Peripheral Smear Examination Research Articles

Comparative Study of Red Blood Cell Parameters in Different Hemoglobinopathies Diagnosed by HPLC at a Tertiary Care Hospital, Rajkot, Gujarat

Background: Inherited disorders of hemoglobin (hemoglobinopathies) are the most common genetic disorders in the world with 7% prevalence. Thalassemia and sickle cell anemia are the most prevalent hemoglobinopathies in India. Screening and diagnosis of hemoglobinopathies require a comprehensive evaluation combining clinical and family history, blood counts, red blood cell indices, and molecular analysis. Aims and Objective: (1) To differentiate the type of hemoglobinopathies on the basis of red cell parameters, (2) to assess the spectrum of hemoglobinopathies, and (3) to study the age at diagnosis and genderwise distribution of various hemoglobinopathies. Material and Methods: A prospective observational study over a period of 1 year (August 2020 to July 2021) at a tertiary care hospital, Rajkot, Gujarat. All indoor patients’ samples were sent for complete blood count (CBC), peripheral smear examination, reticulocyte count, sickling test, and high-performance liquid chromatography (HPLC). Result: A total of 140 subjects were included in the final analysis. The mean age at diagnosis was 24.7 ± 10.5 years; 48 participants were male, and the remaining 92 were female with an M:F ratio of 0.5:1. The most common hemoglobinopathy in this study was sickle cell trait (40 cases, 28.6%). Conclusion: To reduce the burden of various hemoglobinopathies, screening is recommended as a part of antenatal checkup and in infants after 6 months of age in high-prevalence districts for particular hemoglobinopathies via CBC including RBC indices and HPLC.

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

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

Comparison of classification of anemia based on mean corpuscular volume by hematology analyzer and peripheral smear examination

Comparison of classification of anemia based on mean corpuscular volume by hematology analyzer and peripheral smear examination

Acute paroxysmal cold hemoglobinuria upon dengue fever: A case report

Rationale: Dengue fever is capable of inciting the formation of transient polyclonal antibodies directed at red blood cell antigens, resulting in complement-mediated hemolysis, leading to intravascular hemolysis and hemoglobinuria. Patient’s concern: A 12-year-old male patient who recovered from dengue fever a week ago had red blood cell agglutination, spherocytes, and engulfment of red blood cells (erythrophagocytosis) by monocytes and neutrophils on routine hematological peripheral blood smear. The unexpected blood smear results prompted the lab physicians to investigate autoimmune hemolytic anemia, which revealed a monospecific positive direct antiglobulin test for complement (C3d, C3b) and the presence of Donath-Landsteiner antibody. Diagnosis: Paroxysmal cold hemoglobinuria (PCH), secondary to dengue fever. Interventions: Oxygen supplements, antibiotics, intravenous immunoglobulins, steroid therapy, and packed cell transfusions were administered. Outcomes: The patient’s condition was improved following the therapy. Lessons: Post-dengue PCH is a rare complication that requires a thorough peripheral smear examination for erythrophagocytosis, as advanced hematology analyzers fail to detect such findings.

Study of Patterns of Leukaemia in a Tertiary Care Hospital

Introduction: Leukaemia arises from abnormal proliferation of hematopoietic or lymphoid cells, categorized as acute or chronic and originating from lymphoid, myeloid, or mixed lineages. Clinical manifestations result from leukemic cell proliferation and tissue infiltration. Objectives: This study aimed to determine the frequency and clinicopathological profile of leukaemia cases. Material and Methods: A three-year cross-sectional observational study was carried out in the Department of Pathology, Indira Gandhi Medical College, Shimla. Diagnosis of Leukaemia was based on complete blood count, peripheral smear examination, bone marrow analysis and cytochemistry wherever required. Data comprising of patient details, clinical examination and haematological parameters were analysed. Results: A total of 163 leukaemia cases were identified, including 102 (63%) acute and 61(37%) cases of chronic leukaemia. Acute leukaemia consisted of 58 cases of Acute Myeloid Leukaemia (AML), 25 Acute Lymphoblastic Leukaemia (ALL), and 19 undifferentiated leukaemia (UL), while chronic cases comprised 47 Chronic Myeloid Leukaemia (CML) and 14 Chronic Lymphocytic Leukaemia (CLL). Most patients were in the age group of 31-60 years, with a male predominance (M:F 1.7:1). Conclusions: Early diagnosis and typing are vital for prompt leukaemia treatment. Despite advanced technologies, cytomorphological examination with cytochemistry remains crucial, especially in resource-limited settings like India. Keywords: Leukaemia, acute, chronic, cytomorphology, observational study

