Peripheral Smear Findings Research Articles

A Comparative Study of Peripheral Smear Findings with RBC Indices and Automated Analyzer Generated RBC Histograms in the Diagnosis of Anemia's

Abstract Introduction The red blood cell (RBC) indices generated by cell counters help in the morphological classification of anemia. The importance of microscopic examination of peripheral blood smears (PBSs) stained by Leishman stain cannot be used alone when it comes to interpretation of the underlying cause of anemia. Hence, all three RBC histograms, indices, and microscopic examination of PBSs are very essential for a complete assessment of anemia. Aims and Objectives To diagnose the type of anemia by examination of PBSs, automated cell-generated RBC histograms, and RBC indices and to compare and correlate the findings of RBC indices and automated cell-generated RBC histograms with PBS examination. Materials and Methods This was a prospective comparative study done on 500 cases of anemia for a period of 5 months from August 2023 to December 2023 in a rural tertiary care teaching hospital and all the patients' RBC indices, RBC histogram findings, and PBS findings were noted and analyzed. Results Among 500 samples, normocytic normochromic anemia consists of the majority of the cases 272 (54.4%), followed by microcytic hypochromic anemia cases 183 (36.6%), macrocytic anemia cases 27 (5.4%), normocytic hypochromic anemia were 10 (2%) cases, and dimorphic were 8 cases (1.6%). When compared with RBC histogram, 265 (53.0%) cases showed normal bell-shaped curve, 188 (37.6%) cases showed left shift, 27 (5.4%) cases showed broad based curve, 10 (2%) cases showed right shift, and 10 (2%) cases showed bimodal curve suggesting normocytic normochromic, microcytic hypochromic, normocytic hypochromic anemia, macrocytic, and dimorphic anemia, respectively. Conclusion This study showed a well correlation in the findings of the automated hematology analyzer with the microscopic examination. Histogram alone could be used as a screening method but when combined with RBC indices and PBS findings, they act as useful supplements and by correlating findings of all three, we could diagnose the majority of anemia.

Correlation of RBC indices and RBC histogram obtained by automated hematology analyser with peripheral smear in the diagnosis of anemia

: The impact of early diagnosis and management of anemia on patient outcome has been tremendous. Although conventional microscopic examination of blood using peripheral smear is unequivocal, the advent of automated hematology analyzer has revolutionized the field of clinical hematology and its practice. This study highlights the efficiency and utility of specific parameters obtained by hematology analyzer and its comparison with peripheral smear in the diagnosis of anemia, also determines the sensitivity of the same.: 501 Ethylenediamine tetra acetic acid blood samples collected at a tertiary care teaching hospital in Karnataka during one and half years from February 2021 to August 2022, were run on the Sysmex 6-part automated hematology analyzer and simultaneous peripheral smears were prepared and stained using Leishman stain based on standard operating procedures. The histogram and peripheral smear findings were noted.: Among the 501 cases, there were 269(53.7%) cases of Normocytic Normochromic Anemia in which 82.9% showed normal curve, 145(28.9%) cases of Microcytic Hypochromic Anemia in which 92.4% showed shift to left, 31(6.2%) cases of Dimorphic Anemia in which 61.3% showed normal curve contrary to the expected double peak, 24(4.8%) cases of Macrocytic Anemia in which 83.3% showed shift to right, 23(4.6%) cases of Pancytopenia in which 39.1% showed normal curve and 9 cases of Normocytic Hypochromic Anemia. : The Automated hematology Analyzer provides highly valuable information with limited sample and is an essential tool in diagnosis, classification and management of anemia.

Correlation of automated cell counter RBC parameters and peripheral smear findings in patients of anemia

Correlation of automated cell counter RBC parameters and peripheral smear findings in patients of anemia

Clinicoaetiological Profile of Infantile Tremor Syndrome in a Tertiary Care Hospital, Punjab, India: An Observational Study

