Evaluation of Double M-Band on Serum Protein Electrophoresis Simulating Biclonal Gammopathy: A Case Report.

Multiple myeloma is characterized by the presence of M-protein (monoclonal) in blood or urine. These proteins are immunoglobulins which are produced by a clone of abnormally proliferating B-lymphocytes and/or plasma cells. To evaluate M-protein, serum protein electrophoresis (SPEP) is used where a single band, known as M-band is seen. This band is usually seen in the gamma globulin region. However, in rare entities like biclonal gammopathy, two M-bands appear simultaneously at different positions on SPEP which may be attributed to the clonal expansion of two different neoplastic cell lines. Here, we describe an atypical case of IgA-kappa multiple myeloma, where two M-bands (one in the beta region and one in the gamma globulin region) were found during SPEP. This simulated a picture of biclonal gammopathy. However the monoclonal nature of this M-protein was proved by performing immunofixation electrophoresis (IFE). Further, we put across images to explain how IFE helps in differentiating between apparent and true biclonality.

Comparison of in-vitro and in-vivo parameters of whole blood derived random donor platelets (RDP) after over-night hold with RDP prepared after 2-h hold: Single centre report from India.

BACKGROUND: Random Donor Platelet (RDP) derived from whole blood is the major source of platelets in India. At our centre, we prepare RDPs by buffy coat method after a holding period of 2-hours (THRDP) as per current regulatory guidelines. Overnight hold of buffy coats before RDP preparation (OHRDP) would logistically optimise the manpower usage at our centre. The aim of this study was to compare both in-vitro as well as in-vivo parameters of OHRDPs with THRDPs. METHODOLOGY: Hematological (Platelet, leucocyte counts), physical (pH and Swirling) and biochemical parameters (pO2, pCO2, lactate, bicarbonate and glucose) as well as platelet activation markers were tested in THRDPs and OHRDPs each at Day-1 and Day-5 as in-vitro studies. Separately, in-vivo study was done where Corrected count increment (CCI) and percentage platelet recovery (PPR) were considered. All parameters were expressed as Mean ± Standard deviation and were analysed using paired t-test with level of significance, p < 0.05. RESULTS: OHRDPs had higher platelet counts and lower leucocytes and CD62 P expression than THRDPs. All other markers were well within the quality control range in both groups. No significant differences were seen in the two groups when comparing CCI and PPR. CONCLUSION: OHRDPs were found to be as good or better as compared to the THRDPs in the in-vitro part of our study. Additionally, there were no significant differences between the two groups when they were compared in vivo. This makes us conclude that overnight hold of buffy coats may be implemented at our center.

A case of 'blue skin' and 'dark urine'.

A 60-year-old female presented with a 20-year history of progressive dark bluish discoloration of skin and passage of dark colored urine, painful arthritis and a recent history of invasive ductal carcinoma of right breast. Skin biopsy revealed hyaline material which was Periodic-Acid-Schiff stain positive and Congo-red stain negative, urine analysis revealed dark urine with presence reducing substance and radio-imaging showed intervertebral ossification and joint ankyloses. The patient was managed symptomatically with physiotherapy and acetaminophen on as required basis. This image is reported as a classic case of Alkaptonuria with clinical, histopathological and radio-imaging findings and the presence of invasive ductal breast carcinoma in the same patient.

Cost Effective Printing of Laboratory Reports: Biochemist's and Physician's debate and Institutions Dilemma.

INTRODUCTION: Laboratory investigations account for significant percentage of healthcare expenses. Every hospital and laboratory especially in the government sector wants to cut down the expenses on reports and offer inferior printouts of reports. The debate of printing attractive reports (clientele aspiration) Vs costs cutting (managerial issues) continues. It becomes the moral responsibility of doctors to guide the management into implementing an effective and economical option of report transcription. Cutting cost is always good but it should be achieved in an effective way keeping in mind the expectation of all the stake holders and ensuring that quality is not significantly compromised. The data regarding economics of printing available on the Internet may be market driven and not a true reflection of printing cost. The present study was undertaken to generate data on the economics of printing reports on various platforms to enable managers to make informed decision on choice of optimal printing option. AIM: To provide practical data on economics of printing reports using various printing options available in the country. MATERIALS AND METHODS: Four printing devices (laser printer, inkjet printer, dotmatrix printer and thermal printer) were connected to the laboratory information system and the reports printed from them were critically evaluated for the following parameters - cost of stationary, printing cost, time of printing and clientele satisfaction. RESULTS: The cost of printing a single report on laser printer, inkjet printer, dotmatrix printer and thermal printers was Rs 0.75, Rs 0.65, Rs 0.20 and Rs 0.93 respectively. The time taken to print 30 reports were 162 sec, 193 sec, 210 and 60 sec respectively. Clientele satisfaction scores were best with Laser and Inkjet printed reports. CONCLUSION: The most economical mode of printing is Dot Matrix printer using DOS output for printing. However, when the workload of a laboratory is high, then the use of laser printer is not prohibitively expensive option and can be resorted to. Use of thermal printer was found to be unsatisfactory.

Congenital Erythropoietic Porphyria with Undescended Testis.

Hereditary porphyrias are a group of metabolic disorders of heme biosynthesis pathway that are characterized by acute neurovisceral symptoms, skin lesions, or both. Congenital erythropoietic porphyria (CEP) is an extremely rare disease with a mutation in the gene that codes for uroporphyrinogen III synthase leading to accumulation of porphyrin in different tissues and marked cutaneous photosensitivity. We report a case of CEP with infancy onset blistering, photosensitivity, red colored urine, and teeth along with scarring. Examination revealed an undescended testis of the left side. Mutation analysis revealed mutation in the uroporphyrinogen III synthase gene (UROS) resulting in c. 56 A > G (Tyr19Cys). The presence of undescended testis with a rare mutation in a case of CEP which itself is an extremely rare condition make the case interesting.