Chandigarh, September 11
Pulmonary thromboembolism (blood clots in
the lungs) has affected younger population in the country as compared to the developed
countries.
A study by doctors from the Histopathology Department of the Postgraduate Institute of Medical Education and Reach (PGIMER), conducted at 1000 adult postmortem examinations found that the incidence of blood clots in lungs were 15.9 per cent (159/1000).
Dr Nandita Kakkar and Dr R.K. Vasishta conducted this study in the past six years to find the true incidence, age group afflicted, disease associations, contribution to death of the pulmonary thromboembolism (PTE) in autopsied patients admitted to the medical wards in a tertiary care centre in North India (Chandigarh).
While conducting the study, PTE was divided into three groups comprising fatal pulmonary emboli (1), significant contribution to death (2) and incidental or chance finding (3). The study shows that the PTE significantly contributed to death in 79.24 per cent (group 1 + group 2) of the 159 patients out of the samples of 1000.
While addressing mediapersons at the PGIMER, Dr R.K. Vasishta claimed that 73 per cent patients (from the sample taken) were less than 50 years of age and 27 per cent were over 50.
In less than 50 age group, 7.14 per cent were between 14-19 years, 22.22 per cent were between 20-29 years, 27.77 per cent were between 30-39
and 15.87 per cent fell between 40-49 age group.
Dr Vasishta claimed that PTE was devastating, though a treatable problem and an important cause of suffering and death in hospitalised patients. Assessment of the gravity of the situation, age groups affected, disease associations and contribution to death were important for its prevention, prophylaxis, early diagnosis
and treatment.
"There is difficulty in establishing an accurate diagnosis because of its non-specific history and physical findings and the lack of a conclusive simple low cost, low risk test for establishing a diagnosis," he added.
Dr Nandita Kakkar said "The main cause of PTE was infection. This was followed in decreasing order by liver or pancreatic, heart, cancers, respiratory, brain, kidney, endocrine, haematological, primary thrombotic and vasculitic
disorders."
She added that sources of pulmonary thromboemboli were present in 25 patients (ie in 15.72 per cent cases) as she had to get a special consent for dissecting
the leg veins.
Of these nine of the 25 patients had documented clots in the deep veins of the legs and the other 16 had the sources in veins of the abdomen. In 90.6 per cent of such cases the PTE was not suspected clinically, she claimed.
Hence, PTE was found an important cause of death in patients admitted to the medical wards, affecting younger population and has been clinically unsuspected in 90 per cent cases in this part of the world and needs to be tackled appropriately, the
doctors said.
They also held this opinion that the key to combat this deadly disease was awareness amongst doctors, early diagnosis and prompt treatment with low molecular weight heparin.
The doctors were also of the view that sophisticated laboratory techniques had improved the detection rate of pulmonary embolism, yet the clinical diagnosis of PTE in
hospitalised patients remained elusive.
The real incidence of PTE was unknown and was difficult to determine the main cause of death, co-morbidity or just an incidental finding.
Major pulmonary embolism remains undiagnosed in 40 to 70 per cent of patients.
"A correct and early diagnosis is essential as this is a fatal condition and if diagnosed in time, thrombolytic therapy or surgical embolectomy can be life saving,"
doctors say.
The doctors claimed that a computer alert programme to encourage prophylaxis has been developed with the
help of which diagnoses of the disease and its prevention was possible.