Introduction: Infantile Tremor Syndrome (ITS) is a condition that mainly affects infants aged 6-24 months. Although predominantly considered a disorder of vitamin B12 deficiency, there have been some reports of an association of other micronutrient deficiencies in ITS babies. Aim: To assess the clinicoaetiological profile of cases of ITS admitted to the tertiary care centre. Materials and Methods: This was a retrospective observational study conducted at Punjab Institute of Medical Sciences, Jalandhar, Punjab, India. All cases of ITS admitted to the Paediatric ward from April 2022 to March 2023 were enrolled. Their case records were studied for clinical signs and symptoms like presenting complaints, demographic profile, feeding history, history of tremors, and developmental milestones. Examination findings were studied for the degree of malnutrition, presence of anaemia, knuckle hyperpigmentation, sparse hypopigmented hair, other evidence of micronutrient deficiency, hepatosplenomegaly, and any focal neurological deficit. Laboratory parameters, mainly blood counts, haemoglobin, Mean Corpuscular Haemoglobin (MCH), Mean Corpuscular Volume (MCV), Mean Corpuscular Haemoglobin Concentration (MCHC), peripheral smear findings, vitamin D and B12 levels, and serum albumin, were analysed to ascertain the clinicoaetiological profile of ITS. Results: A total of 19 cases were included in the study. All of them had sparse hypopigmented hair and anaemia. Thirteen (68.4%) had knuckle hyperpigmentation, 11 (58%) had tremors, and 16 (84.2%) had developmental delay/regression without any other underlying cause. Only 9 (47.4%) had laboratory evidence of vitamin B12 deficiency, while 14 (73.7%) had vitamin D deficiency. All the babies were discharged home, and tremors resolved in all of them after vitamin D, B12, and zinc therapy. Conclusion: In addition to vitamin B12, Vitamin D deficiency was seen in most cases of ITS. Hence, all patients with ITS need to be evaluated and treated for vitamin B12 as well as vitamin D deficiency for optimal treatment of this disorder.

Diagnostic Significance Of Bone Marrow Examination Amongst The Patients With Abnormal Haematological Parameters.

Bone Marrow examination is considered to be the most indispensable diagnostic tool for the evaluation of many neoplastic and non-neoplastic haematological disorders. After an initial assessment of suspicious cases on abnormal laboratory parameters along with the clinical presentation of the patient marrow examination is finally required for diagnosis as well as management of many haematological malignancies as it offers a clear cytological as well as histological picture of Bone Marrow aspirate and biopsy respectively. The Objective was to evaluate the significance of Bone Marrow examination in patients with abnormal haematological parameters. A retrospective study conducted at the Pathology Department of Pak Emirates Military Hospital from (Jan-June 2022) On data from150 patients who were advised to undergo bone marrow examination due to abnormal lab parameters and peripheral smear findings after informed consent and approval from the ethics review committee, to find out the correlation of abnormal haematological parameters and aspirate findings which have led to a definitive diagnosis. Data comprising basic demographic variables (age, gender etc.), Abnormal Haematological Parameters (CBC), peripheral smear findings and Aspirate findings were analyzed using SPSS version 23.0. Out of 150 studied participants with abnormal haematological parameters 24 (16%) were diagnosed on bone marrow examination as acute leukaemia / Hodgkin's and Non-Hodgkin's lymphoma respectively, 13 (9%) cases of aplastic anaemia and Autoimmune HaemolyticAnaemia, 33 (22%)cases of hypersplenism, CML and multiple myeloma. While 22 (15%) cases were diagnosed with BME as CKD and reactive changes. Moreover, 22(15%) cases were found to have Iron Deficiency anaemia respectively. The study revealed that patients with abnormal haematological parameters should undergo bone marrow examination to ascertain the diagnosis for malignant as well as non-malignant conditions that could cause abnormal lab parameters.

Two cases of vitamin B12 deficiency in patients with beta-thalassemia trait: lessons in diagnosis

BackgroundCoexisting pathologies is not a new phenomenon and can cause diagnostic difficulties when they overshadow one another. They may alter the cytomorphology of cells and the machine readings to an extent that the actual diagnosis is missed. One such scenario is created by coexisting megaloblastic anemia and beta-thalassemia trait where the RBC indices and the hemoglobin chromatogram findings conform to neither of the two. Case presentationWe present two cases of anemia presenting with normocytic normochromic indices, increased red cell distribution width (RDW), elevated HbA2 levels and moderately high HbF levels in both of them and an additional low HbA1c in case 2. Upon evaluation of peripheral smear and biochemical tests, a non-immune hemolytic component was also identified with deficient Vit B12 levels in case 1 and highly elevated levels post-supplementation in case 2. ConclusionsTaking together the peripheral smear, erythrogram, chromatogram and biochemical findings, it was deduced that the alterations were caused by coexisting beta-thalassemia trait and megaloblastic anemia. Vit B12 deficiency was the cause behind hemolysis owing to intramedullary destruction of abnormal precursors. Upon supplementation in case 2, the immediate reticulocyte response was the reason behind spuriously low HbA1c.

