Introduction
hello viewers a very good morning Welcome to our FP live session and today our topic is what is blood cancer what are its causes symptoms and the latest treatment options available with us and today for our discussion we have with us Dr padmaja loii ma’am she is a consultant hemoncologist and bone marot transplant consultant at Apollo hospitals ju Hills Hyderabad and ma’am is also an expert in treating bone marrow transplant leukemia Myoma lymphoma enemia and low platelets so dear audience if at all you have any doubts related to blood cancer or any other diseases which I’ve mentioned just leave your doubts in the comment session and Dr paja ma will be taking them uh live during the session hello ma’am Welcome to our live session and so dear audience sorry and so dear audience uh just leave your doubts in the comment SE we going live now uh ma’am as our topic itself says what is blood cancer let’s so let’s start off with the first question please answer
What Is Blood Cancer?
so blood cancer is another ter called a leukemia so there is an unchecked mechanism where the abnormal cells are proliferating in the blood so what happens when you’ve got an excess of very immature blood cells which proliferate they take off the normal space for the normal cells that is why you get uh low blood counts like low hemoglobin low platelets but in turn white cell count will go very high that’s the time when we do a special test and the simple blood test like CBC will show a very high white silk count and under the microscope you would see a cells called Blast cells that’s the time we suspect a leukemia and do further test like bone marrow to confirm this there are various types of leukemias some could be coming on in very few weeks so the patient is very well and within the next 3 weeks they become very unwell and having a diagnosis of leukemia they are called acute leukemias they come on very sudden with a very short distance short time duration and chronic leukemias are indolent they go slowly and they they develop over a period of time months to years and there is no immediate life threat because of chronic leukemias they can be managed sometimes as an outpatient maybe a short inpatient state but acute leukemias where they come on in a short span of time in otherwise well patient are the ones which are life-threatening and have to be diagnosed in time to have a good outcomes
Causes and Risk Factors
ma’am what are the causes for this uh blood cancer what what is the reason behind of this starting or forming in the body that’s a a good question har every patient who comes through the door will ask this question why did they develop leukemia and they’ve not done anything wrong this is very true almost 95% of the times we don’t have a reason unlike liver cancers where you’ve got a history of alcohol unlike lung cancers where you have got a chronic history of smoking in blood cancers you hardly have any precipitating event which patient has done it they come as a denovo there is some mutation in the genetics which has happened and they change over to a leukemia and most of the times these are not hereditary they have not born with it they developed this genetic mutation in the couple of weeks prior to this diagnosis so there’s nothing they could have done to prevent it however there are few reasons what we say that they may enhance the development of leukemia like uh you know where there is uh radiation exposures this is main mainly so in areas where there is atomic bombing which we have seen and uh Benzene chemical dies people who work with a petroleum products uh in people who work in petrol bunks they should wear gloves all the time because they’re consuming these chemicals all throughout or excessive use of pesticides there also a certain culprit which can increase the chances but they do not de over cause the leukemia
White Blood Cells, Red Blood Cells, and Platelets
so ma’am as you have mentioned that increase in the white blood cells count is what results in blood cancer in the other way can we even say it as because of the red blood cell count is also low in these patients or the red blood cells remain high as well as the white blood cells count increases so the first thing is white cells are increasing when they start increasing there is no space in the bone marrow for the normal red cells and pl platelets so the normal cells are being replaced that’s why you lose the hemoglobin you lose the platelets so in the initial phases you may not have anemia and a low platelets you may just have a high white cell count to start with and as you go further you will develop the rest of the features
Differentiating From Dengue and Other Conditions
so how do we identify ma because one of our known family friends I’m just taking it as an example so even audience can connect to it they were having U sudden fatigue and having vomitings and after going to the doctor and after blood test and everything they in the local hospital they said it is denu fever after they going to a corporate hospital after some series of tests they said you have blood cancer so they were in a shock they said all the others were just saying dingu because of the low plateless how can you just say it is bone marrow because many people uh sorry blood cancer many people have these small small minor doubts because of low platelets because of no Red Blood so please bust these all these mths sure so when whenever we have an abnormality suppose the leukemias can just present with fever extreme tiredness or infection they had fever they had some antibiotics not settling that’s the time you go ahead and do a blood test blood test is a key important investigation and also looking at the blood under the microscope is another by an expert is another key thing whenever we say denu fever we need to have an establish dingu IGM or ns1 something positive so it’s a definitive evidence that you’ve got a dingu and it’s it’s not a presumed that it is possible dangu and second thing you look under the microscope and you should not have any abnormal cells if you do not have a definitive diagnosis you should always follow it up because Dango fever platelets will settle back to normal s about a week’s time and if they don’t settle or if you’re seeing any abnormal cells or you’re dropping your hemoglobin which is very unusual in denu or a highbid cell count so these are the things which raises suspicion and then further investigations will confirm so a key important thing is to have a definitive diagnosis and do not have a presumed thoughts about a denu and if things are not settling you should have further investigations and have a definitive cause for your problem
Which WBCs Increase?
