Clinician-Ordered Peripheral Smear Review by a Pathologist Has Low Clinical Utility-A Reference Laboratory Perspective.

Objective: This study aims to investigate hematological abnormalities in Ukrainian patients with rheumatoid arthritis(RA) and analyze their causes. Patients and methods: Eighty nine patients who met the American College of Rheumatology (ACR) criteria for RA were included in this study. Individuals with no history of joint pains were enrolled as healthy controls, and matched for age and ethnicity with patients of RA. All patients received methotrexate (10.5 ? 5.5 mg/week) in combination with folic acid. Steroid hormones were prescribed to 92% (19.3 ? 3.8 mg/day) of patients; nonsteroidal anti-inflammatory drugs were taken on demand. The blood count was measured to determine the white blood cell (WBC), red blood cell (RBC), hemoglobin and thrombocyte levels. TNFα, CRP and IL-1β were also investigated. Results: Anemia was observed in 57 (64% (95% CI 53.7-73.8%)) of the patients. Most of them (70.2% (95% CI 57.5-81.5%)) had mild degree of anemia, the rest (29.8% (95% CI 18.5-42.5%)) - moderate degree of anemia. In 13 (14.6% (95% CI 8.0-22.8%)) patients was found low WBC level (3.05 ? 0.84 G/L), mainly caused by low lymphocytes level (0.74 ? 0.21 G/L). Twenty one (23.6% (95% CI 15.3-33.1%)) patients had thrombocytosis (482.0 ? 29.1 G/L). Increased sedimentation rate (37.91 ? 15.65 mm/h) was recorded in all patients. The healthy controls had normal complete blood count. The correlation analysis revealed a negative correlation between the hemoglobin level and ESR, CRP, TNFα, IL-1β concentrations. There were statistically significant positive correlations between platelets level and ESR, CRP, TNFα, IL-1β concentrations. Conclusion: Our findings suggest that patients with RA have serious hematological abnormalities violations that can be caused by the activity of the disease.

ObjectiveSince the beginning of the coronavirus disease 2019 (COVID-19) pandemic, many studies have described the quantitative peripheral blood findings seen in COVID-19 patients. However, morphologic changes have been described by only a few studies. We report morphologic and quantitative changes in peripheral blood of COVID-19 patients.DesignWe reviewed electronic medical records, complete blood counts, and peripheral blood smears of 20 patients who were COVID-19 positive by reverse transcriptase-polymerase chain reaction (RT-PCR), from March 1, 2020, through May 31, 2020. The peripheral blood smears of all 20 patients were retrieved and morphological features of white blood cells, red blood cells, and platelets were reviewed and documented. Appropriate pictures were taken.ResultsOf the 20 patients reviewed, 13 were males and seven were females. The average age of the patients was 65.1 years. The most common quantitative hematologic abnormalities noted on complete blood count (CBC) were anemia followed by neutrophilia, neutrophilic left shift, and lymphopenia. The most significant morphologic changes noted were neutrophils with clumped chromatin, multiple abnormal nuclear shapes, pseudo-Pelger-Huet deformity, and smudged neutrophils. Lymphocytes showed abundant blue cytoplasm and/or lymphoplasmacytoid morphology and monocytes were activated with abnormal shapes and vacuolization. Platelets were adequate in number in the majority of patients and platelet clumping was the most significant finding noted. The red blood cells were normocytic and normochromic with few nucleated red blood cells and coarse basophilic stippling.ConclusionOur study identifies and describes significant morphologic changes in the peripheral blood cells of COVID-19 patients. An understanding of these morphologic changes in addition to established hematologic parameters can aid in the diagnosis of COVID-19 and serial CBC and peripheral smear review may help with management decisions in COVID-19 patients.

Immunoglobulin and Lymphocyte Subset Abnormalities in Patients with Fanconi Anemia and Dyskeratosis Congenita.

