COMPARATIVE STUDY OF AUTOMATED CELL COUNTER HISTOGRAM AND PERIPHERAL BLOOD SMEAR IN DIAGNOSIS OF ANEMIA

Introduction: Over the past few years, complete blood count, RBC histogram and peripheral blood smear have become the important diagnostic tools to diagnose various haematological conditions. Major public health burden worldwide is anemia with high prevalence in developing countries like India1. Red blood cell and histogram are indispensable for diagnosis and management of anemia2. The major diagnostic tool for work up of most commercial laboratories has been analysing the blood film routinely. The aim AIM: of the study is to compare between automated cell counter histogram and peripheral smear finding in diagnosis of anemia. Material and method: A prospective comparative study of RBC histogram and peripheral blood smear in diagnosis of anemia was done on 100 patients of HB<14gm%, over six month time span (June2022-Nov2022) in the central laboratory of Saraswathi Institute of Medical Sciences Hapur, (UP) India. This study included all the age groups. All cases of anemia that have undergone blood transfusion is excluded from this study. In Result: our study it was observed that on peripheral blood smear, the most common type of anemia was microcytic hypochromic anemia followed by normocytic normochromic anemia, when we compared with automated cell counter generated histogram most common type of anemia was normocytic normochromic followed by microcytic hypochromic anemia. In our study female population were more than males. The mean age was(32.4yr). Automated cell counters generated CBC histograms and peripheral blood smears Conclusion: plays a major role in diagnosis and management of red cell disorder. Our study observed that histogram patterns and their confirmation by peripheral blood smear along with clinical history gives accurate and confirmed diagnosis of various haematogical conditions. There is much improvement in accuracy and precision 3 reducing the subjective errors .

A telepathology based screening tool for COVID-19 by leveraging morphological changes related to leukocytes in peripheral blood smears

As we approach the aftermath of a global pandemic caused by Severe Acute Respiratory Syndrome-Corona Virus (SARS-CoV-2), the importance of quickly developing rapid screening tests has become very clear from the point of view of containment and also saving lives. Here, we present an explorative study to develop a telepathology-based screening tool using peripheral blood smears (PBS) to identify Coronavirus Disease (COVID-19)-positive cases from a group of 138 patients with flu-like symptoms, consisting of 82 positive and 56 negative samples. Stained blood smear slides were imaged using an automated slide scanner (AI 100) and the images uploaded to the cloud were analyzed by a pathologist to generate semi-quantitative leukocyte morphology-related data. These telepathology data were compared with the data generated from manual microscopy of the same set of smear slides and also the same pathologist. Besides good correlation between the data from telepathology and manual microscopy, we were able to achieve a sensitivity and specificity of 0.83 and 0.71, respectively, for identifying positive and negative COVID-19 cases using a six-parameter combination associated with leukocyte morphology. The morphological features included plasmacytoid cells, neutrophil dysplastic promyelocyte, neutrophil blast-like cells, apoptotic cells, smudged neutrophil, and neutrophil-to-immature granulocyte ratio. Although Polymerase Chain Reaction (PCR) and antibody tests have a superior performance, the PBS-based telepathology tool presented here has the potential to be an interim screening tool in resource-limited settings in underdeveloped and developing countries.

Comparison of peripheral blood smear and automated cell counter in 100 cases of anemia

Background: Hemogram/ Complete Blood Count (CBC), performed on hematology analyzers, is one the most commonly ordered blood test in clinical practice especially in patients presenting with fever. The aim of the present study was to compare accuracy of RBC histograms shown by our 5 part cell counter to that of microscopy examination of blood film stain by field stain. Materials and methods: The present observational study was conducted during June 2020 - August 2020. Samples were run on 5 part hematology analyzer. Population of both anemic and healthy individuals in the age group 0-60 years were evaluated for the study. Total 100 patients in the age group of 0- 60 years were enrolled in this study. Hematological parameters were obtained by using 5 part automated hematology cell counter. The hemoglobin concentration and red blood cell (RBC) indices, encompassed mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), and mean corpuscular hemoglobin concentration (MCHC) and erythrocyte count. Results: We studied 100 blood samples of patients. Among them 82 cases showed correlation between histogram to that of the peripheral blood smear examination.Conclusion: The result of the study shows that the automated hematology analyzer are appropriate for screening purposes because it increases the turnaround time and reduces the labor cost. But to diagnose and differentiate different types of anemia manual scan of peripheral smear is a method of choice.