A Cross-Sectional Study of Hematological Parameters in the Geriatric Population Using Peripheral Smear Examination and a Five-Part Cell Counter.

"Healthy aging" is a major public health challenge, as the prevalence and incidence of diseases are much higher in older people. Among them, diabetes mellitus, hypertension (HTN), and cardiovascular illnesses are the most prevalent chronic ailments. A complete blood count test can give an overall picture of a patient's health status because abnormal counts might indicate the presence of many different types of disease. Using advanced hematology analyzers, a typical microscopic examination of a peripheral blood smear can yield vital information about the clinical state of the patient. The objective of the study was to investigate the hematological parameters in the elderly population in a tertiary care hospital, utilizing a five-part cell counter and a peripheral smear test. A cross-sectional study was conducted at a tertiary care institute on 188 patients aged 60 years and above attending the outpatient department for two years. The routine complete blood count and differential count were determined on the Siemens Advia 2120 analyzer. All the data were collected and entered into the data sheets. Appropriate statistical analysis was carried out to interpret the results. HTN, diabetes mellitus, cardiovascular disease (CVD), and generalized weakness were the most common conditions affecting our senior group. Decreased Hb was positively correlated with widespread weakness. Total leukocyte count (TLC) was found to be more prevalent in people with CVD and HTN. A sizable share of the elderly population who had diabetes mellitus and CVD showed an elevated red cell distribution width (RDW) percentage. The results indicated a significant deviation from normal hematological parameters, which were associated with various health issues. These parametric associations can be used as risk indicators, which can help healthcare professionals ensure the good health of the geriatric population.

HEMATOLOGICAL DYNAMICS IN HEMODIALYSIS: A COMPREHENSIVE EXAMINATION OF PATIENTS WITH CHRONIC RENAL FAILURE IN A TERTIARY CARE HOSPITAL

Background: Chronic kidney disease (CKD) is a significant health burden in developing countries like India, leading to high morbidity and mortality rates. The study aimed to determine the incidence of anemia among patients with CKD and examine its potential association with other predictive markers. Methods: A cross-sectional observational research was undertaken within a tertiary hospital setting to examine the incidence of hematological abnormalities and explore the association between anemia and its many manifestations in patients with stages 3-5 chronic kidney disease (CKD). The markers for anemia encompassed measurements of hemoglobin percentage (Hb%), mean corpuscular volume (MCV), and examination of peripheral smears. The investigation also examined the correlation between stages of chronic kidney disease (CKD) and red cell distribution width (RDW), thrombocytopenia, leucocyte count, and differential count. Result: The study found that 96.8% of participants displayed symptoms of anemia, characterized by normocytic and normochromic observations on peripheral measures. A significant number of patients (57.3% of them) had a higher total leucocyte count (TLC), but there was no statistically significant link between a higher TLC and the worsening stages of CKD. The mean corpuscular volume (MCV) and platelet levels exhibited a predominantly normal range, with relatively few observed fluctuations. However, there is a positive link between the advancement of CKD and an increase in red cell distribution width (RDW). Conclusion: The study highlights the changes in blood parameters observed in individuals with CKD, with particular attention given to the high occurrence of anemia. The findings underscore the importance of comprehensive iron investigations and the timely identification and intervention of anemia. Adopting a comprehensive strategy that includes regular monitoring of blood parameters, specifically focusing on anemia and iron levels, is crucial for effectively managing and enhancing the overall health of individuals with CKD KEY WORDS- Anemia in CKD, Chronic kidney disease, Iron deficiency anemia

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.

