Study of Twenty One Cases of Red Cell Exchange in a Tertiary Care Hospital in Southern India.

INTRODUCTION: Red Cell Exchange (RCE) is removal of a patient's red blood cells while replacing with donor red blood cells either manually or using automated systems. RCE is beneficial in patients with Sickle Cell Disease (SCD) either during sickling crisis or prior to major surgical procedures to bring down the sickling percentage as high sickling percentage during prolonged anaesthesia may lead to vaso-occlusive crisis. It is also employed in patients infested with malaria and babesiosis where parasitic index remain high despite medical management. RCE is also tried as an adjuvant therapy in certain poisons like nitrobenzene and carbon monoxide when first line management fails. AIM: To study the effectiveness, clinical outcome, challenges and complications of RCE in various clinical scenario and to understand how this procedure can be effectively utilized in the management of patients in Indian scenario. MATERIALS AND METHODS: This retro prospective study was conducted in tertiary care center in southern India which analyzed 21 RCE procedures performed on patients with different clinical conditions. Of the 21 RCE performed, 18 procedures were performed on patients with case of sickle cell disease, Two procedures were performed on patients infested with severe falciparum malaria and one procedure was performed on a patient with nitrobenzene poisoning. All procedures were performed using Spectra Optia(®) Apheresis System - Terumo BCT. RESULTS: All the 18 patients who underwent the RCE for sickle cell anaemia were admitted for hemi-arthroplasty for avascular necrosis of the head of femur. The average initial HbS levels were between 73-85% and post RCE it was brought down to 22-29% and was achieved in a single sitting in all the cases. Among the two patients infested with severe falciparum malaria, RCE helped in reducing the infestation rate. In case of nitrobenzene poisoning, RCE helped in improvement of oxygen saturation and patient showed significant improvement. CONCLUSION: RCE is an safe and clinically effective therapeutic modality with very minimal to nil side effects. RCE is possibly underutilized therapy in developing world like India due to various reasons like inadequate awareness/ technical expertise, lack of equipments and facilities to identify the clinical conditions per se etc.

An Audit of Requests for Fresh Frozen Plasma in a Tertiary Care Center in South India.

AIM: To audit the fresh frozen plasma (FFP) usage with an insight into various guidelines. MATERIALS AND METHODS: The blood bank records pertaining to FFP usage in patients admitted in our medical college hospital were retrospectively reviewed for 2 years for usage of FFP in various departments and evaluated for appropriateness of usage based on various guidelines, which included the 2013 guidelines published by the National Health and Medical Research Council and the Australasian Society for Blood Transfusion. RESULTS: A total of 785 units of FFPs were transfused to 207 patients during the study period. The appropriate usage was found to be 59.3%, and the usage was most appropriate in massive transfusions. CONCLUSION: This study highlights the nonadherence to guidelines among clinicians which is mainly due to lack of knowledge of appropriate usage.

Spectrum of cytology of neck lesions: comparative study from two centers.

BACKGROUND: The objective of this descriptive study was to observe the frequency of various pathological conditions detected in FNAC of patients presenting with neck swellings coming from two different regions of southern India. MATERIALS AND METHODS: This study included 100 consecutive patients from each region (Region 1: Wyanad, Region 2: Salem) presenting to the department of Pathology with swelling in the neck region as the chief complaint. All age groups were included. All patients underwent FNAC and results were recorded. Frequency of various pathologies was determined. RESULTS: Thyroid lesions were predominant in both the regions with colloid goiter being the commonest lesion followed by lymphadenitis. Metastasis was more common compared to primary malignancies in Salem due to the elderly population under study. CONCLUSION: Non-neoplastic lesions were commonly encountered in our study which is in accordance with findings in similar studies conducted in other developing countries. FNAC should be the primary investigation of choice as it is inexpensive, safe and has a high degree of diagnostic accuracy.

The value of systematic pattern analysis in FNAC of breast lesions: 225 cases with cytohistological correlation.

BACKGROUND: Fine needle aspiration cytology (FNAC) has a high rating in the assessment of breast lesions. Various methods have been used to diagnose cytology of breast lesions. AIMS: Present study was undertaken to evaluate the feasibility of application of systematic pattern analysis based on morphology in diagnosing breast aspirates. MATERIALS AND METHODS: This is a retrospective study of FNAC of the breast done over a period of 4 years in a tertiary care centre. A total of 225 cases of breast lesions for which FNAC was done with histological follow-up were included in the study. Breast aspirates were provisionally diagnosed based on systematic pattern analysis. Aspirates were grouped into six categories based on predominant cellular pattern, and correlation between cytological and histological diagnosis was assessed. RESULTS: Application of pattern analysis on FNAC of breast lesions in our study had a sensitivity of 94.5%, specificity of 98%, diagnostic accuracy of 97%, positive predictive value of 95.8%, and negative predictive value of 97.4%. CONCLUSIONS: Systematic pattern analysis based on morphology of FNAC smears was found to be highly reliable and could be easily reproducible in the assessment of breast masses.

Cytohistological correlation of grading in breast carcinoma.

Assigning a tumor grade to breast cancer provides important prognostic information and guides optimal therapy. The present study was undertaken to grade breast carcinoma on aspirates by Robinson grading (RGS) and Scarff-Bloom-Richardson grading system (SBR). Histological grading was done according to Nottingham modification of Scarff-Bloom-Richardson method and the two cytological grading systems were compared. Fifty cases of breast carcinoma with preoperative cytologic diagnosis were assigned tumor grade. Histologic grading was done on corresponding mastectomy or partially resected specimens. Statistical analysis was performed; correlation between cytologic and histologic grading was established using Spearman correlation coefficient. Regression analysis was done to assess the significance of each cytological feature. Univariate analysis showed strong correlation (P < 0.01) for all features except dissociation. Multiple regression analysis of cytologic features revealed cell dissociation nucleoli and nuclear margin as the most influential features. A concordance of 72.5% between RGS (cyto) and SBR (cyto), 64% for RGS (cyto) and SBR (histo), 82% for SBR (cyto) and SBR (histo) was noted. There was a significant association (P < 0.001) between the grades assigned to cytologic and histologic specimens. Cytologic grade could be used to predict histologic grade as significant relationship exists between grades assigned to cytologic and histologic specimens.