Peripheral Smear Research Articles

Immunological Responses of Arsenicum album 30CH to Combat COVID-19: Protocol for a Double-Blind, Randomized, Placebo-Controlled Clinical Trial in the Pathanamthitta District of Kerala.

COVID-19 is a recent major public health concern caused by the SARS-CoV-2 virus, with approximately 44.6 million COVID-19-positive cases and 530,000 deaths in India (as of February 1, 2023). The COVID-19 vaccination drive in India was initiated in January 2021; however, an effective preventive strategy with high efficacy and immunological safety remains elusive. The aim of this study is to assess the immunogenic responses of Arsenicum album 30CH (AA30CH) as COVID-19 prophylaxis, including assessment of immunological markers, innate and acquired immune responses, COVID-19 symptoms, and its associated antibody responses. This randomized controlled clinical trial (RCT) will include two parallel comparator groups of AA30CH and placebo with an allocation ratio of 1:1 conducted in the Pathanamthitta district of Kerala, India. The placebo or AA30CH will be administered in three intervention schedules and blood samples will be collected before and after each of the intervention schedules. Based on the inclusion and exclusion criteria, 112 participants per arm (with an expected dropout of 20%) will be screened. Immunogenic responses will be evaluated by determining the antigen density and modulation in immunological markers and lymphocyte subsets CD3, CD4, CD8, CD24, CD27, CD38, CD4 interferon-γ, CD4 CD17, CD4 CD25 (activated T lymphocytes), T cells, B cells, dendritic cells (mature and immature), and natural killer cells on days 1, 5, 23,27, 45, 49, and 66. The innate and acquired immune responses will also be evaluated by a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) array profiler (84-gene set) before and after the study interventions. The toxicity status of AA30CH in study participants will be evaluated through hepatic, renal, and hematological parameters and peripheral smears on days 1, 5, 23, 27, 45, 49, and 66. The number of participants developing COVID-19-like symptoms per National Centre for Disease Control guidelines and the number of participants testing positive for COVID-19 in RT-PCR during follow-ups in any of the three intervention schedules will be identified. Moreover, a subgroup analysis will be used to assess the COVID-19 antibody responses between vaccinated and unvaccinated participants. This RCT protocol has been approved by various committees and funded by the Central Council for Research in Homoeopathy, Ministry of Ayush, Government of India. The project has been implemented in collaboration with the Department of Homoeopathy, Government of Kerala. The RCT was rolled out on January 25, 2023, and enrollment was completed April 3, 2023. The immunological assays will be conducted at the Department of Biotechnology-Translational Health Science and Technology Institute, Faridabad, India. This study will represent the first evaluation of the immunological efficacy and safety of AA30CH in an RCT, which may significantly impact the use of homeopathy as an evidence-based medicine approach. Clinical Trials Registry-India CTRI/2022/08/045089; https://tinyurl.com/mryrpkvk. DERR1-10.2196/48479.

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.

Clinicohematological Profile of Visceral Leishmaniasis in the Pediatric Population

Abstract Background Visceral leishmaniasis (VL) is a major public health problem worldwide. In addition to the clinical manifestations, varied hematological abnormalities have also been observed. We aim to study morphology both in peripheral smear and bone marrow aspirates (BMAs) along with clinicohematological correlation in the pediatric age group. Materials and Methods: A retrospective analysis of clinicohematological findings of 47 pediatric patients (0–18 years) diagnosed with leishmaniasis on BMAs from 2006 to 2017 was undertaken. All the results were tabulated and compared for evaluation. Results: From the 47 VL patients, the following abnormalities were noted. Pancytopenia 44.7% (21/47), bicytopenia 42.5% (20/47), anemia 10.6% (5/47), leukopenia 81% (38/47), and thrombocytopenia 53.2% (25/47). On peripheral smear, shift to left (48.3%), nucleated red blood cells (19.4%), toxic granules (6.7%), and Leishmania donovani (LD) bodies (5.7%) were noted. About 5.7% were seen. Bone marrow examination revealed erythroid hyperplasia in 44.6% of cases showing normoblastic (88.8%), megaloblastic (4.4%), and mixed (10.6%) reactions. Dyserythropoiesis (15.5%), drug-induced karyorrhexis (2.1%), dysmyelopoiesis (17%), giant stabs and metamyelocytes (6.3%), coarse granulation (2.1%), intrahistiocytic organisms (100%), increased plasma cells (3.4%), granulomas (25.5%), parasitophorous vacuoles (25.5%), nonhistiocytic intracellular organisms (15%), intracellular granule-like organism (8.5%), hemophagocytosis (8.5%), Reed–Sternberg-like cells (2.1%). Conclusion: BMA findings such as increased plasma cells, granulomas, hemophagocytosis, and granule-like organisms are important clues for suspecting leishmaniasis and further searching for LD bodies in patients with fever and splenomegaly.