Analysis of Changes in Variation of Neutrophil and Monocyte Parameters, Including Volume, Conductivity and Scatter in Sepsis Patients and Healthy Controls: A Cross-sectional Study

Introduction: Sepsis continues to be a leading cause of mortality and prolonged hospitalisation. The conventional method of blood culture, while considered the gold standard, has limitations such as contamination and delayed reporting. The examination of peripheral smears has uncovered signs suggestive of septicaemia; however, these findings suffer from inter-observer variability and reliance on staining quality. Aim: To investigate the variation of neutrophil and monocyte parameters, including Volume, Conductivity, and Scatter (VCS), in sepsis compared to healthy controls. Materials and Methods: A cross-sectional analytical study was conducted at the Himalayan Institute of Medical Sciences, Swami Rama Himalayan University in Dehradun, Uttarakhand, over the course of one year, from January 2021 to December 2021, involving patients over 18 years of age categorised into sepsis group based on clinical suspicion, sepsis screen, blood culture, and Sequential Organ Failure Assessment (SOFA) score (n=117). A group of healthy controls was also included (n=140). Haematological investigations were performed using the DXH 800 Haematology Analyser (Beckman Coulter, CA, USA) with VCS Technology. Categorical variables were analysed using the Chi-square test, while non parametric data was compared using the Mann-Whitney U test. Results: The average age in the sepsis group was 50.17±13.17 years, while in the control group, it was 38.14±8.78 years. The results revealed higher White Blood Cell (WBC) counts (16.76±7.39)×103 / cumm in the sepsis group compared to healthy controls (6.68±1.42)×103 , absolute neutrophil counts (13.74±7.280)×103 in sepsis patients, and eosinopenia in the sepsis group (0.0114±0.0104)×103 compared to controls (0.23±0.116)×103 . Moreover, mean neutrophilic volumes (158.00±14.840) and monocytic volumes (182.58±18.64) were higher in the sepsis group, while they were lower in healthy controls, which were (149.52±5.23 and 171.17±6.28), respectively. Axial light loss for neutrophil and monocyte was 142.40±11.78 and 121.50±17.93, respectively, while it was lower in healthy controls showing a value of 135.51±7.63 and 119.45±8.25, respectively. Furthermore, mean neutrophilic and monocytic conductivity and scatter were decreased in sepsis. The observed higher WBC counts and absolute neutrophil counts in sepsis patients suggest a premature release of neutrophils from the bone marrow. The alterations in cell volume reflect an immune response. Additionally, the overall scatter of neutrophils and monocytes was reduced, accompanied by increased cellular transparency. Conclusion: The present study contributes valuable insights into the pathophysiological mechanisms underlying sepsis, emphasising the dynamic interplay between immune cells and their functional characteristics. Understanding these variations in cellular parameters could potentially aid in the development of more targeted diagnostic and therapeutic approaches for sepsis, ultimately improving patient outcomes. Further research is warranted to delve deeper into the specific mechanisms driving these observed changes and to explore their clinical implications in the context of sepsis management.

Experience of external quality assessment scheme in hematology at Shantabaa Medical College, Amreli: An observational 5-year study

Background: The complete blood count is one of the most frequently requested tests in laboratory medicine. External quality assessment programs are intended to allow medical laboratories to compare the closeness of their output (test results) to their peers through statistical evaluation against a target value. External quality assessment schemes (EQAS) are accepted around the world as an invaluable tool by laboratories to assess the performance of their testing systems. Results are objectively compared to other laboratories, using the same methodologies for every parameter. Aims and Objectives: To review EQAS results from time to time in an effort to improve the performance of the laboratory. Materials and Methods: An observational study is done for hematology EQAS test results at the hematology laboratory, Shantabaa Medical College and General Hospital, Amreli, from June 2017 to August 2021 (5 years). One ethylenediaminetetraacetic acid whole blood sample for blood cell counts and two slides for peripheral smear examination and reticulocyte count are received quarterly in a year from all India Institute of Medical Science, New Delhi. The test results of all Indices of blood samples and peripheral smears for cell morphology and reticulocyte count were analyzed and documented. Results: Satisfactory results were obtained in all the cycles except once. The discrepancy was observed in RBC, MCH, and reticulocyte count. Root cause analysis was performed and necessary action was taken. Conclusion: This participation in EQAS over the past 5 years has helped us significantly to improve our laboratory services in terms of performance evaluation, patient care, and overall quality of laboratory practices.