Comparison of platelet count by manual and automated method

Background: Since the emergence of dengue fever in the past few years, platelet count has become a routine test in every pathology lab. Common methods are by peripheral blood smears made from blood collected in ethylenediaminetetraacetic acid (EDTA) tubes, by neubaeur chamber, automated method by hematology cell counter.Methods: Blood samples of 460 adult patients and 72 children (<15 years), including indoor and outdoor, between May to August 2019, attending Hind institute of medical sciences, were collected in EDTA tubes. Samples were properly mixed on blood shaker and immediately peripheral blood smears were made and stained with Leishman stain. Platelet count of every sample was done by peripheral blood smear and by Mindray (BC5150) automated cell counter, simultaneously.Results:  Results by manual slide method are slightly higher than automated method but significantly not different from automated method.Conclusions: Traditional slide method can also be used if done carefully comparable to automated method especially useful in small labs which can’t afford automated cell counter.

Estimation and comparison of thrombocyte count by peripheral blood smear method and automated method in women with pregnancy

Background: Thrombocyte is important and very essential component of blood and have significant role in maintenance of hemostasis. Thrombocyte count is an important investigation done in various acquired and congenital coagulable states which include conditions like pregnancy. Thrombocyte count is routinely done by automated hematology analyzer method. The automated hematology analyzer counters are not usually available at all centres especially in peripheral and rural side though thrombocytes can also be assessed from the peripheral blood smears, which can be easily and precisely done at any set up. Aim and objective of this study was to compare the thrombocyte estimation by peripheral blood smear method and automated hematology analyzer in pregnant women.Methods: Thrombocyte estimation was done from samples taken from 120 normal pregnant women between December 2018 to March 2019, where samples were Ethylene Diamine Tetra Acetic acid (EDTA) anticoagulated. Thrombocyte was counted manually using PBS (Leishman stain) and hematology analyzer (Sysmex XN1000 series). Thrombocyte counts were expressed in Mean and standard Deviation. Statistical analysis was done by student’s t test using MS excel and SPSS version 17.Results: Thrombocyte count by PBS have mean value of 2.04 lacs/mm3 with standard deviation of 0.56 lacs/mm3 and by automated method have mean value of 1.89 lacs/mm3 and standard deviation of 0.71 lacs/mm3 with p value 0.010. Thus, there was no statistically significant difference found between two methods.Conclusions: Estimation of thrombocyte count on the basis of manual thrombocyte count is a reliable technique and can be used to validate automated thrombocyte counts. It can also be used in under resourced laboratories, where there are no automated counters of good precision available. In fact, all the tests showing abnormal thrombocyte counts must be reported only after cross examining on PBS.

A Case of False-negative Malaria Rapid Diagnostic Test Induced by Treatment with Doxycycline

Rapid diagnostic tests (RDTs) for malaria using antibodies against pan-Plasmodium antigen lactate dehydrogenase (pLDH) are commonly used for malaria diagnosis. The level of malaria parasitemia determined by peripheral blood smears (PBS) correlates with the pLDH concentration in most cases. We report a case of malaria recurrence associated with false-negative RDT results. A 22-year-old male patient was admitted to the Armed Forces Capital Hospital with fever and chills, and was diagnosed with malaria infection. Four days after antimalarial treatment, these symptoms recurred. After admitting to our hospital, doxycycline was administered for 4 days. Even after administration of doxycycline, the malaria parasites in blood smears remained positive, but RDT showed negative results. Therefore, for patients receiving doxycycline, serial blood smear testing should be performed to exclude false-negative malaria RDT results.

An Automated Draft Report Generator for Peripheral Blood Smear Examinations Based on Complete Blood Count Parameters

