Peripheral Smear Research Articles

An unusual case of hyperleukocytosis, hyperuricemia in an infant, mimicking leukemia – Is peripheral smear and hypertriglyceridemia clue to diagnosis? – A case report

An unusual case of hyperleukocytosis, hyperuricemia in an infant, mimicking leukemia – Is peripheral smear and hypertriglyceridemia clue to diagnosis? – A case report

Clinical profile and characteristics of cerebral malaria: An observational study in a tertiary care hospital in Western Maharashtra

Background: Cerebral malaria is a serious and potentially fatal complication of malaria caused by Plasmodium falciparum parasites. Symptoms may include an unarousable coma lasting for at least 30 min, seizures, altered sensorium, and fever. Diagnosis is made through a combination of clinical and laboratory findings, including the identification of parasites in blood smears or rapid diagnostic tests. Treatment involves prompt use of antimalarial drugs and supportive care. Severe cases of malaria can lead to complications such as cerebral malaria, severe anemia, and organ failure. Aim and Objective: The aim of thje study was to understand clinical profile and characteristics of cerebral malaria. Materials and Methods: This observational study conducted at a tertiary care center from September 2016 to June 2018. The study included patients aged 18 years and above who were admitted to the center and exhibited symptoms of altered sensorium, coma, convulsion, and fever with altered sensorium. Patients who tested positive for malarial parasites on peripheral smear or rapid malaria antigen were also included in the study. The study was ethically approved by the institutional committee and all participants provided informed consent before enrollment. The sample size included 30 patients. Results: The study involved 30 hospitalized patients with severe falciparum malaria. Of the patients, 60% were male and 40% were female, with a male to female ratio of 3:2. The average age was 42.3 years, with the highest number of patients belonging to the age group of 18–30 years. All patients had fever, with the majority reporting altered sensorium, chills and rigors, headache, and nausea. Multiorgan dysfunction was more common than extracranial single system involvement. CSF analysis showed normal cytology, with normal or slightly elevated protein and sugar levels. Most patients had a Glasgow coma scale score between 11 and 15, with brain edema and retinal changes observed in some patients. Conclusion: The study concludes that hospitalized patients with severe falciparum malaria, predominantly affecting young adults. Symptoms included fever, altered sensorium, chills, and rigors, with multiorgan dysfunction being more common than single-system involvement.

EFFECT OF NASAL CORTICOSTEROIDS ON OXIDATIVE STRESS PARAMETERS IN CHILDREN WITH ALLERGIC RHINITS

Oxidative stress (OS) is a result of an imbalance between the production of free radicals and the antioxidant defense mechanisms in the organism. Allergic rhinitis (AR) is characterized by chronic inflammation and increased presence of eosinophils, basophils and mast cells in nasal secretions and mucosa. Stimulation of these cells results in production of free radicals (reactive oxygen metabolites). The aim of this study was to determine the level of OS and antioxidant capacity in children with AR after 8 weeks treatment with nasal corticosteroid (NCS). Thirty children with AR (mean age 8.3 ± 2.9 years) were included. The FRAS 5 Bravo system was used to determine the OS parameters. Demographic characteristics, medical history, children's living conditions and eating habits were obtained from the questionarrie. Anthropometric measurements, absolute number of eosinophils in the peripheral smear and eosinophils in nasal smear were performed in each child. The mean value of blood concentration of serum peroxides (d-ROMs) was 403.4 ± 91.3 U. Carr, while the mean value of OS index was 95.1 ± 45.9. After 8 weeks of treatment with NCS, the mean values were 337.6 ± 71.9 U. Carr, and 53.6 ± 28.3, respectively. Both parameters had significantly lower values (p<0.05) compared to those before the initiation of NCS therapy. After treatment, a significant improvement in the symptoms score of AR was detected (p<0.05). NCS therapy makes asignificant improvement of the symptoms and a considerable reduction in the OS in children with AR. Keywords: allergic rhinitis, children, oxidative stress, d-ROMs, PAT, OSI

