RESUMO
Pancytopenia is a common hematological abnormality encountered in clinical practice. We here report a 36-year-old male who presented to emergency department with complaints of weakness of bilateral lower limbs, burning sensation in all four limbs with history of loose stools, and vomiting 5 days back. The complete blood count of patient showed pancytopenia with no circulating atypical cells. Bone marrow examination performed showed nonspecific but characteristic findings. After excluding the possibility of infective etiology, a possibility of heavy metal toxicity was suspected in multidisciplinary meeting. The urine and blood levels of arsenic done came out very high, and a diagnosis of arsenic poisoning was made. Patient had multisystemic involvement with features characteristic of arsenic poisoning. The present case was a diagnostic challenge in face of nonforthcoming history. This case beautifully highlighted the importance of multidepartmental approach in such cases to arrive at unerring diagnosis and the unique bone marrow findings, although nonspecific were sufficient enough to indicate the possibility of acute insult to the hematopoiesis. How to cite this article: Nair RR, Singh PK, Sharma J, Gambhir I, Khanna S, Jain AK, et al. An Unusual Case of Pancytopenia: The Lessons Learnt. Indian J Crit Care Med 2022;26(1):141-144.
RESUMO
BACKGROUND: Developed countries adopted liquid-based cytology (LBC) cervical cytology, partly because of its lower proportions of unsatisfactory (U/S)/inadequate samples. This study was carried out to evaluate effect on the rate of U/S samples after introduction of LBC in our laboratory. MATERIALS AND METHODS: An audit of U/S cervical samples was performed, which included split samples (n = 1000), only conventional Pap smear (CPS) smears (n = 1000), and only LBC samples (n = 1000). The smears were reviewed by two observers independently, and adequacy for the samples was assessed as per The Bethesda System 2001. The reasons for U/S rate in split samples were categorized into various cytologic and/or technical reasons. RESULTS: U/S rate was far less in only LBC samples (1.2%) as compared to only CPS (10.5%) cases. Cases in the satisfactory but limited category were also less in only LBC (0.4%) as compared to only CPS (3.2%) samples. The main reasons for U/S smears in split samples were low cell count (37.2% in CPS; 58.8% in LBC). The second main reason was low cellularity with excess blood and only excess blood in CPS samples. CONCLUSION: There was a significant reduction of U/S rate in LBC samples as compared to CPS samples, and the difference was statistically significant. The main cause of U/S samples in LBC was low cellularity indicating a technical fault in sample collection. The main cause of U/S rate in CPS was low cellularity followed by low cellularity with excess blood. Adequate training of sample takers and cytologists for the precise cell count to determine adequacy in smears can be of great help in reducing U/S rate.
RESUMO
Human papillomavirus (HPV) DNA testing is replacing cervical cytology as a primary cervical cancer screening tool. The aim of this study was to determine the frequency of occurrence of HPV types 16 and 18 in liquid-based cytology (LBC) cervical samples in our set-up. This study comprised of 302 LBC cervical samples. HPV 16 and HPV 18 were detected by polymerase chain reaction (PCR), and the results were compared between normal (n = 155), inflammatory (n = 99), squamous (n = 37) and glandular abnormalities (n = 11). Of our patient cohort, 73.8 % was ≤40 years old. We found HPV 16 DNA in 91/302 (30.1 %) cases and HPV 18 DNA in 21/302 (6.95 %). HPV types 16 and 18 were detected in 25.8 and 4.5 % cytologically normal samples, respectively. HPV 16 was positive in 29.3 % of inflammatory samples. Squamous cervical abnormalities were more often HPV positive (HPV 16 in 48.6 %; HPV 18 in 29.7 %) than glandular abnormalities (36.4 and 18.2 %, respectively). We found high-risk HPV DNA in more than one third of the tested women. A good number of these HPV-positive cases were negative in cervical cytology.
