Dimorphic Anemia Research Articles

A Study of Clinical, Hematological and Biochemical Profiles of Patients with Pancytopenia

This study aimed to investigate patients’ clinical, hematologic, and biochemical profiles with pancytopenia. This prospective observational study was conducted at a tertiary care hospital from January 2019 to June 2020 on 80 patients, 39 (48.7%) were males and 41 (51.2%) were females, over the age of 18 presenting with pancytopenia. All the patients were subjected to thorough clinical and physical examinations. A complete blood count (CBC), peripheral smear examination, bone marrow aspiration, and reticulocyte count were performed. The data was analyzed using the IBM SPSS 20.0 software. Most of the cases had moderate (Hb<7-9.9g/dl) anemia (63.7%, 51/80 cases), while severe anemia (<7g/dl) was seen in 31.2% (25/80) cases, and 5% (04/80) cases showed mild anemia (Hb<10-11.9g/dl). Most patients with severe anemia had vitamin B12 deficiency anemia (12/80), that is, 15%. Macrocytic anemia was noted in preponderance (50% cases, 40/80), whereas microcytic hypochromic and normocytic hypochromic anemia constituted 21.3% (17/80), and dimorphic anemia was seen in 7.5% (06/80) cases. Based on WBC counts, 56.3% of cases (45/80) showed counts between 2000 and 4000 cells/cu.mm, while counts between 1000 and 2000 cells/cu.mm were seen in 31.3% of cases (25/80), and 12.5% of cases (10/80) had counts of <1000 cells/cu.mm. The study highlighted that 28.8% (23/80) had a platelet count between 50,000 and 1 lakh/cu.mm (mild thrombocytopenia), 36.3% (29/80) cases had a platelet count between 20,000 and 50,000/cu.mm (moderate thrombocytopenia), and 35% (28/80) cases had a platelet count less than 20,000/cu.mm (severe thrombocytopenia). The most common diagnosis of bone marrow aspiration was megaloblastic anemia, seen in 50.0% (6/12) cases. Megaloblasts were seen in 50.0% (6/12) cases of megaloblast anemia. The bone marrow aspirate of a patient with dengue fever and malaria showed macrophages containing engulfed red blood cells, lymphocytes, and platelets. Myeloblasts (>20%) were seen in 1 (8.3%) case of AML, and decreased myelopoiesis was seen in 25% of cases (two cases of aplastic anemia and one case of MDS). This study concludes that vitamin B12 deficiency is the most common cause, which is more common in people who are strict vegetarians, with a predominance in the younger age group. The study also emphasized the vitality of the physical findings, detailed primary hematologic and biochemical investigations, and peripheral blood pictures, all of which provide precious information in the work-up of pancytopenia patients.

Anaemia and selected micronutrient deficiencies among young women in rural North India – A community-based study

ABSTRACT Introduction: Anaemia is a major problem which affects half of young Indian women, impacting their health, education, and offspring. Despite ongoing efforts, a comprehensive understanding of anaemia remains limited. This study aims to assess the prevalence of anaemia among young women in rural Haryana and explore its causes comprehensively, which would help in tailoring targeted interventions for anaemia at a primary health care level. Methods: Young, non-pregnant women aged 15–24 years (n = 422) were assessed for socio-demographic details, menstrual/diet history, and anthropometry. Dietary diversity was assessed using Minimum Dietary Diversity for Women scale. Venous haemoglobin (Hb) was estimated using an auto-analyser. Serum ferritin, folate, and vitamin B12 were assessed for 260 participants. Anaemia was classified based on micronutrient deficiency. The morphology of anaemia was classified based on Red Blood Cell (RBC) indices. Multivariable analysis examined associations of anaemia with socio-demographic and clinical variables. Results: The prevalence of anaemia was 60.7%. Among those participants tested for micronutrient deficiency (n = 260), 170 (65.4%), 48 (18.5%), and 124 (47.7%) participants had deficiency of ferritin, folate, and vitamin B12, respectively. Iron deficiency anaemia (39.1%) and dimorphic anaemia (38.5%) were the two most common types of anaemia. The mixed morphology of RBCs was the most common morphology (41.8%). Almost all participants (98.2%) had inadequate dietary diversity. Being overweight was associated with lesser odds of having anaemia [OR = 0.41; 95% CI: 0.24 – 0.71 (P = 0.01)]. Conclusion: The high magnitude of anaemia is high, and there is a need for nutrition-based interventions for anaemia at a primary health care level among young women in rural India.