ma’am we have a question from an audience uh he is a doctor and he says uh he’s asking which type of WBC is increasing okay so in blood cancers as we said there is an acute blood cancer and there is a chronic blood cancer if you’ve got a CBC done you would have a very high number of atypical lymphocytes that is generally in ALS you could have a lymphocytosis normally lymphocytes are about 40% and if you are having 80% of lymphocytes then one has to think that there is an abnormality or if you’re seeing myocytes or you’re seeing increase in number of atypical cells or a blast that’s the time you should suspect there is a acute leukemic process suppose if you’re seeing the neutrophils are high occasional nrpc then there is a some condition called a chronic myoid leukemia where the white cells are high patient is otherwise well initially they think it’s an infection but once we confirm that it’s persistent and there is a little bit of spleen we do a specific test called a BCR abl PCR and confirms the CML diagnosis so in a sense it’s more of a lymphocytes atypical cells blast cells any amount of abnormal myocytes which should not be there in the blood smears then you should suspect there is something going wrong with the blood disorders
What Are Blast Cells?
so ma’am as you are mentioning blast cells which is something a new term that we are hearing apart from the red blood cells white blood cells and plasma and the platelets please uh elaborate a bit about this blast cells so blast cell means it’s a very immature cell normally they should just reside in the bone marrow and they’re less than 5% in the bone marrow if they’re in excess in the bone marrow they come out into the bloodstream and you should not see any blast cells in the blood smear if you see even one you should start thinking there is something seriously wrong blast cell is nothing but a very immature large cell and you should not see it in the peripheral blood whatever the blood test we do we should not see that we start seeing it in the your report you should inform you should consult your hematologist
Staging and Related Blood Cancers
so ma’am in blood cancer are there any stages because sometimes doctors say have have come late because there were no symptoms you couldn’t identify it in time so are there any stages and so that we can come ahead and look look for treat so blood cancers in a generic term we are talking about a leukemia but in generic in general population a lymphoma Myoma these are the other bone marrow cancers they are also called blood cancers by many people so lymphoma the people can present with the lumps in the neck lumps in the axilla you know under the armpits that’s how people will know and another reason how people present with a lymphoma is ongoing fevers they have no reason they have continuous fevers this is called pyrexia of Unknown Origin and during the investigations people will have several tests including CD scans and they find some enlarged spleen enlarg lymph nodes and following that they would have a biopsy and will have a diagnosis of lymphoma but blood cancers most of the time they are in the blood so they are stage four so you don’t have to worry just because it’s stage four does not mean that it’s not curable many of the times in blood Related Disorders we do find them coming in stage four unlike lung cancers the stage four carries a poor prognosis but blood cancers do not carry such kind of a prognostic value depending on the staging but what is more important in blood cancers is how well you are when you presented and when we made a diagnosis if you’re very unwell you started an ICU your outcomes may not be good so early diagnosis is always the KE key for a better outcome and also blood cancers are very expensive diseases and we can cut down the cost of the treatment by 50% if you started as an outpatient rather than being very unwell and started in an intensive care
Life After Treatment and Remission
uh ma’am we have a question from an audience man if the blood reports are normal after chemo and radiotherapy will the patient return to normal life in future post the treatment so it is a very generic question it depends on what diagnosis we’re talking about is it a chronic my or leukemia is a is a diagnosis many people correlate where the blood cells are abnormal patient otherwise well and you had a BCR abl particular genetic mutation has happened and you keep monitoring that particular mutation and if that returns to normal you need to continue the tablets and people nearly have a normal lifespan but other blood disorders there is a lot of followup depending upon the stage of the disease how good the response to the treatment is what we call as how deep the response is with the chemotherapy the deeper the remission we call it as a complete remission or less deeper then you call it as a partial remission that response depends on the intensity the type of disease in particular patient you can assess whether they need a three monthly followup six monthly followup or they need a surveillence CT scans to see that is there any chance of disease coming back in generic we say for about 5 years after the treatment if you’re disease free you could be be considered as a Curative from that particular disease until that time you may need a very um distant followups but you do need to consult your consultant regularly perhaps it may be a three-monthly basis
Diagnostics: Tests and Technologies