An Uncommon Display of the Sickle Cell Trait Coupled with the Beta-Thalassemia Trait as Hypersplenism

Abstract A structural flaw in the globin gene causes hemoglobinopathies, while a flaw in the globin chain’s synthesis causes thalassemia. One of the most prevalent hemoglobinopathies worldwide is sickle cell disease. Any region of the body can be affected, but the spleen is one of the most often afflicted and the first organs to suffer damage in sickle cell anemia (SCA). Splenomegaly, splenic infarction, hypersplenism, and acute splenic sequestration are the most common manifestations. Usually enlarged in the first 10 years of life, it gradually atrophies and eventually requires an autosplenectomy. It is well established that splenic complications from SCA are linked to higher rates of morbidity and in some cases, even death. This case report discusses a unique presentation of a patient who has hypersplenism together with beta-thalassemia and sickle cell trait. This is a case report of the adult patient admitted in Dhiraj General Hospital, SBKS MIRC, Sumandeep Vidyapeeth, Waghodia, Piparia, Vadodara-391760. The high-performance liquid chromatography (HPLC) technique was used to diagnose thalassemia trait and sickle cell trait. The clinical, ultrasonographic and computed tomography scan methods have been used to identify splenomegaly. The patient had clinical symptoms suggestive of beta-thalassemia and sickle cell trait with hypersplenism. This was supported by his peripheral smear, ultrasonography, contrast-enhanced abdomen–pelvis, HPLC, and bone marrow biopsy. It is imperative that clinicians remain cognizant of this infrequent consequence. Hence, early diagnosis and genetic counseling are of great importance for improving the prognosis of these patients.

A study of atypical presentations and rare complications of malaria

Objective: To analyse and observe various atypical presentations and rare complications of malarial diseaseMaterial and Methods: In this analytical study, 60 patients who are admitted with or diagnosed with malaria (P. falciparum/P. vivax) in GSL General Hospital, Rajahmundry studied in a period of 2years investigated with complete homograft, peripheral smear, liver function tests, renal function tests, CT chest, ECG, 2D ECHO in relevance to complaints/symptoms/presentation were included after a well-informed consent. Detailed history and findings of clinical examination were noted in a prevalidated proforma.Results: In this current study the mean age of the participants was observed to be 46.83 ±17.23 years. 58.3% were the cases which are falciparum positive, 8.3% were positive for vivax and falciparum, 33.3% were positive for vivax. most common presenting complaints were that 40% had pain abdomen 3.3% had anasarca, 23.3% had diarrhoea, 1.7% had jaundice, 5% had pedal edema, 5% had decreased urine, 11.7% had seizures, 1.7% had quadriplegia, 6.7% had add altered sensorium, 1.7% had weakness and tingling toes, 5% had headache.Conclusion: In the area’s endemic to malaria, even with unusual presentation with multisystem involvement one need to consider Malaria as high degree of suspicion or as an alternate diagnosis to prevent further clinical deterioration.

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.

Severe Hereditary Spherocytosis Presenting with Non-Immune Fetal Hydrops

Background: Hereditary spherocytosis (HS) is characterized by spherocytes on the peripheral smear and heterogeneous clinical presentation (mild, moderate, moderate/severe, and severe) depending upon the severity of hemolytic anemia, jaundice, and splenomegaly. The underlying cause is defects in various red blood cell membrane proteins due to pathogenic mutations. Genotype-phenotype correlation is known. Clinical Description: We report a consanguineous family with a healthy daughter, multiple pregnancy losses due to fetal hydrops, and the current daughter. She was diagnosed with fetal anemia at 22 weeks gestation, developed fetal hydrops, was born premature and developed respiratory distress, severe anemia, severe jaundice, and postnatal hemolysis. Management: The case was managed since intrauterine life till date by multispecialty coordination. Intrauterine transfusions were given during pregnancy. In the neonatal period, she received surfactant for respiratory distress syndrome, double volume exchange transfusion and phototherapy for the jaundice, and repeated blood transfusions for the hemolytic anemia, that is still continuing. Rational and sequential investigations were planned and a systematic approach used. She was diagnosed with severe HS due to a homozygous likely pathogenic variant in the SPTA1 gene (affecting formation of spectrin), and heterozygous variant of uncertain significance in the ANK1 gene (that encodes ankyrin). At 3 years she has transfusion dependent hemolytic anemia, moderate splenomegaly, and age appropriate growth and development. Conclusions: HS is a rare but manageable (albeit challenging) cause of nonimmune hydrops fetalis. Genetic diagnosis allows precise management and family counselling.

