Peripheral Blood Smear Examination Research Articles

Idiopathic Immune Mediated Haemolytic Anaemia (IMHA) in a 2.5-Month-old Puppy: A Case Report

Background: A 2.5-month-old puppy was presented to the Veterinary Clinical Complex of the College of Veterinary Sciences and AH, Jalukie, Nagaland with a complaint of emesis for one week, inappetence, icterus of the lower abdominal area and other visible mucous membrane. Detailed clinical history was collected and clinical examination was conducted. Methods: 4 ml blood peripheral blood was collected from the cephalic vein in the Lev-Lock blood clot activator vacutainer to harvest serum for biochemical analysis. Another 2 ml of whole blood was also collected in Lev-Lock K3 EDTA vacutainer for complete blood count, blood smear examination for blood parasites, morphological changes in the RBC and IDEXX SNAP 4Dx Plus test kit was also used for diagnosis of the blood parasites test. Result: Peripheral blood smear examination and IDEXX SNAP 4Dx Plus test were found to be negative for blood parasites, but spherocytosis could be observed in the blood smears. A complete blood count (CBC) examination revealed severe anaemia of macrocytic normochromic type, neutrophilic leucocytosis and thrombocytopenia. Serum biochemistry revealed a decrease in blood urea nitrogen (BUN) and creatinine with normal alanine transaminase (ALT). Treatment with whole blood transfusion, corticosteroid and other supportive therapy was successful in this case. Based on the clinical presentation, laboratory findings and its response to the treatment with prednisolone, it was diagnosed as an idiopathic immune-mediated haemolytic anaemia (IMHA) with an extravascular mechanism of haemolysis. A follow-up review after 1 year and 4 months post-treatment reported that the dog was still alive and healthy.

HAEMATOLOGICAL PROFILE AND MENTZER INDEX IN PEDIATRIC PATIENTS PRESENTING WITH ANEMIA

Objective: The objective of this study was to analyze clinical and hematological profile of children with anemia and determine the Mentzer index of all cases presenting with anemia. Methods: This was a cross-sectional observational study conducted in the Department of pediatrics of a tertiary care medical college. Eighty pediatric age group patients diagnosed to be having anemia on clinical examination were included in this study. Demographic details such as age and gender were noted in all cases. A through history was obtained and a clinical examination was done. Presenting complaints were also noted. Complete blood count with peripheral blood smear examination was done in all cases. The Mentzer index was determined from complete blood count reports. Results: Out of 80 studied cases, there were 57 (71.25%) boys and 23 (28.75%) girls. The mean age for boys was 9.12±3.14 years and for girls, it was slightly higher at 10.24±3.46 years. Fatigue (73.75%), pallor (71.25%), and anorexia (56.25%) were common complaints. About 55% had mild anemia 22.5% had moderate anemia and 22.5% suffered from severe. Mean hemoglobin concentration of studied cases was found to be 8.42±3.98 g/dL. The most prevalent blood picture was the normocytic normochromic blood picture, representing 60% of cases. Mentzer index ranged from a minimum of 10.83 to a maximum of 27.76, with the mean value being 17.40±2.92. Notably, the vast majority of patients (97.5%) had a Mentzer Index >13, suggesting a high prevalence of iron deficiency. Conversely, only 2.5% of the patients had a Mentzer Index at or below 13, indicating a much smaller subset in whom Hb electrophoresis was needed to rule out thalassemia trait. Conclusion: Although most of the children with anemia are secondary to iron deficiency Mentzer index should be determined in all patients of anemia so as to avoid inadvertently prescribing iron supplementation in cases of thalassemia trait.

Comparison of platelet count by automated hematology analyzer and peripheral blood smear in thrombocytopenic patient

Platelet count estimation is one of the common as well as important laboratory investigations to diagnose many diseases like dengue, malaria etc. Different methods for platelet estimations are automated haematology analyzer, peripheral blood smear examination method etc. Most common causes of inaccurate platelet count by automated analyser are the presence of giant platelets, platelet clumps etc. leading to erroneous result like false low platelet count etc. We aimed to compare platelet count estimation by automated haematology analyzer and the peripheral blood smear examination in thrombocytopenic patients. A comparative cross-sectional study was conducted on 100 blood samples of patients which came thrombocytopenic on automated haematology analyzer. Each case was also analyzed by peripheral blood smear examination and compared with its corresponding automated haematology platelet count value. Our study included 63% males and 37% females, with the mean age of 38.8 years. Most of the patients belonged to the age group of 30-40 years (34%). The mean platelet count on automated analyzers was 85.46 ± 38.81 x 103/uL whereas on peripheral smear was 92.13 ± 38.30×103/uL with a significant difference between the two groups (p-value <0.0001).Pseudo-thrombocytopenia was observed in 10% of patients, with giant platelets observed in 29% of the cases on blood smear. In view of false low platelet count by automated analyser, we concluded that manual examination by peripheral blood smear examination should always be considered whose platelet count is low by automation.