A Case of Catastrophic Atypical Hemolytic Uremic Syndrome Unresponsive to Eculizumab and the use of Ravulizumab Off-label

“A 40-year-old woman with melanoma, under treatment with Dabrafenib and Trametinib, was evaluated in our hospital for rapidly progressive deterioration of renal function”. 8 months before the current admission, the patient had been diagnosed with melanoma, and underwent radical surgery and subsequent therapy with Dabrafenib and Trametinib. After 5 months of therapy, the patient was brought to this hospital for precordial pain, with a diagnosis of myopericarditis, therapy was started for heart failure with a good response. However, the patient developed a progressive impairment of renal function, associated with hemolytic anemia and thrombocytopenia. The peripheral smear showed the presence of schistocytes. The suspicion of atypical Hemolytic Uremic Syndrome (aHUS) was confirmed by the assay of C5B-9 induced by serum on endothelial cells, which showed a deposition of 331%, treatment with Eculizumab was initiated. After 3 administrations the patient did not improve, with further worsening of the hemolytic condition, and progression of renal damage. Due to the failure of Eculizumab, we considered the use of Ravulizumab. However, in Italy only can be administered to patients in Eculizumab stable treatment for at least three months. Nevertheless, faced with the catastrophic condition, it was decided to shift the therapy and use off-label Ravulizumab. After 10 days of the first administration, the laboratory tests showed a continuous rise in the values of haptoglobin, platelets, and hemoglobin, and a decrease in LDH. The renal function failed to return to normal values but after 20 days of therapy with Ravulizumab, there was complete resolution of the hemolytic condition.

Vitamin B-12, Homocysteine, and Hematological Parameters in Ischemic Stroke Patients

Background: A cerebrovascular accident or stroke is one of the leading causes of disability and death in the world. Several risk factors have been detected and extensively studied and are part of preventive strategies. Emerging risk factors for ischemic that have recently acquired interest are vitamin B-12 and homocysteine levels. A study has been conducted in a tertiary hospital in Chennai to evaluate the levels of vitamin B-12, homocysteine, and hematological variables. Aims: The objective of the study was to estimate the serum levels of homocysteine and vitamin B-12 in patients with ischemic stroke and transient ischemic attack and to analyze hematological parameters, including complete blood counts and peripheral smear and correlate with vitamin B-12. Materials and Methods: A total of 80 individuals with either ischemic stroke or transient ischemic attack were included in the study. Vitamin B-12, homocysteine, complete blood counts, and peripheral smear were analyzed for the patients. Results: Either frank or subclinical vitamin B-12 deficiencies were noted in 59 (73.8%) of the study population. Fifty-seven (71.2%) of the study population had elevated homocysteine. Fifty (62.5%) had a high neutrophil-to-lymphocyte (N:L) ratio and 52 (65%) had elevated red cell distribution width. Conclusion: High homocysteine levels are prevalent among ischemic stroke patients and this elucidates that homocysteine has a role in the thrombus formation and is a risk factor for the development of the stroke. It was also noted that vitamin B-12 deficiency, either frank or subclinical, is prevalent among these patients and can be a target for supplementation strategies.

