Peripheral Blood Smear Examination Research Articles

Utility of digital cell imaging as an aid to enhance pathologist peripheral blood smear review for routine and on call practice: A verification study

Abstract Introduction/Objective Microscopic examination of peripheral blood smear (PBS) provides important information to support the diagnosis of hematological diseases. However, manual microscopic examination of PBS is labor-intensive and cannot be done remotely. CellaVision is digital cell imaging technology that provides pre-classification and digital imaging of the red blood cells (RBCs), white blood cells (WBCs), and platelets, myeloid, lymphoid and erythroid precursors. Several studies have evaluated the performance of this technology in the hematology laboratory as tool to assist laboratory technologists; our study evaluates its use for pathologist review of peripheral blood smears both during routine and on call practice. Methods/Case Report Our study included 30 PBS and two hematopathologists with greater than 10 years’ experience in performing PBS review. We compared pathologist’s own impression of microscopic PBS review to their own impression using CellaVision software (intraobserver comparison). Additionally, pathologist to pathologist impression was compared for both methods (interobserver comparison). All 30 cases revealed abnormal findings including, but not limited to: pancytopenia, leukocytosis, leukopenia, anemia, thrombocytopenia, and thrombocytosis. Of the 30 cases, 5 “on-call” were cases when the pathologist had to come on–site for pathologist PBS review. Results (if a Case Study enter NA) The pathologists own PBS interpretation (intraobserver) by microscopy and CellaVision had a concordance of 96.7%. The pathologist to pathologist interpretation of both methods had a concordance of 96.7%.The one discrepant case was a smear with platelet clumping and normal platelet count. On chart review of this case, this discrepancy would have minimal impact on patient care. Conclusion Pathologist use of CellaVision in their routine practice may result in speedier PBS review, particularly in cases with leukopenia, and better communication with laboratory technologists. CellaVision is less reliable in identifying platelet clumps and should not be used in isolation in evaluating thrombocytopenia. Used with other relevant data, CellaVision has the potential to preempt in person microscopic review of PBS when on-call in certain situations.

Rare Adult acute leukemia with Coexisting myeloblastic (basophilic differentiation) & B-lymphoblastic subpopulations Case Study

Abstract Introduction/Objective Acute basophilic leukemia is a very rare subgroup of acute myeloid leukemia that is defined in the 2022 WHO classification by presence of at least 20% blast cells in peripheral blood or bone marrow with immature and maturing cells of basophil lineage. The simultaneous occurrence of two hematological malignancies in a middle- aged adult patient is quite a rare event as evidenced by the rare cases reported in the literature. To our knowledge, this is the first case to be reported with concomitant acute basophilic and B-lymphoblastic leukemia in adult patients. these findings necessitates the comprehensive systematic approach to attain accurate diagnosis and plan the appropriate treatment protocol. Methods/Case Report Bone marrow aspiration & biopsy procedure was performed under local anesthesia and marrow samples were subjected to: lieshman staining of marrow films and direct examination. Immunophenotypic analysis of marrow aspirate by FACS Canto II flow cytometer. Cytogenetics studies were done as karyotyping and gene mutation detection by FISH. Results (if a Case Study enter NA) NA Conclusion Morphology of marrow films: 50% Blast cells, group of them are medium to larg-cells with high nucleocytoplasmic ratio and immature chromatin and the other group shows blast cells with sparse basophilic granulations, plus 20% immatue and maturing basophils. IPT shows two populations: the Myeloblast population (basophilic differentiation) is Positive for CD45dim, CD34het, CD13, CD33, CD117prt, CD25het, CD123het, cyt MPO part, HLA-DR partial. the B lineage lymphoblast population is Positive for CD45dim, CD34het, CD19, CD79a, TdT, CD20het, CD38. Cytogenetics studies: hyperploidy 56, (X, Y, 9, 10, 12, 13, 15, 18, 22, mar+ extra-chromosomes) FISH: +ve for FLT3-ITD mutation. the picture is by morphology & IPT consistent with biclonal leukemia, myeloid clone (acute basophilic leukemia) & ProB-ALL. The systematic laboratory approach from careful morphological examination of peripheral blood and bone marrow smears to confirmatory immunophenotypic analysis of marrow specimens by flow cytometry, and the comprehensive cytogenetics analysis, has a vital role in diagnosing such rare and aggressive phenomenon and provide a good chance for planning the appropriate treatment protocol with critical timesaving and cost effectiveness.