BACKGROUND: Complete blood count (CBC) results play an important role in peripheral blood smear (PBS) examinations. Many descriptions in PBS reports may simply be translated from CBC parameters. We developed a computer program that automatically generates a PBS draft report based on CBC parameters and age- and sex-matched reference ranges. METHODS: The Java programming language was used to develop a computer program that supports a graphical user interface. Four hematology analyzers from three different laboratories were tested: Sysmex XE-5000 (Sysmex, Kobe, Japan), Sysmex XN-9000 (Sysmex), DxH800 (Beckman Coulter, Brea, CA, USA), and ADVIA 2120i (Siemens Healthcare Diagnostics, Eschborn, Germany). Input data files containing 862 CBC results were generated from hematology analyzers, middlewares, or laboratory information systems. The draft reports were compared with the content of input data files. RESULTS: We developed a computer program that reads CBC results from a data file and automatically writes a draft PBS report. Age- and sex-matched reference ranges can be automatically applied. After examining PBS, users can modify the draft report based on microscopic findings. Recommendations such as suggestions for further evaluations are also provided based on morphological findings, and they can be modified by users. The program was compatible with all four hematology analyzers tested. CONCLUSIONS: Our program is expected to reduce the time required to manually incorporate CBC results into PBS reports. Systematic inclusion of CBC results could help improve the reliability and sensitivity of PBS examinations.

Haematologist-reviewed peripheral blood smear in paediatric practice

Manual examination of the peripheral blood smear (PBS) is currently performed on a fraction of samples sent for automated complete cell count. 39 children (age range 0-16.2 years) referred to a private paediatric practice during a 16-month period were retrospectively reviewed. Clinical scenarios, haematological features, laboratory-initiated PBS review, haematologist's PBS review and final diagnosis were described. Clinical indications included isolated thrombocytopenia (n = 10), unexplained bruises (n = 5), acute febrile illnesses (n = 11), anaemia (n = 8) and others (n = 5). The laboratory reviewed the PBS in 30 cases according to preset criteria and made no conclusive remarks. All slides were reviewed by a haematologist and a diagnosis was made in 27 (69%) cases, including 7 (78%) of the nine slides the laboratory did not review. The practice of laboratory-initiated PBS review requires re-evaluation. Haematologist-reviewed PBS is an important diagnostic tool for children with anaemia, bleeding disorders and acute febrile illnesses.

Diagnostic Value of Peripheral Blood Smear Spherical Erythrocyte Count in ABO-Hemolytic Disease of the Newborn / 现代检验医学杂志

Objective To evaluate the clinical value of neonatal peripheral blood smear spherical erythrocyte count in the diagnosis of ABO-HDN.Methods 165 cases clinically diagnosed with ABO-HDN in Zhongshan Boai Hospital from 2009 to 2015 were listed as the experimental group by retrospective analysis,68 cases of non-ABO-HDN were listed as control group.Besides,relevant clinical data and experimental examination were investigated,and the results of their hemolysis test were analysed.Results Peripheral blood smear spherical erythrocyte count were positive in 110 cases of 165 patients with ABO-HDN,the positive rate of spherical erythrocytes was 66.7 ％ (x2 =58.069,P＜ 0.05).The spherical erythrocyte positive rates were 68.8 ％,60.5 ％ and 66.7 ％ in patients aged ≤2d,3 ～4d,≥5d respectively.The diagnostic sensitivity of spherical erythrocytes to ABO-HDN was 66.7 ％,the specificity was 88.2 ％,the positive predictive value was 93.2 ％,and negative predictive value was 52.2 ％.When spherical erythrocyte count positive point was set as ≥5 ％ spherical erythrocytes,the diagnostic sensitivity of spherical erythrocytes to ABO-HDN was 66.7％ and the specificity was 88.2％.If the positive point was set as ≥10％ spherical erythrocytes,the sensitivity of ABO-HDN decreases to 9.3％,and the specificity reaches 98.5 ％.In ABO-HDN group,the levels of nucleated red blood cell,RDW and Ret were higher,along with the lower level of hemoglobin compared with non-ABO-HDN group (all P＜0.05).Conclusion The peripheral blood smear spherical erythrocyte count had a high sensitivity and specificity for the diagnosis of ABOHDN.Combined with jaundice,anemia and RDW,peripheral blood smear spherical erythrocyte count can provide guidance for the early diagnosis,prevention and treatment of ABO-HDN.