Can Pseudothrombocytopenia be recognised at first look?

Our aim was to determine the laboratory parameters that distinguish pseudothrombocytopenia from true thrombocytopenia. A total of 107 patients who were referred to the adult hematology outpatient clinic with thrombocytopenia and subsequently diagnosed with acute myeloid leukaemia, immune thrombocytopenia and pseudothrombocytopenia were included in our study. Hemogram parameters on admission, platelet value in the control hemogram and peripheral smear findings were recorded. Forty three (40.2%) males and 64 (59.8%) females, were included in our study. There were 25 patients in the leukaemia group, 39 in the immune thrombocytopenia group and 43 in the pseudothrombocytopenia group. Control platelet value and red cell distribution width/platelet ratio were found to be statistically significantly different between the 3 groups. Receiver operating characteristic analysis based on platelet values showed that platelet value ≤ 38,000/µL (86% sensitivity, 78.1% specificity, P < .001), difference between 2 consecutively measured platelet levels ≤ 11. 000/µL (79.1% sensitivity, 79.7% specificity, P < .001), red cell distribution width/platelet ratio ≥ 0.413 (90.7% sensitivity, 78.1% specificity, P < .001) were found to be in favor of true thrombocytopenia. In the differentiation of pseudothrombocytopenia and true thrombocytopenia, the difference between the hemogram parameters at the time of admission and the platelet count in the control blood count may be guiding. This result may reduce patient and physician anxiety and prevent patient referral.

Evaluation of patients admitted to the hematology outpatient clinic for spontaneous ecchymosis: Does it suggest bleeding diathesis?

Background: Spontaneous ecchymosis is a common reason for referral to the hematology outpatient clinic. It is important to determine whether the underlying bleeding is benign or a symptom of diathesis. Methods: The sample of this retrospective study consisted of 119 patients with normal platelet counts who presented to the adult hematology outpatient clinic with spontaneous ecchymosis between September 2021 and August 2022. The site of the ecchymosis, patients’ familial and bleeding histories, and the drugs they have been using were queried. Hemogram and coagulation parameters and peripheral smear findings of the patients were recorded, and their ISTH-SSC (International Society on Thrombosis and Haemostasis Scientific and Standardization Committee) Bleeding Assessment Tool scores were calculated. Results: The median age of the patients, of whom 113 (95%) were female and 6 (5%) were male, was 30 (18-85) years. The ecchymosis was in the extremities and the trunk in 110 (92.4%) and 9 (7.6%) patients, respectively. There was no significant difference between the patients with and without bleeding history in terms of the site of spontaneous ecchymosis, the hemogram parameters and peripheral smear findings. Similarly, the patients with and without factor deficiency have not differed significantly in terms of hemogram parameters and peripheral smear findings. Patients with any factor deficiency had significantly higher ISTH-SSC Bleeding Assessment Tool scores compared to the patients without factor deficiency. Conclusion: The findings of the study revealed that the site of ecchymosis and hemogram and coagulation parameters cannot be used as markers in the general sense, except for the ISTH-SSC Bleeding Assessment Tool scores, which predicted factor deficiency. Another finding of the study worth mentioning is the fact that number of patients with ecchymosis on the trunk among the patients presenting with the complaint of ecchymosis was significantly lower than that of patients with ecchymosis on the extremities.

Primary Plasma Cell Leukaemia with Lambda Light Chain secretion and Chromosomal abnormalities presenting as hyperleukocytosis - A case report.

Primary plasma cell leukaemia (pPCL) is a rare and lethal form of plasma cell dyscrasia that can occur either de novo (primary) or as a leukemic transformation of refractory or relapsed multiple myeloma. We report a case of pPCL with lambda light chain disease and multiple chromosomal abnormalities in a 75-year-old female who presented with generalized weakness. Her peripheral blood smear showed hyperleukocytosis with 78% circulating plasma cells. Serum protein electrophoresis (SPE) does not reveal the M band and serum immunofixation (SI) light chain analysis in serum showed an elevated lambda light chain. Skeletal radiography and PET-CT (positron emission tomography—computerized tomography) did not reveal any lytic lesions. Immunophenotypic studies reveal a CD38-positive population with negativity for T cells, B cells, myeloid markers, and a negative CD45. Fluorescent in situ hybridization (FISH) analysis results disclosed the deletion of 13q14.3 and t(11; 14). This case highlighted the usefulness of the peripheral smear findings and high fluorescent lymphocyte activity, which directed the pathologist to initiate workup for pPCL, and comprehensive laboratory biochemical and radiological evaluation further helps to confirm and differentiate pPCL from multiple myeloma. Bangladesh Journal of Medical Science Vol. 22 No. 04 October’23 Page : 932-936

