Spurious platelet count due to cryoglobulins in a patient with smoldering myeloma.

Use of automated hematology analyzers for routine blood count reporting has increased the reproducibility and accuracy of test results. However, at times, these instruments may generate spurious test results. Such results can result in inappropriate investigations or treatment decisions in patients. Spuriously normal or high platelet counts carry the risk of under diagnosis of the true thrombocytopenia with adverse clinical implications. We present a patient with smoldering myeloma with spurious platelet count due to cryoglobulins.

Red cell distribution width (RDW) in the diagnosis of iron deficiency with microcytic hypochromic anemia.

OBJECTIVE: To study the utility of red cell distribution width (RDW) in the diagnosis of iron deficiency among children with microcytic hypochromic anemia. METHODS: 151 children (6 months-12 years) with microcytic (MCV<75 fl) anemia were classified into iron deficient (IDA) and non-iron deficient anemia (non-IDA) on the basis of serum ferritin and total iron binding capacity (TIBC). RDW values were obtained on an automated hematology analyzer. Receiver operator curves (ROC) were constructed and the utility of RDW in diagnosis of iron deficiency was studied. RESULTS: The mean RDW value was 18.37+/-2.22% in IDA group (97 children) compared to 16.55+/-1.51 % in the non-IDA group (54 children) (p<0.0001, unpaired t test). In IDA group, the mean RDW value was 16.60+/-1.78%, 17.95+/-1.91% and 20.55+/-1.32% among mild, moderate and severely anemic children (p<0.0001, ANOVA test). The corresponding values in non-IDA group were 16.03+/-1.25%, 16.76+/-1.20% and 16.77+/-2.68% respectively (p=0.269, ANOVA test). At a cut-off value of 17.4%, as obtained from the ROC curve, the sensitivity and specificity of RDW in diagnosis of IDA were 81.0% and 53.4% and a positive and negative predictive value of 63.0% and 72.2% respectively. CONCLUSION: RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.

Auer rod-like inclusions in myeloma cells in a patient with IgG multiple myeloma.

Various inclusions have been reported in the past in plasma cells as well as myeloma cells. Most of these represent light chains of immunoglobulins which are concentrated within these cells. Auer rod-like inclusions in myeloma cells have been infrequently reported. They do not influence prognosis in patients with multiple myeloma but are more of a morphological variance. We report a patient of IgG myeloma with auer rod-like inclusions in myeloma cells in the bone marrow aspirates.

Inappropriate platelet transfusion in a patient with ethylenediamine tetra- acetic acid (EDTA)--induced pseudothrombocytopenia.

Automated platelet counts in the laboratory may be fictitiously low at times and require manual confirmation. Ethylenediaminetetra-acetic acid (EDTA) in few patients and healthy individuals can induce platelet aggregation, giving rise to a spuriously low automated platelet count. This phenomenon which occurs due to the presence of IgG antibodies, if unrecognized, can result in incorrect diagnosis and consequent inappropriate treatment. We present a patient who received inappropriate platelet transfusion as a result of EDTA induced spurious thrombocytopenia.

Hemoglobin E-thalassaemia in a Sikh child: a case report.

Hemoglobin E is a beta chain variant that has its most clinically significant interaction with thalassaemia. The compound heterozygous state, thus produced, can result in a thalassaemia intermedia/major phenotype with affected individuals being transfusion dependent. Hemoglobin E is very common in north-east India with relatively fewer reportsfrom rest of the country. Reports of hemoglobin E in the Punjabi population are even rarer. A case of hemoglobin E-thalassaemia in a Sikh child is being presented because of its highly uncommon occurrence in natives of Punjab.

Artifactual shortening of prothrombin time in a semi-automated coagulometer because of lipaemic plasma.

Widespread use of coagulometers over the past few decades has improved the accuracy and precision of coagulation tests. However, test results even from sophisticated coagulometers are prone to errors due to both analytical and pre-analytical factors. Coagulometers utilizing absorbance variation for end point detection can generate erroneous results due to turbidity in the test plasma. We present a case with artifactual shortening of prothrombin time because of lipaemic plasma.

Voluntary donors-need for a second look.

Voluntary non-remunerated blood donation is the source of the safest blood supply to the transfusion service. In the Indian set up where voluntary donations are fewer and poorly structured, safety of blood could still be compromised. This study was carried out to find out the seroprevalence of transfusion transmitted diseases among replacement and voluntary donors. A retrospective study of replacement and voluntary donors over a three and a half year period was carried out and the seroprevalence for human immunodeficiency virus (HIV), hepatitis B, hepatitis C, syphilis and malaria was noted. A total of 41122 donors were studied comprising of 94.7% replacement and 5.3% voluntary donors. The prevalence of transfusion transmitted diseases was marginally higher among voluntary donors (3.3%) as compared to replacement donors (2.9%). All cases of HIV were seen in the replacement donors while the figures for hepatitis B and C were marginally higher in the voluntary donors (p>0.05). Voluntary donations in our study were not voluntary in the real sense. There is a need to work on building a stronger voluntary donor base and to create awareness among the populace in order to gradually abolish the replacement donations; thereby ensuring the safety of blood and its products.