Difference of peripheral blood leucocyte percentages in malaria patients among Sysmex-XE5000,CellaVisionDM96 and manual microscope classification / 国际检验医学杂志

Objective To compare the difference of peripheral blood leucocyte percentages in malaria patients among Sysmex‐XE5000 ,CellaVisionDM96 and manual microscope classification ,and to verify the accuracy and reliability of the Sysmex‐XE5000 automatic blood corpuscle detection instrument for detecting the leukocyte classification in blood routine .Methods The leucocyte percentages data in 82 cases of malaria detected by using the Sysmex‐XE5000 in the Shenzhen Municipal Third People′s Hospital from January 2011 to December 2015 were retrospectively collected ;the peripheral blood smear in 82 cases of malaria obtained the percentages after the classification by the CellaVisionDM 96 ;then the peripheral blood smear was performed the leucocyte classifica‐tion by the manual microscopy for calculating the percentage .Results In the pairwise comparison of percentage obtained from the peripheral blood leucocyte classification by Sysmex‐XE5000 ,CellaVisionDM96 and manual microscopy ,only the monocytes percent‐age had statistical difference between CellaVisionDM 96 and manual microscopy (P0 .05) .Conclusion By comparing the peripheral blood leucocyte percentages data in malaria patients by Sysmex‐XE5000 ,CellaVisionDM96 and manual microscopic classification ,it is indicated that the leukocyte classification data by Sysmex‐XE5000 are accurate and reliable ,malaria parasite does not affect peripheral blood leukocyte classification ,but it is necessary to pay more attention to monocytes classification in CellaVision DM 96 classification .

APPLICABILITY OF ADOPTING MORPHOLOGICAL PATTERNS IN PEDIATRIC ANEMIAS AS ETIOLOGICAL INDICATORS

Background: Pediatric anemia is a global phenomenon. The magnitude of this problem gets exaggerated in developing countries like India wherein majority of the population are vulnerable since they live in rural areas and come under low socio-economic status. Though pediatric anemias can be diagnosed by simple blood tests like complete hemogram and peripheral smear examination, the evaluation of underlying etiological factor to initiate appropriate therapy involves expensive work up which may not be affordable in a rural setup. This need-based study of pediatric anemia was conducted to determine the morphological patterns of anemia by simple baseline investigations and to detect the related etiologic factor. Methodology: The probable etiological factors contributing to the anemias were diagnosed by determining the morphological patterns using simple baseline investigations like complete hemogram and peripheral blood examination and treated accordingly. Conclusion: The etiology of microcytic hypochromic anemia was found out to be iron deficiency as confirmed by serum iron profile studies. Presence of dimorphic anemia suggested combined nutritional deficiency of Iron, vitamin B12 deficiency or folate. Hemolytic anemias detected by routine hematological investigations were confirmed by serum electrophoresis. Morphological examination of red blood cells on peripheral smear examination is thus an effective, simple and cost effective method to determine the etiology of various types of anemia.

Congenital and neonatal malaria in Asian Indian population.

Background: Congenital malaria is defined as malarial parasites demonstrated in the peripheral blood smear of the newborn from twenty four hours to seven days of life. Malaria is endemic in India, neonatal disease is considered rare. Routine screening for malaria is essential for all neonates with fever in endemic areas. Early diagnosis and treatment of malaria could effectively prevent infant mortality. The aim of the present observational prospective study is to describe the occurrence and clinical spectrum of congenital vivax malaria in admitted neonates in Bikaner, India (low endemic region). Congenital malaria has been predominantly reported for P. falciparum from different parts of the world but the reports with P. vivax are very scanty. Methods: This prospective study was conducted on admitted neonate from January 2011 to December 2012. The species diagnosis was done by peripheral blood smear examination and rapid diagnostic test. The possibilities of other disease/infections causing similar illness were investigated thoroughly and stringently. A structured questionnaire was used to collect clinical data on newborn and maternal health during pregnancy. Results: A total of 1168 new born admitted in first week of life were screened. Out of them 23 (1.97%) had evidence of parasitaemia (P. vivax 17 and P. falciparum 6). The criteria for admission in these 17 neonates with congenital vivax malaria were LBW and prematurity (41.18%), septicemia (35.29%), perinatal asphyxia (17.65%), jaundice (17.65%) and seizures (5.88%). Conclusions: This study emphasizes the occurrence of P. vivax congenital malaria even in neonates in low transmission area and without typical manifestations. The emphasis is also on the relevance even in very low transmission areas of not only maintaining, but even increasing clinical and epidemiological awareness of this preventable and treatable disease in pregnancy and in the neonate.

Usefulness of a centrifuged buffy coat smear examination for diagnosis of malaria.