A Comparative Study of Peripheral Smear Findings with RBC Indices and Automated Analyzer Generated RBC Histograms in the Diagnosis of Anemia's

Abstract Introduction The red blood cell (RBC) indices generated by cell counters help in the morphological classification of anemia. The importance of microscopic examination of peripheral blood smears (PBSs) stained by Leishman stain cannot be used alone when it comes to interpretation of the underlying cause of anemia. Hence, all three RBC histograms, indices, and microscopic examination of PBSs are very essential for a complete assessment of anemia. Aims and Objectives To diagnose the type of anemia by examination of PBSs, automated cell-generated RBC histograms, and RBC indices and to compare and correlate the findings of RBC indices and automated cell-generated RBC histograms with PBS examination. Materials and Methods This was a prospective comparative study done on 500 cases of anemia for a period of 5 months from August 2023 to December 2023 in a rural tertiary care teaching hospital and all the patients' RBC indices, RBC histogram findings, and PBS findings were noted and analyzed. Results Among 500 samples, normocytic normochromic anemia consists of the majority of the cases 272 (54.4%), followed by microcytic hypochromic anemia cases 183 (36.6%), macrocytic anemia cases 27 (5.4%), normocytic hypochromic anemia were 10 (2%) cases, and dimorphic were 8 cases (1.6%). When compared with RBC histogram, 265 (53.0%) cases showed normal bell-shaped curve, 188 (37.6%) cases showed left shift, 27 (5.4%) cases showed broad based curve, 10 (2%) cases showed right shift, and 10 (2%) cases showed bimodal curve suggesting normocytic normochromic, microcytic hypochromic, normocytic hypochromic anemia, macrocytic, and dimorphic anemia, respectively. Conclusion This study showed a well correlation in the findings of the automated hematology analyzer with the microscopic examination. Histogram alone could be used as a screening method but when combined with RBC indices and PBS findings, they act as useful supplements and by correlating findings of all three, we could diagnose the majority of anemia.

RBC histogram: Useful diagnostic tool in evaluating anaemia

: Anaemia is a widespread public health problem, more common in developing countries. Red blood cell histogram is a vital part for evaluation and diagnosis of anaemia. Histogram can be a useful modality for arriving at the probable diagnosis of anaemia reporting in short span of time.: To observe various RBC Histogram on haematology Analyser in anaemia and analyse the usefulness of RBC Histogram to correlate with peripheral smear.: A prospective study was done in Department of Pathology of Secondary Care hospital from January 2024 to March 2024 on 300 anaemia patients. RBC Histogram were observed, analysed and correlated with peripheral smear. Out of total 300 patients, Most common anaemia is Microcytic Hypochromic (60%), Normocytic normochromic (21.33%), Dimorphic anaemia (12.33%) and macrocytic anaemia (6%). 95.5% microcytic hypochromic anaemia showed left shifted curve, 84.3% Normocytic normochromic anaemia showed normal curve, 88% macrocytic anaemia showed right shift curve. Considering the speed, reliability and less inter observer variation of the modern haematological analysers RBC histogram are important diagnostic tool for various types of anaemia and provide accurate morphological typing of anaemia in most cases hence presumptive report can be released based on RBC histogram.

Importance of bone marrow examination in cases of pancytopenia: A morphological study in a tertiary care center

Background: Anemia, leukopenia, and thrombocytopenia are all combined as pancytopenia. It could be a symptom of many diseases that directly or indirectly impact the bone marrow. The cause of pancytopenia, however, differs depending on the location. An essential step in determining the cause of pancytopenia is bone marrow aspiration (BMA). Aims and Objectives: This study aimed to determine the causes of pancytopenia and the morphology of the bone marrow in pancytopenia patients. Materials and Methods: This study was carried out over a year in the pathology department of a tertiary care facility in central India. Patients taking chemotherapy or radiation therapy were excluded from the study. Inclusion Criteria: Cases with hemoglobin <10 g/dL, total leukocyte count <4000/mm3, and platelet count <100,000/mm3 were included in this study. The patient’s posterior iliac crest was used for BMA. The Leishman stain was used to color BMA smears for microscopy. Results: This study comprised 51 cases of pancytopenia, with acute leukemia and megaloblastic anemia accounting for the majority (11 cases each out of 51), followed by dimorphic anemia (10/51), hypocellular marrow (9/51). The clinical symptom of generalized weakness and pallor was present in all instances (100%) and was followed by fatiguability (72%) and dyspnea (48%). The last two least frequent symptoms, lymphadenopathy, and hepatomegaly, were also present in many patients. A significant proportion of pancytopenia individuals experienced lymphadenopathy and hepatomegaly, which were the last two least prevalent appearances. Conclusion: In most cases, bone marrow aspiration in pancytopenia patients aids in determining the underlying reason. Understanding the illness process, planning future research, and managing cytopenia patients can all benefit from it.

