Peripheral Smear Examination Research Articles

CLINICAL & HEMATOLOGICAL PROFILE OF ANEMIA AMONG MALE PATIENTS: A SNAPSHOT STUDY FROM TERTIARY CARE CENTRE OF WESTERN INDIA

Background: In India, the prevalence is 47-50% for all ages while as per NFHS-4, the prevalence of anemia among men 15-49 year age (<13gm/dl) is 18.5% for urban & 25.3% for rural areas. Most of the programs are directed at the Reproductive & Adolescent age group & mainly for females & children. The above data shows 1 in 4 men suffers from anemia & may face complications & consequences. Objective: Thus the present study is aimed to assess the Clinical & Hematological profiles of Male anemic patients admitted to Medical wards. Methodology:100 Male patients admitted to the medical ward for anemia at tertiary care hospital affiliated with the medical college, during the study period, who met inclusion criteria and who were willing to participate in this study were subjected to further evaluation. Along with clinical data, demographic information was also obtained. Results: Severe Anemia was present in 70% of males. Moderate anemia was seen in 30% of males with a Mean age of 43 years. Hence in male patients, anemia should be screened vigilantly so that we can treat it and avoid complications. Nutritional deficiency is the most common etiology found. All patients had pallor. The most common symptom observed were weakness (85%) followed by easy fatigability (82%)and breathlessness on exertion (47%). In peripheral smear examination, 50% of males were having microcytic hypochromic anemia. The most common type of anemia was Iron deficiency anemia observed in 50% of patients. In male anemic patients, a thorough evaluation of the type of anemia will make etiology-specific treatment more effective.

Recurrent Ischemic Stroke In Elderly With Polycythemia Vera: Case Report

<p><strong>Background</strong>: Myeloproliferative disorders can rise a risk of thrombotic events. Ischemic stroke is one of presenting symptoms can be found in such patients. These coexisting conditions can burden patients with more severe complications.</p><p><strong>Objectives</strong>: To discuss a case of polycythemia vera with multiple episodes of ischemic stroke.</p><p><strong>Case description</strong>: The patient was a 70-year-old female with chief complaint of sudden rotatory dizziness with moderate to severe intensity. Nausea, vomiting, slurred speech, and facial muscle weakness were also reported. Onset of symptoms started 3 hours before hospital admission. Medical history including previous ischemic stroke in 2020 and 2015 with remaining right extremity weakness. Physical examination showed weakness, hypertension. Nystagmus horizontal bidirectional and upper motor neuron lesion of left CN VII and XII, weakness in right upper and lower extremities were observed. Physiological reflexes were increased, and pathological reflex was found. Head CT showed hypodense lesion led to her ischemic stroke diagnosis. Blood test showed increased hemoglobin count, leukocytosis but normal platelet count. Increased cell numbers and variations of size, morphology and distribution were found in peripheral smear. This finding was also supported with bone marrow examination which showed hypercellularity, panmyelosis with dysplasia of all hematopoietic lineage. Patient was diagnosed with polycythemia vera and treated accordingly.</p><p><strong>Conclusion</strong>: Further examination of hematology, such as peripheral smear or bone marrow examination should be considered in patients with recurrent episodes of stroke to rule in underlying myeloproliferative disorders.Appropriate treatment and routine hematology<strong> </strong>follow up are in need to increase awareness of future thrombotic events or leukemic transformations.</p>

FREQUENCY OF PANCYTOPENIA AMONG PATIENTS WITH VITAMIN B12 DEFICIENCY

Objective: To determine the frequency of pancytopenia among patients with vitamin B12 deficiency in a tertiary-care hospital, in Peshawar. Materials and Methods: A descriptive cross-sectional study was carried out at the Department of Hematology, Hayatabad Medical Complex, Peshawar from 18/4/2021 to 18/10/2021. In this study, a total of 252 patients were observed. From all patients, a sample of venous blood was obtained and sent to the hospital laboratory for the peripheral smear examination. Pancytopenia was diagnosed based on a peripheral smear showing Hemoglobin below 10g/dL, Total leukocyte counts less than 4,000 cells per mL, platelets count less than150,000 cells per mL, and reticulocyte count <2%. All the peripheral smears were done by an expert hematologist. Strictly exclusion criteria were followed to avoid cofounders and make the study results clear of any bias. Results: In this study mean age was 42 years with a standard deviation of ± 15.84. Thirty-eight percent of patients were males and 62% of patients were females. Moreover, 5% of patients had pancytopenia and 95% of patients didn’t have pancytopenia. Conclusion: The frequency of pancytopenia was 5% among the local patients with vitamin B12 deficiency. Keywords: pancytopenia, B12 deficiency, Peshawar, Pakistan.

