Peripheral Blood Film Examination Research Articles

NEED OF EXTERNAL QUALITY ASSESSMENT SCHEME – AN EXPERIENCE IN CENTRAL LABORATORY AT RNTMC, UDAIPUR

Objectives: The objectives of the study are to periodically assess the quality of the external quality assessment scheme (EQAS) with the aim of enhancing laboratory performances. Methods: An observational study was done at our central laboratory at RNTMC, Udaipur, after approval from the institutional review board. Our laboratory receives quarterly blood samples and already prepared slides from AIIMS, Delhi, for complete blood count (CBC). In addition, lyophilized blood samples for fibrinogen, prothrombin time/international normalized ratio (PT/INR), and activated partial thromboplastin time (APTT) analysis are received quarterly from CMC, Vellore, through courier package. As for cytopathology, the third package includes already prepared 10 slides of 2 cycles for cytopathology analysis along with a brief clinical history. Results: CBC, peripheral blood film examination findings, and reticulocyte count results were consistently acceptable, except in August 2021, December 2022, and March 2023 when some parameters of CBC were deemed unacceptable. Results for PT/INR, APTT, and fibrinogen were within consensus at all-time except in March 2022, when they were out within consensus and deemed unacceptable. Similarly, results for cytopathology evaluation were in concordance with the results of the provider except for a few occasions were deviations were seen for some diagnoses due to interpretation error. Conclusion: Engaging in EQAS has facilitated the enhancement of test result accuracy, thereby improving the overall quality of laboratory practices and minimizing erroneous outcomes.

The Prevalence and Molecular Characterization of Bovine Babesia Species and the First Report of B. bovis from Kashmir Himalayas.

Bovine babesiosis, a global disease, has not been studied so far in Kashmir valley, which is having temperate type of climate as compared to rest of India having tropical to sub-tropical climate, so we felt the need to investigate it. To diagnose the babesiosis in clinically suspected cattle (n=450), peripheral blood film examination and PCR tests using generic and species-specific primers targeting Babesia/Theleria genera and B. bigemina, B. bovis as well as B. divergens, respectively were conducted. Four PCR products were sequenced and subjected to BLASTn analysis. Ticks were collected from the clinically suspected animals and identified as per the standard morphological keys. The prevalence of babesiosis among suspected cattle in central Kashmir by peripheral blood film examination and PCR technique was 11.11% and 33.62%, respectively. The 18S rRNA gene of Isolate B1 of Babesia spp. showed 99.0 to 100% nucleotide sequence homology with 18S rRNA gene of different isolates of B. bigemina registered in the GenBank, while as 18S rRNA gene of Isolate Z showed 98.5 to 99.2% and 93.1 to 93.9% nucleotide sequence homology with 18S rRNA gene of different isolates of Babesia spp. and B. bigemina, respectively, registered in the GenBank. Rhipicephalus spp. and Haemaphysalis spp. were the two major tick genera identified in the present study. Bovine Babesiosis in Kashmir is attributed to B. bovis, B. bigemina and some other Babesia spp. or strains which needs further investigation. To our knowledge, this is the first report of Babesia bovis from northern India in cattle.

MORPHOLOGICAL TYPES OF ANEMIA AND ITS ASSOCIATION IN GERIATRIC POPULATION

Objective: To determine the prevalence and morphological types of anemia in geriatric patients in a tertiary care hospital. Material and Methods: This cross-sectional descriptive study was conducted out at Combined Military Hospital, Multan, a tertiary care hospital Pakistan from September 2019 to February 2020. After due approval of Ethical review committee, a total of 175 elderly patients ranging from 50 to 80 years of age of all genders referred to the hematology department for Blood Complete Picture and RBC morphology were included in the study after formal consent. Patients taking immunosuppressive/ steroid therapy and with history of recent blood transfusions were excluded. 2ml blood sample was taken in EDTA and analyzed using Sysmex KXx 21 hematology Analyzer. Leishman-stained Peripheral blood film examination for RBC morphology of patients with Hemoglobin level of < 10 g/dl was also performed and results recorded. Results: The age of 175 patients ranged from 50 to 80 years with mean of 65.77± 6.23 years. Majority of the patients 90 (51.43%) were between 50 to 65 years of age. In this study, frequency of anemia in elderly population was found in 23.43%(41) patients. Most frequent anemia was normocytic anemia 75.61% followed by macrocytic 19.51% and microcytic anemia 4.88%. Conclusion: The anemia is quite prevalent in older patients with normocytic anemia being the commonest. Key Words: Anemia, Elderly population, Normocytic, Macrocytic, Microcytic

