Search

Objectives: Translocation (8;21) is a RUNX1-RUNX1T1 fusion transcript, a favorable risk cytogenetic abnormality with a variable clinicopathological profile. However, there is a paucity of data on the outcomes of acute myeloid leukemia (AML) with t(8;21) from East India. This report is an analysis of data of AML with t(8;21) at our center. Material and Methods: De novo AML patients with the presence of t(8;21) cytogenetic abnormality from 2015 to 2019 were analyzed for clinical, pathological, and molecular characteristics and were compared with treatment outcomes. Relapse-free survival (RFS) and overall survival (OS) were determined using Kaplan–Meier curves. Results: Twenty-nine patients (10%) with de novo AML had t(8;21) with 18 male patients and a median age of 20 years. Aberrant expression of CD19, CD56, and CD7 expressions was noted in 44.8%, 17.24%, and 10.29% of patients, respectively. Additional cytogenetic abnormality was observed in 31.03%. CD19 had an 80% correlation with the occurrence of C-kit status. High-dose induction therapy had complete remission rates of 100%. The median duration of follow-up was 287.5 days. The presence of myeloid sarcoma (MS) and C-kit positivity had inferior OS and RFS (P < 0.05). The dose of cytosine arabinoside, given in consolidation of 3 g/m2 and 1.5 g/m2, had a median OS of 758 and 479 days (P = 0.661) and median RFS of 348 and 150 days (P = 0.002), respectively. In the group that received intensive therapy, by the end of 3 years, only 15.7% of patients remain in remission. Conclusion: AML with t(8;21) is seen in young patients with a positive correlation between CD 19 with C-kit positivity. The presence of MS and C-kit positivity endowed inferior OS and RFS. Cytosine arabinoside consolidation in a dose of 3 g/m2 offered an advantage in median RFS.

Introduction Acute leukemia (AL) is among the most common treatable cancers in childhood but many children are forced to abandon therapy. Objective We have explored reasons for treatment abandonment through this study. Materials and Methods Retrospective analysis from an ongoing registry data of childhood AL patients, where all newly diagnosed AL patients of ≤18 years of age (June 2014–November 2017) were included. Patients >18 years of age, having any history of treatment of AL outside our institute, and/or patients with relapsed AL were excluded. The primary outcome of the study was treatment abandonment rate. Results A total of 710 AL patients were included in the study, average distance traversed to reach the hospital being 161.66 km. Most children were aged 1 to 10 years (49.4%, n = 351), followed by >10 to 18 years (46.6%, n = 331), and ≤1 year age (3.9%, n = 28). The commonest symptoms were fever (67.4%), pallor (38.6%), bleeding (11.5%), bone pain (13.8%), neck swellings (14.9%), and, rarely, testicular swellings or Superior vena cava (SVC) syndrome (1.1%). A high abandonment rate was noted prior to leukemia subtyping (35.2%, n = 250) mostly among males 62% (n = 155) and the 1- to 10-year group 55.6% (n = 139). A total of 460 (64.8%) patients were subsequently subcategorized by immunophenotyping. Precursor B-cell (Pre-B) Acute Lymphoblastic Leukemia (ALL) in 307 (43.2%) patients was the commonest subtype, followed by early Pre-B ALL (Pro-B ALL) in 10 (1.4%), T-cell ALL (T-ALL) in 51 (7.1%), Acute Myeloid Leukemia (AML) in 45 (6.3%), Acute Promyelocytic Leukemia (APML) in 28 (3.9%), and Mixed Phenotypic Acute Leukemia (MPAL) in 19 (2.6%). Conclusion The most common group of patients was aged 1 to 10 years (median age: 5 years). An abandonment rate of 35.2% was seen prior to complete diagnostic workup. The reason for this high abandonment, despite good disease prognosis, is a relevant social and health issue, and needs further evaluation. The problems discussed in this study are relevant to lower-income families and areas where health care is not easily accessible. The government agencies, nongovernment organizations and society would need to work together to overcome these issues.