Acute Myeloid Leukemia in a Three-Year-Old Girl Mimicking Chronic Myeloid Leukemia in Blast Crisis, Challenge in Diagnosis and Treatment in Limited-Resourced Health Care Facility: A Case Report

Introduction: : Acute myeloid leukemia (AML) is the second most common hematologic cancer in childhood. Clinically, AML has similar symptoms to other types of leukemias, and diagnosis remains a challenge due to limited access to pediatric hemato-oncology diagnostic examination. This study aims to report AML in a 3-year-old girl who was first suspected of Chronic Myeloid Leukemia (CML) in blast crisis, using a combination of clinical-hematology parameters and conventional morphology examination in a limited-resourced healthcare facility. Case Presentation: A 3-year-old girl was referred from a rural Eastern Indonesia hospital with symptoms of prolonged fever, leucocytosis, severe anemia, and severe thrombocytopenia. In the previous hospital, the patient had a history of hyperleukocytosis and peripheral blood smear suspected of CML in blast crisis. A peripheral blood smear was repeated in our hospital and showed findings of Auer rod cells suggesting AML. Two bags of packed red cells and 2 thrombocyte concentrations were administered before referral for further diagnostic evaluation with bone marrow aspiration. Bone marrow aspiration revealed multiple nucleoli suggested for AML with FAB classification as M4 subtypes, and she received chemotherapy in a tertiary hospitalConclusions: With limited resources, suspicion based on persistent clinical symptoms, routine hematology tests, and peripheral blood smear examination are important to distinguish AML from CML in blast crisis. Understanding clinical hematology parameters and peripheral blood smears is the first step in AML diagnosis pathway and decision for further diagnostic referral. Supportive therapy and early recognition of oncologic emergency must be done before referral to a tertiary referral hospital.

Positive correlation of glomerular filtration rate with burr cells on peripheral blood smear examination in patients with chronic kidney disease

Positive correlation of glomerular filtration rate with burr cells on peripheral blood smear examination in patients with chronic kidney disease

A Review of Three Cases of Primary Plasma Cell Leukemia: Incidental Finding Discovered by Blood Smear Revision

Introduction: Plasma cell leukemia (PCL) is the most aggressive variant of the monoclonal gammopathies (MG). Its diagnosis is based on standard morphological examination of peripheral blood, by finding plasma cells with an atypical morphology. The International myeloma working group (IMWG) has updated the diagnostic criteria for PCL considering that patients with newly diagnosed MG with 5% or greater plasma cells in peripheral blood should be considered as PCL. Case report: We present three cases of primary PCL that were admitted to the hospital due to the study of an anaemia and whose diagnosis was an incidental finding. All the patients had >5% of circulating plasma cells, whose clonality and aberrant phenotype was determined by peripheral and blood marrow flow cytometry immunophenotype and all of them had high-risk cytogenetics related with a poor and adverse outcomes of the disease. Discussion: This cases highlight the importance of peripheral blood smear revision, because the identification of aberrant plasma cells leaded the diagnosis of the MG and the patients were able to start treatment as soon as possible. Carefully examination and interpretation of peripheral blood smear should be always performed, with special attention in patients with a suspicion of MG, because with the new IMWG definition, it is possible that this entity is underdiagnosed.

Pancytopenia in Pediatric Population: An Etiological and Haematological Analysis in a Tertiary Care Hospital, TS

Pancytopenia is a haematological condition rather than a disease, where the RBC, WBC and platelets are decreasedin a patients blood. If one has pancytopenia it means there is an underlying cause responsible for it .Diagnosticevaluation of pancytopenia requires detailed clinical history, physical examination, haematological investigationsincluding thorough peripheral blood smear and bone marrow examination. Pancytopenia is a serious condition,which should not be ignored. Prompt treatment is required. The etiological causes vary from simple causes to lifethreatening conditions. So early recognition of the causes helps in improving the prognosis of the patients.

