Maharat Nakhon Ratchasima Hospital Journal

ปัจจัยที่มีส่วนรบกวนผลการตรวจวิเคราะห์ชนิดของฮีโมโกลบิน

2024-06-11T09:26:01+07:00

Anemia in hemoglobin E traits resistant to treatment: report of two cases

2024-06-11T14:13:15+07:00

Introduction: The hemoglobin E traits are always asymptomatic; they mostly have normal hemoglobin concentration and normal MCV. Their hemoglobin analysis usually reveals only Hb A and E. But herein we reported two cases of supposed Hb E traits that had moderate microcytic anemia which could not be simply corrected. Case Presentation: Case 1. A 40-year-old Thai woman had moderate microcytic anemia without hepatosplenomegaly. Her blood tests showed: Hb 9.1 g%, MCV 52.3 fl, MCH 16.3 pg, ferritin 444.3 ng/ml, Hb analysis using the high performance liquid chromatography method: Hb AE, Hb E 15.2 %, Hb F 1.2 %. Case 2. A 36-year-old Thai woman had no anemic symptom and no hepatosplenomegaly. The blood tests included: Hb 9.3 g%, MCV 46.2fl, MCH 15.3 pg, ferritin 198 ng/ml, Hb analysis using the capillary zone electrophoresis method: Hb AE, Hb A 82.3 %, Hb E 12.0 %. They both were initially diagnosed as having Hb E heterozygosity with moderate anemia from unknown causes. They were supportively treated with the iron tablets and folic acid without the improvement within three months. Because both patients had some clues, viz. the Hb, MCV, MCH and the Hb E level which were all too low to be solely attributed by Hb E heterozygosity, the PCR for alpha thalassemia genes was performed and revealed the existence of Southeast Asian (SEA) and 3.7 kb deletions similarly in both patients. Their diagnoses were finally corrected to be Hb AEBart disease, the co-inheritance of Hb E heterozygosity and Hb H disease. Conclusion: The absence of Hb Bart in Hb AEBart disease could lead to the wrong diagnosis. To correct the diagnosis in this situation, it needs the clinical competence of the physician and the sophisticated test such as genotypes study.

The co-existence of autoimmune hemolytic anemia and iron deficiency anemia: a case report

2024-06-11T14:55:39+07:00

Background: Autoimmune hemolytic anemia (AIHA) is a rare acquired hemolytic disease due to the autoantibody against the antigen upon the own red blood cells whereas the iron deficiency anemia is resulted from the inadequate production of red blood cells due to lack of the iron. Their basic pathogeneses are totally different, so it is hardly to see both entities co-exist. This study is aimed to describe the co-existence of AIHA and IDA simultaneously in a Thai woman. Case Presentation: A 33-year-old Thai woman presented progressive fatigue for a few weeks without blood loss. The physical examination revealed only pallor without jaundice, no hepatosplenomegaly. The blood tests were: Hb 9.0 g%, WBC 4,050/mm³, platelet 238,000/mm³, MCV 90.8 fl, MCH 30.6 pg, reticulocyte 1.72 %, ferritin 8.57 ng/ml and the direct anti-globulin test-weakly positive. The urine hemosiderin was negative. The diagnosis was the co-existence of AIHA and IDA. The treatment was started with oral prednisolone, folic acid and the oral iron tablets. And she responded well to therapy, Hb 11.7 g%, MCV 95.3 fl within 8 weeks. Conclusion: The co-existence of AIHA and IDA is very unusual but they are not mutually exclusive. Its diagnosis is not simple because the microcytosis or hypochromia, the significant clues of IDA, are all masked. Likewise, the jaundice and reticulocytes, the clues of hemolysis with the increased erythropoietic compensation, are not recognized in this co-existence.

