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Objective: To evaluate the effectiveness of guidelines driven platelet transfusion as well as to compare effectiveness of low verses high dose of the platelets transfusion. Study design: Observational chart analysis study. Place and duration of study: Jinnah Post Graduate Medical Center, Medical unit II, for 2 years in 2011 (Study-A) and 2012 (Study-B). Material and method: Study A included 130 and Study B included 111 patients. In Study-A, retrospective chart analysis was done for all the patients who were either bleeding or had low platelet counts. Platelet transfusions given to these patients were evaluated. Based on these results and WHO bleeding stages; guidelines were structured for futures platelet transfusion. In Study B platelet transfusion were driven by these guidelines. Outcomes in form of discharge and death of patients given low, medium and high dose platelets were compared. Results: In Study A; 98 patients were transfused platelets, out of which only 76 were actively bleeding; while in Study B platelets were transfused in 65 patients of whom 62 patients were having active bleeding. The outcome in term of patient discharged and expired was seen to be comparable in different dosage groups with a significant P value <0.005. Conclusion: After following guidelines, 1% inappropriate platelet transfusions were administered as compared to 20% inappropriate transfusions in previous year. Low dose platelets were as effective as high dose platelets.

Currently, COVID-19 is one of the most pressing healthcare problems across the world. With no definitive pharmacological guidelines, multiple drugs were used to treat critical patients with little success. of Tocilizumab, a monoclonal antibody has shown some role in the treatment of Covid-19 infection. The study was a cross-sectional prospective observational study. It was conducted in the COVID-19 Intensive Care Unit (ICU) of Liaquat National Hospital and Medical College, and National Medical Centre Karachi. The study was conducted from 15 th June 2020 to 31 st July 2020. Objective of the study was to compare the outcomes of severe to critical COVID-19 patients with established Cytokine release Syndrome (CRS), who received Tocilizumab with the group received Tocilizumab followed by intravenous immunoglobulins (IVIG). Two groups were made with one receiving Tocilizumab alone while the other received IVIG after Tocilizumab. Comparison was then made based on frequency of mortality as well the need of mechanical ventilation and its range of days. In results 4 (15.4%) patients in Tocilizumab only group died while Tocilizumab followed by IVIG treated group had 10 (38.46%) deaths. 20 (76.9%) patients needed mechanical ventilation in Tocilizumab only group while Tocilizumab followed by IVIG treated group consisted of 23 (88.46%) patients. This concludes that the group with only Tocilizumab therapy has better outcome as compare to the group who received both Tocilizumab and intravenous immunoglobulins.

Background: Beta-thalassemia is an autosomal recessive hemoglobinopathy with frequent skeletal complications, often debilitating in adolescent patients. We aim to evaluate the bone mineral density (BMD) by dual-energy x-ray absorptiometry (DEXA) and ascertain osteoporosis/osteopenia frequency in patients with β-thalassemia major. Methodology: In this cross-sectional study, 36 adolescent patients with β-thalassemia major were enrolled from June 2015 to March 2017. BMD was measured in the anteroposterior lumbar spine (L1-L4) and femoral neck by DEXA. For the biochemical estimations, blood and urine samples were obtained and analyzed. The results of a bone density test were presented as T and Z scores. Results: There were 20 male and 16 female patients with a mean age of 21.33 ± 3.7 years. The mean bone mineral content (BMC) was 20.10 ± 6.0 gm, and the mean BMD was 0.65 ± 0.07 gm/cm 2 . The mean T score was -3.17 ± 1.04, and the Z score was -3.06 ± 1.06. All patients had low BMD, as depicted by their T or Z scores. The reported frequency of osteoporosis and osteopenia was 77.7% and 22.2%, respectively. Conclusion: All Beta-thalassemia major patients had low BMD with a remarkable incidence of osteoporosis. It is recommended to perform an annual BMD among thalassemic patients to prevent fatal consequences and achieve an optimal bone density among such patients.

Background: Pre-donation donor screening is a crucial step in ensuring the safety of both blood donors and recipients. Donors who do not meet predetermined criteria are temporarily or permanently deferred. Aim: To assess the patterns and prevalence of deferrals at our institution. Study design: Prospective study Place and duration of study: Karachi Tertiary Care Hospital, Karachi from 1st January 2014 to 31st December 2015. Methodology: Thirty six thousand, nine hundred and fifty four potential donors presented themselves, 33853 were selected and 3101 were excluded. Blood donors' demographic information was stored in the blood bank's database, and secondary measures such as the type of deferral (permanent/temporary) and reasons for deferral (donor or patient safety) were evaluated. Results: The majority 2663(7.20%) of donors were deferred due to complete blood count, followed by medical history 264(0.71%) and examination findings 174(0.47%). The majority of donors (96%) were temporarily deferred, while only 3.9% were permanently deferred. Low haemoglobin counts were the most frequent cause of treatment delays (78.8%), followed by hypertension (3.64%) and a history of medication usage (1.32%). Donor safety accounted for the majority of donor rejections (91.5%), while recipient safety accounted for 8.41%. Conclusion: The majority of donors were deferred due to abnormality in the profile of blood count mainly low hemoglobin level. The low hemoglobin counts were the most frequent cause of treatment delays, followed by hypertension and a history of medication usage. Only small numbers of donors were permanently deferred. Keywords: Blood donor, Deferral, Permanent, Temporary