Evaluation of Pancytopenia in Adults

Introduction: Pancytopenia, simultaneous presence of anemia, leucopenia and thrombocytopenia, is a commonclinical entity that we see in day to day practice Proper diagnostic evaluation requires detailed clinical history,physical examination and haematological assessment including careful peripheral blood smear examination andbone marrow evaluation.Materials and Methods: A total of 80 adult patients with pancytopenia/bicytopenia presenting between January2021 to January 2022 were included in the study. All patients underwent detailed clinical history and physicalexamination. Careful peripheral blood smear examination, CBC and bone marrow aspirate was done in all. Bonemarrow biopsy was done wherever feasible.Results: Megaloblastic anemia was the commonest cause of pancytopenia/bicytopenia making up 37.5% of allcases followed by erythroid hyperplasia (20%), aplastic anemia (10%). Haematological malignancies accounted for23.75% cases of the total. Bone marrow biopsy aided in the diagnosis of 8 cases (6 cases of aplastic anemia and twocases of dry tap) while in others it was concordant with aspiration findings.Conclusion: Bone marrow aspiration and biopsy are an important adjunct to peripheral smear examination forevaluation of cytopenias. Bone marrow trephine biopsy is helpful in cases of dry tap. We also conclude that thereis high prevalence of megaloblastic anemia due to nutritional deficiency among young population. Hence, this agerange should be the prime target for education regarding proper dietary habits, the remediation of which mightreduce the clinical burden of megaloblastic anemia.

Bio-net dataset: AI-based diagnostic solutions using peripheral blood smear images

Peripheral blood smear examination is one of the basic steps in the evaluation of different blood cells. It is a confirmatory step after an automated complete blood count analysis. Manual microscopy is time-consuming and requires professional laboratory expertise. Therefore, the turn-around time for peripheral smear in a health care center is approximately 3–4 hours. To avoid the traditional method of manual counting under the microscope a computerized automation of peripheral blood smear examination has been adopted, which is a challenging task in medical diagnostics. In recent times, deep learning techniques have overcome the challenges associated with human microscopic evaluation of peripheral smears and this has led to reduced cost and precise diagnosis. However, their application can be significantly improved by the availability of annotated datasets. This study presents a large customized annotated blood cell dataset (named the Bio-Net dataset from healthy individuals) and blood cell detection and counting in the peripheral blood smear images. A mini-version of the dataset for specialized WBC-based image processing tasks is also equipped to classify the healthy and mature WBCs in their respective classes. An object detection algorithm called You Only Look Once (YOLO) with a refashion disposition has been trained on the novel dataset to automatically detect and classify blood cells into RBCs, WBCs, and platelets and compare the results with other publicly available datasets to highlight the versatility. In short the introduction of the Bio-Net dataset and AI-powered detection and counting offers a significant potential for advancement in biomedical research for analyzing and understanding biological data.

An isolated case of pseudothrombocytopenia due to platelet satellitism with the review of literature

Abstract Platelet interaction with neutrophil polymorphs happens rarely, forming platelet aggregates like rosettes/beads around neutrophils, an uncommon phenomenon called ‘platelet satellitism’ (PS). It has been observed in peripheral blood smears prepared from blood samples anticoagulated with ethylene diamine tetra-acetic acid, but not in blood samples treated with heparin or sodium citrate. Automated hematology analyzers in present times have increased the reproducibility and accuracy of platelet counts, they may not completely resolve pseudothrombocytopenia. Being a rare cause of spurious thrombocytopenia, it might mislead the clinician into unnecessary investigations and treatment. To avoid false reporting of low platelet count, the peripheral blood smear examination should be performed in all patients with thrombocytopenia. PS usually occurs around neutrophil granulocytes and only in extremely rare cases are platelets phagocytosed by neutrophils, forming rosettes around lymphocytes and monocytes as observed only in patients with neoplastic lymphocytes. This study presents an isolated case of spurious thrombocytopenia due to PS around neutrophils, with platelet phagocytosis.

Comparative evaluation of traditional and molecular diagnostic methods for malaria: An analysis of performance.