Examining the Relationship between Severity of Thrombocytopenia and the Pattern of Malaria: A Hospital-Based Study

OBJECTIVES To determine the association between the severity of thrombocytopenia and the pattern of malaria. METHODOLOGY This descriptive cross-sectional study included 194 patients who tested positive for malarial parasites on peripheral smear examination. The study comprised smear-positive malaria cases, both males and females, who were Pakistani nationals aged between 8 and 50. Exclusion criteria were individuals with dengue, typhoid, immunocompromised status, liver disease, and pregnancy. Data were recorded for age, gender, the pattern of malaria (Plasmodium (P). vivax, P. falciparum, or mixed), and type of thrombocytopenia (mild, moderate, and severe). The association between the severity of thrombocytopenia and the pattern of malaria was determined using a chi-square test, with the analysis stratified by gender. RESULTSThe mean age of the participants was 28.58±11.70 years, with 114 (58.76%) being male. The lowest platelet count (64,627 ± 43,062) was found in cases of falciparum malaria, while the highest mean platelet count was found in cases of vivax malaria (130,919 ± 107,723), and this difference was statistically significant (p=0.004). The most common occurrence of severe thrombocytopenia was in falciparum malaria cases (n=11, 42.31%), and the difference was statistically significant (p=0.024). CONCLUSION Falciparum malaria has the lowest mean platelet count and more severe thrombocytopenia than vivax and mixed type.

Development and Pilot Testing of a Comprehensive Mobile Application to Assist Cell Count Determination During Peripheral Smear and Bone Marrow Examination.

In the modern era of complete blood count analysis, manual differential count is performed whenever 'flags' are generated by an automated hematology analyzer. Traditionally, tally counters with five or eight keys are used for manual differential count. A few mobile applications are available to perform this task; however, the application features and cell representation are limited. The primary objective of our study was to develop an indigenous, comprehensive mobile application to assist with manual blood cell differential count. The secondary objective was to measure the usability of a newly developed application among undergraduate medical students. A new mobile application was developed using a Java development kit, Version 11.0.13 (Oracle Corporation, Austin, USA) in Android Studio Dolphin (2021.3.1) (Google, California, USA). The application content was validated by three pathologists with more than five years of experience. The app's usability was tested among 60 participants using a validated mHealth App Usability Questionnaire (MAUQ). The questionnaire had 18 items covering three domains: ease of use, interface & satisfaction, and usefulness. The newly developed application supports peripheral smear WBC differential count, platelet count, reticulocyte count, malaria parasite quantification, and bone marrow differential count. During usability testing, the app was easy to use in 95% (57/60) of participants, time-efficient in 91.7% (55/60), and helpful for healthcare practice learning in 96.7% (58/60). The total mean score was 6.11, indicating high usability. A comprehensive mobile application to assist manual differential count with adequate cell representation was developed. The mobile application was easy to use, time-efficient, and valuable among the study participants.

