scholarly journals Sehgal index and its comparison with Mentzer's index and Green and King index in assessment of peripheral blood smear with marked anisopoikilocytosis

2020 ◽  
Vol 8 (8) ◽  
pp. 2972
Author(s):  
Naincy Rastogi ◽  
Arvind S. Bhake
Keyword(s):  
Developing Countries ◽  
Peripheral Blood ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Blood Film ◽  
Beta Thalassemia ◽  
Cell Parameters ◽  
Microcytic Hypochromic Anaemia ◽  
Hypochromic Anaemia ◽  
Youden’S Index

Background: Mild microcytic hypochromic anaemias due to iron deficiency (IDA) and beta thalassemia trait(β-TT) continue to be a cause of significant burden to the society, particularly in the poorer developing countries. The objective of the present study was to study the RBC based indices in patients of marked anisopoikilocytosis in determining the etiology of it, to standardize few automated red cell parameters, and also objective grading of RBC morphology on peripheral smear and interpreting its utility in indicating a diagnosis. Also, to establish a relation between value of RBC indices with that of degree of anisocytosis.Methods: A total of 500 patients diagnosed with mild microcytic hypochromic anaemia on complete blood count and peripheral blood film were included in the study. Hb, RBC count, MCV, MCH and RDW obtained from the electronic cell counter were used to calculate discrimination indices by various mathematical formulae. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Youden’s index (YI) were calculated.Results: Green and King index demonstrated the lowest sensitivity of 70.51%. Mentzer index demonstrated the highest specificity of 96.80%. The highest and lowest PPV were found for Mentzer index (97.09%) and Sehgal index (92.81%) respectively. Sehgal’s index demonstrated the highest NPV of 95.96% and lowest NPV was exhibited by G and K (87.9%). The highest and the lowest values for Youden’s index were shown by Sehgal’s index (87.82%) and G and K index (68.47%).Conclusions: Sehgal’s index followed by Mentzer index are highly sensitive and reasonably specific in differentiating β-TT from IDA and none of the indices is 100% sensitive and specific. Though HbA2 estimation is the gold standard for diagnosing β-TT, in developing countries, Sehgal index followed by Mentzer et al, index can be used to screen mild microcytic hypochromic anaemia cases to eliminate as many false positive cases as possible to reduce the financial cost.

scholarly journals Beta Thalassemia Trait among Antenatal Mothers and Those with Microcytic Anaemia

2021 ◽  
Vol 8 (28) ◽  
pp. 2503-2508
Author(s):  
Mohan D. Kashinkunti ◽  
Radhika Acharya
Keyword(s):  
Iron Deficiency ◽  
Complete Blood Count ◽  
Gene Mutations ◽  
Beta Thalassemia ◽  
P Value ◽  
Microcytic Hypochromic Anaemia ◽  
Hypochromic Anaemia ◽  
Thalassemia Minor ◽  
Thalassemia Trait ◽  
Patient Department

BACKGROUND Among microcytic hypochromic anaemias, the most common disorders are iron deficiency anaemia (IDA) and co-pathological conditions such as α- or βthalassemia (α- or β- thalassemia) traits. Thalassemia minor is often an asymptomatic carrier state but exhibit marked microcytosis that can be mistaken for iron deficiency. About 1.5 % of the global population (80 to 90 million people) are carriers of thalassemia and more than 200 mutations are described in thalassemia, the only effective way to reduce burden of thalassemia is to prevent birth of homozygotes. The purpose of this study was to estimate the prevalence of beta thalassemia trait (BTT) in adult individuals with microcytic hypochromic anaemia and among antenatal mothers visiting the Obstetric Department of SDMCMSH. METHODS In this prospective descriptive study, 101 adult patients between 18 and 40 years who were in in-patient department (IPD) or attending out-patient department (OPD) from department of general medicine and department of haematology were studied during a period of one year from October 2018 to October 2019 and their blood sample was sent for complete blood count (CBC), iron studies and haemoglobin electrophoresis. All the data was entered in Microsoft Excel software and analysis was done using Minitab software. P value of less than 0.05 was considered statistically significant. RESULTS Out of the 101 microcytic hypochromic anaemia patients analysed, 7 patients have beta thalassemia trait. 4 of the 7 are females. Their haemoglobin electrophoresis report showed high HBA2 value of > 3.8. There were no carriers among the pregnant individuals tested. A regression model was fitted for predicting HBA2 based on values of serum iron, serum ferritin, and mean corpuscular volume (MCV). CONCLUSIONS In conclusion, identification of thalassemia gene mutations in our population is necessary because of the country’s multiracial population. This will prevent unnecessary treatment with iron supplements in thalassaemic patients and also helps in pregnant women to prevent thalassemia major children. Molecular genotyping provides a rapid and reliable method for identification of common, and unknown α - and β - gene mutations, which help to diagnose unexplained microcytosis and thus prevent unnecessary iron supplementation. We conclude that microcytosis due to thalassemia is common in north Karnataka. This illustrates the importance of adequate prenatal and laboratory investigation for these abnormalities. KEYWORDS Beta Thalassemia Trait, Microcytosis, Haemoglobin Electrophoresis, Antenatal Screening, Thalassemia