Diagnostic Accuracy of Peripheral Blood Film Examination in Comparison to Bone Marrow Aspiration in Various Haematological Disorders: A Cross-sectional Study

Introduction: Bone marrow aspiration is a routine diagnostic procedure performed in hospitals for the diagnosis and management of haematological disorders. It involves cytomorphological assessment of all blood cells through bone marrow aspiration and Peripheral Blood Film (PBF) examination. Aim: To analyse the diagnostic accuracy of PBF in comparison to bone marrow aspiration for diagnosing various haematological diseases in southern Rajasthan, India. Materials and Methods: This cross-sectional study was conducted at the Department of Pathology, Rabindra Nath Tagore (RNT) Medical College, Udaipur Rajasthan, India, from January 2016 to June 2022. The study included microscopic findings of 638 bone marrow cases along with corresponding PBF and complete blood count findings. The results were entered into an MS Excel sheet and evaluated using Statistical Package for the Social Sciences (SPSS) 22.00 software. Chi- square test was used to calculate p-values. Results: The study included a total of 638 bone marrow aspiration cases, with 368 cases (57.68%) being male and 270 cases (42.32%) being female. The mean age was 30.8 years (4 months to 87 years). The most common bone marrow diagnosis was Erythroid Hyperplasia, with 187 cases (29.31%) (including micronormoblastic, megalonormoblastic, normoblastic, and nutritional), followed by Chronic Myeloid Leukaemia (CML) with 154 cases (24.14%), and acute leukaemia with 152 cases (23.82%). Among the benign diagnoses, micronormoblastic erythroid hyperplasia was the most common with 68 cases (27.09%). Among the malignant diagnoses, CML was the most common with 154 cases (39.79%). The sensitivity of PBF diagnosis was 100% for Chronic Lymphocytic Leukaemia (CLL), CML, and Prolymphocytic Leukaemia (PLL), and 82.24% for acute leukaemia; 45.5% for lymphoma infiltration. The specificity was 100% for all cases. The accuracy was 95.75% for acute leukaemia, 99.06% for lymphoma infiltration, and 100% for CML, CLL, PLL, and myeloproliferative disorder-eosinophilia. The p-value was <0.001 for Acute Leukaemia, CML, CLL, PLL, myeloproliferative disorder-eosinophilia, and <0.002 for lymphoma infiltration. The overall sensitivity, specificity, accuracy, and p-value were 84.5%, 100%, 90.6%, and <0.001, respectively. Conclusion: While bone marrow examination is crucial for confirming the diagnosis of haematological disorders, PBF examination alone can be used for phasing and confirming the diagnosis of CML and CLL.

Infectious mononucleosis with follicular tonsillitis and urinary tract infection

Despite the prevalence of Epstein-Barr virus (EBV) infection, new reports of weird and atypical manifestations of the infection continue to emerge, raising the question of how well we know this pathogen. The clinical appearance of patients who become infected throughout their youth or early adulthood is changing as the infection age rises in developed countries. Other physical symptoms are less noticeable and liver involvement is more noticeable throughout these stages. To inform health-care professionals of this change, an update on infectious mononucleosis variable manifestation is necessary. This case presented a 28-year-old female presented with a history of fever, nausea, and vomiting with odynophagia and cervical lymphadenopathy. Complete blood count and peripheral blood film examination revealed lymphocytic leukocytosis with many reactive lymphocytes. Her monospot test for EBV was positive along with a urine culture positive for Staphylococcus aureus.

Anaemia In Preschool Children:its Correlation With Pica

Introduction: According to the third National Family Health Survey, 79% of Indian children are anaemic. Pica is characterized by the persistent ingestion of non-nutritive substances such as plaster, charcoal, chalk, and earth for at least one month in a manner that is inappropriate for their developmental level. We investigated the correlation between pica behaviour and anaemia in preschool children. Methods: In total, 103 children of ages six to 48 months attending the OPD were randomly included in this study for six months; they presented with clinical features of anaemia. Complete blood count and peripheral blood film examination were carried out. The children were assessed clinically for signs and symptoms of anaemia. History of ingestion of clay, sand, chalk, wall paints etc was asked from the parents. Results: Most of the children (90.3%) had microcytic hypochromic anaemia with a mean haemoglobin value of 8.82 g / dl. The mean age was 18 months, and boys slightly outnumbered girls. In total, 57.3% of children had a positive history of pica, and all of them were found to be anaemic. However, no significant statistical correlation was observed between anaemia and history of pica. Conclusions: All children with history of pica were anaemic and the most common type of anaemia was microcytic hypochromic. Although no significant statistical correlation was observed between and history of pica, it is very important for the clinicians to be cautious of this common condition and evaluate for anaemia