Scatter gram patterns of hematological malignancies in Sysmex XN series

Background: Scatter grams-graphic depictions of the cell populations in a blood sample are produced by automated analyzers. These scatter grams can be employed to screen for various hematological conditions, including anemia, leukemia, and other blood disorders by examining the scatter gram’s cell population distribution and patterning. Aims and Objectives: In this study, we wish to study the scatter grams generated by the Sysmex XN-series analyzer for confirmed cases of hematological malignancies. Materials and Methods: In this study, 58 cases of hematologic malignancies diagnosed based on peripheral smear findings and bone marrow morphology data were extracted. We retrieved the complete blood count and scatter gram patterns analyzed by Sysmex XN-1000 analyzer for these cases along with peripheral smear findings. Scatter gram patterns in white blood cell differential and white cell nucleated were analyzed correlating with peripheral smears. Results: Among 58 cases, 20 cases were acute myeloid leukemia (6 were acute promyelocytic leukemia), 32 cases were chronic myeloid leukemia, and 5 cases were chronic lymphocytic leukemia. Unique scatter gram patterns were seen with different leukemias. Conclusion: Pattern analysis of scatter grams has the potential to improve the efficiency and accuracy of leukemia diagnosis and also help to prioritize the evaluation of cases that require further testing, such as molecular and cytogenetic evaluations, especially in limited resources or high sample volumes conditions.

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.

Prevalence and clinic hematological profile of vitamin B12 deficiency associated megaloblastic anemia in children of Jammu region - A hospital based observational study

: Vitamin B12 deficiency (VBD) Megaloblastic Anemia (MA) is a relatively common disease encountered by pediatricians in Jammu region of north India, yet the data on prevalence of VBD in this age group remains scarce. Hence this study was conducted to study the prevalence and clinic hematological profile of VBD associated MA in children between 6 months to 18 years of age. To estimate the prevalence and clinico hematological profile of vitamin B12 deficiency associated MA in children between 6 months to 18 years, who were admitted in SMGS Hospital, Government Medical College Jammu. A Retrospective cross sectional study was conducted in children between 6 months to 18 years, who were admitted in SMGS Hospital, Government Medical College Jammu with diagnosis of Nutritional Anemia from April 2020 - March 2021.Case records of patients were reviewed for vitamin B12 deficiency as a cause of MA who were included in study. Vitamin B12 deficiency was diagnosed by measuring B12 levels in blood and by bone marrow examination if required. Clinic hematological profile of the participants was observed by reviewing their records for age, sex, socioeconomic status, food habits, presenting complaints, clinical signs and symptoms, peripheral smear findings and need for transfusion. All descriptive data collected was represented by tables and evaluated for statistical outcomes. The prevalence of vit. B12 deficiency associated MA in our study is 16.66 %. Among them 60% were females and 40% males. Age wise distribution was 6months -1 year 20 %, 1-5 years 22%, 6-10years 16% and 11-18 years was 42%. Vitamin B12 deficiency was more prevalent in lower socioeconomic group 80% and in those who were vegetarians 60%. Anorexia, generalised weakness, pallor was observed in 100% subjects. Neurologic involvement in the form of irritability, tremors was present in 30%. Icterus was seen in 10% while hepatomegaly and splenomegaly was present in 20 % and 22% respectively. Edema was seen in 2% of the subjects. Hyperpigmentation of knuckles was observed in 86% of the patients. Macrocytic anemia (MCV &amp;#62;100 ug/L) was observed in 100%. Bicytopenia was seen in 80% while Pancytopenia was present in 20%. Among 150 cases of Megaloblastic Anemia 80% of the patients were diagnosed by Vitamin B12 essay, 20% were diagnosed by Bone marrow examination. Blood transfusion secondary to severe anemia was required in about 10%. Vitamin B12 deficiency is not that uncommon in our population with prevalence of 16.66% in hospitalized children. However true prevalence can only be estimated by population based surveys in pediatric age group. The most common presenting complaint in Megaloblastic Anemia is anorexia, generalised weakness, irritability manifesting clinically as pallor, hyperpigmentation of knuckles and hematologically as macrocytic anemia with 80% bicytopenia and 20% pancytopenia. Thus vitamin B12 addition in anaemia control and prophylaxis programmes may be considered.

