Pure Red Cell Aplasia Following Thymothymectomy: A Case Report

Thymoma, a rare epithelial neoplasm, is the most common anterior-superior mediastinal tumour. Thymoma can occur sporadically or in association with other conditions, such as myasthenia gravis, pure red cell aplasia (PRCA), and hypogammaglobulinemia. Only 5% of thymoma cases develop PRCA; however, 10–50% of patients presenting with PRCA have an associated spindle cell type thymoma. Thymoma complicated by PRCA is associated with a poor outcome. We report the case of a 38-year-old female who presented with chest pain, and was diagnosed with an anterior mediastinal mass. A thymectomy was performed, and histopathological examination revealed mixed thymoma; two months later, the patient developed PRCA. The present case reinforces the need for clinicians to be vigilant with thymoma patients, even following thymectomy

Correlation of morphologic and cytochemical diagnosis with flowcytometric analysis in acute leukemia

Introduction: The classification of acute leukemias has revolutionized over the years. Immunophenotyping of acute leukemia has gained popularity because of its influence on treatment and prognosis of the disease. The various antigens expressed by the leukemic cells can be assessed by flowcytometry (FCA) and can be used in rendering specific treatment and predicting the outcome of the different types of acute leukemia. Aims: The main aim of this study was to compare the morphologic and cytochemical diagnoses with flowcytometric diagnoses in acute leukemia and to analyze the usefulness of FCA over morphology. Results: In this study we analyzed 50 cases of acute leukemia and found concordance rate as high as 86% between morphologic/cytochemical diagnosis and flowcytometric diagnosis. Of these, complete concordance was seen in 58% of the cases and partial concordance was seen in 22% of the cases. Non-concordance was seen in only 4% of our cases. In remaining 16% of our cases FCA helped in sub classifying the acute leukemia where morphology and cytochemistry had failed to do so. CD19 and 20 were found to be consistent B-cell markers and CD3 was a very specific marker for T-cell leukemia. CD13 and 33 were important myeloid markers and were aided by other secondary panel of markers like CD14, CD117 and CD41. Conclusion: FCA not only helps in confirming morphologic diagnosis in acute leukemia but also helps in assigning specific lineage to the blasts, particularly in acute lymphoid leukemia. Immunophenotyping is of utmorst importance in classifying acute leukemia as it greatly influences the treatment and the prognosis

Cold Agglutinins associated with Plasmodium falciparum malaria: A case report

Abstract- The combination of anemia in malarial infestations ranges from nutritional deficiency to marrow suppression. An immune hemolytic anemia in Plasmodium falciparum malaria is also a part of this wide-ranging spectrum. But the co-existence of cold agglutinins in a Plasmodium falciparum malaria has only sporadically been reported in literature. We present a case of a patient with falciparum malaria who developed severe anemia and jaundice at the time of presentation. The Coombs ’ test and cold agglutinin test were negative. This case underlines a rare association of cold agglutinins in Plasmodium falciparum malaria. Index Terms- Plasmodium falciparum; cold agglutinins; hemolytic anemia; jaundice

ISSN 2347-954X (Print) Malaria detection by automation: The Manipal experience

Abstract: Diagnosis of malaria has always been a diagnostic challenge in endemic areas. For many centuries microscopy based diagnosis has been a standard method for routine diagnosis of malaria. And still this is a routine diagnostic method used in low endemic areas which allows species identification. In endemic countries like India microscopy based diagnosis of malaria is still used and despite the presence of expert microscopists, laboratory misdiagnosis of malaria is still a problem. This may be due to immense work load, limited resources and manpower. The aim of the study was to confirm utility of the formula developed by Briggs et al and evaluate the feasibility of rapid diagnosis of malaria by using CBC data and malaria factor derived from standard deviation (SD) values of lymphocyte and monocyte by using haematology counter Beckman -Coulter series LH 750 and 755 TM . Three hundred and ten cases and controls were selected from samples sent to clinical lab for evaluation of fever and for routine examination. All cases and controls were scrutinised for malaria factor, thrombocytopenia, monocytosis, mean monocyte volume and pseudoeosinophilia. At cutoff value of 3.4, 97% sensitivity and 89% specificity was obtained. Detection of malaria by automated hematology counters my replace current screening methods for detection of malaria in future, but need of extensive study in different population is need for validation of this method

Hemosiderin tubulopathy-induced acute kidney injury - A rare initial manifestation of paroxysmal nocturnal hemoglobinuria

Paroxysmal nocturnal hemoglobinuria (PNH) is characterized by episodes of intravascular hemolysis, infections, and thromboembolic complications. Renal abnormalities are rare which occur either due to hemolytic crisis or repeated thrombotic episodes involving small venules. Acute kidney injury (AKI) requiring hemodialysis due to toxic effects of hemoglobinuria, with a stable disease is exceptional. We describe a case of an elderly gentleman presenting with features of severe AKI requiring hemodialysis due to hemosiderin tubulotoxicity as the first manifestation of PNH. The diagnosis was challenging because of the rarity and unfamiliarity with this entity. The outcome was complete recovery of renal function with hemodialysis