Spuriously elevated automated platelet count in severe burns--a report of two cases.

Increasing use of automated analyzers in the hematology laboratory has resulted in enhanced accuracy of results. However, operators of automated analyzers and the end users utilizing the automated data need to be aware of factitious results which might be reported at times by these instruments. Case summaries of two patients with severe burns showing spuriously elevated automated platelet count are presented here.

Utility of white blood cell suspect flags and histogram pattern in the detection of acute leukemia by Advia-60 automated hematology analyzer.

Blood samples from patients with acute leukemia, when analyzed with automated hematology counters, tend to introduce inaccuracies in the automated differential count and can cause diagnostic confusion without providing definite clues to the presence of abnormal cells. We designed this study to assess the utility of white blood cell (WBC) flags and histogram pattern generated by Advia-60 automated hematology analyzer in the recognition and categorization of acute leukemia. Data printouts of 31 newly diagnosed cases of acute leukemia, 22 with acute myeloid leukemia (AML) and 9 with acute lymphoblastic leukemia (ALL) were reviewed. All cases of AML and ALL generated the WBC suspect blastflag M2 associated with two of the non blast suspectflags G1 and G2. Among the cases of AML, 95.5% of the WBC histogram patterns were definitive of the presence of abnormal cells and were indicative of the myeloid nature of cells. Only 44.4% of the histograms in the cases of ALL could be definitive of the presence of abnormal cells and 33.3% were indicative of their lymphoid nature. Significantly, 55.5% of the histograms in ALL were normal. The false positives for both AML and ALL were 10.5% when only WBC flagging was considered and were reduced to 0.05% when the flags were combined with histogram patterns for interpretation. Combined flagging and histogram recognition can be of aid in identifying cases of acute leukemia and the morphologist can then assess these samples further. This ensures that cases of acute leukemia, especially in high output laboratories, are not inadvertently missed.

Spurious automated red cell parameters due to cold agglutinins--a report of two cases.

Although automation in hematology has resulted in improved accuracy of results, there are certain clinical conditions in which even the technologically advanced cell counters give out spurious results. It is therefore important that operators of these instruments are aware of these factitious results and the clues in the automated data that can be of help in identifying them. Two cases with spurious automated red cell parameters due to cold agglutinins are reported here.

Abnormal leukocyte histogram with a factitious automated white cell count due to Plasmodium vivax parasitemia--a case report.

Automated hematology analyzers are designed to produce accurate and precise blood counts on specimens which are either normal or show only numerical abnormalities. However they alert the operator in samples with unusual characteristics which could result in inaccurate measurement or require review of the blood smear. Even the most sophisticated instruments cannot recognize all the significant abnormalities that can be recognized by a human observer. Spurious automated white cell counts could result from platelet aggregates, nucleated red cells, non lysis of cells and a variety of other causes. We present a case with spurious leukocytosis due to Plasmodium vivax parasitemia which was flagged by the automated analyzer.

Use of the gel-based DiaMed-ID microtyping system for crossmatching enhances sensitivity.

A host of newer techniques have been introduced over the past decade in blood bank serological testing. One such technology which has been in vogue in the west since early 1990s is the gel test. The procedures used are standardized and they provide clear and stable reactions that improve result interpretation. The principle involves the differential passage of red cell agglutinates and free red blood cells through a dextran acrylamide gel. The results are stable and may be read even after many hours. The test is easy to perform, sensitive and reproducible. We report our experience in compatibility testing with use of the DiaMed micro typing system which is based on the gel technology. Over a one year period since this technology was introduced in our blood bank, we noticed a startling 65 fold rise (p<0.0001) in the reported number of incompatible units in one year which rose from a paltry 4 (0.02%) to 260 (1.6%). We found the DiaMed system easy to use and as our findings suggest it proved to be more sensitive than the conventional tube agglutination technique.

Paraganglioma of the urinary bladder--a case report.

Paragangliomas of the urinary bladder are extremely rare tumors accounting for less than 1% of all bladder tumors. Males and females are affected roughly equally with an average age of 41 years. Hypertension and headache during or immediately after voiding in association with intermittent hematuria is virtually diagnostic of urinary bladder paragangliomas. A high index of clinical suspicion is required to diagnose these tumors. We present a case of a urinary bladder paraganglioma because of its rarity.