Evaluation of bone marrow infiltration in lymphoma is usually done by bone marrow biopsy (BMB). This study analyzed the utility ofTreatment-naïve lymphoma patients underwent bothThe study population consisted of 80 patients and comprised 37 Hodgkin's lymphoma (HL) patients, 30 aggressive non-HL (NHL) and 13 indolent NHL patients. The majority of the aggressive NHLs were diffuse large B-cell lymphoma (20/30) and major indolent lymphoma was follicular lymphoma (5/13). When compared to BMB, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of focal (±diffuse) marrow FDG uptake on

Objectives: The field study was undertaken at the adjoining villages of Rasikbil of Cooch Behar district, West Bengal, India to record the ethnomedicinal plants used by the Rava, Santal and Oraon people and to explore their traditional knowledge to treat common ailments. Methods: With the help of pretested semi-structured questionnaire, tribal men and women were interviewed on ethnomedicinal uses of local flora during July 2018 to January 2020. The questionnaire covered aspects like local name, scientific name, family, used parts, ethnomedicinal uses, among others. Routine methods of plant collection and herbarium techniques were followed and the collected species were identified using relevant sources. Findings: A total of 57 plant species of 34 families were found to be used to treat several diseases like cough and cold, diabetes, among others. In few cases, the plant parts were used in combination with other plant parts to prepare traditional medicine. The plant family Fabaceae represents the highest number (6 species) of ethnomedicinal plants among others. Among different plant parts used for the preparation of medicine, leaves were most frequently used (49.12%) for the treatment of diseases. Besides, fruits, seeds, roots, etc. were also found to be used as traditional medicine for the treatment of ailments among human beings. Applications: The traditional knowledge of ethnic people regarding the utilisation of ethnomedicinal plants may be used in the preparation of pharmaceutical products which could contribute towards availability of essential drugs at much reduced cost. In addition, populations of medicinal plants must be monitored in order to conserve them and aid in planning sustainable utilisation. Novelty: In comparison to earlier reports, present study revealed 14 more plant species having immense ethnomedicinal values and frequently used by the tribal people in the area. In this regard, the study is significant to enrich the existing database. Keywords: Ethnomedicine; Medicinal plants; Rava; Santal; Oraon; Rasikbil; Cooch Behar

Objectives: Telomere length and telomerase activity have been implicated in the control of cell proliferation and genomic stability. We recently introduced a novel technique for measurement of the average telomere length in cells using fluorescence in situ hybridization (FISH) with peptide nucleic acid (PNA) probes and flow cytometry (flow-FISH). Results: Using this technique, we have analyzed the telomere length kinetics in subpopulations of unseparated peripheral blood leukocytes (PBLs) in a large population of healthy donors as well as patients with cytopenia. We only found significantly shortened telomeres from patient with cytopenia compared to age-adjusted controls. Strikingly, the telomere length in granulocytes from cytopenia patients differed significantly from controls. Furthermore, an inverse correlation between of granulocyte telomere length and age was found among healthy controls. However, surprisingly, telomere length in cytopenia patients with hypocellular marrow was significantly shorter from patients with non-hypocellular marrow. These results support the concept of accelerated granulocyte telomere shortening in cytopenia patients in India and suggest a potential use of telomere-length measurements as a prognostic tool in this group of disorders as well.

