C. Kariyawasan

Hump-Nosed Viper Bite-Associated Thrombotic Thrombocytopenic Purpura: A Rare Complication

Curēus, Mar 9, 2024

Thrombotic thrombocytopenic purpura (TTP) is one of the rarely encountered complications of hump-... more Thrombotic thrombocytopenic purpura (TTP) is one of the rarely encountered complications of hump-nosed viper bites, which requires early detection and specific management. Hump-nosed viper bites are well known to affect multiple systems, and it is imperative to identify and manage each complication simultaneously. A 48-year-old patient presented to the hospital following a hump-nosed viper bite, where he subsequently developed local necrosis, acute kidney injury (AKI), and TTP. A diagnosis of TTP was made using the PLASMIC score (which refers to the score's seven components: platelet count; combined hemolysis variable; absence of active cancer; absence of stem-cell or solid organ transplant; mean corpuscular volume (MCV); international normalized ratio (INR); and creatinine) and supporting blood picture findings despite the diagnostic difficulties encountered due to the misleadingly normal automated platelet counts. The patient underwent multiple blood transfusions, 12 cycles of hemodialysis, and two cycles of therapeutic plasma exchange, the latter contributing to a significant improvement in his overall clinical and biochemical markers. In this case presentation, we report a rare case of TTP occurring after a hump-nosed viper bite, with the outcome of the report focusing on the diagnostic difficulties and available therapeutic modalities.

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Thrombophilia testing for whom, why and when – a review of current practices

Deleted Journal, Apr 24, 2024

Hump-Nosed Viper Bite-Associated Thrombotic Thrombocytopenic Purpura: A Rare Complication

Cureus Medical Publishing , 2024

Thrombotic thrombocytopenic purpura (TTP) is one of the rarely encountered complications of hump-... more Thrombotic thrombocytopenic purpura (TTP) is one of the rarely encountered complications of hump-nosed viper bites, which requires early detection and specific management. Hump-nosed viper bites are well known to affect multiple systems, and it is imperative to identify and manage each complication simultaneously. A 48-year-old patient presented to the hospital following a hump-nosed viper bite, where he subsequently developed local necrosis, acute kidney injury (AKI), and TTP. A diagnosis of TTP was made using the PLASMIC score (which refers to the score's seven components: platelet count; combined hemolysis variable; absence of active cancer; absence of stem-cell or solid organ transplant; mean corpuscular volume (MCV); international normalized ratio (INR); and creatinine) and supporting blood picture findings despite the diagnostic difficulties encountered due to the misleadingly normal automated platelet counts. The patient underwent multiple blood transfusions, 12 cycles of hemodialysis, and two cycles of therapeutic plasma exchange, the latter contributing to a significant improvement in his overall clinical and biochemical markers. In this case presentation, we report a rare case of TTP occurring after a hump-nosed viper bite, with the outcome of the report focusing on the diagnostic difficulties and available therapeutic modalities.

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A Retrospective Analysis of the Significance of Serum Bilirubin Levels and Glycemic Measurements in Type 2 Diabetes Management in a Cohort of Patients in a Tertiary Care Hospital

BackgroundIn type 2 Diabetes Mellitus (T2DM) chronic hyperglycemia leads to multi-organ damage. I... more BackgroundIn type 2 Diabetes Mellitus (T2DM) chronic hyperglycemia leads to multi-organ damage. It is a chronic low-grade inflammation resulting in reduced antioxidants leading to many complications. Hyperglycemia causes glycation of serum proteins forming advanced glycation end products (AGEs). HBA1c is an AGE of haemoglobin. Bilirubin considered a waste product of the heme catabolic pathway, has proven to be a natural antioxidant associated with a lower prevalence of oxidative stress-mediated diseases. Bilirubin prevents glycation of proteins providing benefit in T2DM. General objective - To evaluate the association of serum bilirubin levels with HBA1c, FBS, PPBS in diabetes patients. Specific objectives - 1) To compare the serum bilirubin levels in diabetes patients with good and poor control. 2) To evaluate the association of HbA1c with FBS, PPBS and age in controlled and uncontrolled diabetes mellitusMethodology -A retrospective analytical study done at the department of Haemat...

