peripheral blood film
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2021 ◽  
Vol 4 (2) ◽  
pp. 502-505
Author(s):  
Swathi C Prabhu ◽  
Anita Tahlan ◽  
Shreya Sharma ◽  
Sarabmeet S Lehl

Malaria is one of the most common parasitic diseases causing a significant burden on health care, especially in India. Light microscopy, the gold standard for malaria diagnosis is time-consuming especially in a setup where the caseload is high and parasite index is low. Knowledge of abnormal scattergrams by the malarial parasite is very essential to suspect malaria and screen those cases thoroughly on a peripheral smear for accurate diagnosis. A timely and accurate diagnosis is crucial to the prognosis of this disease. Herein, we report a case of a 40-year-old male from Punjab who presented to the emergency with fever and an altered sensorium. Analyzer showed characteristic pseudo eosinophilia with greying of neutrophil eosinophil zone with double eosinophil cluster. According to flagging rules because of eosinophilia, peripheral blood film (PBF) was made and examined, which revealed Plasmodium falciparum gametocytes.


Author(s):  
Tanya Pruthi ◽  
Bimal K. Agrawal ◽  
Shiv Pankaj Khanna ◽  
Jaskaran Bazad ◽  
Mini Bhatnagar

An elderly male presented with symptoms suggestive of anemia. During workup for the same he was found to have very high levels of serum Ferritin along with a normocytic, normochromic peripheral blood film and no other apparent cause for hyperferritinemia .A swelling which incidentally found on his shin was further investigated by FNAC confirmed presence of soft tissue sarcoma.


Author(s):  
Amber Haroon ◽  
Huda Zameer ◽  
Aneeqa Naz ◽  
Sohaib Afzal ◽  
Tooba Ammar ◽  
...  

Background: Alterations in the hematological parameters are thought to have the capacity to act as an adjuvant tool in strengthening the suspicion of malaria, thereby prompting a more meticulous search for malaria parasites.Methods: 186 cases with malaria positive for immunochromatographic test (ICT) malaria presenting with fever ≥101 °F, confirmed on peripheral blood film, of 20-60 years were included. Patients with coagulopathy and bleeding disorders such as hemophilia, brain tumors, tuberculosis meningitis, viral or bacterial encephalitis and multiple sclerosis were excluded. Sample was taken to the laboratory, for routine investigations like ICT malaria and complete blood count (CBC) to diagnose anemia and low platelet count.Results: Patients of 20 to 60 years of age with mean 41.80±8.51. Out of 186 patients, 101 (54.30%) were male and 85 (45.70%) were female with 1:2:1 ratio. Mean duration of disease was 4.91±1.32 days. Frequency of derangement in hematological parameters was anemia in 27 (14.52%) patients and 142 (76.34%) with thrombocytopenia. 127 cases were of Plasmodium vivax and 59 cases were of Plasmodium falciparum. Patients were more anemic as disease period prolonged. Patients infected by Plasmodium vivax showed more tendencies towards anemia and reduction in platelet count as compare to Plasmodium falciparum.Conclusions: The frequency of derangement in hematological parameters i.e. anemia and low platelet count, among malarial patients is quite high and more cases were of Plasmodium vivax and it showed anemia and thrombocytopenia was more pronounced in Plasmodium vivax.


Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4226-4226
Author(s):  
Francis N. Ssali ◽  
Joan Aturinde ◽  
Daniel Muyanja ◽  
Cissy Kityo

