Ranjith Kumar Chikine
70 Years female resident of Jadcherla, Mahabubnagar district attended the emergency department of SVS Medical College with complaints of fever since 8 days, 5 episodes of vomiting and epigastric pain since 1 day. She was diagnosed diabetes mellitus type II, 8 years back. She has been using oral hypoglycaemics (Glycomet GP 1) since 3 years. Blood samples were received for routine blood investigations, fasting plasma glucose postprandial plasma glucose were analysed in Beckman coulter AU 480 by hexokinase method, values obtained as 224 mg/dl & 302 mg/dl respectively. For HbA1c, whole blood (K2 EDTA tube) processed in HPLC based Biorad D-10 analyser and found HbA1c value as 14.1% with a variant window value 24.9%. We analysed the same sample for HbA1c in boric acid affinity method and reported as 11.2% and advised for fructosamine. We processed the fresh sample in the Bio-Rad D10 for haemoglobin electrophoresis and found Hb A2 as 20.9%, Foetal Hb F = <0.8%, Hb A0 = 56.3%, P3 = 10.4%. Serum Iron studies as follows Iron = 15 μg/dl, TIBC = 202 μg/dl, UIBC = 182 μg/dl, Ferritin = 290 ng/ml. Complete blood picture (Sysmax XS- 800i) findings as follows Hb = 9gm/dl; MCV = 64.3 fl (N:80-100 fl); MCH = 21.6 pg (N:27 – 32 pg); RDW – SD = 35.6fL; RDW – CV= 15.4%, Neutrophils = 80%, Lymphocytes 15%, Eosinophils 2%,Monocytes = 3%, White blood cells 13,500; platelets 4.3 lacks/ cu.mm and peripheral smear findings as follows microcytic hypochromic anaemia with neutrophilic leucocytosis. Liver function tests as follows total bilirubin = 0.4 mg/dl, direct bilirubin = 0.1 mg/dl, alkaline phosphatase = 80 U/L, alanine transaminase = 20 U/L, total proteins = 6.7 gm/dl, albumin = 3.0 gm/dl, globulin = 3.7 gm/dl.