Introduction:Sickle cell disorders were originally found in the African regions, Arabian Peninsula and parts of India. However, in today's age of globalization patients with homozygous or compound heterozygous Sickle cell disorders can be found all over the world. The objective of our study was to assess the distribution and clinical presentation of patients with Sickle homozygous or heterozygous diseases in the Eastern part of India. Methods:Patients who attended the Thalassemia Clinic in our tertiary care center, between 1st January 2018 to 31st May 2020 (2 years and 4 months) were retrospectively analysed and the ones with a component of Sickle haemoglobin(HbS), either in the form of Sickle cell anemia/homozygous Sickle cell disorders(SCA) or compound heterozygous diseases, like Sickle cell/β thalassemia(HbS/β), Sickle cell/Delta thalassemia(HbS/D), Sickle cell Haemoglobin/E thalassemia(HbS/E), were included in the study. People having Sickle cell trait (HbS trait), have also been included. Thorough history of painful crises, blood transfusions, family history and treatment history was elicited and every patient was clinically examined. The patients were diagnosed by High Pressure Liquid Chromatography (HPLC) or Thalassemia Mutation analysis by Polymerase Chain reaction (PCR). Results:A total of 95 patients with a component of HbS were considered as our study cohort, with HbS/β thalassemia patients being the majority (53.7%), followed by SCA (30.5%). Age of the study cohort ranged between 2-50 years age. HbS/β thalassemia patients presented at a later age (median 17.5 years) than SCA patients (median 12 years). Their demographic distribution is depicted in Table 1. The most common clinical presentation was painful crisis (32,33.7%), be it abdominal pain (11,11.6%) or bone pain (13,13.7%). Other presenting complaints were pallor (26,27.4%), jaundice (12,12.6%) and fever (4,4.2%). Some rarer presenting manifestations were fatigue (4,4.2%), splenic infarction (1,1%), convulsions (1,1%), Raynaud's phenomenon (1,1%), headache (1,1%) or itchy skin lesions (1,1%). Few patients (4,4.2%) had recurrent pregnancy loss, and one patient was diagnosed incidentally during an antenatal check-up. Most patients had more than one complaint. Very occasionally patients required hospital admission, the reasons being, chest pain, fever, convulsions or abdominal pain. HbS trait was diagnosed incidentally during evaluation for other illnesses, most commonly during evaluation of pallor (3,60%): one patient was later diagnosed with iron deficiency anemia. Most patients who attended our center were from within the state or neighbouring states. The patients were treated with Hydroxyurea, with/without blood transfusions, chelation therapy with Deferasirox as required and Folic acid supplementation. People with HbS Trait continued to receive Folate supplementation. Discussion and Conclusions:This study highlights the varied distribution of HbS among the population attending a tertiary care center, irrespective of a specific area-based population. Till date most studies conducted in India have highlighted the prevalence of Sickle cell disorders among specific focused populations. HbS/β thalassemia was the most common sickle cell disorder in our study. This is in contrast to most findings in published literature from other countries, where SCA is the commonest. Only one other study conducted in eastern India, has depicted a finding similar to ours. The median age of disease presentation was at a later age in our study, in contrast to findings in published literature from other countries. There is a variation in the severity of disease manifestation in our study cohort. The most common painful crisis was bone pain, followed by abdominal pain. Pallor was also one of the commonest presenting symptoms. Stroke, a common manifestation of SCA in other countries, was rare in our study cohort. Disclosures No relevant conflicts of interest to declare.

Background: Rarity of rare bleeding disorders (RBDs) is attributed to very low incidence based on ethnicity, distribution and complexity of diagnostic tools. There is scarcity of data on RBDs from Eastern India. This study aims to understand the distribution of RBDs in this region for better patient care.Methods: Retrospective study conducted on patients presented with symptoms/signs of bleeding from January 2018 to December 2019 (two years). Patients having bleeding manifestations from causes other than inherited coagulation disorders, IPDs, and vWD were included. Complete haemogram, peripheral blood smear, coagulation tests, vWD assay and platelet function tests were carried out.Results: Out of 2415 patients, 1570 were included after exclusion of other diseases. Immune Thrombocytopenia (ITP) and Hemophilia being excluded, 40/1570 (2.5%) patients were found to have RBDs. Median age was 11.6 years (range, 1.25-40 years). Most common was IPDs (2.9%, n=19); Glanzmann thrombasthenia was commonest (1.5%, n=10). vWD was second (1.7%, n=11) in occurrence; vWD type-III was the commonest subtype (0.9%, n=6). ICDs comprised 1.5% (n=10) of all patients; congenital afibrinogenemia (0.6%, n=4) was most common. Other ICDs prevalent in this cohort included FVII, FV, FX and FXIII deficiencies. Most common presentations were ecchymoses or prolonged bleeding from cut injuries or menorrhagia.Conclusions: RBDs may present in varied ways and are often difficult to diagnose correctly. Distribution of RBDs in this patient cohort differs from published literature from Western studies.