An autoimmune hemolytic anemia and an ovarian cyst: a case report

2024-06-11T15:38:58+07:00

Autoimmune hemolytic anemia (AIHA) is a rare acquired disease caused by the antibody specifically against some antigens upon the surface of the own red blood cells (RBC). It may spontaneously occur or it can be rarely found as a paraneoplastic syndrome in the patients with various solid tumors. Herein we reported a case of AIHA diagnosed in a patient with an ovarian cyst. She was a 72-year-old Thai patient who had low-graded fever for a week. The physical examination revealed pallor and a large cystic mass occupying the entire left lower abdomen without tenderness. The blood tests were: Hb 8.4 g%, WBC 13,470/mm³, platelet 455,000/mm³, MCV 80.6 fl, reticulocyte 2.6 %, direct anti-globulin test 1+, indirect anti-globulin test 2+, ANA-negative, CA-125 50.4 U/ml, Hb analysis-normal, osmotic fragility-positive. The ultrasonography of the whole abdomen showed a 7.2x11.6x15.6 cm cyst at the left adnexa with internal fluid/fluid level and one septation. She was diagnosed as having AIHA and a large ovarian cyst. And she was treated with corticosteroid and responded well. Hb was 9.5 g% whereas the direct anti-globulin test became weakly positive within one month. AIHA in our patient could be much improved with just only the corticosteroid therapy although the resection of the cystic ovarian mass was not allowed. This outcome was different from nearly all other cases of AIHA associated with tumors. So, AIHA in our case looked likely to be the co-incidence more than the paraneoplastic syndrome of the ovarian tumor. Therefore in a case of AIHA happening in patients with various tumors and the operation could not be accessed due to any reason, the corticosteroid therapy should be considered one of the initialtherapies of choice.

An emergence of adenocarcinoma in the lung following longstanding systemic sclerosis: a case report

2024-06-12T09:15:16+07:00

Abstract: Systemic sclerosis (SSc) is one of the chronic autoimmune diseases characterized by the infiltration of the excess collagen in various organs especially the skin. It is found associated with more prevalence of internal malignancies particularly the lung carcinoma. Herein we reported a case of adenocarcinoma confining within the lung in a Thai patient who had long-standing SSc. He was a 67-year-old Thai patient presenting with fever and productive cough for two weeks. He had been clinically diagnosed as having SSc based on the evidence of the sclerodactyly, the telangiectasia at the upper chest wall, multiple pitting scars at many finger tips and the interstitial lung disease and he had been treated with colchicine and azathioprine for 10 years. Besides the sclerodactyly and the telangiectasia, the lymphadenopathy and lung abnormality were not detected on the physical examination. The chest film and the computed tomography of the lung revealed a 2x2.8 cm mass at the left lower lung field. The pathology of the lung mass biopsied via the bronchoscopy was adenocarcinoma. LDH was 1,814 U/L. HIV antigen/antibody was negative. He was definitely diagnosed as having adenocarcinoma of the lung with an underlying long term SSc although he was not a smoker. He did not accept the further investigations and/or any treatment. Our case seemed to support the fact that the prevalence of cancers particularly the adenocarcinoma of the lung was significantly increased among SSc patients more than that of general population.

A comparison of hypotension among pregnant women undergoing spinal anesthesia for Cesarean section between isobaric bupivacaine and hyperbaric bupivacaine at Pakchong Nana Hospital

2024-06-11T11:07:39+07:00

Background: Spinal anesthesia becomes more popular because it is a simple, convenient and effective method. Hence, it is a preferred choice for Cesarean section. Patients and Methods: This quasi experimental research recruited pregnant women undergoing Cesarean section under the spinal anesthesia at Pakchong Nana Hospital during 1 July 2018-31 October 2018. They were equally allocated into 2 groups, 30 patients/ group. The 1^st group received hyperbaric bupivacaine while the 2^nd group received isobaric bupivacaine. The hypotension was compared between both groups at the 1^st, 3^rd, 5^th 15^th, 20^th, 25^th and 30^th minutes after introducing bupivacaine. The data were presented using descriptive statistics, frequency distribution and percentage, and analyzed using Chi-Square and T tests. Results: General data and anesthesia data were not different between both groups. The incidences of spinal anesthesia-induced hypotension in hyperbaric bupivacaine group were higher than those of isobaric bupivacaine group at the 15^th, 20^th, 30^th minutes after receiving the drug (76.7, 43.3), (90.0, 43.3) and (90.0, 63.3) with P value of 0.00, 0.00 and 0.01, respectively. But they were not significantly different at the 1^st, 3^rd, 5^th and 25^th minutes. Conclusions: The incidences of spinal anesthesia-induced hypotension in isobaric bupivacaine were less commonly seen than those of hyperbaric bupivacaine groups with statistical significance. Isobaric bupivacaine should be considered in Cesarean section for reducing the incidence of spinal anesthesia-induced hypotension.

Development of system for prevention and management of early postpartum hemorrhage following vaginal delivery at Pakchong Nana Hospital

2024-06-11T11:43:51+07:00

The objective of this research was to develop a preventive care system for postpartum hemorrhage after vaginal delivery at Pakchong Nana Hospital. It comprised 4 steps, 1) analysis of the conventional system, 2) new system design, 3) new system development, and 4) new system evaluation. The sample groups for evaluation were categorized as control groups and test groups, and each groups consisted of 43 pregnancies. The research instrument included 1) new system developed and 2) data collection sheet. The data were expressed with descriptive statistics, and risks were analyzed with correlation coefficient and logistic regression and compared with T-test.

