Assessment of Malaria by 5 Part Cell Counters CBC Analysis to Improve the Sensitivity and Specificity of Diagnosis

This study is undertaken to compare efficacy of peripheral smear (PS) and malarial antigen methods (contemporary methods of malaria diagnosis) and 5 part haematology cell counter scatterogram and flagging's in cases of malaria for effective treatment and reducing morbidity and mortality. The study was conducted by selecting 60 cases on strong clinical suspicion, first PS and antigen test was done followed by 5 part haematological cell counter for CBC. Results were subjected to statistical analysis. CBC has a sensitivity and specificity of 96.66% and 50%respectively while peripheral smear showed 96.15% sensitivity and 16.66% specificity for detection of malaria. Antigen has sensitivity of 98.24% and specificity of 93.6%. The study proved that various diagnostic modalities to diagnose malaria are far much better than only one diagnostic method.

An Evaluation of Nucleated Red Blood Cell Count by an Automated Haematology Analyser- A Tertiary Centre Experience.

nRBCs also referred to as normoblasts are seen in the peripheral blood films invariable numbers; both in physiological as well as pathologic states. Enumeration ofthese cells by modern day automated analysers remains a challenge. We wanted toassess the precision of the Beckman Coulter LH 755 & 780 haematology analysersTMin enumerating the nRBC count.METHODSThis is a retrospective study conducted in the Clinical Laboratory and HaematologyDivision of Kasturba Hospital, Manipal over a 3-month period on the BeckmanCoulter LH 755 & 780 haematology analysersTM (Beckman Coulter Inc., Miami, FL,USA) after obtaining requisite clearance from the Institutional Ethics Committee. Adata of 47,332 random blood samples run on the analysers was collected. Bothdescriptive and analytical statistics were performed using the SPSS softwareversion 22.0TM (Chicago, IL, USA). The sensitivity, specificity and kappa agreementwere calculated using the same.RESULTSA total of 797 cases from the 47,332 samples showed a “flag” for nRBCs. TwoTwenty of these cases were confirmed microscopically to have had nRBCs in theperipheral smear (true positives). 137 cases had nRBCs in the smear but were notdefinitively evaluated by the instrument (false negatives). A vast majority of thecases (577) did not reveal any nRBC on microscopic examination despite a flaggenerated by the machine (false positives). Additionally, a sensitivity of 27.6% andspecificity of 99.7% were also noted. The kappa agreement was 0.376 whichshowed a fair agreement between the two methods.CONCLUSIONSThe automated haematology analysers Beckman Coulter LH 755 & 780 were foundto be less sensitive in adequately enumerating the nucleated red blood cells. Thenumber of false positives can be reduced by noting the ‘cellular interference’ flag. Amanual review of such smears is necessary to confirm or refute such instrument

Megaloblastic anemia and non-vegetarian diet – Is there a changing trend?

Background: According to various studies, non-vegetarians are not at an inherent risk of developing megaloblastic anemia, a common deficiency of Vitamin B12. However, recent trends of the consumption of non-vegetarian food in the processed form as well as changes in cooking methods may gradually change the trend of the occurrence of megaloblastic anemia in nonvegetarians. Very few studies have been conducted on the same in a non-vegetarian population. Objectives: The objective of this study was to study the prevalence of megaloblastic anemia in a non-vegetarian population. Materials and Methods: The study was conducted on 100 non-vegetarian adults after due approval of the institutional ethics committee. The patients were evaluated on the basis of their hematological profile including peripheral smear examination and indices. Results: About 29% of total patients presented with features suggestive of megaloblastic anemia, of which 72% of patients agreed to predominantly be consuming non-vegetarian food from processed sources such as fast-food outlets at an average frequency of 3 weeks. Conclusion: There is a changing trend of megaloblastic anemia in the non-vegetarian population. Processing of food and change in conventional cooking practices along with the recent decline in home cooking of meat seem to be the major factors putting the non-vegetarians at a risk of developing megaloblastic anemia.

Evaluating iron deficiency anaemia in the third trimester of pregnancy with haematological parameters and serum ferritin concentration

Background: Iron deficiency is the commonest cause of anaemia and at least half of anaemia cases will have causes other than iron deficiency. The objective of this study was to determine the prevalence of iron deficiency anaemia among antenatal mothers based on haematological parameters and serum ferritin levels.Methods: This was a hospital based cross sectional study, conducted at Meenakshi Medical College and Research Institute, Kancheepuram from January 2017 to June 2018. Two hundred antenatal mothers who were diagnosed with anaemia in the third trimester of pregnancy were evaluated by haematological parameters and serum ferritin assay.Results: 38% of women had mild anaemia, 50% had moderate anaemia and 12% had severe anaemia. On peripheral smear, 60% had microcytic hypochromic anaemia indicating iron deficiency, and 12% had megaloblastic anaemia. In 41% of cases, the mean corpuscular volume was <82fL indicative of iron deficiency. Among the 120 women diagnosed with iron deficiency anaemia on smear, the mean ferritin level was 16.62±73.42 (less than 30µg/l). There was a statistically significant low levels of serum ferritin levels in those diagnosed with iron deficiency anaemia (P < 0.05). The serum ferritin level was >160µg/lit in 19% of cases.Conclusions: Based on the haematological parameters and serum ferritin estimation, in 60% of cases, anaemia was due to iron deficiency. Before initiating treatment, it is important to differentiate various types of anaemia, so that appropriate treatment can be given.