Unilateral periorbital swelling as initial rare presentation of pediatric leukemia

Background: Acute lymphoblastic leukemia (ALL) is considered the most typical type of cancer in children, representing around 26% of childhood cancer. Case Presentation: A 13-month-old girl was presented to our clinic who developed unilateral periorbital swelling as her initial sole symptom of ALL. In this report, we described this case with a summary of previously reported cases. The patient previously medically free, was presented with left periorbital swelling and inferior globe displacement, progressing over the preceding 3 weeks. At the initial presentation, slit lamp examination revealed a normal anterior segment with characteristic leukemic retinopathic changes in both eyes with no detected hepatosplenomegaly or enlarged lymph nodes. On investigation, a peripheral smear and bone marrow biopsy showed 80% blast cells. A CT scan showed varying degrees of bilateral extraocular/ocular muscle infiltration. ALL was diagnosed, and the patient immediately underwent induction chemotherapy. Conclusion: This case highlights the importance of understanding and considering rare, aggressive diseases potentially masquerading as simple periorbital edema.

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.

Utilisation of Different Blood Components in Paediatric Patients: A Cross-sectional Study

Introduction: The term “blood component” refers to the separation of Whole Blood (WB) into packed red cells, platelet- rich plasma, Fresh Frozen Plasma (FFP), cryoprecipitate, and leukocytes. The practice of separating donated WB units into different blood components and supplying only those components to patients is now considered a standard practice in all blood banks. Therefore, regular auditing of blood usage and its components is essential to assess blood utilisation patterns. Aim: The aim of this study was to analyse the distribution and appropriateness of blood and blood product transfusions in children aged 1-18 years. Materials and Methods: A cross-sectional study was conducted over an 18-month period from December 1, 2014, to June 30, 2016, involving paediatric patients requiring blood and blood product transfusions, who presented to the Department of Paediatrics, Shri B.M. Patil Medical Hospital, Vijayapura, Karnataka, India. The study population consisted of children aged 1-18 years. Data from blood component requisition forms were collected, and reports of investigations such as pre-transfusion/ post-transfusion haematological parameters, coagulogram, and peripheral smear were recorded. Predetermined criteria were used to assess each transfusion episode. The results were then analysed, tabulated, and expressed as a percentage. The appropriateness of Packed Red Blood Cell (PRBC), platelet, and FFP transfusions was estimated using predetermined criteria. Data from blood component requisition forms were collected, coded, tabulated, analysed, and expressed as a percentage. Results: The study included 149 paediatric patients aged 1 to 18 years. Out of a total of 214 episodes of blood and blood component transfusions among the 149 patients, 102 episodes (47.7%) were WB transfusions, 67 episodes (31.3%) were packed red cell transfusions, 26 episodes (12.1%) were platelet transfusions, and 19 episodes (8.9%) were FFP transfusions. Out of the total 214 transfusion episodes, 126 (58.5%) were deemed appropriate, while 88 (41.5%) were deemed inappropriate. The most commonly inappropriately used component was WB, followed by platelets, FFP, and packed red cells. Inappropriateness of WB usage was primarily due to attempts to achieve haemostasis in bleeding patients, while sepsis was the most common indication for inappropriate platelet usage. Conclusion: This audit highlights significant variation in transfusion practice patterns among paediatricians. The most common indications for usage were found to be achieving haemostasis, threshold haemoglobin concentration, and sepsis in children.