Purpose: Malaria continues to be a global public health challenge. Microscopic examination of peripheral blood smear (PBS) is the standard method for malaria diagnosis, which is easily available and has low cost but its reliability is questionable at low level of parasitaemia. The present study was undertaken to assess the usefulness of a modifi ed centrifuged buffy coat smear (CBCS) technique for diagnosis of malaria and to compare it with conventional PBS examination and antigen detection test. Materials and Methods: The study was carried out over a 6-month period from July to December 2011. Blood samples (2–3 ml per patient) collected in EDTAvials from patients with a clinical suspicion of malaria were subjected to all three tests, that is PBS, CBCS and antigen test and results were compared with antigen test as the gold standard. Result: Of 1655 samples received, 394 (23.8%) samples were positive for infection with malaria parasites. All the three tests detected malaria infection equally in 279 samples, and gave varied results in the remaining 115 samples. Addition of centrifugation (i.e. CBCS) to the conventional method of PBS enabled detection of 80 more cases of plasmodia infection, especially (43, 53.7%) at low levels of parasitaemia (<200 parasites/μl). While both PBS and CBCS had excellent specifi city (99.7% and 99.2%, respectively), PBS examination had low sensitivity (72.9%) in detecting malaria parasites in comparison to CBCS. The sensitivity of CBCS in detecting malaria parasites was 91.9%. Conclusion: The development of easy, rapid and accurate tests for the reliable detection of plasmodia infection is highly desirable. The CBCS technique fulfi ls most of these criteria and may be adopted for rapid and reliable diagnosis of malaria in resource-limited settings.

Annual Report on the External Quality Assessment Scheme for Diagnostic Hematology in Korea (2014) / 임상검사와정도관리

During 2014, the Diagnostic Hematology Subcommittee of the Korean Association of Quality Assurance for Clinical Laboratories performed laboratory proficiency testing for blood cell count, cell morphology, and coagulation tests. Four trials for blood cell count and cell morphology tests and 2 trials for coagulation tests were performed. The trials for blood cell counts had a reply rate of 96.8% among 1,343 laboratories, compared to 99.3% among 489 laboratories for cell morphology and 98.6% among 565 laboratories for coagulation tests. The homogeneity of the external quality materials was stable (80% for most of the participating laboratories. The CVs for the coagulation tests varied according to the specific instruments or reagents that were used. An educational workshop was held in July to provide hands-on experience in diagnostic hematology. During 2014, the number of participating laboratories was increased, while the performance of hematology tests was similar to that observed in the previous year.

Annual Report on External Quality Assessment in Diagnostic Hematology in Korea (2013) / 임상검사와정도관리

Diagnostic hematology subcommitee of The Korean Association of Quality Assurance for Clinical Laboratory performed laboratory proficiency testing for blood cell count, cell morphology and coagulation tests in 2013. Four trials for blood cell count and cell morphology and 2 trials for coagulation tests were executed. Average 1,308, 494, and 558 laboratories participated in the surveys of blood cell count, cell morphology and coagulation tests, respectively. The overall reply rates were 95.78%, 97.75%, and 97.38%, respectively. The homogeneity of external quality materials was stable (less than 3%) and status of use of the instrument and reagents was similar to those of the previous year. The CVs in white blood cell count, red blood cell count, platelet count, hemoglobin, and hematocrit were 3.15%, 2.00%, 5.10%, 1.81%, and 2.71%, respectively. For cell morphology, most showed concordant rate >80%. CVs of coagulation tests showed difference depending on instruments or reagent groups. An educational workshop on hands-on experience in diagnostic hematology was held in July. In 2013, the number of participating laboratories is more increased and the performance of surveys of hematology tests is similar performance compared to previous year. In addition, the revision in the way of evaluation of coagulation tests is needed.

The detection of peripheral blood smear and bone marrow examination in patients with panhematopenia and its clinical significance / 中国基层医药

Objective To explore the clinical significance of peripheral blood smear and bone marrow examination in the etiological diagnosis of panhematopenia.Methods 180 cases of panhematopenia were selected and were given peripheral blood smear and bone marrow examination,and the results were analyzed.Results There were 50 cases of panhematopenia because of non hematopoietic system diseases.Among 50 cases of non-hematopoietic system disease,there were 20 cases of chronic hepatitis,3 cases of cirrhosis,4 cases of lung cancer,10 cases of malignant tumors,3 cases of endocarditis,7 cases of connective tissue-like illness,1 case of gastric cancer,1 case of systemic lupus erythematosus and 1 case of hypersplenism.Due to diseases of the hematopoietic system,there were 130 cases of panbematopenia.Among 130 cases of panhematopenia due to diseases of the hematopoietic system,there were 74 cases of acute leukemia(AL),13 cases of myelodysplastic syndrome(MDS),13 cases of aplastic anemia(AA) and 30 cases of megaloblastic anemia(MA).Conclusion Peripheral blood smear and bone marrow examination is conducive to diagnose the cause of the panhematopenia.Bone marrow examination could improve the accuracy rate of panhematopenia.

