Study of Hematological Alterations in Malaria at a Tertiary Health Care Center of South Gujarat, India

Background: Malaria is a disease with a great global burden. It is one of the most prevalent parasitic infection common intropical, subtropical countries, particularly Asia and Africa. Malaria causing plasmodia is parasites of blood and hence induceshematological alterations. The hematological changes that have been reported to accompany malaria include anemia,thrombocytopenia, leukocytosis as well as leukopenia, mild-to-moderate atypical lymphocytosis, monocytosis, eosinophilia,and neutrophilia. Hence, the present study is undertaken to evaluate the various hematological parameters affected in malariaand to observe the variations, if any, in Plasmodium falciparum, Plasmodium vivax, and mixed infections.Materials and Methods: The present study was carried out in the Department of Pathology at Tertiary Health Care Centerof South Gujarat from August 2018 to October 2018. A total of 480 smear-positive malaria cases were analyzed and varioushematological parameters were studied.Results: Out of 480 smear-positive cases, P. vivax was positive in 77% of cases, P. falciparum was positive in 22% of casesand mixed infection in 1% of cases. Most of the cases were seen in the age group of 21–40 years. Anemia was seen in 53.1%of cases. Normocytic normochromic blood picture was the most common type in anemic patients (46.6%). Thrombocytopeniawas seen in 84.58% of the patients. Out of which, 75.86% were affected by P. vivax, 23.15% were affected by P. falciparum,and 0.98% were affected by the mixed infection. About 28.75% of cases showed hematological features of leukopenia, and5.2% of cases were having leukocytosis.Conclusions: Various hematological findings can help in early diagnosis of malaria which is essential for timely and appropriatetreatment which can limit the morbidity and prevent further complications

Histomorphological Spectrum of Ovarian Lesions in a Tertiary Care Institute in Gujarat with Special Emphasis on Ovarian Tumors

Introduction: Ovarian cancer is the third most common cancer among women of India. Microscopic examination is the goldstandard for diagnosing ovarian tumors and plays an important role in determining prognosis.Purpose: The aim of the study is to assess the frequency of non-neoplastic and neoplastic lesions in ovarian specimens andbiopsies and to study the histomorphological spectrum, gross features, and age distribution of the ovarian tumors.Materials and Methods: The present study was an observational retrospective study conducted over a period of 1 year(February 2019–January 2020) in the Department of Pathology in a Tertiary Care Hospital in South Gujarat. A total of cases (8ovarian biopsies and 82 ovarian specimens) were analyzed. Tumors were classified according to the WHO classification 2014.Results: Of 90 cases, eight were of non-neoplastic lesions, 13 were tumor-like lesions, and nine neoplastic lesions. Amongneoplastic lesions, 43 cases (62.3%) were benign, 3 (4.4%) were borderline, while 23 (33.3%) cases were malignant.Histopathologically, surface epithelial tumors (76.7%) were the most common subtype followed by germ cell tumors (13.3%)and then sex cord tumors (10%). Malignant surface epithelial tumors constitute 78.2% of the total malignant ovarian tumors. Themost common neoplastic lesion was serous cystadenoma. 30–39 years age group was the most common age group overall inovarian tumors. Benign tumors were most common in the 30–39 years age group, while malignant tumors were most commonin the 60–69 years age group. Bilaterality was seen in 10 (16.4%) of 61 gross specimens of ovarian tumors.Conclusion: The frequency of malignant ovarian tumors was higher in our institute. Accurate histopathological diagnosis isessential for management and determining prognosis

Pattern distribution of abnormal hemoglobin variants by cation exchange High Performance Liquid Chromatography: a study of 9,116 subjects

Background: The present study was conducted to identify pattern distribution of abnormal haemoglobin variants by using HPLC method in a tertiary care hospital, Surat, Gujrat, India.Methods: A cross sectional study of one-year duration was conducted including 9,116 patients screened for the presence of abnormal haemoglobin variants. Blood samples were initially tested for solubility test and run on automated haemoglobin analyzer for complete haemogram. All the suspected and family study cases were processed for HPLC (Bio-Rad Variant II) for conclusive diagnosis. Patients with a history of recent blood transfusion of less than 3 months duration were excluded from the study.Results: A total of 9,116 cases (1390 males, 7726 females) were included in the present study. The age group of patients ranged from 1 month to 95 years. Solubility test and complete haemogram were performed in all the cases. Out of the 9,116 cases, 8409(92.24%)cases had normal HPLC pattern. 492(5.40%)cases were diagnosed as sickle cell trait, 176(1.93%) cases as sickle cell disease, 29(0.32%) cases as β thalassaemia trait, 1(0.01%) case as β thalassaemia major, 2(0.02%)cases as Hb E heterozygous and 03 (0.07%) cases as Hb D Punjab heterozygous. One case of double heterozygous for Hb E-β thalassaemia was also found.Conclusions: HPLC is a rapid, accurate and useful method for diagnosing haemoglobinopathies. It serves as an reliable tool in diagnosing the presence of abnormal haemoglobin variants in suspected cases on routine haematology in developing countries like India, where the resources for detection of haemoglobinopathies are limited. Early diagnosis may help in proper management of patients.

