How I investigate dysgranulopoiesis.

Dysgranulopoiesis is a condition in which granulocytic production is defective and is most often described in neoplastic conditions. However, it can also be frequently seen in non-neoplastic conditions. Early suspicion and detection of these non-neoplastic causes may prevent further invasive and expensive interventions. In this review, we take a look at the various causes of dysgranulopoiesis with an emphasis on non-neoplastic etiologies, followed by a detailed outline of the laboratory approach for determining its many causes.

Quality management and accreditation in laboratory hematology: Perspectives from India.

Quality management (QM), including quality assurance and quality control, was developed in clinical laboratories in North America and Western Europe, but must be implemented worldwide to ensure accurate, reproducible, and clinically useful results. India, a middle income country with a population of over 1.34 billion, has limited budget allotted to health care. As yet accreditation for clinical laboratories is not mandatory, which contributes to challenges in implementing good laboratory practice. This review provides a summary of internationally laid down QM principles and their application in a middle income country like India.

Aggressive Lymphomas Diagnosed in the Bone Marrow: Two Illustrative Cases.

Lymphomas with subtle patterns in the marrow can be a diagnostic challenge, unless a high index of suspicion is maintained. We present two patients with aggressive lymphomas who presented with cytopenias and the subsequent bone marrow examinations yielded surprising results. These cases highlight the potential usefulness of a bone marrow examination in the diagnosis of lymphomas in the absence of nodal or other tissue specimens.

Gastrointestinal ALκ amyloidosis presenting as protein-losing enteropathy correctly diagnosed by immunohistochemistry using amyloid-type-specific antibodies.

A 54-year-old man presented with protein-losing enteropathy. Biopsies from the stomach, duodenum, ileum and colon showed deposits of amyloid. The bone marrow showed plasmacytosis. After an initial misdiagnosis of AA amyloid, a revised diagnosis of ALκ amyloidosis was made at an expert referral laboratory. Care must be taken in the use of antibodies and proper controls in the performance and interpretation of immunohistochemistry for amyloidosis. A wide panel of amyloid-type-specific antibodies must be used and interpreted in comparative mode to avoid misdiagnosis.

Copper deficiency with 20q deletion and a paroxysmal nocturnal haemoglobinuria clone presenting with bicytopenia.

Copper plays an essential role in numerous enzymatic reactions in the human body and hypocupremia manifests itself as cytopenias and/or neuropathy. Copper deficiency is also a mimic of dysplasia, and this may cause diagnostic difficulties with true myelodysplasia. In this case report, we present a patient with anaemia, thrombocytopenia and marginally decreased leucocyte count, who was found to have low copper levels. In addition, he had isolated 20q deletion and a small paroxysmal nocturnal haemoglobinuria clone, which have not been reported previously. His counts normalized after steroid therapy followed by copper supplementation. This case is presented to highlight the fact that copper deficiency may be present without the characteristic morphologic changes, and may be coexisting with other abnormalities.