BANGALORE, KARNATAKA
ANNEXURE II
PROFORMA FOR REGISTRATION OF SUBJECTS
FOR DISSERTATION
1. / Name of the candidate
and address / DR. VARDENDRA KULKARNI
POST GRADUATE
DEPARTMENT OF PATHOLOGY
KIMS, HUBLI.
2. / Name of the institution / KARNATAKA INSTITUTE OF MEDICAL
SCIENCES, HUBLI
3. / Course of study and subject / M.D. PATHOLOGY
4. / Date of admission to course / 26th MAY 2007
5. / Title of the topic / CLINICO-HEMATOLOGICAL STUDY OF PATTERNS OF ANAEMIA IN INFANCY AND CHILDHOOD.
6.
7.
8. / Brief resume of the intended work :
6.1 Need for study :
Anaemia is a major health problem in India. In children it assumes great importance because of many adverse effects on health including changes in immune functions, cognitive development, temperature regulation, energy metabolism and work performance. The situation in developing countries like India with her legacy of overpopulation, poverty, illiteracy, religious taboos and malnutrition is still worse. The pathogenesis of anaemia in children due to environmental factors and complex developmental process constitutes a syndrome of multiple etiologies and varied presentations.
Anaemia can be diagnosed and treated easily. Early intervention improves symptoms and ensures healthier and more productive lives. KIMS hubli is a major referral centre in north Karnataka. The patients attending this hospital are representative of the local community. The present study intends to review in detail the patterns of anaemia in infants and children in this part of the state.
6.2 Review of Literature
Anaemia is a global problem of immense health significance affecting persons of all ages and economic groups . it is ranked as the chronic malady of mankind affecting approximately 30-40 % of the world population . in India and other developing countries incidence of nutritional anaemia is as high as 60-80 % of the childhood population .1
Anaemia is generally defined as reduction in the oxygen carrying capacity of blood leading to tissue hypoxia and is characterized by reduced red cell mass and / or blood hemoglobin concentration . child is said to be anaemic when the hemoglobin and / or hematocrit is two standard deviations below mean for that age and sex. 1 the hemoglobin levels for characterization of anaemia recommended by a WHO study group on nutritional anaemia are : children between 6 months to 6 years- below 11g/dl and 6-14 years – below 12 g/dl at sea level. Singla and agarwal suggested the following values for Indian children ; for 6 months to 1 year- 9.8g /dl, 1-5 years -10.5 g / dl, 5-12 year-11.0 g /dl 2
On the basis of blood indices anaemia can be classified into three morphological types 1.microcytic hypochromic anaemia 2. macrocytic anaemia 3. normocytic normochromic anaemia. The initial classification can be substantially improved by including red cell distribution width(RDW) 3 According to a study conducted in Baroda (gujrat) by U.N.Betkerur and et al, the commonest etiological type of anaemia in children was iron deficiency anaemia.(71.9%) followed by hemolytic anaemia(11.3%), megaloblastic anaemia (9.8%), aplastic anaemia (3.7%) and leukemia(3%) 4
Iron deficiency was correctly diagnosed by serum iron in 41%, TIBC in 84%, percentage saturation in 50% and serum ferritin in 90% of the patients 5 gold standard for the diagnosis of iron deficiency has been considered to be the assessment of a bone marrow aspirate stained with pearl’s stain. 6
6.3 Objectives of the study :
1. To study the morphological patterns of anaemia in infants and children
2 To make an attempt to classify anaemia etiologically
3. To study bone marrow wherever possible
Material and methods :
7.1 Source of data : all cases of anaemia referred to the department of pathology for complete hemogram from oct 1st 2007 to jun 30th 2009
Inclusion criteria : all cases of anaemia admitted at KIMS hubli and reffered to department of pathology
Exclusion criteria : cases which are not found to be anaemic
7.2- Method of collection of data :
A prospective study will be conducted for one and half year period. Patient history will be taken and clinical examination will be done on personal interview or will be collected from medical records.blood samples sent for complete hemogram will be used for estimation of hemoglobin percentage, red blood cell count, packed cell volume, red cell indices, RDW, white blood cell count and platelet count using Sysmex KX 21 hematology autoanalyser. Serum separated from fresh blood will be used for estimation of serum iron and TIBC by ferrozine method. peripheral smears will be studied for describing cell morphology . bone marrow studies will be done wherever possible. The total sample size amounts to about 1500 cases. statistical tests like percentage amd student t test will be used.
7.3 Does the study require any investigations or interventions to be conducted on patients or other humans / animals? If so please describe briefly.
Complete hemogram ,Serum iron , TIBC, bone marrow studies and relavent radiological, microbiological, and biochemical investigations will be done
7.4 Has ethical clearance been obtained from your institution in case of 7.3?
Clearance from ethical committee of KIMS hubli has been obtained
List of references :
- Dr. M.R. lokeshwar, Nitin shah et al – Approach to a child with anaemia – Pediatric clinics of India – Jan1996;51-62
- K.N.agarwal –Nutritional anaemia in infancy and childhood – Indian journal of hematology oct 1984, vol 2 no. 4
- J D Bessman and et al – Improved classification of anaemia by MCV and RDW –American journal of clinical pathology 1983; 80;322-326
- U.N. betkerur and et al –Pattern of anaemia in childhood; Indian pediatrics vol 8, no. 7: 350-354
- E R Burns and et al – Clinical utility of serum tests for iron deficiency in hospitalized patients. American journal of clinical pathology 1990;93: 240-245
- DA Hughes et al – How should stainable iron in bone marrow films be assessed – journal of clinical pathology;; 2004: 57: 1038-1040
9. / Signature of candidate
10. / Remarks of the guide / Anaemia is one of the common health problems in children in developing countries. This is a condition wherein appropriate investigations and early management can improve the outcome drastically. In this view the present study has been taken up to classify anaemias and aid towards their management.
11. / Name& designation of
11.1 Guide / DR. P.K. RANGAPPA
PROFESSOR
DEPT. OF PATHOLOGY
KIMS, HUBLI
11.2 Signature
11.3 Co-guide (if any) / Co guide is not required for this study
11.4 Signature
11.5 Head of the department / DR. M.H. KULKARNI
PROFESSOR AMD HEAD
DEPT. OF PATHOLOGY
KIMS, HUBLI
11.6 Signature
12. / 12.1 Remarks of Chairman and Principal
12.2 Signature