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Flow Cytometry Findings of Aberrant Expression in a Cohort of Patients with Acute Myeloid Leukaemia

Background: Acute leukaemia is defined as the presence of over 20% of blasts cells in the blood o... more Background: Acute leukaemia is defined as the presence of over 20% of blasts cells in the blood or bone marrow. Acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) are the 2 main types. AMLs have characteristic morphological findings and molecular features with different surface and cytoplasmic cluster of differentiation (CD) markers. These CD markers are determined by immunophenotyping/flow cytometry on leukocytes which helps with accurate diagnosis and reproducibility of AMLs. Flow cytometry plays an important role in the diagnosis, sub classification and monitoring of patients with AML. AML generally shows aberrant CD expression or coexpression in relation to normal myeloid cells. Objective of the Study: Objective of the Study was to evaluate the frequency and the pattern of aberrant CD expression in AML patients referred to a tertiary care hospital in Sri Lanka in comparison to other published data. There was no comparative data available in respect of Sri Lank...

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A Clinically Asymptomatic Patient with a Flowcytometry Profile of Mycosis Fungoides/Sezary Syndrome

Introduction: Mycosis fungoides (MF) is the most common type of cutaneous T –cell lymphoma accoun... more Introduction: Mycosis fungoides (MF) is the most common type of cutaneous T –cell lymphoma accounting for 50% of all cutaneous lymphomas. Sezary Syndrome (SS) and MF are closely related T –cell neoplasms. They are considered separately on the basis of clinical features and cell of origin. Flowcytometry plays an important role in the diagnosis of MF/SS with a characteristic immunophenotypic expression of a lack of CD 7 as a common feature in all stages of the disease. Our case is a clinically asymptomatic patient with a flowcytometric pattern of Mycosis fungoides/Sezary syndrome. There is no documentation of such a case in the literature. Case: A 55 year – old male presented with persistent lymphocytosis. Investigations revealed a Hb of 15.5 g/dl, ESR 03 mm/1st hour, platelet count of 178,000/cu mm, total WBC count of 10,700/cu mm and an absolute lymphocyte count of 7000/cu mm (62%). The serum protein electrophoresis was normal. LDH was 149 IU/L (150-250) IU/L. A chest X-ray showed n...

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PB2273: Analysis of the Haematological Parameters and Blood Picture Findings and Their Impact on the Duration of Stay in a Cohort of Patients with Covid 19 Infection in a Tertiary Care Hospital in Sri Lanka

HemaSphere

Uncommon presentation of hypereosinophilic syndrome

Ceylon Medical Journal, 2009

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Multiple myeloma: causes and consequences of delay in diagnosis

haematological malignancy with reported mortality of 10–20 % within the first 2 months of present... more haematological malignancy with reported mortality of 10–20 % within the first 2 months of presentation. Symptoms are non-specific, and patients thus present to a range of medical practitioners. Aim: To analyse the causes and consequences of a delay in diagnosis of myeloma. Design: Retrospective case review. Methods: The number and type of disease–related complications present at diagnosis of 92 patients with myeloma were categorized according to the medical practitioner to whom the patient initially presented, the time before diagnosis and the status of the patient at study end in 2006. Overall and disease-free survival were analysed. Results: Duration of symptoms46 months prior to diagnosis was seen in 40 % of the patients, of whom 450 % had initially consulted a general practitioner. The most common presenting symptom (67%) was bone pain. The most common complications pre-sent at diagnosis were anaemia (54%), bone disease (45%) and renal failure (36%), with the highest frequency o...

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Uncommon presentation of hypereosinophilic syndrome

The hypereosinophilic syndrome is a group of diseases characterised by persistent blood eosinophi... more

Two Atypical Cases of Classical Hairy Cell Leukaemia and Hairy Cell Leukaemia Variant: A Case Study

Introduction: Classical Hairy Cell Leukaemia (cHCL) and Hairy Cell Leukaemia variant (HCL-v) are ... more Introduction: Classical Hairy Cell Leukaemia (cHCL) and Hairy Cell Leukaemia variant (HCL-v) are both rare and slow-growing mature B cell neoplasms. According to flowcytometry data, they fall into the group classified as CD5- CD10- B cell lymphoproliferative disorders. Methods: Two cases with features atypical to two neoplasms at the time of diagnosis were studied. Results: Case 1 was a 15 year old male with right cervical lymph nodes (1x1 cm) in the posterior triangle, a few ecchymotic patches on the arm and a massive splenomegaly. C-reactive protein (CRP) level was 53 mg/dL. Erythrocyte Sedimentation Rate (ESR) was 98 mm/1 st hour. Full Blood Count (FBC) revealed typical features of pancytopenia with monocytopenia. The liver and renal profiles were normal. Morphology of bone marrow was suggestive of cHCL. Flowcytometry and BRAF V600E mutation was positive confirming the diagnosis of cHCL. Case 2 was a 55 year old male presenting with moderate splenomegaly and absolute lymphocytosi...

