Angiomatoid fibrous histiocytoma in an elderly male: An unusual presentation with review of literature

Angiomatoid fibrous histiocytoma (AFH) is a rare soft tissue tumor occurring mostly in children, adolescents, and young adults. Clinically and radiographically, it is difficult to differentiate AFH from hematoma, soft tissue hemangioma, and malignant fibrous histiocytoma. Here, we present the clinical, radiologic, and pathologic findings of a case of AFH due to its rarity in a 67-year-old man. The patient underwent wide surgical excision with a provisional diagnosis of sarcoma. On pathological examination, the lesion demonstrated solid-cystic nodules of histiocytes with blood-filled cysts, a dense hyaline fibrous pseudo capsule, and a very focal peripheral lymphoplasmacytic infiltrates. The tumor cells showed strong positivity for CD68, variable positivity for CD34, Desmin, EMA, negativity for CK and a low Ki67 index

Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. Compared with developed countries, low-income and middle-income countries have limited access to resources and advanced technologies that require highly specialized staff for HBV diagnosis. In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. The World Health Organization (WHO) goal of eliminating hepatitis B by 2030 seems very difficult to achieve due to the existing diagnostic infrastructure in low-resource regions. The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. WHO’s elimination plan is at risk of derailment due to phases like the window period, immune control, and occult HBV infection (OBI) not being detected by standard tests. Here, in this article, we are focusing on various diagnostic platforms for the better diagnosis of HBV. The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods

Analysis of Causes and Frequency of Blood Donor Deferral in a Tertiary Centre in North India – An Insight Into The Regional Deferral Pattern

Introduction: Blood donor screening should be done through a stringent process so that it ensures blood availability and accessibility while maintaining the blood safety at the same time. Donors who get rejected in the process are called deferred donors. We, hereby aimed to assess various reasons of deferral and their relative proportions and to categorize donors according to type of deferral, age and gender. Method: We performed a retrospective analysis of data of donors who presented to Department of Immunohematology and Blood Transfusion, Lady Hardinge Medical College or at VBD Camps for a period of 20 months from January 2020 to August 2021. Rate of deferral was quantified and various causes were characterised according to gender and age. Result: A total of 19,151(18,665 males,486 females) donors presented at our centre and VBD camps, of whom 17,632(92.07%) were accepted while 1,519 were deferred. Out of total donors accepted, 17,345 were males and 287 females. The percentage of deferred donors was 7.93%. Amongst 486 females, 199 were deferred, i.e. 40.95%, while 7.07% males were deferred amongst males(1320 out of 18665). Out of total deferrals, majority i.e. 1302(85.71%) were due to temporary reasons while 217(14.29%) were deferred permanently. Overall, most common reason for deferral was low hemoglobin(514/1519 i.e. 33.84%). Amongst temporary deferrals, most common reason overall was due to low hemoglobin (514/1302, 39.48%) with low hemoglobin also being the most common reason of temporary deferral in both males(393/1111= 35.37%) and females(121/191= 63.35% ). Amongst the permanent deferrals, most common reason was due to history of High risk behaviour (46/217=21.20%). History of High risk behaviour was also the most common reason of permanent deferral in males(46/209= 22.01%) and Thyroid disorders, the most common amongst permanent deferral in females(03/08=37.5%). Majority of deferred donors belonged to the age group of 29–38 years (42.66 %). Conclusion: Estimation of incidence and causes of deferral is important to get better insight of the regional deferral pattern. Temporary causes account for the majority of deferral and such donors should be followed up for the maintenance of the VBD pool and ensuring the safety of both donors and recipients. Abbreviation: VBD= voluntary blood donation, Hb= Hemoglobin, NACO = National AIDS Control Organization. WHO= World Health Organisation

Analysis Of Causes And Frequency Of Blood Donor Deferral In A Tertiary Centre In North India – An Insight Into The Regional Deferral Pattern