Variations in complete blood counts and cellular morphological alterations in blood smear of COVID-19 patients from a tertiary care center

Corona viruses are a large family of viruses of which Corona virus disease 19 (COVID 19) infection evokes a hyperinflammatory response and severe acute respiratory distress syndrome in human beings. Complete blood count evaluation and peripheral smear examination is an essential tool for early diagnosis and management of COVID-19 positive patients. This study was aimed to evaluate the variations in complete blood counts (CBC) and changes in the cellular morphology in the blood smear in patients affected with COVID-19. This was an observational study, undertaken in a tertiary care center. The study included baseline blood samples from 96 proven COVID-19 positive cases. The samples were subjected for automated complete blood count analysis and peripheral smear examination.Thequantitative data were expressed by mean and Standard deviation. Qualitative categorical variables were expressed as numbers and percentages. Out of the total 96 cases, the most common quantitative finding was neutrophilic leukocytosis with relative lymphopenia. Five cases of absolute lymphopenia was observed. Majority of the cases had normal hemoglobin values and normal platelet counts. The characteristic morphological changes were seen in neutrophils and lymphocytes. The neutrophils showed presence of toxic granules, cytoplasmic vacuolations and hypolobation.The morphological alteration in lymphocytes included reactive lymphocytes with plasmacytoid and monocytoid morphology, large granular lymphocytes and Turk cells. Infrequent finding of leukoerythroblastic reaction was also observed in our study.To summarize, hematological investigation of COVID 19 cases may show several abnormal findings. Quantitative findings like Neutrophilia and lymphopenia were characteristic, whereas, the most common morphological alteration observed was atypical lymphocytes. Quantitative and qualitative alterations of hematological parameters are one of the investigations which would aid timely diagnosis of the disease. Toxic granules and cytoplasmic vacuolations in neutrophils may indicate ongoing sepsis in COVID 19 patients which in turn aids in efficient management of the patients to reduce the mortality rate.

Iron Deficiency Anemia Presenting With Pancytopenia: A Study From India.

Iron deficiency anemia (IDA) is the most common cause of anemia worldwide. IDA is commonly associated with thrombocytosis and normal or slightly decreased leukocyte count. Sometimes it can present with thrombocytopenia, but rarely present with pancytopenia. Here we are presenting six cases of severe iron deficiency presenting with pancytopenia, which responded to iron replenishment. This 12-month observational study was conducted in the Department of General Medicine at a tertiary care Centre in India. All cases of pancytopenia (after exclusion of other causes) with IDA were included. IDA was established with the help of a complete blood count (CBC), peripheral smear examination, serum iron studies, and serum ferritin. Results: In our study, CBC at four weeks later of iron transfusion without other supplementation showed significant improvement in hematological parameters. Severeiron deficiency is a reversible etiology of pancytopenia. It should be kept as a differential diagnosis of pancytopeniaif common causes of pancytopenia are ruledout.

Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study.

Sepsis is a life-threatening condition. Nowadays, hospitals rely on laboratory parameters like CRP and procalcitonin to detect sepsis. There is a need to evaluate and validate more accurate and early predictors of sepsis in critically ill patients. We analyzed volume, conductivity, and scatter (VCS) parameters of leukocytes in sepsis patients and compared them with the control group with no illness. It was a prospective case-control study. A total of 80 patients were studied with 40 sepsis cases and 40 controls. Peripheral smear examination was done in all the cases. Other parameters, such as WBC count, neutrophil%, absolute neutrophil count (ANC), High-sensitive C-reactive protein (hs-CRP), procalcitonin, and blood cultures were analyzed. We took the data of the patients from medical records and correlated it with other tests. Complete blood picture reports were generated by the Beckman Coulter LH series (LH 750 and 780). VCS parameters for neutrophils, lymphocytes and monocytes were compared between both groups. The results were analyzed using SPSS software (16.0 version). The age group was 20-85 years with male predominance. The mean neutrophil volume (MNV) and mean monocyte volume (MMV) were higher in the sepsis group when compared with the control group. The mean neutrophil conductivity and scatter was lower in the sepsis group and comparatively higher in the control group, but it was insignificant. The mean neutrophil volume values were higher in the sepsis group even with low total leukocyte count (TLC) when the patient had sepsis. There is no change in the mean lymphocyte VCS parameter and mean monocyte conductivity, scatter in both the groups. The mean neutrophil volume and MMV are found to be good sensitive markers in the prediction of sepsis. Even when TLC is on the lower side in patients with sepsis, these parameters predict sepsis accurately. This helps clinicians to assess sepsis in patients at an early stage and has an important practical implication. Goyal H, Singhal A, Joseph M. Utility of VCS Parameters as a Cost-effective and Early Marker of Sepsis: A Hospital-based Study. Indian J Crit Care Med 2023;27(9):647-650.

