<p>A 60-year-old man with a history of deep vein thrombosis put on anticoagulation therapy with warfarin 2 mg daily. Achieving a therapeutic level of anticoagulation was difficult despite escalating doses of warfarin, because of the interaction with rifampicin. A 5 to 6 fold increase in warfarin dose was prescribed to reach therapeutic international normalized ratios (INRs), but even these increases were insufficient to maintain his INR in the therapeutic range. After rifampicin was discontinued, warfarin doses were gradually reduced over the next 2 months. When concurrent warfarin-rifampicin therapy is necessary, vigilant monitoring of INR is imperative and rifampicin should be stopped. Warfarin is an oral anticoagulant used to get target INR to prevent thrombosis in various cardiovascular diseases. Its metabolism is affected by dugs, diet and individual characteristics. It is metabolized in liver by microsomal cytochrome P450 enzyme. Rifampicin is an essential component of first line antitubercular   regimen. It induces enzyme P450, responsible for metabolism of warfarin. So to get target INR 2.5 to 3.5 is very difficult even with maximum possible dose of warfarin when patient taking simultaneously both drugs. In this case, rifampicin was stopped to achieve target INR. Tuberculosis patient on warfarin should not take rifampicin as component of first line antitubercular regimen.</p>

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Sickle cell disease is commonly seen in rural population of western part of India. It is one of the common causes of recurrent hospitalization, morbidity and mortality in paediatric population. As there are limited studies addressing the pattern of sickle cell disease amongst paediatric population in Bihar, This study was taken up to evaluate the clinic-haematological prole of paediatric population with sickle cell in tertiary health centres. METHODS: This was a retrospective observational study. Data were retrieved from haemato-pathology departments of tertiary care centres of Bihar. Data of children diagnosed with sickle cell disease from January 2019 to January 2021 were collected and analyzed to assess the , clinical ,haematological and HPLC prole at the time of diagnosis. RESULTS: 10 patients were included in the study. Clinically, Vasoocclusive crisis was the most common presentation (43.93 %) followed by generalized body ache and joint pain (36.99 %) and acute febrile illness (26.39 %), while 3 (30%) patients presented with severe anemia. Haematological nding was suggestive of moderate anemia, low Mean corpuscular volume and low Mean hemoglobin concentration. CONCLUSION: At the time of diagnosis vasoocclusive crisis and generalized bodyache were the most common manifestations in patients with sickle cell disease while haematological picture was suggestive of microcytic hypochromic moderate anemia. All cases were conrmed with HPLC.There was a positive correlation between age at presentation and severity of anemia at the time of diagnosis.