33 Impact Factor -
Article: Down syndrome with microgranular variant of acute promyelocytic leukemia in a child: a case report.
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ABSTRACT: Acute promyelocytic leukemia (APL) accounts for less than 10% of pediatric AML. Cases of APL in Down syndrome (DS) have been described in the literature rarely and it is rarer still to find the microgranular variant (M3v) of APL in trisomy 21 patients. We present a case of a five-year-old female with Down syndrome diagnosed with acute promyelocytic leukemia (APL). She came to our hospital with bleeding manifestations. Blood and bone marrow examination revealed promyelocytes showing a few fine granules and occasional Auer rods. Based on this morphology and cytochemistry, a diagnosis of APL microgranular variant (M3v) was made. This case report emphasizes the importance of a high index of suspicion in the diagnosis of acute promyelocytic leukemia microgranular variant in Down syndrome.Journal of Medical Case Reports 02/2007; 1:147.
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Institutions
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2006–2008
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Maulana Azad Medical College
- Department of Pathology
New Delhi, NCT, India
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