A Clinico-Haematological Study of Causes of Pancytopenia

BACKGROUND This is a clinic-haematological study, conducted in Sidhanta Hospital, Bhopal, to identify the causes of pancytopenia. Out of total 1200 cases of complete hemograms, 56 cases were categorized as pancytopenias, and out of these, 24 cases were subjected to bone marrow examination. The remaining 32 cases of pancytopenia, were put on periodic follow up with peripheral blood smear examination, based on clinical data. Pancytopenia is the simultaneous presence of anaemia, leucopenia and thrombocytopenia that may result from various disease processes, involving the bone marrow primarily or secondarily. Pancytopenia is reduction in all the three cellular components of the blood, namely red blood cells (RBCs), leucocytes (WBCs) and platelets. It is a common entity which is encountered by practitioners. The presentation is in the form of cytopenias leading to infections, anaemia, or bleeding manifestations. All the cases of pancytopenia need a through approach to reach to the cause of the same so that it can be managed in the best possible manner. Cytopenias are reduction in any of the three cellular components of the blood i.e. RBCs, WBCs or platelets. It can be reduction in two cellular components (bicytopenia) or a reduction in all the three cellular components (pancytopenia). In bicytopenia, the most common combination to be seen is anaemia and thrombocytopenia, whereas the least common is leucopenia with thrombocytopenia. (1) For practical purposes, it should have haemoglobin < 10 g%, absolute neutrophil count < 1,500/cumm and platelets < 1,00,000/cumm. It is labelled as severe when the three values are < 7 g%, < 500/cumm and < 20,000/cumm respectively. The purpose of this study was to find out different causes of pancytopenia and the use of bone marrow examination in evaluation of pancytopenia. METHODS This is a cross sectional study, conducted exclusively in the Department of Medicine, at a tertiary care hospital, in Bhopal from August 2019 to December 2019. A total of 56 cases of pancytopenia were analysed with clinico-haematological features. Criteria for diagnosis of pancytopenia were: Haemoglobin less than 10 gm/dl, TLC less than 4000/mm3 and platelet count less than 1,00,000/mm3. We have correlated the complete hemogram findings with bone marrow examination (if required) and peripheral smear examination in order to analyse the root cause of every case of pancytopenia. Pancytopenia is a haematological entity, we have to analyse the cause of it in order to find out the correct diagnosis and treat the patient accordingly. Bone marrow examination is useful in the investigation of PUO (pyrexia of unknown origin), as it leads to an etiological diagnosis in many of the cases. RESULTS In these 56 cases, only 24 cases (42.85 %) were subjected for bone marrow examination. Commonest cause of pancytopenia was episode of viral fever constituting 28 cases (50 %). CONCLUSIONS In cases of PUO, bone marrow examination is a very useful investigation. In cases diagnosed as idiopathic thrombocytopenic purpura (ITP), when the patient does not show improvement in counts, a repeat bone marrow examination should be done, as very rarely; acquired amegakaryocytic thrombocytopenia may be the cause. Though bone marrow examination is an absolute indication in cases of pancytopenia, it is important to wait for at least 2 – 3 weeks, and do a repeat hemogram, especially in cases of viral fever where the counts usually improve after fever subsides. KEY WORDS Pancytopenia, Bone Marrow, Viral Fever

Comparison of peripheral blood smear examination with automated haematology analyzer for diagnosing different types of anemia.

