Peripheral Smear Research Articles

A study of iron status in children with cyanotic congenital heart disease

Background: Iron deficiency is a common problem in patients with cyanotic congenital heart disease (CCHD), but it is often underdiagnosed. Cyanotic patients with iron deficiency will experience higher morbidity due to symptoms of hyper viscosity. The consequences of iron deficiency anemia in cyanotic heart disease may manifest either in infancy or later. The tendency to develop metabolic acidosis and hyper-cyanotic attacks is exacerbated by relative iron deficiency anemia. This study was performed to identify the prevalence of iron deficiency in children with CCHD based on definitive tests like serum ferritin. Methods: We included 100 patients with congenital cyanotic heart diseases between 3 months to 18 years. Baseline characteristics were noted in specific proforma. Data from the blood tests were collected and analysed statistically to find out the prevalence of iron deficiency, along with tests that best predict the presence of iron deficiency. Results: Serum ferritin-based prevalence of iron deficiency in CCHD was 46%. Iron status based on haemoglobin, MCV values with the serum ferritin, and the strength of agreement were almost perfect. The strength of agreement for PCV, MCH, RDW, and peripheral smear was substantially significant. The strength of agreement for MCHC was moderate significance (Kappa value 0.41-0.60). Red cell distribution width (RDW) was an independent predictor of iron deficiency in logistic regression analysis. Conclusions: RDW seems to be a good indicator for predicting iron deficiency in children with congenital cyanotic heart diseases.

To Study Hematological Features in Various Etiologies of Macrocytic Anemias

Background: Mean corpuscular volume (MCV) increases by more than 100 fl. in macrocytosis, a condition in which erythrocytes are larger than normal. The purpose of this study was to evaluate the haematological characteristics in various aetiologies and to determine the underlying reasons of macrocytosis, which was found in regular hemograms. In addition to doing full blood counts, renal function tests, liver function tests, vitamin B12 assays, folate assays, and peripheral smear evaluations and few case were bone marrow examination. Material and Methods: In this prospective observational study conducted over a period of one-year, medical records of 250 subjects were evaluated. Data was compiled of Megaloblastic, Non-megaloblastic Macrocytosis levels, along with clinical diagnosis and other biochemical parameters. Based on clinical evaluation and hematological and biochemeical evidence, patients were diagnosed as positive cases of Megaloblastic(166), Non-Megaloblastic (133).Among this two variable group Mean ±SD were also calculated .

Quantification of Sickle Cells in the Peripheral Smear as a Marker of Disease Severity in Sickle Cell Disease in Paediatric Patients

Background: Sickle cells are easily identified on the peripheral smear however quantification of sickle cells is seldom done. This study attempts to understand the importance of the sickling index in the reporting of peripheral smear in patients with SCD. Objectives: This study aims to standardize the methodology of quantification of sickle cells on the peripheral smear in paediatric SCD cases and study its relation to the patient characteristics like age and sex, SCD genotype, and treatment. Materials and Methods: A prospective study of 6 months duration was conducted at a tertiary paediatric referral hospital for 6 months. 30 known cases of SCD were admitted during this period. Routinely studied peripheral smears were used in the study. 30 normal smears of age-matched patients were also used for comparative purpose. The sickling index was calculated in both patient and age matched smears. The sickling index was compared in both the groups and also the index in the known SCD cases was studied in relation to the patient's age, SCD genotype, and treatment with blood transfusions or hydroxyurea. Statistical analysis: Descriptive statistics were used in the study Results & Conclusion: Hb SS was the commonest genotype seen in 69% of the cases. Higher sickling index was noted in older children, SS genotype and those on treatment with blood transfusions or Hydroxyurea. Sickling index is an interesting prospect which may provide helpful information regarding cases with increasing hemolysis and vasocclusive crises and also help in follow up of patients on treatment. Keywords: Paediatric, Disease severity, Sickling index

Myeloid Sarcoma: A Mediastinal Masquerader

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

The catch in complete blood count when vitamin B12 deficiency is hiding behind microcytic anemia