As we edge closer to the eradication of malaria, several methods for detecting Plasmodium species have been developed, including peripheral blood smear examination (PBS), rapid diagnostic tests (RDTs), serological evaluations, fluorescent microscopy, polymerase chain reactions (PCRs), fluorescent in situ hybridization, and flow cytometry. The suitability of these tools for routine diagnosis requires evaluation, considering both their diagnostic accuracy and cost-effectiveness. Our study compared four diagnostic techniques for malaria: PBS, quantitative buffy coat (QBC), RDT, and PCR. We used PCR as the benchmark standard and statistically assessed the performance of PBS, QBC, and RDT against PCR in detecting malaria. Adopting a prospective observational approach, we collected blood samples from 117 patients exhibiting the symptoms suggestive of malaria. The findings from our study showed that PBS had a positivity rate of 93.4%, with a 95% confidence interval (CI) of 0.881-0.987, indicating reliable results for a similar population. The QBC assay demonstrated an elevated positivity rate of 96.7% with a solid 95% CI of 0.930-1.000. Although the RDT had a slightly lower rate of 92.4%, it still delivered dependable results, presenting a significant 95% CI of 0.868-0.980, ensuring a robust diagnostic performance compared to PCR. PCR is a reliable test when the identification of the specific species is inconclusive. Conversely, the commonly used PBS occasionally overlooks positive malaria cases due to the specialized skills needed for accurate reading. The cost-effective RDT is feasible for field operations without the need for expert knowledge. However, it fails to differentiate between old and new infections. Meanwhile, the QBC test, known for its sensitivity and speed, can be consistently employed for malaria diagnosis in a tertiary care settings.

Correlation of Manual Peripheral Blood Smear Examination with RBC Indices and Histograms Obtained from an Automated Hematological Analyzer in Anemic Patients at Jimma Medical Center, Southwest Ethiopia, 2022

Correlation of Manual Peripheral Blood Smear Examination with RBC Indices and Histograms Obtained from an Automated Hematological Analyzer in Anemic Patients at Jimma Medical Center, Southwest Ethiopia, 2022

Comparative studies on the detection of Theileria annulata infection by clinical, parasitological and molecular techniques in buffaloes (Bubalus bubalis)

During the period of 2019-2021, a total of 715 buffaloes were screened for Theileria infections. A set of clinical parameters were used to identify the theileriosis suspected animals which were later confirmed through microscopic tests (peripheral thin blood smear examination and lymph node biopsy smear examination) and molecular assay (cytochrome b based T. annulata specific polymerase chain reaction test). On the basis of clinical evaluation, 33.43% (239/715) buffaloes were suspected for the presence of theileriosis. Through laboratory examination, 63.60% (152/239), 7.48% (16/214) and 100% (239/239) were found positive for Theileria infection by blood smear examination, lymph node biopsy and PCR, respectively, among the clinically suspected theileriosis animals. The efficiency of PCR was recorded to be highest, followed by microscopic examination of peripheral blood smears, and the lowest value was obtained for lymph node biopsy smear examination. The results indicated that PCR is a highly sensitive diagnostic technique for confirmatory diagnosis of T. annulata parasitic infection in buffaloes, even at very low level of parasitemia. Analysis of the data based on thin blood smear examination revealed that the field incidence of theileriosis was 11.55% in the south-western region of Gujarat, India. The high incidences of T. annulata infection in buffaloes may be due to the sub-tropical climate of the region which is favorable for the growth and development of vector ticks and parasites.

Comparison of Platelet Counts Estimated by Peripheral Blood Smear Examination and Automated Haematology Analyzer

Introduction: Platelet count estimation is one of the common as well as important investigations in clinical practice to diagnose many diseases like dengue, malaria, etc. Different methods for platelet estimations are available. These methods are manual counting semi-automated and automated hematology analyzer counting, platelet count estimation by peripheral blood smear (PBS) method, etc. Semi-automated or automated analyzers may produce erroneous results in the presence of particles or light scatter like giant platelets, fragmented red blood cells, and platelet clumps, so alternative methods like PBS examination can be used for validation. Aim: To compare platelet count estimation performed by the automated cell counter method and the PBS examination method. Objective: Peripheral Blood smear examination acts as a good quality control tool to validate the results produced by the automated cell counter. Materials and Methods: The present study was carried out in the Department of Pathology, Akshaya Health Centre, Urban Bangalore. The study included 100 random blood samples collected into ethylenediaminetetraacetic acid (EDTA) vacutainers over 3 months. These were analyzed by both peripheral blood smear and automated cell counter for platelet estimation. The statistical analysis was done for test performances and their comparisons by using the coefficient of variation (CV), linear regression, and mean differences with SPSS software. Results: No significant difference (p = 0.06635) was observed between the manual peripheral blood smear (PBS) method (platelets average per 100x, multiplied by 15000/ µl) of platelet estimation (207.13 ±15.898 x 1000/ µl) and that of automated cell counter platelet value (206.53 ±16.278 x 1000/ µl). A significant positive correlation was observed between the results of both methods (r=0.9995, p < 0.001) when analyzed by the Pearson correlation test. Conclusion: The peripheral blood smear platelet estimation results are comparable with automated analyzer results. Hence, the PBS examination serves as a quality control tool in assessing the results of the automated cell counters.

