Pravas Mishra

Publications of Pravas Mishra

• Eosinophilia: Rare cause of arterial thrombosis and cardioembolic stroke in childhood.

  Authors: Sanjeev Kumar Sharma, Suman Kumar, Tulika Seth, Pravas Mishra, Manoranjan Mahapatra

  World journal of cardiology. 04/2012; 4(4):128-9.

  Eosinophilia has been reported as a very rare cause of stroke in children. The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein, that is, theEosinophilia has been reported as a very rare cause of stroke in children. The thrombotic event may be either due to cardiac damage induced by eosinophils and their granular protein, that is, the major basic protein, or the systemic hypercoagulable state induced by eosinophilia. We report here a case of eosinophilia whose initial presentation was recurrent strokes and cardiac and arterial thrombosis.

• Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches.

  Authors: Anita Chopra, Haraprasad Pati, Manoranjan Mahapatra, Pravas Mishra, Tulika Seth, Suman Kumar, Saroj Singh, Sangita Pandey, Rajive Kumar

  Annals of hematology. 04/2012;

  Flow cytometry (FCM) is being increasingly evaluated for the diagnosis of myelodysplastic syndrome (MDS). We employed multiple FCM approaches to assess MDS. Five-color FCM, morphology blind, was doneFlow cytometry (FCM) is being increasingly evaluated for the diagnosis of myelodysplastic syndrome (MDS). We employed multiple FCM approaches to assess MDS. Five-color FCM, morphology blind, was done on bone marrow aspirates of 57 suspected MDS and 31 normal controls. Maturation pattern, quantitative FCM for low-grade MDS that awards FCM score, and expression of selected antigens on erythroid cells and CD34(+) blasts were evaluated. FCM results were correlated with clinical and laboratory workup. Patients (n = 57) included proven MDS (n = 14), suspected MDS (n = 13), and non-MDS (n = 30). By pattern-based approach, all proven cases were FCM positive. In suspected MDS, 11 (84.61 %) were positive including morphology-negative cases, and two (15.38 %) were intermediate. In non-MDS cases, 27 of 30 (90 %) were FCM negative, 2 of 30 (6.67 %) intermediate, and 1 of 30 (3.33 %) a hematinic-responsive case, positive. Quantitative parameters that characterized MDS included FCM score of >3, percentage CD34(+) B cells, and expression of CD11b, CD15, and CD56 on myeloblasts. CD71 MFI on CD235a(+) erythroblasts and CD38 MFI on myeloblasts were significantly lower in MDS. The former was present in FCM-intermediate suspected MDS but not FCM-intermediate non-MDS cases. Used in the overall clinical context, both maturation pattern recognition and quantitative approaches, the latter for low-grade MDS, are sensitive methods of diagnosing MDS, including cases negative by morphology and cytogenetics, especially if combined with evaluation of selected antigens, CD71 on CD235a(+) cells and CD38 on CD34(+) cells. The value of FCM in morphology-negative cases needs better definition of specificity through more extensive evaluation of secondary dyspoiesis.

• Clinical profile and outcome of patients of acute myeloid leukemia with high hyperdiploidy.

  Authors: Sanjeev Kumar Sharma, Monica Sharma, Tulika Seth, Pravas Mishra, Mohit Chowdhry, Manoranjan Mahapatra, Renu Saxena

  Leukemia research. 12/2011; 36(3):e60-1.

• Immune thrombocytopenic purpura following anti-rabies vaccines.

  Authors: Sanjeev Kumar Sharma, Tulika Seth, Narendra Agrawal, Manoranjan Mahapatra, Pravas Mishra

  Platelets. 10/2011;

• Rituximab in Steroid Refractory Autoimmune Hemolytic Anemia.

  Authors: Nitin Gupta, Sanjeev Sharma, Tulika Seth, Pravas Mishra, Manoranjan Mahapatra, Suman Kumar, Rajan Kapoor, Narendra Agarwal

  Indian journal of pediatrics. 08/2011;

  Autoimmune hemolytic anemia is rare in children and infants and steroids are the corner stone of therapy. Management of the patients with steroid refractory/dependent disease is difficult .RituximabAutoimmune hemolytic anemia is rare in children and infants and steroids are the corner stone of therapy. Management of the patients with steroid refractory/dependent disease is difficult .Rituximab is being used in the treatment of a variety of autoimmune diseases including Autoimmune hemolytic anemia (AIHA),especially in adults but there is scarce data regarding the use of this agent in pediatric AIHA patients.The authors report two cases of steroid refractory AIHA, who responded to rituximab with review the literature of its use in pediatrics.

• Successful management of refractory chronic immune thrombocytopenia with intracranial hemorrhage by emergency splenectomy.

