Ayub Medical College, Abbottabad has a tradition of holding Seminars of National interest under the kind supervision of the Principal, Ayub Medical College Prof. M.A. Khaliq and the sincere efforts of its Staff & Students. The aim is to update knowledge and to get information regarding latest advancements in the field of medicine and to help in promotion and encouragement of research.

One such Seminar was arranged in Ayub Medical College, Abbottabad at the “ International Thalassaemia Day” on 8th May 1997, in the main Seminar hall of AMC. Pakistan Thalassaemia Welfare Society [PATHWEL] and Abbottonians Medical Association [AMA] jointly organized this.

The Seminar started at 10.15 am with the recitation of the Holy Quran by Mr.Mudassar. Miss Saadia Ishaq of 4th Year MBBS recited a poem regarding Thalassaemic patients written by Dr. Bashir Choudhry , Secretary General PATHWEL, which really moved the audience.

The compere of the function, Dr. Ghufran Saeed invited Prof. M.A. Khaliq, Principal AMC who is also a renowned Hematologist, for his welcome address. He gave a brief Introduction to Thalassaemia and said that this disease, which is actually a syndrome, is very prevalent in our country. In one study done at Ayub Medical College on selected hospital cases, showed that 10-15 % population is somehow affected with this disease. However the mortality and morbidity associated with Thalassaemia Major patients is enormous. Over the years, blood transfusion becomes ineffective as a result of anti-bodies formation against the transfused RBCs. Moreover, cost of treatment is over Rs.100 / day on average & about 20% of the earnings of the parents goes in the treatment of this disease

He thanked the honorable Chief Guest Lt. Gen.( R ) Fahim Ahmed Khan for taking the trouble of coming to Abbottabad to attend this function in spite of  very inclement weather.
 
Dr. Bashir Choudhry, Secretary General of PATHWEL was then requested to present gifts to 24 Thalassaemic patients who were invited by AMA specially for this occasion from Abbottabad, Haripur, Mansehra and Kohistan. Each gift comprised of a stuffed toy along with stationery items, plasticine, one pack of juice, biscuits, sweets and chocolate etc.

Lt. Gen.( R ) Fahim Ahmed Khan in his address thanked Prof. M.A. Khaliq, Principal AMC, Dr. Abdul Aziz Awan, Chairman AMA & Dr. Noaman Siddiqui, Chief Organizer AMA for making excellent arrangements for the function. He said that basic idea for celebrating the “International Thalassaemia Day” is to highlight the existence of this dreadful disease and to inculcate the feeling in the Thalassaemia patients that their miseries are being recognized and efforts are being made to make their lives as comfortable as possible.

He said that PATHWEL is an active member of Thalassaemia International Federation [ T.I.F. ]. It has a branch at Lahore, and there are Thalassaemia centers in some of the big cities of Pakistan. He opined that the work of Abbottonians Medical  Association is of very high nature and in a short span of time AMA has done a lot for the Thalassaemic patients in Hazara. He said that unfortunately, although 6 % of our children are suffering from this fatal disease, and 7500 new births are added every year, still its existence has not yet been recognized. There are over 2 lacs of estimated Thalassaemic patients in Pakistan who, unfortunately  are being haphazardly treated with irregular blood transfusions, iron therapy, and without any iron chelation. It is estimated that about 10% of  Thalassaemia population of the World now resides in Pakistan while most of the countries have almost eradicated this disease from their respective countries. Procurement of blood is a major problem and well organized campaign both on press and electronic media is needed  to educate the masses for voluntary blood donation as these patients can only survive on borrowed blood.

He said that PATHWEL was formed in 1990 by some very senior physicians and is the only establishment in Pakistan which is working in accordance with the protocol approved by Thalassaemia International Federation. It is patronized by Ministry of Health and the Infaq foundation etc. Thalassaemia Centre at Rawalpindi is taking care of over 400 Thalassaemic patients by providing free, fully screened blood, administering  Desferrol on subsidized rates and by providing Iron Pumps at nominal charges. It is also trying hard to eradicate this disease by providing Genetic Counseling, Prenatal Diagnosis, conducting clinical trials of L 1, the oral Iron Chelating drug. He also recommended that funds should be provided for the immunization of all the thalassaemic patients against Hepatitis B & possibly C by including these vaccines in the normal EPI Programme.

