Objective: To evaluate the effect of iron deficiency anemia on HbA2 levels. Study Design: Comparative cross-sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Lahore Pakistan, from Jan to Oct 2020. Methodology: A total of 206 subjects were included in the study out of which 56 served as healthy controls. Five milliliters of whole blood were extracted in an EDTA tube and basic haematological parameters were performed using automated hematology analyzer (Sysmex KX-21). HbA2 levels were determined by cellulose acetate hemoglobin electrophoresis at alkaline pH (Mini Hor-8). Serum Ferritin levels were measured by chemiluminescence on Cobas e411 and Serum Iron levels by spectrophotometric method using ferrozine (Cobas c501). Results: Mean hemoglobin in control group was 12.5±0.7 g/dL and in iron deficiency anemia group was 8.1±1.36 g/dL (p=0.01). Mean HbA2 level in control group was 2.69±0.24% and iron deficiency anemia group was 1.76±0.25 % (p=0.001). HbA2 levels were reduced in individuals having haemoglobin levels less than 10g/dL and remained unchanged/minimally changed with hemoglobin levels reaching near normal levels. Conclusion: There was a statistically significant association of HbA2 levels with degree of anemia and serum ferritin levels (p=0.001).

Objective: To determine the efficacy of platelet indices as a tool for differentiation between clonal thrombocytosis and reactive thrombocytosis. Study Design: Cross sectional study. Place and Duration of Study: Department of Pathology, Combined Military Hospital, Lahore Pakistan, from Nov 2019 to Oct 2020. Methodology: Fifty-six subjects were included in Reactive thrombocytosis group and 56 in Clonal thrombocytosis group. Fresh blood in EDTA anticoagulant was analyzed to determine complete blood counts and platelet parameters (Platelet distribution width, mean platelet volume, Platelet large cell ratio, Plateletcrit) using the automated hematological analyzer Sysmex KX-21. Results: Mean age of the patients was 45.76 years with a range of 17-75 years. Assessing the cause of reactive thrombocytosi revealed that 20(35.7%) was infection and 16(28.5%) was iron deficiency anemia. In clonal thrombocytosis group 21(37.5%) were diagnosed with Chronic myeloid leukemia, 13(23.2%) with Essential thrombocythemia and 14(25%) with Polycythemia rubera vera. Platelet indices were compared in clonal thrombocytosis group and the reactive thrombocytosis group. Mean platelet volume, Platelet large cell ratio and Plateletcrit were significantly higher in the clonal thrombocytosis group (p=0.001). Difference in Platelet distribution width was not found to be statistically significant in the two groups (p=0.07) Conclusion: Platelet indices were higher in the clonal thrombocytosis group. Along with platelet count, they can serve as an efficient and cost-effective method in differentiating between clonal and reactive thrombocytosis.

Background: Pyrexia of unknown origin (PUO) is a major complication which remains undiagnosed. Different diagnostic test were used to arrive at final investigation. Bone marrow biopsy (BMB) plays a vital role in diagnosis of PUO. The objective of current study was to determine the role of bone biopsy in diagnosing various types of causes of pyrexia of unknown origin. Patients and methods: A prospective cross-sectional study was conducted from 1st September 2018 to 28th February 2019 at Department of Hematology, Combined Military Hospital Lahore, Pakistan. The data of 120 patients who were remained undiagnosed for at least 1 week were enrolled. Standard procedures were used to obtain the biopsy specimens and bone marrow aspiration was sent for microbiological examination. All the demographic information was kept on a structured self-designed proforma. Data was entered and analyzed using SPSS v.24. Results: Out of 120 patients recruited in the study there were 67 (55.8%) were from age group 16 to 35 years, were males (65.8%) and 65.0% patients were suffering from fever for more than 3 days. The majority of the participants (30%) were diagnosed with infections, fever due to reactive changes (10.0%), acute leukemia (14.2%), lymphoma (11.7%), chronic leukemia (10.0%), aplastic anemia (4.2%), multiple myeloma (2.5%) and 11.7% patients were undiagnosed Conclusion: In the diagnosis of pyrexia of unknown origin, morphological and histological investigation of bone marrow plays a vital role. However, if it is combined with other diagnostic modalities such as radiological, microbiological, and serological examinations, the efficiency of diagnosis can be improved.

Objective: To determine the alteration of coagulation profile (PT, APTT, D-dimers) in malaria patients and its correlation with the degree of Parasitemia.Study Design: Cross-sectional study. Place and Duration of Study: Pathology department of Combined Military Hospital Lahore, from Jan to July 2018. Methodology: A total of 92 patients were included in the study. The malarial parasite was identified using thick and thin smears. Hemoglobin, Red blood cell, White blood Count, Prothrombin Time, Activated Partial Thromboplastin Time, and Ddimer levels were measured using automated analyzers Sysmex KX-21 and CA-600. Results: The mean age of the patients was 23.35 ± 14.4 years with 53 (57.6%) males and 39 (42.4%) females. Plasmodium falciparum was identified as the causative species in 33 (35.9%) of the cases, 59 (64.1%) cases were caused by Plasmodium vivax. Based on parasitic load, 50 (54.3%) patients were found to have a mild degree of parasitemia whereas 26 (28.3%) had moderate and 16 (17.4%) had severe parasitemia. A significant association was found between the degree of parasitemia and coagulation parameters. Conclusion: Partial thromboplastin time, activated partial thromboplastin time and D-dimer levels were positively correlated with the degree of parasitemia specifically in plasmodium falciparum as compared to the other species. Therefore, special care should be exercised in patients having an underlying inherited bleeding disorder and a strict prevention protocol should be made.