Introduction: Blood donor screening should be done through a stringent process so that it ensures blood availability and accessibility while maintaining the blood safety at the same time. Donors who get rejected in the process are called deferred donors. We, hereby aimed to assess various reasons of deferral and their relative proportions and to categorize donors according to type of deferral, age and gender. Method: We performed a retrospective analysis of data of donors who presented to Department of Immunohematology and Blood Transfusion, Lady Hardinge Medical College or at VBD Camps for a period of 20 months from January 2020 to August 2021. Rate of deferral was quantified and various causes were characterised according to gender and age. Result: A total of 19,151(18,665 males,486 females) donors presented at our centre and VBD camps, of whom 17,632(92.07%) were accepted while 1,519 were deferred. Out of total donors accepted, 17,345 were males and 287 females. The percentage of deferred donors was 7.93%. Amongst 486 females, 199 were deferred, i.e. 40.95%, while 7.07% males were deferred amongst males(1320 out of 18665). Out of total deferrals, majority i.e. 1302(85.71%) were due to temporary reasons while 217(14.29%) were deferred permanently. Overall, most common reason for deferral was low hemoglobin(514/1519 i.e. 33.84%). Amongst temporary deferrals, most common reason overall was due to low hemoglobin (514/1302, 39.48%) with low hemoglobin also being the most common reason of temporary deferral in both males(393/1111= 35.37%) and females(121/191= 63.35% ). Amongst the permanent deferrals, most common reason was due to history of High risk behaviour (46/217=21.20%). History of High risk behaviour was also the most common reason of permanent deferral in males(46/209= 22.01%) and Thyroid disorders, the most common amongst permanent deferral in females(03/08=37.5%). Majority of deferred donors belonged to the age group of 29–38 years (42.66 %). Conclusion: Estimation of incidence and causes of deferral is important to get better insight of the regional deferral pattern. Temporary causes account for the majority of deferral and such donors should be followed up for the maintenance of the VBD pool and ensuring the safety of both donors and recipients. Abbreviation: VBD= voluntary blood donation, Hb= Hemoglobin, NACO = National AIDS Control Organization,WHO= World Health Organisatio

Current Challenges and Future Perspectives of Diagnosis of Hepatitis B Virus

It is estimated that approximately 260 million people worldwide are infected with the hepatitis B virus (HBV), which is one of the leading causes of liver disease and liver cancer throughout the world. Compared with developed countries, low-income and middle-income countries have limited access to resources and advanced technologies that require highly specialized staff for HBV diagnosis. In spite of the heavy burden caused by hepatitis B virus, 90% of people are still undiagnosed. The World Health Organization (WHO) goal of eliminating hepatitis B by 2030 seems very difficult to achieve due to the existing diagnostic infrastructure in low-resource regions. The majority of diagnostic laboratories still use hepatitis B surface antigen (HBsAg)-based tests. WHO’s elimination plan is at risk of derailment due to phases like the window period, immune control, and occult HBV infection (OBI) not being detected by standard tests. Here, in this article, we are focusing on various diagnostic platforms for the better diagnosis of HBV. The aim of the elimination of HBV can only be achieved by detecting all phases of HBV infection, which can be executed by a combined approach of using new marker assays along with advanced pretesting and testing methods

Treponema pallidum hemagglutination assay seroreactivity among healthy Indian donors and its association with other transfusion transmitted diseases