A Peripheral Smear Finding Beyond Cells: Cryoglobulins in a Case of Lymphoplasmacytic Lymphoma

A well prepared peripheral smear is an indispensable requisite for the diagnosis of hematological disorders and in some situations, non-hematological diseases. Here, we present the typical hemogram and peripheral smear findings of circulating cryoglobulins that led to the unraveling of the underlying lymphoproliferative disorder. A 51-year lady presented with symptoms of anemia since four months. Her hemogram showed anemia and leucopenia with flagging of platelet count. Peripheral smear at room temperature revealed marked artefactual changes in red blood cells including fragmentation. The morphology was better appreciated after incubating the sample at 37°C and showed normocytic normochromic RBCs, thrombocytopenia with a few lymphoplasmacytic cells and amorphous pinkish material in the background. Bone marrow examination showed near total replacement of marrow spaces by lymphoid cells positive for CD20 and CD138 and was diagnosed as lymphoplasmacytic lymphoma. Cryoglobulins can thus cause a range of laboratory artefacts which need to be recognized, warranting further search for possible underlying etiologies.

Clinicopathological profile of peripheral blood lymphocytosis

Background: Reactive lymphocytes can be presented with a different number of morphologies. The significance of evaluation of lymphocytes on peripheral smear tests and its clinical correlation are still neglected. Materials and methods: Clinical details along with other clinical investigations like cell counter results of patients presented with lymphocytosis and other hematological parameters including hemoglobin, total WBC count and platelet count, were collected from Department of Pathology, Dhanalakshmi Srinvasan Medical College and Hospital, India. Results: A total number of 120 cases were studied, out of which 82 patients showed absolute lymphocyte count more than 4000/ul. Out of the 120 patients, a total of 31 patients had history of smoking/tobacco chewing. 18(58%) of them showed reactive/ atypical lymphocyte morphology and 13(41%) of them showed mature lymphocytes. Of the 10 patients with alcoholism history, only 4 of them showed a normal morphology of lymphocytes, other 6 patients showed reactive lymphocyte morphology. Only one patient in the study population showed atypical lymphocytes and in peripheral smear and subjected to lymph node biopsy and rest of the patient failed to follow up after advised biopsy. Conclusions: Current study also reports that, lymphocytosis with reactive lymphocytes have a correlation with acute stress, smoking, and other ailments.

Effectiveness of the International Consensus Group criteria for manual peripheral smear review

Context: The International Consensus Group for Hematology Review (ICGHR) are essentially review criteria designed to reduce the number of manual smear reviews following analysis in automated hematology analyzers (AHAs). Although AHAs are an indispensable part of the present-day clinical laboratory, manual smear reviews still play an integral role in identifying morphological abnormalities and to confirm the results of the analyzers. Aims: The aim of this study is to evaluate the efficacy of the ICGHR criteria and our laboratory criteria using the Sysmex XN-1000 for manual peripheral smear review (MSR). Study Design: A prospective cross-sectional comparative study between the two sets of criteria for MSR was performed. Material and Methods: A total of 860 whole blood samples sent over a period of 19 months for complete blood count testing to our laboratory were collected using systematic random sampling. Truth tables were prepared for each set of criteria. Tests of proportion were used to compare performance specifications between both sets of criteria. Results: Using ICGHR criteria, sensitivity was 81.58%, specificity was 84.61%, 83.38% positive predictive value, and 82.92% negative predictive value. The microscopic smear review rate was 47.56% and efficiency was 83.14%. Using our laboratory criteria, sensitivity was 98.80%, specificity was 41.40%, positive predictive value of 61.46%, and negative predictive value of 97.34%. The microscopic smear review rate was 78.14% and efficiency 69.30%. Conclusions: There was a significant reduction in the microscopic smear review rates using the ICGHR criteria compared to our laboratory criteria. The ICGHR criteria can thus be adapted to daily laboratory practice provided they are first optimized and locally validated before use.

Fatal meningococcal septicemia without meningeal signs, contribution of the peripheral smear in diagnosis: Report of a case

Acute meningococcemia is characterized by extensive purpurae consisting of both petechiae and ecchymoses. This condition can be rapidly fatal without treatment due to shock and severe consumptive coagulopathy. We report a case of fatal meningococcal septicemia in a military recruit who presented with fever and associated rapidly progressive purpuric rash (purpura fulminans) without any meningeal signs. Evaluation revealed evidence of disseminated intravascular coagulopathy and multiorgan failure. Diplococci were demonstrated in peripheral blood neutrophils and monocytes. On autopsy, extensive hemorrhages were found in both adrenals, lungs, liver, skin, and kidneys with secondary hemophagocytic lymphohistiocytosis in bone marrow. This report highlights useful information obtained from examination of peripheral blood smear in purpura fulminans.

