RBC INDICES, PERIPHERAL SMEAR AND PLATELET INDICES CORRELATION FOR MICROCYTIC ANEMIA ASSESSMENT: A CROSS-SECTIONAL STUDY.

Aim The current study aims to explore the relationship among platelet indices, RBC indices and peripheral blood smears in the assessment of microcytic hypochromic anemia.  Methods A cross sectional study was conducted at the Indira Gandhi Institute of Medical Sciences, Patna, Bihar over the duration of a February 2021 to March 2022, which included 4560 cases comprising indoor and outdoor patients. Peripheral blood smear stained with Leishman were made using blood samples obtained in EDTA tubes. Automated cell counters were for analysis of complete blood counts including hemoglobin, RBC indices and other hematological parameters.  Results Among 4560 cases, 51.63% were male and 48.37% were female, and adults in their thirties (19.35%) were the group most affected. The most prevalent morphological type was microcytic hypochromic anemia (48.10%), mostly of intermediate severity (63.47%), affecting females and children. Normocytic normochromic anemia (41.01%) was primarily mild (61.52%) and common among the elderly. Macrocytic anemia (11.54%) showed no significant age or severity variations. Only 4.08% cases had dimorphic anemia, with 63.7% being mild.  Conclusion Anemia's prevalence and severity vary across age groups due to diverse underlying causes. As individuals age progresses, anemia becomes more common, linked to infections, inflammation, chronic diseases, and reduced bone marrow response. Accurate diagnosis and treatment planning require identifying cause, type, and severity of anemia.  Recommendations According to the study, healthcare providers should monitor age-related anemia prevalence and severity. Consider infections, inflammation, chronic illnesses, and diminished bone marrow response when examining patients, especially as they age. To optimize patient outcomes, accurate diagnosis and individualized treatment regimens should focus on anemia etiology, type, and severity

Primary plasma cell leukemia in a 19-Year-Old female: An unusual presentation of a rare entity

Plasma cell leukemia (PCL) is a rare form of plasma cell dyscrasia with 2 variants: the primary form, which occurs de novo in patients with no previous history of multiple myeloma (MM), and the secondary form, which represents a leukemic transformation in patients with a previously recognized MM. Unlike myeloma, PCL typically follows an aggressive course, and the median age at presentation is usually above 50 years. In this report, we present a case of primary PCL that manifested at 19, an exceptionally rare occurrence

A HOSPITAL-BASED STUDY ON UTILISING HPLC TO DETECT HB-VARIANTS AND HEMOGLOBINOPATHIES: A RETROSPECTIVE DESCRIPTIVE STUDY.

Background Hemoglobinopathies are a growing global health issue. These hereditary diseases are most common worldwide. WHO says the Middle East and India have the highest incidence. HPLC is a good way to screen hemoglobin variants such HbF and HbA2. The present study was carried out to diagnose hemoglobinopathies and thalassemias by the use of HPLC in Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India.  Materials and Methods  A retrospective descriptive research assessed 550 patients for thalassaemia or other hemoglobin structural abnormalities. This investigation included all cases of microcytic hypochromic anemia (MCV< 80 fl, MCH< 27 pg) with a clinical suspicion of hemoglobinopathy that did not respond to usual treatment. The trial excluded patients who had blood transfusions within three months.  Results This study included 550 cases, 310 boys and 240 females, aged 2 months to 40 years. HPLC analysis revealed abnormal hemoglobin fractions in 96 cases. One person had delta thalassemia, one had delta with beta-thalassemia, one had hemoglobin D Iran, two had HbE with beta, six had HbE trait, eight (1%) had beta major, and less than 1% had HbE homozygous. Of the cases, 72 (13%) had beta thalassemia. The HPLC pattern was normal in 48%. In all cases, peripheral blood smears showed target cells, microcytosis, and hypochromia. The majority of patients had increased RBCs.  Conclusion Hemoglobinopathies can be quickly, accurately, and effectively diagnosed with HPLC. It is a valuable diagnostic technique for beta thalassemia characteristics, particularly in impoverished nations like India where hemoglobinopathies are difficult to identify. Prompt diagnosis could aid in appropriate and targeted treatment.  Recommendation This study emphasizes the need of HPLC for hemoglobinopathy diagnosis, especially in high-burden countries like India. HPLC screening and diagnosis can help combat hemoglobinopathies' global health issues by enabling early detection and focused treatment

THE ROLE OF ABSOLUTE RETICULOCYTE COUNTS IN EVALUATION OF PANCYTOPENIA: A CROSS-SECTIONAL STUDY, BIHAR, INDIA.

