RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, BANGALORE, KARNATAKA ANNEXURE II PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION

1. NAME OF THE CANDIDATE AND ADDRESS DR VIJAYASHRI. B HANCHINAL POSTGRADUATE. PHYSIOLOGY KIMS, HUBLI. KARNATAKA INSTITUTE OF MEDICAL SCIENCES, HUBLI 5800022. MD PHYSIOLOGY.

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NAME OF THE INSTITUTE

COURSE OF THE STUDY AND SUBJECT DATE OF ADMISSION TO THE COURSE TITLE OF THE TOPIC

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1"#$ JUNE 200".

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INFLUENCE OF DIFFERENT PHASES OF MENSTRUAL CYCLE ON BLOOD PARAMETERS.

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BRIFE RESUME OF INTENDED &ORK %.1 NEED FOR STUDY Menstruation is physiological phenomenon which occurs in women during her reproductive years. The sequence of hormonal events leading to ovulation dictates the menstrual cycle. The endocrine effects consisting of dramatic drop in circulating level of estradiol & progesterone are critical to allow the follicular development & ovulation of the next ovarian cycle. In addition the regression of corpus luteum & drop in circulating steroids signal the endometrium to initiate the molecular events that will lead to menstruation.

Both these hormones have individual interactive & sometimes opposing physiological actions on blood parameter & also blood loss during menstruation. So we underta e this study to analy!e the effect of hormonal changes in different phases of menstrual cycle on blood parameters in normal menstruating women. %.2 REVIE& OF LITERATURE " study conducted by Swati. #. Ti are et. al for distribution of immune cells may change at different phases of menstrual cycle. " study has been underta en to examine the changes in various type of blood cell counts & hormonal profile in different phases of menstrual cycle. The study was conducted on $% healthy women in their reproductive age group who volunteered for the study and having regular menstrual cycle& during proliferative phase there was percent change decrease in all counts except absolute and differential lymphocyte counts compared to menstrual phase. " maximum fall of '(.'% ) was noticed in case of absolute neutrophil count& in comparisons to proliferative phase& the counts increased during the secretary phase ranging from '.*() to $%.'+). This may also be due to hormonal changes during luteal phases ovarian cycle. The levels of estrogen & progesterone are important factors in regulating the neutrophil count. ,strogen seems to enhance granulocyte proliferation in vitro. The absolute and differential lymphocyte count increased during proliferative and secretory phase in comparison to menstrual phase& increase in granulocyte and monocyte numbers in the secretory phase have already been reported earlier and also suggested to be due to increased '-.beta estradiol concentration. " study conducted by Swati.et.al to evaluate the influence of different phases of menstrual cycle on platelets and to assess the relation between platelet count and mean platelet volume /M012. 3esult showed apparently non significant variation in platelet count during various phases. The counts were lower during menses and pea during proliferative phase. This relative variation may be due to variation in platelet half life& platelet response to bleeding and also luteal hormones may play a role.

" study conducted by "ish 4avaid et al showed comparison of body weight& hemoglobin concentration and hematocrit during follicular & luteal phases in young menstruating women. These parameters were measured in $* healthy normal menstruating women& over $.5 consecutive menstrual cycles. 6emoglobin concentration were significantly /p78.8*2 lower in follicular phase than in the luteal phase. 6ematocrit & body weight did not show any statistically significant differences in both the phases of menstrual cycle. " study was conducted by 3 "bbott MS et.al to assess total platelet count& adhesive platelet count& platelet adhesiveness in normal menstrual cycle and functional uterine bleeding. The menstrual cycle is nown to influence the heamodynamic and thrombocytic elements in women. '88 cases in this study were investigated to exclude any bleeding disorder or severe anaemia. In control group of *8 women& with normal and regular menstrual cycle& it was observed that the total platelet count /T092 and adhesive platelet count /"092 increased gradually to a pea from menstrual to the mid cycle phase and subsequently declined to an intermediate level in the premenstrual phase& platelet adhesiveness /0"2 showed negligible change. " study was conducted by :ares Marc te et.al to assess reticulocyte count variation in different phases of menstrual cycle. ,rythrocyte filterability& reticulocyte count were measured throughout one menstrual cycle in 'women. The filterability was significantly depressed during the progesterone phase compared with the estrogen phase. The depressed filterability was accompanied by significant increase in reticulocyle count. " study conducted by Barbara 4. Bain et.al showed cyclical variations during menstrual cycle& most consistently a fall in the neutrophil count at menstruation. The neutrophil counts of - women& three ta ing oral contraceptives & four not ta ing them& showed pea twice during each cycle. ;ne woman not ta ing oral contraceptive was studied in detail over eight cycles. She showed two neutrophil pea s per cycle and a similar variation in monocyte count the eosinophil count showed a reciprocal relation with the neutrophil count & basophil count fell in end of cycle. The changes in her