Peripheral smear reckons the nature of IgM cold agglutinins: A case‐based study asserting the role of thermal amplitude and clonality

Peripheral smear reckons the nature of IgM cold agglutinins: A case‐based study asserting the role of thermal amplitude and clonality

Hematological Profile in COVID-19 Infection Among Patients in a Tertiary Care Hospital in Tamil Nadu, South India.

Introduction A wide range of hematological abnormalities has been observed in SARS-CoV-2 infection which is directly related to the disease progression, clinical severity, and mortality among affected individuals. The objective of this study was to evaluate the abnormalities in hematological parameters among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected patients in a tertiary care hospital in south India. Methods This was a cross-sectional study carried out in the pathology department of Karpaga Vinayaga Institute of Medical Sciences and Research Centre,Chengalpattu, Tamil Nadu, India from 1st May 2021 to 30th June 2021. The hematological reports including complete blood count (CBC), neutrophil-lymphocyte ratio (NLR), serum ferritin, serum C-reactive protein (CRP), serum lactate dehydrogenase (LDH), and D-dimer levels of all the blood samples from COVID-19 positive patients were retrieved from the laboratory records. The Leishman-stained peripheral smear findings were also tabulated and analyzed. Results Out of 65 patients, 38 (58.5 %) were males and 27 (41.5%) were females with amajority (78.4%) of them being more than 40 years of age. The salient hematological abnormalities were leukopenia (21.5%), elevated NLR (43%), and thrombocytopenia (6.2%). Peripheral smear showed schistocytes (15.4%), neutrophils with ring nuclei (84.6%), and toxic granules (81.5%). A statistically significant association between elevated NLR and serum CRP was seen among male patients. The association between the presence of schistocytes with serum LDH and D-dimer levels was statistically insignificant. Conclusions The significant hematological abnormalities in patients with COVID-19 infection were elevated NLR, lymphopenia, thrombocytopenia, and elevated D-dimer levels. Careful evaluation of the hematological parameters will help in categorizing the high-risk cases and thereby initiating early intervention and appropriate intensive care management. This will bring down the morbidity and mortality among COVID-19 patients.

Myriad of hematological manifestations in COVID-19 infected paediatric age group: our experience

Background: The incidence of COVID-19 is remarkably less in pediatric population compared to the adult population. Little information on the association of various hematological abnormalities with disease severity, clinical course and age exists in children. There is also paucity of data regarding peripheral smear findings in children with SARS-CoV-2 infection.Methods: A retrospective-cum-prospective review of the hematological parameters and peripheral smear findings of children diagnosed with COVID-19 infection admitted in tertiary care hospital over a period of two months was conducted. The study was conducted after obtaining approval from the Institute’s Ethics committee. Data was recorded in a pre-designed form and analyzed anonymously.Results: A total of 72 SARS-CoV-2 positive cases were included. Age of patients ranged from 2 days-18 years with male to female ratio of 1.6:1. Patients were grouped, based on age, into &lt;1 year (21%), 1-5 years (15%) and 5-18 years (64%). Mild disease was noted in 82.1% cases. Anemia was the commonest hematological abnormality noted in 62.5% cases followed by leucopenia in 21% cases. Neutrophil to lymphocyte ratio (NLR) ranged from 0.1-11 and was raised in 40% cases of &lt;1 year of age, 27% of 1-5 years and 28% of 5-18 years age group. Abnormalities in RBC and WBC morphology on peripheral smear were noted in 45.8% and 41.6% each. Peculiar finding was the presence of covicytes on peripheral smear showing Sandglass pattern in WBC scattergram.Conclusions: The present study showed that the majority of children with COVID-19 had a mild disease with absence of significant lymphopenia.