Background Hematological conditions like pancytopenia are widespread in our lab. Diagnosis and therapy of pancytopenia require etiology analysis. Most pancytopenia causes are determined by the Absolute Reticulocyte Count (ARC), which has been neglected. The aim of this study is to determine the importance of the Absolute Reticulocyte Count (ARC) in assessing the etiology of pancytopenia, with a focus on its role in distinguishing between different causes of this hematological condition. Materials and Methods The study was conducted in a tertiary health care institution in Bihar, India. Over the course of 1 year (April 2021 to March 2022), a descriptive cross-sectional study was carried out. Complete blood counts (CBC), reticulocyte count including ARC and peripheral blood smear (PBS) examination were performed in all cases of pancytopenia. Serum ferritin, Serum vitamin B12 level and serum folate were also estimated. Bone marrow examination was done in all cases. Results A total of 200 pancytopenia cases were assessed, and the findings were recorded. In cases of aplastic anemia, ARC was found to be 100x109 /L was seen in neoplastic disorders. Lower ARC values were associated with conditions like aplastic anemia, while higher ARC values were indicative of acute leukemia and metastatic deposits, making ARC a valuable diagnostic tool. Conclusion It was concluded that ARC is crucial in distinguishing between different causes of pancytopenia, and it must be a regular part of work-up to prevent needless invasive bone marrow examinations in cases of pancytopenia. Recommendation This study suggests that pancytopenia patients be routinely assessed with Absolute Reticulocyte Count (ARC). ARC helps identify pancytopenia etiologies, preventing needless bone marrow exams. Pancytopenia diagnosis and treatment can be improved by adding ARC to diagnostic techniques

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Twin Malignancy of Acute Myeloid Leukemia and Multiple Myeloma in a Chemotherapy-Naïve Patient: A Rare Occurrence

Synchronous diagnosis of acute myeloid leukemia (AML) and multiple myeloma in chemotherapy-naïve patients is a rare event and poses a serious therapeutic challenge as it imparts a poor prognosis. We report a case of concurrent AML with multiple myeloma in a 44-year-old male along with a PUBMED-based research of previously reported similar cases in published literature

Vancomycin-Induced Maturation Arrest with Reactive Promyelocyte Proliferation: A Diagnostic and Therapeutic Challenge

Drug-induced leukopenia is a diagnostic and therapeutic challenge. A detailed clinical history is a must to come to a right diagnosis. Certain drugs are known to cause bone marrow suppression, leukopenia, myeloid maturation arrest, and reactive promyelocyte proliferation. Here, we report an unusual case of vancomycin-induced maturation arrest with marked promyelocyte proliferation in a 47-year-old male patient who was being treated for novel coronavirus disease 2019 (COVID-19) infection. Most times, this reactive promyelocyte proliferation is confused with neoplastic promyelocytes, leading to incorrect diagnosis and management

Clinico-Hematological Profile of Acute Leukemia Cases in Bihar: A Multiparameter Study in a Tertiary-Care Hospital

Objective The actual incidence and demographic profile of hematological malignancies are unknown in Bihar because of lack of population-based cancer registry (PBCR) data and specialized tertiary cancer center facilities. The objective of this study was to estimate the prevalence, clinico-hematological profile and subtyping of acute leukemia cases by retrospective medical records. Materials and Methods A retrospective study was conducted in the Department of Hematology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India, over 2 years from July 2019 to June 2021. A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Medical records were studied and data were retrieved. Statistical Analysis Data were recorded and analyzed using SPSS version 25. Results A total of 176 cases with relevant clinical features and hematological findings were involved in the study. Acute myeloid leukemia (AML) was most prevalent (52.8%), followed by acute lymphoblastic leukemia (ALL) (34.1%) and unclassified acute leukemia cases (13.1%). Flow cytometry correlation was available in 150 cases. The ratio of males (62.5%) to females (37.5%) is 1.6:1. There was statistically significant difference in physical examination findings between AML and ALL patients. Splenomegaly, lymphadenopathy, and sternal tenderness were more often seen in ALL than in AML patients (p < 0.05). Pallor was more significantly associated with AML than with ALL patients (p < 0.05). Anemia and leucocytosis were found to be significantly associated with acute leukemia patients (p < 0.000). Conclusion AML M2 was the most common subtype of AML, and B-ALL was the most common subtype of ALL cases