AYURVEDIC INTERVENTION IN THE MANAGEMENT OF PANDU ROGA (DIMORPHIC ANAEMIA)

Pandu Roga is an Ayurvedic ailment clinically comparable to many types of Anaemia. This study was done to establish the effect of Ayurvedic management on the patient of Pandu Roga (Dimorphic Anaemia). In the IPD, Arogyashala Rugnalaya, Nashik, from 08/01/2022 to 17/01/2022, A 69-year Male patient, suffering from Pandu Roga (Dimorphic Anaemia) was treated with Ayurvedic management. Shamana Chikitsa (ayurvedic medicinal treatment) And Virechana Karma (Therapeutic Purgation) were administered. The patient felt a significant increase in Hb g% and other hematological investigations. Symptoms were assessed as per the criteria of assessment, and improvement was seen in symptoms. Panduta (Pallor) 75%, Daurbalya (General weakness) 75%, Ayasaja Shwasa (Dyspnoea on exertion) 66.66%, Pindikodveshtana (Leg cramps) 50%, Nidraluta (Sleepiness) 50%, Shiroruk (Headache)100%, Bhrama (Giddiness)0%, Sadana (Fatigue) 66.66%, Gatra Shoola (Body aches) 66.66%, Agnimandya (Impaired appetite) 66.66%, Aruchi (Anorexia) 66.66%. This case study demonstrates that Ayurvedic management was significant in Pandu Roga (Dimorphic Anaemia).

Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia. : The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.

Red Cell Histograms and Spurious Parameters in Anemia – Study of Diagnostic Utility of Autoanalyzer Results

BACKGROUND: Red blood cell (RBC) histograms generated by automated hematology analyzers have shown characteristic patterns useful in identifying the different red cell populations and give diagnostic clues. Although the analyzer results are precise, spurious results have been reported owing to preanalytical and analytical variables which warrant the evaluation of validity of other parameters. AIMS: The study was meant to evaluate the diagnostic utility of red cell indices and histograms in the morphological diagnosis of anemia and to interpret the spurious values generated by autoanalyzers. SETTINGS AND DESIGN: A retrospective cross-sectional study was undertaken including 917 cases of anemia. MATERIALS AND METHODS: The histograms and the red cell indices generated by autoanalyzer Mindray CAL-6000 were studied in all cases and correlated with peripheral smear. STATISTICAL ANALYSIS USED: Analysis was done using Mann–Whitney U-test for medians and interquartile range of numerical variables and Chi-square test/Fisher’s exact test for categorical variables. RESULTS: Characteristic patterns were observed in histograms such as left shift, right shift, and bimodal peaks in microcytic hypochromic anemia, macrocytic anemia, and dimorphic anemia, respectively. Spurious parameters in the study comprised high red cell indices, low RBC count, hemoglobin, and hematocrit mismatch in cases of autoimmune hemolytic anemia. Spuriously high mean corpuscular volume was associated with reticulocytosis. In vitro hemolysis was identified by factitious thrombocytosis with abnormal platelet and RBC histograms. CONCLUSION: Histograms when combined with red cell indices are of practical utility in differentiating the various morphologic types of anemia and are speculative in alerting the hematologists about the spurious parameters, forming an indispensable diagnostic tool.