Objective: This study aims to determine diagnostic accuracy of peripheral blood smear and automated haematology analyzer and to determine frequency of different types of anemia diagnosed by peripheral blood smear and automated hematology analyzer. Study Design: Cross Sectional study. Setting: Department of Pathology, Rawal Institute of Health Sciences, Islamabad. Period: November 2015 to April 2016. Material & Methods: Sample size of 149 suspected anemia patients was calculated using WHO calculator with 95% confidence interval. Research approval was taken from hospital ethical board. Patients were approached through non probability consecutive sampling method. Both peripheral blood smear examination and automated haematology analysis of each sample was performed. Diagnostic accuracy and frequency of anemia types was measured. Data analysis was done with the help of SPSS version 25. Chi-square and fissure exact test and ROC curve analysis was applied and significant (p<0.05) results were reported. Results: Total 149 patients were included in study. There were 42(28.2%) male and 107(71.8%) female. Mean age of patients was 35.1±2.1SD. Peripheral blood smear and automated haematology analyzer showed sensitivity (68% vs 92%), specificity (59% vs 88%), PPV (72% vs 92%), NPV (55% vs 88%) and diagnostic accuracy (64% vs 91) respectively. Most common type of anemia diagnosed with peripheral blood smear was microcytic hypochromic anemia with raised RDW 36.7% followed by normocytic normochromic anemia with raised RDW 13.3% and macrocytic anemia (p=0.001) while in automated haematology analyzer microc ytic hypochromic anemia with raised RDW54.4% followed by normochromic normocytic anemoia with normal RDW 11.1% (p=0.000). Conclusion: Automated haematyology analyzer had high diagnostic accuracy for diagnosis of anemia. Microcytic hypochromic anemia and normocytic normochromic are most common anemias diagnosed by peripheral blood smear and automated hematology analyzer and peripheral blood smear cannot be completely replaced by automated haemolytic analyzer. However, if both methods are used simultaneously, more accurate results can be obtained.

CYTO-DIAGNOSIS OF PLEURAL EFFUSIONS: A COMBINED APPROACH TO MORPHOLOGICAL FEATURES IN ROUTINELY STAINED CYTOLOGY SMEARS AND CELL BLOCK TECHNIQUE

Introduction: Pleural cavity is a potential space between the parietal pleura and visceral pleural. It consists of some amount of uid called pleural uid which is normally less than 25ml. Pleural uid is produced by parietal lining and absorbed by visceral lining. Fluid is produced by plasma ltration through capillary endothelial cells. Aims & Objectives:Acombined approach of cytology and cell block technique in diagnosing the cause of pleural effusion. To evaluate the utility of cell block preparation over the conventional smear in the cytodiagnosis of serous effusions. Material & Methods: The present study was conducted on patients having pleural effusions. The cases and specimens were selected from the outdoor as well as indoor patients admitted in a tertiary care centre of North India and also from those sent directly to Pathology department from other hospitals. The duration of study was from January 2019 to September 2020. The specimens obtained were processed in the biochemistry, cytopathology and histopathology laboratory in the Pathology department of GSVM Medical College, Kanpur. Result And Analysis: Out of 100 cases studied it was found that 83 (83%) cases were of reactive pleural effusion and 17 (17%) cases were of malignant pleural effusions.Out of 17 malignant effusion, 16 (94%) cases were exudative, while 1 (6%) case was transudative.Only 8 cases of adenocarcinoma were diagnosed on smear examination, while 11 cases were diagnosed on cell block examination. 3 cases of poorly differentiated carcinoma were diagnosed on conventional smear and 5 cases on cell block examination.Out of total 17 malignant pleural effusions diagnosed by cell block, only 12 cases were diagnosed by conventional smear examination. Hence diagnostic yield increased by 30% using cell block preparations. Conclusion: Thus it was concluded that routine centrifuge is not satisfactory in reporting uids with scant cellularity. Hence for uids with scant cellularity cell block preparation is a useful method. Also the morphology of the cells were well appreciated by cell block as compared to routine centrifuge, thus aiding in accurate diagnosis. In this study the diagnoses which were missed or incompletely diagnosed on conventional smear were diagnosed by cell block.

