Determination of mononuclear cell count using peripheral smear and flow cytometry in peripheral blood stem cell products: A retrospective study from an Indian cancer center.

BACKGROUND: Mononuclear cells (MNCs) are considered equivalent to hematopoietic stem cells, and differential count using peripheral smear was routinely practiced to enumerate MNC. Flow cytometry plots used for CD34 enumeration assay can also be used in MNC enumeration as it counts more WBC events than manual methods. The aim was to determine the relationship and degree of agreement between peripheral smear and flow cytometry in MNC enumeration of peripheral blood stem cell (PBSC) products. METHODS: In 63 patients, 73 PBSC products were collected between January 2017 and September 2019. The differences in MNC count estimated by peripheral smear method and from flow cytometry plots used for CD34 enumeration were analyzed using Mann-Whitney test. Agreement between the two methods for MNC enumeration was determined by regression analysis. Receiver operating characteristic curve was performed to determine MNC threshold in peripheral blood and PBSC product for adequate mobilization and harvest. RESULTS: There was no difference in enumeration of median MNC count between peripheral smear and flow cytometry (52% vs. 59%, P = 0.185) in PBSC product. However, regression analysis indicated a constant and proportional difference between the methods with r = 0.52. Cumulative sum test for linearity showed deviation from linearity (P = 0.04). MNC counts in peripheral blood failed to achieve discrimination capacity in predicting adequate CD34+ yield/kg body weight in product. CONCLUSION: Peripheral smear estimated lower MNC counts than flow cytometry with weaker agreements between the two methods. Hence, MNC count derived from flow cytometry plot can substitute peripheral smear method for MNC dose calculations. MNC dose at 3.4 × 108/kg consistently predicted >2 × 106/kg CD34+ cells collected.

Filarial abscess in the submandibular region.

Filariasis is a parasitic infectious disease caused by filarial nematode worms. These worms mainly dwell in subcutaneous tissues and lymphatics of the human host, with a predilection for lower limbs, retroperitoneal tissues, spermatic cord, and epididymis. Oral or perioral involvement of the filarial nematode is rare. This case report describes a filarial abscess in the right submandibular region. Fine needle aspiration cytology of the abscess revealed the presence of microfilaria of Wuchereria bancrofti species. The parasite was also present in the peripheral blood smear. Filarial infection presenting in this region is unusual and can cause diagnostic dilemma. The clinician can consider filariasis as one of the differential diagnosis while treating those abscesses in the orofacial region that are unresponsive to routine management, especially, patients hailing from endemic areas.

Disseminated cryptococcosis presenting with generalized lymphadenopathy.

Cryptococcosis is a common opportunistic infection among immunocompromised individuals. Some of the commonly affected sites are respiratory and central nervous system. Lymph node is an unusual site of involvement which could mimic tuberculosis, as seen in our case. We report a 32-year-old male immunocompromised patient presenting with generalized lymphadenopathy who was clinically suspected to have tuberculous lymphadenitis. He was diagnosed to have disseminated cryptococcosis on fine needle aspiration cytology and fungal isolation on culture.

Nonrejection pathology of renal allograft biopsies: 10 years experience from a tertiary care center in north India.

BACKGROUND: Renal dysfunction in allograft transplant is common and its assessment is done using Revised Banff '97 working classification, which is the accepted formulation for the evaluation of histological appearance of renal allograft biopsies. The nonrejection category under the Banff working classification of renal allograft pathology forms a large group resulting in allograft dysfunction. AIM: To evaluate the spectrum of histopathological changes seen in renal allograft dysfunction. MATERIALS AND METHODS: A total of 119 renal biopsies were studied over 10 years presenting with renal allograft dysfunction from a tertiary center in North India. RESULTS: Majority of the biopsies were in the nonrejection category (47.1%), which included few cases of acute tubular necrosis (25.2%), cyclosporine nephrotoxicity (16%), infections (10.9%), and thrombotic microangiopathy (3.4%). The second largest category in our study was acute/active cellular rejection group (31.9%), which displayed moderate to severe tubulitis, mononuclear cell infiltrate in the interstitium, and vasculitis. Antibody-mediated rejection cases were seen in 28.6% of the renal biopsies followed by chronic allograft nephropathy cases (12.6%) showing features of tubular atrophy and interstitial fibrosis. Borderline changes with features of mild tubulitis contributed to 7.6% of the biopsies. The smallest group comprised of only 4.2%, which were within normal histological limits. CONCLUSION: Timely accurate diagnosis of renal allograft dysfunction is essential for prompt, effective management of renal transplant patients. Thus, nonrejection pathology forms a significant cause of renal dysfunction in patients with renal allograft transplantation.

Evaluation of iron status: zinc protoporphyrin vis-a-vis bone marrow iron stores.

Zinc protoporphyrin (ZPP) in the red cells is an indicator of iron status in the bone marrow (BM) and can be easily measured by Protofluor-Z Hematofluorometer from Helena Laboratories. It is well known that bone marrow iron is a gold standard for the diagnosis of iron deficiency anemia (IDA) even in the pre-latent phase. Hence, it was considered pertinent to evaluate the diagnostic utility of ZPP in comparison with bone marrow iron stores. 107 random BM were selected over a period of 2(1/2) years; in each case, RBC indices where recorded along with ZPP and Perls' Prussian blue reaction for BM iron stores. The specificity and sensitivity were found to be 77.8% and sensitivity 69.8%, respectively. However, the sensitivity increased up to 96.2% when Hb, RBC indices and ZPP were considered for the diagnosis of IDA.