Rateesh Sareen

• MBBS , DNB Pathology, PGDMLE (NLSIU), PGDCLP (NLSUI)PGDHM
• Santokba Durlabhji Memorial Hospital and Medical Research Institute

Body fluids are those excreted or secreted from the body. In the laboratory, the use of the term “body fluids” designates a category that excludes blood and urine. Determining the etiologic cause of fluid accumulation in various body cavities (i.e., joints, chest, and abdomen) is critical for proper treatment of various disorders. To evaluate the c...

Utility of lymphglandular bodies in lymphoma diagnosis

The automated examination of body fluids (BF) serves as a valuable screening tool for the presence of malignant cells in such samples. Malignant cells are identified as high fluorescence cells (HFC) when analyzed using the Sysmex XN-1000 automated analyzer. This study aimed to assess the correlation between HFC cell counts generated by the automate...

Introduction: The etiology of malignant MCA infarctions is mostly due to thrombosis or embolic occlusion of either the internal carotid artery or the proximal MCA. The cornerstone of ischemic stroke diagnosis remains the history and neurological examination. A prospective study to compare outcome of early verses late decompression craniotomy was do...

An adult male admitted in emergency with complaint of fever and respiratory distress. On work up several fold increase in Troponin I levels were noted. The cardiac work up did not reveal any abnormality. The patient was tested for H1N1 Influenza RNA PCR which came positive and patient was treated with Tamiflu. The spurious high sensitivity Troponin...

Sarcomatoid carcinoma presenting as bone marrow metastasis with unknown primary is a rare entity. Usually patients present with widespread symptoms of extensive disease process. In the present case patient was evaluated for anemia and a subsequent bone marrow examination showed metastatic malignancy. All complimentary diagnostic tests were performe...

COVID 19 infection in asymptomatic blood donors , screened for antibody against COVID 19 infection as a research part to evaluate possibility of any Herd immunity in population.

Needle stick injuries at a tertiary care hospital in India , the study came as a result of Audit as part of NABH exercise

Aim: The aim of this study is early detection of G6PD deficiency in neonates with hyperbilirubinemia and association of G6PD activity with appearance and severity of jaundice in G6PD deficient neonates. Material and methods: We conducted a Prospective Analytical study on all term and preterm neonates with hyperbilrubinemia admitted to tertiary care...

Aim: The aim of this study is early detection of G6PD deficiency in neonates with hyperbilirubinemia and association of G6PD activity with appearance and severity of jaundice in G6PD deficient neonates. Material and methods: We conducted a Prospective Analytical study on all term and preterm neonates with hyperbilrubinemia admitted to tertiary care...

PROCALCITONIN IN SEPSIS

We present a case of severe immune mediated hemolytic anemia in a 28-years-old woman who presented with severe unexplained anemia. The history of previous transfusion prompted immune hematology work up revealing presence of anti-c IgG (prior transfusion related); warm and cold auto antibodies making a diagnosis of allo and thermo labile antibodies...

Cognitive bias is well known recognized factor that causes many diagnostic errors. Such errors hampers with quality patient care in medical practice. This paper focuses on various biases that may affect decision making and idea flow. Growing awareness for such biases is need of hour as only then de biasing techniques could be adopted to prevent suc...

POST COVID HIPPURIC ACID CRYSTALS IN URINE

Introduction: COVID pandemic marked greater use of ECMO (Extra corporeal membrane oxygenation) in the form of rescue cardiopulmonary life support especially for patients awaiting lung transplant however we found it lifesaving in poisoning cases as well. Methods: We conducted a retrospective study from January 2020 till Jan 2022 in critical care uni...

The current case report illustrates the role of vigilant laboratory services that helped in unmasking the asymptomatic HbE variant in a middle-aged known diabetic woman who came as an outdoor patient and on subsequent HbA1c testing was found to have a lower value-2.9 %. It triggered extensive workup after looking for common causes and electrophores...

Introduction- HER2 is now well recognized as a key factor in the development of certain solid human tumors .The expression of Her2/ Neu in gastrointestinal malignancies is new concept with paucity of literature. Aim- The present study was conducted in a tertiary care cancer hospital in India to evaluate Clinicopathological features in resected case...

ETHICS PERTAINING TO COVID 19 VACCINATION TO FRONT LINE WORKERS

Artificial intelligence (AI) has given powerful models for diagnosis , using huge patient data with increased precision in a dynamic manner. It poses ethical challenges in terms of patient safety, privacy , responsibility for decisions taken and confidentiality. These machine based learning 'black boxes' may seriously jeopardize the traditional Hip...