COMPATIBILITY BETWEEN PLATELET HISTOGRAM WITH IP MESSAGE AND PLATELET MORPHOLOGY IN THROMBOCYTOPENIA PATIENTS

Thrombocytopenia is a condition characterized by low levels of platelets in the blood. The platelet count can be checked using a Hematology analyzer, which is an automatic tool for checking a Complete Blood Count (CBC). The principle of this tool is to detect a signal that is comparable to the cell size that has been set on the tool. The results of the CBC examination are accompanied by a histogram and IP Message if there are abnormal cells, so a confirmatory test using a peripheral blood smear is necessary. The purpose of this study was to determine the suitability of the results of the platelet histogram with the IP Message on the platelet morphology of peripheral blood smears of thrombocytopenia patients. This research is a quantitative descriptive study of 54 samples taken using the Saturation Sampling technique at Grati Pasuruan Hospital using the Sysmex XN-1000 from April 1–30, 2023. The variables in this study are histogram results accompanied by IP Messages and platelet morphology on peripheral blood smears. The results of this study are that the histograms that often appear are abnormal heights on the PU Flag and the IP Messages that often appear are “PLT Clumps?”, with a suitable level of platelet morphology on peripheral blood smear examination reaching 90.7%, so it can be concluded that there is a compatibility between the results of the platelet histogram accompanied by the IP Message on the platelet morphology of the peripheral blood smear of thrombocytopenia patients.

Disseminated histoplasmosis diagnosed on peripheral blood smear: a case report

Abstract Introduction/Objective Histoplasmosis is an infection caused by the inhalation of a dimorphic fungus, Histoplasma capsulatum. H. Capsulatum var capsulatum is the main variety we encounter in the United States and is endemic in the Mississippi river valley. In immunocompetent individuals the infection is usually asymptomatic or presents as flu- like symptoms. Disseminated histoplasmosis is a severe and often fatal opportunistic infection if not treated, usually seen in immunocompromised patients. Methods/Case Report We report a case of a 27-year-old female intra-venous drug user with past medical history of untreated HIV diagnosed in 2018, who is being admitted for suspected necrotizing fasciitis of the vulva. On admission, her complete blood count shows pancytopenia with a white blood cell count of 2.9 × 109/L (NR 4.3-10.8 × 109/L), hemoglobin 6.1 g/dL (NR 12-16 g/dL), and a platelet count of 43 × 109/L (NR 150-400 × 109/L). A peripheral blood smear obtained showing rare neutrophils with intracellular organism highly suggestive of histoplasma capsulatum. CT Chest showing diffuse ground glass opacities and a subsequent cytology from bronchoalveolar lavage performed revealed numerous macrophages filled with ovoid organism surrounded by a cytoplasmic halo, GMS stain highlights the rim consistent with histoplasma capsulatum. Patient expired after one week in the ICU for severe acute respiratory distress syndrome, sepsis, histoplasmosis, strep pneumonia and hepatic failure. Results (if a Case Study enter NA) NA Conclusion Careful examination of Peripheral blood smear along with correct clinical history can aid in early diagnosis of disseminated histoplasmosis.

Chronic Myeloid Leukemia Presenting with Mixed Phenotype B/Myeloid Blast Phase: A Diagnostic Challenge

