Deepak Nayak M’s research while affiliated with Manipal Academy of Higher Education and other places

nRBCs also referred to as normoblasts are seen in the peripheral blood films in variable numbers; both in physiological as well as pathologic states. Enumeration of these cells by modern day automated analysers remains a challenge. We wanted to assess the precision of the Beckman Coulter LH 755 & 780 haematology analysers TM in enumerating the nRBC count.

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.

Glucose-6-phosphate dehydrogenase (G6PD) deficiency is an X-linked disease responsible for moderate to severe hemolytic anaemia. Despite being the most common erythrocyte enzyme disorder, it is often overlooked in the regular diagnostic parlance. A 40-year-old male patient admitted to the casualty with an acutely exacerbated diabetic ketoacidosis, showed features of hemolytic anaemia on peripheral smear examination. Crucially, the spherocytes and bite cells suggested a possibility of G6PD deficiency. This was substantiated by an increased reticulocyte count (6.8%) and a reduced quantitative G6PD enzyme assay (7.2%). There was no significant family or prior medical/ drug history. Interestingly, the hemolytic features were evidenced when blood glucose levels were returning to normal values. The insulin mediated NADPH loss may have resulted in an increased erythrocyte oxidant sensitivity and a loss of sulfhydryl group availability; causing hemolysis to manifest. G6PD deficiency is conventionally affiliated with drug induced oxidative stress. But an association with a diabetes mellitus is seldom reported. This case is being presented as it highlights the lesser known complication of diabetic crisis such as hemolysis secondary to a G6PD deficiency.

BACKGROUND: Bone marrow examination is the gold standard test in determining the cause of thrombocytopenia; whether it is of hypoproductive or hyperdestructive nature. However,this process has distinct disadvantages such as being invasive, not feasible in critical situations and is often not preferred by clinicians and patients alike. The introduction of platelet indices in automated hematology analyzers has provided a small window into the cause of thrombocytopenias in the recent years. Mean platelet volume (MPV) has evoked much interest in this regard. This study aimed at assessing the predictive value of MPV in determining the aetiology of thrombocytopenia.MATERIALS AND METHODS: We analyzed 100 case s of thrombocytopenia (platelet count < 100x10 3 / cu.mm) on a retrospective basis for a period of one month. The cases were divided into 2 groups: with and without bone marrow diseases; based on individual pathophysiology. A statistical analysis was done to assess predictive values, odds ratio and confidence intervals and also to elicit a cut - off value for MPV. RESULTS : The mean MPV in the group with marrow disease was 8.95fl while the group without marrow disease was 9.42fl. The difference in MPV between the 2 groups was not statistically significant (P value: 0.088). The sensitivity and specificity scores as tabulated by the receptor operating characteristic (ROC) curve at a cut - off of 9.35fl were 69% and 55% respectively.CONCLUSIONS:The study concluded that although MPV may provide a small initial insight into the aetiology of thrombocytopenia, it is limited by insufficient sensitivity and specificity. A bone marrow examination continues to be the gold standard to differentiate the hypoproductive and hyp erdestructive thrombocytopenias

Phenomenon such as cold agglutination of red blood cells and platelets are well recognized and extensively studied. Nevertheless, a ggregation of leukocytes in vitro is a rare phenomenon and may result in pseudoleukopenia. The ex act mechanism for this phenomenon has not been elucidated. We report one such rare cas e where a male patient with HIV presented with leucopenia. The analysis of ethylene diamine te traacetic acid (EDTA) anticoagulated blood was done on Coulter LH 750 hematology analyzer. The Volume Conductivity Scatter (VCS) parameters and histogram generated were inconclusive .The peripheral smear revealed small aggregates of leucocytes. The leucoaggregates were reversed on incubating the blood sample at 37 degree Celsius for 30 minutes. This suggests the role of a temperature dependent antibody causing clumping of leucocytes; possibly in conjuncti on with EDTA

VesMATIC cube80™ is a newly developed automated met hod for measurement of erythrocyte sedimentation rate (ESR). AIMS: The aim of our study was to compare the ESR values by VesMATIC cube80™ against the modified Wes tergren method. MATERIALS AND METHODS: This cross-sectional study was conducted at clinic al laboratory in Kasturba Hospital, Manipal on 162 patients. The samples taken we re as per the recommendations charted out by International Council for Standardization in Hematology (ICSH) for comparing automated and manual Westergren method. STATISTICAL ANALYSIS USED: Bland and Altman statistical analysis was applied for evaluating VesMA TIC cube80™ against the conventional Westergren method. RESULTS: The analysis revealed a low degree of agreement be tween the manual and automated methods especially for higher E SR values (25mm/hr.), i.e., mean difference -0.44 (95% limits of agreement, -41.23 t o 40.37). This discrepancy which is of clinical significance was less evident for ESR values in the normal range

Transient abnormal myelopoiesis (TAM) is a unique di sorder of newborns associated intimately with Down’s syndrome, present ing with clinical and morphological features indistinguishable from acute myeloid leuka emia (AML). We report a case in a neonate, presenting with severe perinatal asphyxia and cyanosis ; complicated by metabolic acidosis. The hemogram revealed leucocytosis and thrombocytopenia. The peripheral smear showed marked left shift and 55% circulating myeloblasts. Additio nal findings included a hepatomegaly and mild dysmorphic features. The child eventually succu mbed to pulmonary hemorrhage on day one itself. TAM has to be differentiated from conge nital leukemia which portends a poor prognosis