Peripheral Blood Smear Findings Research Articles

Complications and the impact of hematological parameters in donors involved in allogenic peripheral blood stem cell transplantation for hematological malignancies

Hematopoietic stem cell transplantation (HSCT) is a vital treatment option for many hematological malignancies, offering a more convenient alternative to bone marrow transplantation. In allogeneic HSCT, donors provide hematopoietic stem cells for transplantation into patients, necessitating careful consideration of the donor's health and hematological parameters to ensure successful engraftment and treatment outcomes. In a study involving 20 adult donors at Apeksha Hospital, Sri Lanka key hematological parameters, comorbidities, clinical histories, and medications were analyzed. Diabetes mellitus and hypertension were the most prevalent comorbidities among donors, while anemia, primarily linked to iron and vitamin B12 deficiencies, was common. Although baseline coagulation abnormalities were rare and no significant complications occurred during transplantation, early clinical issues such as pain and paresthesia correlated with abnormal peripheral blood smear findings. Notably, a 4-day single daily G-CSF dosing schedule was favored over a 5-day twice daily regimen due to fewer reported problems. While anemia and thrombocytopenia were infrequent, these findings underscore the critical importance of meticulous donor selection and vigilant monitoring throughout the transplantation process to optimize outcomes.

Deep learning-assisted smartphone-based quantitative microscopy for label-free peripheral blood smear analysis.

Hematologists evaluate alterations in blood cell enumeration and morphology to confirm peripheral blood smear findings through manual microscopic examination. However, routine peripheral blood smear analysis is both time-consuming and labor-intensive. Here, we propose using smartphone-based autofluorescence microscopy (Smart-AM) for imaging label-free blood smears at subcellular resolution with automatic hematological analysis. Smart-AM enables rapid and label-free visualization of morphological features of normal and abnormal blood cells (including leukocytes, erythrocytes, and thrombocytes). Moreover, assisted with deep-learning algorithms, this technique can automatically detect and classify different leukocytes with high accuracy, and transform the autofluorescence images into virtual Giemsa-stained images which show clear cellular features. The proposed technique is portable, cost-effective, and user-friendly, making it significant for broad point-of-care applications.

Spur Cell Anemia: A Rare and Under-Diagnosed Cause of Anemia in Alcoholic Patients with Advanced Liver Disease

Anemia in patients with alcohol use disorder (AUD) has a wide range of differential diagnoses, which can be challenging to interpret. It is often multifactorial, such as due to blood loss with or without coagulopathy, direct toxic effect of alcohol on hematopoietic cells, chronic inflammation, abnormalities in red blood cells (RBC) membranes, and nutritional deficiencies. Alcohol-induced liver disease may contribute to anemia through coagulopathy, splenomegaly, and hypersplenism. Macrocytosis is a common finding in patients with AUD due to B12 or folate deficiency or RBC membrane abnormality due to changes in lipid composition of RBC membranes. Patients with cirrhosis may have low haptoglobin due to impaired synthetic liver function. However, non-autoimmune hemolytic anemia and concomitant alcohol-induced liver damage should raise suspicion for spur cell anemia (SCA) and Zieve's syndrome. These medical conditions tend to be underreported or misdiagnosed. We describe a 44 year old male patient with a past medical history of AUD who presented with alcohol intoxication and was found to have newly diagnosed decompensated cirrhosis with severe macrocytic anemia with Hgb of 5.9 g/dl. Patient denied overt bleeding. Initial workup revealed high absolute reticulocyte count of 10.8% with retic index of 3, low haptoglobin of <15 mg/dl, elevated LDH of 275 u/l, negative Coombs test consistent with non-autoimmune hemolytic anemia, normal folate and B12 levels, and mixed direct and indirect hyperbilirubinemia. Peripheral blood smear showed anisopoikilocytosis, macrocytes, many spur cells, increased reticulocytes, but no schistocytes. Endo-colonoscopy showed grade 1 esophageal varices without evidence of recent bleeding. Given the history of heavy alcohol intake and cirrhosis, combined with Coombs-negative hemolytic anemia and peripheral blood smear findings of numerous spiculated red cells, our patient was diagnosed with SCA. At the time, due to active alcohol use, the patient was deemed not to be a candidate for liver transplant. This case report aims to aid physicians with the recognition of acute hemolytic anemia in patients with alcoholic liver injury and consideration of SCA and Zieve's syndrome as potential underlying causes. Prompt recognition and differentiation between these medical conditions are crucial as prognosis and treatment are different. Early recognition of SCA and timely consideration of liver transplantation can significantly improve patient outcomes.