Aberrant Cytomorphological Features of Primary Plasma Cell Leukaemia: A Case Series

Primary Plasma Cell Leukaemia (pPCL) is a rare but distinctive sub-type of Plasma Cell Myeloma (PCM) comprising approximately 2-4% of cases of PCM and characterised by short remissions and survivals. Apart from these clinical distinctions, this entity also demonstrates unique cytomorphological features. The authors here attempted to highlight this unusual spectrum of leukaemic plasma cells, posing diagnostic challenges in the blood and bone marrow examinations. The cases presented in this series (48 years old male, 72 years old male,68 years old male and 63 years old female) patients, showed presence of atypical cells in the peripheral smear with few cells portraying the characteristic “hairy cell” morphology, the fourth case in addition, showed small sized plasma cells resembling lymphocytes. Bone marrow biopsy in three cases showed haematopoetic cells replaced by sheets of atypical plasma cells. In addition, the fourth case showed atypical cells having convoluted and notched nuclei giving a differential diagnosis of lymphoplasmacytic lymphoma and small B-cell lymphoma with plasmacytic differentiation. As plasma cell neoplasm was not suspected clinically in all four cases, flow cytometry was sought for confirmation which showed atypical cells expressing CD38 (+), CD138 (+), CD56 (–) with Cykappa (+) in first case, Cylambda (+) in the second case and Cykappa (+) in the fourth case with aberrant expression of cyclin D1 thus confirming a diagnosis of PCL in first two cases and PCM-lymphocytic type with PCL in the fourth case. Immunophenotyping was not performed in the third case due to financial constraints. This case series showcases this mélange of cytomorphological variations of plasma cells ranging from cells masquerading as hairy cells to small sized plasma cells resembling lymphocytes, each posing a unique diagnostic dilemma. This has been rarely discussed in prior published case series. Aberrant morphological features rarely seen in PCL, could lead the pathologist astray from the diagnosis, therefore appropriate use of ancillary tests are essential to arrive at a correct diagnosis.

To evaluate the hematological markers in patients having nutritional anemia attending National Institute of Medical Sciences Hospital of Jaipur, Rajasthan

Abstract Background: Nutritional anemia is the most common preventable cause of anemia. Anemia of nutritional origin is an acquired problem caused by consumption of diets that lack sufficient quantity of vitamin B12 levels and serum iron and other components. As per World Health Organization guidelines, hemoglobin (Hb) of <10 g/dL concentration treated as anemia. Nutritional anemia is identified by determining Hb concentrations, evaluating red cell indices and examining peripheral blood picture accompanying serum iron parameters and serum vitamin B12 level. Objectives: To study complete blood count indices with different serum vitamin B12 levels and serum iron profile among nutritional anemia patients attending NIMS Hospital, Jaipur. Materials and Methods: An observation study was conducted among 274 patients having nutritional anemia from General medicine out patients between 15 and 60 years. Two blood samples were collected from each participant to estimate the complete blood counts and red blood cells (RBCs) morphology and to analyze the iron profile and vitamin B12. Results: This presence study shows nutritional anemia in 55% of women than men. 15.6% of patients were from age group 15–20 years. 56.57% patients had moderate anemia, 29.92% patients had severe anemia, and 13.56% patients had mild anemia. Study shows 55% population were nonvegetarians and 45% had vegetarian diet. Microcytic hypochromic blood picture was found in 59.49% patients. Conclusions: Nutritional deficiency anemia was the most prevalent anemia. Peripheral smear is in concordance with serum iron parameters and serum vitamin B12 level. Our study suggests RBC morphology along with red cell indices in diagnosis and management of nutritional anemia which can be cured by dietary adjustment and fortification of food with iron and other micronutrients.