Vitamin B12 assay is one of the most frequently ordered tests particularly as a part of regular medical checkups. The deficiency is rampant in vegetarian population. It is of immense importance that laboratories establish their own reference interval (RI) of analyte specially Vitamin B12 as a diagnosis of Vitamin B12 deficiency based on RI of kit i...

The measurement of quality matrix has become increasingly important in current health care environment. Quality management system have been recommended by accreditation bodies to reduce errors in surgical pathology but there is strong need of standardization so that errors are kept to minimal thereby improved patient care. The histopathology report...

Introduction: COVID-19 pandemic has been a nightmare for entire medical community with no definitive treatment available

Cerebrospinal fluid is an emergency test which requires stringent monitoring from sample collection, transport, acceptance and release of report. These all must be in time framework .Our audit was regarding the turn around time of cerebrospinal fluid and found that TAT for CSF testing was actually falsely high due post analytical errors. Our study...

ETHICAL PRINCIPLES IN A PANDEMIC

We report a case of Hemophagocytic lymphohistiocytosis in a 16 year old child. The clue to diagnosis was made by peripheral blood same which showed hemophagocytosis. The disease is under reported in a developing country like India as it mandates certain diagnostic criteria which require advanced testing facilities as well as thorough microscopic ex...

M Pneumoniae infection commonly presents with respiratory involvement. Extra pulmonary involvement is uncommon presentation. The case describes M Pneumoniae infection presenting as hemolytic anemia which on work up turned out to be cold agglutinin disease. The rare presentation of M Pneumoniae infection without pulmonary involvement makes the case...

We report a case of Hemophagocytic lymphohistiocytosis in a 16 year old child. The clue to diagnosis was made by peripheral blood same which showed hemophagocytosis. The disease is under reported in a developing country like India as it mandates certain diagnostic criteria which require advanced testing facilities as well as thorough microscopic ex...

Palliative care is a health care that involve physical, emotional, mental , behavioral care to persons with debilitating illness from diagnosis till death .Obstacles of growth of palliative care in India has various factors as population density, poverty, geographical and cultural diversity, workforce scarcity at base level, limited national pallia...

Peripheral blood smear examination is an invaluable investigation for the diagnosis of various clinical diseases, it includes cellular description of various blood cells seen on slide. The identification of various morphological abnormalities may lead to a definitive or differential diagnosis and provide clue for further investigations. For diagnos...

Introduction: SARS COV-2 pandemic has been a nightmare for medical, political and social systems all over the world, right from the point of initial diagnosis, treatment protocols, anticipated vaccine development and prevention strategies.

The problem of infertility is on rise among married couples. The advancements in medical science particularly in the field of artificial human reproductive technologies (ART) has benefitted childless couples and provided them with various options to beget a genetically related child. The major types by technique are Traditional, Gestational & accor...

Introduction: SARS COV-2 pandemic has been a nightmare for medical, political and social systems all over the world, right from the point of initial diagnosis, treatment protocols, anticipated vaccine development and prevention strategies.

This work is an endeavor to enable health care workers to understand the significance of 'consent in medical treatment in India'. There have been increased litigations in recent years in health care therefore it is prudent to respect patient autonomy and refrain from too harsh medical paternalistic attitude. The Bolam test has been the yard stick f...

Procalcitonin is 116 amino acid peptide that belongs to the calcitonin superfamily of peptides it is an acute-phase reactant protein made by the C cells of the thyroid gland [1]. Outside from the thyroid gland, it is also produced by lungs, kidneys, liver [2] and other tissues in increasing amounts in response to bacterial endotoxin in the bloodstr...

Leukemoid reaction (LR) refers to a reactive, excessive leukocytosis outside the bone marrow in the absence of hematological malignancy and has been described in response to inflammation, severe infection, malignancies, hemorrhage, acute hemolysis, or bone marrow stimulants. There is a significant increase in mature neutrophils in the peripheral bl...

PNH arises from a somatic mutation involving a gene on the X chromosome which codes for a protein involved in the formation of phosphatidylinositol glycan (PIG A), which anchors many proteins to the surface of cell membranes. Due to shortage of PIG, the two protective proteins which inactivate complement complexes, decay accelerating factor (DAF; C...

Biotinidase deficiency (BD) is an inborn metabolic disorder caused by low enzyme activity giving rise to impaired biotin release from dietary proteins. The first symptoms may be seen at first week following birth until 1 year of age. The goal of the therapy is to increase biotin bioavailability by daily 5-20 mg lifelong biotin replacement. Three-mo...