Clinical and hematological parameters in six cases of paroxysmal nocturnal hemoglobinuria (PNH) are presented. The mean delay in diagnosis after onset of symptoms was 3.7 years. Initial diagnoses considered were: (a) hematuria; (b) iron-deficiency; hemolytic; megaloblastic or refractory anemia and (c) myelodysplastic syndrome. Clinical features included; reddish urine (5/6), unexplained abdominal pain (4/6) and pallor (6/6). Laboratory investigations showed anemia (6/6), leucopenia (3/6), thrombocytopenia (3/6), unconjugated hyperbilirubinemia at some stage (6/6), and bone marrow erythroid hyperplasia (6/6). Complications encountered were (a) gall stones needing cholecystectomy, hemosiderosis and proximal tubular acidosis in 1 case, (b) disseminated tuberculosis in 1 case and (c) abortion with congestive cardiac failure in one. PNH may present with atypical features and tests for hemosiderinuria, sucrose lysis test and HAM's test are required to establish the diagnosis.

There is paucity of information from eastern India with regard to observed dominant micro-organisms causing febrile neutropenia (FN) in patients with haematological malignancies. To identify the prevalence of pathogenic microorganisms associated with FN. A total number of 268 episodes of FN were analysed from September’2010 to October’2013. The blood samples were inoculated into brain heart infusion broth, glucose broth, Hicombi dual performance media (Himedia, LQ-12) at 37° C for 168 h and Bactec method was also performed for these samples. Blood agar, chocolate agar, MacConkey’s agar and cystine lactose electrolyte deficient agar were used for isolation of the microorganisms. A total number of 78 (29.10 %) episodes revealed positive growths. Gram negative bacilli and Gram positive cocci were isolated in 61.53 and 34.61 % cases respectively. The eight commonest isolates were Pseudomonas aeruginosa (14.10 %), methicillin resistant Staphylococcus aureus (MRSA-12.82 %), Acinetobacter sps (11.53 %), coagulase negative Staphylococcus (10.25 %), Klebsiella pneumoniae (8.97 %), Escherichia coli (8.97 %), ESBL E. coli (6.41 %), methicillin sensitive S. aureus (MSSA-6.41 %). Amongst other less common isolates were Citrobacter kosseri (3.84 %), Citrobacter freundii (2.56 %), Ralstonia paucula (2.56 %), Cedecia neteri (1.28 %), methicillin resistant coagulase negative Staphylococcus (2.56 %). Candida spp. including two cases of Candida non-albicans was isolated in 3.84 % of cases. P. aeruginosa was the commonest pathogenic isolates in FN patients associated with haematological malignancies in this study. Gram negative bacteria were the commonest isolates in FN including significant numbers of rare opportunistic micro-organisms.

India is in the thalassemia belt of the world. Both α- and β-thalassemia (α- and β-thal) are found in West Bengal, a state in the eastern part of India. There was no systematic large published study to investigate the prevalence rates of different hemoglobinopathies in West Bengal. This study was conducted in school and college students, newly married couples and pregnant women after proper counseling in the rural areas of five districts of West Bengal state in eastern India. Thalassemia testing was done using high performance liquid chromatography (HPLC). A total of 35,413 individuals were screened for hemoglobinopathies. β-Thalassemia trait was found in 10.38%, Hb E [β26(B8)Glu→Lys] trait in 4.30%, sickle cell trait in 1.12%, borderline Hb A(2) value 0.73%, low Hb A(2) 0.68% and Hb D trait 0.37%. This is the first study that addresses the prevalence of different hemoglobinopathies in rural areas of West Bengal. The prevalence of β-thal trait is higher in West Bengal than other parts of India. This data is likely to be helpful in planning screening programs in rural areas of West Bengal, India.