The results showed that the main causes of postpartum hemorrhage were the uterine atony, birth canal tear, inadequately trained staff and indistinct practical guideline. Factors positively associating with postpartum hemorrhage with statistical significance were non-Thai nationality, history of medical illnesses, history of uterine curettage, prolonged first, second and third stages of labor and the integrity of the placenta. The factors predicting the postpartum hemorrhage included history of uterine curettage, prolonged first and second stages of labor, integrity of the placenta with 91.9 % accuracy.

The new system development comprised; personnel side: increased nurses’ performance, procedure side: improved screening for pregnancies at risk for postpartum hemorrhage at every stage, promoting the usage of active management practice conclusively and early management for blood loss 300 ml and innovation in blood collector bag. The test group under new system implementation showed no hemorrhage, shortened duration of second stage of labor, less blood loss and higher hematocrit level with statistical significance as compared with the control group under the conventional system.

It should be concluded that the new system of prevention and management of postpartum hemorrhage after vaginal delivery at Pakchong Nana Hospital could efficiently prevent the postpartum hemorrhage and its complications.

Etiologies and Predictors of Upper Gastrointestinal Bleeding at Pakchong Nana Hospital

2024-06-11T13:04:23+07:00

Introduction: Upper gastrointestinal bleeding is a common problem in a gasstrointestinal system. It is an important emergency that needs immediate management. The causes and predicting factors of upper gastrointestinal bleeding at Pakchong Nana Hospital has never been previously studied so this research was performed. Patients and Methods: This retrospective descriptive research is aimed to study the causes and predicting factors of upper gastrointestinal bleeding of patients at Pakchong Nana Hospital during October 2014-September 2017. All patients had hematemesis with black tarry stool and underwent the upper gastrointestinal endoscopy. The data were analyzed using descriptive statistics, correlation and multi-logistic regression analysis. Results: There were 179 with upper gastrointestinal bleeding, majority were older than 60 years. The ratio of male to female was 2.3:1. Of all, 140 were resulted from non-variceal bleeding (78.2%) and among them the most common cause was gastric ulcer (94 patients, 52.5%). The variceal bleeding was found in 39 patients (21.8%). The common sites of peptic ulcer consisted of the gastric antrum in 74 patients (66.1%) and gastric pylorus in 12 patients (10.7%). Factors significantly relating to the upper gastrointestinal bleeding included the alcohol drinking and smoking, the hematocrit less than 30%, receiving NSAIDs, hematemesis, fatigue, and abdominal pain with p values of 0.03, 0.00, 0.00, 0.02, 0.00, 0.02 and 0.03, respectively. Conclusion: If the relating factors could be controlled or diminished, the occurrence of upper gastrointestinal bleeding should be decreased or even prevented.

Incidence and factors associated with anemia among Thais aged 6-12 months at Pakchong Nana Hospital

2024-06-11T13:22:42+07:00

Introduction: Anemia among Thais aged 6-12 months is one of major public health problem of Thailand. The major cause of anemia in most children is iron deficiency resulting in slow growth, fatigue, inactivity, attention deficit, and learning problem. In addition, anemia is a major cause of cognitive dysfunction. Patients and Method: The aim of this prospective study was to find the incidence of anemia, the risk opportunity, and predicting factors contributing to anemia among Thais aged 6-12 months. Data were collected using the interview care-givers of children who accepted vaccination at child health supervision clinic of Pakchong Nana Hospital during 1 July-31 October 2018. All 194 children firstly had their blood checked for anemia. Data were presented using the descriptive statistics and analyzed using correlation and regression analysis. Results: Of 194 children, 35 were anemic (18.0 %) whose hematocrit was less than 33 %, averaged Hct of 25.5%. The ratio of male to female children with was 77.1:22.9. From analysis of risk opportunity of anemia, children who had been breastfed more than six months had 8.2 times of opportunity for anemia as compared with children who had been breastfed less than six months (95 % C.I. 3.6-18.7). Pregnant women with anemia had opportunity for having anemic children 7.6 times of women without anemia (95% C.I. 2.4-23.5). With multiple regression analysis, pregnant women with earning less than 10,000 Baht, Hct of pregnant women < 33%, gestational age < 37 weeks, breast feeding > 6 months, Hct of neonates < 45% were significant factors for prediction of anemia (p 0.01). Conclusion: From incidence and factors associated with anemia, the best prevention methods of anemia were: do not leave the pregnant women to lack of iron, to extend breast feeding till 6 months, to start food supplement at 4-6 months of age, and to add oral liquid iron at 4 months of age for full term but since birth for preterm. The blood check for anemia should cover widely for early detection of anemia.