Pseudothrombocytopenia is an ex vivo EDTAdependent artefactual thrombocytopenia, that has been described in association with several conditions. When EDTA-blood samples are drawn from patients with pseudothrombocytopenia and analysed by automated cell counters, low platelet counts are obtained (often below 50,000/mm 3 ). However, simultaneous heparinised samples show normal platelet counts, and peripheral smears show no reduction in numbers of platelets. We report a series of 12 patients with scrub typhus infections and pseudothrombocytopenia. An association between these two entities has only recently been appreciated. It appears that pseudothrombocytopenia may sometimes accompany acute scrub typhus infections. The distinction between pseudothrombocytopenia and true thrombocytopenia is of great clinical relevance, as the former is merely a laboratory artefact, and does not require blood product transfusions despite apparently severe reductions in platelet counts. It is therefore important to recognise that apparent thrombocytopenia, especially in patients with an acute febrile illness due to scrub typhus, is not always true thrombocytopenia.

BACKGROUNDBleeding diathesis and coagulopathies are common in critically ill patients. Patients may have clinical bleeding or only laboratory abnormalities in haemostatic tests. Aims-To determine the incidence and types of bleeding diathesis that commonly occur in our medical ICU. Settings and Design-50 patients were studied who were admitted in IMCU, IIM, RGGGH. Study Design-Observational study. MATERIALS AND METHODSThe patients included in this study were those with any medical illness admitted to the ICU for > 48 hours, who had no primary haematological disease at the time of admission. Patients have their history taken and subjected to clinical examination and investigations. The following tests of haemostasis are done only once: Platelet count and peripheral smear, PT (Prothrombin time), aPTT (activated Partial Thromboplastin Time), Fibrinogen and D-dimer. The results were tabulated and analysed. RESULTSThrombocytopenia was the most common coagulation abnormality seen in 46% of the study population. More than half of the patients who had abnormal coagulation parameters had clinical bleeding. Melena was the most common bleeding manifestation. No patient had life-threatening bleeding; 10 out of 50 patients studied had aPTT prolongation with 2 patients having combined PT and aPTT prolongation. No patient had hypofibrinogenaemia, but 17 patients had hyperfibrinogenaemia. Sepsis ranks first in causing coagulopathy, followed by liver failure and antithrombotic drugs. CONCLUSIONA rationale approach must be developed in treating critical care patients with abnormal coagulation parameters. Too much aggressive transfusions can do more harm than good. A good clinical judgement is required along with the current knowledge for treating such patients.

BACKGROUND It has been found that patients with heart failure frequently have associated iron deficiency, which may or may not be associated with anaemia. Furthermore, it has been established that this iron deficiency is independently associated with exercise intolerance, poorer quality of life and increased mortality. The purpose of this study is to estimate the burden of iron deficiency and anaemia in patients who have heart failure with reduced ejection fraction. MATERIALS AND METHODS 50 patients with heart failure with reduced ejection fraction (EF < 40%) were compared with 50 age-matched controls who had no evidence of heart failure on history and clinical examination. All patients were investigated to identify iron deficiency and anaemia. RESULTS The prevalence of iron deficiency was 72% among cases and 36% among controls (P-value < 0.05). The prevalence of anaemia was 54% among cases and 28% among controls (P-value < 0.05). Patients with heart failure were 4.63 (95% CI 1.92-11.17) times more likely to be iron deficient and 3.21 (95% CI 1.26-8.21) times more likely to be anaemic compared with normal controls. CONCLUSION This study showed that there is a large burden of iron deficiency and anaemia in patients with heart failure with reduced ejection fraction. In view of the randomised controlled trials that have demonstrated benefit in correction of this iron deficiency, it may be prudent to assess and use iron status as a therapeutic target in all patients with heart failure.

BACKGROUNDThere is a significant prevalence of thyroid disorders in patients with diabetes mellitus, the most common being subclinical hypothyroidism. The coexistence of subclinical hypothyroidism in diabetes may alter the glycaemic profile and lipid profile that is expected in these patients Objectives-To determine the prevalence of subclinical hypothyroidism in patients with type 2 diabetes mellitus and to evaluate glycaemic profile and lipid profile in patients having both the disorders.

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