Erdheim-Chester disease with multisystemic involvement: a diagnostic challenge

Erdheim–Chester disease (ECD) is a rare, non-inherited, non- Langerhans form of histiocytosis of unknown origin, first described in 1930. This entity is defined by a mononuclear infiltrate consisting of lipid laden, foamy histiocytes that stain positively for CD68. Individuals affected by this disease are typically adults between their 4th and 6th decades of life. The multi systemic form of ECD is associated with significant morbidity, which may arise due to histiocytic infiltration of critical organ systems. Among the more common sites of involvement are the skeleton, central nervous system, cardiovascular system, lungs, kidneys (retroperitoneum) and skin. The most common presenting symptom of ECD is bone pain. Bilateral symmetric increased tracer uptake on 99mTc bone scintigraphy affecting the periarticular regions of the long bones is highly suggestive of ECD. However, definite diagnosis of ECD is established only once CD68(+), CD1a(−) histiocytes are identified within a biopsy specimen with aid of clinical and radiological data. Here we present a rare case of Erdheim-Chester disease in a 46 year male patient based on clinical data, radiological data, histopathological and immunohistochemistry findings.

Analysis of spectrum of ovarian tumours: a study of 55 cases.

Background: Malignant epithelial tumours are the most common ovarian cancers and also the most lethal gynaecological malignancies. This study was undertaken to analyse histomorphological spectrum and clinicopathological correlation of ovarian tumours. Methods: This retrospective study was done for the period of one year at Department of Pathology, New Civil Hospital, Surat, which is a tertiary health care center. Here we studied 55 cases of ovarian mass received in formalin, which were subjected to histopathological examination and immunohistochemistry as and when required. Results: In total, 55 ovarian tumour specimens were examined. Out of which 28 cases (51%) were benign, 3 cases (5%) were borderline and 24 cases (44%) were malignant. Most common histological type was surface epithelial tumours (60%) followed by germ cell tumours (13%). The commonest benign tumour was mucinous cystadenoma and commonest malignant tumour was serous adenocarcinoma. Malignancy was quite common in ovarian masses in our institute. Conclusions: Ovarian tumours are quite common in our set up and epithelial tumours are the commonest variety of ovarian tumours. The histological type of ovarian tumour correlates with the prognosis of the tumour.

A rare case of retroperitoneal leiomyosarcoma.

Leiomyosarcoma, a rare malignancy of smooth muscle may arise from the retroperitoneum. They often reach a large size before diagnosis is made. Patient presents with vague symptoms, as such retroperitoneal malignancies are related to displacement of organs and obstructive phenomenon. The present paper is one of the very few case reports of retroperitoneal leiomyosarcoma which illustrates the presenting symptoms, gross and microscopic findings, treatment modalities and prognostic indicators of a 70 years old male seen at Government medical college, New Civil Hospital, Surat.

Factors influencing yield of platelet aphaeresis using continuous flow cell separator.

Background: In Transfusion Medicine, screening for suitable donor for platelet aphaeresis is difficult and time consuming procedure. This might lead to delayed supply of life saving Single Donor Platelet to critically bleeding patient. Aims & Objective: The aim of this study was to analyse the effect of various donor and procedure related parameters on the yield of single donor platelet so that the transfusionist as well as clinician can screen blood donors effectively in less time. Pre-donation platelet count, haemoglobin, haematocrit & weight were included as donor related variables. Processing time and blood volume processed were assessed as procedure related variables. Material and Methods: A total number of 265 platelet aphaeresis procedures were performed on CS 3000 plus with AMS cell separator (Fenwal, USA) using closed & open system aphaeresis kits & studied with respect to donor’s, procedure’s & patient’s related data. The statistical analysis used in this study was Pearson Correlation (‘r’ value). Results: The mean pre-donation platelet count was 286 ± 55 x 103/cu mm & mean platelet yield of all procedures was 3.3 ± 0.68 x 1011. Conclusion: Platelet yield correlated positively with pre-donation platelet count (r = 0.302, P < 0.0001). Donor’s weight, haemoglobin & haematocrit were not correlated with the yield & did not affect the yield of single donor platelets.