Introduction: β Haemoglobinopathy, is one of the commonest inherited disorders, with a higher prevalence in the eastern part of India. In view of the lack of facilities for allogeneic stem cell transplantation, including financial constraints, this disease is considered to be incurable in this part of India. So, preventing the birth of a symptomatic Thalassemic child is the best way to prevent the disease, considering the immense medical, social & financial implications in the community. Therefore, prenatal diagnosis is the most important tool for detecting & preventing symptomatic haemoglobinopathies. Objectives: To detect the status of haemoglobinopathies in the foetus of carrier or affected parents, so as to prevent the birth of symptomatic patients with Thalassemia & other haemoglobinopathies. Material & Methods: This is a retrospective analysis of an ongoing registry data of routine prenatal diagnosis of haemoglobinopathy, conducted at NRS Medical College, Kolkata, over a period of approximately 4 ½ years (September,2013-April,2018). The process involves, collection of Ultrasound guided chorionic villous samples (CVS) by an Obstetrician between 12-16 weeks of gestation (maximum up to 19 weeks). Considering the prevalence of specific mutations in this part of India, a total of 25 β mutations are analysed by ARMS-PCR, using specific probes. Some of the common mutations tested are: IVS1-5(G→C), 619bp del, IVS 1-1(G→T), CD 30(G→C), CD 26(G→A) & CD6 (A→T). Results: Total number of CVS were 407(407 mothers were tested), of which 329 samples (80.8%) showed presence of β haemoglobinopathy mutations, & 78(19.2%) did not have any mutations. Among the mutated genotype, heterozygous carrier state was detected in 232(57%), & homozygous/ compound heterozygous state(affected) was detected in 92 foetuses (22.6%). Among the carriers, β Thalassaemia trait was most common(n=185,45.45%), followed by HbE Trait(n=41,10.07%). HbS trait(n=3), HbD trait(n=1) & δβ Thalassemia trait (n=2) were rarely detected. Among the affected foetuses, 44 had compound heterozygous genotype (10.8%), majority being HbEβ thalassemia (n=42,10.3%), followed by δβ-β Thalassemia(n=1) & HbSβ Thalassemia(n=1). The remaining 48 affected cases were homozygous β Thalassemia Major (11.7%). Of the 92 affected pregnancies, 91(22.35%) had been counselled for medical termination of pregnancy (MTP). One case of δβ-β Thalassemia, a milder phenotype, was excluded from MTP counselling. Total number of β mutations detected (both homozygous & heterozygous states) were n=373, and the commonest was IVS1-5(G→C) (n=244,65.4%), followed by CD 26(G→A) (n=85,22.78%), CD 30(G→C) (n=9,2.4%), CD 41/42(-CTTT) (n=8,2.1%), CD 15(G→A) (n=8,2.1%) & CD8/9 (+G) (n=4,1.1%). Rarer β mutations detected were CD15(-T) (n=4,1.1%), CD16(-C) (n=1), CD6 (A→T) (n=4,1.1%), βD-PunjabCD121 (G→C) (n=3) & Asian Indian inversion deletion Gγ (Aγδβ)0(n=2). We know that sometimes maternal cell contamination may occur during villous sampling. So, at the time of childbirth, cord blood was collected & β mutation studies were re-performed. If this could not be done, an HPLC was conducted when the child was >1year old. We have data of 26 children & each time the results have corroborated with the primary CVS sampling data. Among both male and female parents(n=814), the commonest genotype was β Thalassemia Trait (n=621, 76.3%). Among the female parents(n=407), some of the other genotypes were HbE Trait (n=94,23.09%) & HbS trait(n=4,0.98%). Among the male parents(n=407), HbE Trait(n=70,17.19%) was the 2nd most common abnormality, few of the other genotypes being: HbS Trait (5,1.2%), β Thalassemia major (n=3,0.73%) & HbE homozygous disease (n=3, 0.73%). Conclusions: From this cohort, total affected (homozygous/compound heterozygous) foetuses are 92(22.6%). β Thalassemia Major (11.7%) is the most common affliction, followed by HbEβ thalassemia (10.3%) & δβ - β Thalassemia. An attempt at prevention of birth of at least 91(22.35%) future thalassemia patients has been done by means of MTP. Ours is an ongoing registry data and we are following up the children by conducting cord blood mutation studies or HPLC (>1year old child), to study the precision and accuracy of our CVS sampling results. So far there has been 100% concordance. One of the limitations of our study is lesser number of reconfirmation of the born children, in view of social and financial constraints. Disclosures No relevant conflicts of interest to declare.