NCMP-17. BEWARE: ALL POSTERIOR FOSSA MASSES IN CHILDREN ARE NOT BRAIN TUMORS

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi150-vi150
Author(s):  
Magimairajan Issai Vanan ◽  
Jie Li ◽  
Muhamad Almiski ◽  
Martin Bunge ◽  
Demitre Serletis ◽  
...  
Keyword(s):  
Posterior Fossa ◽  
Peripheral Blood ◽  
Complete Blood Count ◽  
Incidental Finding ◽  
Vasogenic Edema ◽  
Blood Film ◽  
Rare Presentation ◽  
Intracranial Mass ◽  
Adjacent Structures ◽  
Definitive Therapy

Abstract INTRODUCTION Isolated Myeloid sarcoma (MS) of the central nervous system (CNS-MS) is a very rare presentation of Acute Myeloid Leukemia (AML). A 10-year-old boy with a two-week history of intermittent headaches was referred to the emergency department (ED) by an optometrist for evaluation of bilateral papilledema. Physical examination in the ED confirmed the presence of papilledema with no other abnormal neurologic findings. Emergent MRI of the brain showed an avidly homogeneously enhancing extra-axial dural based mass in the right posterior fossa measuring 4.8 cm (AP) x 3.2 cm (CC) x 4.6cm (T), with significant mass effect and peri-tumoral vasogenic edema. Neuro-surgery consultation was obtained and complete blood count (CBC) was normal except for the presence of 13% blasts with occasional Auer rods seen on the peripheral blood smear. Bone marrow aspirate demonstrated 56% myeloblasts; A diagnosis of AML with CNS-MS (CNS-3c) was made and the initial lumbar puncture (LP) was deferred due to the risk of CNS herniation. Induction chemotherapy was initiated as per protocol. A CT scan done two weeks later showed complete resolution of the intracranial mass. DISCUSSION The incidental finding of papilledema, with imaging to investigate the intracranial pathology revealed a large posterior fossa mass in our patient. However, the atypical features of the mass (dural based extra-axial location; extensive infiltration into adjacent structures) and the finding of blasts with Auer rods in peripheral blood helped us to diagnose CNS-MS, and avoided an extensive neurosurgical procedure and a delay in definitive therapy. Our patient had a normal CBC and the review of the peripheral blood film by an experienced Hematologist was very crucial in making a clinical diagnosis of MS. CONCLUSION Myeloid sarcomas should be considered in the differential diagnosis of an intracranial mass, particularly when accompanied by abnormal findings in the CBC.

scholarly journals Haemoglobin D Trait-An Uncommon Haemoglobinopathy in Chattogram: A Case Report

2021 ◽  
Vol 20 (1) ◽  
pp. 81-83
Author(s):  
Razia Sultana ◽  
Tani Gosh
Keyword(s):  
Laboratory Medicine ◽  
Blood Film ◽  
Subsequent Pregnancy ◽  
Heterozygous State ◽  
Compound Heterozygosity ◽  
Medicine Department ◽  
Microcytic Hypochromic Anaemia ◽  
Hypochromic Anaemia ◽  
Hb E ◽  
Peripheral Blood Film

This case presents haemoglobin D Trait (Hb-D) which is a rare disease in Bangladesh. It is a heterozygous state for haemoglobin D who came to Laboratory Medicine Department of Chattogram Maa Shishu-O-General Hospital (CMSOGH) for heamoglobin electrophoresis. Our patient was 9 years old girl from Noakhali, Bangladesh. She was clinically silent with no splenomegaly. Her peripheral blood film was microcytic hypochromic anaemia and Capillary Electrophoresis (CE) of Hb revealed Hb D Trait. On family screening her father was Hb E trait, mother was Hb D trait and younger sister turned out normal Hb study. Compound heterozygosity for haemoglobin D and haemoglobin E may be present in subsequent pregnancy of her mother. Chatt Maa Shi Hosp Med Coll J; Vol.20 (1); January 2021; Page 81-83

scholarly journals Explore the Predictive Value of Peripheral Blood Cell Parameters in Refractory Mycoplasma pneumoniae Pneumonia in Children Over 6 Years Old