A Rare Presentation of Primary Plasma Cell Leukemia: A Case Report and Review of Literature

Background: The primary plasma cell leukemia (pPCL) is an aggressive plasma cell neoplasm. It is diagnosed by the presence of an absolute plasma cell count of >2 × 109/L or 20% plasma cells in the peripheral blood. pPCL is rare and reported to be <1 in a million. Hence, our case report is a rare opportunity to describe clinical presentation and management of pPCL. Case Details: A 72-year-old male patient with benign prostatic hyperplasia, presented to the hospital for cough, breathlessness, and intermittent fever of one month. On arrival, he was tachypnoeic with altered sensorium and rales in his chest. Laboratory examination showed anemia, leucocytosis, and thrombocytopenia. The peripheral blood smears revealed 25-30% circulating atypical plasmacytoid cells. Flow cytometry on the peripheral blood revealed 58.7% lymphoid cells. Out of the total lymphoid cells, 73.6 % cells were characterized by expression of CD38, CD138, CD19, CD49d, CD43, CD27, CD81 (96.9% dim positives) CD 56 with dim kappa light chain restriction suggestive of PCL. Furthermore, serum protein electrophoresis and serum immunofixation showed an M-band (0.53g) of IgG kappa subtype. However, the patient developed lower respiratory tract infections with multi-organ dysfunction and he succumbed to the same.Conclusion: The prognosis of pPCL is very poor and the high risk of infective complications. Early diagnosis and optimal chemotherapy would be the key to the management. Detailed peripheral blood film examination and characterization of abnormal cells with immune phenotyping are of utmost importance in diagnosing pPCL.

Differentiation of the β-thalassemia Trait from Iron Deficiency Anaemia by Red Cell Indices among Pregnant Women in Southern Haryana

Background: Due to similar red cell morphology, patients of beta thalassemia trait ( -TT) are often misdiagnosed as Iron Deficiency Anaemia (IDA) and given unnecessary iron medication. Facilities for diagnosing them are usually not available in underserved areas where health system and laboratory facilities are not strengthened. Aim: We planned this study to discriminate -TT from IDA by red cell indices among pregnant women in southern Haryana. Methods: One hundred and forty eight antenatal women were screened for presence of anaemia with help of haemoglobin value at the time of admission. Typing of anaemia was done. After staining, it was examined for red cell morphology and various red cell indices were also noted. Results: Of total 148 pregnant women, 104 were found to be anaemic thus the overall prevalence of anaemia was found to be 70.27% (104/148) in our study. Microcytic hypochromic picture (38.4%), followed by normocytic hypochromic to microcytic hypochromic (20.1%) was predominant on peripheral blood film (PBF) examination followed by dimorphic anaemia. RBC count was found to be normal in 85.5% cases followed by decreased count in 14.4% cases. None of the case had increased RBC count. MCV was normal in 58.6% of cases followed by decreased below 80 femtolitre in 28.8% of cases. Conclusion: Higher prevalence of anaemia in pregnant women indicates that anaemia still continues to be a major health problem in India. In resource constrained settings, where definitive diagnostic facilities do not exist; red cell indices may be used to discriminate -TT from IDA among pregnant women.

Prevalence and aetiologies of anaemia among first trimester pregnant women in Sri Lanka; the need for revisiting the current control strategies

