what is the basic life support system if native Ladakhi highlanders
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Answer:
Hematological adaptations to high altitude (HA) are long studied but are focused either on lowlanders visiting HA or native highlanders from Andes and Tibet. The literature on native highlanders from the Indian subcontinent or paediatric highlanders is scarce. We aimed at assessing hematological parameters in native highlanders of Ladakh, India, aged 4–19 years and derive nomograms in an age stratified manner specific to these native highlanders. A total of 335 self-reported healthy native highlanders of Ladakh, without any known comorbidities and not on hematinic nor any drugs in the age group of 4–19 years were included in the study. Complete hemogram including red cell indices was measured. R ver 3.4.0 was used to compare the hematological parameters based on gender/age stratification, pubertal and nutritional status. The hematological reference ranges were created for various parameters in the paediatric population. The mean (SD) haemoglobin (Hb) concentration was 14.74 (2.07) gm/dL. The mean hematocrit (Hct) was 40.43 (5.57%) %, mean corpuscular volume (MCV) was 81.87 (7.22) fL, white blood cell (WBC) count was 7596 (2172) cells/μL and platelets was 378.4 (152.8) × 103/μL. Hct and MCV increased with age. Hb concentration, Hct, and MCV in girls was significantly lower than boys. Severely underweight subjects (body mass index < 16) showed significantly higher platelet counts compared to their nourished counterparts. The hematological nomograms for the native paediatric highlanders from Ladakh, India have been reported in this study.
Electronic supplementary material
The online version of this article (10.1007/s12288-018-0967-4) contains supplementary material, which is available to authorized users.
Keywords: Hemogram, Paediatric, Highlanders, Ladakh, India
Introduction
High altitude (HA) has always intrigued physiologists because of the remarkable ability of man to adapt to the hostile environment. Hematological changes associated with HA exposure is believed to be driven by hypobaric hypoxia of HA. Paul Bert back in 1878 in his book Pression Barometrique suggested that adaptation to HA might include the increase in red blood cell (RBC) count and hemoglobin (Hb) concentration [1]. Viault in 1890 further quantified this in his studies by measuring RBC count at Lima (sea level) and Morococha, a mining township at 4372 m in the Andes. Since then almost all studies conducted in HA natives or the lowland visitors of HA have consistently documented an increase in RBC count and Hb with the ascent to HA [2]. There are three major shortcomings with the available literature on hematological parameters in HA. Firstly, the majority of the studies on HA physiology and hematological adaptation have focused on the hematological adaptation in lowlanders visiting HA or have compared the hematological profile of native highlanders from Andes and Tibet with those of the neighboring lowlanders [3–6]. Secondly, these studies have mostly been directed towards an adult population with no or little reference to pediatric age group. Lastly, these studies have been done mostly on the Highlanders of Andes and Tibet with no data on Indian highlanders. Moreover, hematological reference ranges in the pediatric age groups are scarce. We attempted at answering a few of these questions through this study.
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