Hemoglobin color scale a diagnostic dilemma.

Hemoglobin color scale (HCS) is a commercially available test to screen anaemia in the absence of laboratory based hemoglobinometry. The present study was aimed at to compare the efficacy of HCS with Sahli's method (SM) for haemoglobin estimation and to estimate its sensitivity and specificity with respect to auto analyzer as the gold standard. The study was conducted from November 2006 to April 2007 at the department of hematology, All India Institute of Medical Sciences, New Delhi as a project of World Health Organization. The haemoglobin level was measured by all the three methods in 401 patients attending Haematology out patient department. Consent was taken from all the patients. Sensitivity of Sahli's method was 98.2% and specificity was 66.2%, whereas the sensitivity of HCS was 30% and specificity was 100%. Sahli's method was found to be in good agreement with autoanalyzer (gold standard). It was thus concluded that HCS is not as efficacious, as sahil's method for hemoglobin estimations in field.

Transient leukemia.

A new born with a mongoloid slant, brachycephaly and low-set ears presented at birth with a total leucocyte count of 57 x 10(3)/microL and the differential leucocyte count revealed 70% of these to be blasts. The morphology of the blasts was not characteristic of myeloid and lymphoid lineage. Cytochemistry showed myeloperoxidase (MPO), Sudan Black B (SBB), periodic acid-Schiff (PAS) and non-specific esterase (NSE) negativity. Flowcytometry showed blasts that were positive for CD-33, CD-34 and CD-7. On second follow-up on the 10th day, the same picture persisted on morphology. On subsequent follow-up, the blasts disappeared. This was thus confirmed to be a case with transient leukemia with Downs syndrome.

Granular acute lymphoblastic leukemia in an adult patient.

Granular acute lymphoblastic leukemia (G-ALL) may mimic the diagnosis of acute myeloid leukemia due to the presence of cytoplasmic granules found in the lymphoblasts. This rare variant is commonly seen in children but may occur in adults also. We report a case of G-ALL in an adult female patient.

Impact of external haematology proficiency testing programme on quality of laboratories.

BACKGROUND & OBJECTIVE: A reliable and reproducible report from a laboratory needs internal quality control within the laboratory and participation in external proficiency testing programmes (EPTP). This study conducted at the Department of Haematology, All India Institute of Medical Sciences (AIIMS), New Delhi, which has been conducting an EPTP since 1992, was undertaken to assess the efficacy of this programme in improving the performance of participating laboratories in reporting test samples sent for Hb, total leucocyte count (TLC), reticulocyte count and assessment of peripheral blood smear (PBS). METHODS: The samples were prepared in our laboratory according to the International Standards Organization (ISO) guidelines. The performance of individual laboratories was assessed using robust Z score, which is an indicator of acceptability of the test result. RESULTS: An improvement in the overall percentage of laboratories with acceptable reports was seen during the study period. It has increased from 38,40,40 per cent in 1992 to 85, 90,94.7 per cent in 2006 for Hb, TLC, reticulocyte count, respectively. However, the results for peripheral smear assessment improved only marginally. INTERPRETATION & CONCLUSION: The external haematology proficiency testing programme run by our department for Hb, TLC, reticulocyte count, and peripheral blood smear assessment, has helped in improving the reporting standards of these parameters in Indian laboratories.