Histomorphology of multiple myeloma on bone marrow biopsy.

In a retrospective study, 49 bone marrow biopsies (BMB) of patients with multiple myeloma (MM) were studied for its role in diagnosis and to determine histological parameters of prognostic significance. Sections were analyzed by 2 observers and classified according to: 1. Cytological grading according to differentiation of the neoplastic cells as plasmacytic, pleomorphic and plasmablastic. 2. Volume of infiltration: quantitating the percentage of myeloma cells in the biopsy. 3. Pattern of neoplastic infiltration. The overall marrow cellularity, presence of marrow fibrosis, micro-osteolesions and normal haematopoeisis were also studied. The bone marrow biopsy (BMB) was diagnostic for myeloma in five cases, where the aspirates were hypocellular: four had early myeloma and one had extensive marrow fibrosis. The pattern of infiltration was interstitial in 19 cases (39%), nodular in 19 cases (39%), and diffuse in 11 cases (22%). In majority of the cases (49%), the cell type was plasmacytic (24 cases), plasmablastic in 10 cases and pleomorphic in 15 cases. All cases of poorly differentiated cell type (plasmablastic) had a diffuse or nodular pattern of infiltration, whereas majority of the well-differentiated cell type had an interstitial pattern. The plasma cell burden in biopsy i.e the volume of infiltration was <10% in 8 cases, <50% in 19 cases and >50% in 22 cases and was used for histological staging of MM. Fibrosis was present in 30% of cases. Follow up was available in 11 cases, and cases with poorly differentiated myeloma, diffuse pattern of infiltration and dense fibrosis had survival less than one year. Cases of well differentiated myeloma, interstitial pattern of infiltration and plasma cell load less than 20% with absence of fibrosis had a more than 5-year survival. Different series have quoted that all these histological parameters provide valuable prognostic information, wherever other modalities like beta 2 microglobulin and IL-6 levels, etc are not available. The effects of therapy can also be monitored by sequential biopsies.

The association of antiphospholipid antibodies with ischaemic stroke and myocardial infarction in young and their correlation: a preliminary study.

AIM: The possible etiological role of antiphospholipid antibodies (APA) in thrombotic events on arterial side has become subject of interest. The present study was undertaken to determine the association and possible etiological role of APA in young Indian patients with acute ischaemic stroke and myocardial infarction (MI). MATERIAL AND METHODS: Forty six patients < 40 years of age including 22 with ischaemic stroke (excluding those with rheumatic heart disease and SLE), 24 with an acute MI and 21 age and sex matched healthy controls were enrolled in the study. All the patients and the controls were tested for the presence of lupus anticoagulant (LA) by a lupus sensitive activated partial thromboplastin time (APTT) and kaolin clotting time (KCT) and anti-caridiolipin antibodies (aCL) of IgM and IgG types using an ELISA technique. RESULTS: The screening tests for LA with APTT and KCT were negative in all the patients and the normal controls. In the stroke subgroup 18.18% patients (4/22) and in MI subgroup 4.16% (1/24) patients had raised aCL titers with statistically significant association only for stroke subgroup (p=0.0201) and not for MI subgroup. Significantly higher proportion of aCL positive cases were found in patients without any risk factor for atherosclerosis (4/12), compared to patients with one or more risk factor for atherosclerosis (1/34), p=0.001. CONCLUSION: Younger patients without identifiable risk factors for atheroscerosis presenting with stroke, are more likely to have an underlying antiphospholipid syndrome (APLS) as the etiology, and should be screened for it. No such association however was observed for MI patients.

Haemostatic changes in children with cyanotic and acyanotic congenital heart disease.

This study was undertaken to screen children with congenital heart disease for coagulation abnormalities and to compare the groups of cyanotic and acyanotic children with congenital heart disease with respect to abnormalities of the coagulation system. Following investigations were done in all the patients: complete blood count, erythrocyte sedimentation rate, peripheral smear examination, bleeding time, prothrombin time, activated partial thromboplastin time, assay of fibrinogen, D-dimer, factors VII and VIII and antithrombin III. Red cell indices were determined in 12 control, 12 acyanotic and 20 cyanotic children. Twenty-five patients each, with echocardiographically proven cyanotic and acyanotic congenital heart disease under 12 years of age constituted the study group; as many children of the same age group were included as the control group. The results showed isolated abnormalities of laboratory tests with equal frequency (28%) in acyanotic and cyanotic groups but coexisting abnormalities of more than one test were seen in significantly larger number of cyanotic children (5/25 and 16/25, respectively). A significant association was noted between thrombocytopenia and a high haematocrit in cyanotic patients. It is concluded that laboratory abnormalities of tests of haemostasis are more common in cyanotic congenital heart disease patients. The patterns of laboratory abnormalities suggest a chronic compensated disseminated intravascular coagulation at a subclinical level, reduced synthesis of clotting factors and/or deranged platelet aggregation in different subgroups of patients.

Symmetric peripheral gangrene and falciparum malaria--an interesting association.

Symmetric peripheral gangrene (SPG) is a rare syndrome in which disseminated intravascular coagulation (DIC) is the most common underlying condition. We report three cases of SPG in association with Plasmodium falciparum malaria and DIC, an association unreported so far.