Download RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE
KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OFSUBJECT FOR DISSERTATION
1.
Name of the candidate and
address
DR ANITHA.K
DEPT OF PHYSIOLOGY
NAVODAYA MEDICAL COLLEGE
RAICHUR-584101
Permanent address
W\o K.SATYANARAYANA
H.NO. 8-11-180\19
LAXMIPURAM LAYOUT
RAICHUR-584101
2.
Name of the Institution
NAVODAYA EDUCATION TRUST’S
NAVODAYA MEDICAL COLLEGE
RAICHUR.
3.
Course of the study and subject
M.D (PHYSIOLOGY) ( 3 YEARS)
4.
Date of admission to course
18th May 2009
5.
Title of the topic
PLATELET ESTIMATION IN
PREGNANCY INDUCED
HYPERTENSION AND TO ASSESS
THE DEGREE OF
THROMBOCYTOPENIA.
6.
Brief resume of the intended:
6.1
Need for the study:
Among the hematological profiles that change in pre-eclampsia and eclampsia,
thrombocytopenia is the common abnormality. Degree of the thrombocytopenia
increases with severity of the disease. The tests like prothrombin time, partial
thromboplastin time, fibronectin level etc. are more sensitive but are expensive and
time consuming and not suitable for routine purpose. Platelet estimation by
peripheral smear is rapid, cheaper and a bedside procedure, and can be used at any
set up for routine monitoring.
6.2 Review of Literature
1. C.Giles MD, BSc. FRC Path, Haematology Dept. Stoke-on-trent.
“Intravascular coagulation in gestational hypertension and pre-eclampsia, the
value of haematological screening tests” showed that in fully developed pre-
eclampsia, macrothrombocytosis is found in about 50% of patients, fibrinogen
degradation productsand thrombocytopenia in about 15%. All three parameters
reflect degree of clinical severity of the disease.
2. Howarth. S, Marshall. L.R. Bars. AL, Evan. S. Et.al “Platelet indices during
normal pregnancy and pre-eclampsia.” From British journal of Biomedical
science . When a probability plot was constructed using discriminant analysis
of mean platelet volume versesplatelet count for pre-eclampsia versesnormal
pregnancy,the sensitivity for pre-eclampsia was 90% and specificity was
83.3%. The plot may be of use inconfirming risk of pre-eclampsia.
3. Mark.A, Zamorski. MD, Mhsa, and Leea, Green, MD MPH. university of
Michigan, NHBPEP report on high blood pressure in pregnancy. A summary of
family physicians states, women who develop hypertension after mid pregnancy
lab evaluation and rationale shows, platelet count thrombocytopenia of less then
100x10per micro liter suggest severe pre-eclampsia.
4. Richard Fischer, MD Co-division Head, maternal- fetal medicine, Alexander
Hagoboutras Associate professor in their article Thrombocytopenia in pregnancy
have sub classified HELLP based on the severity of thrombocytopenia(platelet
count)
5. S. Mohapatra, B.B. Pradhan, U.K. Satpathy, Arati Mohanty, and J.R .Pattnaik.
“Platelet estimation: its prognostic value in pregnancy induced hypertension.”
Showed that there is inverse relationship between severity of PIH and platelet
Number. So this method of platelet estimation is a rapid method of PIH
estimation, and can be done even in rural hospital setup.
6.3
Objective of the study:
1. To assess the degree of thrombocytopenia by platelet estimation(peripheral
Smear) which is easier, rapid and cost wise cheap and easier method that can be
done in primary hospital setup.
7.
Material and methods:
7.1
Source of Data.
Duration of study 12-18 months..
Pregnant women with different severity of PIH. From the OPD and labour room of
Navodaya Medical college Hospital and Research centre Raichur and from various
maternity homes in and around Raichur city.
7.2
Inclusive criteria:
Female patients with pregnancy induced hypertension.
Exclusive criteria:
Any significant history of anemia, cardiovascular disease, Diabetes mellitus,
Hemorrhagic disorder h/o drug intake which can affect the platelet count and bone
marrow depression.
