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OBJECTIVE: To compare the mRNA expression of placental iron transporters (TfR-1 and FPN), markers of placental vascularization (VEGF and sFLT1) and marker of structural integrity (LMN-A) in term women with and without iron deficiency anemia. MATERIALS AND METHODS: A total of 30 pregnant women were enrolled; 15 cases of iron deficiency anemia (Hb 7-10.9 gm/dL) and 15 gestational age matched healthy controls (Hb ≥ 11 gm/dL). Peripheral venous blood was collected for assessment of hemoglobin levels and serum iron profile. Placental tissue was used for assessing the mRNA expression of TfR-1, FPN, VEGF, sFLT-1 and LMN-A via real time PCR. RESULTS: Placental expression of TfR-1, VEGF and LMN-A was increased in pregnant women with anemia compared to healthy pregnant controls. Placental expression of sFLT-1 was decreased in pregnant women with anemia compared to healthy pregnant controls. There was no change in the placental expression of FPN. CONCLUSION: The increased expression of TfR-1, VEGF and LMN-A in cases of iron deficiency anemia are most likely to be compensatory in nature to help maintain adequate fetal iron delivery. WHAT DOES THIS STUDY ADDS TO THE CLINICAL WORK: Compensatory changes in the placenta aimed at buffering transport of iron to the fetus are seen in pregnant women with anemia compared to healthy pregnant controls.
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Anemia Ferropénica , Biomarcadores , Proteínas de Transporte de Catión , Hierro , Placenta , Receptores de Transferrina , Factor A de Crecimiento Endotelial Vascular , Humanos , Femenino , Embarazo , Placenta/metabolismo , Adulto , Receptores de Transferrina/metabolismo , Receptores de Transferrina/genética , Anemia Ferropénica/genética , Anemia Ferropénica/metabolismo , Factor A de Crecimiento Endotelial Vascular/genética , Factor A de Crecimiento Endotelial Vascular/metabolismo , Proteínas de Transporte de Catión/genética , Proteínas de Transporte de Catión/metabolismo , Hierro/metabolismo , Biomarcadores/metabolismo , Biomarcadores/sangre , Receptor 1 de Factores de Crecimiento Endotelial Vascular/genética , Receptor 1 de Factores de Crecimiento Endotelial Vascular/metabolismo , Estudios de Casos y Controles , Antígenos CD/metabolismo , Antígenos CD/genética , ARN Mensajero/genética , ARN Mensajero/metabolismo , Expresión Génica/genéticaRESUMEN
AIM AND OBJECTIVES: We compared the effect of different doses of oral folic acid (FA) supplementation (5 mg/day vs. 2.5 mg/day vs. 5 mg/week) on the proportion of children with folate excess (serum folate >20 ng/ml) and plasma homocysteine (Hcys) excess (>15 µmol/l) in transfusion-dependent thalassemia (TDT). MATERIALS AND METHODS: Children with TDT aged 5-18 years received oral FA in doses of 5 mg/day (Group 1), 2.5 mg/day (Group 2) and 5 mg/week (Group 3) for 9 months, after a wash-off period of 8 weeks. Folate levels (Serum and RBC) and plasma Hcys levels were measured after the therapy. RESULTS: Ninety children were randomized to receive one of the three interventions (30 per group). After wash-off period, the median serum folate levels were significantly lower and five children developed folate deficiency; the median [interquartile range (IQR)] serum folate levels (ng/dl) were comparable in the three groups [Group 1: 6.5 (3.3-14.2), Group 2: 5.1 (2.6-10.5) and Group 3: 4.8 (3.4-10.0)]. After 9 months of intervention, the median (IQR) serum folate levels (ng/ml) were comparable in all participants [Group 1: 18.0 (6.5-28), Group 2: 13.5 (6.4-24.5) and Group 3: 9.7 (5.3-22.5); p = 0.11]. Proportion of children with serum folate excess was 40%, 26.7% and 26.7% in Group 1, Group 2 and Group 3 (p = 0.48). Proportion of children with RBC folate excess was 92%, 86.7% and 86.7% in Group 1, Group 2 and Group 3 (p = 0.79). Hyperhomocysteinemia was seen in eight children with no significant difference between median Hcys levels in the groups (p = 0.75). CONCLUSION: Folic acid supplementation is recommended in TDT with 5 mg weekly dose being adequate.
