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ABSTRACT
TO STUDY THE FREQUENCY OF IRON DEFICIENCY ANAEMIA,IT'S CLINICAL PRESENTATIONS AND
IT'S CORRELATION WITH HAEMATOLOGICAL
AND BIOCHEMICAL PARAMETERS.
THESIS
SUBMITTED IN PARTIAL FULFILLMENT OF
THE REQUIREMENTS FOR THE DEGREE OF
DOCTOR OF MEDICINE IN PATHOLOGY
BY
DR. MANOHAR PRADHAN, MBBSMAHARAJGUNJ CAMPUS & T. U. TEACHING HOSPITAL
INSTITUTE OF MEDICINE
TRIBHUVAN UNIVERSITY
KATHMANDU, NEPAL
JANUARY 2000
Certificate
This is to certify that the work of
Dr. Manohar Pradhan on
"To study the frequency of
iron deficiency anaemia,
it's clinical presentations
and its correlation with
Haematological and
Biochemical parameters"
was conducted in
Department of Pathology
and Department of Biochemistry
under our supervision and guidance.
DR. SUSHEILA DALI MR. BHARAT JHA
Preceptor, Co-guide,
Professor and Head, Associate Professor,
Department of Pathology Department of Biochemistry
Maharajgunj Campus and T.U. Teaching Hospital
Maharajgunj, Kathmandu
Nepal
Declaration
This thesis has not been submitted in candidature for any other degrees. Reproduction or transmission of this thesis, in any form or by any means, electronic, mechanical, photocopying including inter-library loans for outside organizations has been granted.
DR. MANOHAR PRADHAN
Dedicated
To
My Parents,
Brothers,
Friends
And
Pathologist
ACKNOWLEDGEMENT
It is with sincere gratitude and pleasure that I acknowledge the invaluable assistance of many kind individuals in the completion of this thesis. Foremost among those to whom I am deeply indebted is my preceptor Professor Dr. Susheila Dali, who has been most supportive with valuable comments and corrections during the course of my work. I am also much indebted to the co-ordinator of MD Pathology and Dean of Institute of Medicine Professor Dr. Hari Govinda Shrestha for his resourceful and constructive advice to accomplish the task. I owe a great debt to my co-guide Assistant Dean and Associate Professor Bharat Jha for his kind guidance and much needed assistance in Biochemistry evaluation.
Special thanks and gratitude are due to Dr. Gita Sayami and Dr. Bidur Osti for their kind guidance and to Dr. Bijayee Shrestha for her invaluable suggestions and helping in literature searches. I also acknowledge my colleagues in Pathology Dr. Rang Bahadur Basnet, Dr. Viswa jeet Amatya, Dr. Bandana Sigdel, Dr. Ram Chandra Adhikari, Dr. Ashok Joshi, Dr. Jagat Singh Pandey and Dr. Reeta Devi Bashyal for being most gracious and resourceful in my effort.
I also acknowledge with gratitude the stimulus of all medical laboratory technologists and technicians, who have helped me in so many ways during my work. For her extra effort, I express my deepest gratitude and sincere appreciation to Mrs. Puspa Bista, without whose help my work would not have been complete. I owe many thanks to Associate Professor Shyam Sunder Malla, Head, Department of Biochemistry, for providing biochemistry lab for biochemical investigation. I am also grateful to Mr. Shree Ram Sharma, Mr. Keshab Parajuli, Mr. Ram Chandra Subedi, Mrs. Purna Maya Rana, Mr. Ram Bahadur Shrestha, Mr. Arun Bajra Bajracharya, Mrs. Jayanti Dhaubadel, Miss Krishna Shrestha, Mr. Diwas Shrestha, Mr. Sameer Jha, Mr. Pramod Raut, Mr. Sumeru Pradhan, Mr. Bijaya Jha, Miss Rushila Chitrakar, Mr. Madhav and Mr. Shiva Ram Budhathoki. In addition, I am grateful to Mr. Chinta Mani Sharma of Microbiology Department for his kind permission to use deep freezer.
I am most appreciative and grateful to Dr. Rajni Mahto, Dr. Eli Pradhan, Dr. Kanchan Koirala, Dr. Man B. KC and Dr. Anil Pahari for all their assistance in referring the associated cases to me.
I would also like to give thanks to my best friend Er. Birendra Raj Pandey, who have taught me to appreciate and apply the statistical analysis in computer. Also I sincerely appreciate the assistance of Neeraj Shrestha for his invaluable contribution in searching literature in Internet. Not to be forgotten are my brothers Er. Harihar Pradhan and Biswambhar Pradhan and my parents for being unfailing source of cheerfulness and encouragement. And finally my thanks to PGMECC for contributing the funds required to accomplish my task.