Background: The aim of the present study was to determine the prevalence of syphilis infection by Treponema pallidum hemagglutination assay (TPHA) among blood donors in Delhi and to study their correlation with other markers of transfusion transmitted infections such as hepatitis C virus (HCV), human immunodeficiency virus (HIV) and hepatitis B surface antigen (HBsAg) so as to establish the utility of TPHA over and above venereal diseases research laboratory test (VDRL), not only as a marker for testing T. pallidum infection, but also as a marker of high risk behavior. Materials and Methods: This prospective study was carried out in the Regional Blood Transfusion Centre, Lady Hardinge Medical College and associated Sucheta Kriplani Hospital, New Delhi for a period of 2 years. Donated blood was screened for TPHA seroreactivity along with screening for anti HIV I and II, anti-HCV, HBsAg by third generation enzyme-linked immunosorbent assay test. A total of 8082 serum samples of blood donors were collected from healthy blood donors in our blood bank. They were classified into two groups- test group and control group based on TPHA positivity. The co-occurrence of HBsAg, HIV and HCV infection were determined in TPHA positive blood donors (test group) in comparison with TPHA negative blood donors (control group). Results: We found the TPHA seroreactivity to be 4.4% in Delhi′s blood donors. Nearly 8.2% (663/8082) of the donated blood had serological evidence of infection by at least one pathogen (syphilis/HIV/hepatitis B virus/HCV) and 6.63% (44/663) donors with positive serology had multiple infections (two or more). Quadruple infection was seen in one donor, triple infection was seen in three donors and double infection was seen in 40 donors. Prevalence of HIV seroreactivity was found to be statistically significant and HCV seroreactivity statistically insignificant in TPHA positive group in comparison to TPHA negative group. Discussion: In our study, the TPHA seropositivity correlated with higher HIV and HCV seropositivity and the same correlation has been observed by several other studies also. In view of these observations, we propose that testing for syphilis by more sensitive and specific treponemal markers like TPHA rather than VDRL, rapid plasma reagin tests; as TPHA also has the added advantage of picking up all the high risk donors, whereas, VDRL picks up only currently infected donors. Moreover, TPHA should be continued as a marker of high risk behavior especially in high prevalence areas like India where we don′t have universal access to markers like nucleic acid amplification technique

The anti-Mia antibody – Report of four cases in a tertiary care hospital with review of literature

Anti – Mia antibody is antibody reacting with Mi III phenotype of the Miltenberger (Mi) subsystem. It is rarely reported in the West, however, it is common in Chinese and South East Asian populations. Very few cases have been reported in India. Here, we report 4 cases of the Anti - Mia antibody picked up on antibody screening of samples (which was performed using Asia ID-Diacell I-II-III Asia (Mia +) 3 cell panel). Patients: In all the four cases, ICT was positive. Antibody screening and Identification was done with 3 cell panel (ID-Diacell I-II-III (Asia)) and 11 cell panel (ID-DiaPanel) respectively. Antibody screening showed reaction in “Asia” cell (carrying Mia Antigen) of 3 cell panel. Antibody identification by 11 cell panel was negative ruling out antibodies of Rh, Kell, Duffy, Kidd, Lewis, P, Lutheran and MNS systems. Reaction with the “Asia” cell suggested the presence of Anti-Mia antibody which was confirmed by obtaining the same result when screening was repeated with 2 different lots of 3 cell panel. Discussion and Conclusion: The Miltenberger (Mi) subsystem comprises of a group of phenotypes of red cells that carry low frequency antigens associated with the MNSs blood group system. The Anti- Mia antibody was first described in 1951 in the serum of Mrs Miltenberger. Anti- Mia antibody is clinically significant and can cause Hemolytic disease of newborn (HDN) and mild to moderate haemolytic transfusion reactions (HTR). Most of the antibody screening and identification panels used in India are imported and represent the Western population. They do not have representation of the Mia antigen on their red cells. This leads to missing out of the Anti- Mia antibody which may cause HDN and HTR leading to significant consequences. Thus, the Mia antigen should be incorporated in our screening panels

Critical evaluation of peripheral smear in cases of anemia with high mean corpuscular hemoglobin concentration in children: A series of four cases

Mean corpuscular hemoglobin concentration (MCHC), a parameter that is reported as a part of a standard complete blood count by automated analyzer, is a measure of the concentration of hemoglobin in a given volume of packed red blood cell. Values of MCHC significantly above reference range are not physiologically possible due to limitations on solubility of hemoglobin. The high MCHC can give us a clue to certain type of hemolytic anemia and necessitate critical evaluation of peripheral smear to reach a definitive diagnosis. Here we are presenting a series of four cases with raised MCHC, emphasizing the importance of systematic and meticulous examination of the peripheral smear to render a definitive diagnosis