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A Clinically Asymptomatic Patient with a Flowcytometry Profile of Mycosis Fungoides/Sezary Syndrome

Introduction: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma account... more Introduction: Mycosis fungoides (MF) is the most common type of cutaneous T-cell lymphoma accounting for 50% of all cutaneous lymphomas. Sezary Syndrome (SS) and MF are closely related T-cell neoplasms. They are considered separately on the basis of clinical features and cell of origin. Flowcytometry plays an important role in the diagnosis of MF/SS with a characteristic immunophenotypic expression of a lack of CD 7 as a common feature in all stages of the disease. Our case is a clinically asymptomatic patient with a flowcytometric pattern of Mycosis fungoides/Sezary syndrome. There is no documentation of such a case in the literature. Case: A 55-year-old male presented with persistent lymphocytosis. Investigations revealed a Hb of 15.5 g/dl, ESR 03 mm/1st hour, platelet count of 178,000/cu mm, total WBC count of 10,700/cu mm and an absolute lymphocyte count of 7000/cu mm (62%). The serum protein electrophoresis was normal. LDH was 149 IU/L (150-250) IU/L. A chest X-ray showed no pathology. The patient was followed up for a period of five months with full blood counts (FBC), monospot test,

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Flow Cytometry Findings of Aberrant Expression in a Cohort of Patients with Acute Myeloid Leukaemia

by Charith Ranatunga and C. Kariyawasan

Background: Acute leukaemia is defined as the presence of over 20% of blasts cells in the blood o... more Background: Acute leukaemia is defined as the presence of over 20% of blasts cells in the blood or bone marrow. Acute myeloid leukaemia (AML) and acute lymphoblastic leukaemia (ALL) are the 2 main types. AMLs have characteristic morphological findings and molecular features with different surface and cytoplasmic cluster of differentiation (CD) markers. These CD markers are determined by immunophenotyping/flow cytometry on leukocytes which helps with accurate diagnosis and reproducibility of AMLs. Flow cytometry plays an important role in the diagnosis, sub classification and monitoring of patients with AML. AML generally shows aberrant CD expression or coexpression in relation to normal myeloid cells. Objective of the Study: Objective of the Study was to evaluate the frequency and the pattern of aberrant CD expression in AML patients referred to a tertiary care hospital in Sri Lanka in comparison to other published data. There was no comparative data available in respect of Sri Lanka. Materials and Methods: A retrospective descriptive study including 26 cases of AML diagnosed over a period of 12 months were analyzed. Diagnosis of AML was made by morphology of Short Research Article

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Two Cases of Multiple Myeloma Revealing 2 Clonal Plasma Cell Populations on Flowcytometry

Flowcytometric immunophenotyping is useful to identify clonal plasma cells which are helpful in t... more Flowcytometric immunophenotyping is useful to identify clonal plasma cells which are helpful in the diagnosis of multiple myeloma. The standard diagnostic method involves the selection of abnormal plasma cells by CD38 and CD 138 which is generally positive. We present two cases who were diagnosed with multiple myelomain the presence of lytic lesions in the skeletal survey and confirmed clonality on flowcytometry, revealing tow populations of plasma cells with positive CD38 and negative CD138 and vice versa respectively.

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The Association between Hba1c- Derived Estimated Average Glucose (Eag) with Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in Patients with Type 2 Diabetes in A Cohort of Patients in a Tertiary Care Hospital in Sri Lanka

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to i... more Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to insulin or poor production. FBS, PPBS and Glycated Haemoglobin (HbA1c) are the major tests that are used to monitor chronic glycemia worldwide. HbA1c level remains the gold standard test for assessment of glycemic control at follow up and it reflects the mean glucose values in the previous three - month period. HbA1c is expressed as a percentage, whereas the day-to-day monitoring and treatment of diabetes are based on blood glucose levels expressed as milligrams per deciliter (mg/dl) or millimoles per liter (mmol/L). Due to the difference in the denominators of FBS/PPBS with HbA1c, it causes confusion to the patients regards their glycaemic control. “Estimated average glucose” or eAG derived from HbA1c has been promoted by the American Diabetes Association (ADA). American Association of Clinical Chemists concludes that the correlation (r =0.92) is strong enough to justify reporting both H...