Dimorphic Anaemia: A Comprehensive Analysis through a Case Study

Dimorphic Anaemia: A Comprehensive Analysis through a Case Study

Screening of antenatal patients for anaemia and haemoglobinopathies

Introduction: Anaemia is an extremely common condition in pregnancy worldwide, conferring a number of health risks to mother and child. Iron deficiency is most widespread micronutritional deficiency in the world and disproportionately affects female because of increased iron requirements during menstruation, pregnancy and lactation. Haemoglobinopathies are a group of inherited disorders because of abnormalities in haemoglobin synthesis or structure. Thalassemia and Sickle cell anaemias are the most prevalent haemoglobinopathies and a national health burden in India so identifying these disorders during antenatal period is necessary to take appropriate measures. Methods: A prospective study of screening for haemoglobin variants in Antenatal Patients due to low haemoglobin and evaluation of other causes was performed for 1 year with 570 samples. In Low Hb patients’ CBC, Reticulocyte staining and sickling test was performed. Haemoglobin analysis was done by HPLC BIO RAD VARIANT II. In Iron Deficiency Anaemia (IDA) Serum ferritin & Serum Iron level were done and in Megaloblastic Anaemia(MA) Vitamin B12 level were done. Result: Prevalence of anaemia in antenatal patients was 90.25%; in this IDA presented with 84.21%, MA with 4.73% and Dimorphic anaemia 1.27%. Prevalence of haemoglobinopathies in this study was 9.75%; in this Beta Thalassemia Minor present with 5.08%, Sickle Cell Trait 4.03%, Hb D Punjab 0.52% and Hb Q india 0.17%. Conclusion: Antenatal screening for genetic disorders, such as Beta thalassemia, Sickle Cell Anaemia, aims to reduce the burden of these diseases by offering information to individual with a high likelihood of giving birth to affected babies and giving parents more choices regarding their reproductive decisions. For this, premarital and antenatal screening should be mandatory to prevent the birth of affected offspring.

PANCYTOPENIA: A CLINICO-HEMATOLOGICAL STUDY IN A TERTIARY CARE CENTRE

Pancytopenia is a clinico-haematological entity often seen in clinical practice as a characteristic of various diseases, vary from non-malignant as drug-induced pancytopenia, nutritional deciencies or infections, to malignant neoplasms. The aim of this study was to evaluate Aim: pancytopenia's clinico-hematological prole. The study was conducted in the depart Materials and Methods: ment of pathology of our college. A prospective study was carried out among 100 patients of pancytopenia. Clinical ndings, CBC & bone marrow examination were performed. Result: Out of 100 cases, 65% were megaloblastic anemia, 11% were dimorphic anemia. Generalized weakness seen in 85% cases. Pallor was present in all cases of pancytopenia. The present study concludes that the e Conclusion: arly hematological investigations along with clinical and bone marrow examination of pancytopenia are helpful in understanding the disease process and to diagnose and to rule out various causes of pancytopenia

Ameliorative Ability of Cyperus esculentus (Tiger Nut) and Phoenix dactylifera (Date Palm) Fruits on Blood Haematology and Film of Wistar Rats in Titanium Dioxide Nanoparticles Ingestion Episode

The present study investigated the ameliorative ability of Cyperus esculentus and Phoenix dactylifera fruits on blood haematology and film of wistar rats in titanium dioxide nanoparticles ingestion episode. 25 rats randomly distributed into five (5) groups were orally administered with varying combinations of titanium dioxide and tiger nut and date palm fruits extracts for 60 days, after which blood was collected for hematological and blood film analysis following standard methods. Hematological analysis showed that titanium dioxide nanoparticles caused a decrease in white blood cell (6.52%), granulocyte (56.06%), hemoglobin (3.10%) and hematocrit (15.47%) with an increase in lymphocyte (0.52%), monocyte (48.51%), red blood cell count (7.53%), platelet count (24.21%) and plateletocrit (37.93%) of wistar rats when compared with the control. Leishman-stained blood film revealed the presence of mild to moderate dimorphic anaemia, polychromatic morphology with some macrocytic cells and aggregated thrombocytes in the blood film of rats administered TiO2NP. There was no significant ameliorative impact of C. esculentus and Phoenix dactylifera extract against TiO2NP toxicity. This may be due to the small particle size and reactive nature of titanium dioxide nanoparticles. The findings of this study indicate that titanium dioxide nanoparticles negatively impacted blood hematological parameters in male wistar rats. Titanium dioxide nanoparticles should be handled and treated carefully to avoid potential health hazard in animals.