2021 ◽  
Vol 9 ◽  
Author(s):  
Yaoyao Ling ◽  
Jing Ning ◽  
Yongsheng Xu
Keyword(s):  
Pleural Effusion ◽  
Blood Cell ◽  
Mycoplasma Pneumoniae ◽  
Peripheral Blood ◽  
Predictive Value ◽  
Fiberoptic Bronchoscopy ◽  
Peripheral Blood Cell ◽  
Binary Logistic Regression Analysis ◽  
Cell Parameters ◽  
Lymphocyte Ratio

Background: To determine the predictive value of peripheral blood cell parameters for refractory Mycoplasma pneumoniae pneumonia (RMPP) in children over 6 years old.Methods: A retrospective study was conducted in children with RMPP admitted to the respiratory department of Tianjin Children's Hospital from September 2017 to September 2019, and non-refractory Mycoplasma pneumoniae pneumonia (NRMPP) was selected by the propensity score method and matched according to the ratio of 1:1.5. We analyzed the differences in clinical characteristics, peripheral blood cell parameters, imaging findings, and treatments between the two groups, and further determined the predictive value of peripheral blood cell parameters on RMPP.Results: There were 76 patients in the RMPP group and 114 patients in the NRMPP group. We found that the RMPP group has a longer clinical course and a higher incidence of intrapulmonary and extrapulmonary complications (p < 0.01). Moreover, the proportion of children in the RMPP group who received immunotherapy (such as glucocorticoid, gamma immunoglobulin) and fiberoptic bronchoscopy intervention was higher than that in the NRMPP group (p < 0.01). Meanwhile, the level of neutrophil, neutrophil/lymphocyte ratio (NLR), platelet count/lymphocyte ratio (PLR), mean platelet volume/lymphocyte ratio (MPVLR), C-reactive protein (CRP), lactic dehydrogenase (LDH), and interleukin (IL)-6 in the RMPP group was significantly higher (p < 0.01) than those in the NRMPP group. The incidence of pulmonary consolidation, atelectasis, and pleural effusion was also higher in the RMPP group (p < 0.05). ROC curve and binary logistic regression analysis showed that NLR > 3.92 (OR = 3.243; 95% CI = 1.485–7.081; p = 0.003), MPVLR > 5.29 (OR = 2.700; 95% CI = 1.258–5.795; p = 0.011), and pleural effusion (OR = 3.023; 95% CI = 1.424–6.420; p = 0.004) were significant factors in predicting RMPP. Our study showed that NLR had higher accuracy in predicting RMPP than CRP.Conclusions: The parameters of peripheral blood cells might be a predictor of RMPP. NLR > 3.92, MPVLR > 5.29, and pleural effusion might have important predictive value for RMPP in children over 6 years old.

How much apoptosis does carbon monoxide poisoning cause? Primary clinical soluble TWEAK protein level study

2019 ◽  
Vol 38 (8) ◽  
pp. 974-982 ◽  
Author(s):  
N Dindar Badem ◽  
E Cömertpay ◽  
F Coşkun
Keyword(s):  
Carbon Monoxide ◽  
Peripheral Blood ◽  
Protein Level ◽  
Cell Apoptosis ◽  
Predictive Value ◽  
Complete Blood Count ◽  
Carbon Monoxide Poisoning ◽  
Control Group ◽  
Co Poisoning ◽  
Arterial Blood

Carbon monoxide (CO) is an important cause of deaths via poisoning. CO poisoning causes inhibition of O2 transport and development of tissue hypoxia, which then causes cell apoptosis. A significant indicator of cell apoptosis, soluble tumor necrosis factor-like weak inducer of apoptosis (sTWEAK) protein, is important for the stimulation of apoptosis. The primary purpose of this study is to determine whether apoptosis occurs during acute CO poisoning and to show that sTWEAK protein is an indicator of apoptosis that can be analyzed as a marker in the peripheral blood sample. The secondary aim is to determine the diagnostic and prognostic values of sTWEAK protein. The study was performed prospectively on 43 patients with CO poisoning and 30 healthy volunteer control individuals. The anamneses were taken from all patients, who also underwent physical examination. Complete blood count, biochemical markers, cardiac enzymes, and arterial blood gas measurements were analyzed. All the patients’ sTWEAK protein levels were also analyzed. The sTWEAK protein level of patients with CO poisoning was 2278 pg/mL (1197–7234), while the level of the control group was 1609 pg/mL (310–3721). The patients’ sTWEAK levels were significantly higher than the controls (area under the curve: 0.77 (0.66–0.89); p < 0.001), and the cutoff value was determined as 1895.50 pg/mL. The cutoff level had a sensitivity of 74.4%, a specificity of 76.7%, a positive predictive value of 82.0%, and a negative predictive value of 67.6%. sTWEAK is a significant indicator of apoptosis in CO poisoning that can be analyzed in the peripheral blood. However, further clinical trials are needed in terms of prognostic criteria.