Development of a Poikilocyte Measuring Method Using Image Analysis Software

BACKGROUND: To achieve consistency in poikilocytes grading in peripheral blood cell examinations, we made an image-based differential count (IDC) software to measure the degree of abnormalities in individual red blood cells (RBCs) and relative fractions of poikilocytes. METHODS: Thirty peripheral blood samples were analyzed. Smear slides were examined on a microscope with charge-coupled device (CCD) camera. To verify this program, we compared the IDC results with the results of manual differential counting (MDC). Relative fractions of schistocytes, echinocytes, and elliptocytes were measured by IDC and MDC. The error rate of IDC was measured by confirming the final processed images of IDC. Correlations of IDC and MDC results were compared using linear regression analysis and the time required for each test was measured. For presentation of the mathematical decision criteria of poikilocytes, IDC algorithms for recognizing schistocytes, echinocytes, and elliptocytes were made using simple geometrical or mathematical formulas. RESULTS: The error rate of IDC was 2.8%. For analysis of 1,000 RBCs, MDC took 7.3 minutes and IDC took 2.7 minutes. Linear regression coefficients were 0.776 (P<0.001) for schistocytes, 0.895 (P<0.001) for echinocytes, and 1.001 (P<0.001) for elliptocytes. CONCLUSIONS: It was possible to define poikilocytes with geometrical or mathematical formulas using image analysis programs. The IDC program would be helpful for consistent grading of poikilocytes.

Giemsa and Grocott in the recognition of Histoplasma capsulatum in blood smears

Objective: To facilitate the recognition of intracellular yeasts of Histoplasma capsulatum and differentiate it from Leishmania amastigotes and other parasites, using the combination of then Giemsa) to previously fixed peripheral blood smears. Microscopy was performed with 400ístudy. Methods: The combination of both stains was applied consecutively (first Grocott and Giemsa and a rapid modification of Grocott stains to peripheral blood smears in a hematological and 1000í, the latter using immersion oil. Results: The yeasts of Histoplasma capsulatum were observed into the cytoplasm of leukocytes as brownish oval elements, with 3-4 μm in diameter. Conclusions: The combination of both techniques is a simple and fast method to facilitate recognition of intracellular yeasts and it is different from intracellular parasitic elements. Moreover, it allows distinguishing the cell elements that are in the microscopic preparations. It may be very helpful in those cases in which the presumptive diagnosis of histoplasmosis has not been established yet and where other more sophisticated methods are not available.

Bone marrow biopsy pathology in combination with bone marrow smear and peripheral blood smear in diagnosis of stubborn hematonosis / 中国综合临床

Objective To investigate the diagnostic significance of synchronous observation on bone marrow biopsy,bone marrow smear and peripheral blood smear in stubborn hematonosis.Methods Thirty-seven patients with difficult and complicated hematologic diseases were detected by peripheral blood smear,bone marrow smear and bone marrow biopsy.Those slides and smears were observed.Results The 37 cases with blood disease was diagnosed of aplastic anemia in 3 cases,5 cases of myelodysplastic syndrome,6 cases of primary myelofibrosis,13 cases of secondary myelofibrosis,7 cases of lymphoma with bone marrow infiltration and 3 cases of metastatic carcinoma of bone marrow.In the diagnosis of aplastic anemia,myelodysplastic syndrome,primary and secondary myelofibrosis,lymphoma and metastatic carcinoma of bone marrow diagnosis,bone marrow biopsy is superior to smear.Conclusion Bone marrow biopsy,bone marrow smear and peripheral blood smear synchronous observation can effectively increase the diagnostic rate,decrease misdiagnosis rate,and correctly identify the stage of the disease.

