Ruchee Khanna’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.

The diagnosis of polycythemia vera (PV) requires the integration of clinical and laboratory findings, bone marrow morphologic features, and JAK2 analysis. JAK2V617F (exon 14) mutation is found in 95% of PV cases. In PV, addition of characteristic bone marrow morphology as one of three major diagnostic criteria allowed reduced hemoglobin/hematocrit threshold for diagnosis to 16.5 g/dL/49% in men and 16 g/dL/48% in women. JAK2 mutation is still the third major diagnostic criterion in PV. Low serum erythropoietin level is now considered as minor criterion in PV and is used to detect cases, which are negative for JAK2 mutation. In this retrospective study, cases diagnosed as PV from January 2013 to December 2015 were reclassified using WHO 2016 criteria. Their clinical and laboratory parameters along with treatment and outcome were studied. Out of 26 patients of previously diagnosed PV, either definitively or provisionally, twenty-one were found to comply with the new 2016 revision of the WHO Criteria. Median age was 55.5 years, with a male preponderance. The median values of hemoglobin, hematocrit and platelets were 17.5 gm/dL, 56.7% and 493 × 10⁹/L, respectively. JAK2V617F was mutated in 17 cases. Bone marrow showed hypercellularity, panmyelosis and marked megakaryocyte dyspoiesis in all patients. All patients had normal oxygen saturation, confirming the primary nature of the disease. Our study, first of its kind in India, underscores the importance of the 2016 revision of the WHO document in detecting cases of masked PV.

Serous atrophy of bone marrow also known as gelatinous transformation or serous fat atrophy is a rare finding. It is characterised by focal loss of hematopoietic elements, fat cell atrophy, and extracellular deposition of gelatinous substance with adjacent marrow hypoplasia. Pathogenesis of such atrophy is poorly understood and is considered to be a non specific finding, which can be associated with various haematological and non haematological conditions. It is mostly seen in adults with a few cases reported in the paediatric age group. We present a case of an 8 year old female patient with bilateral knee joint pains since one year. Blood counts and peripheral smear examination revealed bicytopenia (anemia and thrombocytopenia) along with a low normal total leucocyte count and a low reticulocyte count. Bone marrow aspirate consisted predominantly of sinusoidal blood and hence was inconclusive. Bone marrow biopsy from the iliac crest of right and left sides showed hypocellular marrow spaces with deposition of extracellular pink amorphous material suggestive of serous atrophy. Alcian blue at a pH of 2.5 was done to confirm the diagnosis and it stained the deposits blue. Therefore a diagnosis of hypoplastic bone marrow with associated serous atrophy was made. Bone marrow study is a vital tool in evaluation of cytopenias in pediatric age group as it helps to narrow down the list of differential diagnosis. In case of extracellular eosinophilic deposits with marrow hypoplasia, a differential of serous atrophy should be borne in mind.

Mantle Cell Lymphoma (MCL) is a type of Non-Hodgkin's lymphoma and has a wide spectrum of histopathological subtypes of which the blastoid or the blastic variant constitutes 10-15% of all cases. It is difficult to diagnose blastoid variant of MCL on the basis of morphology alone as it mimics lymphoblastic lymphoma and centroblastic large cell lymphoma, hence additional analysis like immunophenotyping and molecular studies aid in its diagnosis. We present a case of 45-year-old male who presented to medicine OPD with chief complaints of fever, fatigability and inguinal swelling. Complete blood count, peripheral smear and bone marrow examination was performed. Peripheral smear showed thrombocytopenia along with 53% abnormal cells. On bone marrow examination 43% abnormal lymphoid cells were seen. This case was diagnosed as blastoid variant of MCL on the basis of routine morphology and immunohistochemistry on bone marrow biopsy and flow cytometric immunophenotyping on peripheral blood.