  Authors: Sanjeev Kumar Sharma, Nitin Gupta, Tulika Seth, M Srinivas, Pravas Mishra, Manoranjan Mahapatra

  Indian journal of pediatrics. 07/2011; 79(3):397-8.

• Treatment of acute myeloid leukemia in children: experience from a tertiary care hematology centre in India.

  Authors: Nitin Gupta, Tulika Seth, Pravas Mishra, Manoranjan Mahapatra, Shyam Rathi, Rajan Kapoor, Narendra Agarwal, Suman Kumar, Renu Saxena

  Indian journal of pediatrics. 05/2011; 78(10):1211-5.

  To assess the treatment and outcome of children with acute myeloid leukemia. The Primary objectives were to assess remission rates, treatment related toxicity and disease free survival. SecondaryTo assess the treatment and outcome of children with acute myeloid leukemia. The Primary objectives were to assess remission rates, treatment related toxicity and disease free survival. Secondary objective was to assess prognostic factors associated with poor outcome. A retrospective analysis of all treated patients with acute myeloid leukemia, less than 18 year of age from Sept 2005 to Aug 2009 was done. Clinical laboratory, treatment and follow up records retrieved to calculate remission rate, treatment related toxicity, disease free survival and poor prognostic factors. This analysis included thirty five patients (male : female; 23:12), twenty seven (77.1%) achieved remission after one 3 + 7 induction and seven required two inductions. High dose cytosine arabinoside consolidation was given in thirty one patients while one underwent allogenic stem cell transplantation. Two patients died during chemotherapy (TRM- 5.7%), two did not complete the therapy, seventeen relapsed (48.5%) with 80% of relapses occurring within first year of remission and no relapse occurred after 2 years. Fourteen patients are in remission (40%, follow up 5-54 months) and cumulative median disease free survival is of 13 months. The present data suggests that 3 + 7 induction, followed by high dose cytarabine consolidation has low treatment related toxicity and resource utilization; however, relapse free survival is inferior to more intensive regimens, highlighting the need to intensify chemotherapy regimen once the treatment related mortality has been minimized.

• Acute renal failure following antithymocyte globulin therapy for aplastic anaemia-report of two cases and review of literature.

  Authors: Nitin Gupta, Manoranjan Mahapatra, Shyam Rathi, Rajan Kapoor, Avinash Singh, Tulika Seth, Pravas Mishra

  Annals of hematology. 02/2011; 90(2):239-41.

• Ileal ulceration during all-trans-retinoic acid therapy for acute promyelocytic leukemia.

  Authors: Sanjeev K Sharma, Pravas Mishra, Tulika Seth, Manoranjan Mahapatra

  Leukemia research. 02/2011; 35(6):e89-90.

• Coexisting pulmonary tuberculosis and mucormycosis in a patient with aplastic anemia post allogenic stem cell transplantation.

  Authors: Sanjeev Kumar Sharma, Narendra Agarwal, Anjan Mukherjee, Tulika Seth, Pravas Mishra, Immaculata Xess, Manoranjan Mahapatra, Sanjay Sharma

  Mediterranean journal of hematology and infectious diseases. 01/2011; 3(1):e2011036.

  Infections are the most common cause of morbidity and mortality in allogenic stem cell transplant recipients. Survival of the patient depends on the accurate diagnosis of the infectious agents andInfections are the most common cause of morbidity and mortality in allogenic stem cell transplant recipients. Survival of the patient depends on the accurate diagnosis of the infectious agents and prompt and effective management of the infection alongwith maintenance of adequate immunosuppression post transplantation. We here reported a case of aplastic anemia who developed left upper lobe consolidation post allogenic stem cell transplantation and was found to have combined infection with tuberculosis and mucormycosis. This is the first case of combined infection with tuberculosis and mucormycosis reported in such a host, with a favourable outcome.

• Clinical profile of dengue infection in patients with hematological diseases.

  Authors: Sanjeev Kumar Sharma, Tulika Seth, Pravas Mishra, Nitin Gupta, Narendra Agrawal, Shobha Broor, M Mahapatra, Renu Saxena

  Mediterranean journal of hematology and infectious diseases. 01/2011; 3(1):e2011039.

  Managing hematological disorders in a tropical country presents several unique diagnostic and management problems. Apart from the disease process, we need to be aware of infections that canManaging hematological disorders in a tropical country presents several unique diagnostic and management problems. Apart from the disease process, we need to be aware of infections that can exacerbate or mimic serious hematological problems. We present here a series of five patients with pre-existing hematological diseases who were infected by dengue virus. These cases highlight the need to keep a strong suspicion of common endemic diseases in tropical countries before considering extensive workup for the basic hematological disease. There was no mortality and all patients recovered without any significant impact on their pre-existing hematological condition inspite of their low baseline blood counts. There was no excessive bleeding, prolonged stay in the hospital or relapse of underlying hematological disease in these patients and the only major concern was the increased anxiety among both the patient and treating physician regarding the relapse/progression of pre-existing hematological disease.