Adult granulosa cell tumor of ovary in a young female: A rare case report

Granulosa cell tumours (GCT) belong to the group of sex cord and stromal tumours of ovary. Adult granulosa cell tumours account for approximately 1% of all ovarian tumours and 95% of all granulosa cell tumours. They are found more often in postmenopausal than premenopausal women, with a peak incidence between 50 and 55 years of age. We present the case of a 35-year female who came with white discharge, irregular menses and excessive bleeding during menses since 5 to 6 months. The complete blood picture with peripheral smear examination, kidney and liver function tests were all within normal limits. CT abdomen was advised which revealed a large solid cystic lesion of left ovarian origin. Surgical intervention was done and histopathology revealed adult granulosa cell tumor of ovary.

Trypanosomes or platelet artefacts? A morphological dilemma!

Peripheral Smear (PS) examination still remains a cornerstone and first step towards diagnostic work up of patients. However, presence of artefacts in PS can sometimes prove perplexing for the pathologists [1]. In one such experience, early morning blood sample in K2 EDTA vial of a 23 year old female was sent to hematology lab.

STUDY OF LABORATORY PARAMETERS IN NEONATAL JAUNDICE

Introduction: Neonatal hyperbilirubinemia with a total serum bilirubin level above 5mg/dL is one of the most vexing situations in neonates thereby becoming a concern for pediatricians. It is observed during the rst week of life in full-term infants and preterm infants. It results from a predisposition to the production of bilirubin in newborns infants and reects the immature excretory pathway of bilirubin by the liver. Preterm infants have higher rates of bilirubin production. This retrospective study considered 150 cases of term and pre-term neonates w Materials And Methods: ith jaundice within one week of diagnosis of neonatal jaundice (NNJ). The blood group of the mother and baby, Serum bilirubin, Complete blood count with peripheral smear examination, Reticulocyte count, Direct coomb's test, and C-reactive protein of the baby were done. The mean age of the neonates was 2 days. 76 (50.66 %) were male while 74 Results: (49.33) were females. Percentage of Preterm babies was 30%. Neonates having low birth weight were 31 %. Physiological jaundice constitutes to 58 % of cases followed by ABO incompatibility Septicaemia, Rh incompatibility. Highest level of serum bilirubin was found in septicemia and Rh incompatibility. Direct Coomb's test and Indirect Coomb's test were found to be positive in all cases in Rh incompatibility while they were positive in 27 % of cases of ABO incompatibility. In cases of septicemia CRP was found to be positive in 100% of cases. Most of the cases were due to physiological jaundice. To rule out hemolys Conclusion: is, causes of hyperbilirubinemia should be enquired widely to avoid complications

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.

Vitamin B12 Status in Rural Adolescent School Girls in Mysuru, India: A Community-Based Cross-Sectional Study

Abstract Almost 56% of Indian adolescent girls aged 15–19 years suffer from anemia. Adolescent age is a period of many significant physiological changes that increase nutritional demand, and they remain at risk for nutritional deficiencies. Our aim is to assess the prevalence of Vitamin B12 deficiency among school-going adolescent girls aged 13–16 years of rural Mysore. This study was a cross-sectional study, conducted in two high schools in rural Mysuru. Adolescent girls aged 13–16 years were included. The chosen subjects underwent complete hemogram, peripheral smear examination, and vitamin B12 level estimation. Out of 98 subjects enrolled, 40.81% were found to be deficient in vitamin B12. Macrocytes and hyper-segmented neutrophils were found to have statistically significant (P value < 0.001) relationship with vitamin B12 deficiency. The relationship between vitamin B12 deficiency with either type of diet and anemia was statically insignificant (P > 0.05). The prevalence of vitamin B12 deficiency among rural adolescent girls in Mysuru is high. Other causes of nutritional anemia apart from iron deficiency, such as vitamin B12 deficiency, must be considered in the etiology of anemia and optimally treated. It is recommended to further strengthen the adolescent national health programs and food fortification programs.

Toxic granules in neutrophils in sepsis patients: Does it really helpful?