thank you ma’am and what are the diagnostic measures to identify blood cancer so a simple blood test called a CBC is the first one which tells us there is a suspicion following that it may be a bone marrow aspiration and biopsy we do bone marrow aspiration and biopsies most of the times to know the prognosis rather than confirming the diagnosis and in that there are a lot of special tests we do a test called flow cytometry where you are actually knowing the markers on these cells previously many years ago about talking about 15 20 years back we didn’t have all these tests so we used to see the blast cells under the microscope there are large cells there are particular size and shape how they look and the expert will say this is acute my or leukemia the other one will say acute lymphoid there are times s you are in a confusion but now with a specific test like flow cytometry it’s very objective you have got a certain set of markers then you can say you know acute myoid or certain set of positivities then you can say lymphoid so it made things much easier more objective and you are able to detect at a very low level so you can monitor the treatment as well after you’ve responded with the treatment you can see how low even one cell abnormality among the 10,000 you can detect by means of these sophisticated test now so we know that the deeper the response after you give treatment the deeper the response the better the outcome is and there are specific test called the cytogenetics you look at all the you know 23 pairs of chromosomes to see which chromosome has got an abnormality to generate this leukemia and after the treatment you want to look back and see that it’s clear or you look at a genetic mutation on a particular chromosome there may be a gene which is amplifying and you want to measure that and see that is gone back so if you identify some problem before the treatment you want to monitor that after the treatment to see that it’s gone away so that’s the importance of doing these special tests to know the depth of the response
Treatment Options: Chemotherapy, Transfusions, and Procedures
thank you ma’am and coming to the treatment options for blood cancer could you please elaborate a bit because the moment we hear it is blood cancer many people think just blood transfusion uh might be the treatment but not something else and they are in search of various methods and mechanisms but many people lack of information is what is exact treatment for blood cancer which is the effective and the latest please elaborate so blood cancer the only treatment is chemotherapy generally surgery is not an option because blood is circulating everywhere so we cannot take them out from the cancer cells you cannot filter them out and radiation very rarely given that is part of the bone marrow transplant we do but all over the treatment for blood cancer is chemotherapy you cannot transfuse or filter the blood and remove the cancer cells uh many people do think that that is possible but it isn’t there is one procedure called leukopheresis when patients come with a blood cancer with a very high Whit cell count like two lakhs three lakhs and they’re compromised in the lung with oxygen that is the time we filter out these white cells and it’s a temporary process we filter them in order to give us a little bit of time that patient does not deteriorate and then we give chemotherapy so when we filter yes it can come down from 1 lakh to about 50,000 or 30,000 from the white cell count but if you don’t filter for 2 days it will go back to the same level so whatever the filtration techniques are very temporary just to give us a day of time for the chemotherapy to work and only these are done in an emergency situations in an intensive care just exchanging the blood or giving blood you can imagine blood cancer the billions of abnormal cells and the amount of blood blood we are giving is a very minute amount we have about 5 L of blood volume and when we give a blood transfusion you’re hardly giving about 300 ml so you cannot uh exchange the whole thing and there is a constant process blood cells are forming every day every hour so you cannot replace the abnormal cells by means of this so what if we do that you are just taking a drop out of the ocean this is what you do
Key Symptoms to Act On Quickly
ma’am we have a question from an audience and actually we have discussed this earlier by Dr DEA what is one common symptom which we need to observe in leukemia to react fast so leukemia yes low platelets where you have a bruises and bleeding or extreme anemia or very high white cell count on the blood test if you see a blood test with a white cell count more than 40,000 more than 30,000 immediately you should go and see hematologist within 24 hours because sometimes the blood cancers are progressive very fast so you do not want to waste time
Sharing Reports and Follow-up
thank you ma’am and one more patient who had earlier asked about the blood reports he’s requesting if we can send his reports through mail so that you can have a look at it and all sure definitely sir we will shortly once the session is done we’ll share you an email ID to which you can send your reports and we will get it verified with Dr pja ma’am and we’ll get back to you
Bone Marrow Transplant: Role and Outcomes