neutrophil count seemed to follow changes in estrogen level with a delay of one to two days estrogen. 0robably promotes release of neutrophils from the bone marrow rather than from the marginated pool. " study was conducted by ;dd. :. 1ellar for hemoglobin& hematocrit & mean corpuscular hemoglobin concentration which were investigated in %-women of child bearing age altogether '$-8 blood samples were tested. There was a pronounced tendency towards increases of hemoglobin together with hematocrit from the early menstrual phase until the post ovulatory period with a subsequent decrease towards the end of the cycle. #o cyclical pattern of matter was observed. These variations in hematological parameters are in good agreement with present menstrual cycle. %.2 OBJECTIVES OF STUDY The study is under ta en to estimate hemoglobin concentration& hematocrit& reticulocyte count& red blood cell count& white blood cell count& clotting time&bleeding time& erythrocyte sedimentation rate& absolute eosinophil count& platelet count& differential lymphocyte count and compare the variations in different phases of menstrual cycle. nowledge of the hormonal changes during the

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MATERIALS AND METHODS '.1 S()*+, (- ./#/0 Study group consists of *8.-*& normal young women of age $8.58years having regular cycles.

I1+2)34(1 +*4#,*4/ '. 6ealthy women in reproductive age groups. $. They should have regular cycles. 5. <omen aged $8.58 years

E5+2)34(1 +*4#,*4/ 6=o thyroid disorders 6=o gynecological disorders 6=o bleeding disorders 6=o diabetes mellitus 6=o hypertension 6=o medication li e antiepileptics. '.2. M,#$(.3 (- +(22,+#4(1 (- ./#/ '. 0ersonal interview with sub>ects. $. 9ollection of blood sample $cc from venepuncture at ''.88am. '$88noon. 5. "nalysis of hematological parameter by auto analy!er. '. . D(,3 #$, 3#).6 *,7)4*, /16 418,3#49/#4(1 #( :, +(1.)+#,. (1 ;/#4,1#3 < /14=/2 3;,+4-6. ?es& this study require following investigation. a2 6emoglobin b2 6ematocrit c2 3ed blood cell count d2 <hite blood cell count e2 ,rythrocyte Sedimentation 3ate f2 Bleeding time h2 9lotting time i2 "bsolute eosinophil count >2 3eticulocyte count 2 :ifferential luecocyte count l2 0latelet count #o animal experiment is required. '. !. H/3 #$, ,#$4+/2 +2,/*/1+, :,,1 (:#/41,. -*(= ,#$4+/2 C(==4##,, (- 6()* I13#4#)#4(1 41 +/3, (- '. > @?es. @The ethical clearance has been obtained from ethical committee of AIMS 6ubli

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LIST OF REFERENCE. '. Swati #. Ti are& Ausal A. & Salim " :hundasi. Blood Beu ocyte profile in different phases of menstrual cycle. I400C $88D *$ /$2 $8'.$8%. $. Swati #. Ti are& Aushal A.:as 0amnci Sisnha Salim " :hundasi :epartment of 0hysiology Bi>apur. Influence of :ifferent phases of menstrual cycle on platelets ;ctober .$88-. 5. " comparative study of body weight& hemoglobin concentration 6eamatocrit during follicular and luteal phases of menstrual cycle. "isha 4avaid& 3uqaiya 6asan& Ta!een #aim. :epartment of 0hysiology Eniversity of Aarachi. 0a istan 4&. Med Sci - /'2 '%(.'%+ 4an.$88-. %. 3 "bbott MS M.9handra MS 3. 9handra MS :epartment of ;bestretics and Fynaecology. S. #. Medical 9ollege. "gra. India. September $%C '+D$. Total platelet count& "dhesive platelet count& platelet adhesiveness in normal menstrual cycle and Gunctional uterine bleedingC " 9omparative study. *. 9laes Mer e M : and Bengt Bund M :. ,rythrocyte filterability and 6erne catabolism during the menstrual cycle. Sept '+-( vol D* issue5 page 5$$. 5$%. (. Barbara 4 Bain& 4 M ,ngland. 1ariation in leucocytes count during menstrual cycle. British medical >ournal '+-*& vol $ page %-5.%-*. -. ;dd : 1ellar. "cta obstretica.,T Fynaecologica Scandinavia.'+-% vol *5 issue 5 page $%5.%(.

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SIGNATURE OF CANDIDATE REMARKS OF THE GUIDE NAME ? DESIGNATION 11.1 GUIDE It is possible to do this pro>ect wor at AIMS& 6ubli. DR.V.S. BALJOSHI M.D. ASSOCIATE PROFESSOR, DEPARTMENT OF PHYSIOLOGY, KIMS, HUBLI.

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11. CO@GUIDE

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11.5 HEAD OF THE DEPARTMENT

DR. K.F. KAMMAR M.D PROFESSOR ? H.O.D DEPARTMENT OF PHYSIOLOGY, KIMS, HUBLI.

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12.1 REMARKS OF CHAIRMAN AND PRINCIPAL

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