Evaluation of the use of gel card system for assessment of direct coombs test: weighing the pros and cons.

A positive direct Coombs test (DCT) is the hallmark of diagnosis of immune hemolytic anemias. The reagent used for the test is the Antihuman globulin (AHG), which may be either 'Polyspecific' or 'Monospecific'. The advent of the Gel card systems has made the procedure and interpretation of DCT simpler. Aim of this study is to evaluate three of the various techniques used for the performance and interpretation of DCT. A total of 96 EDTA samples were included in the study. DCT was performed by (i) polyspecific AHG manual tube method (ii) polyspecific AHG Gel card method and (iii) monospecific AHG (Anti IgG and Anti Complement) manual tube method. In our study we considered positivity by monospecific AHG as the standard for diagnosis. Of the total 96 samples evaluated, 44 cases positive by Gel card method, were also positive for either one or both the monospecific AHG reagents. 17 cases positive by Gel card were negative by all manual methods. These false positive cases were attributed to reasons such as increased ESR, macrocytosis and marked leucocytosis. Nine cases were negative by Gel card but were positive with the Monospecific AHG. The sensitivity of DCT done by the Gel card technique was 83.01% and the specificity was 60.46%. Use of Gel card technique to perform and interpret DCT is easier than manual tube methods, but positivity by Gel card needs to be correlated with clinical presentation of the patient and other laboratory findings. Monospecific antisera can be used to confirm cases that are positive by the Gel card systems.

Clinical patterns and hematological spectrum in autoimmune hemolytic anemia.

BACKGROUND: Autoimmune hemolytic anemia (AIHA) results from red cell destruction due to circulating autoantibodies against red cell membrane antigens. They are classified etiologically into primary and secondary AIHAs. A positive direct antiglobulin test (DAT) is the hallmark of diagnosis for AIHA. METHODS AND RESULTS: One hundred and seventy-five AIHA cases diagnosed based on positive DAT were included in the study. The cases showed a female predilection (M: F = 1:2.2) and a peak incidence in the third decade. Forty cases were found to be due to primary AIHA, while a majority (n = 135) had AIHA secondary to other causes. The primary AIHA cases had severe anemia at presentation (65%) and more often showed a blood picture indicative of hemolysis (48%). Forty-five percent of primary AIHAs showed positivity for both DAT and indirect antiglobulin test (IAT). Connective tissue disorders were the most common associated etiology in secondary AIH A0 (n = 63). CONCLUSION: AIHAs have a female predilection and commonly present with symptoms of anemia. AIHA secondary to other diseases (especially connective tissue disorders) is more common. Primary AIHAs presented with severe anemia and laboratory evidence of marked hemolysis.

The diagnostic utility of bone marrow trephine biopsies.

The bone marrow examination is invaluable in the diagnosis of certain haematological and non haematological conditions. The diagnosis of haematological disorders is achieved mainly by the examination of peripheral blood and bone marrow aspirate smears. Although bone marrow histology can provide additional information, for many technical reasons, trephines are not so popular and their diagnostic value is overlooked. Our experiences in the role of trephine biopsies in the diagnosis are presented in this article. All the bone marrow biopsies performed at the St. John's Medical College Hospital over the last 12 years (1990-2002) were reviewed The bone marrow biopsies were grouped into 3 categories for analysis. The trephine biopsy is invaluable in cases where the aspirate fails or is a dry tap as in the case of myelofibrosis, focal marrow involvement as in granulomatous lesions, metastatic tumour and lymphomas.

Plasmodium malariae malaria--a case report.

The tropical zone is the endemic home for all malarial parasites. Plasmodium vivax and Plasmodium falciparum are the species that are prevalent commonly in India. Plasmodium malariae is a parasite of both the tropical and subtropical zones, especially West and East Africa, Guiana and parts of India, but its presence in various zones tends to be patchy. In Karnataka state, its prevalence is rare. A case of Plasmodium malariae malaria from St John's Medical College, Bangalore in the background of the rarity of occurrence in this part of the country is presented.

Antiphospholipid antibodies--our experience.

Antiphospholipid antibodies (APA) have aroused multispeciality interests. In our study of 200 cases worked up for APA, we have used a few simple coagulation tests to detect lupus anticoagulant (LA) and ELISA to detect anticardiolipin antibodies. The positivity rate for LA among cases with recurrent pregnancy loss was 4.16% and for aCL 20.8%. The positivity rate for LA in patients with venous thrombosis was 6.2%, in arterial thrombosis was 7.14% and in SLE patients was 58.3%. In conclusion APAs are to be looked for in cases of recurrent pregnancy loss, thrombosis in people < 45 years of age without risk factors and SLE patients to assess the thrombotic risk and to decide on anti coagulant therapy for further management.

Changing trends in malaria--a decade's experience at a referral hospital.

A 10 year study of malaria during 1989-98 recorded an increase in the incidence of malaria from 0.22 in 1989 to 1.3 in 1996 following which it has reached a plateau. The cases were chiefly from Karnataka, Andhra Pradesh and Tamil nadu. The P. falciparum infection and mixed infections (P. falciparum and vivax) were found to be on the rise. Peak of malaria cases were recorded in the months of June-July and in Oct-Nov coinciding with the rains showing a seasonal pattern. The common haematological findings were anemia, thrombocytopenia, pancytopenia and leucopenia. Complications noted in our study were haemolysis, renal failure, hepatopathy and cerebral malaria. The unusual cases were congenital malaria, malaria with sickle cell anemia, AIHA and G-6PD deficiency. Mortality due to cerebral malaria was found to be 13.5%.

Haematological changes in HIV infection.

HIV infection is associated with a wide range of hematological abnormalities. The peripheral blood findings and the morphological abnormalities in the bone marrow can simulate myelodysplastic syndrome, myeloproliferative disorders, and T cell lymphoma. We studied the peripheral blood smear and bone marrow findings of 42 patients with HIV infection over a 3-year period with the aim of recognising the morphological findings sufficiently characteristic of HV infection. The salient peripheral blood smear findilngs were anemia, bicytopenia and pancytopenia. The bone marrow revealed trilineage dysplasia, plasma cells and eosinophils, increased megakaryocytes, increased iron and reticulin fibrosis. In two cases the bone marrow revealed granulomata.

Disseminated histoplasmosis in an AIDS patient diagnosed on bone marrow.

A 29 year old male drug addict, who was HIV positive presented with fever and hepatosplenomegaly. Bone marrow examination revealed Histoplasma capsulatum confirmed by PAS & GMS stains. However patient had a rapid downhill course with multiorgan failure and died before specific treatment could be instituted.

An unusual case of haemophilia--a case report.

Haemophilia in a female is very rare. We report a case of haemophilia in a female with a male sex chromosome pattern.

How safe are our safe donors?

One of the greatest challenges of transfusion medicine is the prevention of transmission of infectious diseases through blood transfusion. The aim of this study is to present the current status of transfusion transmitted diseases among healthy unpaid blood donors so as to heighten the awareness of the complications of blood transfusion and make usmore vigilant with regard to the specifics of blood collection and testing as well as judicious use of blood. 8617 donors donated at St. Johns Medical College Hospital Blood bank from 1st. September 1997 to 31st August 1998. The tests done on all units included testing for HIV 1&2, HBsAg, HCV, VDRL and malarial parasites. The seropositivity among donors for HIV was 0.44%, for HBsAg 1.86%, for HCV 1.02% and for VDRL 1.6% No MP Positives were picked up in the study period. The focus has been on HIV so far. We have found the magnitude of hepatitis to be far more than that of HIV. Hence testing for HCV routinely is recommended.