BackgroundThe Sustainable development goals, which focus strongly on equity, aim to end all forms of malnutrition by 2030. However, a significant cause of intergenerational transfer of malnutrition, anaemia in pregnancy, is still a challenge. It is especially so in the low- and middle-income settings where possible context-specific aetiologies leading to anaemia have been poorly explored. This study explores the prevalence of etiological factors significantly contributing to anaemia in pregnancy in Sri Lanka, a lower-middle-income country with a high prevalence of malnutrition albeit robust public health infrastructure.MethodsAll first-trimester pregnant women registered in the public maternal care programme in the Anuradhapura district from July to September 2019 were invited to participate in Rajarata Pregnancy Cohort (RaPCo). After a full blood count analysis, high-performance liquid chromatography, peripheral blood film examination, serum B12 and folate levels were performed in anaemic participants, guided by an algorithm based on the red cell indices in the full blood count. In addition, serum ferritin was tested in a random subsample of 213 participants. Anaemic women in this subsample underwent B12 and folate testing.ResultsAmong 3127 participants, 14.4% (95%CI 13.2–15.7, n = 451) were anaemic. Haemoglobin ranged between 7.4 to 19.6 g/dl. 331(10.6%) had mild anaemia. Haemoglobin ≥13 g/dl was observed in 39(12.7%). Microcytic, normochromic-normocytic, hypochromic-normocytic and macrocytic anaemia was observed in 243(54%), 114(25.3%), 80(17.8%) and two (0.4%) of full blood counts in anaemic women, respectively. Microcytic anaemia with a red cell count ≥5 * 106 /μl demonstrated a 100% positive predictive value for minor haemoglobinopathies. Minor hemoglobinopathies were present in at least 23.3%(n = 105) of anaemic pregnant women. Prevalence of iron deficiency, B12 deficiency and Southeast Asian ovalocytosis among the anaemic was 41.9% (95%CI 26.4–59.2), 23.8% (95%CI 10.6–45.1) and 0.9% (95%CI 0.3–2.3%), respectively. Folate deficiency was not observed.ConclusionEven though iron deficiency remains the primary cause, minor hemoglobinopathies, B 12 deficiency and other aetiologies substantially contribute to anaemia in pregnancy in this study population. Public health interventions, including screening for minor hemoglobinopathies and multiple micronutrient supplementation in pregnancy, should be considered in the national programme for areas where these problems have been identified.

Prevalence of microcytic hypochromic anaemia among teenagers

Background: Anaemia is the most common nutritional disorder worldwide. According to WHO adolescent age group is defined as life span between 10-19 years. Hence; the present study was conducted for assessing the prevalence of microcytic hypochromic anaemia among teenagers. Materials & Methods: A total of 100 teenagers within the age arrange of 12 to 18 years were enrolled. The following data were collected: age, gender, and the results of a CBC and Hb electrophoresis. Samples obtained by venipuncture were collected and processed. Peripheral blood film examination was also done. Microcytic hypochromic examination was done. All the results were record and analysed by SPSS software. Results: Microcytic hypochromic anaemia was found to be present in 15 percent of the patients. Out of 15 patients with presence of Microcytic hypochromic anaemia, 33.33 percent of the patients were males while the remaining were females. Conclusion: Anaemia is a public health problem among school adolescents in the area. School-based intervention among school adolescents based on identified determinant factors will be very important for the prevention and control of anemia among the group.

Differentiation of the β-thalassemia Trait from Iron Deficiency Anaemia by Red Cell Indices among Pregnant Women in Southern Haryana, India: A Cross-sectional Study

Introduction: Due to similar red cell morphology, patients of beta Thalassemia Trait (β-TT) are often misdiagnosed as Iron Deficiency Anaemia (IDA) and given unnecessary iron medication. Facilities for diagnosing them are usually not available in underserved areas where health system and laboratory facilities are not strengthened. Aim: To differentiate β-TT from IDA by red cell indices among pregnant women in Southern Haryana, India. Materials and Methods: This hospital-based, cross-sectional study was conducted in the Department of Obstetrics and Gynaecology at Shaheed Hasan Khan Mewati Government Medical College, Haryana, India, from May 2020 to October 2020. Total 148 antenatal women were screened for presence of anaemia by their haemoglobin level at the time of admission. Types of anaemia were documented. After staining, it was examined for red cell morphology and various red cell indices were also noted. Data collected was entered in Microsoft excel 7, then data was analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software package. Results: Of total 148 pregnant women, 104 were found to be anaemic thus the overall prevalence of anaemia was found to be 70.27% (104/148). Most of pregnant women were in the age group of 18-24 years (54.8%). Microcytic hypochromic picture (38.4%), followed by normocytic hypochromic to microcytic hypochromic (20.1%) was predominant on Peripheral Blood Film (PBF) examination followed by dimorphic anaemia. Red Blood Cell (RBC) count was found to be normal in 85.5% cases followed by decreased count in 14.4% cases. None of the case had increased RBC count. Mean Corpuscular Volume (MCV) was normal in 58.6% of cases followed by decreased below 80 fL in 28.8% of cases. Conclusion: Higher prevalence of anaemia in pregnant women indicates that anaemia still continues to be a major health problem in India. In resource constrained settings, where definitive diagnostic facilities do not exist, red cell indices may be used to differentiate β-TT from IDA among pregnant women.