DR. MANOHAR PRADHAN
ABSTRACT
Iron deficiency Anaemia (IDA) is the most common cause of anaemia not only in Nepal but even worldwide. A prospective study was conducted in Tribhuvan University Teaching Hospital from April 1998 to March 1999 to determine the frequency of iron deficiency anaemia in anaemic patients. Blood samples from 100 anaemic patients (58 men and 42 women) and 12 controls were analyzed. Haematological parameters like Haemoglobin, MCV (mean corpuscular volume), MCH (mean corpuscular haemoglobin), MCHC (mean corpuscular haemoglobin concentration), and other routine haemogram were studied. Biochemical parameters like serum iron, serum ferritin and percentage saturation of transferrin were also determined. Out of 100 anaemic patients 36 had all the three biochemical parameters decreased and were diagnosed as iron deficiency anaemia. In IDA, the mean Haemoglobin was 6.42 gm/dl, MCV was 76.44 fl, MCH was 20.43 pg, MCHC was 27.34%. The mean serum iron was 21.85 (g/dl, mean serum ferritin was 8.94, mean percentage saturation of transferrin was 5.83% and mean total iron binding capacity was 406.47 (g/dl. Bone marrow examination was performed in 37 patients. 22 patients had grade 0 and 15 patients had grade 1+ iron in the bone marrow as demonstrated by Prussian blue stain. Significant correlation was observed between haemoglobin level with MCHC, percentage saturation of transferrin and total iron binding capacity. ANOVA (Analysis of variance) showed significant p value in IDA and control in all haematological parameters and three biochemical parameters. Analysis between IDA and anaemia with no biochemical parameters decreased showed significant difference in all the haematological and biochemical parameters. ANOVA showed significant stastical difference in all the haematological and biochemical parameters except serum ferritin and TIBC between anaemic patients with decreased any two of the three biochemical parameters and control. Analysis of variance test between anaemia with only one of three biochemical parameter decreased and control showed that this group does not have iron deficiency. ANOVA between bone marrow with and without iron granules showed statistical significance in all biochemical parameters, Haemoglobin, MCH and MCV emphasizing reliability of bone marrow iron staining for diagnosing iron deficiency anaemia.
CONTENTS
Cover pagei
Certificateii
Declarationiii
Dedicationiv
Acknowledgev
Abstractvii
Contentsix
Abbreviationx
List of Tablexi
List of figurexiii
Introduction1
Historical Background 3
Epidemiology5
Etiology8
Clinical Manifestations14
Laboratory Evaluation of Iron Deficiency Anaemia19
Aims and Objectives25
Materials and Methods26
Results37
Discussion51
Conclusion56
Index
I. Proforma58
II. Photographs61
Bibliography66
ABBREVIATIONS
IDA Iron deficiency anaemia
Non-IDA Non iron deficiency anaemia
MCV
Mean corpuscular volume
MCH
Mean corpuscular haemoglobin
MCHC Mean corpuscular haemoglobin concentration
TLC
Total leukocyte count
TRBC
Total red blood cell count
PCV
Packed cell volume
Hb
Haemoglobin
ELISA
Enzyme linked immunosorbent assay
TIBC
Total iron binding capacity
MPO
Myeloperoxidase stain
PAS
Periodic acid schiff stain
sTfR
Serum transferrin receptor
% S. Tra.Percentage saturation of transferrin
EZP
Erothrocyte zinc protoporphyrin
EP
Eyrthrocyte protoporphyrin
LIST OF TABLES
TABLE 1 Age Distribution of IDA, Non IDA and Control Patient.
TABLE 2Sex Distribution of IDA, Non-IDA and Control Patients.
TABLE 3 Showing Ethnic origin of IDA, Non-IDA and Control Patients.
TABLE 4 Occupation of the IDA, Non-IDA and Control Patients.
Table 5 The frequency of clinical features of IDA, Non-IDA and Control.
TABLE 6 Showing decreased haematological and biochemical parameters in control and study group
Table 7 Mean Haematological parameters of IDA, Non-IDA and Control.
TABLE 8Mean Biochemical parameters of IDA, Non-IDA and Control
TABLE 9 Showing haematological values in the patients with iron deficiency anaemia
TABLE 10 Showing Red cell morphology in Iron deficiency anaemia.
TABLE 11 Showing Grade of Iron in Bone marrow aspirates.
TABLE 12 Showing the finding of bone marrow examination in iron deficiency anaemia patients.
TABLE 13 Showing correlation of haemoglobin with haematological parameters
TABLE 14 Showing correlation of haemoglobin with biochemical parameters
TABLE 15 Analysis of Variance test showing p value of Biochemical & Haematological parameters between Control and all three biochemical parameters decreased
TABLE 16 Analysis of Variance test showing p value of Biochemical & Haematological parameters between All three
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