Hereditary Elliptocytosis: An Incidental Finding in a 6-year-old Child.

A case of hereditary elliptocytosis (HE) in a 6-year-old child diagnosed as an incidental finding has been presented.

Prevalence and spectrum of anemia among 3920 pediatric in-patients A cross sectional study.

Background: Anemia is one the common hematological laboratory abnormality in pediatric practice. To this reason we have studied the prevalence and spectrum of anemia among pediatric in-patients whom were admitted in a tertiary care hospital in Andhra Pradesh. Materials and methods: The present cross sectional study was done in the Department of Pathology at tertiary care hospital for two years. All pediatric patients with anemia due to clinically suspected or proven cases of leukemia were included. Patients with other causes of anemia such as chronic infection and systemic disorders were excluded. The study was based on peripheral smear examination and bone marrow aspiration cytology reports. Clinical details of these patients were recorded. Anemia and leukemias were grouped and classified based on the morphological type of the FAB classification. Data was extracted from patient case records and laboratory reports. Data management was done using Microsoft excel spreadsheet and statistical analysis using SPSS-16. Actual numbers and percentages were used as descriptive statistics. Results: A total of 3920 patients were admitted in pediatric ward. Among them, 212/3920 (5.4%) were being the hematological diseases, 170/212 (80.2%) being anemic due to causes other than leukemia’s and 42/212 (19.8%) were anemia due to leukemia’s. Among the 170 cases, the anemia due to Iron, Folate and B12 deficiency was 163 cases (76.88%) of total cases and seven cases (3.31%) were hemolytic anemia’s. Among these 42 leukemia cases, acute lymphoblastic leukemia’s were 32 (76.2%) AML were 19.04% (8) and CML was 4.76% (2). Conclusion: The commonest type of anemia noticed was the microcytic hypochromic anemia due to nutritional deficiency, followed by macrocytic anemia. 20% anemias were due to leukemias. The Neeraja P, Reddy CB. Prevalence and spectrum of anemia among 3920 pediatric in-patients – A cross sectional study. IAIM, 2016; 3(4): 11-14. Page 12 commonest acute leukemia noted was ALL (L1 type). There is seasonal raise of anemia incidences was also noticed between June and September, of which cause is not known. Nutritional anemias can be preventable and treatable effectively through better mother and child health care policies.

Chylomicronemia Syndrome–A Rare Metabolic Disorder of Infancy

Chylomicronemia syndrome is a disorder passed down through families in which the body does not metabolize lipids. This causes fat particles called chylomicrons to build up in the blood. It is also known as Familial lipoprotein lipase (LpL) deficiency. Chylomicronemia syndrome occurs due to a rare genetic disorder in which the enzyme LpL is broken or missing and it causes accumulation of chylomicrons. This is known as Chylomicronemia. LpL is normally found in adipose tissue and muscle. It helps in the breakdown of lipids. Symptoms may start in infancy and include: Abdominal pain due to pancreatitis, neurological symptoms, xanthomas and failure to thrive. Peripheral smear showed blasts with normocytic hypochromic anemia and thrombocytopenia and the Refrigeration test was positive. We report 3 cases of Chylomicronemia syndrome in the last 2 years.

Rising incidence of malaria in Ahmedabad, Gujarat in 2011-12.

Background: Malaria, a disease of antiquity, has proved to be a formidable deterrent to the cultural and socioeconomic progress of man in tropical, subtropical and monsoon prone zones if world. Aims & Objective: To highlight that the incidence of malaria is static throughout the year in India. Material and Methods: We analysed our institutional data for the period between April-2011 to Aug-2012 P. vivax was found to account for 69% of all malaria cases and P. falciparum for the other 31%. Infection by P. vivax and P. falciparum (63.13%) was commonest age group of 16 to 40 years. Results: Plasmodium infection was more common in the age group 16-40. Male were having more incidence of plasmodium infection. The incidence of P. vivax infection was peak during May to Sep. Same way incidence of falciparum was peak in August to November. Conclusion: The incidence of p. vivax was present throughout the year. Overall incidence of p.vivax was high. The available data indicate that the burden of malaria morbidity (P. vivax) is very high in this country. P. Vivax malaria is present throughout the year with the peak in months of May to September. On the other hand incidence of p. Falciparum has a peak in monsoon months i.e. Aug to Nov. In order to implement an effective malaria control program, accurate information on the incidence and prevalence of malaria is required.

Critical evaluation of peripheral smear in cases of anemia with high mean corpuscular hemoglobin concentration in children: A series of four cases.

Mean corpuscular hemoglobin concentration (MCHC), a parameter that is reported as a part of a standard complete blood count by automated analyzer, is a measure of the concentration of hemoglobin in a given volume of packed red blood cell. Values of MCHC significantly above reference range are not physiologically possible due to limitations on solubility of hemoglobin. The high MCHC can give us a clue to certain type of hemolytic anemia and necessitate critical evaluation of peripheral smear to reach a definitive diagnosis. Here we are presenting a series of four cases with raised MCHC, emphasizing the importance of systematic and meticulous examination of the peripheral smear to render a definitive diagnosis.