Rate of Peripheral Blood Smear Examination Service Provision and Its Barriers Among Public Hospitals in Southern Ethiopia: A Mixed-Methods Study

Introduction: Peripheral blood smear examination is a vital hematological test for diagnosis and monitoring of disorders in blood. Despite the considerable benefits of this test in the battle against the growing burden of communicable and non-communicable diseases, its rate of provision is low. This study aimed to assess the rate of peripheral blood smear examination service provision and its barriers among public hospitals in southern Ethiopia.Method: We have conducted a descriptive cross-sectional study from January 01 to March 31, 2019, among five public hospitals in Southern Ethiopia. We collected socio-demographic data from patients and healthcare providers. We prepared peripheral blood smears from 423 patients with abnormal complete blood cell count. We examined a wright’s stained peripheral blood smear under the microscope to identify abnormality in the morphology of blood cells. We conducted key informant interviews with healthcare providers. We assessed health facilities using a standard checklist. We did descriptive statistical analysis for quantitative data using Statistical Package for Social Sciences (SPSS) version 20.0 software. We transcribed, categorized, and thematically analyzed the qualitative data. We presented the results in tables and figures.Result: The rate of provision of peripheral blood smear examination service was 11.6% (n= 49). Nearly 90% of the eligible patients did not receive this service. Relatively better rate of service provision was seen among hospitals with essential resources for the service, and those participating in Hematology external quality assurance. Lack of training, shortage of laboratory supplies, and inadequate supportive supervision were identified as barriers to regularly provide peripheral blood smear examination service.Conclusion: Rate of peripheral blood smear examination service provision is low. A large proportion of eligible patients missed the deserved service. Adequate laboratory supplies, training, and continued supportive supervision should be considered to improve the provision of this service.

Cytohistological Correlation of Cervical PAP Smears - A TwoYear Retrospective Study from Ongole, Andhra Pradesh

BACKGROUND Cervical cancer is one of the most common forms of cancer. In India it is the second most common cancer after breast carcinoma. PAP smear is the best screening method to reveal spectrum of lesions in cervix ranging from inflammatory to the neoplastic process. Because of easy accessibility of cervix, cervical screening is helpful for ready diagnosis of 90 % to 96 % cytological abnormalities even in the pre-invasive stage. We wanted to evaluate the importance of PAP smear examination as a preliminary method accommodating histopathology and assess the spectrum of lesions. METHODS The study was done to identify the target age groups for the early detection of cancerous cervix by PAP smear examination. The study was done on patients who attended government general hospital (GGH), Ongole, from January 2018 to December 2019. Lesions were categorized based on 2014 Bethesda system as negative intraepithelial lesion for malignancy (NILM) / Inflammatory, benign, premalignant, and malignant. The clinicocytological and histopathological examination (HPE) of cervical biopsy of corresponding smears were compared and analysed in the present study. RESULTS Of the 584 cases studied by PAP smear examination, maximum number of patients were between 21 and 60 years of age. Maximum number of patients came with the complaint of white discharge. Highest number of cases reported were NILM / inflammatory (54.18 %), followed by atypical squamous cells of undetermined significance (ASCUS) (20.68 %), high-grade squamous intraepithelial lesion (HSIL) (13.84 %), squamous cell carcinoma (SCC) (6.84 %), low-grade squamous intraepithelial lesion (LSIL) (1.65 %), metaplasia (1.19 %), atypical glandular cells of undetermined significance (AGUS) (0.51 %), adenocarcinoma (0.17 %). CONCLUSIONS Cervical PAP smear screening is simple, cost effective and reliable method for early detection of cervical cancers. Classification of lesions based on Bethesda terminology is most informative and useful. Correlation of PAP smear cervical cytology with gold standard HPE provides greater efficacy in diagnosis. KEYWORDS PAP smears, NILM, ASCUS, AGUS, LSIL, HSIL

Prevalence of Theileria equi and Babesia caballi Infections in Horses in South Gujarat, India

Background: Equine piroplasmosis (EP) is a tick-borne disease of horses caused by the intraerytrocytic protozoan parasites. The infected animals remain carriers of these blood parasites for long periods and spread the disease. The introduction of carrier animals into areas where competent tick vectors are prevalent can lead to an epizootic spread of the disease.Methods: Total 295 blood smears from diseased and healthy horses were examined and 295 serum samples were analyses by cELISA for the presence of antibodies against T. equi and B. caballi whereas 90 DNA samples from seropositive horses were screened by PCR for presence of parasite’s DNA. Result: In present study, 1.35% horses were found positive for T. equi by means of blood smear examination. Using c-ELISA, it was found that 03 (1.02%) horses had antibodies against B. caballi and 182 (61.69%) against T. equi, while none of the sample showed mixed reactions. Ninety (90) seropositivehorses screened for T. equi and B. caballi by PCR method, out of which, only Nine (09) horses werefound positive indicating an overall prevalence rate of T. equi was 10.00% by PCR. None ofthe horses found positive for B. caballi through blood smear examination and PCR method.