An interactive e-learning module on peripheral blood smear analysis is an effective option for teaching pathology trainees.

This study compares the effectiveness of an interactive e-learning module with a traditional text-based method for teaching peripheral blood smear analysis. Pathology trainees at Accreditation Council for Graduate Medical Education residency programs were asked to participate. Participants completed a multiple-choice test on peripheral blood smear findings. Trainees were randomized into completing an e-learning module or a PDF reading exercise with the same educational content. Respondents rated their experience and completed a postintervention test composed of the same questions. In total, 28 participants completed the study; 21 improved their score in the posttest (mean, 21.6 correct answers) compared with the pretest (19.8; P < .001). This improvement was seen in both the PDF (n = 19) and interactive (n = 9) groups, with no difference in performance between the 2 groups. Trainees with less clinical hematopathology experience showed a trend of having the largest performance improvement. Most participants completed the exercise within 1 hour, rated the exercise as easy to navigate, were engaged, and reported learning new information about peripheral blood smear analysis. All participants indicated that they would likely complete a similar exercise in the future. This study suggests that e-learning is an effective tool for hematopathology education and equivalent to traditional narrative-based methods. This module could easily be incorporated into a curriculum.

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

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

The Morphologic Spectrum of Myelokathexis in WHIM Syndrome and Germline CXCR4 Variants: New Insights into Cellular Changes in the Bone Marrow and Peripheral Blood

Introduction WHIM syndrome (WHIMs) is a rare disorder caused by germline CXCR4 mutations, classically characterized by warts, hypogammaglobulinemia, infection, and neutrophil retention in the bone marrow (BM), with distinctive morphology termed myelokathexis. Demonstration of myelokathexis by BM evaluation plays a key role in disease recognition and diagnosis. However, the spectrum of BM morphologic features and correlation with specific CXCR4 mutations are not well described. Moreover, diagnostically useful peripheral blood (PB) smear findings and morphologic changes after CXCR4 antagonist therapy are largely unknown. Methods We conducted a multinational, retrospective review of clinicopathologic features of patients with established WHIMs (n=20) or germline CXCR4 variants considered likely pathogenic or of uncertain significance (n=3), including 14 BM specimens and 10 PB smears. Assessments to date were performed by 2 observers in 6 cases and a single observer in the remainder. BM morphology was compared to other neutropenia disorders (Shwachman-Diamond syndrome, n=5; GATA2 deficiency, n=5; severe congenital neutropenia with ELANE variants, n=4) and patients without hematologic disorders (n=10), together "controls." Correlations and contingency analysis (2-tailed Fisher exact test) were performed using Prism v.9.4.0 (GraphPad Software). Results Median age at WHIMs diagnosis was 18.5 years (range, 0.1-53 years), with female:male ratio of 1.1:1. Recurrent infections, warts, and hypogammaglobulinemia were present in 100%, 53%, and 40% of cases, respectively. BM aspirate smears contained neutrophils with long intranuclear chromatin strands and hypermature condensed chromatin ("myelokathectic neutrophils") in all WHIMs cases, making up 32% to 80% (median 66%) of total neutrophils (Table). In comparison, neutrophils with myelokathectic changes were seen in 0% to 4% of control BMs. Myeloid hyperplasia (myeloid:erythroid ratio >4:1) was present in 50% of WHIMs and 4% of controls (P=.0028); vacuolated neutrophils in 92% of WHIMs (≤29% of total neutrophils) and 17% of controls (P<.0001); apoptotic neutrophils in 58% of WHIMs (1%-4% of total neutrophils) and 8% of controls (P=.0025); and nonparatrabecular neutrophil clusters on core biopsy in 3/3 WHIMs and 5% of controls (P=.0017). Vacuolated eosinophils and myeloid shift toward hypermaturity were present in WHIMs. There was no correlation between percentage of BM myelokathectic neutrophils and degree of CXCR4 truncation. BM in 2 patients with CXCR4 p.S341Y showed myeloid hyperplasia, increased neutrophil apoptosis, and infrequent myelokathectic neutrophils (5%-10%). Neutropenia was present in all untreated WHIMs. Myelokathectic neutrophils were present in PB of all patients with known WHIMs and accounted for 8% to 30% (median, 18%) of total neutrophils. Percentage of PB myelokathectic neutrophils showed an inverse correlation with absolute neutrophil count (ANC) (r=-0.783; P=.0074). Neutrophil apoptosis, neutrophil vacuolization, dysmorphic (hypogranular, hyperlobated, vacuolated, or apoptotic) eosinophils, and/or dysmorphic basophils were present in 80%, 30%, 70%, and 60% of WHIMs cases, respectively (Figure). PB in 1 patient with CXCR4p.D84H showed neutrophil hypolobation without myelokathectic morphology. CXCR4 antagonist therapy with plerixafor (n=4) [Dale et al. Blood. 2011] or mavorixafor (n=1) (interval, 4-12 h) resulted in increased white blood cell (WBC) count and ANC, with a similar proportion of myelokathectic neutrophils as before therapy. Conclusions In WHIMs BM specimens, the proportion of myelokathectic neutrophils is variable and may not be prominent; the classic finding of myeloid hyperplasia is only present in a subset of cases, which may result in underrecognition of the disease and delayed diagnosis. Neutrophil vacuolization and apoptosis, eosinophil vacuolization, and prominent neutrophil clusters may also prompt disease recognition. We establish characteristic PB morphologic features which, in a patient with unexplained neutropenia, may suggest a diagnosis of WHIMs, including myelokathectic neutrophils, neutrophil vacuolization or apoptosis, and dysmorphic eosinophils and basophils. CXCR4 antagonist therapy led to an increase of WBC/ANC, while pretreatment morphologic changes persisted after a short interval. Analysis of additional cases is ongoing. Figure 1View largeDownload PPTFigure 1View largeDownload PPT Close modal