Clinico-Etiological and Clinico-Haematological Study of Patients with Pancytopenia in Rural Area

Abstract Background Pancytopenia is a manifestation of other underlying conditions, commonly associated with multiple benign and malignant conditions. Any patient presenting with pancytopenia requires a thorough evaluation to identify the underlying aetiology. Aim This current evaluates various hematological parameters including bone marrow aspiration (where ever feasible) in pancytopenia in adult group. Study also correlates clinico-haematological profile. Method Fifty patients with a hematological diagnosis of pancytopenia were studied during the period August 2020 to August 2022. The study included adult patients of both sexes having the age of 18 years and above. Tests for complete blood count, reticulocyte count, peripheral smear, bone marrow aspiration, and trephine biopsy were done. Results Various etiological factors were identified in which majority were of megaloblastic anaemia (48.9%), followed by mixed nutritional anaemia (22.2%), hypersplenism (13.3%), aplastic anaemia (8.9%), malignant conditions (6.7%), myelodysplastic syndromes (2%), and others (4%) respectively. Megaloblastic anaemia cases observed in the age group of 31–50 years with male preponderance. Hemoglobin, TLC, Platelet count, and Reticulocyte count ranged from 2 g% - 10g%, 500–4000 cells/cumm, 24,000–1.5 lakh cells/cumm, and 0.1% – 2%. MCV was higher than 100 fl in 57.5% of cases. Majority of the patients had macrocytic and dimorphic anaemia. Hypersegmented neutrophils were present in all the patients. Bone marrow of Megaloblastic anaemia was hypercellular. Megaloblastic erythropoiesis with giant meta- myelocytes and band forms were seen. Nutritional anaemia seen in the age group of 51-60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 2.3 g%–7.8 g%, 1000–4000 cells/cumm, 5000–1.4 lakh cells/cumm, and 0.1–8%. Two cases had microcytic hypochromic anaemia in Nutritional anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 93.8% of cases. In hypersplenism seen in the age group of 51–60 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.8 g% – 10 g%, 1700–3800 cells/cumm, 26000-1.4 lakh cells/cumm, and 0.6–2% respectilvey in hypersplenism. 40% of hypersplenism patients had microcytic hypochromic anaemia. Bone marrow was hypercellular with a reversal of M:E ratio in 70% of hypersplenism cases. Aplastic anaemia seen in the age group of 41–50 years. Haemoglobin, TLC, Platelet count, and Reticulocyte count ranges from 3.1–10 g%, 1100–4000 cells/cumm, 51000–1.5lakh cells/cumm, and 0.2%–1.8%. Aplastic anaemia (35.8%) cases showed macrocytosis. Bone marrow was hypocellular with an increase in marrow fat and Lymphocytes and plasma cells were prominent in Aplastic anaemia cases. Leukaemia commonly seen in the age group of 31–40 years with male predominance. Hemoglobin, TLC, and Reticulocyte count ranges from 5.1–9.8%, 1100–4000 cells/cumm, and 0.6–2% respectively. Bone marrow was hypercellular with a reversal of M:E ratio in 80%. Conclusion Megaloblastic anaemia was the commonest cause of pancytopenia. Most other studies have reported aplastic anaemia as the commonest cause. This seems to reflect the higher prevalence of nutritional anaemia in the Indian subjects. The haematological parameters and bone marrow morphological features in patients with megaloblastic anaemia, aplastic anaemia, and malignant diseases including MDS in the present study were comparable to the findings by other authors. Uncommon etiological factors like dengue fever and hemolytic anaemia were identified in this study. A comprehensive clinical, haematological, and bone marrow study of patients with pancytopenia usually helps in identification of the underlying cause. However, in view of a wide array of etiological factors, pancytopenia continues to be a challenge for hematologists.