The assay of serum free light chains (FLCs) is established in the diagnosis and prognosis of several plasma cell dyscrasias, but its significance in plasma cell leukemia (PCL) has not been reported so far. PCL is a rare and aggressive disease with a poor prognosis. The authors describe two cases of PCL with divergent clinical profiles where the serum FLC assay was available. Although both patients had greatly elevated serum beta(2)-microglobulin, one patient had much higher levels of serum FLCs and evidence of renal impairment, which were absent in the other; however, the latter, who had multisystem involvement, showed a more rapidly downhill course with early mortality.

[Figure][1] A 6-year-old female presented with complaints of thirst, polyuria, weight loss, and fainting spells lasting more than 1 month. Neck swelling and fever had occurred for a week. On examination, the child was underweight and afebrile, with mild pallor and no icterus. An ulcerating

Pure red cell aplasia (PRCA) is a bone marrow failure disorder. Several drugs have been reported as having induced PRCA, but lenalidomide-induced PRCA is rarely reported. Here we present a patient with myelodysplastic syndrome (MDS) who developed PRCA after treatment with lenalidomide.A 47-year-old male presented with a history of weakness with effort intolerance for 5 months. Examination showed pallor and mild splenomegaly. Blood count showed Hb level of 86 g/L, total WBC count of 5.2x10

Various studies have reported the effect of severe malnutrition on electrolyte levels and electrocardiographic parameters. However, only a few have reported these findings in mild and moderate grades of malnutrition in children. Therefore, the objective of this study was to assess the effect of malnutrition (mainly mild and moderate grades) on corrected QT interval (QTc) and QT dispersion (QTcd) and electrolyte changes. A total of 20 malnourished children in the age group of 2-11 yrs were enrolled in the study group and 20 age and sex matched healthy children were taken as controls. Anthropometry, serum levels of albuminelectrolytes were determined. QTc and QTcd (difference between maximumminimum corrected QT interval) were measured with the help of RMS Polyrite D. Our results have shown that body weight, height, body mass index (BMI), serum levels of albumin, potassiumcalcium were lower (P0.01) in malnourished children. QTc (P0.01)QTcd (P0.01) were significantly greater in malnourished children than controls. We concluded that increase in QTc and QTcd intervals is associated with electrolyte disturbances in malnourished children. Electrolyte disturbance correction and appropriate nutrition therapy followed by further cardiac evaluation must be taken into account in the management of these patients.

Bone marrow may be the initial or rarely the only site of involvement in Hodgkin's lymphoma. A high index of suspicion is required to pick up the histopathological changes of Hodgkin's lesions in the bone marrow like necrosis, presence of Reed-Sternberg cell or its variant in a polymorphic background infiltrate, focal fibrosis and myxoid change especially in the absence of classical clinical picture. Bone marrow with immunohistochemistry has a valuable role in the staging and in the diagnosis of primary medullary Hodgkin's lymphoma. B-symptoms may easily masquerade as an infectious process as in all our cases the patients had fever as a presenting feature, in four of them tuberculosis was suspected clinically and two had received antitubercular therapy elsewhere. We report six human immunodeficiency virus-negative patients diagnosed over a period of 5 years in which the initial diagnosis of Hodgkin's lymphoma was suggested from bone marrow histology.

Crystal storing histiocytosis (CSH) is a very rare association with plasma cell dyscrasias. It is presumed to be an intra-lysosomal accumulation of the secreted paraprotein aggregated into crystals and is associated with presence of variable numbers of histiocyte-like cells with phagocytosed crystalline inclusions in the bone marrow and other extramedullary sites Herein we report a case of multiple myeloma associated with CSH with a rapidly downhill clinical course. There was diagnostic confusion at the outset with a histiocytic disorder which was clarified with the use of Immunohistiochemistry along with serum protein electrophoresis and immunofixation.