Laboratory Evaluation and Pathological Features of Bone Marrow Metastasis in Non-haematological Malignancies.

This study aimed to analyse the diagnostic accuracy of different laboratory parameters that can predict bone marrow metastasis. A cross-sectional analytical study was conducted at the Armed Forces Institute of Pathology (AFIP), Rawalpindi from March 2021 to August 2021. Bone marrow aspirates and biopsy procedures were done on 60 newly diagnosed cases of non-haematological malignancies as part of staging. Laboratory parameters noted for the study included peripheral blood smear findings, serum lactate dehydrogenase (LDH), radiological findings, and bone marrow aspirate/trephine biopsy results. Bone marrow metastasis was seen in 21/60 patients. The most common malignancies with bone marrow involvement were retinoblastoma and neuroblastoma. Laboratory findings showed no significant statistical difference in mean haemoglobin and total leukocyte count between cases and controls. Positive cases had a mean platelet count of 261.7 x 109/L and mean LDH of 750.1 U/L (p <0.05) for both parameters. ROC analysis showed the area under the curve (AUC) for LDH to be 0.969 (highly significant) showing a strong predictive value of LDH. Positive radiological findings were detected in only one case with bone marrow metastasis. The elevated level of serum LDH is not only cost-effective but also has high diagnostic accuracy to predict bone marrow metastasis. Key Words: Bone marrow, Biochemical, Lactate dehydrogenase, Metastasis, Non-haematological malignancies.

Peripheral Blood Smear Findings in 2 Patients With Coexisting Thalassemia and Hereditary Spherocytosis.

*Gazi University Faculty of Medicine, Pediatrics Hematology, Ankara, Turkey †Laboratório de Hematologia Molecular Hospital, Pediatrico, Portugal This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent was obtained from the patient and his parents. The authors declare no conflict of interest. Reprints: Zühre Kaya, MD, Department of Pediatrics, Unit of Pediatric Hematology, Gazi University School of Medicine, Beşevler, Ankara, Turkey 06500 (e-mail: [email protected]).

