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.

A Case Study of Assessment of Haemato-Biochemical Profile, Clinical Diagnosis and Therapeutic Management of Canine Monocytic Ehrlichiosis (Tropical Canine Pancytopenia) In A Male Doberman DOG

Ehrlichia canis is an obligate intracellular rickettsial agent that is transmitted by a brown dog tick called as Rhipicephalus sanguineus which is considered as the principal vector of this disease. A 3-year-old male Doberman dog weighing 25 kg is presented with the history of inappetence, fever, weakness, anemia, scanty feces, hemoglobinuria, shrunken eye ball with mild corneal opacity and reluctant to walk due to pain in the joints. Clinical examination revealed elevated rectal temperature of 104.30F, tachycardia, increased respiratory rate and pale mucous membrane. Blood and serum samples were collected for hematology and serum biochemistry respectively. On blood smear examination with Giemsa staining, Ehrlichia morulae were noticed in monocytes suggestive of Canine Monocytic Ehrlichiosis / Tropical Canine Pancytopenia.

Faktor Sosiodemografi dan Riwayat Klinis Malaria Terhadap Insidensi Malaria di Manokwari

Malaria is an endemic disease in Manokwari. Malaria transmission was influenced by sociodemographic and geographic factor. However, clinical manifestation of malaria in endemic area was various from asymptomatic, mild to heavy manifestation. The aim of this study was to identify the incidence, sociodemographic, geographic factors, and clinical manifestation of Plasmodium infection in Manokwari. This was a cross sectional study, in August 2019 in two endemic villages, that is Amban and Wosi village, Manokwari district, West Papua. The number of subject involved in this study was 100. 55 subjects came from Amban and 45 from Wosi village. The sociodemographic characteristics of subject such as age, gender, address, education and occupation were recorded. Blood smear examination and Giemsa staining were performed to identify Plasmodium sp on each subject. Results of this study showed that 3% of population were infected by Plasmodium sp. Plasmodium sp. infection. more experienced by men, higher education level and have a job. The demographic and geographic factors were not related with Plasmodium sp. infection (p > 0.05). All of the subjects who infected with Plasmodium sp. show manifestation such as fever, chills, sweating, nausea/vomitus, and diarrhea. The conclusion of this study is highlighted that socio-demographic and geographical factors are not associated with Plasmodium sp. infection, and Plasmodium infection is characterized by clinical symptoms.

Molecular identification and phylogenetic analysis of Trypanosoma evansi in dromedaries (Camelus dromedarius) from Iran

Surra is of great concern to countries in the world such as Iran, which have a considerable camel population. The present study was aimed at determining the prevalence of Trypanosoma evansi in the camels of Iran. A total of 167 blood samples from farmed camels were examined for the presence of T. evansi infection using parasitological and molecular methods. Blood smear examination revealed 10 (6%) positive samples, while the PCR method 14 (8.4%) found positive samples. Age, sex, and region were not determined as risk factors for T. evansi infection in this study. The phylogenetic tree inferred from VSG gene sequences of T. evansi clearly separated the sequences of this study into two clades, A and B, which reflects the intrasequence heterogeneity among Iranian isolates. The phylogenetic tree showed that Iranian T. evansi strains are members of the T. brucei clade.

Peripheral Blood Examination Findings in SARS-CoV-2 Infection in Pediatric Patients

Background The findings of peripheral blood examination (PBE) in SARS-CoV2 infection in pediatrics patients have not been fully described, the reports have been done on the adult population so far. In this study we showed the characteristics in the PBE in SARS-CoV2 infection in the pediatric population. Methods Descriptive, observational, longitudinal, prospective study. Information from the medical records of pediatric patients < 17 years of age with a diagnosis of SARS-COV-2 (positive PCR test) was analyzed and peripheral blood smear examination was performed. Results 16 pediatric patients with a diagnosis of SARS-CoV-2 /COVID-19 were evaluated. 100% of the patients had PBE done, 62.50% (10/16) had no morphological alteration of the erythroid cell line, the erythroid changes were: anisocytosis and echinocytosis in 12.5% (2/16), in white cell line a predominance of plasmacyte lymphocytes was found in 37.5% (6/16), followed by hyposegmented neutrophils “Pelger-Huet anomaly” 31.25% (5/16), hypersegmented neutrophils 12.5% (2/16) , atypical lymphocytes 18.75% (3/16), granular lymphocytes in 6.25% (1/16), prolymphocytes in 6.25% (1/16), hyposegmented eosinophils in 12.5% (2/16). Conclusion Plasmacytoid lymphocytes and large granular lymphocyte are seen more frequently in pediatric patients with COVID-19. Abnormalities in the neutrophils with acquired Pelger-Huët anomaly (APHA) were important findings in pediatric patients with COVID-19.