thank you and so ma’am when we are when you’re talking about this blood and all so as please correct me if I’m wrong the blood cells are generated in the bone marrow is what is commonly known please correct me if I’m wrong so if at all we do bone Maro transplant for the blood cancer patients uh will their survival rate and the recovery rate increase and will they lead a normal life like earlier so the question you asked me uh one simple answer is yes but it’s so complex you cannot just say the answer of yes there are multiple variables involved in so blood cancer yes definite Curative treatment is B transplant but not every blood cancer patient needs a transplant so primarily you have to give chemotherapy to get the disease into remission we use the word remission that means that cancer is not detectable by any means what we know it does not mean that it’s completely cured because there may be a small number of cells we cannot identify them by the current means of any of the testing as I said there are lot of sophisticated tests now we can detect one abnormal cell among among the 10,000 normal cells so that is our ability to test it anything below that we cannot identify and these SK cells can abnormal cells can remain dormant and can grow back again this is what we call as disease coming back or relapse in a patients with a leukemia we always think about what is the risk of this particular patient if they’ve had a good response good genetic then we think that his risk is very low so we don’t consider bone Mar transplant but suppose if they had some abnormal gen IC variation and we know those are associated with the increased risk of disease coming back or they’ve not gone into a good response how we were talking about you know the MD minimal residual diseases positive then these patients needs to go through a bone marrow transplant to prevent this disease coming back at that time we give intensive chemotherapies and sometimes we use a total body irradiation mechanism to clear out any dormant leukemia cells lying anywhere and also to give a new immune system from a new donor that is the donor immune system to fight these leukemia cells to keep a check on these new leukemia cells anything developing it just takes off from the immune system so this is the process of bone marrow transplant it has got a good cure rates provided the first remission if you do a transplant the outcomes are good the patient when he comes he should be in a fit position and have a good disease response and donor status as well makes a difference supp you have got a sibling donor the transplant is easier compared to unrelated compared to a hlo donor so there are multiple variables in it sometimes if the patient has got a very bad disease type we would want a little bit of graft versus host disease and we actually choose an unrelated donor superior to the sibling so there are lots of permutations and combinations in a given patient for what is good for them yeah
Transfusions During Treatment
thank you so much ma’am and ma’am uh in uh blood cancer patients when they regularly uh get their blood test done weekly or for every fourn night and all if at all their blood cells their red blood cells and the count drops in they the doctor suggest them to immediately get some blood transfused or platelets be given to them is it advisable and is it good that they take regularly uh these Bloods and all because taking blood and platelets from different different people is it a good thing to take and will that support them a lot uh that’s it’s a great question har so blood blood cancer treatments are very intense when you’re giving intensive treatment it literally takes off all the normal cells and an abnormal cells in the bone marrow in order to get a cure at that time your blood counts are going to drop down your platelets are going to go down you definitely need a transfusion otherwise we cannot survive with a very low blood count and it’s not going to we know that it’s not going to recover that quick so we need to support it there is no doubt that we need to support it there are different things we can do in order to reduce the risk so all the blood is tested for all the viruses like he B hepatitis C you know HIV in a very sophisticated manner what we call as a knack testing where you can detect it a very very low level so that makes it almost 99% safe and uh we give lucco depleted so we remove the white cells from the blood we no longer give whole blood so that practice is almost obsolete what you see in a movies like you collect one person’s blood and give it to the other person it is never never done after the 1970s that process has been stopped so we now what we call as a components the blood is separated into red cells and platelets so only the packed red cells what we give what we call is a blood transfusion so you only have the red cells even a tiny amount of white cells we remove it with what we call as a lucco depletion filter so there is a specific uh transfusion filter sets available you can remove those white cells by doing so by repeated blood transfusions you don’t get transfusion reactions there are certain things you can limit by doing that and platelets as well single donor platelets are always superior rather than a random platelets it is always good to have you know a donor who is male healthier who would be able to give a larger volume of platelets and we can actually rotate the same donor the donors can donate every week of platelets they will not lose any of the platelet volume in them blood you cannot donate for 3 months but platelets you could be a regular platelet donor as well for your loved ones if you’re supporting with their cancer treatment and the need a frequent platelet transfusions you could perhaps have four donors and then rotate them around to have the platelet support in that way you minimizing the amount of uh donor exposures so there are a lot of measures we take to prevent and one myth people say is can we have our relatives who come and donate blood no blood is always a replacement we do a lot of processing to prevent any of these reactions so feel free to discuss about these and the blood now is safe there are a lot of tests we do to make it safe and lucco depletion is one using a single donor and of course whenever we don’t need to give blood transfusions there are alternatives we should always go for that
Platelet Donation Explained