Haematological Patterns of Anaemia in Geriatric Patients and Its Etiology: A Study of 500 Cases

Introduction: Anaemia in the elderly is a global health problem, since it is associated with significant morbidity and mortality. The World Health Organization’s criteria consider anaemia when level of haemoglobin is less than 13g/dl in male and 12g/dl in female. Anaemia is easier to miss among the elderly because symptoms such as fatigue, generalized weakness, or mental confusion can be linked to the ageing process. However, anaemia should never be considered as a natural part of growing older.&#x0D; Aim: To investigate the haematological pattern of anaemia and its underlying etiology in elderly Indian patients.&#x0D; Materials and Methods: A prospective study undertaken over a span of 2 years in a tertiary care hospital in Western Maharashtra. The study included 500 geriatric (&gt;65years) anaemic patients who underwent a complete haemogram and the results were correlated with peripheral blood smear findings. Other diagnostic tests were done as indicated.&#x0D; Results: The spectrum encompassed all patterns of anaemia with the most common being normocytic normochromic pattern (57.26%). Overall, there was slight male preponderance (53%) with 65-74 years (69%) being the most common age group afflicted. Maximum number of elderly people had moderate anaemia(56%) in this study; and chronic disease (27.2%) was the most common etiological cause of anaemia followed by iron deficiency (23.4%). Upper gastrointestinal lesions (59%) were the most common causes of iron deficiency anaemia in the present study followed by nutritional deficiency (31.6%).&#x0D; Conclusion: Correlation of haemogram and peripheral blood smears is a crucial first step to identify the haematological pattern of anaemia and advise subsequent investigations for assessing and diagnosing it’s etiology. Thus, it plays a role in deciding the management protocol and contributes towards a better quality of life for geriatric anemic patients.

Clinicopathological features of pancytopenia in adults and the role of bone marrow study in etiological categorization: A one-year cross-sectional study

Background and Objectives: Pancytopenia is a combination of anemia (with a reduction of the red blood cell count), leukopenia, and thrombocytopenia. Leukopenia is usually mainly due to a reduction in the neutrophil count although the number of other granulocytes, monocytes, and lymphocytes are often also reduced. Pancytopenia is a manifestation of many serious and life-threatening diseases. This study was undertaken to evaluate the clinicopathological features of pancytopenia and the role of bone marrow study for etiological categorization. Settings and Design: This is a cross-sectional observational study conducted in a tertiary referral center of north east India, for a period of 1 year (from August 2020 to July 2021). Materials and Methods: Proper history taking and clinical examination were done for all patients attending with hemoglobin <10 mg/dL, total leukocyte count <3000 cells/cmm, and platelet count <1 lakh/cmm. The investigations done were peripheral blood smear examination with Leishman stain, special staining, as well as specific biochemical and radiological investigations as per requirement in cases; bone marrow aspiration (under all aseptic precaution); and bone marrow trephine biopsy (under all aseptic precaution). The results are presented in tables and compared with similar studies. Results: A total of 42 cases of pancytopenia were evaluated. The age group of 18–20 years was the most commonly affected. Male-to-female ratio was 1.33:1. All the patients presented with generalized weakness and pallor, and a large portion also with abdominal discomfort, hepatomegaly, and splenomegaly. Anisocytosis and macrocytosis were the most common peripheral blood smear findings. Vitamin B12 level was decreased in 75% of all the evaluated cases (15 of 20 cases). Bone marrow was hypercellular in most of the cases (80.95%) followed by hypocellular marrow (14.29%). Megaloblastic erythroid hyperplasia was the most common abnormality found in bone marrow. Megaloblastic anemia was the most common etiology followed by hypoplastic/aplastic anemia. A significant portion (7.14%) also showed bone marrow involvement by myeloma. One case of involvement by metastatic tumor was found. Conclusions: Most cases of pancytopenia were due to megaloblastic anemia and so easily curable. The bone marrow study is essential to evaluate a case of pancytopenia to know the exact etiology for proper management.

