04 July 2004	Sunday	15 Jamadi-ul-Awwal 1425

KARACHI, July 3: An estimate eight per cent per million population in Pakistan was inflicted with varied blood diseases, a senior haematologist, Dr. Khalid Zafar Hashmi, said at a programme on "Platelet Disorders - Diagnosis to Management" held here at Liaquat National Hospital on Saturday.

Mentioning that sudden and unexplained bleeding could be significant, the speaker stressed that the family practitioner should be aware of the possible cause and first time management. The speaker explicitly discussed the role of platelet in the "Haemostatic Mechanism - Body's Response to Bleeding".

Dr. Khalid Hashmi, who is also the Director of the Liaquat National Hospital, said that the most significant and commonly seen disorders were related to serious reduction in the number of circulating platelet. Various causes of low platelet count were also enumerated by him.

Outlining the role of platelet in the Hematology Pathway, he said these are produced in the bone marrow of the body adding that they were also the essential components of the primary haemostatic plug.

In the event of any damage to the blood vessel lining due to any reason, they stick to the damaged surface and initiate a process that eventually leads to control of bleeding and repair of the damage, the speaker added.

Reminding that certain inherited disorders result in repeated bleeding in children, the haematologist stressed that this must be recognized through a process of evaluating the patient and the family members. He emphasized the importance of educating the parents and the child and creating awareness among the family physicians so that complication of disease are recognized early and proper treatment is given before the child loses too much blood.

Dr. Naila Rahman of LNH in her presentation "Thrombocytopenia" mentioned that very low platelet counts could be presented as acute bleeding from the nose or gum or as widespread purpura and bruising.

In adults this could progress to a chronic disease process adding that correct diagnosis is important since the disorder could be of auto-immune origin affecting only the platelet or the low platelet count may be part of a systemic disease process.

Discussing thrombocytopenia in children, she said the onset is very sudden and usually follows some viral infection. The child may be covered with purpura, but serious bleeding is very unlikely.

She also focussed on another important group of patients that of young expectant mothers. Platelet count in pregnancy usually drops a little and this is normal.

But stressed that the count may drop significantly in cases of "gestational thrombocytopenia" adding that it was important to recognize the condition but there is no need to panic. Such deliveries should be conducted in hospitals where a team of haematologist, paediatrician, obstetrician could work together to ensure that the mother and the new born baby are safely handled.

Dr. Shaheen Kauser discussed an uncommon but significant disorder where the platelet increases. She said that some patients show a high count in association with infections. However, the disorder could be serious if platelet production goes out of control and its count is very high.

Blocking of the small blood vessel of the heart could result in heart attack while blocking of the blood vessels in the brain will result in paralysis or stroke, she elaborated.

Dr. Shaheen also discussed the methods of diagnosing such cases and mentioned that some of the patients could progress to situation of malignancy. Many drugs are available for controlling the platelet count. -APP