Predictors of Mortality and Outcomes of Liver Transplant in Spur Cell Hemolytic Anemia

BACKGROUND :Spur cell hemolytic anemia (SCHA) is a rare, acquired, non-immune hemolytic anemia of decompensated cirrhosis resulting from abnormal lipid composition of the red cell membrane. Treatment is limited to red cell transfusion. Data describing prognostic impact, outcomes of liver transplant, and clinical hematologic characteristics of SCHA are absent or limited; published data on SCHA are limited to single-patient case reports and small single-center case series. The independent prognostic impact of SCHA on patients with cirrhosis remains unclear, and it is not known if hemolytic anemia severity has a significant impact on survival of these patients. As a result, SCHA is not formally considered during liver transplant evaluation, and patients do not receive MELD exception points for this diagnosis.METHODS :We performed a multicenter, 24-year observational cohort study of patients with SCHA, retrospectively analyzing hepatic and hematologic parameters, independent predictors of mortality, and long-term outcomes of liver transplant. Strict diagnostic criteria for SCHA were applied, requiring all of the following: (1) decompensated cirrhosis; (2) anemia; (3) objective laboratory evidence of hemolysis; (4) no alternate contributing cause of hemolysis or acanthocytosis; and (5) chart documentation of a confirmed diagnosis of SCHA incorporating peripheral blood film examination. The primary outcome was mortality at 3 months after date of SCHA diagnosis. The impact of hemolytic parameters on 3-month mortality was evaluated utilizing multivariable logistic models. Observed mortality vs. expected mortality (per MELD-Na score and Child-Turcotte-Pugh class) was compared using standardized mortality ratios. Given the limited survival of this population, red cell transfusion dependence was defined as 4 or more units of red cells transfused during the 60-day peri-diagnostic period.RESULTS :Patients: 69 patients with SCHA were included (FIGURE 1). The median (interquartile range) age was 53 (42-59) years; 46.4% were female, and 11 (15.9%) received liver transplant. Alcohol contributed to the etiology of cirrhosis in 53 patients (76.8%). The median (IQR) survival from SCHA diagnosis of patients not receiving liver transplant was 58 (23-113) days. 39 patients (56.5%) were red cell transfusion-dependent. Hematologic parameters are described in TABLE 1.Outcomes of Liver Transplant: All 11 patients undergoing transplant had rapid and complete resolution of SCHA, with an improvement in median hematocrit from 22.1% to 34.6% post-transplant (P=0.001) (TABLE 2) and excellent post-transplant outcomes, with 9 patients still alive after 6.1 years median follow-up.Independent Predictors of Mortality in SCHA: In multivariable logistic models adjusting for age, sex, etiology of cirrhosis, active/recent variceal bleeding, and Child-Turcotte-Pugh score, transfusion dependence had an OR for 90-day mortality of 9.14 (95% CI, 2.46-34.00) and reduced pre-transfusion hematocrit had an OR of 4.73 (95% CI, 1.42-15.82) per 6% decrease; increased red cell transfusion requirement, reduced hemoglobin, increased lactate dehydrogenase, and increased indirect bilirubin were also independently predictive of higher 90-day mortality (FIGURE 2).Performance of MELD-Na and Child-Turcotte-Pugh Scores in Estimating 90-Day Mortality: MELD-Na and Child-Turcotte-Pugh scores consistently significantly underestimated 90-day mortality, with standardized mortality ratios (SMRs) >1 across all scores/classes [MELD-Na 20-29, SMR 2.42 (1.18-4.44); Child-Turcotte-Pugh class B, SMR 4.46 (1.64-9.90)], FIGURE 3.CONCLUSIONS :In this largest study of SCHA to date, SCHA was associated with substantial excess mortality than was predicted by MELD-Na or Child-Turcotte-Pugh scores. Several clinical and laboratory parameters of hemolytic anemia severity, including transfusion burden, hemoglobin, and markers of hemolysis were each independent predictors of 90-day mortality in SCHA. Despite its unique morbidity as a complication of decompensated cirrhosis, outcomes of liver transplant were excellent in all 11 patients undergoing this intervention, with total resolution of SCHA and no evidence of recurrence. These findings should promote greater awareness of SCHA as a clinical entity and broader consideration of MELD exception points for afflicted patients when transplant-eligible. [Display omitted] DisclosuresAl-Samkari: Novartis: Consultancy; Amgen: Research Funding; Argenx: Consultancy; Rigel: Consultancy; Dova/Sobi: Consultancy, Research Funding; Agios: Consultancy, Research Funding; Moderna: Consultancy.