Estimation of the levels of C-reactive protein, interleukin-6, total leukocyte count, and differential count in peripheral blood smear of patients with chronic periodontitis in a South Indian population / Estimado de los niveles de proteína C-reactiva, interleucina-6, Conteo total de leucocitos, y conteo diferencial en el frotis sanguíneo periférico de pacientes con periodontitis crónica en la población del sur de la India

AIMS: The aim of the present study is to investigate systemic levels of inflammatory markers of cardiovascular diseases like C-reactive protein (CRP), interleukin-6 (IL-6), total leukocyte count and differential count in patients with chronic periodontitis, in comparison to healthy individuals without periodontal disease. SUBJECTS AND METHODS: A total of 42 individuals, both males and females, above the age of 30 years, were included. Healthy controls (Group I, n = 14), patients with chronic localized periodontitis (Group II, n = 14) and chronic generalized periodontitis (Group III, n = 14), all without any other medical disorder were recruited and peripheral blood samples were taken. Serum samples of CRP and IL-6 were estimated by using different techniques. Total leukocyte count and differential count were estimated by standard clinical laboratory method. RESULTS: Groups II and III had higher mean CRP levels than Group I (0.479, 0.544 versus 0.304 mg/dL). C-reactive protein level in Group III was statistically significant when compared to Group I (p = 0.04). Group III had higher median IL-6 level (6.35 pgm/ml) than Group II (< 5.0 pgm/ml) and Group I (< 5.0 pgm/ml). Median values of IL-6 were not statistically significant in any group (p = 0.29). Total leukocyte count was also elevated in Group III (10.4 x 10³/c.mm) compared to Group II and Group I (9.2 x 10³/c.mm and 7.9 x 10³/c.mm). This was statistically significant between different study groups (p < 0.0001). Neutrophil count in Group III was higher (68.0%) than Group II (62.4%) and Group I (57.4%). Neutrophil percentage was statistically significant in Group III, when compared to Group I (p = 0.0003). CONCLUSION: Periodontitis results in higher systemic levels of CRP, IL-6, total leukocyte count and neutrophils. These elevated inflammatory factors may increase inflammatory activity in atherosclerotic lesions, potentially increasing the risk for cardiovascular events.

OBJETIVOS: El objetivo del presente estudio es investigar los niveles sistémicos de los marcadores inflamatorios de enfermedades cardiovasculares, como la proteína C-reactiva (PCR), la interleucina-6 (IL-6), el conteo total de leucocitos, y el conteo diferencial en los pacientes con periodontitis crónica, en comparación con individuos saludables sin la enfermedad periodontal. SUJETOS Y MÉTODOS: El estudio comprendió un total de 42 individuos - varones y hembras - mayores de 30 años de edad. Los controles saludables (Grupo I, un = 14), los individuos con periodontitis crónica localizada (Grupo II, n = 14), y aquellos con periodontitis crónica generalizada (Grupo III, n = 14), todos sin ningún otro problema médico, fueron reclutados y se tomaron muestras de sangre periférica. Las muestras de suero de PCR e IL-6 fueron estimadas usando técnicas diferentes. El conteo total de leucocitos y el conteo diferencial fueron calculados mediante el método estándar de laboratorio clínico. RESULTADOS: Los grupos II y III tuvieron niveles promedio más altos de PCR que el Grupo I (0.479, 0.544 frente a 0.304 mg/dL). El nivel de proteína C-reactiva en el Grupo III fue estadísticamente significativo, comparado con el Grupo I (p = 0.04). El Grupo III tuvo un nivel mediano más alto de IL-6 (6.35 pgm/ml) que el Grupo II (< 5.0 pgm/ml) y el Grupo I (< 5.0 pgm/ml). Los valores medianos de IL-6 no fueron estadísticamente significativos en ningún grupo (p = 0.29). El conteo total de leucocitos también fue elevado en el Grupo III (10.4 x 10³/c.mm) comparado con el Grupo II y el Grupo I (9.2 x 10³/c.mm y 7.9 x 10³/c.mm). Dicho conteo fue estadísticamente significativo entre diferentes grupos de estudio (p < 0.0001). El conteo de neutrófilos en el Grupo III fue más alto (68.0%) que en el Grupo II (62.4%) y el Grupo I (57.4%). El porcentaje de neutrófilos fue estadísticamente significativo en el Grupo III, en comparación con el Grupo I (p = 0.0003). CONCLUSIÓN: La periodontitis produce niveles sistémicos más altos de PCR, IL-6, conteo total de leucocitos y neutrófilos. Estos factores inflamatorios elevados pueden aumentar la actividad inflamatoria en las lesiones ateroscleróticas, aumentando potencialmente el riesgo de accidentes cardiovasculares.