Myeloid Sarcoma: A Mediastinal Masquerader

Mediastinal Myeloid Sarcoma is a rare entity. Here we present a case of a 28-year-old gentleman, who first presented with a mediastinal mass and was clinically considered lymphoblastic lymphoma. He was diagnosed initially as having T lymphoblastic lymphoma on a mediastinal trucut biopsy. After one month patient was diagnosed with Acute myeloid leukemia on peripheral smear and bone marrow examination and was confirmed with the help of flow cytometry. The biopsy slides from the mediastinal mass were reviewed and based on the smear findings additional immunohistochemical markers were added and diagnosed as Myeloid Sarcoma. Keywords: Myeloid sarcoma, Mediastinum, Acute myeloid leukemia

Utility of automated cell counter histogram in diagnosis of thrombocytopenia and pseudothrombocytopenia

Background: Automated hematology analyzers have become mainstream of complete blood count (CBC) during the past two decades; they are potential, more accurate to produce results of CBCs. However, often automated analyzers can give false results too, specially, falsely low platelet count due to platelets aggregates, which have to be confirmed on peripheral smears. Aims and Objectives: The aim and objective of the study was to diagnose thrombocytopenia (TCP) cases and differentiate them from pseudothrombocytopenia (PTCP) cases by analyzing platelet histogram and to determine the sensitivity and specificity of platelet histograms for diagnosing TCP and PTCP. Materials and Methods: The present study was conducted in the Department of Pathology at Shyam Shah Medical College, Rewa, M.P., after obtaining ethical clearance from the Institutional Ethics Committee. It was prospective study conducted for a period of 15 months from January 2021 to May 2022 on 1000 samples. Results: The sensitivity and specificity of platelet histogram flags and presence of multiple peaks to diagnose TCP and PTCP cases were calculated as 73.60% and 93.60%, respectively. The present study also interpret that mean platelet volume and platelet distribution width cannot use as indicator to differentiate between TCP and PTCP. Conclusion: The present study concludes that analysis and interpretation of histogram more specifically platelet histogram flagging provide clue for early detection of PTCP cases prior peripheral smear examination and also helpful in differentiating them from true TCP cases. These platelet histogram flagging can be used as a screening parameter for the detection of PTCP and these are helpful in preventing unnecessary stress for clinician, patients, and their relatives. However, the peripheral smear examination will remain the gold standard to differentiate TCP from, PTCP.

To Evaluate the Clinical and Laboratory Profiles of Patients with Abdominal Tuberculosis in Western Odisha

Background: Tuberculosis (TB), caused by Mycobacterium tuberculosis (M. tuberculosis) complex bacteria, is one of the oldest diseases known to affect humans and the leading cause of mortality worldwide. Milk contaminated with Mycobacterium bovis (reservoir cattle) can transmit tuberculosis to the gastrointestinal tract. TB can affect any portion of the digestive tract, from the buccal cavity to the anus, pancreato-biliary tree, and peritoneum. The peritoneum and ileocecal regions were most frequently affected. Aim: This study aimed to evaluate the clinical and laboratory profiles of patients with abdominal tuberculosis. Materials & Methods: The current study was conducted at the VSS Institute of Medical Sciences and Research (VIMSAR), Burla, located at 21.5027 o N and 83.8865 o E in western Odisha, India, after receiving approval from the Institutional Ethics Committee. Outdoor (OPD) and indoor (IPD) patients of the Division of General Medicine, VIMSAR, Burla The duration of the research was from November 2019 to October 2021 (24 months). This was a cross-sectional study. All patients were admitted to the Department of General Medicine with suspected abdominal tuberculosis. Results: The distribution of socioeconomic status in the study population according to the modified Kuppuswamy scale was predominated by the upper lower class IV population (60.3%), followed by the lower middle group (26%); only 13.7% belonged to class II of the upper middle group. The residential patterns showed that 74% of the cases belonged to the rural population, whereas only 26% lived in urban areas. Anemia was the major finding in comments on peripheral smear examination in 74.2% of the population and pancytopenia in 10.6% of cases. A minimum number of patients (4.5%) had a normal peripheral smear. Erythrocyte sedimentation rate by the Westergren method was increased in 87.7% of cases, and the rest of the population was within the normal range. Conclusion: This study has once again shown how common tuberculosis is in our country, particularly in underdeveloped Western Odisha, due to lack of hygiene and poverty. Abdominal tuberculosis has undergone modification over time because of the rampant and improper use of antibiotics and other drugs, thus creating a clinical dilemma. The irregularity of daily drug intake is another factor leading to the emergence of drug-resistant organisms.