Abstract Background Insufficient stores of vitamin B12 in human body are thought to result in macrocytic anemia. However, anemia in most of the patients is multifactorial. This is commonly owing to mixed nutritional deficiencies or bowel disorders affecting absorption of more than one element. Resultantly, a single causative agent of anemia like vitamin B12 deficiency may take macrocytic, normocytic, or microcytic forms. Patients presenting with microcytic anemia may have underlying insufficiency of this vitamin in some instances. Assessment of complete blood count (CBC) parameters may be helpful to identify such cases. Methods This study was conducted on 155 patients of microcytic anemia. Assessment of complete blood count (CBC) parameters and vitamin B12 was done using state of the art analyzers. The overall data was analyzed using SPSS version 23. Results Subnormal vitamin B12 levels were found in 17.4% of the studied cases. CBC parameters showed distinct changes in this group. Mean hemoglobin and red blood cell values were lower compared to the subjects having normal B12 values, and mean corpuscular volume and mean corpuscular hemoglobin concentration had an upward trend in cases of severe deficiency. Features of leucopenia and pancytopenia were more frequent also. Macrocytic red blood cells on peripheral smear were useful to detect the hidden deficiency even when the predominant picture consisted of microcytic cells. Conclusions Vitamin B12 deficiency maybe underlying in microcytic anemia patients. Important clues in CBC include very low hemoglobin but mildly decreased MCV values in the presence of leucopenia and macrocytic RBCs on peripheral smear.

Isolated Scalp Hematoma

Background: Congenital fibrinogen disorder is a rare autosomal recessive blood coagulation disorder, where majority of patients present with bleeding, whereas a few may paradoxically develop thrombosis. While many of the affected children have prolonged umbilical cord bleeding during the neonatal period, manifestations may go unnoticed till adolescence. We describe such a child with congenital afibrinogenemia Clinical Description: A 12-year-old boy presented with painless diffuse scalp swelling for 2 weeks without any antecedent history of trauma, hemarthrosis, muscle hematoma, or any skin bleed, except a history of prolonged bleeding post trauma since toddler age. Examination revealed diffuse, boggy, nonpulsatile swelling over the entire scalp, more prominent on the right side, without any focal neurological deficit. A noncontrast computed tomography head showed a scalp hematoma without any intracranial bleeding. Blood investigations revealed extremely elevated prothrombin time (PT) and activated partial thromboplastin time (aPTT) with normal platelet counts and normal platelet morphology on peripheral smear. A detailed coagulation work-up revealed an extremely high thrombin time and an almost undetectable Factor I (fibrinogen) level. Genetic analysis revealed a homozygous single-base pair deletion in exon 5 of the fibrinogen gene of alpha chain, thus confirming the diagnosis of congenital afibrinogenemia. Management: The child was managed with multiple fresh frozen plasma transfusions and serial PT/aPTT monitoring. Once PT and aPTT were normalized, transfusions were discontinued. The child is currently on regular follow-up maintaining a fibrinogen level of more than 0.5 g/L. Genetic counseling was done for the family. Conclusion: Congenital afibrinogenemia may be detected late in adolescence with atypical bleeding manifestations. Awareness of this entity may help the physician to suspect this disease. Early and appropriate investigations can be conducted to identify the condition, so that appropriate management can be initiated.

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.

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

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

Acute Liver Failure as a Presenting Feature in an Adolescent with Acute Lymphoblastic Leukemia

Background: Acute lymphoblastic leukemia (ALL) is a common pediatric malignancy, typically manifesting with symptoms of bone marrow and hematolymphoid organ infiltration. Although hepatic involvement in the form of hepatosplenomegaly is seen in nearly two-thirds of the patients, primary presentation as acute liver failure is rare. Clinical Description: A 12-year-old boy presented with complaints of abdominal distention with jaundice for the past 15–20 days, associated with transient fever of 6 days. Examination revealed pallor, icterus, and hepatosplenomegaly. A possibility of acute infectious or autoimmune hepatitis or hemolytic anemia was considered. Management: Liver function tests were deranged with hyperbilirubinemia with modest increase in transaminases and serum alkaline phosphatase along with deranged prothrombin time. The complete blood count showed pancytopenia with normal peripheral smear. Investigations for common infectious causes were noncontributory, as also those for autoimmune hepatitis. The direct Coombs test was also negative. In view of persistent pancytopenia with hyperbilirubinemia and hepatosplenomegaly, a bone marrow evaluation was done, which revealed B-cell ALL (B-ALL). Thus, the child was diagnosed with a case of ALL presenting with acute liver failure. The child was initially managed as a case of acute liver failure and on diagnostic confirmation, he was started on the B-ALL chemotherapy protocol as per his risk stratification with hepatic dose modification of chemotherapy. The child showed complete normalization of the liver functions by about 4 weeks of induction chemotherapy and achieved remission. Conclusions: A child presenting with acute liver failure may be having an underlying undiagnosed, clinically silent ALL. After ruling out common causes of acute liver failure, one must not forget the possibility of leukemic blast infiltration of the liver as a cause of liver failure. With early initiation of advanced chemotherapeutic induction regimens, there can be dramatic resolution of liver injury and remission of ALL.