Seizure-Induced Coma in Patient with Haemoglobin 1.3 gram per decilitre and MultiOrgan Dysfunction: A Rare Case Report

People of all ages are affected by anaemia which is a serious global health problem. Iron Deficiency Anaemia (IDA) seems to be the most commonly occurring type of anaemia in women. Elderly people with anaemia have higher morbidity and mortality. The purpose of treatment is to tackle the disorder’s underlying cause. Older people with persistent anaemia may need regular blood transfusions. The authors present a case report of a 55-year-old woman who visited the Emergency Department with primary complaints of convulsions and subsequent unconsciousness. She had generalised oedema and weakness since eight days. On examination she was afebrile with pulse 92 beats/min, Blood Pressure (BP) of 80 mmHg systolic. Laboratory results showed haemoglobin of 1.3 g/dL, increased White Blood Cells (WBC) and peripheral smear showed pencil-shaped cells and teardrop cells. Radiological investigation showed grade III renal parenchymal disease, cirrhosis of liver, gross ascites with bilateral pleural effusion, and splenic cyst. A 2D Echocardiography was done, which was suggestive of left ventricular hypertrophy, mild to moderate systolic dysfunction, along with dilated left ventricle. She was intubated in view of low Glasgow Coma Scale (GCS) and unconsciousness. On further stay in the hospital, she received blood transfusion. Hence, this case is a rare finding of severe anaemia.

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.

Haemolytic uraemic syndrome with acute kidney injury following paraphenylenediamine-containing hair dye ingestion

Abstract A 20-year-old male patient presented with an alleged history of consumption of 80 mL of paraphenylenediamine (PPD) hair dye. At initial presentation, throat pain, anasarca and reduced urine output were evident. On general physical examination, tachycardia and tachypnoea were evident; blood pressure was 130/80 mm Hg. Oxygen saturation measured with a pulse oximeter (SpO2) on ambient air was 98%. Laboratory investigations revealed haemoglobin (Hb) 14.7 g/dL, platelets 250,000/mm3, neutrophilic leucocytosis, total leucocyte count 23,600/mm3, 86% neutrophils) elevated serum creatinine (6.8 mg/dL), creatine phosphokinase levels (1466 IU/L), hyperkalaemia (6.2 mEq/L) and myoglobinuria. Abdominal ultrasonography revealed normal-sized kidneys and grade 2 renal parenchymal disease changes with maintained corticomedullary differentiation indicating acute kidney injury. Laboratory investigations done on day 7 of admission revealed anaemia Hb 9 g/dL, thrombocytopenia platelets 73,000/mm3, haemoglobinuria and elevated serum lactate dehydrogenase levels (3005 IU/L) with a negative direct and indirect Coombs test and schistocytes (5%) on peripheral smear suggesting microangiopathic haemolytic anaemia. Serum calcium, magnesium and phosphorous were within normal limits. Urinalysis showed plenty of red blood cells with dysmorphia. Haemolytic uraemic syndrome (HUS) was diagnosed and 15 sessions of haemodialysis as well as 7 sessions of plasma exchange were instituted. Clinical improvement was noted with improvement in urinary output; normalisation of laboratory parameters occurred over the next 3 weeks. He was discharged in a haemodynamically stable state. The present case highlights the unusual occurrence of HUS secondary to a hair dye (PPD) poisoning which responded to plasma exchange treatment.

Retinal hemorrhage – A red flag in detecting chronic myeloid leukemia blast crisis

An 18-year-old presented with a diminution of vision and was detected to have a retinal hemorrhage, low hemoglobin, and high blood pressure, with ultrasonography showing splenomegaly, large neck nodes, and finally peripheral smear revealing chronic myeloid leukemia (CML). This rare case of blast crisis was taken care of by imatinib, i.e., BCR-ABL tyrosine kinase protein inhibitor, subsiding of the crisis led to improvement of vision. This case report highlights the rarity of ocular manifestations in CML and the importance of all systemic investigations in the diagnosis of this case.

Tuberculoid granuloma in bone marrow biopsy can be a rare cause of pancytopenia

Tuberculoid granuloma in bone marrow biopsy can be a rare cause of pancytopenia

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.