Evaluation of role of hematological parameters in patients with covid-19 infection: A study at tertiary care centre

SARS COV2 is the third known corona virus responsible for fatal respiratory illness in humans. The initial clinical features of the disease are quite often non-specific &amp; not all suspected patients can be tested to exclude or confirm the disease. Abnormalities in the routine laboratory tests particularly haematological tests have the potential to indicate in a quick, practical &amp; economical way, the need for a specific laboratory test for the diagnosis for SARS COV2. Besides these tests help in assisting the prognosis of the disease &amp; in the optimization of its clinical monitoring. The present study was prospective &amp; observational done in the department of pathology by observing the haematological parameters of 1000 COVID positive patients admitted in the COVID hospital of a tertiary care centre. The CBC (1000 pts), coagulation profile (250 pts), ESR (100 pts) as well as peripheral smear examination (1000 pts) was done with the collected samples. 1000 samples were receives for CBC which was run in 5 part Horiba analyzer &amp; significantly higher values were found in TLC, Neutrophil count as well as N:L ratio, while lymphocyte values were significantly decreased. Thrombocytopenia was present in a significant number of patients &amp; so were high ESR values. Coagulation profile was significantly deranged &amp; so were the peripheral smear findings. Hematological abnormalities in COVID 19 are related with disease progression, severity &amp; mortality.

Patterns of Neonatal Thrombocytopenia with A Note on Platelet Indices and Optical Technology – A Cross-Sectional Study

Introduction: Neonatal thrombocytopenia is defined as a platelet count &lt;150×10^9/L regardless of gestational-age. It results from hypo-proliferation in marrow or peripheral destruction of platelets. Platelet count can be rapidly measured using automated hematology analyzers, but peripheral smear remains best method. The causes of neonatal thrombocytopenia are defined by time of presentation into foetal (mainly TORCH infections), early (&lt; 3 days), and late. The present study highlights pattern and severity of neonatal thrombocytopenia in study hospital, adding importance of platelet indices and optical technology.&#x0D; Aim: To study patterns and severity of neonatal thrombocytopenia, platelet indices and to measure accuracy of platelet count by optical technology methods against peripheral smear.&#x0D; Materials and methods: A cross-sectional study done for a period of 8 months from December 2018 to July 2019, at ASRAM medical college, Eluru. During this period blood samples of 113 critical cases of newborns, admitted with thrombocytopenia, were collected in Ethylenediamine tetra acetic acid (EDTA) vials. The platelet count was analyzed by two automated analyzers, Sysmex XN1000 and Horiba ABX Pentra XL 80. The Leishman-stained films were examined under a light microscope. ANOVA test was used to find mean difference between platelet counts, sensitivity, and specificity, and accuracy was calculated by MEDCALC CALCULATOR.&#x0D; Results: Out of total of 113 critical cases of new-borns admitted to Neonatal intensive care unit (NICU) at institute, 85 presented with thrombocytopenia. The variation of platelet indices was noted in 40 cases, blood cultures were collected in 77 cases. Thrombocytopenia showing platelet count less than 20,000/ mm3 is considered very severe, with 30.5% (26 cases) of total number. Elevated platelet indices were noted at 47.5%. The common clinical diagnosis was neonatal sepsis (42.3%), followed by neonatal jaundice (18.8%). The light scatterer principle of platelet evaluation proved to have better accuracy than electrical impedance, in comparison to peripheral smear findings.&#x0D; Conclusion: The study concludes that neonatal septicemia is major cause of neonatal thrombocytopenia as proved by correlating platelet count with platelet indices. And also, usage of automated hemogram reports with platelet indices, is a source of information to suspect etiology of thrombocytopenia thereby preventing adverse outcomes. The principle of Optical Light scatterer technique in an automated analyzer gives better results than the electrical impedance technique for detecting platelet count value, though peripheral smear examination is mandatory for confirmation.

Assess the changes in hematological parameters in dengue and malaria fever

Introduction: Dengue fever is the most common cause of arboviral disease. Dengue fever presents with confusing clinical profile and dengue is diagnosed by reverse transcription polymerase chain reaction. Hematological parameters like platelet count, hematocrit, leucocyte count and peripheral smear findings will aid in the diagnosis of dengue fever whereas malaria which is responsible for Leukemia, anemia and thrombocytopenia. Method: Total number of cases was 138. Out of which 121 Dengue IgM positive cases and for Malaria 107 rapid card test positive and smear positive cases were selected. period of 1 year. Jan 2020 to Sep 2021. Result: dengue incidence is 66.10% up to 30yrs of age group, where as in Malaria incidence is 60.90%. Dengue is more common in females(64.50)% than Males(35.50%) as compared to malaria. Reduction in RBC count less than 4 million is more common in malaria (48.76) than dengue (48.76%). anemia is more common in malaria(74.76%) compared to dengue(46.23%). Conclusion: Raised hematocrit, thrombocytopenia, leucopenia, and atypical lymphocytes in the peripheral smear will aid in the early diagnosis of dengue infection. Hematological changes and their diagnostic values in malaria infected patients found out that hemoglobin levels, white blood cell counts, and platelet counts were significantly reduced.