SCKansformer: Fine-Grained Classification of Bone Marrow Cells via Kansformer Backbone and Hierarchical Attention Mechanisms.

The incidence and mortality rates of malignant tumors, such as acute leukemia, have risen significantly. Clinically, hospitals rely on cytological examination of peripheral blood and bone marrow smears to diagnose malignant tumors, with accurate blood cell counting being crucial. Existing automated methods face challenges such as low feature expression capability, poor interpretability, and redundant feature extraction when processing highdimensional microimage data. We propose a novel finegrained classification model, SCKansformer, for bone marrow blood cells, which addresses these challenges and enhances classification accuracy and efficiency. The model integrates the Kansformer Encoder, SCConv Encoder, and Global-Local Attention Encoder. The Kansformer Encoder replaces the traditional MLP layer with the KAN, improving nonlinear feature representation and interpretability. The SCConv Encoder, with its Spatial and Channel Reconstruction Units, enhances feature representation and reduces redundancy. The Global-Local Attention Encoder combines Multi-head Self-Attention with a Local Part module to capture both global and local features. We validated our model using the Bone Marrow Blood Cell FineGrained Classification Dataset (BMCD-FGCD), comprising over 10,000 samples and nearly 40 classifications, developed with a partner hospital. Comparative experiments on our private dataset, as well as the publicly available PBC and ALL-IDB datasets, demonstrate that SCKansformer outperforms both typical and advanced microcell classification methods across all datasets.

Molecular and microscopic detection of haemoprotozoan diseases in dogs from Haryana, India.

Haemoparasitic infections are frequently observed in dogs from tropical regions, including India. The present investigation combined microscopic blood smear examination and PCR assays to assess the occurrence of canine tick-borne diseases (CTBD) from suspected dogs in and around Hisar, Haryana. Using the Giemsa-stained peripheral thin blood smear examination, 15 (12.5%) of the 120 dogs were infected with CTBD, with 5.8%, 3.3%, 2.5%, and 0.8% dogs testing positive for Hepatozoon canis, Ehrlichia canis, Babesia vogeli, and Babesia gibsoni, respectively. Using the PCR assay, CTBD was found to be 64.16% (77/120) in examined dogs. Of the 77 PCR-positive canines, 56 were infected with a single haemoparasite, while 21 were infected with two or more species. H. canis was the most abundant tick-borne pathogen, representing 35%, followed by E. canis 25.8%, B. vogeli 20%, and B. gibsoni 2.5%. The most common co-infection was with H. canis along with E. canis (7.5%). The PCR assay was proven to be more efficient for detecting haemoparasites in dogs compared to blood smear examinations. The study suggests that canine tick-borne diseases are common in Haryana and recommends using PCR-based molecular tests in addition to conventional microscopic examination to diagnose these infections for effective treatment and management of infected canines.

Histidine-rich protein (hrp) 2-based RDT false-negatives and Plasmodium falciparum hrp 2 and 3 gene deletions in low, seasonal and intense perennial transmission zones in Cameroon: a cross - sectional study.