ABSTRACT Introduction: Timely diagnosis of bacteremia/sepsis is essential for the initiation of antimicrobial therapy and further reducing morbidity and mortality. Aims and Objective: This study is undertaken to find out the importance of toxic granulations in neutrophils in the diagnosis of sepsis. Materials and Methods: This was a cross-sectional type of study which was carried out for 1 year (August 2020 to August 2021). A total of 100 cases were included in the study. The smears were studied to assess the differential leukocyte count and neutrophils toxic granules. Observations and Results: The age of the patients ranged from 11 to 92 years, with M:F ratio 1:1. Total leukocyte count (TLC) ranged from 1.6 to 37.3 × 109/l with a mean of 14.7 × 109/l. Absolute neutrophil count (ANC) varied from 1.31 × 109/l × to 32.4 × 109/l with a mean of 10.4 × 109/l. On peripheral smear examination, 31% of cases showed no granules in the neutrophils, 35% of cases showed scattered darkly stained granules in the cytoplasm of neutrophils (1+), 29% showed an increase in the number of granules and increase in intensity (2+), and only 5% cases showed numerous granules with increase blue–black stain. However, none of the cases showed numerous coarse granules crowing the cytoplasm (4+). Conclusion: In this study, we found that none of the single parameters, for example, the TLC and ANC, toxic granulations, and left shift are diagnostic of sepsis but all these are complementary to each other in predicting the diagnosis of sepsis.

Morphological Changes in Blood Cells as Indicators for Disease Progression in COVID-19

BACKGROUND: COVID-19 as a pandemic has caused an alarming increase in mortality and morbidity. Viral-induced morphologic changes in the peripheral blood cells are well characterized in certain infections and can direct diagnostic workup to ensure timely therapeutic intervention. This study describes the morphological changes of blood cells in various stages of COVID disease. MATERIALS AND METHODS: A total of thousand COVID-positive patients admitted in the tertiary care center were taken for the study. They were classified as mild, moderate, and severe based on the clinical criteria suggested by World Health Organization. Peripheral smears of the patients were analyzed, and the morphological changes in various blood cells were correlated with the disease stage and coagulation parameters. RESULTS: The study demonstrated significant morphological changes in the blood cells of COVID patients during the course of disease progression and during the onset of COVID-associated coagulopathy. Leukocytosis, neutrophilia, and toxic changes in neutrophils were seen in the severe stage of the disease and in COVID coagulopathy suggesting these are important indicators of disease severity. Activated lymphocyte was found to be the most common morphological presentation seen in all patients irrespective of the disease stage, whereas plasmacytoid lymphocytes were an important finding in severe-stage disease. Schistocytes an important finding in any other coagulopathy was present only in 1% of cases of COVID coagulopathy. CONCLUSIONS: The study demonstrated significant morphological changes in the blood cells of COVID-positive patients during the course of disease progression. Comprehensive daily complete blood count and peripheral smear examination should be undertaken in patients hospitalized with COVID-19 to predict potential clinical deterioration and signs of disease progression. These morphological changes in peripheral smear can be used as one of the factors indicating disease progression which can formulate for further evaluation. Since follow-up and post-COVID morphological examination were not done, additional research in this aspect can shed light on the clinical categorization of COVID patients based on the morphological findings.

Clinicopathological Profile of Patients with Multiple Myeloma: An Ambispective Study

Introduction: Multiple Myeloma (MM) is a clonal expansion of B lineage plasma cells in bone marrow. MM accounts for 10- 15% of haematological malignancies and 1% of all malignant diseases. Though, the aetiology of the disease is largely unknown, various factors have been found to increase the incidence of MM. The present comprehensive research work on MM in the Malwa region of central India is an attempt to establish on clinicodemographic, haematological, biochemical and radiological parameters and finally to stage them according to Durie Salmon Staging (DSS) system. Aim: To study clinicopathological profile of patients with MM. Materials and Methods: The present ambispective study was conducted on total 70 cases of MM reported in the Department of Pathology at Sri Aurobindo Medical College and Post Graduate Institute, Indore, Madhya Pradesh, India, from July 2012 to June 2020. The study design included retrospective studies from July 2012 to December 2018 (six years and five months) and prospective studies from November 2017 to April 2019 (one year and five months). The demographic data of patients’ including history and clinical findings were recorded. Complete Blood Count (CBC) was done in all cases. Biochemical investigations were also done. Urine samples of all patients were screened for the presence of Bence Jones protein. Biochemical parameters and staging of MM patients was done. Statistical analysis prepared in excels spreadsheet and quantitative data were presented as proportions. Results: The study included a total of 70 cases of MM diagnosed on peripheral smear and/or bone marrow examination. The male:female ratio was 2.1:1, with a male preponderance. The results of the present study, reported 48 (68.57%) patients were male and 22 (31.43%) patients were females. In the present investigation, the authors diagnosed serum Lactate Dehydrogenase (LDH) levels were estimated in 63, out of 70 patients. Out of which, 25 (39.69%) patients had levels <240 U/L, while 23 (33%) and 17 (23.81%) patients had levels between 241-480 U/L and >480 U/L, respectively. Conclusion: The present study, underlines the association between clinical presentation, laboratory parameters and radiological findings in establishing the diagnosis of MM. The present study emphasises not only the role of a bone marrow aspiration and biopsy in establishing a diagnosis of MM, but also, assessing the plasma cell burden in the marrow.