and ma’am uh I I have a bit knowledge about the platelets but please elaborate a bit about audience because recently my husband has donated his platelets and for the first time we are seeing that uh initially the blood was flowing out it was taking in platelets and again pushing back the entire blood which is uh for our surprise that oh we didn’t know know that only platelets will be taken and his blood will be given back so please explain a bit about the this is called a platelet donation what we were just talking about it’s a single donor platelet donation that means a donor comes only he’s donating platelets so it is similar to a dialysis machine it looks you put a needle one blood will flow from one arm to the machine the machine will filter out and only takes a platelet so you put a frequency where it has to filter and it will filter the top layer of the blood and the remaining red cells everything will be given back through the other arm into the same uh you know donor so they won’t lose any of the hemoglobin they’re only collecting the platelets and that’s hardly about 200 we collect and it depends on the patients you know the person who is donating their weight and height then we decide how much to take it people will not feel tired it just needs that you need uh two Pricks on both arms and about it takes about an hour to two hours for the feres to go on so there is no harm in donating this at all
Donation Frequency and Myths
thank you so much ma’am and dear audience as Dr padja mam is mentioning plates can be platelets can be donated once in every week and blood can be donated once in every every 3 months so uh it is benefit of the patients and your family members who all are in need of this blood and platelets please do please do go and donate and then there is I don’t know whether to call it as a myth or it is a fact uh people say that the more often we donate blood the more we get active we get new blood and and all all that stuff you might be knowing all that what you hear so please tell us a bit about that so people do feel that I think it’s a psychological impact that they feel happy that they’ve done something good and this is a voluntary people are not paid for so it just gives you a lot of positive impact and there are certain people who are polyamic that their hemoglobin is high because of smoking or whatever the reasons when you have a too much of blood it gives you a headache so those kind of people when they donate they feel they become a bit lighter they feel a bit refreshed that could be the reason but more so it is psychological they feel better about it
Costs and Financial Considerations
thank you so much m’ and one of the audience is asking uh Revenue part for the testings I think he what he meant is not Revenue I think he has asked for the cost for this test for the blood cancer test so I would like to mention Here My Dear audience that the test may be vary we cannot say exactly what could be because once the doctor sees and does your basic CBC test which Dr padja has just mentioned earlier so the regular test and the other test will be followed as for prescribed by the doctor so you can get in touch with your doctor doctors at your own centers and get to know about more information and if I think uh there is a little bit of a difference what you’re asking it’s a simple CBC will cost about 200 to 300 rupees but that’s very simple where you suspect and a bone marrow just if you’re doing a bone Mar aspirate and biopsy it will cost you about 10,000 and that all again the cost will differ along whether you’re using disposable needles whether you’re using a reusable needles whether you needed a sedation to do a bone marrow how comfortable you wanted your procedure to be and how sophisticated test you want you can make a diagnosis of leukemia without any of those sophisticated tests you don’t need to have a flow cytometry you don’t need to have a fish but all these extra tests are giving you a little bit more information but by all means you can diagnose leukemia by simple bone marrow test and a basic test which would be cheaper but there are lot of things that available now in the market internationally so we call it as a FL cytometry fish and the new test has come called the Next Generation sequencing that will cost quite high but it only gives one additional information it may or may not be that useful if you’re somebody who have enough money you could have it but you don’t have to have all these tests to have a Leukemia treatment so feel free to discuss with your doctor what are your financial constraints and what is the absolute minimum you need to do for the testing and what is the extra thing what benefit you get so always feel free to be open to discuss these things because now we are Global Market we have got everything available what is new in the market the newer things are always going to be expensive but they give a little additional information that may not be necessary for every patient so feel free to discuss with your doctor about the need for these new tests
Immunotherapy and Emerging Treatments
uh ma’am we have one more question ma’am is immunotherapy suitable for blood cancer so as per se immunotherapy is not generally part of blood cancer treatment specifically in acute lymp blastic leukemias there is cd20 positive so some patients we give a rxm up along with the chemotherapy and generally immunotherapy is not part of the Leukemia treatment there are few new molecules are coming they’re still in the trial process
Blood Cancer Care During COVID