High incidence of asymptomatic cases during an outbreak of Plasmodium malariae in a remote village of Malaysian Borneo

An outbreak of Plasmodium malariae occurred in Sonsogon Paliu village in the remote area of Ulu Bengkoka sub-district of Kota Marudu, Northern Sabah, Malaysian Borneo from July through August 2019. This was the first outbreak of malaria in this village since 2014. On 11th July 2019 the Kota Kinabalu Public Health Laboratory notified the Kota Marudu District Health Office of a Polymerase Chain Reaction (PCR) positive case of P. malariae. This index case was a male from Sulawesi, Indonesia working for a logging company operating in Sonsogon Paliu. During the resulting outbreak, a total of 14 symptomatic cases were detected. All of these cases were positive by thick and thin blood smear examination, and also by PCR. During the outbreak, a mass blood survey screening was performed by light-microscopy and PCR. A total of 94 asymptomatic villagers 31 (33.0%) were PCR positive but thick and thin blood smear negative for P. malariae. Both symptomatic and asymptomatic cases received treatment at the district hospital. When symptomatic and asymptomatic cases were considered together, males (29/45. 64.5%) were infected more than females (16/45, 35.6%), the male:female ratio being 1.8:1. Adults were the predominant age group infected (22/45, 48.9%) followed by adolescents (19/45, 42.2%) and children under five years of age (4/45, 8.9%). This report illustrates that symptomatic and submicroscopic cases pose a challenge during P. malariae outbreaks and that PCR is a valuable tool for their identification. The rapid identification and control of imported malaria is crucial for the continued control of malaria in Malaysia.

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.

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.

ANAPLASMOSIS IN KINTAMANI CROSSBREED DOG: A CASE REPORT

Anaplasmosis is a disease in dogs caused by gram-negative intracellular microorganisms belonging to the Anaplasmataceae family. A 1 year old Kintamani mix dog was examined at the Veterinary Hospital, Faculty of Veterinary Medicine, Udayana University with complaints; itching, tick infestation, weakness, decreased feeding and erythema throughout the dog's body. Clinical examination results show pale mucous membranes in the mouth, weak dogs, Riphicephalus tick infestation of the skin. Routine haematological examination revealed hyperchromic normocytic anemia and thrombocytopenia. Positive blood smear examination found Anaplasma spp. The therapy given is in the form of causative, symptomatic and supportive therapy. Causative therapy was given doxycycline dose 10 mg / kg BW given orally for 28 days, ivermectin dose 0.2-0.3 mg / kg BW, subcutaneously once a week for three weeks, symptomatic therapy with vetadryl dose 1-5 mg / kg BW, subcutaneosly once a week for three weeks, while supportive therapy was given by giving vitamin Livron b-plex once a day for 10 days. Treatment with doxycycline, ivermectin, vetadryl and livron b-plex gave good results in case dogs in terms of animal activity, hair growth, good appetite and free animals from ticks.

Two Hyperparasitaemic Plasmodium Falciparum Cases Successfully Treated with Artemisinin-based Combination Therapy

BackgroundHyperparasitaemia is an important event in a cascade of Plasmodium falciparum severe malaria (SM) but requires host responses to cause cerebral malaria (CM) leading to death, if left untreated. Here, we report two hyperparasitaemic patients with no CM.MethodsMalaria diagnosis was performed based on thick and thin smears examination, and immunochromatographic-based rapid diagnostic test assay. Parasitaemia was calculated following World Health Organization (WHO) protocol. Haematological and biochemical investigations were also performed. Weekly follow-up of blood smear examination and temperature were recorded up to day 63.ResultsThe first patient had 42% parasitaemia (100% asexual parasites). The second one had 9.5% parasitaemia comprising 46% asexual, and 54% sexual stages with 1:1 male to female ratio. On the day of admission, both had presented abnormal haematological and biochemical parameters compared to the reference ranges. Remarkably, both the patients recovered successfully with oral artemisinin-based combination therapy (ACT) and a single dose of primaquine. Weekly follow-up did not show any parasite breakthrough except few drug-affected gametocytes in the second patient. This indicated successful treatment with ACT.ConclusionThe presence of hypergametocytaemia may hinder the elimination efforts, if not treated immediately. This report also signifies the need of accurately estimating the parasitaemia in malaria patients and their timely management to prevent complications and mortality.