On behalf of the General Medicine department I am very proud to write the editorial for this edition of Chettinad Health City Medical Journal, on the occasion of our fourth annual conference Chetmedicon-2017. The theme of the conference is “Recent Advances in Hematology And their Management (RAHAM)”. The issue has five review articles on the practical aspects of hematology apart from the latest developments in this field. In addition the abstracts of papers and posters presented in conference have been included in the issue.

: Studies show that serum uric acid (SUA) plays a role in cardiovascular morbidity in general population as well in hypertensives, type2DM and cardiac or vascular diseases. Independent role of SUA as a risk factor is debate for decades. Pathophysiological mechanisms are cardiovascular damage at cellular and tissue level by proliferation of vascular smooth cells, stimulation of inflammatory pathway and possibly by platelet activation. SUA proved to be a better marker also for endothelial dysfunction.

An adrenal mass can be found as a part of an evaluation for a specific complaint related to adrenal pathology or an incidental finding on imaging (incidentaloma). Most masses are either adenomas, malignantmetastasis, carcinoma or pheochromocytomas and hence warrant evaluation. Our patient, a 29 year old male with nocomorbidities , presented with mild right hypochondrial pain for almost a year and acute gastroenteritis for 2 days.USG revealed a right suprarenal mass 12.7x 9 x12.2 cm.CECT Abdomen showed central necrosis and non visualization of the adrenal gland; features suggesting adrenal tumor ganglioneuroma/cortical carcinoma.Hormonal workup and 24 hour metanephrine test was normal.USG guided biopsy revealed ganglioneuroma. Patient was planned for adrenalectomy. Adrenal ganglioneuromas are rare, hormonally silent tumors which can resemble malignancies.Careful evaluation by endocrine tests ,imaging and histological examination is essential for a definitive diagnosis.

Autoimmune hemolytic anemia (AIHA) is caused by autoantibodies that react with Red Blood Cells. It is an uncommon entity. Even being a well-recognized entity for so many years, there are lot of difficulties regarding its diagnosis and therapies used for treatment. There are different types of autoimmune hemolytic anemia like warm antibody hemolytic anemia, cold agglutinin disease/paroxysmal cold hemoglobinuria and mixed type. The warm antibodies react at temperatures ≥37°C and cold agglutinin disease/ paroxysmal cold hemoglobinuria react at <37°C. Usually the hemolysis is extravascular. The positive direct antiglobulin (direct Coombs) test establishes the diagnosis and may suggest the cause. Treatment is usually cause dependent and includes corticosteroids, splenectomy, IV immune globulin, immunosuppressants and withdrawal of drugs.

Plasma cell disorders are monoclonal neoplasm due to underlyng clonal plasma cell or B cell. This is a group of disorders that comprise of multiple myeloma, Waldenstrom’s macroglobulinemia, amyloidosis and heavy chain disease together called monoclonal gammapathy. Immunoglobulins or its fragments secreted by these neoplastic plasma cells cause clinical manifestations. Protein electrophoresis identifies the presence of these monoclonal proteins whereas immunofixation identifies the fragments like heavy or light chain and clonality, flow cytometry identifies the cell type. Treatment modalities with drugs and stem cells are focused to prolong survival by reducing tumour load and its effects.

Pancytopenia is a one of the challenging disorder to the treating physician due to its diverse etiologies. It may be due to bone marrow failure syndromes, malignancies, infections or side effect of drugs, and it is also noted in hypersplenism. These patients may present without any symptoms and diagnosed during routine blood investigations or may present with symptoms of thrombocytopenia, anemia and leucopenia. The workup for pancytopenia is often quite extensive and includes a detailed clinical history, meticulous physical examination, and appropriate laboratory investigations in relation to the clinical scenario. Bone marrow examination helps to find out the underlying condition causing pancytopenia. Treatment of the pancytopenia includes supportive care for infections, bleeding and symptomatic anemia until the patient receives definite and/or curative treatment which depends upon the etiology.

Iron deficiency anemia (IDA) is the leading cause of anemia worldwide, which causes significant morbidity. In this evidence based review, the etiology of IDA, guidelines on screening, most useful diagnostic tests, and the role of various modalities of treatment have been elaborated. Timely diagnosis and appropriate management of IDA are crucial especially in developing countries.

Hemoglobin is made of Heme and globin and disorders of hemoglobin can be due to abnormality in either one of them. More than 1000 genetic mutations have been identified to cause hemoglobin disorders. Mutations can affect heme molecule and cause disorders like Methemoglobinemia. Mutations affecting globin chains are called Hemoglobinopathies and can be quantitative (thalassemia) or qualitative (sickle cell Anemia) .Hemoglobin disorders are mostly inherited and only a few are acquired. In this article we discuss about the structure of heme and globin molecules, abnormalities that can occur in them and review about Acquired Heme and Globin disorders. Acquired heme disorders are Methemoglobinemia and Sulfhemoglobinemia and an example for acquired globin disorder is alpha thalassemia.