Challenges of bone marrow transplant for sickle cell disease in resource limited setting

Sickle cell disorders (SCD) are a group of inherited disorders that results from both parent being carriers, haemoglobin AS resulting in haemoglobin (SS), causing anemia, infections, pain, stroke, priapism, sequenstration crisis, multiple organ dysfunctions etc. There are several ways of managing sickle cell disorder but the best way, which is considered a gold standard cure for the disease is a successful bone marrow transplant of haematopoietic stem cells (HSCT). Bone marrow (BM), Peripheral blood (PBSC) and Umbilical cord blood (UCB) are rich in stem cells. In order to have a good bone marrow transplant, without graft rejection, the laboratory plays a vital role especially in compatibility testing of donor and recipients at the various stages of the transplant, which includes initial stage, during the transplant and follow up testing to ensure tolerance to the new graft and testing for chimerism. There are various types of transplant which include Autologous, Allogeneic (Sibling/ Unrelated Donor), Parent or relative, etc. The various pre transplant tests includes: Sickling test, High Performance Liquid Chromatograph (HPLC), Genetic studies, RBC Indices Hb – 6-9 gm/dL, Peripheral Smear, Retic count Reticulocytosis, ESR, Bone marrow analysis. Post-transplant test Includes Engraftment Analysis, Complete Blood counts, kidney function, liver function, Cholesterol, HIV, Hepatitis B, Hepatitis C, additional infectious studies (Endemic testing), Urinalysis etc. Haemopoietic transplantation challenges in a resource limited settings like Nigeria are enormous and they includes: Danger of serious illness associated with donor-to-patient stem cell transplant, lack of appropriate donors, Graft-versus-host disease (GVHD), Inadequate Human resource, Inadequate equipped facility, cost of the service, Corruption, Lack of political will, Leadership incompétence, Lack of strategic planing, Policy inconsistency, Lack of qualified personnel, Poor healthcare administration, Conflict of interest among health workers. The cost of Bone Marrow Transplantation is highly exorbitant to Nigerians and government need to play vital role towards funding part of the cost and alleviating the pain of sickle cell. Effective implementation of National Health Insurance Scheme and address corruption are the most efficient ways the cost would be subsidized. Appropriate information campaigns largely championed by maternal and child health-care professionals would significantly contribute to raising the level of awareness and acceptance of Cord Blood donation. Training and re training of medical personnel cannot be over emphasized.

Acute pancreatitis complicated by hemolytic uremic syndrome: a pediatric case

BackgroundHemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia (MAHA), thrombocytopenia, and acute kidney injury. The acute pancreatitis-associated HUS is a rare entity, and this case is one of the few pediatric cases reported.Case presentationA 17-year-old girl referred to the emergency department with complaints of abdominal pain, fever, and vomiting. The skin and sclera were icteric. Murphy’s sign was positive. Hemogram was normal, biochemical analysis revealed an increase in liver function tests and cholestasis enzymes. Abdominal CT revealed multiple stones in the hydropic gallbladder lumen and the pancreas was edematous. With a diagnosis of acute pancreatitis supportive treatment was started. Acute kidney failure, cholestasis, anemia, and thrombocytopenia developed at the 2nd day of follow-up. Thrombotic thrombocytopenic purpura was excluded with normal ADAMTS-13 level. Intermittent hemodialysis and plasma exchange (PE) treatments were initiated, considering pancreatitis-related HUS. On the 3rd day of PE, the patient’s urine output exceeded 1 cc/kg per hour. No schistocyte was found in the peripheral smear after 7 PE and 5 hemodialysis sessions. Anemia, thrombocytopenia, and kidney functions improved. On the 15th day of the follow-up, endoscopic retrograde cholangiopancreatography performed, and gallbladder stones were removed.ConclusionThe pathogenesis of HUS developing after acute pancreatitis is not fully understood. The mechanism proposed is that acute pancreatitis triggers cytokine release, resulting in endothelial damage and HUS. In conclusion, HUS may rarely develop in patients with acute pancreatitis. With the early diagnosis and appropriate treatment, the kidney functions can be completely normalized.