Clinicohaematological Study of Leukaemias at a Tertiary Care Centre, Vindhya Region of India: A Cross-sectional Study

Introduction: Leukaemia is characterised by widespread proliferation of leucocytes and their precursors in the body tissues and is usually associated with qualitative and quantitative changes in circulating white blood cells. The global burden of leukaemia is increasing. Aim: To study the morphology of leukaemia from Peripheral Blood Smears (PBS) and/or bone marrow smears and evaluate the clinical and haematological profile of leukaemia patients. Materials and Methods: This prospective observational study was conducted in a Tertiary Care Centre of the Vindhya region, in the Department of Pathology at Shyam Shah Medical College, Rewa, Madhya Pradesh, India. The study was carried out over a period of one year, from June 2019 to June 2020. A total of 90 newly diagnosed cases of all types of leukaemia during the study period. Detailed history, physical examination, complete blood counts, and bone marrow examinations were performed to confirm the diagnosis. Cytochemistry was used for the diagnosis and classification of acute leukaemia according to the French-American-British (FAB) classification. The data was compiled and analysed using appropriate statistical methods, and the mean was described with Standard Deviation (SD). Statistical significance was assessed using Analysis of Variance (ANOVA) test conducted with Statistical Package for Social Sciences (SPSS) version 22.0. Results: The study included 90 cases of all types of leukaemia, with a mean age of 36.5±22.5 years. There was a male preponderance in the study, with 65 (72.2%) males and 25 (27.8%) females, resulting in a male-to-female ratio of 2.6:1. Chronic Myeloid Leukaemia (CML) was the most common malignancy, accounting for total 40 (44.4%) cases. Non specific symptoms such as fever in 50 (55.6%), weight loss 49 (54.4%), and loss of appetite 42 (46.7%) cases were the most common symptoms across all types of leukaemia. Acute leukaemia also presented with leukopenia and normal leucocyte counts, while chronic leukaemia mostly showed markedly elevated Total Leucocyte Count (TLC) with a mean count of 1,30,912±63,792 per mm3. Conclusion: Light microscopic features of peripheral smear and bone marrow examination still play an important role in the diagnosis of leukaemia, especially in resource-poor health centres lacking immunotyping and cytogenetics.

Macrothrombocytopenia: Role of Automated Platelet Data in Diagnosis.

Inherited macrothrombocytopenia is an underdiagnosed condition and may result in misdiagnosis and inappropriate management. This research was done to study this condition in a hospital setting. This study was conducted over 6 months in a teaching hospital. Patients whose complete blood count (CBC) samples were sent to the hematology laboratory were included. Patients were suspected to have inherited macrothrombocytopenia according to pre-defined criteria. Demographic information, automated CBC and peripheral smear examination was carried out. Seventy five healthy individuals and 50 patients with secondary thrombocytopenia were also analyzed. Likely inherited macrothrombocytopenia was identified in 75 patients. Automated platelet count in these patients ranged from 26 × 10^9/L to 106 × 10^9/L while MPV ranged from 11.0 to 13.6 fL. There was significant difference (p < .001) in mean platelet volume (MPV) and platelet large cell ratio (P-LCR) amongst patients with likely inherited macrothrombocytopenia, those with secondary thrombocytopenia and the control group. Mean platelet diameter was significantly higher (3.5 ± 1.1μm) in patients with likely inherited macrothromboctopenia compared to those with secondary thrombocytopenia (2.4 ± 0.7μm) and control group (1.9 ± 0.7μm). All patients with suspected inherited macrothrombocytopenia showed abnormal platelet histograms with descending limb in the high volume and red cell zone. Four distinct histogram patterns were identified. Inherited macrothrombocytopenia is an underdiagnosed condition. The patient's history, clinical examination, judicious use of automated CBC data including platelet histograms and careful review of the peripheral blood smear are useful tools to suspect this condition. The online version contains supplementary material available at 10.1007/s12288-022-01590-6.

