Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait

Background: The heterozygous state of Beta-Thalassemia i.e. Beta-Thalassemia Trait (BTT) is usually not associated with any clinical symptoms and possesses abnormality in only a single BetaGlobin gene. Materials and methods: The present study was undertaken from October 2015 to October 2017 in the Department of Pathology of Mahatma Gandhi Medical College and Hospital. In our study, a total of 100 subjects were included with mild or no anemia (Hemoglobin >8 gm/dl) who were referred to the central lab for hemoglobin screening. Hb A2 values were determined by Capillary Hemoglobin electrophoresis for all 48 (BTT) and 52 (Normal/non BTT) subjects. The complete hemogram was done by automated hematology analyzer. The values of red cell indices TRBC, MCV and MCH and six discriminative indices were evaluated for detection of β-thalassemia trait. The results were compiled in tabular form and bar diagram. Results: In the present study, the patients in the BTT group had statistically significantly decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH) and increased TRBC count as compared to those in non BTT group. Among the six discrimination indices used highest sensitivity was found for Shine and Lal index (87.5%) followed by Mentzer index (79.16%). The highest specificity was found for E and F (88.46%) followed by RDWI (84.61%). Youden’s index was highest for Mentzer index (61.85%) followed by RDWI (55.44%). Conclusion: From this study, we thus conclude that although no screening test can diagnose β− Thalassemia Trait with 100% sensitivity or specificity, among the hematological parameters MCV, TRBC and MCH most efficiently discriminates β−Thalassemia Trait from other microcytic, hypochromic anemia. Mentzer index with CBC may be the simple, low cost, rapid and can be reliably Prachi Gupta, BP Nag, Abha Mathur. Evaluation of Red Cell Indices and Discriminant Functions in the Detection of Beta Thalassemia Trait. IAIM, 2019; 6(3): 50-59. Page 51 used as a screening test for thalassemia as a routine. However none of the formulas are 100% sensitive and specific.

Unusual presentation of a case of intra cystic papillary carcinoma of breast

The term “intra cystic papillary ductal carcinoma in situ”, has recently changed and is now more appropriately referred to as “intra cystic papillary carcinoma’’ constituting only 0.5% to 1% of all breast cancers. Herein, we discuss an unusual case of intra cystic in situ papillary carcinoma of breast in a postmenopausal woman, the diagnosis of which was made on histopathology. So careful histopathological evaluation is the mainstay to arrive at the correct diagnosis to avoid untoward complications related to under diagnosis and/ over diagnosis.

Sarcomatoid Renal Cell Carcinoma: A Rare Case Report

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive variant of renal cell carcinoma. It is thought to originate predominantly from clear cell carcinoma through de-differentiation. It is a rare entity constituting about 1-5% of all renal malignant neoplasms and is more commonly associated with conventional (clear cell) renal cell carcinomas. We report a case of 62 years old male who presented with complaints of haematuria and abdominal pain. The histopathology confirmed sarcomatoid renal cell carcinoma.

Sertoli cell nodule of the testis: An incidental finding

The case of a 21year old man with complaints of pain in the lower abdomen reported in the surgery OPD. USG showed a case of undescended testis. A radical Orchidectomy was performed and the specimen was received in the department of pathology. Grossly the testis was normal .Microscopic examination showed the encapsulated nodule composed of tubules lined by immature Sertoli cells interspersed with tubules and Spermatogonia and an interwoven network of hyalinised basement membrane having foci of calcification. The findings were identical to those of a Sertoli cell nodule-A typically microscopic encapsulated lesion commonly detected in crypt orchid testes. Here we present a case of undescended testis where incidentally we found all the features of sertoli cell nodule

A Rare Case of an Adult with Untreated Bladder Exstrophy Presenting with Adenocarcinoma of Urinary Bladder.

Untreated bladder exstrophy in an adult is rare, as the defect is obvious and primary reconstruction is usually done in infancy. There are less than 90 reported cases of primary adenocarcinoma in an untreated bladder exstrophy in literature and only two such case reports from India. We report the case of adenocarcinoma in a 29 year old male with untreated bladder exstrophy to highlight the extreme rarity, yet distinct possibility and challenges faced in surgical management of such cases.

Uterus Didelphys presenting with ruptured uterus in third pregnancy: A rare case report

Uterus Didelphys “double uterus” is a congenital malformation that results from complete failure of fusion of the ipislateral paramesonephric ducts during embryonic development. Ideally, diagnosis should be made before pregnancy and labor to prevent adverse outcomes. Here we report a case of uterus didelphys in 30 year old female Gravida4 Para3 Living2 at 31st week of pregnancy admitted with prolonged rupture of membrane, hypovolemic shock and intrauterine fetal death. Postoperative recovery of the mother was uneventful. Clinicians should have high index of suspicion of uterine anomaly when assessing cases of dysfunctional labor to avoid delayed diagnosis and the associated adverse outcome