Effect of Gasoline Exposure on Hematological Parameters of Gas Station Workers in Mekelle City, Tigray Region, Northern Ethiopia

BackgroundThe adverse health effects of chronic gasoline exposure may be related to impairment of the hematopoietic system with bone marrow suppression, an increased risk of blood cell morphology abnormality and developing cancer.ObjectiveTo assess the effect of gasoline exposure on hematological parameters among gas station workers in Mekelle City, Tigray Region, Northern Ethiopia.MethodsThis cross-sectional study was carried out on 43 subjects (exposed group) and 77 subjects (unexposed group) with matched age and sex. Socio-demographic characteristics and duration of exposure data were collected using a structured questionnaire and an observation checklist. Sysmex XP-300 was used for hematological analysis and stained peripheral blood smear was examined for any abnormality. Data were entered and analyzed using SPSS version 23.ResultsOf exposed individuals, 28/43 (65.1%) and 49/77 (63.6%) of controls were males. The average exposure time was 5.19±4.38 years, with an average working hour of 11.74±1.89 hours/day. The mean RBC count (1012/L), HCT (%), HGB (g/dl) and platelets count (109/L) of the exposed group were significantly lower (4.88±0.573, 43.29±3.71, 15.04±1.33 and 248.95±58.19) compared with controls (5.35±0.533, 44.95±3.10, 15.59±1.26 and 292.45±62.17) at p<0.05, respectively. The MCH (pg) (30.48±2.06 vs 29.52±1.66) and MCHC (g/dl) (34.83±0.988 vs 34.32±0.927) were significantly higher in the exposed group compared with controls (p<0.05). HCT, RBC, HGB and platelet counts were significantly decreased with increased years of exposure (p<0.05). The peripheral blood film examination revealed basophilic stippling and macrocytosis in 9.3% of the exposed group.ConclusionLong-term exposure to gasoline at gas stations affected RBC parameters and platelet count. A significant negative correlation was noted between duration of exposure and HGB, HCT and platelet count, warranting implementation of protective measures at gas stations.

Morphological patterns of anemia among under five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu county, Kenya

Background: Anaemia during childhood adversely affects mental, physical and social development of the children, therefore morphological patterns of anaemia in under- five children are considered essential for classification, diagnosis and management. Aim: This study aimed at assessing morphological patterns, the prevalence and associated factors of anaemia among under-five children on Prevention of Mother-To-Child Transmission (PMTCT) programmes in Masogo sub-county hospital, Kisumu County, Kenya. Method: A cross-sectional health facility-based study was conducted among 175 children aged 6 to 59 months who attended clinic for the PMTCT programme for the period of January 2020 to December 2020. Pretested and structured questionnaires were used to collect socioeconomic and demographic characteristics of the family and child. Capillary blood sample was collected from each child for malaria parasite and Peripheral Blood Film (PBF) examination. Result: Complete blood counts indicate that microcytic pattern was the most common, representing 30 (42.3%) followed by microcytic hypochromic pattern 20 (28.2%), normocytic normochromic pattern with 11 (15.5%) and lastly dimorphic pattern with 10 (14.0%). High prevalence of anaemia was observed in children who were urban dwellers (50.0%), in children whose mothers aged 18-27 years (44.0%) and had no formal education (48.1%). Besides, the high prevalence rate of anaemia was found among children with a family monthly income of less than 500 Ksh. (46.9%), early (&lt;6 months) introduction of complementary foods (71.4%). Conclusion: This study has revealed that the prevalence of anaemia in children less than five years is high and is a severe public health problem in the study area. Therefore, the policymakers should make a strategy that can reduce poverty and increase the awareness to women on breastfeeding, nutrition, and other associated factors to reduce anaemia.