thank you ma’am and as this is now we are in this pandemic of everybody is in the scare of covid so what is that the blood cancer patients need to take precautions so that they don’t get this infection and if at all they delay the treatments what would be the adverse effects so one thing is the common thing what we are seeing now is the delay in diagnosis because of the scare of covid people are coming quite late for confirmation of diagnosis they come through most of the time through emergency and then we confirm leukemia or the most of the covid symptoms are very similar to leukemia they’ve got fever they’ve got shortness of breath and they’ve become anemic so these are the three key things the simple thing early diagnosis is by blood test early blood test CBC any abnormality consult as an outpatient you could do the covid testing beforehand as an outpatient during the treatment somebody has got a positive leukemia they don’t have to worry about covid because leukemia is more life-threatening than the covid so continue your treatments and if we look at all our leukemia patients they’ve not had a higher incidence of covid and we’ve not had patients who have lost U during the leukemia treatment because of the covid most of our patients are well known to take all the precautions what we talk about wearing the mask and taking the precautions and yet another thing a follow-ups is very important people stop treatments and it’s actually the disease coming back which is killing the patients rather than the covid so be aware of these life-threatening conditions and find out alternative Avenues where you can reach out to your doctor it could be uh telephone consults and doing a regular checkups keeping in connection with your doctor if not physically uh from remote and continuing your treatments perhaps you can discuss and reduce your intensity of treatments for a time period but do not stop following up so it’s very important to continue treatment
Services at Apollo Cancer Institute Hyderabad
thank you so much ma’am and please tell audience about the blood cancer treatment available at Apollo Cancer Institute Hyderabad so blood cancer one we believe it has to be very much integrated you need a lot of support from the laboratory from the blood bank intensive care along with a specialist on board and it’s a teamw work and we want to have all the systems in place and Under One Roof so the tests and the procedures are very quick if you had come with a suspected leukemia within 48 Hours within 24 hours you need to confirm your diagnosis you need to get on with your treatment we do not have time to wait for too long so all these processes are available to have a quicker diagnostic modalities inh house and to start the treatment early and if you needed a transplant the same processes are available here at jub Apollo we do very high intensive Milo ablative transplants using total body radiation for a pediatric patients adult patients we do autolus allogenic bone marrow transplants and sibling or unrelated donor Registries we collect donors from datri or International from German Registries we have done many transplants and we do a half match transplants to an extent we moved ahead further doing the tel depleted in order to reduce the complications we do a specific other modalities and uh to to prevent a relapses we use specific cell therapies called donor lymphocytes and if there was a failures you could use a stem cell second transplant or a boost up so all these complicated procedures are done and we have now completed 150 bone marrow transplant at a poo ju Hills we’re very proud to introduce extracorporal photopheresis is the new Avenue for preventing any graft versus host disas so we’re stepping every year to have a new things adding onto a basket and moving on to a very complex uh uh transplants as well
Closing Remarks
thank you thank you so much ma’am and I hope I’ve asked covered everything ma’am if at all I’ve missed out please uh explain us so no I I think you covered most of the things we could sit here and talk the whole day about what is available many people think Leukemia treatment is expensive unfortunately it is expensive and you have to be very open to your doctor discuss your financial situations there are ways you can deal with cut down the cost there may be a small risk people take but some treatments can be delivered as an outpatient with a very close followup perhaps some patients we do an alternate day follow-ups as an outpatient in order to reduce their financial burden and have the little safety thank thank you so much ma’am and thank you dear audience and I would like to make a note so dear audience at all our Apollo Hospital centers We are following strict measures to ensure that you’re entering a covid free zone all our doctors our Frontline Warriors our staff a security staff our nursing staff housekeeping staff everybody are wearing a mask using glos sanitizing their hands and the desks and everything and so that you’re entering a safe Zone and even uh we do take your measures as well like take do your temperature check we even give a mask to the patients if at all you’re not carrying yourself and sanitize your hands before you enter our hospital all our premises are safety so you can be rest assured that you’re entering a CO free uh safe Zone and please don’t delay your treatments or your follow-ups because you might land up in serious troubles other than Co thank you so much ma’am for joining us and clarifying most of the questions that audience have asked we have covered everything and if at all your audience you have missed out anything the causes symptoms or the treatment options diagnostic options once the session is done just rewind the session and you’ll find your answers but still if you have any doubts I’ve already given Dr padja M’s profile Link in the text box on one click you can book appointment and get yourself consulted with Dr pja man and if at all you have still any doubts we will definitely leave an email ID in the text box as well so you can even get in touch with us through an email thank you so much ma’am and thank you dear audience for tuning in
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