• Acute lymphoblastic leukemia presenting as non-oliguric renal failure and hypertension.

  Authors: Nitin Gupta, Sanjeev Kumar Gupta, Shyam Rathi, Sanjeev Kumar Sharma, Manoranjan Mahapatra, Tulika Seth, Pravas Mishra, Renu Saxena

  Leukemia research. 07/2010; 34(7):e150-1.

• High dose dexamethasone therapy shows better responses in acute immune thrombocytopenia than in chronic immune thrombocytopenia.

  Authors: Rahul Naithani, M Mahapatra, Rajat Kumar, Pravas Mishra, Renu Saxena

  Platelets. 03/2010; 21(4):270-3.

  Oral high dose dexamethasone (HDD) was given as a single daily dose for four consecutive days, every 14 days for four courses. Twenty-nine patients were enrolled. Overall 20 patients (69%) responded:Oral high dose dexamethasone (HDD) was given as a single daily dose for four consecutive days, every 14 days for four courses. Twenty-nine patients were enrolled. Overall 20 patients (69%) responded: complete response (CR) was achieved in 16 (55%) patients, partial response (PR) in three (10%) patients and MR in one (3%) patient. In acute immune thrombocytopenic purpura (ITP) response rates after the first, second, third and fourth cycles were as follows: 64% (9/14), 64% (9/14), 79% (11/14), and 85.7% (12/14), respectively. In chronic ITP, overall response rates after the first, second, third and fourth cycles were as follows: 33% (5/15), 40% (6/15), 53% (8/15) and 53% (8/15) respectively. The median time to response was 14 days (4-42 days). Twelve out of 20 patients (5/12 acute ITP and 7/8 chronic ITP) relapsed; median relapse free survival till last follow-up in the remaining eight patients was 130 days (65-365 days).

• Efficacy and Safety of Anti-D for Immune Thrombocytopenic Purpura.

  Authors: Rahul Nathani, Rajat Kumar, M Mahapatra, Seema Tyagi, Pravas Mishra

  Indian pediatrics. 10/2009;

  We conducted this study in 20 children (16 males) (mean age 9.2 +/- 4.34) with immune thrombocytopenic purpura (ITP) to assess the response to anti-D immunoglobulin. Six patients had newly diagnosedWe conducted this study in 20 children (16 males) (mean age 9.2 +/- 4.34) with immune thrombocytopenic purpura (ITP) to assess the response to anti-D immunoglobulin. Six patients had newly diagnosed ITP, 6 had persistent ITP and 8 had chronic ITP. The overall response rate was 70% (14/20). The median time to response was 3 days (1-13 days). Response to anti-D was not related to age, sex, severity of bleeding, platelet counts at presentation, ABO blood group, or prior steroid or IVIG response.

• Patterns of Acquired Bleeding Disorders in a Tertiary Care Hospital.

  Authors: Bhushan Asthana, Prashant Sharma, Ravi Ranjan, Prachi Jain, Ajisha Arvindan, Pravas Mishra, Renu Saxena

  Clinical and applied thrombosis/hemostasis : official journal of the International Academy of Clinical and Applied Thrombosis/Hemostasis. 07/2009;

  Bleeding disorders constitute a large proportion of referrals to hematology departments. Worldwide, acquired causes of bleeding are commoner than inherited ones. To identify the spectrum of theseBleeding disorders constitute a large proportion of referrals to hematology departments. Worldwide, acquired causes of bleeding are commoner than inherited ones. To identify the spectrum of these disorders, we evaluated all referrals for bleeding encountered in this tertiary care centre over a one-year period. Of the total 1342 cases, 1040 (77.5%) had underlying exclusively acquired causes, whereas inherited causes constituted 302 cases (22.5%). Amongst acquired causes, disseminated intravascular coagulation was seen in 297 (28.6%), hepatic coagulopathy in 218 (20.9%), neurosurgical causes (intracranial bleeds) in 154 (14.8%), malignancy in 89 (8.6%), and miscellaneous multiple acquired causes including those due to anticoagulant drug overdose in 282 patients (27.1%). Referrals for isolated prolonged prothrombin time or thrombocytopenia were common, but were excluded from this study because not all presented with bleeding. Prompt laboratory work-up and precise identification of acquired causes of bleeding is the key to planning appropriate patient management including transfusion support.