Abstract Introduction/Objective Chronic myeloid leukemia (CML) is typically identified in chronic phase, however about 5% of cases present in a more advanced phase. In blast phase (BP), the blasts are most commonly of myeloid lineage, less commonly lymphoid, and rarely mixed lineage cases are encountered. A mixed phenotype at presentation raises the possibility of a de novo mixed phenotype acute leukemia (MPAL) with BCR::ABL1 fusion and requires careful correlation with ancillary studies to confirm the diagnosis. Methods/Case Report The patient is a 60-year-old man who presented with leukocytosis, anemia, normal platelet count, and blasts identified on peripheral blood smear examination. A bone marrow biopsy demonstrated hypercellular marrow and a dimorphic population of large and small blasts, comprising nearly 70% of cellularity. Flow cytometry demonstrated distinct myeloid and B-lymphoid blast populations, both of which expressed CD13 and TdT. Interphase fluorescence in situ hybridization (FISH) showed the BCR::ABL1 fusion in more than 90% of nuclei, including segmented nuclei, and conventional cytogenetic studies showed t(9;22)(q34.1;q11.2) in 19 of 20 metaphases. Molecular studies demonstrated the minor BCR::ABL1 p190 transcript, as well as ASXL1 and dual RUNX1 mutations. The discrepant number of BCR::ABL1 positive cells by FISH and conventional cytogenetic studies compared to the proportion of blasts, and its presence in segmented nuclei, enabled a diagnosis of CML with mixed phenotype blast phase despite absence of features such as basophilia or significant granulocytic left shift. Results (if a Case Study enter NA) NA Conclusion We share this case of CML in mixed phenotype blast phase to highlight the importance of careful evaluation in distinguishing this rare presentation from de novo MPAL, particularly with BCR::ABL1 fusion. Features such as a disproportionate number of nuclei or metaphases carrying the t(9;22) translocation on FISH or conventional cytogenetic studies and the presence of BCR::ABL1 in mature granulocytes can be helpful when other morphologic features of CML are absent.

Evaluation of Novel Minimal Screening Antibody Panel for Immunophenotypic Detection of Hematological Malignancies in a Resource-Constrained Setting: A Prospective Study

INTRODUCTION Immunophenotyping of abnormal cells by flow cytometer enabled this technology in diagnosing, prognostication and guiding therapy for blood malignancies. International consensus exist for diagnosis of leukemia, lymphoma and plasma cell neoplasm (PCN) 1-3 using flow cytometer, but it is seldom used for screening these diseases. In clinical setting, including our tertiary care center in India, we come across patients whose peripheral blood (PB) smear examination does not hint towards the type of blood-related disorder. We identified the need to screen these patients by flow cytometry before channelling them towards established diagnostic work-up for malignancies. The aim of this study is to evaluate a flow cytometry screening assay, designed in-house, to detect blood malignancies in a resource-limited (sample, time, cost, infrastructure) clinical setting. MATERIALS AND METHODS This prospective double-blinded study was conducted between November 2022 and June 2023 with institutional ethical approval. Remainder of samples sent for routine clinical tests that met our inclusion/exclusion criteria were selected (n=221). Symptomatic patients with blood-related disorder, whose PB did not show any abnormal cells were included. All patients who had blast, lymphocytosis with atypical lymphocytes, lymphadenopathy, B-symptoms, splenomegaly or found to have plasmacytoma/amyloidosis/CRAB features were excluded. Three tube 8 colour 19 antibody panel (Table1) was designed. Immaturity markers and lineage specific markers are combined in a single tube to detect leukemias. CD5, CD10, CD19, CD20, kappa and lambda were put together to identify B-CLPD. A lyse-wash-stain protocol was followed and the samples were analysed in BD FACSCantoII flowcytometer with autofluroscence and compensation correction done for each sample. The findings of our screening assay were validated with morphological and clinical correlation and GraphPad Prism version 8.0.2 was used for statistical analysis. RESULTS Our antibody panel targeted only cell surface antigens, which reduced the cost of the test and permitted the analysis of the sample within 1 hour. During the study period, out of the 396 discard samples obtained, 221 patients met our inclusion criteria (Figure1). We analysed these samples with our screening assay and detected 51 patients with blood malignancies that included 19 acute leukemias, 11 lymphomas and 21 PCN and 167 samples with no evidence of leukemia, lymphoma or PCN which were subsequently diagnosed with anemias, platelet disorders, drug- or disease-induced leukocytosis/leukopenias and organ dysfunction not involving blood or bone marrow. The number of samples studied and the computed statistical parameters are given in Table2. Representative bivariate dot plots are given in Figure2. Out of the 221 test results, 214 had clinical, morphological and screening test concordance. One case of PCN could not be identified by morphological examination, where screening assay could identify clonal plasma cell population. Another one case was clinically diagnosed as PCN, but missed on screening panel because we did not see a definite cluster of CD38 + cells showing light chain kappa/lambda restriction. The remaining 5 samples were dilute in nature. In 3 out of 5 dilute samples, screening panel could identify the abnormality which was concordant with clinical diagnosis (based on clinical, biochemical, imaging, molecular and cytogenetics) where morphology failed. The other 2 cases were identified morphologically on bone marrow imprint. This flow cytometry screening assay was found to have overall 94.4% sensitivity, 100% specificity, 100% positive predictive value and 98.2% negative predictive value, delineating the efficacy of this minimal antibody screening panel in detecting blood malignancies. CONCLUSION Compared to the existing screening panels, this novel screening test has comprehensive set of antibodies (19 only) to detect leukemia, lymphoma and PCN simultaneously within 1 hour and at a lower cost. In patients screened negative, further blood malignancy-related testing may be avoided, thereby reducing the total cost incurred to the patient. The usefulness of this screening test is limited with dilute sample. However, the present study shows that this screening panel can be used in small resource-constrained and remote settings with a trained flow cytometry technologist alone.

