Reactive thrombocytosis following acute infection and pancytopenia

A 15-year-old girl was admitted with a fifteen day history of high grade intermittent fever with chills along with passage of loose watery stools, 6-8 times/day, not containing any blood or mucus. On examination, she was thin lean girl, who was markedly pale but fully conscious and well oriented. Initial laboratory investigations were suggestive of pancytopenia with haemoglobin of 4.7 g/dl; white cell count 1.3x10[9]/1 and a platelet count of 13x10[9]/1. Mean corpuscular volume [MCV] was 99.3 fl, while peripheral blood film showed macrocytosis, anisocytosis and poikilocytosis. Erythrocyte sedimentation rate was 120 mm at the end of 1st hr and C-reactive proteins were elevated. Her ALT was raised to 70 U/L, bilirubin and alkaline phosphatase were with in normal limits. Serology for Hepatitis B and C was negative. Reticulocyte count was 1%. Her bone marrow aspiration and trephine biopsy showed hypercellularity with megaloblastic as well as dyserythroblastic cells suggesting a differential diagnosis of either myelodysplasia secondary to some infections or aplastic anemia in evolution. Injection Trividox B1, B6, and B12] and folic acid were also added to treatment because her serum B12 level was found to be at lower normal limit. Complete picture repeated 15 days showed a platelet count of 1610 x 10[9]/L. This high countindicated reactive thrombocytosis confirming bone marrow recovery. The probable cause of this reactive thrombocytosis was recovery from acute infection or Vit B12 supplementation

Diagnostic yield of fibreoptic bronchoscopy in smear negative new cases of pulmonary tuberculosis

To assess the diagnostic yield of bronchial washings for detection of AFB in clinically suspected new smear negative cases of pulmonary tuberculosis. Non-interventional analytical Combined Military Hospital Quetta and Fatima Jinnah General and Chest Hospital Quetta, Pakistan. From outpatient departments of these two hospitals, fifty smear negative new cases of pulmonary tuberculosis [PTB] were included in whom diagnosis was made on the basis of clinical findings and x-ray. All these patients underwent fibrotic bronchoscopy for collection of bronchial washings from the lobe1 segment where lesions were evident on plain chest x-ray. These secretions were sent to microbiology department for preparation of smear and detection of acid-fast bacilli [AFB] with Zeihl- Nelson staining. Out of 50 patients, 33 [66%] were males and 17 [34%] were females. On smear of bronchial washings, 21 [42%] were positive for AFB while 29 [58%] were still negative. Bronchial washings were found to have better diagnostic yield of AFB on direct smears as compared to standard sputum smear examinations. Moreover, clinical suspicion of PTB is not always correct, as significant numbers of clinically suspected cases did not yield AFB in bronchial washings. Where feasible, fibreoptic bronchoscopy and direct washings should be employed for confirming the clinical impression of PTB in smear negative cases