scholarly journals Ascites in a young male: idiopathic FIP1L1-PDGFRA-negative hypereosinophilic syndrome

JRSM Open ◽  
2020 ◽  
Vol 11 (1) ◽  
pp. 205427041989482
Author(s):  
Ganesh Kasinathan ◽  
Jameela Sathar
Keyword(s):  
Peripheral Blood ◽  
Eosinophil Count ◽  
Complete Blood Count ◽  
Epigastric Pain ◽  
Hypereosinophilic Syndrome ◽  
Blood Film ◽  
Whole Body ◽  
Wall Thickening ◽  
Medical Department ◽  
Absolute Eosinophil Count

Introduction Idiopathic hypereosinophilic syndrome is defined as persistently elevated peripheral blood absolute eosinophil count of more than 1.5 × 109/L for at least six months with no obvious secondary cause. Case Presentation We report the case of a 26-year-old gentleman of Malay ethnicity who presented to the medical department with a three-week history of abdominal distension associated with dyspepsia and epigastric pain. Physical examination revealed ascites. The complete blood count portrayed peripheral leucocytosis with eosinophilia of 8.84 × 109/L. Parasitic serology was negative. Paracentesis analysis showed exudative ascites with an absolute eosinophil count of 8 × 109/L. He was referred to the haematology department. He was noticed to have bilateral tonsillitis and pruritic skin rash at the legs. There were no palpable lymph nodes or organomegaly. A peripheral blood film showed 44% eosinophils with no excess blasts. Clonal eosinophilic fusion studies did not detect FIP1L1-PDGFRA mutation. JAK2 V617F and BCR-ABL1 mutations were undetected. Serum B12 and tryptase levels were normal. A whole-body computed tomography imaging showed bowel wall thickening at the duodenum, jejunum, ileum, rectosigmoid and splenic flexure. Sections of fragments taken from the endoscopy showed features of eosinophilic gastritis and colitis on histology. Bone marrow biopsy depicted marked eosinophilia. He was started on oral imatinib mesylate 200 mg daily and oral prednisolone 0.5 mg/kg daily which was tapered based on response. He achieved complete remission and is now asymptomatic. Conclusion The diagnosis of hypereosinophilic syndrome should be considered in a patient with unexplained ascites. Secondary sinister causes such as malignancy should always be excluded.

scholarly journals COMPARATIVE STUDY OF ANAEMIA CASES BASED ON PERIPHERAL BLOOD SMEARS AND CELL COUNTER GENERATED RED CELL INDICES

2020 ◽  
pp. 32-34
Author(s):  
Durga Nand Jha ◽  
Ajit Kumar Chaudhary ◽  
Debarshi Jana
Keyword(s):  
Peripheral Blood ◽  
Red Cell ◽  
Peripheral Smear ◽  
Microcytic Hypochromic Anaemia ◽  
Hypochromic Anaemia ◽  
Blood Smears ◽  
Normocytic Normochromic Anaemia ◽  
Red Cell Indices ◽  
Peripheral Blood Smears ◽  
Cell Counter

Background: Analyzing peripheral blood smears routinely has facilitated interpretation of various hematological disorders and has been a major diagnostic tool. The advent of automated hematology cell counter has improved accuracy, precision and safety. There is still a need to depend on manual techniques for primary calibration. This highlights the importance of maintaining the manual technical skills, Thus, the present study was undertaken to compare anaemia cases based on peripheral blood smears and cell counter generated Red blood cell (RBC) Indices. Material and Methods: The peripheral blood smears in anaemia were evaluated and compared it with cell counter generated red cell indices of 500 anemic patients. The automated analyzer SYSMEX XP-100 was used.Simultaneously, a peripheral smear was prepared according to standard operating procedures and stained by Leishman stain. Results: The cases consisted of normocytic normochromic anaemia (14%), microcytic hypochromic anaemia (76.2%), macrocytic anaemia (0.4%) and dimorphic anaemia (13.4%). In normocytic normochromic anaemia on peripheral smears 65.7% showed normal curve. In microcytic hypochromic anaemia 81.1% showed left shift. In cases of macrocytic anaemia 100% histogram showed right shift. Majority of the curves in dimorphic anaemia showed broad based curve (46.26%). Discussion: The relationship between histogram patterns and peripheral smear diagnosis in dimorphic anaemia posed queries regarding the validity of histocytograms. Hence, peripheral smear examination along with clinical history is an important diagnostic tool while handling the patients with hematological conditions.

