Spectrum of Hematological Disorders in Young Navy Recruits

Introduction:

Hematological disorders can vary from simple anemias to complicated malignancies. The aim of our study was to identify the spectrum of hematological disorders in young navy recruits that prompted a hematology oncology consult. We also aimed to obtain a sense of the recruitment process, screening tests performed and help prevent medical-hematological emergencies.

Materials and Methods:

A retrospective chart review was conducted at our hospital, Captain James a Lovell Federal Health Care Centre, North Chicago. Recruits who were referred to hematology and oncology clinic in the past one year(2015-2016) were included.

Results:

We reviewed a total of 122 patients, which included 84 males and 38 female recruits. The age range was 18 to 31. The most common reason for consult was microcytic anemia evaluation (30%), followed by normocytic anemia (21%) and coagulopathy evaluation (13%). Other reasons for consult included neutropenia, leukocytosis, microcytic anemia with neutropenia, normocytic anemia with neutropenia, thrombocytopenia, thrombocytosis, pancytopenia, splenomegaly, pancytopenia in association with splenomegaly, recurrent epistaxis, unusual bleeding, history of deep vein thrombosis and testicular tumor (Table 1).

Microcytic anemia was secondary to Iron deficiency anemia(IDA) in 59% of recruits, either due to malnutrition and menorrhagia in females or gastritis with blood loss in males. Other causes of microcytic anemia were E-Alpha thalassemia, alpha thalassemia minima alone or in combination with IDA, beta thalassemia trait, sickle cell trait in association with IDA and alpha thalassemia minima. The most common cause of normocytic anemia was Anemia of Chronic disease in association with Vitamin D deficiency (15%). Other causes are mentioned in table 1. Coagulopathy was mostly secondary to viral syndrome causing abnormal liver function tests/LFT (75%). Coagulopathy due to mild hemophilia was identified in 3 patients. Thrombocytopenia occurred because of ITP (Immune Thrombocytopenia) or viral syndrome in most patients.

Navy recruits are routinely screened for sickle cell disease and G6PD deficiency, but are not screened for anemia or coagulation abnormalities. Most recruits in our study presented with severe anemia or bleeding after dental extraction (especially hemophiliacs and thrombocytopenic patients) which disrupted recruit training. Few recruits were also separated depending on severity of hematological illness. In our retrospective study, even mild hemophiliacs had abnormal PTT. Hence, if complete blood count(CBC) and prothrombin time/partial thromboplastin time (PT/PTT) testing were included as a part of screening during recruit enrollment, many hematological disorders can be diagnosed early and complications can be prevented. Early diagnosis will also help identify recruits with severe and disabling hematological disorders, thereby preventing their admission to boot camp and avoiding unnecessary training expense. Good testicular exam is also recommended as part of initial screening as one of our patients was diagnosed with testicular tumor.

Conclusion:

Young navy recruits are a unique group of people, many of whom have minimal medical and dental care because of poor socio-economic status at home. Demanding physical activity in presence of underlying anemia, or dental extraction in presence of bleeding disorders or platelet abnormalities cause medical-hematologic emergencies. Simple screening tests such as CBC, PT/PTT and testicular exam can help identify hematological disorders early and prevent complications.

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