A comparative study of red cell histogram along with CBC parameters and peripheral blood smear in various anemias

: The red blood cell (RBC) parameters generated by cell counters can aid in morphological categorization of anemia, the significance of microscopic analysis of peripheral blood smears (PBSs) cannot be overlooked when it comes to interpreting the underlying cause of anemia. Therefore, both RBC parameters and microscopic examination of PBSs are essential for a comprehensive assessment of anemia.This study aimed to evaluate and compare the results obtained through two different methods: examination of peripheral blood smears (PBS) and automated cell counter generated parameters. The objective was to identify any differences or similarities in the diagnostic outcomes produced by each method. Over the course of one year, from December 2020 to November 2021, a hospital-based, prospective study was conducted. The study aimed to evaluate and compare the PBS findings and RBC parameters and histograms generated by a cell counter in 1000 anemic patients.In a sample of 1000 cases, we compared the typing of anemia using an automated analyzer and peripheral smear examination. Out of these cases, 690 showed consistent typing results between the two methods, while 310 showed discordant typing. The automated analyzer diagnosed majority of cases 70.1% as microcytic anemia and Normocytic, dimorphic, and macrocytic cases were found in 13.5%, 7.8%, and 4.3% of cases, respectively. Additionally, a normal histogram was observed in 17.6% of cases.We have concluded that while the automated analyzer is useful in reducing the overall workload through its graphical representation of anemia typing, it should always be confirmed through microscopy. The automated analyzer is a helpful tool, it should not be relied upon solely for accurate anemia typing. Microscopy remains an essential method for confirming the results of automated analysis.

Transition from Morphocytochemical Diagnosis to Immunophenotypic Diagnosis of Acute Leukemia: A Flow Cytometry Experience from Southern Odisha

ABSTRACT Background: In today’s generation of targeted therapy, traditional reporting of acute leukemia by morphology using the FAB system of classification has limited uses due to a lack of standardization and use in risk stratification. Immunophenotyping by flow cytometry has gained popularity due to its influence on the treatment and prognosis of the disease. The present study evaluates the judicious application of flow cytometry as an adjunct to morphocytochemical assessment in all newly diagnosed cases of acute leukemia in Southern Odisha. Materials and Methods: A total of 61 cases were subjected to complete blood count analysis, peripheral smear examination, bone marrow study, cytochemistry, and those suspected of leukemia underwent flow cytometry analysis using BD FACS CANTO II as per manufacturer’s instructions. Results: Out of 61 cases of acute leukemia diagnosed, 35 were acute lymphoblastic leukemia, and 24 were acute myeloid leukemia. There was 96.7% correlation between diagnosis by cytomorphology and flow cytometry. Seven cases showed aberrant expression of various antigens. Two cases of acute leukemia on cytomorphology were diagnosed as hematogones and the other as reactive lymphocytosis on flow cytometry. Conclusion: Although morphologic FAB diagnosis is still widely used to classify acute leukemia, flow cytometry has more specificity and should be used as an adjunct to morphology. Along with subclassification of leukemia, flow cytometry can also detect the possibility of an associated genetic abnormality.