Abstract 5303 The state of West Bengal in the eastern part of India has a high prevalence of the carrier states of beta thalassemia and Hb E. Analysis of Hb HPLC screening data from 200 individuals, including adults and children from urban areas around Kolkata in West Bengal, carried out in our institution1, reveals a prevalence 6.5% for beta trait and 5.5% for HbE trait. (unpublished data) It may be possible to reduce births of beta thalassemia major and E beta thalassemia by preventive strategies, including mass screening and awareness campaigns. The best preventive method is debatable, because of the highly variable prevalence of the haemoglobin disorders within defined geographic regions (Weatherall DJ, Blood.2010), the economic factors involved and most importantly the question of acceptance of prevention methods. Because of the social stigma attached to the diagnosis of a genetic disease, families of young men and women diagnosed as thalassemia carriers in community screening programs often suppress this information when marriages are arranged, according to prevalent social practice. Therefore pre-marital screening, in our experience, is unlikely to be effective in reducing the number of beta thalassemia major and E-Beta thalassemia births in eastern India. Antenatal screening on the other hand has the potential for greater acceptability. Concern for the welfare of the unborn child are likely to make prospective parents more amenable to counselling and getting themselves tested for the thalassemia carrier state. We analysed data of 1000 antenatal mothers (Table 1), who had undergone screening for the thalassemia carrier state by red cell indices and Hb HPLC, as part of a government funded screening programme conducted in our institution1 in Kolkata city of West Bengal, India, in order to determine whether red cell indices, which is more economical than Hb HPLC, was an effective screening tool. Results of Hb HPLC screening data of 1000 antenatal women (Table 1) Result Beta Trait (HbA2% 3.6-6.6) Hb E trait (A2+E% 22.8-42.8) E Beta E Disease Sickle trait Sickle Beta D Trait D disease No of cases (%) 58(5.8%) 48(4.8%) 3(0.2%) 2(0.2%) 2(0.2%) 1(0.1%) 1 1 Where both partners were carriers, mutations were confirmed by complementary reverse dot blot hybridisation or DNA sequencing. Red Cell Indices in Thalassemia Carrier States (Table 2) Thalassemia Carrier State (1000 Antenatal Women) MCV (fl) MCH (pg) Mean Range (±95%CI) (±2SD) Mean Range (±95%CI) (±2SD) Beta Trait (n= 58) 68.6±1.70 55.4–81.8 21.80±0.64 16.6–26.8 E Trait(n=48) 78.8±1.42 67.8–89.8 26.4±0.62 22.0–30.8 Most antenatal women received iron and folic acid supplements, therefore iron status was not separately examined. To exclude the possibility of the effect of pregnancy on red cell indices, evaluation of MCV and MCH in 50 HbE trait individuals and 250 beta trait drawn from community screening data, comprising non-pregnant females and males, with normal serum ferritin values, mean MCV was 76.6fl (range 66.3–86.8fl), mean MCH 25.6pg (range 21.5–29.7pg) for E trait. For beta trait mean MCV was 67.0 fl (range 50–84 fl), mean MCH 21 pg (range 15–26 pg). There was no statistically significant difference from antenatal cases (Student's t-test ). MCV of Red Cell Indices as Predictor of Beta Trait and HbE Trait (Table 3) Sensitivity (%) Specificity (%) Positive Predictive Value (%) Negative Predictive Value (%) No of Beta Trait Missed on Screening (%) n=58 No of E Trait Missed on Screening (%) n=48 MCV Conclusion –MCH and MCV tend to be higher in E trait compared to beta trait. We recommend that in high prevalence areas, Hb HPLC should be performed in all antenatal women irrespective of red cell indices, to avoid missing thalassemia carriers and facilities for genetic diagnosis and counselling be made available to couples at risk of beta thalessemia major and E beta thalessemia births. Disclosures: No relevant conflicts of interest to declare.