False negative rapid diagnostic tests (RDTs) accruing to the non-detection of Plasmodium falciparum histidine-rich protein 2/3 (Pfhrp2/3) is threatening the diagnosis and management of malaria. Although regular monitoring is necessary to gauge the level of efficacy of the tool, studies in Cameroon remain limited. This study assessed Plasmodium spp. prevalence and Pfhrp2/3 gene deletions across ecological and transmission zones in Cameroon. This is a cross-sectional, multi-site, community- and hospital- based study, in 21 health facilities and 14 communities covering all five ecological settings in low seasonal (LS) and intense perennial (IPT) malaria transmission zones between 2019 and 2021. Participants were screened for malaria parasite using Pfhrp2 RDT and light microscopic examination of thick peripheral blood smears. DNA was extracted from dried blood spot using chelex®-100 and P. falciparum confirmed using varATS real-time quantitative Polymerase Chain Reaction (qPCR), P. malariae and P. ovale by real-time qPCR of Plasmepsin gene, and P. vivax using a commercial kit. Isolates with amplified Pfcsp and Pfama-1 genes were assayed for Pfhrp 2/3 gene deletions by conventional PCR. A total of 3,373 participants enrolled, 1,786 Plasmodium spp. infected, with 77.4% P. falciparum. Discordant RDT and qPCR results (False negatives) were reported in 191 (15.7%) P. falciparum mono-infected samples from LS (29%, 42) and IPT (13.9%, 149). The Pfhrp2+/Pfhrp3 + genotype was most frequent, similar between LS (5.5%, 8/145) and IPT (6.0%, 65/1,076). Single Pfhrp2 and Pfhrp3 gene deletions occurred in LS (0.7%, 1/145 each) and IPT (3.6%, 39/1,076 vs. 2.9%, 31/1,076), respectively. Whilst a single sample harboured Pfhrp2-/Pfhrp3- genotype in LS, 2.4% (26/1,076) were double deleted at IPT. Pfhrp2+/Pfhrp3- (0.3%, 3/1,076) and Pfhrp2-/Pfhrp3+ (1.2%, 13/1,076) genotypes were only observed in IPT. Pfhrp2, Pfhrp3 deletions and Pfhrp2-/Pfhrp3- genotype accounted for 78.8% (26), 69.7% (23) and 63.6% (21) RDT false negatives, respectively. Plasmodium falciparum remains the most dominant and widely distributed Plasmodium species across transmission and ecological zones in Cameroon. Although the low prevalence of Pfhrp2/3 gene deletions supports the continued use of HRP2-based RDTs for routine malaria diagnosis, the high proportion of false-negatives due to gene deleted parasites necessitates continued surveillance to inform control and elimination efforts.

Clinical manifestation and management of hypomagnesemia in Theileria spp. infected periparturient Malabari goats

BackgroundGrass tetany or hypomagnesemia is a metabolic syndrome causing acute neurological manifestations in periparturient ruminants grazing on rapidly grown green pastures or cereal crops with high potassium or nitrogen content and low magnesium levels. Clinical reports of naturally occurring grass tetany in goats are least described in the literature and it is considered to be a rare disease. The present study documents the clinical manifestation and management of hypomagnesemia-associated excitatory neuropathy in two Theileria spp. infected Malabari goats presented to the small ruminant medicine OP unit of the University Veterinary Hospital and Teaching Veterinary Clinical Complex, Mannuthy, Thrissur, Kerala, India. MethodsThe first goat was in the last trimester of pregnancy and was showing signs of hyperesthesia, limping, difficulty in standing, and inappetence for the last six hours. The second goat was kidded six weeks back and was showing recurrent epileptic seizures and hyporexia from the previous day. Both the goats were kept on extensive grazing from the forest areas with unidentified lush vegetation. On clinical evaluation, both the goats were showing persistent excitatory neurological signs. Fecal examination, peripheral blood smear examination, PCR screening panel for hemoparasites, Complete Blood Count, and serum levels of calcium, magnesium, and glucose were evaluated. ResultsA significant reduction in serum magnesium levels was noted in both cases along with the varied glucose levels. Theileria spp. infection was noticed in blood smear examination and confirmed by PCR. The goats responded well to the therapy using MIFEX™ and other supportive medications and showed uneventful recovery. ConclusionIt is suggested that the farmers should be vigilant enough while allowing goats to graze in unknown vegetation and prevent indiscriminate fodder intake during periods of drought. This is the first documented report of hypomagnesemic excitatory neurologic symptoms in Theileria spp. infected periparturient Malabari goats and showing response to appropriate therapy.