Hematological changes in hypothyroidism and hyperthyroidism in adults

Thyroid function disorders are among the most common endocrine diseases. Thyroid disorders can cause certain forms of anemia, more commonly in hypothyroidism. Slightly decreased TLC, relative neutropenia, relative lymphocytosis or relative eosinophilia may be found in thyroid disorders. These observations confirmed the association between thyroid gland dysfunction and hemopoiesis.1) To study the pattern of hematological changes in thyroid dysfunction 2) To correlate thyroid function tests with complete blood count &amp; red cell indices findings 3) To correlate complete blood count investigations and peripheral blood smear findings with serum TSH levels.It was an Observational study conducted during 18 months of period from March 2018 to October 2019 with 100 subjects of hypothyroidism, 80 subjects of hyperthyroidism and 100 euthyroid subjects as control group. CBC was done on automated cell counter. PBS was stained with Leishman stain and observed under microscope. TFTwas done by immunoassay method.It was done with SPSS Software.: Predominance of female was seen in hypothyroidism and hyperthyroidism. Significant decrease was seen in RBC, Hb, HCT, MCV and MCH in hypothyroid group, while in hyperthyroid group RBC, Hb and HCT were significantly decreased as compared with euthyroid control group. Both groups showed significant increase in RDW as compared with control group.It is important to carefully evaluate the thyroid hormones in cases of unexplained anemias. So, periodic evaluation for probable hematological changes should be done in all the patients with hypothyroidism and hyperthyroidism.

Red Blood Cell Morphological Changes and Enlarged Platelets Found in Idiopathic Multicentric Castleman Disease

BACKGROUNDIdiopathic multicentric Castleman disease (iMCD) is a rare polyclonal lymphoproliferative disorder characterized by systemic inflammatory symptoms, cytopenias, generalized lymphadenopathy, and multiple organ system dysfunction. iMCD is subclassified into iMCD-TAFRO, with thrombocytopenia, anasarca, fever/elevated C-reactive protein, reticulin myelofibrosis/renal failure, and organomegaly, and iMCD-NOS (not otherwise specified), with high platelet counts and hypergammaglobulinemia. Despite recent diagnostic guidelines, iMCD diagnosis remains challenging because many of the histopathologic features and clinical/laboratory abnormalities are non-specific. Characterization of easily measurable findings from minimally invasive procedures, such as peripheral blood smear, could help to improve the accuracy of diagnosis as well as potentially providing insights into disease pathogenesis. Peripheral blood smears are often performed during routine clinical evaluation and enable morphologic evaluation of red blood cells (RBCs) and white blood cells (WBCs). In this study, we systematically characterized peripheral blood smear morphologic findings in iMCD for the first time.METHODSPeripheral blood smear morphologic findings in medical records from 68 iMCD patients, who were enrolled in an international registry for CD patients and had been confirmed to meet iMCD criteria by an expert panel, were reviewed and analyzed. Patients were also categorized into iMCD-TAFRO (N=39) or iMCD-NOS (N=29) based on clinical and laboratory data. Two-sample proportion tests were used to compare the frequency of features between iMCD-TAFRO and iMCD-NOS, when the abnormality was present in ≥ 5 subjects in both subtypes. P-value correction was not performed as findings are preliminary and hypothesis generating.RESULTSAmong the 68 iMCD patients, average age was 35.8 years (14-61); 46% were female, 54% were male; racial distribution was 62% white; 10% Black; 15% Asian; 13% other. The most common peripheral blood smear findings across all iMCD patients included abnormalities in RBC size and color, with anisocytosis (58.8%), polychromasia (57.4%), hypochromia (55.9%), and microcytosis (50.0%) being the most prevalent findings in the overall cohort (Table 1). Other RBC abnormalities were observed but less frequently, including abnormalities in shape such as poikilocytosis (44.1%). Giant or large platelets were found in 47% of iMCD cases. Abnormalities in WBCs, including toxic granulation, atypical lymphocytes, and toxic vacuolization, were detected less frequently. When comparing the two clinical subtypes, patients with iMCD-TAFRO had more frequent anisocytosis (p=0.043), hypochromia (p=0.002), polychromasia (p=0.022), and giant/large platelets (p<0.001) versus iMCD-NOS.DISCUSSIONHere, we have characterized peripheral blood morphologic abnormalities in iMCD for the first time. The most common findings in this cohort included abnormalities in RBC size and color. These abnormalities can be found in a number of conditions, including myelofibrosis, autoimmune diseases, and other inflammatory conditions. In iMCD, they are likely related to cytokine-driven anemia of chronic inflammation. The presence of large or giant platelets in nearly half of iMCD patients, with significantly more in iMCD-TAFRO than iMCD-NOS, is particularly notable since this has not been described in iMCD. These enlarged platelets, which can be found in immune thrombocytopenic purpura, myeloproliferative disorders, pseudothrombocytopenia, and inherited platelet disorders, may reflect hyperactivity of megakaryocytes and/or early release from the bone marrow in response to peripheral platelet sequestration. Though less common in this cohort, there are additional changes in RBC shape and WBC features that may be more specific to iMCD and potentially informative in increasing the index of suspicion for iMCD. These findings suggest that the peripheral blood smear may be able to support the diagnosis of iMCD and result in faster treatment administration. Future work is needed to determine whether the constellation of findings in the peripheral blood identified herein is unique to iMCD or seen in various other infectious, malignant, and autoimmune diseases. [Display omitted] DisclosuresFajgenbaum: Pfizer: Other: Study drug for clinical trial of sirolimus; EUSA Pharma: Research Funding; N/A: Other: Holds pending provisional patents for ‘Methods of treating idiopathic multicentric Castleman disease with JAK1/2 inhibition’ and ‘Discovery and validation of a novel subgroup and therapeutic target in idiopathic multicentric Castleman disease’.