Karakurt N, Uslu İ, Aygün C, Albayrak C. Hematological disturbances in Down syndrome: single centre experience of thirteen years and review of the literature. Turk J Pediatr 2019; 61: 664-670. Neonates with Down syndrome (DS) may have hematological abnormalities such as polycythemia, thrombocytopenia and transient leukemia (TL). The primary objective of this study was to report the descriptive data of complete blood counts (CBC) of neonates with DS, which were obtained within first week of life. We wanted to focus on neonates with hematological abnormalities and compare them among those with and without TL. The secondary objective was the description of hematological malignancies in the first six years of life. Medical records of 100 neonates with DS between 2006-2018 were assessed. Hematological abnormalities were present in 73/100. We detected anemia in 16, polycythemia in eight, microcytosis in 10, leukopenia in two, leukocytosis in 11, thrombocytopenia in 26, thrombocytosis in 7 and TL in 11 patients. TL group had higher levels of leukocyte count (115.0±93.0x103/mm3) when compared with neonates without TL (11.7±5.6x103/mm3) (p < 0.001). No other statistically significant difference between groups for hemoglobin, MCV and platelet count levels was detected. In the follow- up period, two patients developed acute lymphoblastic leukemia, one hemophagocytic lymphohistiocytosis and one Burkitt lymphoma. None of the TL survivors developed myeloid leukemia of Down Syndrome (ML-DS). Thrombocytopenia may be detected frequently in DS and it may not be a part of TL. We suggest that CBC with peripheral blood film should be evaluated for every patient to check for TL and other hematological disturbances. Despite the fact that none of our TL survivors developed overt leukemia (ML-DS), we also suggest that patients with DS be followed due to the risk of developing leukemia.

Background: Automated cell counters are a very important part of pathology laboratory for evaluation of complete blood count (CBC). They also provide RBC histograms to interpret differentmorphological variations of Red Blood Cells.These histograms and other parameters have been found veryuseful in diagnosing various hematological conditions and Red Blood Cell disorders if they are correctly interpreted.Examination of peripheral smears is still the gold standardfor diagnosing some of the RBC disorders which might not be diagnosed otherwise by automated cell counters. They play an important role in quality check of automated analyzers. Materials and Methods:In this prospective study we have taken 200 samples over a period of 6 months. We did comparative study between RBC histograms obtained by automated hematology analyzer and peripheral blood smears stained by field stain. We have discussed morphological variations of red blood cells and their characteristic changes in respective RBC histograms. Result:Out of 200 samples of RBC histogram interpretation, 138 cases showed correlation with peripheral smear findings while 62 cases showed discrepancies. Conclusion: Microscopic examination of peripheral blood smear still remains gold standard for diagnosis of various hematological conditions.

JAK2 (V617F)-Positive Essential Thrombocythemia and Polycythemia Vera Are Different Expressions Of a Genotypic/Phenotypic Continuum

The pathogenesis of Epstein-Barr virus-positive (EBV+) mature T-cell and natural killer (NK)-cell neoplasms is challenging to understand. The clinical features are diverse, with no typical manifestation. Therefore, it is important to analyze the association of the clinical characteristics and prognoses of patients with various factors associated with EBV+ T/NK-cell neoplasms, particularly extranodal NK/T cell lymphoma, systemic EBV+ T/NK cell lymphoproliferative disorders, aggressive NK cell leukemia and EBV+ peripheral T-cell lymphoma. Therefore, 42 cases of EBV+ T/NK-cell neoplasms with information on age, gender, fever, LDH level, complete blood count (CBC) and immunophenotype (CD5/CD20) were retrospectively analyzed to examine the clinical features, prognoses and related factors. It was found that patients ≤60 years old accounted for 86% of cases. The frequency of stage III/IV disease was higher in groups with pancytopenia (P=0.005), high LDH level (P=0.020), CD5-expression status (P=0.031) and fever (P=0.024). There were significant differences in the mean International Prognostic Index (IPI) scores according to the presence or absence of fever (P=0.022), elevated or normal lactose dehydrogenase (LDH) levels (P=0.001), and pancytopenia or normal complete blood count (CBC; P=0.046). Analysis of overall survival showed that CD5 expression, CBC, IPI scores and LDH levels were factors associated with OS. CD5 expression (P=0.003), CBC (P=0.003) and IPI scores (P=0.017) were identified to be important risk factors on the basis of Cox regression analysis. The mean survival time was longer in the CD5+, CD20+ and normal CBC groups, and there was no clear difference in survival time according to LDH level or fever. In summary, CD5 and CD20 may be prognostic factors in EBV+ T/NK lymphoid neoplasms, and CBC and fever are most likely to influence the IPI score and Ann Arbor stage.

