Adaptation of a Public-Private Partnership Model for the Implementation of Minipool Nucleic Acid Testing for Screening Routine Blood Donations and Assay Evaluation.

Background Nucleic acid amplification testing (NAT) for the screening of blood donations is known to improve blood safety. The decision to initiate NAT requires careful deliberation of infrastructure, skilled manpower, and financial resources. This report outlines the initiative of the Government of Odisha to implement NAT screening in government blood banks in the state of Odisha, India, through public-private partnership (PPP) and evaluates the incremental yield of minipool NAT screening over serology testing of blood donations. Methods Blood donations collected between June 2016 and September 2018 were initially screened for HBV (HBsAg), HCV (anti-HCV), and HIV (anti-HIV-1 and HIV-2) by ELISA, and syphilis and malaria. Sero-nonreactive donations were further screened in pools of six by Roche cobas TaqScreen MPX test version 2.0 (MPX2) NAT. Results On screening 3,39,472 blood donations, 1.34% seroreactive donations were detected. In all, 847 NAT-reactive donations (0.26%): 693 HBV, 58 HCV, and 96 HIV were detected. The NAT yields were 1:386 overall, 1:472 for HBV, 1:5642 for HCV, and 1:3409 for HIV. Conclusion NAT testing using the highly sensitive MPX2 assay leads to incremental detection of TTIs over serology. Implementation of NAT along with serological testing in blood centers all over India will be an important step towards providing safe blood. Our study not only highlights the benefits of minipool NAT testing but also presents a scalable PPP model that can serve as a template for application across other states.

Clinical Profile and Severity of Hemolysis in Adult Patients of Primary Autoimmune Hemolytic Anemia and Their Response to Steroid: A Prospective Cohort Study from Single Institution.

Autoimmune hemolytic anaemia (AIHA) has traditionally been classified based on the temperature sensitivity of the autoagglutinins as warm (WAIHA), cold (CAIHA) and mixed type. Autoagglutinin may be of IgG or IgM type. The present prospective study was conducted to evaluate the profile of clinical picture, severity of haemolysis, treatment response of steroid. This study on patients of adult primary AIHA was conducted by taking complete history followed by detail physical examination. Laboratory investigations were performed to establish haemolytic anaemia and to assess severity of haemolysis. Immunehematological work up including blood grouping, direct antiglobulin test (DAT), IAT, antibody screening, adsorption elution was performed to diagnose type of AIHA. All cases were followed up to assess the response to prednisolone. All the data were collected and analysed by SPSS 19. Out of 62 primary AIHA cases, female were affected more than male (41:21). WAIHA is most common type (42, 67.8%) followed by mixed (20.9%) and cold AIHA (11.3%). Severity of haemolysis showed significant correlation with the DAT strength and not with type of AIHA. (P < 0.05) On oral prednisolone, 22 cases attended complete remission, while relapse, drug dependency and partial remission was achieved in 13, 9, 3 cases respectively. Severity of haemolysis in AIHA is directly related with DAT strength. WAIHA is most common type and can be managed with oral prednisolone (cr 45.2%), without red cell transfusion in most of cases. Mixed type AIHA cases were presented mostly with severe haemolysis, with minimum therapeutic response to prednisolone and maximum relapse/drug dependency.

Intra-operative cytodiagnosis of primary ovarian choriocarcinoma with Ki67 immunoexpression.

Primary ovarian choriocarcinoma is a rare neoplasm that can be gestational and non-gestational in origin. It accounts for one in 369 million pregnancies. Both types present with similar clinical, histomorphological and ultrastructural findings. But, it is essential to differentiate the two because the gestational type has a better clinical course and responds to single-agent chemotherapy. Usually, the gestational ovarian choriocarcinoma is metastatic from uterine choriocarcinoma and follows antecedent pregnancy and is seen in females of 40 years or older. DNA polymorphism analysis showing the presence of paternal genes in the tumor establishes the gestational origin of choriocarcinoma. We present the intra-operative cytological findings of a case of primary ovarian choriocarcinoma in a 25-year-old lady arising from ectopic pregnancy with Ki67 immunostain.

Cryptococcal lymphadenitis in HIV: a chance diagnosis by FNAC.

Cryptococcosis is a life threatening, opportunistic fungal disease in human immunodeficiency virus-infected individual. Lymph node involvement as a presenting feature in Cryptococcosis is not a common manifestation. A prompt diagnosis is of utmost importance in this disseminated form of cryptococcosis. There are very few reports, however, of cryptococcal lymphadenitis as a presenting feature. We report here a case of cryptococcal lymphadenitis that was diagnosed by fine-needle aspiration cytology of the involved cervical lymph node.

Extraovarian primary peritoneal papillary serous carcinoma.

OBJECTIVE: To identify an unusual histologic entity, extraovarian primary peritoneal carcinoma (EOPPC) along with a review of the recent literature. METHODS: A thorough clinical examination along with detail laboratory parameters was studied in a 56-year-old female who presented with ascites and an elevated serum CA-125. Multiple microscopic sections were studied from the surgical specimen received comprising of total hysterectomy, bilateral salpingo-oophorectomy and omentectomy. RESULTS: A diagnosis of EOPPC was made after a thorough study. CONCLUSION: A correct diagnosis and timely management of this unusual histologic entity can result in long-term disease-free survival of the patient.