Systematic Evaluation of Hematological Parameters and Blood Smear Findings Reveals Significantly Fewer Abnormalities in Patients Admitted with SARS-CoV-2 Compared to Other Viral Respiratory Infections

Abstract Peripheral blood abnormalities like variant lymphocytes, Pelger-Huët anomaly, and granulocytic left shift have been reported in patients with active severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. However, the specificity of these findings for SARS-CoV-2 infection is unknown as there is a lack of comparative data between SARS-CoV-2 and other viral respiratory illnesses. In this study, we examined the peripheral blood findings in patients admitted with acute SARS-CoV-2 and other viral respiratory infections. We reviewed the complete blood differential counts and peripheral blood leukocyte morphology on peripheral smears received from patients admitted with a positive viral respiratory panel (VRP) or SARS-CoV-2 test from March 20th – May 31st, 2020. Cases where the specimen was collected 10 days after the symptom onset were excluded. During the study period, we reviewed 122 blood specimens from 59 patients (mean±SD age: 46.7±21.7 years, female: 49.2%). Of these, 53 (43.4%) specimens were from patients with SARS-CoV-2 infection and 69 (56.6%) specimens from patients with other viral respiratory infections. There were no significant differences in the demographic characteristics of the two groups. For the blood cell counts, absolute leukopenia (11.3% versus 40.6%, P&amp;lt;0.001), low red blood cell count (45.3% versus 78.3%, P&amp;lt;0.001), low hemoglobin (56.6% versus 76.8%, P0.018), low hematocrit (43.4% versus 78.3%, P&amp;lt;0.001), high mean corpuscular volume (3.8% versus 31.9%, P&amp;lt;0.001), high mean corpuscular hemoglobin concentration (1.9% versus 14.5%, P0.016), thrombocytopenia (11.3% versus 58.0%, P&amp;lt;0.001), low mean platelet volume (3.9% versus 15.0%, P0.048), and high red cell distribution width (13.2% versus 53.6%, P&amp;lt;0.001) were all less common in patients with SARS-CoV-2 infection as compared to those with other viral respiratory infections. There were no significant differences in the differential leukocyte counts between the two groups, except neutropenia was less common in SARS-CoV-2 infection (17.3% versus 44.1%, P0.002). Among the peripheral blood smear findings, toxic granulation in neutrophils (1.9% versus 42.01%, P&amp;lt;0.001) and the presence of myelocytes (13.2% versus 29.0%, P0.042) were less commonly seen in SARS-CoV-2 infection. Other findings like elevated band neutrophils (8.3% versus 27.5%, P0.081), presence of metamyelocytes (13.2% versus 27.5%, P0.060), presence of promyelocytes (5.7% versus 13.0%, P0.186), plasmacytoid lymphocytes (66.7% versus 91.7%, P0.177), and hypogranular neutrophils (7.6% versus 8.7%, P0.819) showed a trend towards being less common in patients with SARS-CoV-2 infection but the differences were not statistically significant. On the contrary, reactive lymphocytes (43.4% versus 33.3%, P0.257) and uni- or bi-lobate neutrophils showed a trend towards being more common in SARS-CoV-2 infection (18.9% versus 17.4%, P0.833), however, the differences were not statistically significant. Abnormalities in peripheral blood count and blood smear findings seem to be less frequent in hospitalized patients with SARS-CoV-2 infection as compared to those with other viral respiratory infections.

