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Introduction: Tuberculosis (TB) is a major public health problem in India and it remains an epidemic, affecting one third of the population. It manifests with diversified haematological manifestations of varying severity like anaemia, leukocytosis, thrombocytosis and raised erythrocyte sedimentation rate levels. Therefore, monitoring clinical and haematological alterations in sputum positive Pulmonary Tuberculosis (PTB) patients necessitates the need for deliberation of supportive care and varied treatment options that would amplify the treatment outcome. This study was carried out to explore the early changes and the relationship between the social risk factors like smoking, alcohol intake and the haematological profile of TB patients which will help in early identification of altered haematological parameters and in minimising the risk of transmission among susceptible population. Aim: To do analysis of various haematological manifestations in sputum positive PTB patients and to evaluate diagnostic and prognostic significance. Materials and Methods: A prospective study was conducted over a period of six months between November 2019 to April 2020 on 50 PTB patients referred by Department of Respiratory Medicine, Navodaya Medical College, Raichur. Patients who were on Anti-Tubercular Treatment (ATT), extra-PTB patients, pregnant women and those with any other major co-morbid condition were excluded from the study. All patients were thoroughly examined clinically and investigated with plain chest x-ray, complete blood count; ESR, PS examination and sputum for acid-fast bacilli stained with Ziehl-Neelsen (Z-N) stain and AFB grading charts were used according to Revised National Tuberculosis Control Programme (RNTCP). Data collected was analysed by SPSS software version 16.0 and Chi-square test was used to calculate the sample size. Results: Of total 50 cases of PTB, there were 30 males and 20 females and mean age of patient was 44 years. Commonest haematological parameters raised were ESR (48 cases; 96%) followed by anaemia (45 cases; 90%), neutrophilia (36 cases; 72%), leukocytosis (24 cases; 48%) and thrombocytosis (12 cases; 24%). The frequent peripheral smear picture was Microcytic Hypochromic Anaemia (MHA) (27 cases; 54%) followed by normocytic normochromic anaemia (21 cases; 42%) and least common was macrocytic anaemia (2 cases; 4%).There was significant improvement in all haematological parameters after three months of treatment, with sputum conversion of PTB cases (75%). Conclusion: TB can lead to heterogenous and diversified haematological abnormalities like anaemia, leukocytosis, neutrophilia, thrombocytosis and raised ESR. These haematological parameters can be a guide to assess the improvement of TB patients after ATT which indirectly speaks about the improvement in immune response.

Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is Non Specific Interstitial Pneumonia (NSIP). Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath from past five years which was gradually progressive, cough initially dry later with minimal expectoration, low grade fever from past two months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in six cycles every four weeks.

Pulmonary involvement is common in patients with systemic sclerosis. The most common underlying histology is Non Specific Interstitial Pneumonia (NSIP). Disrupted immunity from the disease or associated medication may render such patients prone to develop tuberculosis infection. A 55-year-old female patient presented with chief complaints of shortness of breath from past five years which was gradually progressive, cough initially dry later with minimal expectoration, low grade fever from past two months. She also gave history of bluish discolouration of fingers tips on exposure to cold water. On examination there was restrictive mouth opening, thickened skin over hands, forearm, face, neck and trunk on pinching. Sclerodactyly was present with clubbing grade 2. On auscultation bilateral fine crepts were present. Serum ANA was highly raised and Scl 70 was positive. PFT was suggestive of restrictive ventilatory abnormality. Sputum smear for AFB was found to be positive. HRCT thorax was suggestive of NSIP. Patient was put on antituberculer treatment under DOTS category 1; nifedipine, pentoxyphylline and nitroglycerine gel was started for raynauds phenomenon. Chemotherapy for systemic sclerosis was given with cyclophosphamide infusion in six cycles every four weeks. [ABSTRACT FROM AUTHOR]