Statistical analysis:
Student t test is used.
7.3
Does the study require any investigation or intervention to be conducted on
the patient or other humans or animals? If so describe briefly.
Yes,
This study requires the blood sample from the subject.
Blood to be collected from the subjects finger tip using all aseptic precaution, an
ideal blood smear prepared and stained with Leishman’s stain and platelet count is
done in 10 oil immersion fields of the smear.
Formula for calculation:
Total No. of platelets in lakhs/mm3 = Average no. of platelets /oil immersion field
x 20,000
7.4
Has ethical clearance been obtained from your institution
Yes, ethical clearance has been obtained from the institution.
8.
List of References:
1. Agarwal S. Buradkar Coagulation studies in Toxemia of pregnancy.
2. Cunningham FG Norman F Gant, Kerneth J. Leveno, Lary C. Gilstrap,
Hauth J.C, Wenstom KD. Hypertensive disorders in pregnancy. In A Seilis,
S.R. Noujaim,K. Davis,editors. Williams Obstetrics. International edn,New
York. MaGraw Hill; 2001;p, 567-618.
3. Dube B, Bhattacharya S. Dube R.K. Blood coagulation profile in Indian
Patients with pre-eclampsia and eclampsia. Br J of obster gynecol 1975 82 p35-39.
4.
Leduce . L, Wheeler. J.M coagulation profile in severe pre-eclampsia.J Obst
Gynaecol 1992; 79; 14.
5.
Maedel, LB. Examination of peripheral blood smear in B F Rodak editor
Hematology clinical principal and application 2nd edition USA SAUNDERS
2002, p, 171-183.
6. Mark, A, Zamarski MD, Mhsa, and Leea, Green M D, MPH university of
Michigan, NHBPEP report on high blood pressure .in pregnancy.
7. Richard Fischer, MD co-division Head maternal fetal medicine
Thrombocytopenia in pregnancy.
8. S.Mohapatra, BB Pradhan, U.K Satpathy, Arati Mohanty and J.R. Pattnaik
Platelet estimation: its prognostic value in pregnancy induced hypertension.
9. Thrombocytopenia in pregnancy. Article from Manchester obstetrical
Associates.
10. VrundaJ K Saila S. Lowered platelet count, A prognostic index in pregnancy
induced hypertension J Obster gynaecol Ind 2004: 54: 3.235-236
9.
Signature of candidate
10.
Remarks of the Guide
11.
Name and designation of (in block letters)
11.1 Guide
Dr. VIJAYANATH ITAGI
M.D.
ASSOCIATE PROFESSOR
DEPT OF PHYSIOLOGY
NAVODAYA MEDICAL COLLEGE’
RAICHUR.
11.2 Signature
11.3 Co-guide (if any)
11.4 Signature
11.5 Head of the Department
Dr .R.H.TAKLIKAR
M.D.
PROFESSOR AND HEAD
DEPT OF PHYSIOLOGY
NAVODAYA MEDICAL COLLEGE,
RAICHUR.
11.6 Signature
12
Remarks of the chairman and
principal
NAVODAYA MEDICAL COLLEGE
DEPARTMENT OF PHYSIOLOGY
PROFORMA
PLATELET ESTIMATION IN PREGNANCY INDUCED HYPERTENSION AND TO ASSESS THE
DEGREE OF THROMBOCYTOPENIA
Case No.
Date
Name
Age
Occupation
Place
Sex
History of present complaints
Obstetric history
Personal History
a) Diet
b) Appetite
c) Bowel/Bladder
d) Sleep
e)H/O Bleeding disorders
Family History
H/o Hypertension/Diabetes mellitus
H/o PIH
H/o bleeding disorder
Various parameters to be recorded.
Height (in cms)
Weight (in kgs)
Pulse rate
Respiratory rate
Systolic blood pressure
Diastolic blood pressure
Blood investigations:
Peripheral blood smears for platelet estimation