ABSTRACT
Background: Mild microcytic hypochromic anaemias due to iron deficiency (IDA) and beta thalassemia trait(β-TT) continue to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to study the RBC based indices in patients of marked anisopoikilocytosis in determining the etiology of it, to standardize few automated red cell parameters, and also objective grading of RBC morphology on peripheral smear and interpreting its utility in indicating a diagnosis. Also, to establish a relation between value of RBC indices with that of degree of anisocytosis.Methods: A total of 500 patients diagnosed with mild microcytic hypochromic anaemia on complete blood count and peripheral blood film were included in the study. Hb, RBC count, MCV, MCH and RDW obtained from the electronic cell counter were used to calculate discrimination indices by various mathematical formulae. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden’s index (YI) were calculated.Results: Green and King index demonstrated the lowest sensitivity of 70.51%. Mentzer index demonstrated the highest specificity of 96.80%. The highest and lowest PPV were found for Mentzer index (97.09%) and Sehgal index (92.81%) respectively. Sehgal’s index demonstrated the highest NPV of 95.96% and lowest NPV was exhibited by G and K (87.9%). The highest and the lowest values for Youden’s index were shown by Sehgal’s index (87.82%) and G and K index (68.47%).Conclusions: Sehgal’s index followed by Mentzer index are highly sensitive and reasonably specific in differentiating β-TT from IDA and none of the indices is 100% sensitive and specific. Though HbA2 estimation is the gold standard for diagnosing β-TT, in developing countries, Sehgal index followed by Mentzer et al, index can be used to screen mild microcytic hypochromic anaemia cases to eliminate as many false positive cases as possible to reduce the financial cost.
ABSTRACT
Background: The liver is a common site for primary and secondary tumors; most often from malignant tumors within the abdomen and from extra-abdominal primary malignant neoplasm, but also for sarcomas and lymphomas. The main indication of fine-needle aspiration cytology (FNAC) of the liver is diagnosis of single or multiple space occupying lesions. This study aims to evaluate the cyto-morphology of primary and secondary neoplasms of liver and non-neoplastic conditions in the smears of ultrasound guided fine needle aspiration of SOL of liver, to evaluate the cytomorphologic features and to evaluate the erroneous diagnosis when compared with cell block preparation of aspirate (tissue diagnosis).Methods: This study is hospital-based prospective study including 57 patients with space occupying lesion of the liver mass. FNAC were carried out under the guidance of sonography and/or computed tomography. The staining performed were conventional for smears of the aspirate. The cell blocks were prepared from the aspirates by the established procedures. The values of correlation were bought out.Results: Males predominated over females. The distribution of cases for cyto-diagnosis were as follows; cirrhosis with hepatic granulosa (3 cases),pyogenic abscess (3 cases), hepatic adenoma (2 cases), Focal nodular hyperplasia (2 cases), hepatoblastoma (1 case), hepatocellular carcinoma (17 cases), adenocarcinoma deposits (20 cases), deposits of small cell carcinoma (3 cases), deposits of ductal carcinoma (2 cases) and 1 case each of deposits of squamous cell carcinoma, non-Hodgkin’s lymphoma, neuroendocrine tumor and adeno-squamous carcinoma. Values of correlation were as follows: sensitivity 97.61%, specificity 100%, PPV 100%, NPV 97.82% and diagnostic accuracy of 98.85%.Conclusions: FNAC is concluded to be first rank diagnostic procedure in diagnosis of SOL of liver of varied etiology with high values of NPV and PPV. It is also concluded that it helps in staging of metastatic malignancies.