Pediatric hematology normal ranges derived from pediatric primary care patients.

258 The Optic Nerve Sheath Diameter in Cerebral Infections

Introduction: Hematological abnormalities are a common complication of HIV infection. Anemia is the most common abnormality found in the people living with HIV. It is observed that the severity of anemia increase the mortality in PLWH independent of CD4 count. There are wide variations in the prevalence of anemia from different countries all over the world. Also gender specific variation observed in different studies. Aims and Objectives: Aim of our study was to collect the data from India and study the anemia and its gender specific variation in people living with HIV in India. Materials and Methods: Two hundred PLWH of age group 18-60 years were included in the study. Study conducted from June 2012 to June 2014 at tertiary care hospital and medical teaching institute in south central India. Out of two hundred subjects ninety nine were males and one hundred one females, Complete blood count done on ERMA-PCE 210 blood cell counter. Hemoglobin values were further studied for diagnosis and classification of anemia. Results: The results of study indicated high prevalence of anemia in PLWH i.e.77.5%. The prevalence of anemia in female (84.15%) was higher as compared to males (70.70%). No significant correlation found between anemia and sex p=0.260. Conclusion: Anemia prevalence is high in PLWH and is higher in females as compare to males.

Background Insufficient stores of vitamin B12 in human body are thought to result in macrocytic anemia. However, anemia in most of the patients is multifactorial. This is commonly owing to mixed nutritional deficiencies or bowel disorders affecting absorption of more than one element. Resultantly, a single causative agent of anemia like vitamin B12 deficiency may take macrocytic, normocytic, or microcytic forms. Patients presenting with microcytic anemia may have underlying insufficiency of this vitamin in some instances. Assessment of complete blood count (CBC) parameters may be helpful to identify such cases. Methods This study was conducted on 155 patients of microcytic anemia. Assessment of complete blood count (CBC) parameters and vitamin B12 was done using state of the art analyzers. The overall data was analyzed using SPSS version 23. Results Subnormal vitamin B12 levels were found in 17.4% of the studied cases. CBC parameters showed distinct changes in this group. Mean hemoglobin and red blood cell values were lower compared to the subjects having normal B12 values, and mean corpuscular volume and mean corpuscular hemoglobin concentration had an upward trend in cases of severe deficiency. Features of leucopenia and pancytopenia were more frequent also. Macrocytic red blood cells on peripheral smear were useful to detect the hidden deficiency even when the predominant picture consisted of microcytic cells. Conclusions Vitamin B12 deficiency maybe underlying in microcytic anemia patients. Important clues in CBC include very low hemoglobin but mildly decreased MCV values in the presence of leucopenia and macrocytic RBCs on peripheral smear.

Introduction: Hemoglobin E (HbE) is the second most prevalent structural abnormality in hemoglobin (Hb), following sickle cell hemoglobin (HbS). Our aim is to assess the clinical and hematological characteristics HbE disease and trait, incorporating observations from High-performance liquid chromatography (HPLC) and iron profiles. Materials and Methods: The study was conducted in the department of hematology, from June 2022 to December 2023. Out of 264 individuals sampled for HPLC, based on their peripheral smear (PS) and complete blood count (CBC) findings, 36 individuals found to have HbE disease. This study involved a comprehensive analysis of the hematological parameters, HPLC findings, and iron profiles of individuals with HbE. Results: In our study, we found 14 cases with HbE trait and 22 cases with HbE disease, out of the 264 cases analyzed in HPLC. It included pregnant females who came for routine check-up as well as referred patients suspected to have hemoglobinopathies who showed a range of symptoms, along with normal or slightly increased red blood cell (RBC) count with decreased mean corpuscular volume (MCV), and presence of microcytic RBCs and target cells in PS. Their iron levels were within normal limits, and HPLC revealed elevated levels of HbA2. Conclusion: HbE disorders constitute a diverse range of diseases, experiencing a significant global rise especially in people of Assam. Normal or increased RBC count with low MCV on CBC, target cells and microcytosis on PS with a normal iron profile should raise a suspicion of HbE and further investigations like HPLC should be performed.

