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Article
Iron Deficiency Anaemia and Beta Thalassaemia Trait in Anaemic Pregnant Women.

Author: Haider H. AL–Shammari
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 3 Pages: 280-283
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Anaemia is one of commonest health problems in antenatal care units of developing countries and contributes significantly to increased maternal and fetal morbidity and mortality.
Patients and methods: During the period from 1st of July 2007 to the end of October 2007, hundred anaemic pregnant women attending the gynaecology and obstetrics department in Al- Yarmook teaching hospital in Baghdad and 20 apparently healthy pregnant women,aged between 17 - 46 years as a control were included in this study. Anaemic women included in this study fulfilled the criteria of haemoglobin concentration of less than 110 g/L in first trimester and 105g/L in the second and third trimesters, no history of acute or chronic illnesses, not receiving any treatment & without any family history of haematological disorders. These women were randomly selected in relation to age , parity ,trimester of pregnancy & social status. Ten mls of venous blood samples were aspirated from each pregnant women in the studied group , two mls were put in ethylendiaminetetra acetic acid (EDTA) tube and analyzed for peripheral blood smear , reticulocyte count & haemoglobin A2 ( Hb A2 )using standard methods for hematological investigation .While the remaining 8 ml were put in a plain tube to evaluate serum iron , total iron binding capacity & serum ferritin. Serum iron, total iron binding capacity was done by colometric method, while serum ferritin was done by immunoenzymatic assay and hemoglobin A2 (HbA2) level by haemoglobin electrophoresis.
Results: Peripheral blood smear study revealed a hypochromic microcytic anaemia in 81% of cases, 8% of cases showed macrocytic anaemia, 8% a normochromic normocytic anaemia while the remaining 3% of cases showed a dimorphic picture .Iron deficiency anemia constitutes 79% of the cases confirmed by serum ferritin. Only two cases ( 2% ) had elevated level of HbA2 .Serum iron, total iron binding capacity & serum ferritin had significant differences in those cases with low social status, increasing parity & increasing gestational age (trimesters).Iron deficiency anaemia was not found to have a significant association with increasing age , while patients with para 4 & more, in the third trimester & low social status were more significantly affected with iron deficiency anemia .
Conclusion: Iron deficiency anemia was found in 79% of anemic pregnant females confirmed by measurement of serum ferritin level. There were a significant difference between parity; social status and gestational age with the incidence of iron deficiency anemia.â-thalassaemia trait constitute only 2% of anemic cases in the studied sample.


Article
Glimpse on Hemostatic Changes Produced By Plasmapheresis

Authors: Haider H. AL-Shammari --- Mayada S. Al-Niami --- Zainab M. Hasan
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2010 Volume: 52 Issue: 2 Pages: 161-168
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Aphaeresis is a term that means to separate or to take away. The basic idea of aphaeresis is efficient removal of a circulating cellular blood component, either cells (Cytopheresis) or plasma solute (plasmapheresis, plasma exchange).Thus, the treatment goal of aphaeresis is to remove the circulating cell or substance directly responsible for the disease process. Acceleration and development of aphaeresis applications had taken place with the arrival of automated cell separators in 1970s that ensure selectively removal of one or more of blood components from the blood and return the remainder to the individual. Plasmapheresis is separation of plasma from blood cells which are returned to the body. It is accompanied by multiple changes in haemostatic system. As many coagulation factors are removed during procedure, changes in selective parameters: Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Thrombin Time (TT), Fibrinogen (FNG) & platelets count are found when the replacement fluids devoid from coagulation factor are used.
Patients and Methods: This clinico-haematological study conducted during a period of six months, from February 2004 to July 2004 at the National Blood Transfusion Center (NBTC) in Baghdad & 50 patients underwent Therapeutic Plasma Exchange (TPE) for various disorders with the use of two types of automated blood cell separators (Haemonetics MCS + which represent an intermittent flow centrifugation technique – IFC & Fresenius AS. TEC 204 which represent the continuous flow centrifugation technique - CFC) in this study, but no instrument type influenced the coagulation screening tests.
Results: The changes in all selective parameter: Prothrombin Time (PT), Partial Thromboplastin Time (PTT), Thrombin Time (TT), Fibrinogen (FNG), Platelets count, Haemoglobin (Hb) and Packed Cell Volume (PCV) were significant after Therapeutic Plasma Exchange (TPE). There was no significant difference in changes in crystalloid group from that in Fresh Frozen Plasma group. In crystalloid group, significant correlation was observed between Prothrombin Time (PT), Activated Partial Thromboplastin Time (APTT), Thrombin Time (TT) & volume of Plasma Exchanged (PE) /session, while spacing between sessions and the number of sessions is significantly correlated with Thrombin Time (TT). Plasma fibrinogen concentration and platelets count were decreased in the patients included in our current study.
Conclusion: There is no significant difference in changes in haemostatic system whether crystalloid or diluted Fresh Frozen Plasma (FFP) was used as replacement fluid. Thus, crystalloid, solution devoid of coagulation material can be used as a replacement fluid in the Therapeutic Plasma Exchange (TPE) if the volume of Plasma Exchanged (PE) is small. These results are of vital importance from the practical & public health point of view in minimizing the usage of blood components((i.e. Fresh Frozen Plasma (FFP) which is a potential source of Transfusion Transmissible Infections (TTIs) worldwide)) & replaced by crystalloid solution as a safer replacement fluid substitute in Therapeutic Plasma Exchange (TPE) process.

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