Thyroid hormone levels in hepatitis B

Thyroid hormone levels were estimated in fifty patients with hepatitis B. In acute phase, T[3] was raised in 10% and T[4] in 60%. This rise was directly proportional to the transaminases levels. Twenty cases were also studied in the recovery phase where thyroid hormones returned to within normal limits. This rise of T[3] and T[4] in acute phase is attributed to increased thyroxin binding capacity due to release of thyroid binding globulin into circulation from necrosing hepatocytes

Economy and quality assessment of home made clinical chemistry reagents

Most laboratories in Pakistan use expensive imported clinical chemistry reagent kits resulting in high cost/test to the patients. To reduce these costs, reagents were prepared from basic chemicals, substrates and enzymes imported from Sigma Chemical Company U.K. This reduced the cost/test by upto 500% in some reagents. The quality of these reagents was tested by Wellcome External, Q.C. Locally prepared reagents were comparable to or better than commercial reagents systems in terms of accuracy and precision. This paper describes the preparations according to I.F.C.C., costs and quality control of some of the reagents i.e., glucose, calcium, bilirubin, albumin, total protein, urea, ALT, AST and LDH and their comparisons with equivalent commercial kits

Pattern of leukocyte acid phosphatase reaction in T-cell lymphoblastic leukemia

Acid phosphatase [AP] reaction is a specific cytochemical marker for T-cell lymphoblastic leukaemia [T-ALL]. Twenty six cases of ALL were diagnosed as T-ALL employing cytochemical profiles including AP and sheep red blood cell rosettes. Three distinct patterns of AP reaction were observed. On one end of the spectrum, 100% of the positive blasts showed the classical dot- like reaction while on the other 100% showed a scattered reaction. Between the two a mixed pattern was observed with 30- 80% of the positive blasts showing the dot-like reaction while the rest showed scattered pattern. Dot-like pattern showed L[1] morphology, high counts and low SRBC rosettes while scattered showed L[2] morphology, low counts and high SRBC rosettes. The pattern observed in our series differs from the dot-like reaction observed in T-ALL in the western series. We recommend that this pattern must be borne in mind when employing AP reaction for T- ALL diagnosis

Quality assessment of the reflotron system: a blood chemistry reagent strip analyser

We tested the accuracy of the Reflotron System by comparing results given by this system for estimations of glucose, SGOT, SGPT, cholesterol and triglycerides on patients samples which were already analysed on either an autoanalyser HITACHI 705 or manually on CLINICON 4010. Reflotron estimations correlated well with both Hitachi and Clinic on estimations and the strips gave reproducible results. We conclude that this or similar systems will be ideal for small laboratories in our expanding rural health services

Efficacy of internal and external quality control in chemical pathology

Quality control in chemical pathology is based on internal and external quality assessment. The internal quality control in clinical chemistry section of AKUH laboratory is based on the analysis of commercially available Beckman normal and abnormal range control sera. These have known concentrations of blood chemistry constituents. After repeated estimations, mean values of all constituents were established for both normal and abnormal sera. Patients samples were analysed only when both controls were within +/- 2SD from the mean or one control reads within +/- 2SD and the other read between +/- 2-3SD [once only] for each constituent. Samples were not analysed if one control was greater than +/- 35D from the mean or both controls were greater than +/- 2SD or one control was between +/- 2-3 SD on two successive runs. External quality control sera with unknown constituent concentrations were analysed twice monthly and results sent to Wellcome England. Our results were compared with the mean of estimations by 1000 laboratories for each constituent. The acceptable standard deviation from this mean for each constituent was +/- 2SD. External quality control evaluated our accuracy in wide ranges of constituent concentrations encountered and helped us identify under or over reporting of different parameters, both substrates and enzymes, at high or low levels or vice versa which internal quality control could not address. Hence external quality control formed the basis of our corrective actions in terms of equipment and reagents. We conclude that internal quality control is limited in the sense that its efficacy has to be tested by external quality assessment

Acid phosphatase positive Tlymphoblastic leukaemia [T-ALL] in Pakistani children

T-Lymphoblastic leukaemia [T-ALL] appears to be associated with factors known to be of bad prognosis in Acute lymphocytic leukaemia [ALL]. Acid phosphatase reaction [AP], a specific non-immunological cytochemical marker for T-ALL was performed on peripheral blood and bone marrow slides of fifty children with ALL to assess the frequency of T-ALL in our population. Myeloperoxidase [P] and Alpha-Napthyl Esterase [NASA] were performed to exclude Acute myelocytic and Monoblastic leukaemia. A strong localised AP reaction in more than fifty percent of the blasts was taken as positive for T-ALL. Of the fifty cases studied 32% showed strong AP positivity in majority of the cells. These were negative for both P and NASA and showed varied Periodic Acid Schiff [P.A.S.] positivity. This high frequency of T-ALL in our series may explain the poor response to therapy and high relapse rates observed in our population

FAB classification of acute lymphoblastic leukemia [all] and its relevance to ALL in Karachi children

FAB classification on ALL describes three morphological variants L1, L2 and L3. Employing scoring criteria outlined by the French American and British co-workers on Romanosky stained bone marrow and peripheral blood films of eighty cases of ALL all aged below fifteen years, the following types were observed L1 55%, L2 40% and L3 nil. A small minority of cases could not fit the criteria outlined by FAB. This comprised 5% of cases with a heterogenous population of blasts with a high nuclear cytoplasmic ratio and indistinct nucleoli. These cases are either a separate variant of ALL or are undifferentiated blast cell leukaemias. We report a high frequency of L2 in our population and since L1 is associated with better prognosis within ALL, this high frequency of L2 may explain the poor prognosis observed in our children with ALL

Differential leukocyte alkaline phosphatase activity [LAPA] in chronic myeloid leukemia [CML] and myeloid leukemoid reaction [MLR]

Leucocyte Alkaline Phosphatase Activity [LAPA] in normal healthy individuals was found to be in the range 17-110. It was markedly increased in patients with myeloid leukemoid reaction [MLR] in the range 100-220. However it was decreased in patients with chronic myeloid leukaemia [CML] in the range 0-16. Increased LAPA in MLR is indicative of enhanced digestive capability of neutrophils while decreased values in CML are suggestive of defective neutrophil function. LAPA is a diagnostic parameter in differentiating between MLR and CML and also seem to have a prognostic and predictive value for blastic transformation in CML