MYH9-related disease with a normal platelet count.

MYH9-related disease (MYH9-RD) is characterized by congenital macrothrombocytopenia, progressive kidney failure, and sensorineural hearing loss. We describe a patient with MYH9-RD and a normal platelet count. A 13-year-old boy with a normal platelet count presented with proteinuria and hematuria and underwent a kidney biopsy. Light microscopy showed mild mesangial matrix expansion. Electron microscopy showed thinning of the glomerular basement membrane and splitting of the lamina densa. A tentative diagnosis of Alport syndrome was made. Unexpectedly, genetic analysis revealed a de novo MYH9 gene variant (p.Gln1068_Leu1074dup). A peripheral blood smear examination showed giant platelets and leukocyte inclusion bodies, confirming a diagnosis of MYH9-RD. In summary, we described a patient with MYH9-RD without thrombocytopenia who showed glomerular basement membrane abnormalities similar to Alport syndrome. Peripheral blood smear examinations may be helpful for an appropriate diagnosis of MYH9-RD, even in patients with proteinuria and a normal platelet count.

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.

A study of etiological spectrum in 106 cases of pancytopenia

Introduction and aim. Pancytopenia is the simultaneous presence of anemia, leucopenia and thrombocytopenia. The aim of this work was to study the etiological spectrum of pancytopenia in the National capital region of India, and evaluate the relationship of pancytopenia with serum vitamin B12 levels. Material and methods. This study is of a prospective and analytical type conducted on patients attending the outpatient and inpatient department of Santosh Medical College and the Saraswathi Institute of Medical Sciences tertiary care centers in NCR. Complete blood counts and peripheral blood smear examination was used for morphological classification and typing of anemia. Bone marrow aspiration and vitamin B12 estimation was performed where required. Results. The maximum number of pancytopenia cases were etiologically attributed to megaloblastic anemia (64.2%) followed by aplastic anemia (19.8%). Malaria was attributed to 6.6% cases of pancytopenia. Iron deficiency anemia and tuberculosis both accounted for 1.9% of cases. each. A history of drug intake and mixed nutritional anemia each contributed to 2.8% of cases. Serum vitamin B12 levels showed a significant relationship with pancytopenic cases. Conclusion. In our study, the main cause of pancytopenia is megaloblastic anemia which responds very well to treatment if diagnosed correctly in time. A detailed hematological assessment along with vitamin B12 levels should be evaluated in all cases of pancytopenia irrespective of the etiological categorization.

The incidence of TP53 mutations in patients with chronic lymphocytic leukemia in Iran

Objectives Chronic lymphocytic leukemia (CLL) is linked to a highly variable disease course regarding responses to chemoimmunotherapy and clinical outcomes. Mutations in TP53 and/or deletions in chromosome 17p locus [del(17p)] may lead to loss of a TP53 allele. We investigated TP53 mutations in patients with CLL. Material and Methods Thirty patients with CLL, aged 40–84 years, were included. Immunophenotyping of B cells was done using flow cytometry by CD5, CD10, CD19, CD20, CD23, CD49d, CD38, FMC7, and CD200 markers. Bone marrow aspiration and peripheral blood smear examination were also performed. DNA was extracted and sequencing was done using the Sanger method. Structural aberrations were investigated using the FISH method. Results TP53 mutations had a frequency of eight cases (23.3%), three of which were missense mutations (37.5%), three were intronic mutations (37.5%), and two were silent mutations (25%). Peripheral B lymphocytes had a mean of 82% with 4.59% prolymphocytes. Conclusion Accurate testing for TP53 mutations [TP53 and del(17p) mutations] before every treatment line enables us to make proper therapeutic decisions to improve patient outcomes.