Prevalence of megaloblastic anaemia and its causative factors in a tertiary care centre at Western India

Background: Anaemia affected population includes male, females as well as children and is a common problem that has been seen in western India. Megaloblastic Anaemia is common in India but regarding its prevalence and causative factors data is insufficient. The most common cause of megaloblastic anaemia includes deficiency of folic acid and Vitamin B12. Due to vegetarian lifestyle of the people the deficiency of Vitamin B12 is more common rather than the other macronutrient. In today's time, only iron and folic acid is provided by Anaemia control or prophylaxis program. This issue needs focus and hence this study has been chosen. Objective: To focus on the incidences of Megaloblastic Anaemia in Western India and analyse the possible causative factors. Materials and Methods: Patients with a haemoglobin &lt;10 g/dl and peripheral smear findings consistent with megaloblastic anaemia present in the hospital over a period of 2 months will be included in the study. Patient's diet, drug intake, present symptoms and other history will be taken into account. Recording of complete blood counts, peripheral film examination, reticulocyte count and cobalamin and folate assays will be done. Patients suffering from chronic disease like renal disease, cancer, tuberculosis, liver disease etc., Will be excluded from the study. All data will be collected and statistically evaluated. Results: In the current study, 500 patients who were admitted to the gynaecology, paediatric, and medical wards were all assessed. These patients were all eligible to participate. They were divided into three groups based on the mean corpuscular volume (MCV) value, serum assay, and peripheral smear results: Macrocytic, normocytic, and microcytic anaemia. A megaloblastic blood film or low serum indicators along with the normal MCV value were categorised as having macrocytic anaemia. A total of 100 patients had macrocytic anaemia identified. The distribution of sexes was: 70 (male), 30 (female). There were discovered to be 55% of patients with cobalamin deficit and 8% of patients with folate deficiency. Every patient were vegetarians, coming from a poor socioeconomic status. Conclusion: The diagnosis of Megaloblastic anaemia was done through complete blood counts, red cells and assays of two vitamins. Majority of patients having megaloblastic anaemia was due to deficiency of cobalamin. Poor diet in cobalamin or folate were the contributing factors in Megaloblastic anaemia. Prevention can be done through awareness camps and education programmes and also through proper diet. Vitamin B12 should be included in the diet of patients along with iron and folic acid.

Spectrum of Aplastic Anaemia; presentation, etiology and overall survival: ASpectrum of Aplastic Anaemia: Presentation, Etiology and Overall Survival-A Tertiary Care Hospital Experience Tertiary Care Hospital Experience

Aplastic anemia (AA) is a hematological disorder with immune pathophysiology. There is a decrease in bone marrow precursors and cellularity which lead to a peripheral decline in at least two cell lines. The incidence of AA is higher in the Asian population as compared to that in the west. Objective: To highlight the disease spectrum of aplastic anemia patients from the clinical presentation and etiological factors to the disease outcome and overall survival. Methods: It was a descriptive cross-sectional study, conducted at Hematology Department King Edward Medical University. All the patients of both genders, diagnosed with aplastic anemia on peripheral smear and bone marrow trephine biopsy findings were included. The patients were followed up, the results were recorded and data were analyzed using SPSS V22. Results: The study included total 91 patients of aplastic anemia out of which 46(50.5%) were males, 45(49.5%) were females The patients were divided into three groups according to the severity of which moderate aplastic anemia was present in 19 (20.9%) patients, severe aplastic anemia was seen in 42 (46.2%) patients and very severe aplastic anemia was seen in 30 (33%) patients. The etiological factors seen included idiopathic 61.5%, hakim medication 14.3%, infections 12% drugs 9.8% and radiation exposure 2.1%. It was observed that the patients with severe aplastic anemia presented with high ECOG score. Conclusion: Aplastic anemia has life detrimental outcome with high mortality rate if left untreated can be provided to the patients since it is one of the high incidences hematological disorders in Asian population.