A RESPON KEMOTERAPI FLUDARABINE PADA HAIRY CELL LEUKEMIA

HCL is part of a rare B-cell lymphoproliferative disorder and is a subtype of Chronic Lymphocytic Leukemia. It is characterized by progressive pancytopenia, splenomegaly, and bone marrow hypercellularity. Patients often come because of abnormal complete blood count results or complications such as infection. This case report explains a case of a 41-year-old woman who had recurrent shortness of breath and cough as symptoms, where the patient had a history of acute myeloblastic leukemia (AML) with non-routine fludarabine chemotherapy. After receiving treatment and underwent further investigations in the form of peripheral blood smear and bone marrow aspiration examination, it was found that the patient had hairy cell leukemia. Fludarabine was given to the patient and it is reported to give effect partial remission (based on last bone marrow aspiration) along with pancytopenia as a clinical manifestation from myelosuppression as a side effect for long-term used fludarabine.
 HCL is part of a rare B-cell lymphoproliferative disorder and is a subtype of Chronic Lymphocytic Leukemia. It is characterized by progressive pancytopenia, splenomegaly, and bone marrow hypercellularity. Patients often come because of abnormal complete blood count results or complications such as infection. This case report explains a case of a 41-year-old woman who had recurrent shortness of breath and cough as symptoms, where the patient had a history of acute myeloblastic leukemia (AML) with non-routine fludarabine chemotherapy. After receiving treatment and underwent further investigations in the form of peripheral blood smear and bone marrow aspiration examination, it was found that the patient had hairy cell leukemia. Fludarabine was given to the patient and it is reported to give effect partial remission (based on last bone marrow aspiration) along with pancytopenia as a clinical manifestation from myelosuppression as a side effect for long-term used fludarabine.

Morphological changes in hematopoietic parameters in COVID-19 and their prognostic significance

The types of morphological changes in the complete blood count, along with other laboratory parameters, can help establish the severity of the condition and provide the prognostic value in determining the survival of a patient with COVID-19. Peripheral blood smear (PBS) examination is a routine and simple procedure that can be performed at any medical institution. However, data on morphological changes in PBS during COVID-19 are still insufficient. Therefore, it is relevant to identify the features and patterns of these changes, taking into account the severity of the clinical presentation of COVID-19, and establish their prognostic significance. The aim. To review the literature on the presence of morphological changes in hematopoietic parameters in the case of SARS-CoV-2 infection with respect to the disease course.Results and Conclusions. Morphological changes in at least one blood cell lineage were observed in all cases of SARS-CoV-2 infection. The most common are nuclear and cytoplasmic disorders of neutrophils, such as hypogranulation and hypo/hypersegmentation of neutrophil nuclei, often with toxogenic stippling. Typical changes in lymphocyte morphology include monocytoid, lymphoplasmacytoid, granular, and atypical cells with nucleoli. Prognostically unfavorable morphological signs in the PBS include giant neutrophils and their toxic granulation, plasmacytization of lymphocytes, and a dynamic decrease in granular and abnormal lymphocytes and monocytes. A low count of lymphocytes and their subpopulations is associated with a severe clinical presentation and an unfavorable outcome of COVID-19 disease, which suggests the feasibility of their immunophenotypic evaluation and monitoring. The detection and serial monitoring of inflammatory monocytes using flow cytometry may be valuable in predicting the course and choosing adequate therapy for SARS-CoV-2 infection. Additionally, an increase in the red cell distribution width was also shown to have prognostic importance.