Title: Raised Red Cell Distribution Width as a Prognostic Tool for Acute Aluminium Phosphide Poisoning (AALPP) Patients

Authors: Dr Akshay Surana, Dr Sachin Sharma

 DOI:  http://dx.doi.org/10.18535/jmscr/v4i10.28

Abstract

Objectives & Aims: Identify the acute aluminium phosphide poisoning. Identify the acute aluminium  phosphide poisoning  induced   changes in hematological parameters  .Raised red cell distribution used as a prognostic  tool for acute aluminium  phosphide poisoning . The changed hematological parameter used as a survival index of acute aluminium phosphide poisoning  patients.  

Material & Methods: Blood was collected in a sterile EDTA containing tube and processed following our established ISO certified hospital laboratory protocol. A complete blood counting including HB%,PCV, Red cell indices ,platelet count and total white cell count and differential was done by  Automated blood  cell counter with peripheral blood smear examination and  further confirmed by manual oil immersion smear study method. Peripheral smears study was done with field A and B stain and leishman stain.

Conclusion: Aluminium  phosphide poisoning  caused  changes in size of peripheral  red blood   cell due to lipid per oxidation  and oxidative stress of cell membrane. These oxidative stress and lipid per oxidations lead to damage the cell membrane of RBC. These damage directly related with severity of exposer of the Aluminium  phosphide. This type of damages decided the outcome survival of patients. So variable size of RBC occurs in peripheral  blood used as a prognostic tool for severity of toxicity, monitoring of patients  ,follow-up  and outcome survival  in the form of RDW .The RDW is a  hematological parameter is easily generated by all type of  hematological cell counters used as a good prognostic tool for acute aluminium phosphide poisoning 

Keyword: aluminium  phosphide poisoning, Red cell distribution width.      

References

1.      Briggs C, Bain BJ. Basic Haematological Techniques. Bain BJ, Bates I, Laffan M, Lewis SM. Dacie and Lewis Practical Haematology. 11th ed. Philadelphia, PA: Churchill Livingstone/Elsevier; 2012. chap 3.

2.      Vajpayee N, Graham SS, Bem S. Basic Examination of Blood and Bone Marrow. McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 22nd. Elsevier/ Saunders: Philadelphia, PA; 2011. 30.

3.      Sungurtekin H, Gurses E, Balci C. Evaluation of several clinical scoring tools in organophosphate poisoned patients. Clin Toxicol 2006; 44: 121-6.

4.      Vidyasagar J, MS, Rajnarayana K, Surender T, Krishna DR. Oxidative stress and antioxidant status in acute organophosphorous insecticide poisoning. Indian J Pharmacol 2004; 36: 76-9.

5.      Kaya A, Isik T, Kaya Y, Enginyurt O, Gunaydin ZY, Iscanli MD, et al. Relationship between red cell distribution width and stroke in patients with stable chronic heart failure: a propensity score matching analysis. Clin Appl Thromb Hemost 2013

6.      Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood cell distribution width in cardiovascular and thrombotic disorders. Clin Chem Lab Med 2011; 50: 635-41.

7.      Şenol K, Saylam B, Kocaay F, Tez M. Red cell distribution width as a predictor of mortality in acute pancreatitis. Am J Emerg Med 2013; 31: 687-9.

8.      Elsharkawy EE, Yahia D, El-Nisr NA. Sub-chronic exposure to chlorpyrifos induces hematological, metabolic disord-ers and oxidative stress in rat: attenuation by glutathione. Environ Toxicol Pharmacol 2013; 35: 218-27.

9.      Ranjbar A, Pasalar P, Abdollahi M. Induction of oxidative stress and acetylc-holinesterase inhibition in organopho-sphorus pesticide manufacturing worker. Hum Exp Toxicol 2002; 21: 179-82

10.  Trevisan R, Uliano-Silva M, Pandolfo P, Franco JL, Brocardo PS, Santos AR, et al. Antioxidant and acetylcholinesterase response to repeated malathion exposure in rat cerebral cortex and hippocampus. Basic Clin Pharmacol Toxicol 2008; 102: 365-9.

11.  Soltaninejad K, Abdollahi M. Current opinion on the science of organophos-phatepesticides and toxic stress: a systematic review. Med Sci Monit 2009; 15: RA75-90

12.  Bhatti GK, Bhatti JS, Kiran R, Sandhir R. Biochemical and morphological perturbati-ons in rat erythrocytes exposed to ethion: protective effect of vitamin E. Cell Mol Biol 2011; 57: 70-9.

13.  Ambali SF, Abubakar AT, Shittu M, Yaqub LS, Anafi SB, Abdullahi A. Chlorpyrifos-induced alteration of hematological parameters in Wistar rats: ameliorative effect of zinc. Res J Environ Toxicol 2010; 4: 55-66.

14.  Edem VF, Akinyoola SB, Olaniyi JA, Rahamon SK, Owoeye O, Arinola OG. Haematological parameters of wistar rats exposed to 2,2 dichlorovinyl dimethyl phosphate chemical. Asian J Exp Biol Sci 2012; 3: 838-41.

15.  Goel A, Dani V, Dhawan DK. Role of zinc in mitigating the toxic effects of chlorpyrifos on hematological alterations and electron microscopic observations in rat blood. Biometals 2006; 19: 483-92.

Corresponding Author

Dr Akshay Surana

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Curewell Hospital Pvt. Ltd 19\1-C New Palasia Indore MP