Role of FAB classification of acute leukemias in era of immunophenotyping.

French-American-British classification for leukemias had been widely accepted due to its objectiveness and good reproducibility. WHO classification of leukemias was formulated in 1997 with a purpose of further enhancing the objectivity. However, the requirement of cytogenetics and immunophenotyping makes it difficult for many countries like India to put WHO classification in routine use. This study was carried to know the effectiveness of FAB classification in an era of technical advancement. A retrospective analysis of all acute leukemias over a period of 2 years was done. Out of total of 469 cases of acute leukemias, 193 were diagnosed as Acute Lymphoblastic Leukemia (ALL), 200 as Acute Myeloid Leukemia (AML), and 76 cases diagnosed as Acute Leukemia, cytochemically undifferentiated. Hence, only 16% of all leukemias remained unclassifiable. Subclassification of AML cases revealed a much higher percentage of AML-M3, as compared to western literature. In conclusion, FAB classification, based on morphology and simple cytochemical stains, remains effective enough, although cytogenetics and immunophenotyping can add to diagnostic accuracy in some cases.

Haematological abnormalities in patients of sarcoidosis.

OBJECTIVE: To study the presence and pattern of haematological abnormalities in patients with sarcoidosis in India. METHODS: Haematological investigations including complete blood cell counts, ESR and peripheral smear examination were carried out in 30 consecutive freshly diagnosed cases of sarcoidosis and compared with equal number of age and sex matched healthy controls. Coagulation parameters such as prothrombin time (PT), prothrombin index (PTI), partial thromboplastin time (PTTK) and fibrinogen levels were also studied. RESULTS: There were 15 men (mean age 40.4 +/- 10.15 years) and equal number of women (mean age 38.6 +/- 12.14 years) in the study group. Haematological abnormalities were present in 11 (36.66%) of the patients. Four cases (13.33%, all females) were found to have anaemia and in three of them no other cause for this was evident. Lymphopenia (lymphocyte count <1500/cu mm) was present in eight (26.66%) patients and three (10%) controls (P<0.05). Only one patient (3.3%) had leucopenia. Number of subjects with raised ESR and the mean ESR was higher in the study group as compared to the controls. No coagulation abnormalities were encountered. CONCLUSIONS: Different haematological manifestations in total are common in Indian patients, leucopenia is relatively rare while anaemia, lymphopenia and raised ESR are common

Acute erythroleukemia (AML-M6)--a study of clinicohematological, morphological and dysplastic features in 10 cases.

Acute erythroleukemia is a relatively rare form of acute myelogenous leukemia. In the present study we analysed ten cases of acute erythroleukemia. All the patients were anemic and nine were thrombocytopenic at the time of diagnosis. Peripheral blood showed blasts in nine cases. Dyserythropoiesis was seen in all the cases whereas dysmegakaryopoiesis was seen in five cases. Dysplasia in the granulocytic series was seen in five cases. Based on the overall features this study concludes that acute erythroleukemia is associated with dysplasia of variable degree.

Vitamin K deficiency in diarrhoea.

The study was undertaken to determine the frequency of occurrence of vitamin K deficiency in infants with diarrhoeal illness. Infants were categorized into four groups as follows: A(acute diarrhoea), B(protracted diarrhoea) C(intractable diarrhoea) and D(healthy controls). Screening coagulation tests, PT and PTTK along with estimation of functional activity and total antigenic levels of prothrombin were performed. The ratio of functional to total prothrombin was calculated. PT was prolonged in 30% (24/75) of all infants with diarrhoea as compared to controls where the abnormality was observed in 11.1% infants (2/18). The ratio of functional to total prothrombin was significantly lower in infants with diarrhoea, the mean +/- SD values being 0.65 +/- 0.41 vs 1.1 +/- 0.26. This difference was statistically highly significant (p < 0.001). Low ratio was observed in 57.3% (43/75) infants with diarrhoea. Thus functional to total prothrombin ratio identified approximately twice as many diarrhoeal infants with vitamin K deficiency as compared to PT alone. There was no significant correlation with breast feeding as the only mode of diet, or the prior administration of antibiotics in infants with diarrhoea. The inherent malabsorptive state in diarrhoea may be a major contributory factor.

Effect of maternal low dose aspirin on neonatal platelet function.