The following papers were presented by various eminent speakers who highlighted various aspects of Thalassaemia.

Dr. Iftikhar Qayyum, a Senior Lecturer and in charge of Research Centre in Pathology Department of Ayub Medical College, presented a lecture on Molecular Genetics of Thalassaemia. He said that there is a lot of advancements being  made in the molecular genetics and now it is possible to identify cases more specifically as most of the tests are nearly 100 % accurate. He quoted the example of Cyprus, where incidence of Thalassaemia has dropped by 96 % through carrier screening, genetic counseling and prenatal diagnosis.

Dr. Modood ul Manan, who is the Assistant Prof., Department of Hematology, AMC,  discussed the “Pathophysiology of Thalassaemia”. He pointed out various types of Hemoglobin and their levels at different ages, various types of Thalassaemia, their  mode of transmission and the overall effects of Beta Thalassaemia Major on different organs of the body.

“ Clinical Aspects and Treatment of Thalassaemia ” was discussed by Dr. Mumtaz Khan Burki, who is the Assistant Prof. of Pediatrics, AMC. He told  the audience one incident where he, while taking history, asked one of the mothers of a Thalassaemic patient what was the problem with her child? The mother’s words were, “ Initially the baby used to be fed on milk, now he is fed on blood ”. Dr. Burki said that the main signs & symptoms of Thalassaemia Major are pallor, reluctant to feed, anorexia, failure to thrive, weight loss & distension of abdomen due to Hepatospleenomegaly. There is severe anemia, with mild to moderate jaundice, bone changes specially the skull and hands with typical facies. Bones become thin and fragile because of narrow cortex and are liable to fracture easily. Physical growth and puberty is delayed due to endocrine abnormalities. There may be hypermetabolic state with fever, recurrent infections and Haemosiderosis because of repeated blood transfusions as with each 500 ml of blood, 200 mg of iron is deposited in the body. He presented some very good clinical slides of Thalassaemic patients.
Dr. Malik Mehmood Alam, who is a highly foreign qualified Peadriatician, highlighted the “Preventive Aspects and  Role of Genetic Counseling and Prenatal Diagnosis”. His message was to form a body of committees, get help from bodies inside and outside the country, get a Centre for Heterozygous detection and Prenatal Diagnosis and procure funds for this project from Govt. agencies, National and International NGOs.

After the presentations by various speakers, there was a session of discussion, which was conducted by Dr. M.M. Alam. There were quite a few good questions from the audience. Surgeon Gul Mohammad, asked the role of spleenectomy and when should it be performed. Dr. M.M. Alam replied that if the transfusion of packed red cells is greater than 200 ml / Kg / year, then spleenectomy should be advised, which then reduces the blood transfusion requirement to < 20 %. However, Prof.  Khaliq was of the view that Spleen should be kept in the body as far as possible so as to prevent infections and if it has to be done, the patient should be vaccinated against pneumoccocal vaccine prior to it.

Answering a question from Dr. Hizbullah regarding the problem of antibodies formation against the RBCs of the donor, Prof. Khaliq said that it is best  to perform cross matching against various other antigens like Kell, kidd, Duffy etc apart from the ABO antigens. Moreover, it is ideal to transfuse washed packed cells excluding the WBCs, Platelets & Plasma.

Replying to a question from Surgeon Gul about the problem of Hepatomegaly and subsequent cirrhosis, Dr. Burki & Dr. Mehmood said that the problem of cirrhosis is not commonly seen, however, there are chances of development of fibrosis of liver, specially due to Haemosiderosis.

Replying to a question of Dr. Imran Khan regarding the advancements in Gene Therapy, Dr. Iftikhar Qayyum said that in future, we are going to see some kind of gene therapy as trials are under way and we have got the laboratory model of the disease, both for Alpha & Beta Thalassaemia. Attempts are being made to provide Genetic Rescue which is being done through Recombinant DNA techniques and by viral vectors, example being Cystic Fibrosis.