Referral Pattern and Haematological Disorders in a Tertiary Hospital

This study aimed to determine the pattern of referrals and haematological disorders at Benue State University Teaching Hospital. This was a retrospective study of records of a total of 222 adults and Paediatric patients suspected to have haematological disorders, seen and referred from different clinics and wards within and outside the study facility to the Haematologists for evaluation between June 2012 to July 2019 inclusive. These patients were clerked by the Haematologists, peripheral blood samples were taken for full blood count, red cell indices, reticulocyte count and peripheral blood film examination. Bone Marrow Aspiration was done on all the patients and the slides examined. Where indicated, further flowcytometry was done for complete diagnosis. Of the 222 referred, 127 (57.2%) were males while 95(42.8%) were females, with M:F ratio of 1.3:1. The age range of patients was 3 to 95 years with median age of 36.5 years. Those in the age group of 16-35 years constituted the majority 81(36.5%), while the least 5(2.3%) referred cases were in the age group of 76 years and above. The highest referral to the Haematologists was 40(18%) in 2015 and 2018 each. The bulk of referrals to the Haematologist was from Medicine 103(46.4%), followed by referrals from General Outpatient Department (GOPD) 29(13.1%) and then Paediatrics 27(12.2%), the least was from Ear Nose and Throat (ENT). The main indication for referral was Unexplained Anaemia 68(30.6%), followed by Splenomegaly 26(11.7%). One hundred and eighty (81.1%) of the total referred cases had at least an established haematological disorder. The most common haematological disorder established from the total referred cases was Combined Iron Deficiency Anaemia and Megaloblastic Anaemia (IDA/MA) 52(23.4%). This was followed by Chronic Lymphocytic Leukaemia (CLL) 23(10.4%). In conclusion, referrals from other physicians to the Haematologists have very high likelihood of haematological disorder. We recommend that attending Haematologists treat all referred cases with very high index of suspicion so as not to miss a potentially life threatening haematological disorder.

Frequency of anemia and micronutrient deficiency among children with cleft lip and palate: a single-center cross-sectional study from Uttarakhand, India.

BackgroundChildren with cleft lip and/or palate can be undernourished due to feeding difficulties after birth. A vicious cycle ensues where malnutrition and low body weight precludes the child from having the corrective surgery, in the absence of which the child fails to gain weight. This study aimed to identify the proportion of malnutrition, including the deficiency of major micronutrients, namely iron, folate and vitamin B12, in children with cleft lip and/or palate and thus help in finding out what nutritional interventions can improve the scenario for these children.MethodsAll children less than 5 years with cleft lip and/or cleft palate attending our institute were included. On their first visit, following were recorded: demographic data, assessment of malnutrition, investigations: complete blood count and peripheral blood film examination; serum albumin, ferritin, iron, folate, and vitamin B12 levels.ResultsEighty-one children with cleft lip and/or palate were included. Mean age was 25.37± 21.49 months (range, 3–60 months). In 53% of children suffered from moderate to severe wasting, according to World Health Organization (WHO) classification. Iron deficiency state was found in 91.6% of children. In 35.80% of children had vitamin B12 deficiency and 23.45% had folate deficiency. No correlation was found between iron deficiency and the type of deformity.ConclusionIron deficiency state is almost universally present in children with cleft lip and palate. Thus, iron and folic acid supplementation should be given at first contact to improve iron reserve and hematological parameters for optimum and safe surgery.

Vitamin B12 deficiency, its prevalence and haematological manifestations - A study in a tertiary care hospital

Aim: To determine the prevalence of vitamin B12 deficiency in subjects with anaemia and elevated mean corpuscular volume. Materials and Methods: Blood samples from 119 subjects were selected for the study based on the inclusion and exclusion criteria laid down. Blood samples were analysed on sysmex KX 21 haematology analyser. Morphological evaluation of blood cells was done on peripheral blood smear. Serum vitamin B 12 assays were done. Qualitative and quantitative variables were analysed by statistical methods. Results: Out of 119 subjects taken for study 70 (58.8 %) were male and 49 (41.2 %) were female with mean age ± SD 40.5± 18. Vitamin B 12 deficiency was noted in 82 (69 %) of which 12 (10.1%) were in Borderline levels of deficiency, 31 (26.1%) were in deficient levels and 39 (32.8%) were in severely deficient group. Red blood cell indices were categorized as per different groups of vitamin B 12 levels. Pancytopenia was noted in 67.1% (54) of B 12 deficient individuals. Significant negative correlation was found between vitamin B 12 levels and mean corpuscular volume (r = - 0.215 .p = 0.019). A positive correlation was found between vitamin B12 and platelet count. (p= < 0.001) and also with leukocyte counts (p value < 0.001) These correlations were found to be statistically significant. Peripheral blood film examination shows macrocytosis in 76 (64%) smears and hypersegmented neutrophils in 66 (56%) smears. Keywords: Vitamin B 12 deficiency, prevalence, Megaloblastic anaemia, Pancytopenia, Mean corpuscular volume.