Transient Hyperleukocytosis in One of the Extreme Preterm Twins: A Case Report with Review of Literature

Background: Although physiological leukocytosis is known in premature neonates, hyperleukocytosis (total leukocyte count more than 100 × 103 /µL) is rarely seen. Commonly known disorders leading to hyperleukocytosis include leukemia, leukocyte adhesion defect, and myeloproliferative disorders. Transient hyperleukocytosis of unidentified etiology or attributed to sepsis has been rarely reported. Clinical Description: One of the extremely preterm twins (delivered at 26 weeks gestation) developed hyperleukocytosis on day 3 of life, without any evidence of blast cells on the peripheral smear, with normal C-reactive protein levels, while Twin 2 had normal leukocyte counts. Management and Outcome: Twin 1 was managed conservatively with mechanical ventilation, supportive care, and broad-spectrum antibiotics. His total leukocyte counts started reducing since day 5 of life and returned to normal after day 18, although he required prolonged respiratory support due to bronchopulmonary dysplasia (BPD). The other twin with a normal leukocyte count had a less difficult course and did not develop BPD. The twins being dichorionic-diamniotic type, and the placental histopathology of Twin 1 showing evidence of chorioamnionitis (the placenta of the other twin was normal), the transient hyperleukocytosis of Twin 1 was attributed to chorioamnionitis. Conclusion: The presence of hyperleukocytosis in only one of the neonates of an extremely preterm delivery highlights the fact that some factors such as chorioamnionitis or early-onset sepsis may contribute to this condition, which is transient, and resolves with supportive conservative care.

Incidence of Facial Nerve Injury in Extracapsular Dissection vs Superficial Parotidectomy of Benign Parotid Lesions

Background: Anemia is the most common health problem during a woman life span. It has serious threats to pregnant women all over the world. Its prevalence in Pakistan is 75%. Thalassemia trait a common cause of anemia is usually diagnosed in pregnancy after workup of anemia. Objective: To find out the frequency of beta thalassemia trait in pregnant anemic women. Study Design: Cross-sectional study. Settings: Gynecology Unit, Hayatabad Medical Complex, Peshawar Pakistan. Duration: 6 months from 9th September 2020 to 8th march 2021. Methods: A total of 193 pregnant anemic women of age 17-40 years with a gestational age of 8-28 weeks were included in the study through a non-probability sampling technique. Those with known liver, and kidney diseases and hypothyroidism and those with pregnancy-related bleeding were excluded. Blood samples were sent for peripheral smear and Hb-electrophoresis and all the parameters were noted in the proforma. Results: Means ±SD for age was 28.35 ± 6.713 years, for gestational age was 17.08 ± 4.620 weeks and for Hb level was 7.71 ± 1.425 g/dl. 25.9% of patients were observed in 21-25 years of age. Cousin marriages were recorded in 71.5% of patients. 60.6% of patients were having a family history of thalassemia while the Beta thalassemia trait was recorded in 58.5% of patients. Conclusion: 58.5% prevalence of Beta thalassemia trait in pregnant women was observed. It was more common in age group 21-25 years. Cousin marriages and family history are the major causes of thalassemia.

