To Assess the Correlation between Bone Marrow Morphology and Immunophenotypic Findings in Patients of Chronic Lymphoproliferative Disorders (CLPD’s) and to Assess the Role of Flowcytometric Immunophenotyping in Diagnosis and Subclassification of CLPD’s

Introduction: Chronic lymphoproliferative disorderrepresent clonal proliferation of morphologically andimmunophenotypically mature B or T cells characterized by alow proliferation rate and prolonged cell survival. Study aimedto assess the correlation between bone marrow morphologyand immunophenotypic findings in patients of ChronicLymphoproliferative Disorders (CLPD’s) and to assess therole of flowcytometric immunophenotyping in diagnosis andsubclassification of CLPD’s.Material and Methods: 48 newly diagnosed cases ofCLPD were included. After complete clinical evaluation theyunderwent marrow aspiration, biopsy and immunophenotypingby flowcytometry with selected panel of monoclonalantibodies.Results: On morphology 47.9% cases were CLL. In 52.1%non CLL cases , 4.2% were PLL , 2% case as LPL and45.8% cases were CLPD-unclassifiable. Commonest patternof marrow infiltration noted on trephine biopsy was diffuse inCLL, HCL-V, B-PLL and T-CLPD. On immunophenotyping95.8% cases were B-CLPD and 4.25% T-CLPD. CD5, CD22,CD23, FMC7 and SmIg were used as first line markersfollowed by CD 10, CD 25, CD103, CD38, CD138 andCyclin D1 (on biopsy sections) as second line markers. Finalimmunophenotypic diagnosis was CLL (54.2%), B-CLPDunclassified (29.2%), 4.1% each of LPL, MCL, T-CLPD and2% each of B-PLLand HCL-V.Conclusion: Concordance rate between morphologicaldiagnosis and immunophenotypic diagnosis was 79.17%.Hence, Flowcytometry is necessary for confirmationof diagnosis and to classify the CLPD cases which areunclassifiable by morphology

Neutrophil Lymphocyte Ratio (NLR) as a Bio Inflammatory Marker in Pre-eclampsia

Introduction: Pre-eclampsia, a systemic disease unique topregnancy, affects 3–14% of pregnant women. The aim ofthe present study was to evaluate Neutrophil LymphocyteRatio (NLR) as a bio inflammatory marker of pre-eclampsia(PE), a hypertensive disorder of pregnancy characterized byhypertension and proteinuria after 20 weeks of gestation.Material and Methods: This case control study was carriedout over a period of 10 months after informed consent andethical clearance. The study population included 70 pregnantwomen (35 pre-eclampsia cases and 35 normotensive pregnantsubjects as controls). 3 ml venous blood samples were obtainedfrom both the cases and controls. Complete blood count wasdone using semi-automated three part haematology analyserwhich gives the reading of cell counts, NLR was calculatedmanually.Results: The case group (subjects with pre-eclampsia) werefound to have higher neutrophil to lymphocyte ratio (NLR)than that of the control group. This difference was statisticallysignificant (p<0.001). The receiver operating curve (ROC)analysis showed significant diagnostic accuracy of NLR todiscriminate cases and controls (area under the curve [AUC]= 0.73, P < 0.001) at cutoff value of >= 4.86, 68.6% sensitivityand 80% specificity.Conclusion: Unlike many other inflammatory markers, NLRproves to be an inexpensive and readily available biomarkers,obtained from routinely done complete blood counts that maybe useful for prediction and diagnosis of pre-eclampsia.

Severe anemia due to parvovirus B19 in a silver haired boy.

Griscelli syndrome (GS) is a rare autosomal recessive immunodeficiency disorder in which the affected children present with characteristic silvery‑white hairs. The hair microscopy of these children is characteristic and is helpful in differentiating GS from Chediak–Higashi syndrome which also presents with immunodeficiency and silver hairs. We report a 17‑month‑old boy with GS type 2 who presented with severe anemia. Bone marrow examination of the child suggested parvovirus B19 as the cause of severe anemia, which was later confirmed by DNA polymerase chain reaction

Post chemotherapy blood and bone marrow regenerative changes in childhood acute lymphoblastic leukemia a prospective study.

Context: This study was done to assess the Serial peripheral blood and bone marrow changes in patients of Acute Lymphoblastic Leukemia on chemotherapy. Aims:To assess the therapy related serial bone marrow changes in patients of Acute Lymphoblastic Leukemia. Settings and Design: Prospective study, carried out in Lymphoma- Leukemia Lab, Department of Pathology, K.G.M.U from March 2011 to March 2012. A total of 60 cases were studied Materials and Methods: History, complete hemogram, bone marrow examination at pretherapy (Day-0), intratherapy (Day-14), and end of induction chemotherapy (Day-28) were done. Peripheral blood smears were evaluated at regular interval to assess clearance of blast cells. Statistical analysis used:The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software. The values were represented in Number (%) and Mean ± SD. The following Statistical formulas were used: Mean, standard deviation, Chi square test, Paired “t” test, Student ‘t’ test, Level of signifi cance P Results: Incidence of ALL-L1 (46.7%) and ALL-L2 (53.3%) was equal. ALL-L2 patients had poor survival.Day 0 (D-0) bone marrow was hypercellular with fl ooding of marrow by leukemic cells. High levels of tumor load at D‘0’ were associated with poor survival. 14th day of Induction phase showed signifi cant decrease in hemoglobin and TLC as compared to D ‘0’ parameters. D28 showed marrow regeneration. Cellularity, Blast%, and Leukemic Index showed signifi cant drop from day ‘0’ to day 14 due to myelosupression, whereas regeneration refl ected by increased cellularity as per day 28 marrow. Lymphocytosis (>20%) at end of induction chemotherapy had better survival and longer remission.Risk of mortality was directly proportional to blast clearance and was a major independent prognostic factor for achievement of complete remission. Conclusions: A bone marrow examination at the end of induction chemotherapy provides information whether patient has achieved remission with regeneration of cells or still has residual leukemia. If the patient is in remission, maintenance treatment is started and if not more intensive chemotherapy or bone marrow transplantation may be embarked upon.

Multifocal renal angiomyolipoma presenting as massive intraabdominal hemorrhage.

Angiomyolipomata of the kidney are unusual lesions composed of abnormal thick walled blood vessels, smooth muscle and adipose elements. These are asymptomatic and occasionally present with flank pain, a palpable mass or gross hematuria. They may be associated with tuberous sclerosis. The risk of bleeding is increased with size, and lesions greater than 4 cm have more than 50% chance of significant bleeding. An unusual case of multifocal renal angiomyolipoma associated with tuberous sclerosis and presenting as massive intra abdominal hemorrhage is reported.