Abstract Introduction The current International Society on Thrombosis and Hemostasis (ISTH) guideline of Thrombotic Thrombocytopenic Purpura (TTP) recommends Therapeutic Plasma exchange (TPE) and corticosteroid in the management of TTP, with Rituximab and Caplasizumab as additional potential therapies [X Long Zheng et al, J Thromb Haemost. 2020;18:2496-2502]. This potentially fatal condition requires prompt diagnosis and treatment but large volume plasma treatment is not without risk and in settings with limited access with sufficient compatible plasma for apheretic exchange, this can delay this emergency therapy. We have been running the first therapeutic apheresis services with an Optia instrument in Uganda at the Joint Clinical Research Centre in Kampala city and TTP is the main indication for TPE. We present 2 recent sequential cases of TTP that were successfully managed when Bortezomib was combined with plasma therapy. Case1. A 25yr woman referred to our service on 29/09/2020, with recent onset of bruising, icterus, severe anemia Hgb5.7g/dL, Severe thrombocytopenia 8 x 10 3/uL, a high LDH 3909U with schistocytes on the peripheral blood film severe thrombocytopenia and a negative Direct Antiglobulin test. She was Blood Group B+. She was managed with 3 sessions of TPE of 2.1, 1.1 and 2.0 plasma volume exchanges with 6727mL, 3026mL and 5459mL of replacement plasma respectively and oral prednisone 60mg daily without remission. Subsequent quantities of plasma were insufficient for apheresis and were instead transfused. She also received weekly Rituximab 500mg (IV) but without significant recovery in the platelet count until she received Bortezomib 2mg (SC) when there was corresponding recovery of the platelet count and with each dose to a total of 4 doses (Figure 1). Case2. A 55yr man was previously well and shopping in a mall when he had an index episode of seizures on 19.Jun.2021 and was hospitalized that day with altered consciousness and focal motor signs. He required intubation for 3 days and at the time of hospitalization, he had Hgb 9gm/dL, PLT 17 x 10 3/uL, LDH2177U, with numerous schistocytes on the peripheral blood film and a negative Direct Antiglobulin Test. The baseline blood sample functional ADAMTS13 was 3% and had Blood Group AB+. He had received the 1 st dose of the Astra-Zeneca Covid19 vaccine on 06.May.2021. It was not possible to get any AB plasma and we considered it risky to perform large volume TPE with non-AB plasma and he was instead treated with daily transfusion with Group A+ Plasma concurrent with daily Prednisone 60mg. Because of our previous experience of poor response to Rituximab, we opted to treat him upfront with 4 doses of 2mg bortezomib (SC) given 3 days apart. He made brisk recovery to complete remission and was discharged for weekly outpatient CBC and LDH monitoring. His platelet count subsequently dropped without a corresponding drop in the Hgb and no rise in the Hgb. We initially re-hospitalized him for 4 more days of plasma transfusion but without a brisk response and since the LDH was not increasing, the isolated Thrombocytopenia was considered a side effect of Bortezomib that was expected to resolve and he receive no further treatment but continued to recover to complete remission as an out-patient (figure 2). Discussion: Our findings suggest a possible role for Bortezomib in frontline therapy for TTP with potential to reduce the plasma requirement in TPE and this approach warrants a randomized clinical trial. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. OffLabel Disclosure: Bortezomib Indicated in the management of Multiple Myeloma and Plasma Cell Dyscrasia


2021 ◽  
Author(s):  
Tushar Sehgal ◽  
Prashant Sharma

UNSTRUCTURED We pay a prosopopoeic tribute to the time honoured, demanding, rewarding and sadly, declining skill of microscopic evaluation of a peripheral blood film.


Author(s):  
Ayesha Butt ◽  
Ruhul Quddus ◽  
Natasha Ali

A-64-year old male presented with cough, weight loss, and maculopapular rash for 15-20 days. On examination, he was found to have cervical lymphadenopathy and splenomegaly. His leukocyte count was 62.1x109/L, platelets were 1169x109/L and LDH was 816 IU/L. Peripheral blood film showed a leukoerythroblastic picture with thrombocytosis. He was started on hydroxyurea and allopurinol. Subsequently, bone marrow evaluation was done which depicted increased lymphoid cells with an M:E ratio of 4:1. Cellular areas exhibited an increase in myeloid precursors along with prominent lymphoid cells and abundant megakaryocytes. Immunohistochemistry showed an increase in B-lymphocytes. Grade MF-2 reticulin fibrosis was noted. Overall findings suggested essential thrombocythemia (ET). On flow cytometry, CD45-positive lymphoid cells population was 31% and showed reactivity to Pan-B-markers with lambda light chain restriction. Janus Kinase 2 (JAK 2) mutation was detected while BCR-ABL1 translocation was negative. A diagnosis of ET progressing to myelofibrosis and mature B-lymphoproliferative disorder was made. Hydroxyurea and allopurinol were stopped while ruxolitinib was introduced and 2.5 years later he remains stable on this treatment.


2021 ◽  
Vol 14 (10) ◽  
pp. e246049
Author(s):  
Hui Ping Lee ◽  
Veena Selvaratnam ◽  
Jay Suriar Rajasuriar

A 50-year-old Indian woman presented with acute dysphasia, left upper limb numbness and thrombocytopenia 12 days after receiving the ChAdOx1 nCoV-19 vaccine (AstraZeneca/Vaxzevria). MRI of the brain was unremarkable. Microangiopathic haemolytic anaemia with thrombocytopenia was noted on her peripheral blood film. A diagnosis of thrombotic thrombocytopenic purpura (TTP) was confirmed through the findings of absent ADAMTS13 (a disintegrin and metalloproteinase with a thrombospondin type 1 motif, member 13) activity and markedly raised titre of ADAMTS13 autoantibodies. Prompt treatment with plasma exchange, adjunctive steroids and rituximab was commenced. A remission of TTP was achieved and she was discharged 3 weeks after admission. While other immune-mediated conditions have been documented after receipt of the vaccine, this report highlights the first case of immune-mediated TTP diagnosed after administration of the ChAdOx1 nCoV-19 vaccine.


2021 ◽  
Vol 20 (1) ◽  
pp. 81-83
Author(s):  
Razia Sultana ◽  
Tani Gosh

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


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