Cerebrospinal fluid cytology in patients undergoing combined spinal epidural versus spinal anaesthesia without an introducer.

The problem of tissue coring exists despite the availability of smaller gauge spinal needles with special tip designs. The aim of the study was to test the hypotheses that a) subarachnoid block given as a part of a combined spinal epidural intervention by needle-through-needle technique introduces a lesser number of epithelial cells into the subarachnoid space compared to isolated subarachnoid block, and b) after lumbar puncture, the initial few drops of cerebrospinal fluid from the spinal needle will have a higher number of epithelial cells than the subsequent sample. One hundred and seven patients of American Society of Anesthesiologists physical status I to III undergoing infra-umbilical surgery were enrolled. Seven patients were excluded from the study and the rest divided into two groups to receive either combined spinal epidural anaesthesia (group A) or isolated subarachnoid anaesthesia, unaided by an introducer (group B). The two groups were compared for the presence of epithelial cells in cerebrospinal fluid. The initial four to six drops of cerebrospinal fluid (sample 1) were collected, the next four to six drops discarded and the following four to six drops (sample 2) collected. The incidence of coring was 96% in group A and 88% in group B (P = 0.142). The median (interquartile range) number of cells in group A, for samples 1 and 2 was 6 (3 to 12.5) and 6 (3 to 10); and in group B, 3.5 (1 to 10) and 4 (1 to 8) respectively. Significant tissue coring was observed with both techniques. Discarding eight to 12 drops of cerebrospinal fluid did not help in reducing the epithelial cell load.

Utility of family studies in diagnosing abnormal hemoglobins/thalassemic states.

OBJECTIVE: To resolve all indeterminate cases on HPLC screening with the help of family studies and to further confirm the results by genetic analysis. METHODS: In our 11 years experience with HPLC at Sir Ganga Ram Hospital, we solved many cases with the help of family studies on parental blood samples in which patient could have possibly been homozygous vs compound heterozygous. Genetic analysis was done on index case as well as on parental samples with ARMS-PCR technique to confirm the results. RESULTS: In 100% of cases, we noted that the diagnosis obtained by family studies was commensurate with that obtained by DNA analysis. CONCLUSION: In centers, which do not have the facility for genetic analysis, family studies by HPLC can be equally useful.

Primary non-secretory plasma cell leukemia with atypical morphology - a case report.

Only one case of primary non-secretory plasma cell leukemia with atypical morphology has been reported thus far. Here we report another such case of plasma cell leukemia diagnosed on fl ow cytometry, as morphological heterogeneity and lack of monoclonal immunoglobulins in both serum and urine, made it difficult to come to a conclusive diagnosis based purely on morphology.

Case report of HbC/beta(0)-thalassemia from India.

This 22-year-old women presented to the ante-natal clinic of this hospital for prenatal screening for beta-thalassemia. Cation exchange high performance liquid chromatography (HPLC) using 'Beta Thalassemia Short Program' on Bio-Rad 'Variant' system revealed HbC value of 81.6%. The CBC showed microcytic hypochromic anemia. The HPLC and CBC suggested the possibility of compound heterozygote state for HbC/beta-thalassemia. The alkali and acid electrophoresis findings were consistent with the above diagnosis. The DNA analysis confirmed compound heterozygote state for HbC/beta(0)-thalassemia (Fr 8/9 mutation). The studies on the parents showed that mother was a compound heterozygote for HbD(Punjab) and HbC while father had beta-thalassemia trait. To the best of our knowledge, this is the first confirmed report of HbC from India. The paper discusses the hematological findings in this subject and her mother (a compound heterozygote for HbD(Punjab) and HbC).