Frequency of thrombocytopenia in neonatal sepsis.

Objective: To determine the frequency of thrombocytopenia in neonatal sepsis. Study Design: Descriptive Cross Sectional study. Setting: King Edward Medical University, Mayo Hospital Lahore. Period: November 2020 to April 2021. Material &amp; Methods: The study was conducted over a period of six months. Neonates with clinical diagnosis of sepsis admitted in Neonatal intensive care unit, who fulfilled the inclusion criteria were enrolled in the study. Platelet count was measured on automated hematology analyser (SYSMEX,XN-1000) and verified on peripheral smear examination. The variables under study were subjected to SPSS 26. Chi Square test was used as a test of significance. P value &lt;0.05 was considered significant. Results: Among 90 neonates with sepsis, Thrombocytopenia was present in 75% cases. P value &lt;0.05%. Conclusion: Frequency of thrombocytopenia was statistically high in neonatal sepsis. Platelet count is a sensitive indicator of neonatal sepsis.

COVID-19 Case Report: Circulating blood cells morphology in convalescent patient

Objective: Many studies have detailed the mechanisms of infection and quantitative peripheral blood findings reported in severe acute respiratory syndrome virus 2 (SARS-CoV-2) patients during the severity of infection since the start of the coronavirus disease 2019 (COVID-19) pandemic. Though, only a few studies have described blood morphologic abnormalities. We report peripheral blood cells morphologic changes in convalescent patient. Design: We performed complete blood counts (CBC), and blood smear of 52-year-old patient who were COVID-19 positive test by (RT-PCR), from May 20, 2021, through June 15, 2021. The peripheral blood smears of a convalescent patient were collected the morphological structures of Leukocytes, red blood cells (RBCs) and platelets were examined and documented, after 3 weeks from infection with COVID-19 RT-PCR was negative to look for viral changes on blood cells morphology. Results: On a complete blood count (CBC), the most common quantitative hematologic abnormalities were mild anemia with RBCs showed no abnormality followed by WBCs normal in count, and relative lymphopenia. Neutrophils showed the most substantial morphologic alterations with C-shaped bi-lobulated nuclei, coarse toxic granulations and cytoplasmic vacuolization. Activated neutrophil granulocytes with elongated cell membrane, pseudo Pelger–Huët anomaly-like nuclei, ring form nuclei and pyknotic nucleus. Lymphocytes were atypical reactive lymphocytes with cytoplasmic pseudopod formation. Plasmacytoid lymphocytes with an eccentric nucleus and deeply basophilic cytoplasm are frequently seen. Monocytes seen in active form with cytoplasmic vacuolization and cytoplasm contain granules, with pseudopod formation. Platelets were adequate in number with giant platelets are occasionally seen. Smudge cell is also seen. RBCs were normocytic; normochromic. Conclusion: Our work identifies and characterizes significant morphologic abnormalities in recovered COVID-19 patients' peripheral blood cells. Understanding these morphologic changes, in addition to established hematologic parameters, can help follow with COVID-19 patient during recovery through serial CBC and peripheral smear examination. Serial complete blood count and blood film review may become an essential tool to help physicians allocate patients to risk categories based on morphological findings if these proposals are supported by large-scale investigations of convalescent patients.

Cutaneous presentation in chediak – Higashi syndrome – A rare case report

A One and half year-old female child born out of 2consanguineous marriage came with multiple hypopigmented patches over the face, trunk and lower limbs. There was history of recurrent upper respiratory tract infections. On examination she had silvery grey hair, hypopigmented patches and mild hepatomegaly. Ophthalmological examination revealed oculocutaneous albinism. Skin biopsy showed coarse clumps of melanin pigment in the epidermis. Hair mount examination revealed melanin granules in cortex and medulla. Routine blood investigations were within normal limits. Peripheral smear examination showed giant granules in neutrophils and lymphocytes.