Study of RBC Histograms and Its Correlation with Etiopathogenesis and Other Parameters in Various Anemias

The pluripotent stem cells which are present in the bone marrow renew by its own and differentiate into mature cells. These stem cells undergo division by the presence of erythropoietin, where the nucleus is extruded out from the cell during the end of differentiation, thereby retaining cytoplasmic RNA to form a reticulocyte. The reticulocyte i s a precursor to red blood cell and on losing the RNA it matures into a Red Blood Cell. The present study aimed to analyze the correlation between the automated histogram patterns along with morphological features of RBC‘s prepared from peripheral smear examination in different types of anemia. viz., MCV, MCH, MCHC & RWD- CV.

Tuberculosis among Migrant Populations in Sicily: A Field Report

Background. In the EU, tuberculosis (TB) mainly affects vulnerable people, including migrants. From 2014 to 2017, we have estimated the frequency of both tuberculosis and latent tuberculosis infection (LTBI) among the migrant population hosted in 41 reception centers in western Sicily (ITaCA network). Materials and Methods. All migrants were consecutively recruited for the screening of TB infection with physical examination and TST in 1,020 migrants and with IGRA in the others 2,690. The screening was carried out 4–8 weeks after landing in Sicily. For all migrants with a positive screening test, chest X-ray and smear examination were performed. LTBI was defined by positivity of TST or IGRA with negative X-ray chest, clinical, and smear examination. Active TB was defined by radiological and/or clinical and/or sputum positivity in a patient with a TST or IGRA positivity. Results. We evaluated a total of 3,710 migrants, of which 89% came from Sub-Saharan countries; 2,811 were males, 899 were females, with a median age of 22 years (IQR: 18–25). TB infection was diagnosed in 501 persons (13.5%) of which 440 (11.8%) had LTBI and 61 had active TB (1.6%): 1 had lymph node TB, 1 had intestinal TB, and 59 had pulmonary TB (38 sputum smear positive TB; no drug-resistant TB were observed). Conclusions. TB screening is critical to early diagnosis and treatment.

Strengthening the Role of Cadres and Village Midwives to Support the Cervical Cancer Awareness Movement in Puhu Payangan Village, Gianyar, Bali, Indonesia

Cervical cancer is the most common type of cancer in Balinese women, and most of the cervical cancer patients came in advanced condition. The health survey conducted in the village of Puhu, Payangan, Gianyar, found that the coverage of cervical cancer screening is 12%, which is considered as low. Payangan’s sub-district health centers (Puskesmas) have made an effort to give free PAP smear screenings to the local community, but it still has not received a good response. This is related to the community’s lack of knowledge on cervical cancer, low awareness of cancer screening, and false stigma about PAP smear examination. To overcome this problem, an effort is needed to increase awareness about the need for PAP smear screening by shaping it into a cervix cancer awareness movement "Gardavi", involving village midwives and housewife members of Empowerment and Family Welfare Group (PKK) in Puhu Village as cadres. Methods that are used in this community service include training for midwives, activation of tiered information system involving midwives-cadres and the community, knowledge provision as well as motivating cadres. This event is done to increase the role of village midwives and cadres to actively participate in PAP smear screenings in their region, therefore, it may increase screening outcomes and lower mother morbidity and mortality numbers due to cervical cancer. This event results in increased midwives’ knowledge and skill on the technique of sampling PAP smear independently, increased visits to the Community Health Sub-Center (Pustu) for PAP smear examination, creation of a midwives-cadres-community coordination system, cadres independently playing an active role in motivating the village community to do screening, as well as increased cadres’ optimism.