Objective: To find out the association of type 2 diabetes mellitus with ABO and Rh blood groups. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology, Combined Military Hospital Lahore, from Jul to Dec 2020. Methodology: A total 179 patients with type 2 diabetes mellitus and 50 healthy individuals were inducted into the study. Five (5ml) blood from the patients was taken via clean aseptic venipuncture in a tube containing EDTA. HbA1C was generated through automated analyzer Cobas c501 and blood grouping was carried out using tube method by an experienced technician. Results: A total of 179 (77.8%) individuals with diabetes mellitus type 2 and 50 (21.7%) healthy cases were inducted into the study as a control group. A statistically significant difference was observed with blood group B being the most prevalent among them (p=0.001). There was a greater frequency of Rh-negative blood group in patients having diabetes mellitus type 2 as compared to the control group. Conclusion: There is a strong association found between ABO and Rh blood group with diabetes mellitus type 2. Blood group B negative was the most common among the patients having diabetes mellitus type 2. Blood group O positive showed the least association.

Objective: To determine the association of mean platelet volume with diabetic retinopathy in our population. Study Design: Cross sectional study. Place and Duration of Study: Department of Hematology & Ophthalmology, Combined Military Hospital Lahore, from Jul to Dec 2020. Methodology: A total of 146 known patients with type 2 diabetes were enrolled in this study. They included 78 patients with diabetic retinopathy (group 1) and 68 without diabetic retinopathy (group 2). Five (5ml) of whole blood was extracted from patients through clean venipuncture in a tube containing EDTA and mean platelet volume was generated through automated haematological analyzer Sysmex KX-21 and HbA1c was generated through automated analyzer Cobas c501. Result: A total of 146 patients with type 2 diabetes were included in this study. The age of patients ranged from 25-70 years (Mean age: 53.3 ± 0.02 years). Out of 146 patients 66 (45.2%) were males and 80 (54.8%) were females. Among patients with type 2 diabetes 78 (53.4%) has retinopathy while 68 (46.6%) have no retinopathy. A statistically significant difference (p<0.005) was observed in mean platelet volume and platelet distribution width among patients with retinopathy to those without retinopathy. Conclusion: Mean platelet volume plays a significant role in the determination of retinopathy with type 2 diabetes and helps to monitor progression of disease.

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Objective: To determine the diagnostic efficacy of haematological indices for the diagnosis of beta thalassemia trait taking haemoglobin electrophoresis as a gold standard. Study Design: Cross sectional study. Place and Duration of Study: Department of Haematology Combined Military Hospital Lahore, from Aug to Dec 2019. Methodology: Two hundred and six anaemic patients 20-70 years of age of both genders were included in the study. Blood was collected from all the patients and complete blood count were generated through automated haematology analyser Sysmex KX-21. Based on the complete blood count parameters like mean cell volume, red blood cell count, red cell distribution width and mean cell haemoglobinthe haematological indices such as Mentzer, Ricerca, mean density of Hb/litre of blood, mean cell Hb density and red cell distributon width indices were calculated. The haemoglobin A2 band of >3.5% on haemoglobin electrophoresis was taken as cut off for Beta thalassemia trait. Results: Out of the 206 blood samples analysed, 120 (58%) were labelled as Beta thalassemia trait after Hb electrophoresis and 86 cases had anemia due to other causes. Mentzer index established the highest sensitivity of 92.5% whereas RICERCA index established the highest specificity of 94.1%. Mentzer and red cell distribution width indexhad highest diagnostic efficacy value up to 90.3%. Conclusion: We conclude that Mentzer and red cell distribution width index showed the highest diagnostic significance. The Mentzer index has the highest sensitivity whereas Ricerca index has the highest specificity. The red blood cell count, haemoglobin and mean cell volume.............

Objective: To find out the correlation between the red blood cell and platelet indices in patients presenting with iron deficiency anemia at a tertiary care hospital of Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Department of Hematology, Combined Military Hospital Lahore, from Sep 2018 to Mar 2019. Methodology: The patients of age 1-70 years of either gender presenting with IDA were included in the study. The blood sample of patients were sent to laboratory to assess the red blood cell and platelet indices. SPSS-23 was used to analyze data. Results: Two hundred and seven patients fulfilling the inclusion criteria were included in this study. The mean age was 25.6 ± 17.8years. Correlation was weak and insignificant between haemoglobin and packed cell volume (r=-0.385**, p<0.01), haemoglobin and mean cell volume (r=-0.225**, p<0.01), packed cell volume and mean cell haemoglobin (r =0.263**, p<0.01), & mean cell haemoglobin and mean platelet volume (r=0.143*, p<0.05). Correlation was moderate and significant between platelet distribution width and mean platelet volume (r=0.511**) & platelet distribution width and platelet large cell ratio (0.502**, p<0.01). Correlation was strong between mean platelet volume and platelet large cell ratio (r=0.759**, p<0.01). Conclusion: In conclusion, there was significant relation between red blood cell and platelets indices in iron deficiency anemia. Furthermore, haemoglobin and packed cell volume are weekly correlated, platelet distribution width and mean platelet volume are moderately correlated and mean platelet volume and platelet large cell ratio are strongly correlated.