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The Association between Hba1c- Derived Estimated Average Glucose (Eag) with Fasting Blood Sugar (FBS) and Post Prandial Blood Sugar (PPBS) in Patients with Type 2 Diabetes in A Cohort of Patients in a Tertiary Care Hospital in Sri Lanka

by C. Kariyawasan and Thushara Balasuriya

European Journal of Medical and Health Sciences

Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to i... more Introduction: Type 2 Diabetes mellitus (T2DM) is a chronic illness, caused due to resistance to insulin or poor production. FBS, PPBS and Glycated Haemoglobin (HbA1c) are the major tests that are used to monitor chronic glycemia worldwide. HbA1c level remains the gold standard test for assessment of glycemic control at follow up and it reflects the mean glucose values in the previous three - month period. HbA1c is expressed as a percentage, whereas the day-to-day monitoring and treatment of diabetes are based on blood glucose levels expressed as milligrams per deciliter (mg/dl) or millimoles per liter (mmol/L). Due to the difference in the denominators of FBS/PPBS with HbA1c, it causes confusion to the patients regards their glycaemic control. “Estimated average glucose” or eAG derived from HbA1c has been promoted by the American Diabetes Association (ADA). American Association of Clinical Chemists concludes that the correlation (r =0.92) is strong enough to justify reporting both H...

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Evaluation of Reticulated Haemoglobin (CHr) as a diagnostic parameter in Iron Deficiency Anemia

European Journal of Medical and Health Sciences

Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts o... more Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts of the world. In developing countries, the commonest cause is inadequate dietary intake [1]. The red cell indices raise the suspicion of iron deficiency state due to the microcytic, hypochromic changes and the wide red cell distribution width. The iron studies are confirmatory of an iron deficiency state, but are not accurate in the presence of infection, inflammation or malignancy as they are acute phase proteins and are affected in these states making the serum iron studies unreliable under these conditions. The reticulocyte haemoglobin content (CHr) indicates the iron available in the marrow for the production of Hb and are not affected by the above-mentioned situations and therefore has been recommended as a reliable marker of iron status in the body. The value for CHr given in the literature was 25pg [3]. Objectives: General objective was to evaluate the significance of CHr in the di...

Evaluation of Reticulated Haemoglobin (CHr) as a diagnostic parameter in Iron Deficiency Anemia

European Journal of Medical and Health Sciences

Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts o... more Introduction: Iron deficiency anemia (IDA) is the commonest nutritional deficiency in all parts of the world. In developing countries, the commonest cause is inadequate dietary intake [1]. The red cell indices raise the suspicion of iron deficiency state due to the microcytic, hypochromic changes and the wide red cell distribution width. The iron studies are confirmatory of an iron deficiency state, but are not accurate in the presence of infection, inflammation or malignancy as they are acute phase proteins and are affected in these states making the serum iron studies unreliable under these conditions. The reticulocyte haemoglobin content (CHr) indicates the iron available in the marrow for the production of Hb and are not affected by the above-mentioned situations and therefore has been recommended as a reliable marker of iron status in the body. The value for CHr given in the literature was 25pg [3]. Objectives: General objective was to evaluate the significance of CHr in the di...

Retrospective Analysis of Causes and Consequence of Delay in Diagnosis of Multiple Myeloma

Blood

We have conducted a retrospective study of 82 patients (49 - male, 33 - female, median age 67 yea... more We have conducted a retrospective study of 82 patients (49 - male, 33 - female, median age 67 years (Male), 63 years (Female) ) of whom 72 were de novo and 10 had a previous diagnosis of MGUS/Smouldering myeloma/Plasmacytoma. The duration of symptoms prior to diagnosis was used to categorise patients into 4 groups [A - 0 - 3months, B - 3 -6 months, C - 6 - 12 months, D > 12 months]. The incidence of complications of myeloma (infection, renal failure, bone disease, neurological disease and anaemia) were assessed in each group. 25 of 72 patients (35%) were in group A, 47 (65%) were in group B,C and D and 30 of these (64%) had presented initially to a general practitioner. The commonest presenting symptom was bone pain (60%) and skeletal disease was the commonest complication seeing in 43% of group A but in 57% of groups B,C and D. All 18 patients in group D had…

Immature Platelet Fraction (IPF) As a Screening Test to Identify the Cause for Thrombocytopenia

International Journal of Scientific and Research Publications (IJSRP)

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