After this very interesting discussion session, Dr. Abdul Aziz Awan, Chairman AMA was invited for the vote of thanks. He briefly told the audience about the inception of Abbottonians Medical  Association, which is the social wing of Abbottonians Old Boys Association [ AOBA ]. He said that so far AMA has organized Nine Free Medical Camps in the far flung areas of Abbottabad, Haripur and Mansehra Districts. AMA started the project of helping Thalassaemic patients early in 1996, and so far it has registered 42 such patients from all over the Hazara division including Kohistan. These patients are being regularly provided screened blood free of any cost. AMA has so far arranged 188 blood transfusions and the number of AMA’s blood donors is 256 which includes voluntary blood donors from Ayub Medical College, Army Burn Hall College for girls & Govt. Girls Degree College No. II. Commenting on a question from Dr. Mohib Ullah, he said that today, after this Seminar, the executive members of PATHWEL and AMA will have a meeting with the Principal AMC to finalize the setting up of a Thalassaemia Centre in Abbottabad. He said that before AMA took the initiative, nobody knew the name of Thalassaemia in Hazara. He formally thanked the members of PATHWEL and Principal AMC for their kind support extended towards arranging this function.

A Poster Exhibition was also organized by Abbottonians Medical  Association on this occasion. Over 15 beautiful posters, made by very talented students of AMC were displayed at this exhibition, the topic of which was “ Voluntary Blood Donation for Thalassaemic Patients.” The judges for this poster competition were Prof. Majid Siddiqui, Ex-Principal  APS & C, Dr. Bashir Choudhry and Mrs. Naheed Salim, a famous artist. At this exhibition, literature regarding Thalassaemia was also distributed to the worthy guests, students of AMC and parents of the Thalassaemic patients.

The  prize distribution ceremony was held at 12.15 pm.  All the speakers were given Certificates of Appreciation from AMA. The winners of AMA’s Poster Competition were Miss Kausar of Final Year MBBS who got the 1st prize of Rs. 1000/= cash, Miss Ukasha of Final Year got the 2nd prize of Rs. 500/= cash and Miss Nazish of 2nd Year MBBS got the 3rd Prize of Rs. 200/- cash. All the rest of the participants of this competition were also given gifts and certificates of appreciation. The winner of the lucky draw for the Poster Exhibition was Mr. Tariq of 3RD Year MBBS who received a special prize [ sponsored by Mr. Nazir Ahmed, Ex-President AOBA ] from Master Sohail Khalid , a Thalassaemic patient. As a token of appreciation, Certificates were awarded to all the AMA’s Blood Donors from staff and students of Ayub Medical College and also to the students from Army Burn Hall college for Girls, and Govt. Girls College II, Abbottabad.

Souvenirs were presented by  the President PATHWEL, Lt. Gen.( R ) Fahim Ahmed Khan to Prof. M.A. Khaliq, Principal AMC and Dr. Abdul Aziz Awan, Chairman AMA. Similarly, Principal AMC & Chairman AMA presented crests of their respective organizations to President PATHWEL. At the end of the function all the distinguished guests including the Thalassaemic children and their parents were served refreshments in the crush hall of AMC.

Dr. Abdul Aziz Awan, Chairman AMA,  along with all its members would like to thank the Distinguished guests who came all the way from Rawalpindi. Special thanks to the Principal AMC, Prof. M.A. Khaliq for providing all the possible assistance to make this function a real  success. Thanks for President PATHWEL, Principal, Abbottabad Public School and College Prof. Hasan Badr ud Din and Mr. Sardar Munawar Zaman, President AOBA, Central Governing Body, Karachi for providing generous donations. Special praise for the engineers and electricians of Ayub Medical College & Hospital Complex for providing uninterrupted electrical supply in spite of the fact that there was no electrical supply for whole of the Hazara division on that day.

Lastly, worth mentioning are the efforts made by both male as well as the female members of Abbottonians Medical  Association who left no stone unturned to make this Seminar a real success. The members of PATHWEL & AMA appeal to the philanthropists to extend support to make the lives of Thalassaemia patients and their parents worth living.
 

Dr. Noaman Siddiqui, Chief Organizer AMA,
Deptt. of Pathology, Ayub Medical College, Abbottabad.
Ph: Off: 380926 Ex: 3025 / Res:380274.