Odynophagia: A Rare Presenting Symptom in Acute Myeloid Leukemia (FAB AML - M2)

Acute myeloid leukemia is more common in adults than in children population. Fatigue, bleeding and fever are the most common presentations. Petechiae, gingival swelling, lymphadenopathy and hepatosplenomegaly are common signs. Here we report a case of a 57 years post-menopausal lady with gum swelling and pain on deglutition for both liquid and solid foods. She was diagnosed with a case of AML- M2 on the basis of peripheral blood smear and bone marrow examination findings.

Erythrocyte T-antigen activation in children: Patient characteristics and the hemolytic risk of transfusion.

T-antigen activation usually occurs upon red blood cell (RBC) membrane cryptantigen exposure due to bacterial enzymes. Although uncommon, the condition is probably underrecognized. There is concern about hemolysis after plasma and plasma-containing platelet transfusions due to naturally occurring anti-T antibody in healthy blood donors. However, experts have debated the extent and severity of clinical hemolysis due to anti-T. We retrospectively identified patients who tested positive for polyagglutination with Arachis hypogea and Glycine max lectins from 2008 to 2019. The records of the patients were reviewed to determine clinical symptoms, laboratory evidence of hemolysis, need for transfusion, and clinical outcomes. Ten patients were identified. At diagnosis, all were anemic and four had thrombocytopenia. Severe Streptococcus pneumoniae infection affected seven patients; one died. Seven of 10 patients (70%) had laboratory evidence of hemolysis. Peripheral blood smear findings in six patients included RBC agglutination and changes suggesting hemolysis (spherocytes and schistocytes), but three had unremarkable RBC morphology. Four patients required plasma or platelet transfusions; all survived to discharge. T-antigen activation is a rare entity. Most patients diagnosed at our hospital had hemolytic anemia and severe pneumococcal infection. Hemoglobin decreased after plasma and platelet transfusions in all patients assessed, but these transfusions were necessary to support treatment. RBCs were given to maintain appropriate hemoglobin levels.

Scattergram patterns of hematological malignancies on sysmex XN-series analyzer

BACKGROUND: Automated hematology analyzers effectively reduce turnaround time and generates scattergrams which can be used to screen for different hematological conditions. AIMS: We wish to study the scattergrams generated by the Sysmex XN-series analyzer for confirmed cases of hematological malignancies and evaluate for the specific patterns to these malignancies. METHODS: Two hundred and ninety-one newly diagnosed cases of various hematological malignancies were included in the study. All these cases were diagnosed and classified in accordance with flow cytometry, bone marrow morphological study, immunohistochemistry, and molecular studies. Forty-eight cases of leukemoid reaction were also included in the study. We retrieved the scattergrams and complete blood count data of all these cases which were processed in the Sysmex XN-analyzer before their diagnosis. Along with scattergrams, the peripheral blood smear findings of all the cases were extracted too. The scattergram patterns in the white blood cell differential (WDF) and white cell nucleated region (WNR) channels were evaluated and correlated with their peripheral blood smear findings. RESULTS: All the scattergrams in the WDF and WNR channels were studied. Patterns seen in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were striking and distinctly separate. After correlating with the peripheral smear and immunophenotyping, AML patterns were subtyped by the French American British classification. Acute promyelocytic leukemia as well as different phases of chronic myeloid leukemia had unique patterns. Scattergram patterns of ALL had minute difference with that of chronic lymphoproliferative disorder. CONCLUSION: In high-volume laboratories, the patterns on Sysmex XN-series analyzer scattergrams can be used as a valuable aid for suspecting and triaging cases of hematological malignancies.

Study of peripheral blood smear findings in patients of anemia and to compare it with automated hematology analyzer generated red cell parameters