STUDY OF SPECTRUM OF HEMOGLOBINOPATHIES IN ADULT AGE GROUP DIAGNOSED ON HIGH PERFORMANCE LIQUID CHROMATOGRAPHY IN TERTIARY CARE HOSPITAL

Background: Inherited abnormalities of hemoglobin synthesis (hemoglobinopathies) include a myriad of disorders ranging from thalassemia syndromes to structurally abnormal hemoglobin variants. Aims and Objectives: To study spectrum of hemoglobinopathies in adult age group diagnosed on HPLC in tertiary care hospital. Materials and Methods: The present study carried out in the deparment of pathology , DR PDMMC AMRAVATI over a period of 18 months from january 2021 to june 2022. A total of 800 cases were included in the present study. The age group of patients ranged from 19 years and above. HPLC , complete blood count, and peripheral smear examination were done in all the cases. Results and Discussion: In the present study total 800 patients were included out of which 134 cases displayed abnormal hemoglobin fractions on HPLC. It was seen that majority of the patients in study were in the 19yrs to 30yrs. The most common hemoglobinopathy observed in the present study was sickle cell trait (51.50 %) followed by Beta Thalassemia trait (26.12 %) and Sickle cell disease (16.42 %).HbDpunjab trait was observed in 3.74 % cases. Sickle cell Disease + Beta thalassemia trait ,HbE trait, HbE homozygous were observed in 0.74% cases each. Conclusion: Detection of β-thalassemia carriers and other structural variants will provide a preliminary insight to the prevalence of hemoglobinopathies in hospital based patients.Awareness can be created in an effort to prevent the birth of affected children.The present study is intended to contribute to the available data as the identification of these disorders is important epidemiologically and aids in prevention of more serious hemoglobin disorders.

Cryoglobulinemia Diagnosed by Peripheral Smear Examination: Value of a Basic Underestimated Test.

Cryoglobulinemia Diagnosed by Peripheral Smear Examination: Value of a Basic Underestimated Test.

Myelomatous pleural effusion developing after autologous stem cell transplantation in a patient with multiple myeloma: A rare case

ABSTRACT Myelomatous pleural effusion (MPE) is a very rare condition with a poor prognosis. In our case of multiple myeloma (MM) with early recurrence presenting with a MPE, management of the treatment is discussed together with the case presentation. A 35 year old female patient with a diagnosis of lambda light chain MM presented with complaints of dyspnea and pain in the left shoulder 2 months after autologous transplantation. On physical examination, respiratory sounds were decreased in the lower lobe of the left lung and there was dullness. Pleural effusion and plasmacytoma, more prominent on the left, were detected on chest X ray and thorax computed tomography (CT). The pleural fluid collected during therapeutic thoracentesis was examined by flow cytometry, cytology, and peripheral smear examination and as a result, the patient was considered to have early recurrence after autologous transplantation, DRd chemotherapy was immediately started, and clinical and radiological improvement was observed. Pleural effusion developing in patients with MM should be evaluated in terms of MPE. In the presence of MPE, the duration of response to treatment is short, thus effective and dynamic treatment methods for bridging should be used before referral of the patients to clinical trials and hematopoietic stem cell transplantation.

Chronic deep venous thrombosis as the presenting manifestation of acute promyelocytic leukaemia : A case report

Background: Acute promyelocytic leukaemia (APL) usually presents with disseminated intravascular coagulation or hyper-fibrinogenolysis followed by bleeding manifestation. But thrombosis as a presenting manifestation is less often reported in APL. Objectives: We describe an uncommon case of chronic deep venous thrombosis (DVT) of lower limb with unsuspected APL. Results: A 27 year old male presented with DVT and was treated with enoxaparin and later Dabigatran for 2 months without any improvement. A routine haematological assessment showed Leucopenia with few circulating abnormal promyelocytes. The bone marrow assessment with flow cytometry and molecular studies established the diagnosis of APL. Patient was never having any bleeding manifestation despite on anticoagulation too. A thrombophilia work up revealed presence of hyper-homocysteinemia and mild lupus anticoagulant in addition to APL as a prothrombotic event. Conclusion: DVT with leukopenia warrants further investigation to rule out Acute Promyelocytic Leukaemia. It includes a thorough peripheral smear examination to look for few circulating abnormal promyelocytes, bone marrow studies and molecular /cytogenetics analysis.