Prevalence of Beta Thalassemia Trait Among Anemic Pregnant Patients

Background: Anemia is the most common health problem during a woman life span. It has serious threats to pregnant women all over the world. Its prevalence in Pakistan is 75%. Thalassemia trait a common cause of anemia is usually diagnosed in pregnancy after workup of anemia. Objective: To find out the frequency of beta thalassemia trait in pregnant anemic women. Study Design: Cross-sectional study. Settings: Gynecology Unit, Hayatabad Medical Complex, Peshawar Pakistan. Duration: 6 months from 9th September 2020 to 8th march 2021. Methods: A total of 193 pregnant anemic women of age 17-40 years with a gestational age of 8-28 weeks were included in the study through a non-probability sampling technique. Those with known liver, and kidney diseases and hypothyroidism and those with pregnancy-related bleeding were excluded. Blood samples were sent for peripheral smear and Hb-electrophoresis and all the parameters were noted in the proforma. Results: Means ±SD for age was 28.35 ± 6.713 years, for gestational age was 17.08 ± 4.620 weeks and for Hb level was 7.71 ± 1.425 g/dl. 25.9% of patients were observed in 21-25 years of age. Cousin marriages were recorded in 71.5% of patients. 60.6% of patients were having a family history of thalassemia while the Beta thalassemia trait was recorded in 58.5% of patients. Conclusion: 58.5% prevalence of Beta thalassemia trait in pregnant women was observed. It was more common in age group 21-25 years. Cousin marriages and family history are the major causes of thalassemia.

Malaria: a masquerader of cytopenias in leukemia

In developing countries where the prevalence of malaria and cancer are high it can be expected to occur together. 6-year-old male child, a known case of B cell acute lymphoblastic leukemia, on maintenance phase of chemotherapy presented to us with fever. His initial investigations showed no identifiable focus or significant abnormalities. He continued to have high grade fever spikes in spite of stepping up antibiotics. A week after admission he was found to have cytopenias and mild splenomegaly. Peripheral smear and bone marrow aspiration study showed enlarged RBCs infested by Plasmodium vivax. We report this case to make the clinicians aware that malaria can be cause of fever in patients on cancer treatment.

A-156 White Blood Cell Measurands, Flagging and Scatter Plot Patterns in Chronic Lymphocytic Leukemia

Abstract Background In this study, we use Alinity hq hematology analyzer to investigate the differences between white blood cell measurands of a healthy control population vs Chronic Lymphocytic Leukemia (CLL). A repeatability study was also conducted to determine the precision of the white blood cell parameter results on the Alinity hq. In addition, we used Alinity hq to identify unique flagging and patterns in the optical channels for CLL. Methods One hundred and fifteen peripheral blood samples of CLL were compared to a population of four hundred and fourteen healthy controls on the Alinity hq analyzer. Statistical differences in Alinity hq’s white blood cell measurands compared between the control population and CLL. For the repeatability study, five CLL samples (with sufficient volume) will be tested in 10 replicates for WBC measurands. These samples can be part of the 115 samples above or can be different samples. Comparison of scatterplots were also analyzed between CLL and control samples. Lastly, a peripheral smear was performed on all CLL samples. Results Statistical analysis of the means of the white and red cell parameters showed that in comparison to the means of the control population there was a significant statistical (P &amp;lt; 0.05) and clinical difference with CLL for the following parameters: absolute white blood cells (WBC) X 103/µL (43.6 CLL vs 7.41 control), percent neutrophils (%N) (18.25 CLL vs 53.71 control), percent lymphocytes (%L) (77.72 CLL vs 33.47 control), and percent monocytes (%M) (2.71 CLL vs 8.75 control). The WBC repeatability study results showed good concordance on the Alinity hq CBC + Diff + Retic test mode with the following percent coefficient of variance (%CV) results: absolute WBC X 103/µL (0.64, 5.31), percent neutrophils (%N) (1.32, 5.57), percent lymphocytes (%L) (0.20, 2.49), and percent monocytes (%M) (3.99, 26.39). As expected, the %CV range for monocytes is wide due to lymphocyte/variant lymphocyte population extending into the monocyte cluster. Evaluation of flagging showed 67 of the 115 (58.26%) CLL samples had a blast flag and 88 out of the 115 (76.52%) CLL samples had a variant lymphocyte flag. Review of the raw data from the optical channels shows a dominant and elongated lymphocyte cluster on the IAS, FL1 and PSS channels vs ALL for the CLL sample group compared to the control population. In the IAS and PSS vs ALL scatter plots in the CLL samples the lymphocyte cluster extends into the monocyte population triggering the blast flag. Peripheral smear review confirmed the presence of CLL (i.e., numerous smudge cells, mature-looking lymphocytes with characteristic condensed “soccer ball” pattern chromatin and scant cytoplasm) in the experimental group. Conclusion CLL is a cancer of the blood and bone marrow that predominately affects the quantity, and morphology of lymphocytes. Patients present with an abnormally high relative and variant lymphocyte populations. As such, there are a number of signs found in WBC measurands, flagging, and scatter plots on the Alinity hq that can be used as an early screening tool for CLL.