Ramifications of Pancytopenia in Children in a Tertiary Care Center in North Indian

BACKGROUND: Pancytopenia generally suggests the likelihood of bone marrow failure syndromes or leukemias. However, other easily treatable entities can also cause pancytopenia. To know the underlying cause of pancytopenia is essential for definite management and prognosis. AIM: The aim of this study is to study the prevalence, clinico-hematological profile, and etiology of pancytopenia in hospitalized children of 1 month to 18 years of age. METHODS: Descriptive study conducted in a tertiary care center included children of age 1 month to 18 years hospitalized with pancytopenia. Sociodemographic data, presenting complaints, and detailed history were noted. Detailed clinical examination and relevant investigations were done. RESULTS: The prevalence of pancytopenia was 2%. Majority of the patients were >10 years of age. Female: Male ratio was 1.15:1. The most common presentation was progressive pallor, followed by fever, icterus, and bleeding manifestations. The most common clinical examination finding was pallor, followed by splenomegaly, hepatomegaly, icterus, and lymphadenopathy. Macrocytic blood picture was most common, followed by microcytic, atypical cells, and normocytic picture. Mean serum ferritin (ng/ml) was 374.77 ± 1662.64. Mean serum B12 (pg/ml) was 117.72 ± 64.71. In bone marrow aspirate examination, megaloblastic erythropoiesis was most common, followed by normoblastic erythropoiesis, dual deficiency, malignant cells of lymphoid series, hypocellular marrow, and malignant cells of myeloid series. Megaloblastic anemia was the most common etiology, followed by dimorphic anemia amid acute leukemia. CONCLUSION: The study showed that megaloblastic anemia and infections (tuberculosis, dengue fever, and enteric fever) both of which are eminently treatable, cause nearly 65% of pancytopenia cases in pediatric patients.

CORRELATION OF PERIPHERAL SMEAR WITH RBC INDICES AND RBC HISTOGRAM IN THE DIAGNOSIS OF ANAEMIA IN TERTIARY CARE CENTRE

Introduction : Anaemia is a decrease in the oxygen-carrying capacity of the blood. RBC histogram is a standard part and is routinely generated by automated cell analyzers. The well-known Coulter principle of counting and sizing the cells provides a basis for generating a histogram. The peripheral blood smear has been the main diagnostic aid in establishing the etiology of anaemia. Examining the blood lms routinely has facilitated the interpretation of various haematological disorders. Materials and Methods: The present study was carried out in the haematology laboratory of Kamineni Institute of Medical Sciences, Narketpally over a period of 3 months. EDTA blood samples from 100 anaemic patients were run in a six-part Sysmex analyzer and peripheral smears were prepared and examined. Results: A total of 100 patients with peripheral blood smear and RBC histogram from automated analyzer were studied. Out of 100 patients, 60% were females and 40% were males. Normocytic normochromic anaemia (50%) was the most commonly observed anaemia in the present study followed by microcytic hypochromic anaemia (40%). Most common histogram pattern observed was normal bellshaped curve. In normocytic normochromic anaemia (50%), the majority of the cases show a normal bell-shaped curve (37%) and the remaining 13% of cases showed broad-based curve. In microcytic hypochromic anaemia (40%) most common histogram pattern observed was shift to the left. In dimorphic anaemia (8%) histogram pattern observed was bimodal peak with a broad base. In macrocytic anaemia (2%) most commonly seen histogram pattern was shift to the right. Conclusion: Histogram plays an additional role with peripheral smear for diagnosing RBCs disorders. Even in the age of molecular analysis, the blood smear examination remains an important diagnostic tool.

EVALUATION OF PANCYTOPENIA WITH BONE MARROW INTERPRETATION

Background: Pancytopenia is one of the most common clinico-haematological entity observed in our day to day clinical practice. It is a disorder in which all the three major elements of blood (i.e. red blood cells, white blood cells and platelets) are decreased in number. The causes of pancytopenia may be due to decrease in hematopoietic cell production in the marrow resulting from infections, toxins, malignant cell inltration, post- chemotherapy or post-radiation. Aims and Objectives: 1) To study the etiology and clinical presentation of pancytopenia in all age groups. 2) To correlate with bone marrow interpretation Materials & Methods: This is a prospective study which was conducted among 50 patients of pancytopenia in the Clinical Pathology, Government General Hospital,Kurnool from January 2021 to October 2022 Bone marrow aspiration was done by using Salah's bone marrow puncture needle. Smears were made from bone marrow aspirate (BMA) and stained by Leishman stain and special stains like Perl`s wherever necessary. The smears were assessed for cellularity, differentiation and maturation of erythroid, myeloid and megakaryocytic lineage, M:E ratio, Plasma cells, Lymphocytes and parasites/ abnormal cells. In the present study the commonest cause of Pancytopenia was Megaloblastic anemia (70%) follo Results: wed by Dimorphic anemia (20%). The less common conditions were Multiple Myeloma (6%),Chronic Myeloid Leukemia(2%),Acute Leukemia(2%). The present study concludes that com Interpretation and Conclusion: plete primary hematological investigations along with bone marrow aspiration in pancytopenic patients are helpful for understanding disease process and to diagnose or to the rule out causes of pancytopenia. These are also helpful in planning for further investigations and management.