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

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

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

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

Plasma Cell Leukemia-Clinicopathological Profile from a Tertiary Care Center in Western India.

Poornima ManimaranIntroduction Plasma cell leukemia (PCL) is very uncommon and aggressive neoplasm constituting 2 to 4% of all plasma cell dyscrasias. By definition, clonal plasma cells should make up 20% of peripheral blood or have an absolute plasma cell count of 2 × 10 9 cells/cu.mm. PCL can be primary or secondary. In this study, the clinicohematological features of PCL, and correlation of immunophenotypic profile and conventional therapies with overall survival was analyzed. Materials and Methods This retrospective study involved PCL patients who were diagnosed across a 12-year period, from 2010 to 2021, at a tertiary care center in western India. Clinical, biochemical, peripheral smear, bone marrow aspirate, immunophenotyping, and molecular analysis were performed. Results Total 39 PCL patients were included in the study among which 36 were primary PCL patients. Splenomegaly (10/27), hepatomegaly (6/26), and lymphadenopathy (5/23) were noted. At presentation, all patients had anemia (<11g/dL), thrombocytopenia (33/39), hypercalcemia (>11mg/dl) 10/33 (30.3%) and lytic lesions was noted in 18/26 (69.2%). Immunophenotype of these patients showed CD 38 positivity, CD 138 positivity, CD56 positivity, and CD 117 negativity were 100, 62, 41.6, and 89%, respectively. Overall survival of our patients was 4.1 months and overall survival of patients treated with VTD (bortezomib, thalidomide, dexamethasone) and VCD (bortezomib, cyclophosphamide, dexamethasone) regimen was 3.4 and 4.1 months, respectively, which was not statically significant ( p -value 0.816). CD117 and CD56 markers were also not having any prognostic significance ( p -value 1.000 and 0.873, respectively). Conclusion Because of rarity of the disease, prospective studies are very limited and hence management and outcome of the disease are difficult to analyze. The current treatment protocols have no survival advantage and hence newer therapeutic approach is mandatory to attain better outcome.

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

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

Recurrent Ischemic Stroke In Elderly With Polycythemia Vera: Case Report

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

Nasal cytology in patients with previous SARS-CoV-2 infection: occurrence of atypical lymphocytes

SARS-CoV-2 is a new pandemic infection that affects at the beginning the upper respiratory system, and, successively, all the organisms, due to cytokine storm, with serious consequences that can reach death. The aim of this work was the observation of the nasal mucosa of enrolled 60 patients, resulting negative for two weeks to the molecular swab for SARS-CoV-2, versus the control group. Rhino-fibroscopy and nasal cytology of nasal mucosa were performed for both the investigated groups. The observation of the samples showed the occurrence of plasmablastic lymphocytes and Downey II lymphocytes type. The former type of lymphocytes was prevalent against the second one, probably because of an immunological “scar”. The rhino-fibroscopy showed a “pseudo ischemia of nasal submucosa” at pre and pericranial levels, not occurred in the control group. The occurrence of atypical lymphocytes in the nasal smear was analog to that observed in the blood peripheral smear, probably caused by mechanisms of local immune reaction and dysregulation like those observed in other virus infections. Our findings suggest that the nasal mucosa study through the nasal cytology, can represent an important predictive tool of the SARS-CoV-2 infection.

