Snakebite Associated Thrombotic Microangiopathy and Recommendations for Clinical Practice

Snakebite is a significant and under-resourced global public health issue. Snake venoms cause a variety of potentially fatal clinical toxin syndromes, including venom-induced consumption coagulopathy (VICC) which is associated with major haemorrhage. A subset of patients with VICC develop a thrombotic microangiopathy (TMA). This article reviews recent evidence regarding snakebite-associated TMA and its epidemiology, diagnosis, outcomes, and effectiveness of interventions including antivenom and therapeutic plasma-exchange. Snakebite-associated TMA presents with microangiopathic haemolytic anaemia (evidenced by schistocytes on the blood film), thrombocytopenia in almost all cases, and a spectrum of acute kidney injury (AKI). A proportion of patients require dialysis, most survive and achieve dialysis free survival. There is no evidence that antivenom prevents TMA specifically, but early antivenom remains the mainstay of treatment for snake envenoming. There is no evidence for therapeutic plasma-exchange being effective. We propose diagnostic criteria for snakebite-associated TMA as anaemia with >1.0% schistocytes on blood film examination, together with absolute thrombocytopenia (<150 × 109/L) or a relative decrease in platelet count of >25% from baseline. Patients are at risk of long-term chronic kidney disease and long term follow up is recommended.

Interpreting the full blood count

The full blood count (FBC) is one of the most commonly requested blood tests in medical practice and can provide a wealth of useful information about a patient’s general state of health, as well as highlighting abnormalities which indicate systemic or sinister pathologies. This article seeks to explore the different parameters of the FBC, and how these relate to some more common clinical presentations, as well as their relation to morphological findings seen on the blood film. As with most investigations, differential diagnoses suggested by any individual laboratory tests are wide and are most valuable when combined with history and examination.

Pseudoeosinophilia with Abnormal WBC Scattergram: an Important Diagnostic Clue on Hematology Analyzer

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.

Matlab Based Potent Algorithm for WBc cancer Detection and classification

This paper aims to automate the detection of cancer using digital image processing techniques in MATLAB software. The analysis of white blood cells (WBC) is a powerful diagnostic tool for the prediction of Leukemia. The automatic detection of leukemia is a challenging task, which remains an unresolved problem in the medical imaging field. This Automation in Biological laboratories can be done by extracting the features of the blood film images taken from the digital microscopes and processed using MATLAB software. The aim of this approach is to discover the WBC cancer cells in an earlier stage and to reduce the discrepancies in diagnosis, by improving the system learning methodology. This paper presents the potent algorithm, which will eliminate the dubiety, in diagnosing the cancers with similar symptoms. This Algorithm concentrates on major WBC cancers, such as Acute Lymphocytic Leukemia, Acute Myeloid Leukemia, Chronic Lymphocytic Leukemia and Chronic Myeloid Leukemia. As they are life threatening diseases, rapid and precise differentiation is necessary in clinical settings. These cancers are categorized by segmentation and feature extraction, which will be further, classified using Random forest classification (RFC). RFC will classify the cancer using a decision tree learning method, which uses predictors at each node to make better decision.

Evaluation of an improved Giemsa staining technique for blood borne parasite in thick and thin blood film from dogs

Many a times the use of rapid diagnostic tests for blood borne parasites like trypanosomiasis and Babesiosis is increasingly being used, but the gold standard for its detection is still the use of microscopy both as reference and confirmatory diagnosis. To determine the effectiveness of the adjusted stock giemsa staining technique over the conventional methods. Venous Blood samples were collected from 10 dogs in EDTA and then used for the simultaneous preparation of two thin and thick smear slides, one stained according to Giemsa 1:20 dilution for 30 mins while the other was stained using the Stock Solution for 30seconds the diluted with buffered saline for 20seconds and rinsed. Fixation of the thin smear was done in a covered staining jar containing anhydrous methanol for 1 to 2 min, after which the slides were air-dried. From the result obtained from 10 dogs blood samples gotten from the veterinary clinic, the adjusted giemsa staining technique showed a positive differentiation when compared to the 1:20 dilution, a total of 7 blood samples tested positive for blood borne parasites, Trypanosoma evansi, Babesiosis cani and Heart worm. The highest percentage occurrence was T.evansi (40%), Babesiosis cani(20%) and Heart worm (10%).The adjusted Giemsa staining technique serves as a fast, easy and less complex alternative to the 1:20 dilution, where the solution has to be diluted from the stock solution and then stained, although the only disadvantage to this technique would be easy contamination of the stock solution, but the advantages here is that it saves time, quicker result output and better differentiation microscopically.

The Prevalence and Determinants of Anaemia among Clients of the AIDS Support Organisation-Entebbe, Uganda

Anaemia, a common hematological disorder in HIV infection, compromises the quality of life and treatment outcomes. At The AIDS Support Organisation (TASO), Entebbe, the records for the 2016-2018 period show a 10% prevalence of anaemia which is lower than that in literature where it is said to be up to 95%. This study determined the prevalence, type, severity, and determinants of anaemia among people living with HIV and AIDS who receive care from TASO Entebbe in Uganda. A questionnaire was used to collect data from 624 TASO clients. A checklist identified the clients’ Antiretroviral Therapy (ART) combination and viral load. The selected clients’ Body Mass Index (BMI) was calculated to assess their nutritional status. A Fully Automated Humacount 60TS Three-Part Hematology Analyzer was used to measure hemoglobin and to do a full blood count. A blood film from each sample was manually examined for the type of anaemia. Data analysis was done with Stata MP 15. The prevalence of anaemia was 44.4%, and the anaemia was mostly mild (54.15%) to moderate (40.80%). Anaemia of inflammation was the commonest type (>58%). Gender, viral suppression, nutritional status, nutritional education, marital and economic status were significantly associated with the anaemia. Duration on ART had a protective effect, but this was not statistically significant. The prevalence of anaemia (44.4%) among the TASO-Entebbe Uganda clients was high, but the anaemia was mostly mild to moderate (>94%) and of inflammation type (>58%). Management of anaemia in HIV requires intentional screening since it compromises treatment outcomes.

Occult Disseminated Metastatic Breast Carcinoma Presenting as Acquired Thrombotic Thrombocytopenic Purpura

Cancer-related microangiopathic hemolytic anemia (MAHA) is a rare and life-threatening condition. We present a patient who had been treated for invasive lobular breast carcinoma in clinical remission with fever and hemolytic anemia. The peripheral blood film showed MAHA and thrombocytopenia, and a functional deficiency of ADAMTS13 activity of 23% consistent with acquired thrombotic thrombocytopenic purpura. Bone marrow aspirate and trephine biopsy confirmed metastatic carcinoma. Further evaluation revealed the involvement of multiple bone sites without recurrence of the primary tumor. The patient received a daily plasma exchange with cryosupernatant and was pulsed with corticosteroids. MAHA related to breast cancer appears to be a rare occurrence.

Hyperferritinemia in a Case of Soft Tissue Sarcoma

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.