Correlation of automated cell counter RBC histograms and peripheral smear in anemia typing

Background: Red blood cell (RBC) indices and histogram obtained from automated hematology gives an idea about the morphological changes in anemia and therefore forms the fundamental process for diagnosis of anemia. Along with the peripheral smear, they can be used for anemia typing and to interpret the cause of anemia. Aims and Objectives: (1) Interpretation of histograms in normal persons and patients with different types of anemia. (2) Anemia typing based on RBC histograms complemented with Peripheral smear examination. Materials and Methods: The present prospective study is conducted in Haematology section of Department of Pathology, Shyam Shah Medical College and Sanjay Gandhi Medical Hospital Rewa, Madhya Pradesh. A total of 1000 patients blood sample is collected for complete blood count and anemia typing irrespective of age and gender and examined over a period of 1 year from August 2021 to July 2022. The patient’s blood sample is collected in EDTA vacutainer and analyzed on the basis of histogram obtained and peripheral smear slide prepared. Results: In the present study, we noted that the predominant age group affected was 20–30 years. Peripheral smear finding shows normocytic normochromic anemia was seen in 6% cases (60/1000), microcytic hypochromic anemia seen in 24.2% cases (242/1000), macrocytic anemia seen in 14% cases (140/1000), dimorphic anemia seen in 50.2% cases (502/1000), and hemolytic anemia seen in 5.6% cases (56/1000). This peripheral smear finding shows well correlation with findings of histogram pattern and RBC indices, where normocytic normochromic seen in 6.4% of cases (64/1000), microcytic hypochromic anemia seen in 24.4% of cases (244/1000), macrocytic anemia seen in 13.8% of cases (138/1000), dimorphic anemia seen in 49.5% of cases (495/1000), and hemolytic anemia seen in 5.9% of cases (59/1000). The most common anemia is dimorphic anemia (combined nutritional deficiency) in 49.5% cases followed by microcytic hypochromic anemia in 24.4% of cases based on histogram findings along with RBC indices. Conclusion: Histogram guides a technologist about the cases that need actual detailed peripheral smear examination by experts. Our study shows a well correlation in findings of automated hematology analyzer with the microscopic examination. Histogram alone could be used as screening method and when combined with peripheral blood smear findings, they act as useful supplement and by correlating findings of both methods, we could diagnose majority of anemia.

EFFECT OF ASSOCIATION OF THROMBOCYTOPENIA WITH ANEMIA ON FETO-MATERNAL OUTCOME

Objectives: To find out effect of association of thrombocytopenia with anemia on feto-maternal outcome. Background: Thrombocytopenia is defined as platelet count less than 150,000/mm3. It is a second common hematological disorder in pregnancy, anemia being the most common. The exact mechanism of Anemia and Thrombocytopenia is not well understood. There is scarcity of literature on association between Anemia and Thrombocytopenia. Pubmed mostly revealed case reports and case series with only a few studies related to our topic. It is pertinent to mention here that most of the studies have been conducted on Paediatric age group. Therefore, the present study is planned to evaluate the effect of association of thrombocytopenia with anemia on feto-maternal outcome. Methodology : The study was conducted after taking informed consent from the patients in the Department of Obstetrics and Gynaecology, with the collaboration of Department of Pathology and Department of Pediatrics, JNMCH, AMU, Aligarh (U.P) on 360 pregnant women at 26-32 weeks of gestation. Complete Blood Count (CBC) and Red cell indices were calculated by Automated Haemotology (H3D Premier Diagnova) Analyzer. Type of anemia was determined on the basis of general blood smear and on indices. Appropriate therapy was given and response seen after 4 to 6 weeks. During labour and after delivery, feto-maternal outcome was evaluated. All the qualitative variables were analyzed using Pearson Chi square test while all quantitative variables were analyzed using independent sample test and Kruskal-Wallis one-way ANOVA test. Results: The association of thrombocytopenia with anemia was highest in cases of dimorphic anemia and lowest in cases of megaloblastic anemia while only 15% of control were having thrombocytopenia in the present study. The maternal outcome in terms of preterm labor, PPH, duration of hospital stay after delivery, maternal sepsis, DIC, bleeding from any other site between cases and controls was not significant. Fetal outcome between cases and controls in terms prematurity, birthweight, neonatal infections, NICU admissions, intracranial hemorrhage, still births was not statistically significant. Only the mean 1 minute Apgar score was lower in cases as compared to controls and this was statistically significant. Conclusion : It can be concluded that there is an association that exists between hemoglobin and platelet count. Appropriate therapy corrects anemia and improves platelet count. Timely detection and correction of anemia with thrombocytopenia reduces intrapartum and postpartum complications. In order to reduce maternal and neonatal morbidities, careful surveillance is required of all pregnancies for early detection and treatment of anemia.