ROUTINE PERIPHERAL BLOOD CHARACTERISTICS, IN PATIENTS WITH COVID-19 - EXPERIENCE FROM STATE COVID HOSPITAL IN SOUTH INDIA

Background: The COVID 19 pandemic is an ongoing pandemic of Corona virus disease 2019. Patients with milder symptoms have good prognosis, but severe and critical patients are difficult to treat and have high mortality rate. Many previous studies show that routine blood parameters help in predicting the progress of infectious diseases. Aims and Objectives: To analyse the peripheral blood characteristics in patients with COVID 19 and assess the efficacy, in the prognostic terms of COVID 19 patients. Material and Methods: this is a retrospective study, conducted at a state COVID hospital in South India. Results: A total of 155 cases of Covid positive patients are presented. According to severity of illness, there are 119 (76.77%) cases, categorized as mild, 24(15.48%) cases as moderate and 12 (7.74%) with severe symptoms. Conclusion: Periodic follow up of routine peripheral blood parameters, including peripheral blood film examination, help in prediction of severe COVID-19 cases.

Analysis of Bone Marrow and Peripheral Blood Film findings in sixty diagnosed cases of Lymphoma

Lymphoma constituting 55.6% of hematological malignancy, its prognosis depends on the correct diagnosis and stage of the disease, which is established after examination of peripheral blood film (PBF), bone marrow aspiration (BMA) and bone marrow biopsy (BMB) along with other parameters. The objective is to find out the percentage and pattern of bone marrow involvement, along with peripheral blood changes in lymphoma. PBF, BMA and BMB findings studied in 60 lymphoma patients during a period of 3 years. The PBF and aspiration smears stained with Leishmann’s stain, while the trephine biopsy processed and stained with Haematoxylin and eosin (H &amp; E) stain and Reticulin stain. The results were scrutinized, compared and evaluated. The male to female ratio was 1.4:1, including 53(88.3%) cases of NHL and 7(11.7%) cases of HL. Most common age group involved in NHL was 51-60 years and in HL was 31-40 years. 19/60 (31.7%) cases showed leucocytic lymphocytosis on PBF examination. Percentage lymphocytes in marrow differential count was increased in 16(26.7%) cases and were reported with bone marrow involvement on BMA and BMB and 1 case having borderline percentage lymphocyte count on BMA was reported as bone marrow involved case, only after examining the BMB. The diffuse pattern of involvement was most common in 7(41.2%), followed by paratrabecular pattern in 6(35.3%) cases. Thus to conclude bone marrow examination give valuable information in lymphoma, about disease burden, percentage of involvement, pattern of involvement and baseline involvement prior to therapy.

Correlation of Microscopic and Automated Cell Counter Results of Newer Hematological Variables in Diagnosis and Recovery of Anemia

Background: The correct interpretation of new hematological parameters generated by Automated Cell Counters (ACCs) requires extensive knowledge for the clinical significance of these results. The present study will enlighten the vital role of the traditional & new parameters of the Complete Blood Count (CBC) in early diagnosis and follow up stage after treatment especially in the setting of anemia Aims: To evaluate the vast & extended utility of newer hematological parameters generated by ACCs beyond their conventional role of CBC and Differential Leukocyte Count (DLC) Study design: This is a cross sectional observational study of results obtained from blood samples of 100 patients having various types of anemia diagnosed over a period of 18 months Subjects & methods: EDTA blood samples of the patient were collected under aseptic precautions and processed within 2 hours through new generation hematology analyzer i.e. ADVIAR 2120i. The peripheral blood film examination in each case was performed on Leishman-Geimsa stained smear. Second EDTA samples were taken on 2nd and 10th day of follow up of IDA and thalassemia cases respectively. Statistical Analysis Used: The hematological, parameters obtained from ACCs/microscopic were assessed by Student’s t-test, Fisher’s exact test using the SPSS 21.0 software with considering p value < 0.05 as significant Results: IRF and reticulocyte% can distinguish well between IDA and thalassemia major. CHr and MCVr are useful parameter for diagnosis of IDA/thalassemia and vitamin B12 deficiency anemia. CHr is the first parameter for monitoring response treatment of anemia.