• Clinico-hematological profile of hereditary spherocytosis: experience from a tertiary care center in North India.

  Authors: Rakhee Kar, Seema Rao, Upendra M Srinivas, Pravas Mishra, Hara P Pati

  Hematology (Amsterdam, Netherlands). 07/2009; 14(3):164-7.

  Hereditary spherocytosis (HS) is an inherited membranopathy characterized by phenotypic and genotypic heterogeneity. This study describes the clinico-hematological profile of 70 HS patients diagnosedHereditary spherocytosis (HS) is an inherited membranopathy characterized by phenotypic and genotypic heterogeneity. This study describes the clinico-hematological profile of 70 HS patients diagnosed at a tertiary care center in North India over a period of five years. Patients commonly presented with intermittent jaundice (82.9%), pallor (80%) and dark colored urine (11.4%). The common signs were splenomegaly (92.9%), hepatomegaly (50%), cholelithiasis or choledocholithiasis (36.8%) and hemolytic facies (10%). Family history was contributory in 28.6% patients. Blood transfusion (BT) requirement was present in 35.7% patients. Unconjugated and conjugated hyperbilirubinemia was seen in 89.1 and 10.9% patients respectively. At presentation, the hemoglobin ranged from 3-14 g/dl with a mean of 9.37 g/dl (SD2.43). Spherocytes were seen in 88.6% and incubated Osmotic fragility test (OFT) was positive in 88.2% patients. The Eosin-5-maleimide (EMA) flow cytometric test was done in 28 patients. Mean fluorescence intensity (MFI) for normal subjects was 11861.5 (SD-883.51) and for confirmed HS patients was 7949.3 (SD1304.1). Taking the MFI range of 5341.1-10 557.5 for HS, eight cases of suspected HS/undiagnosed hemolytic anemia with a negative (n=5) or equivocal (n=3) incubated OFT were diagnosed as HS. An increase in HbF level was seen in 10 cases ranging from 2.1 to 17.7% with a mean of 5.66%, three of these had associated beta thalassaemia trait. Twelve patients (17%) underwent splenectomy and 91% of them did not require any BT post-splenectomy. Among the patients treated conservatively 49% had persisting pallor and 16.3% had transfusion requirement.

• Acute lymphoblastic leukaemia with unusual chromosomal abnormality: t(3;9) (p21;p13), del(10p12) [13].

  Authors: Bhavna Dhingra, Rahul Bhargava, Pravas Mishra

  Leukemia research. 06/2009;

  We report a case of pre-B acute lymphoblastic leukaemia with an unusual translocation between chromosome 3 and 9, with del(10p12) [13]. The diagnosis at presentation was made by the morphology,We report a case of pre-B acute lymphoblastic leukaemia with an unusual translocation between chromosome 3 and 9, with del(10p12) [13]. The diagnosis at presentation was made by the morphology, cytochemistry and immunophenotyping. Cytogenetic analysis was also done at presentation. To the best of our knowledge and after literature search this appears to be a rare cytogenetic abnormality in ALL.

• Pseudotumor cerebri in a child in early phase of induction therapy for APL with ATRA.

  Authors: Rahul Naithani, Rajat Kumar, Pravas Mishra

  Indian journal of pediatrics. 05/2009; 76(4):439-40.

• Intracranial hemorrhage in childhood immune thrombocytopenic purpura.

  Authors: Dharma R Choudhary, Rahul Naithani, M Mahapatra, Rajat Kumar, Pravas Mishra, Renu Saxena

  Pediatric blood & cancer. 01/2009;

  We retrospectively analyzed 750 patients with ITP for development of intracranial hemorrhage (ICH). Seventeen cases with age range of 10 months to 18 years were studied. Ten patients were of acuteWe retrospectively analyzed 750 patients with ITP for development of intracranial hemorrhage (ICH). Seventeen cases with age range of 10 months to 18 years were studied. Ten patients were of acute ITP and seven had chronic ITP. Nine patients developed ICH one month after the onset of ITP and five patients had ICH on presentation. ICH was precipitated by trauma in four patients and possibly the use of NSAIDs in one patient. Median platelets counts at the time of ICH were 12 x 10(9)/L (range 2-50 x 10(9)/L). Most patients were treated with corticosteroids. Four patients (24%) died due to ICH. Pediatr Blood Cancer (c) 2008 Wiley-Liss, Inc.

• Early discharge from hospital after consolidation chemotherapy in acute myeloid leukemia in remission: febrile neutropenic episodes and their outcome in a resource poor setting.

  Authors: Rahul Naithani, Rajat Kumar, Manoranjan Mahapatra, Neerja Agrawal, Pravas Mishra

  Haematologica. 08/2008;