Consent is one of the key elements for protection of welfare of patients or research participants. The physician has a legal and ethical responsibility to provide adequate information to the patient so that he or she is able to process the information and make appropriate decisions. The patient's consent must be voluntary and competent. In order to...

The morphology of normal red cell is biconcave disc-shaped that measures about 7-8 µm in diameter, has central pallor which is approximately one third of the red cell diameter and lacks intra-cytoplasmic inclusions. Red cells are pink in color when stained with Rowmanosky dye because the haemoglobin content of the red cell picks up eosin, the acido...

The clinical laboratory plays an increasingly important role in the patient-centered approach to deliver healthcare services. Physicians rely on accurate laboratory test results for proper disease diagnosis and for guiding therapy; it is estimated that more than 70% of clinical decisions are based on information derived from laboratory test results...

Erythrocyte sedimentation rate (ESR) is the most common test done for diagnosis and follow up treatment in patients suffering from autoimmune disorders and chronic illness. It is imperative for clinicians to understand the methodology, limitations and variations in testing platforms for ESR from ICSH standardized Westergreen method to various autom...

Submit Manuscript | http://medcraveonline.com the testing site and sample preparation. The errors during this phase can have a significant impact on laboratory results and it is imperative that laboratory personnel are able to spot these erroneous results, rather than falsely attributing them to an underlying medical cause. To improve quality, accu...

Thrombotic thrombocytopenic purpura (TTP) is a life threatening, fulminant disease characterized by fever, microangiopathy hemolytic anemia, thrombocytopenia, neurological signs and renal insufficiency. The real culprit is agglutinated platelets and fibrin which form micro thrombi, gets deposited in arterioles and capillaries without eliciting infl...

The book is intended for practitioners in the field of IHC establishing and performing IHC. The central theme of the book entails basic steps pivotal in performing IHC and address common problems faced in routine staining.. The underline premise of the book is to explain staining protocols in lucid language to under resourced laboratories aspiring...

Quality is simply defined as doing right things for the right people, at the right time and doing them right Quality is simply for the first time. It is a process which involves patient centered care, safety, effectiveness and efficacy. Achievement and maintainance of quality needs stringent control in clinical laboratory. Lack of quality is a burd...

Pre analytical errors have a major impact on diagnostic accuracy of laboratory results. There have been tremendous work and established quality control criteria for analytical phase of testing but there is paucity of standards for pre analytical phase. Recommendations for sample collection, storage, processing and transport have been developed by n...

HEREDITARY BONE MARROW FAILURE SYNDROMES - A CONCISE PRESENTATION FOR RESIDENTS IN PATHOLOGY.

A GOOD SUMMARY FOR PATHOLOGY RESIDENT DOCTORS

SAFE TRANSFUSION PRACTICES - ORDERING AND INFUSION OF BLOOD BAGS

APLAS FOR RESIDENTS PATHOLOGY.

The main role of External Quality Assessment (EQA) is to score laboratories on the basis of their performance and provide scores like Q score and Z score to quantitative data to the participant laboratories. These scores are widely applicable for analytical laboratories by scaling difference in the participant’s result and assigned value. The prese...

We report a case of EDTA induced pseudothrombocytopenia (EDTA-PTCP) in a patient who was treated with platelet transfusion and with refractory thrombocytopenia was referred to us. The Automated blood analyzer and peripheral blood smear examination revealed numerous platelet aggregates, leading to falsely low platelet count on automated hematology a...

In the era of evidence based medicine laboratories play a pivotal role. Maintaining quality in laboratory results, keeping errors minimum is a daunting task. The preanalytical phase of testing is most error prone as it involves many personnel. Measures to reduce preanalytical errors include- continuous education & training, written policies, implem...

Basics of blood banking

Splenic marginal zone lymphoma is a rare low grade B cell lymphoma arising from post-germinal center marginal zone B cells. Comprising less than 2% of the lymphoid neoplasm; affects mainly middle-aged and elderly patients. We report a case of 58 years old female with the history of fever, malaise, and abdominal discomfort. Laboratory evaluation rev...

In modern medicine, doctors rely heavily on diagnostic testing to assist them with patient management, making or excluding diagnosis and implementing an appropriate treatment plan. It is therefore important that the laboratory produces quality test results. As laboratory testing errors mainly occur outside the analytical process, they are likely to...

BACKGROUND: Leishman stain is the universal stain used in staining of peripheral blood smears all over the world. AIM: To study the effect of incubation of buffer solution, slide alone and slide & buffer both on standard Leishman staining. The staining at times causes difficulty particularly in rainy season when there is increased moisture. METHOD...