PANCYTOPENIA: Epidemiological and Etiological Profile in Adult Patients of the Internal Medicine Department, CHU Hassan II, Fès.

Introduction: Pancytopenia is a fairly common hematological condition encountered in routine clinical practice. Since there is a wide variation in the etiologies of pancytopenia, even in different populations of the same geographical region, the identification of underlying etiologies is important. With this in mind, our study was undertaken to investigate the epidemiological and clinico-hematological profile of pancytopenic adults with the aim of identifying the different etiologies of pancytopenia. Materials and Methods: This is a retrospective study including all adult patients with pancytopenia admitted to the internal medicine department at Hassan II University Hospital in Fez, Morocco, from January 1, 2019 to December 31, 2022. Pancytopenia is defined by the simultaneous presence of a hemoglobin level < 13.0g/dL in men and 12.0g/dL in women, a total leukocyte count < 4.0 × 10^9 /L and a platelet count < 150 ×10^9 /L. Each patient included in the study underwent a series of investigations, including: blood count and reticulocyte count; peripheral blood smear examination; vitamin assays; bone marrow aspiration; immunophenotyping; osteomedullary biopsy (OMB) and serologies. Patients already diagnosed and under treatment, as well as patients under 18 years of age, were excluded from the study. Results: A total of 164 patients with pancytopenia were identified during our study period. The mean age of our patients was 48 years [extremes 18y-89y], with a preponderance of women (87women/77men). Mucocutaneous pallor was present in 100% of our patients, hepatosplenomegaly in 22.56% and hemorrhagic syndrome in 18.29%. Infectious syndrome and bone pain were observed in 12 patients (7.31%) and 05 patients (3.04%) respectively. Nineteen (19) patients had microcytic anemia, 85 had normocytic anemia and 60 patients had macrocytosis. Vitamin assays revealed vitamin B12 deficiency in 43 patients (26.91%), while 15 patients (9%) had folate deficiency. Combined B12 and folate def

Transient Abnormal Myelopoiesis in Down Syndrome Patients

Neonates with Down Syndrome (DS) have a propensity to develop the unique myeloproliferative disorder, Transient Abnormal Myelopoiesis (TAM). Transient abnormal myelopoiesis usually resolves spontaneously in < 3 months, but approximately 10% of patients with TAM die from hepatic or multi-organ failure. After remission, 20% of patients with TAM progress into acute myeloid leukemia associated with down syndrome (ML-DS). The patient was a full-term 2-day-old baby girl with a birth weight of 3300 gr. Physical examination revealed dysmorphic facial features, hypertelorism, macroglossia, and low set ears, which is a characteristic sign of DS face, skin rash, and there was no anus. On examination of peripheral blood smears and bone marrow aspiration, hematological abnormalities, and circulating blast cells were found. Early diagnosis of low-lying anorectal malformation (MAR) without fistula and down syndrome. In treating patients with TAM, it is first necessary to know whether they have trisomy 21 syndrome, then trace the existing hematological disorders to find the GATA 1 genetic mutation. The most crucial hematological problem in patients with DS is leukemia. Mutations in the GATA 1 gene and the presence of DS can result in abnormal proliferation of megakaryocytes and erythroid progenitors in the fetus and hematological abnormalities in TAM. Transient abnormal myelopoiesis can be fatal in up to 10% of patients and resolves spontaneously. Therefore, laboratory examinations are very significant, including blood tests, peripheral blood smears, supporting examinations such as bone marrow aspiration, monitoring of clinical symptoms, and close monitoring of comorbidities. Examination repeat or follow-up bone marrow aspiration is required within six months of patient follow-up to reduce the risk of further complications. In this case, a follow-up examination is highly recommended because if there are no changes, the further examination must be carried out.

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.