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

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

Leukemia cutis: An atypical manifestation of myelodysplastic syndrome

Leukemia cutis is the infiltration of neoplastic leukocytes or their precursors into the epidermis, dermis, and subcutaneous tissue, resulting in various cutaneous manifestations. A young girl presented with multiple painful hard indurated nodules and plaques over the abdomen, back, breast, and bilateral lower limbs for 4 months. Biopsy showed a dense lymphocytic infiltrate seen with large atypical lymphocytes. Immunohistochemistry (IHC) revealed positivity for CD34, C-KIT, and Glycophorin A. Peripheral smear revealed 32% blast cells. Bone marrow aspirate were suggestive of hyper-cellular marrow with myeloid preponderance. IHC showed myeloperoxidase (MPO) negativity which led to the diagnosis of leukemia cutis secondary to myelodysplastic syndrome with blast showing myelomastocytic differentiation with MPO negative acute leukemia.

FREQUENCY OF THROMBOCYTOPENIA IN CONFIRMED CASES OF MALARIA IN CHILDREN

Objective: To determine the frequency of thrombocytopenia in confirmed cases of malaria in children&#x0D; Methods: This cross sectional study was conducted in Pediatric Department of Mayo Hospital Lahore from January to June 2018. A total of 80 Children between two years- 12 years of age, of both the genders with confirmed malaria were included by non-probability consecutive sampling. A blood sample was taken within 48 hours of admission and their complete blood count was reviewed for the presence of thrombocytopenia after malaria was confirmed on positive peripheral smear. Thrombocytopenia was defined as platelet count of less than 150,000/µl of blood. All collected data was entered and analyzed in SPSS version 22. Data was stratified for age and gender to address effect modifiers. Presence of thrombocytopenia was presented as frequencies and percentages.&#x0D; Results: Out of total 80 patients with positive malarial parasite (MP) slide, 65 cases (81.25%)were of Plasmodium Vivax,12(15%) were of Plasmodium Falciparum while 3 cases (3.75%) were of Mixed infection. 44 patients( 55%)were having low platelet count (less than 150,000/µl) while 36 patients(45%) had no thrombocytopenia. Out of 44 patients with thrombocytopenia, 16 patients (20%) had mild thrombocytopenia, 21 patients (26.3%) had moderate thrombocytopenia while 7 patients (8.8%) had severe thrombocytopenia. There was no significant association of thrombocytopenia with age, gender or duration of malaria. &#x0D; Conclusions: Frequency of thrombocytopenia in confirmed cases of malaria in children is 55% hence; presence of thrombocytopenia in febrile patients can raise the possibility of malaria leading to early diagnosis and management.

Pancytopenia as the initial presenting feature in multiple myeloma: a case series

Multiple myeloma is a plasma cell neoplasm characterized by abnormal proliferation of clonal cells in the bone marrow. Anaemia is generally the most common feature from hematologic aspect and bone pain being the other important symptom, but pancytopenia as the presenting feature is unusual. Here, we shared our experience of 3 cases with non-specific symptoms with pancytopenia which on through evaluation revealed our diagnosis. A hospital based observational descriptive case series was conducted wherein all the cases of multiple myeloma presenting with pancytopenia were included. Complete blood picture, peripheral smear, bone marrow aspirate and serum protein electrophoresis were reviewed and analysed. Pancytopenia as the initial presenting feature of multiple myeloma is an unique manifestation and diagnosing such cases require high degree of suspicion to avoid delay in the initiation of treatment.

Iron deficiency anaemia as a novel immunological indicator of recurrence in chronic tonsillitis

Trace elements such as iron play essential roles in the metabolic and immune functions of the body. Anaemia is known to suppresses immunity and it was assessed based on iron deficiency. The present study was done to elucidate the correlation of iron deficiency anaemia to chronic and recurrent tonsillitis. A 1 -year observational study was conducted and 100 patients with recurrent tonsillitis were included. Serum iron were estimated by spectrometry. Anemia was assessed based on Hb levels, TIBC and peripheral smears. Spearman’s and Pearson’s correlation Coefficients were used for the statistical analysis. 84% of the patients had a iron deficiency anaemia, 56% had low serum iron, There was a significant corelation between anaemia and low serum iron among the study population, the Spearman’s correlation coefficient r value was 0.824 and the p value was less than 0.05 between iron deficiency anaemia and recurrent tonsillitis with higher grades of hypertrophy and symptoms as well. In order to plan the treatment of tonsillitis and predict the prognosis accurately we need to assess the patient’s immune status, for which serum iron and markers of anaemia can be used. This will be a novel and economical prognostic biomarker which can be embraced in the modern, evidence-based practice of otorhinolaryngology.