OBJECTIVE: To evaluate the effect of maternal low dose aspirin ingestion in platelet function of newborn. DESIGN: Prospective randomized placebo controlled study. METHODS: 25 neonates born to mothers receiving low dose aspirin and 25 matched neonates with no maternal exposure to aspirin were studied. 2 ml of EDTA and 4.5 ml of citrate blood was collected from umbilical vein using double clamped umbilical stump for hemogram, coagulation profile and platelet functions. RESULTS: The platelet counts (10(9)/l) of study and control groups were 186.4 +/- 22.76 (116-225) and 205.28 +/- 17.34 (176-225), respectively. There was no significant difference in coagulation parameters. Prothrombin time index (PTI) was 86.24 +/- 6.623 and 87 +/- 6.43, respectively in the study and control group while PTTK (sec) was 55.88 +/- 20.54 and 52.12 +/- 11.82 in study and control subjects, respectively. The platelet aggregation studies (platelet function) with various platelet agonists in study and control group did not show any significant difference. Clinically, none of the babies had bleeding. CONCLUSIONS: Use of low dose aspirin in pregnant women was found to be safe and had no adverse effects on platelet functions of newborn.

Histological and clinical evolution patterns of chronic myelocytic leukemia.

Trephine biopsies of 101 chronic myelocytic leukaemia (CML) patients were analysed to study the relationship between initial and subsequent histological features vis-a-vis clinical behaviour of the disease. The patients with blast crisis at presentation were excluded. At diagnosis 62 (61.4%) patients revealed granulocytic-megakaryocytic (gran-meg) proliferation whereas granulocytic (gran) proliferation was found in 39 (38.6%) patients. Gran pattern at diagnosis was associated with shorter survival and early evolution into blast crisis (36.8%) in 12 months, although the difference in the total incidence of blast crisis between the two histological groups was not statistically significant. Myelofibrosis was detected in more number of cases on follow up (89.1%) as compared to the initial biopsies (80.2%). However myelofibrosis did not correlate with initial cellular composition, overall survival or the phase of CML (P > 0.05). Transition from one histological type to another was observed in 15 out of 60 (25%) cases while remaining in the chronic phase.

Aplastic anaemia versus hypocellular myelodysplastic syndrome.

It is important to differentiate non-dyplastic aplastic anaemia from hypocellular myelodysplastic syndrome (MDS). Four patients presenting with hypocellular bone marrow and different evolution patterns are being described. Certain morphological features and variable hypocellularity were found to be useful indices for this purpose.

Morphology of spleen in steroid resistant idiopathic thrombocytopenic purpuras.

Twenty spleens of steroid resistant cases of idiopathic thrombocytopenic purpuras were studied by light and electron microscopy. Weights of the spleen were within normal range and were unremarkable grossly. On light microscopy reactive lymphoid follicles were seen in the five of the cases. Prominent and dirty looking sinusal histiocytes contain phagocytosed materials. Prominence of plasma cells were seen in the red pulp and also in the marginal zone. The three cases which failed to respond to splenectomy did not show any morphological variation from the others who had responded.

Clinico-hematological profile and natural history of childhood myelodysplastic syndromes.

The clinical and hematological characteristics of ten children with myelodysplastic syndromes diagnosed and followed up over a 3 year period are presented. All of them had anemia and a low platelet count whilst the white blood cell count was variable. Presentation with bilateral proptosis and acute febrile neutrophilic dermatosis (Sweet's syndrome) were unique features observed in one case each. None of these cases could afford specific therapy and thus serve to illustrate the natural history of the disease in pediatric practice.

Neutropenic enterocolitis and cecal perforation in acute lymphatic leukemia.

A ten year old boy who died of the consequences of an infrequent gastrointestinal complication, whilst on induction chemotherapy for acute lymphatic leukemia, is being reported. Recent trends in the diagnosis and management of typhilitis or neutropenic enterocolitis have been reviewed.

Routine hematological values in term newborns.

Routine hematological parameters were investigated in 240 term normal neonates, 40 neonates in the first week of life and 49 infants between 3 and 6 months of age. Term normal neonates were selected on the basis of well defined criteria. Cord blood Hb values of 16.2 +/- 1.5 g/dl compared well with some of the recent Indian studies and Caucasian figures. Cord blood hemoglobin was lower in the presence of low maternal hemoglobin and in newborns delivered by Cesarean section. A wide variation existed in the total and differential leucocyte counts, thus limiting the clinical utility of white cell counts in the newborn period. Platelet counts were within the adult normal range.

A clinico-pathological study of six cases of hairy cell leukaemia.

Clinicopathological findings of six cases of Hairy cell leukaemia are presented. All the patients were males, the age ranged between 32-57 years. Complications of anaemia and neutropenia were common modes of presentation. Hepatomegaly and splenomegaly were present in all the cases whereas only 2 patients had lymphadenopathy. Severe pancytopenia was detected in 3 cases and circulating hairy cells were present in all the cases. Trephine biopsy done in all six patients was found to be diagnostic. Tartrate resistant acid phosphatase was detected in the hairy cells of 2 cases.