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.

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

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

A rare case of Hermansky-Pudlak syndrome

Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder characterised by oculocutaneous albinism, a bleeding diathesis and platelet storage deficiency. Aim of this paper is to report a case of patient with HPS who was followed over a decade. A 2-and-a-half-year-old boy presented with recurrent respiratory tract infections and global developmental delay. On examination, he had light golden hair, grey iris with nystagmus, fundus hypo-pigmented fovea and white macules all over body. Also found to have neutropenia without granules on peripheral smear. HPS can often be diagnostic dilemma mimicking disorders like Chediak-Higashi syndrome (CHS), in this case diagnosis was made due to characteristic skin and hair hypopigmentation and ocular findings along with bleeding diathesis. Our patient categorised under HPS2 subtype which has mild immunodeficiency. HPS is usually associated with neutropenia and hence pyogenic infections, present case however was associated with advanced form of pulmonary tuberculosis-miliary TB and granulomatous TB lymphadenitis giving rise to the possibility of T-cell defect.

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

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

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

Morphological Spectrum of Bone Marrow Aspirates in Infections: A Clinico-Hematological Analysis.

Bone marrow examination (BME) is an invaluable tool for cases with pyrexia of unknown origin and pancytopenia. However, it is under-utilized for diagnosing infectious etiology and there is a paucity of literature regarding its role in infective pathology. This study aims to bring to light the role of BME in diagnosing infectious pathology. A retrospective study was carried out on bone marrow aspirates (BMAs) sent to the hematology department over the past 4 years. Clinical details, peripheral smears and BMA were retrieved from the records and analyzed. Leishman-stained peripheral smears and BMA were studied along with bone marrow biopsy wherever feasible. A total of 52 cases were studied. The most common clinical presentation was fever, clinical finding was splenomegaly and hematological finding was anemia. Based on the morphological findings in combination with clinical history, cases were categorized into-parasitic (26.9%), viral (23.1%), tubercular (11.5%), and nonspecific infections (38.5%). Parasites such as Leishmania donovani, microfilaria, plasmodium falciparum, and vivax were reported in 14/52 (27%) cases. Associated BMA findings were plasmacytosis, eosinophilia, reactive lymphocytosis, or dyserythopoiesis. In 38% (20/52) cases, no specific cause of infection was found in the bone marrow. These patients showed histiocytosis, hemophagocytosis, maturation arrest in myeloid lineage, relative myeloid hyperplasia, dysmyelopoiesis, toxic granulation/vacuolation in myeloid cells, lymphocytosis, increased plasma cells or monocytosis in marrow. Increased histiocytes, hemophagocytosis, dysplastic changes, maturation arrest, relative myeloid hyperplasia or reactive plasmacytosis, lymphocytosis, and monocytosis are BMA features which must alert the pathologist towards an infectious disease process, a knowledge of these changes can help extend the scope of BME beyond hemato-lymphoid malignancies.