scholarly journals Predicting asymptomatic neurosyphilis using peripheral blood indicators

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Weijie Li ◽  
Jiaqi Han ◽  
Pan Zhao ◽  
Dagang Wang ◽  
Tianhao Sun ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Lumbar Puncture ◽  
Peripheral Blood ◽  
Predictive Value ◽  
Area Under The Curve ◽  
Youden’S Index ◽  
Hiv Negative

Abstract Background The high misdiagnosis rate of asymptomatic neurosyphilis (ANS) has long challenged infectious disease clinicians. We aim to develop a model for diagnosing ANS in asymptomatic syphilis (AS) patients without CSF indicators. Results 277 AS patients with HIV-negative and underwent lumbar puncture were enrolled in this horizontal study.The area under the curve for predicting ANS by CSF leukocytes and protein was 0.643 and 0.675 [95% CI, 0.583–0.699VS.0.616–0.729]. Through LRM, the AUC increased to 0.806 [95% CI, 0.732–0.832], and the Youden's index was 0.430. If the score is ≤ 0.159, ANS can be excluded with a predictive value of 92.9%; we can identify ANS while the score is over 0.819, with a predictive value of 91.7% and a specificity of 99.25%. This study showed that the LRM can diagnose ANS in AS patients effectively. Conclusion Given a large number of misdiagnosis ANS patients and CSF results' insufficiency, the model is more practical. Our research will help clinicians track suspected syphilis, especially those who cannot accept the CSF test.

scholarly journals Analysis of peripheral blood white blood cell parameters in White stork (Ciconia ciconia L.) chicks varies by sex

2018 ◽  
Author(s):  
Monika Grandtke ◽  
Mariusz Kasprzak ◽  
Mateusz Ciepliński ◽  
Ewa Burda ◽  
Ariel Durajski ◽  
...  
Keyword(s):  
Peripheral Blood ◽  
Blood Cells ◽  
White Blood Cells ◽  
Blood Film ◽  
White Stork ◽  
Qualitative And Quantitative Analysis ◽  
Cell Parameters ◽  
White Storks ◽  
Males And Females ◽  
Dark Blue

The aim our study was qualitative and quantitative analysis of white blood morphometric elements of peripheral blood (determining the quantity, blood cells dimension and several hematological values) in White Stork chicks. One of the aims was to indicate whether the sex relevantly influences the variety of the examined white blood indicators. White blood cells parameters of 53 White Stork chicks, with molecularly marked sex, was examined. Blood samples were collected in southern Poland (around Krapkowice town, near Opole city). Lymphocytes of White Storks (mean 37% for females and males) were identified as round cells with dark purple non-lobed, eccentrically positioned nucleus. Among the whole population we differentiated small lymphocytes: with diameters of 5.31 ± 0.65 μm in males and 5.57 ± 0.59 μm in females, and large lymphocytes with a diameter of 8.10 ± 0.66 μm and 8.28 ± 0.74 μm, respectively in females and males. Monocytes (mean 8% for female and males) were the largest leukocytes found in the blood film of White Stork, measuring 13.40 ± 0.97 μm for males and 13.09 ± 1.05 μm for females in diameter. The cytoplasm was abundant and it stained blue-gray, very often contained vacuoles. Heterophils (mean 42.7%) were the largest in granular leukocytes group. They were round and 11.14 ± 0.65 μm for males and 11.01 ± 0.48 μm for females in diameter. The nucleus of heterophils was lobed, usually with two or three lobes. The cytoplasm contained brick-red, elongated granules. Eosinophils (mean 9.44%) were round cells, with a diameter of 10.72 ± 0.49 μm and 10.97 ± 0.53 μm, respectively in males and females. The nucleus was lobed and mostly stained clear blue and contained red-orange, round or rod-shaped granules. Basophils (mean 1.84%) were round and contained dark blue granules, with average of 9.56 ± 0.78 and 9.13 ± 0.84 μm in diameter, for males and females. The nucleus was usually non-lobed. The H/L ratio was 4/4 for both sexes. No significant differences in levels and types of leukocytes between male and female juvenile storks have been observed.

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