Introduction: Anemia is one of the common medical conditions prevalent in our society. The correct categorization of varying types of anemia is essential for therapeutic purposes. Various laboratory tests are done to find out its underlying cause, but peripheral smear (PS) study of red blood cells (RBCs) morphology is important along with study of red blood cell indices in the classification of anemia.&#x0D; Objectives: This study was done to evaluate RBC morphology on peripheral smear examination in patients of anemia and to compare these findings with cell counter generated red blood cells indices comprising of Mean corpuscular volume (MCV), Mean corpuscular hemoglobin concentration (MCHC) and Mean corpuscular hemoglobin (MCH)&#x0D; Methodology: Red blood cell morphology on peripheral blood smear was studied in 350 patients of anemia irrespective of age and gender received under six months duration from 1st January 2019 to 30 th June 2019 and findings were compared with cell counter generated red cell parameters generated by automated hematology analyzer.&#x0D; Results: Most common anemia seen on smear examination was microcytic hypochromic anemia which accounted for 210 (60%) cases followed by dimorphic anemia in 73 (20.86%) cases. Most of the patients were female, comprising of 227 (64.85%) cases. Highest numbers of patient were in the age group of 21-30 years (20.30%). Sensitivity of MCV was 78%, MCHC was 14% and MCH was 80% in detection of microcytic hypochromic anemia. The sensitivity of MCV and MCH was found to be 100 % in detection of macrocytic anemia. Sensitivity of MCHC was only 10% for detection of macrocytic anemia. The sensitivity of MCV, MCHC and MCH was 78%, 100% and 67 % respectively in detection of normocytic normochromic anemia. &#x0D; Conclusion: The peripheral smear examination should always be interpreted along with the red blood cell indices generated by an automated analyzer in order to classify various types of anemia.

Peripheral Blood Smear Findings in COVID-19

Peripheral Blood Smear Findings in COVID-19

A novel SPTB gene mutation in neonatal hereditary spherocytosis: A case report.

The aim of the present study was to enhance the understanding of the diagnosis and treatment of neonatal hereditary spherocytosis (HS). Gene sequencing and analysis was performed for the crucial splicing signals on the exons and introns of the 302 known pathogenic genes [including ANK1, SPTAN1, SPTA1, EPB42, SLC4A1, and SPTB] that are associated with this genetic deficiency of erythrocytes. A 26-day-old female presented with jaundice, anemia, an increased count in peripheral blood reticulocyte and spherocytes and a positive acidified glycerol hemolysis test. Gene sequencing revealed a novel mutation of c.3737delA (p.Lys1246fs) in the exon 16 of SPTB (14q23|NM_000347.5) gene in the patient and her father. The mutation was a frame-shifting mutation, which may result in the truncation of β-haemoglobin in the erythrocyte membrane can lead to loss of normal function, leading to the occurrence of diseases, including jaundice and hemolytic anemia. For neonates with jaundice and anemia, family history, erythrocyte index and peripheral blood smear findings have been indicated to contribute to the diagnosis of HS. In the current study, gene sequencing was indicated to be helpful for the diagnosis of HS. A novel mutation of SPTB gene was identified, which may be pathogenic via modulating the activity of β-spectrin in the erythrocyte membrane.

Assessment and reliability of suspect flags in automated hematology analyzers for diagnosing white blood cell and platelet disorders

Background: The automated hematology analyzers have replaced the traditional manual methods for assessing hematological parameters. Most of the automated hematology analyzers are programmed to identify abnormalities in the form of “suspect flags.” Aims: The aim of the study was to correlate white blood cell (WBC) and platelet (PLT) flag messages provided by automated analyzers with their respective peripheral blood smear (PBS) findings. Materials and Methods: A descriptive cross-sectional study was undertaken on 100 patients who showed WBC and PLT suspect flags and/or abnormal peripheral smears. The flag messages were analyzed with their respective PBS findings. Pearson's Chi-square test was used for the statistical analysis. Results: Analyzer and PBS showed WBC defects (n = 46, 32), PLT defects (n = 39, 54), and combined defects (n = 36, 43) respectively. WBC defects included leukocytosis (n = 27, 22), leukopenia (n = 20, 18), immature granulocytes (n = 10, 3), left shift (n = 3, 2), myeloblast blast (n = 2, 1), and eosinophilia (n = 4, 4) on analyzer and PBS. Correlation between the WBC suspect flags and their peripheral smears was found to be statistically significant (P = 0.006). PLT defects included thrombocytopenia (n = 22, 30), thrombocytosis (n = 13, 17), giant PLTs (n = 10, 15), PLT clumps (n = 8, 12), and PLT debris (n = 2, 5) on analyzer and PBS. Correlation between the PLT characteristics in analyzers and in peripheral smears was statistically significant (P = 0.042). Conclusion: Suspect flags should be used as a screening tool to pick up pathological samples. These should then be followed up with a PBS examination for definitive diagnosis.