Objective: Chronic menorrhagia causes anemia and impairment of life quality. In this study the aim was the screening of bleeding disorders in adolescents and young women with menorrhagia. Materials and Methods: The study was performed prospectively by pediatric hematologists. A form including demographic characteristics of the patients, bleedings other than menorrhagia, familial bleeding history, characteristics of the menorrhagia, and impairment of life quality due to menorrhagia was filled out by the researcher during a face-to-face interview with the patient. A pictorial blood assessment chart was also used for evaluation of blood loss. All patients underwent pelvic ultrasound sonography testing and women also received pelvic examination by gynecologists. Whole blood count, peripheral blood smear, blood group, serum transaminases, urea, creatinine, ferritin, PFA-100, PT, aPTT, INR, TT, fibrinogen, VWF:Ag, VWF:RCo, FVIII, and platelet aggregation assays were performed. Platelet aggregations were studied by lumiaggregometer. Results: Out of 75 patients enrolled, 60 patients completed the study. The mean age was 20.68±10.34 (range: 10-48) years and 65% (n=39) of the patients were younger than 18 years. In 18 (46%) of the adolescents, menorrhagia subsided spontaneously. In 20% (n=12) of the patients, a bleeding disorder was detected (1 case of type 3 von Willebrand disease, 2 patients with low VWF:Ag, 1 case of probable von Willebrand disease, 3 cases of Bernard-Soulier syndrome, 2 cases of Glanzmann thrombasthenia, 2 cases of immune thrombocytopenic purpura, 1 case of congenital factor VII deficiency). Conclusion: In patients with menorrhagia, at least complete blood count, peripheral smear, aPTT, PT, VWF:Ag, VWF:RCo, FVIII, and fibrinogen assays must be performed. When there is history of nose and gum bleeding, platelet function assay by lumiaggregometer must also be performed. In nearly 50% of adolescents, menorrhagia is dysfunctional and transient. Detailed coagulation assays can be postponed in adolescents if bleeding history other than menorrhagia and/or family history of bleeding and/or parental consanguinity is absent. All subjects with menorrhagia must consult with gynecologists and hematologists.Conflict of interest:None declared.

Background: Perinatal asphyxia is failure to establish breathing at birth. It is a common cause of neonatal mortality in developing countries. Hypoxic Ischemic Encephalopathy (HIE) is the major complication of asphyxia, resulting in permanent neurological and other multi-organ damages. Some haematological changes have also been observed in patients with this disease.&#x0D; Objectives: The objective of this study was to investigate the haematological features in babies with perinatal asphyxia in Zimbabwe.&#x0D; Methodology: A prospective laboratory based cross sectional study was carried out at the Sally Mugabe Hospital Neonatal Unit from December 2018 to April 2019. Routine full blood counts on samples from babies with perinatal asphyxia on their first day of life. Peripheral blood smears were examined on all those with abnormal full blood count results.&#x0D; Results: Full blood counts were done on 180 babies with perinatal asphyxia of whom 103 (57%) and 77 (43%) were females and males respectively. The median white cell count and nucleated red cell count were elevated. The platelet and red cell count were decreased. Haemoglobin, haematocrit, and Mean Corpuscular Haemoglobin Concentration (MCHC) were within normal range. The Mean Corpuscular Volume (MCV) and Mean Corpuscular Haemoglobin (MCH) were increased. There was a correlation between increased nucleated red blood and white cell counts with the severity of perinatal asphyxia in the order of Asphyxia Without Hypoxic Ischemic Encephalopathy (AWHIE), Hypoxic Ischemic Encephalopathy (HIE I), HIE II, and HEI III. The most common haematological abnormalities were thrombocytopaenia 52(29%), anaemia 51(28%) and leukopaenia 28(16%). Twenty-four (47%) of anaemia patients had microcytic hypochromic anaemia. Thirty-one (47%) of 65 blood films examined exhibited immature granulocytes and 28(43%) had burr red blood cells.&#x0D; Conclusion: Babies with perinatal asphyxia may present with haematological abnormalities such as anaemia, thrombocytopaenia, leukocytosis and elevated nucleated red cell count as complications of sever hypoxia. Full blood count may be a useful in the effective management of perinatal asphyxia.

Detection of Hemoglobin (Hb) Variants By HPLC Screening in Cord Blood Units (CBU) Donated to the National Cord Blood Program (NCBP)