Incidentally Detected Anaemia in Elderly: A Cross-sectional Study from a Tertiary Care Hospital, Pune, Maharashtra, India

Introduction: Iron Deficiency Anaemia (IDA) is most prevalent nutritional deficiency observed worldwide. The elderly population is particularly susceptible. It is a significant risk factor for increased mortality and morbidity, reducing mobility and quality of life. Currently less Indian data is available for incidentally detected anaemia in elderly. The known causes of anaemia in elderly are nutritional, anaemia of chronic disease and malignancy. Aim: To evaluate the haematological profile and to identify potential aetiologies of anaemia in elderly who had an incidental diagnosis of anaemia. Materials and Methods: This was a prospective cross-sectional observational study, which included 90 incidentally diagnosed patients with anaemia above 60 years of age, admitted in Bharati Hospital and Medical College, Pune, Maharashtra, India during March 2021 to September 2022. Complete Blood Counts (CBCs) with peripheral blood smear, Haematocrit (Hct), reticulocyte counts, Red Blood Cells (RBC) indices like Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin (MCH) and cell morphology were all examined for each patient. The statistical programme Statistical Package for the Social Sciences (SPSS) (version 26.0) was used to analyse the data. The Chi-square test was used to evaluate the qualitative parameters. Results: The mean age was 66.44±5.87 years; 52 (57.8%) were men, and 38 (42.2%) were women. The most prevalent co-morbid conditions were diabetes and hypertension. The common clinical signs observed were pallor, oedema, knuckle pigmentation. In this study, IDA was the most frequent aetiology 53 (58.9%), second being megaloblastic anaemia 24 (26.7%), followed by dimorphic anaemia 13 (14.4%). Gastritis was commonest finding on gastroscopy. Conclusion: Anaemia is a common finding amongst elderly population which remains undiagnosed and is ignored. The main cause is nutritional deficiency leading to IDA, megaloblastic anaemia or dimorphic anaemia. Hence, geriatric population should undergo regular screening for early recognition of anaemia. Further large population studies are required for detailed evaluation to determine the causes of anaemia in elderly.

A Cross-Sectional Study of Lipid Profile in Anemic Patients in a Tertiary Care Center

Background: Various studies have reported a correlation (both positive and negative) between the status of anemia and lipid profile. Studies observed that the lipoproteins levels were significantly lower in anemic patients, and this reduction was proportional to the severity of anemia and not related to the type of anemia. Objectives: To study the lipid profile among the anemia patients and the correlation between the severity of the anemia and lipid subfractions. Materials and Methods: This is a cross-sectional study among 85 subjects with anemia in a Tertiary care hospital, who satisfied the eligibility criteria. After detailed history, clinical examination and blood investigations including blood counts, hemoglobin, and lipid profile were done. Results: The mean hemoglobin (g/dL) among the subjects was 7.86 (±2.03) g/dL ranging from 3 to 11 g/dL. Among the 85 subjects, 35 (41.18%) had dimorphic anemia followed by 21 (24.71%) had microcytic hypochromic anemia, 15 (17.65%) had normocytic hypochromic anemia, and 14 subjects (16.47%) had normocytic normochromic anemia. Body mass index was not significantly associated with the type and severity of anemia. Lipid subfractions were not associated with the type of anemia and significantly decreased with an increase in the severity of anemia. Conclusion: The lipid profile parameters in our study were not associated with type of anemia and significantly decreased with an increase in the severity of anemia.