Keywords: Dengue, Epstein Bar virus, Africa We present a case of young male who travelled and stayed in Africa for few months. He developed fever, weakness and fatigue and was treated with antimalarials. There was no improvement in his condition and he finally returned back to India where his diagnostic work up was done at a tertiary care hospital...

We describe a case of 40 year male who was diagnosed with Hodgkin’s lymphoma by using Immunohistochemistry on bone marrow. The case was a diagnostic challenge as Fine needle aspiration cytology of cervical lymph node showed reactive hyperplasia and the patient didn’t consent for lymph node excision biopsy, leaving us with limited options. The prese...

In modern medicine, doctors rely heavily on diagnostic testing to assist them with patient management, making or excluding diagnosis and implementing an appropriate treatment plan. It is therefore important that the laboratory produces quality test results. As laboratory testing errors mainly occur outside the analytical process, they are likely to...

We present a case of 54 year old male with chronic alcoholic disease and decompensate ascites admitted in our hospital for recurrent epistaxis. The physical examination revealed hepatomegaly, splenomegaly and ascites. The hemogram showed, hemoglobin-12.3g/dl, Hematocrit-39.2%, white blood cells-2230/Ul (differential-87% Neutrophils, 10% lymphocytes...

There has been spurt in the diagnosis of Vitamin D deficiency cases in the country. As there are lacks of data for reference ranges for Indian population for Vitamin D levels, many times clinicians face the dilemma of treating patients who have ample sunlight exposure and have low Vitamin D levels. There is also lack of guidelines for fortification...

The presentation address to the role of Pathologist as a teacher , to colleagues. The importance of continuous learning cannot be under pinned. The routine day to day work of Pathology provided ample opportunities of learning with proper channelization. Learn , share and disseminate. Else you shall perish.

Vitamin D deficiency is increasingly detected now days, making clinicians prescribe Vitamin D in oral or inject able preparation to patients. In developing countries like India where there is enormous patient load & cost constraints regular Vitamin D monitoring is not routinely done. The case in light of current indiscriminate un monitored Vitamin...

Background Early diagnosis of lung cancer plays a pivotal role in reducing lung cancer death rate. Cytological techniques are safer, economical and provide quick results. Bronchoscopic washing, brushing and fine needle aspirations not only complement tissue biopsies in the diagnosis of lung cancer but also comparable. Objectives (1) To find out di...

We present a case of 62 year male with dyspnea, cough and abdominal pain. There was a diagnostic dilemma for TTP as Hemolytic uremic syndrome, dengue, malaria and autoimmune hemolytic anemia were ruled out by investigations. ADAMTS-13 testing could not be performed due to financial constraints. The deteriorating life threatening condition of the pa...

We report a case of spurious elevation of platelet count on three consecutive occasions in a pediatric patient on six part Sysmex Hematology auto analyzer. Falsely low platelet counts are frequently reported in literature but falsely elevated Platelet counts are uncommon. The case emphasizes the important role of careful peripheral blood smear exam...

The immunohistochemistry technique is used in the search for cell or tissue antigens that range from amino acids and proteins to infectious agents and specific cellular populations. Immunohistochemistry is of paramount importance for the elucidation of differential diagnoses which are not determinable by conventional analysis with hematoxylin and e...

It is not uncommon to receive hemorrhagic fluids for cytological examination. The red blood cells impair diagnostic efficacy of smears. The body fluid can be processed in many ways-NSRT (Normal saline rehydration technique) is one such technique. The present study was done to evaluate quality of smears prepared by NSRT and Carnoy's fixation. The sm...

Pleuropulmonary synovial sarcoma is a diagnostic challenge. Synovial sarcoma is a soft tissue tumor of joints and extremities and are rarely seen in the mediastinum. We report this tumor at a very unusual location – the mediastinum in a 40-year-old female. The histopathology picture along with the location suggested a differential diagnosis of soli...

Health and intelligence are two closely related aspects of human well being. Nutrition, including iron levels, affects cognitive function and thereby may influence the occupational performance of an individual. Inadequate nutrition during adulthood may lead to decreased work efficiency, poor exercise tolerance and increased susceptibility to infect...

Salivary duct carcinoma is a distinctive primary neoplasm of the major salivary gland characterized by aggressive behavior with early metastasis, local recurrence and significant mortality. We report a 40 year old male with parotid swelling diagnosed as pleomorphic adenoma, who underwent parotidectomy with modified radical neck dissection and later...

Context: The current regulatory requirements for donor eligibility pose a challenge to blood centers in recruitment of voluntary blood donors, particularly in a developing country like India where awareness of the general population is low and myths about blood donation are prevalent. This study evaluates the reasons and rates of donor deferral in...