Cow’s Milk Protein Allergy in an Infant - A Case Report

Cow's milk protein allergy (CMPA) is a common condition of food allergy in babies, and it is encountered in childrenwith an incidence of 2% to 7.5% estimated in the first year of life. Breast-fed and formula-fed babies can present with CMPAsymptoms, and it's essential to diagnose CMPA to avoid the repercussion of overdiagnosis or underdiagnosis. A one-year-oldfemale child complained of fresh blood in her stools for two days which was painless. She was on breast milk and complimentaryfeeds, and her nutritional status was normal. she had been through 7 similar episodes of easy blood in stools from 4 months ofage. She was treated with IV antibiotics and initially suspected of colitis, and investigations were not done. There was no familyhistory of allergy, atopy, or asthma. On examination revealed pallor, vitals stable, and systemic examination were normal.Complete blood count shows low HB, peripheral smear shows microcytic anaemia, CRP-negative. Stool for occult bloodpositive. Faecal calprotectin was negative. USG Abdomen - normal, USG Endoscopy -Normal, Colonoscopy showedOedematous mucosa of the terminal ileum and prominent villi with erythema, sigmoid, and rectum revealed erythematous witherosion with prominent Pit pattern. Biopsy- From sigmoid and rectum showed increased eosinophils in lamina propria. Hencethe child was diagnosed to have Cow's milk protein allergy. The mainstay treatment includes avoiding Cow's milk consumptionfor four weeks - 6 months’ post-diagnosis. In that instance, breastfeeding mothers should be advised to avoid milk and milkproducts during breastfeeding.

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

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

Study on clinical presentation of malaria and response to antimalarial treatment in children less than twelve years

Background: In the tropical country of India, malaria in pediatric age group is one of the most important cause of mortality and morbidity. The study aimed to identify the clinicoepidemiologic features and response to antimalarial treatment in the children. Methods: Prospective analytical study conducted for the same over the period of two years in tertiary care hospital (September 2019 to September 2021). All children under twelve years hospitalised with fever and were diagnosed to have malaria by Peripheral smear or RDT were included in the study after ethical clearance and parental consent. Total sample size was 90. Results: Incidence of the malarial disease among total admitted patients in our study period was found to be 3.5%. The highest percentage of patients with malaria belonged to age group of 13m to 5 years (40%) and least being the age group 10-12years (7.7%). In study fever was found to be the major chief complaint followed by chills and rigor. Bleeding diathesis was least common It was found out from our study that overall most common clinical finding in the study patients was anemia or pallor with an overall of 35 patients (38.8%). Almost 73.3% (66) patients had anemia out of which 14.4% (13 patients) overall where found to have severe anemia and 27.7% (25) had moderate anemia and 31.1% (28 patients) had mild anemia. 27.7% (25) cases satisfied one or more WHO criteria for severe malaria. Conclusions: The emergence of severe malaria caused by P. vivax could have significant implications in planning the malaria-control programmes for the community. The widespread use of ACT for severe malaria as per the guidelines of the WHO could result in the emergence of resistant parasite strains. It may be rational to continue the use of chloroquine for malaria due to P. vivax in chloroquine-sensitive areas. In places where both P. vivax and P. falciparum co-exist, measures need to be equally targeted to P. vivax to decrease morbidity and mortality due to severe malaria.

EVALUATION OF ACTIVITY OF ALTERNANTHERA SESSILIS LEAVES AQUEOUS EXTRACT ON PLATELET COUNT IN DRUG-INDUCED THROMBOCYTOPENIA IN ALBINO RATS

Objectives of Study: (1) To determine the platelet augmenting effect on drug-induced thrombocytopenia in rats. (2) To observe any adverse effects and mortality in the animals. Methods: Albino rats of either sex of average weight 150–200 g are used. A total of 36 (n=36) rats were divided into VI groups of 6 each. Groups I, II, III received cyclophosphamide 25 mg/kg body weight and group IV, V, VI received 50 mg/kg body weight for 3 consecutive days respectively. Blood was withdrawn from the retro-orbital plexus on the 1st, 4th, 7th, and 11th day of study after subjecting the animals to light anesthesia using ether and platelet count determined by making peripheral smear [8]. Results: Platelet count: Alternanthera sessilis leaves aqueous extract at concentrations of 200 mg/kg and 400 mg/kg were found to significantly increase the platelet count in cyclophosphamide-induced rat model. Conclusion: The present study demonstrated the platelet augmenting effect of A. sessilis leaves aqueous extract. Further detailed studies are required to establish its usefulness.