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Ácido Fólico , Talasemia , Niño , Suplementos Dietéticos , Homocisteína , Humanos , Talasemia/tratamiento farmacológicoRESUMEN
AIM: We compared the performance of plasma lactate with high-sensitivity C-reactive protein (hs-CRP), and paediatric sepsis-related organ failure assessment (pSOFA) score for predicting mortality in septic children. METHODS: Serial plasma lactate and hs-CRP levels and pSOFA score was assessed during early hospital stay in septic children. RESULTS: Out of 149 participants, 45 died. Plasma lactate at 0 h and 6 h was significantly higher, and lactate clearance was significantly lower in non-survivors. The optimal cut-off of plasma lactate at 6h for identifying mortality was 2.5 mmol/L (sensitivity 85% and specificity 74%). pSOFA score had the best predictive ability for mortality (AUC 0.89) followed by hs-CRP at 0 h (AUC 0.86), hs-CRP at 48 h (AUC 0.83), plasma lactate levels at 6 h (AUC 0.83), and plasma lactate at 0 h (AUC 0.67). CONCLUSION: pSOFA score, hs-CRP and hyperlactemia at 6 h can identify septic children at risk of dying.
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Sepsis , Proteína C-Reactiva , Niño , Pruebas Diagnósticas de Rutina , Mortalidad Hospitalaria , Humanos , Ácido Láctico , Pronóstico , Curva ROC , Sepsis/diagnósticoRESUMEN
Bone marrow iron estimation remains the gold standard for diagnosing iron-deficiency anemia (IDA); serum ferritin, total iron-binding capacity, and transferrin saturation are routinely used as surrogate markers of IDA. However, these tests are marred by problems like poor specificity and sensitivity. Recently, hepcidin, a protein hormone synthesized in the liver and excreted in urine, has been shown to be related to iron status. We estimated the serum and urinary hepcidin levels in healthy children 6 to 60 months of age with (n=30) and without IDA (n=30). The mean (SD) serum hepcidin levels in children with IDA were significantly lower than those in children without IDA (3.03 [1.06] vs. 4.78 [3.94] ng/mL; P=0.02). The mean (SD) urinary hepcidin levels were also significantly lower in children with IDA than those in children without IDA (2.29 [0.53] vs. 2.79 [0.75] ng/mL; P=0.004). Performance of urinary and serum hepcidin compared with serum ferritin (<12 µg/L) for diagnosing IDA in terms of area under the receiver operating characteristic curve was 0.704 (P=0.007) and 0.59 (P=0.22), respectively. Serum hepcidin is not useful for diagnosing IDA in under-5 children. In contrast, urinary hepcidin holds promise as a noninvasive diagnostic tool for IDA in under-5 children.
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Anemia Ferropénica/diagnóstico , Hepcidinas/sangre , Hepcidinas/orina , Biomarcadores/sangre , Biomarcadores/orina , Estudios de Casos y Controles , Preescolar , Femenino , Humanos , Lactante , Masculino , Sensibilidad y EspecificidadRESUMEN
BACKGROUND & OBJECTIVES: Diagnosis of paroxysmal nocturnal haemoglobinuria (PNH), a rare haematopoietic stem cell disorder, is challenging in patients with bone marrow failure (BMF) syndrome like aplastic anaemia (AA). This study was conducted with the aim to test the efficacy of the newly recommended markers viz. anti-CD16 and CD66b antibody over the existing anti-CD55 and CD59 antibody for PNH diagnosis in India. METHODS: This study was conducted on 193 suspected cases of PNH by flow cytometry using lyse wash technique to stain the granulocytes with CD16/CD66b and CD55/CD59. RESULTS: Of the 193 suspected cases, 62 patients showed the presence of PNH clone. Forty six patients were detected by CD55/CD59/CD45, whereas 61 were detected by CD16/CD66b/CD45. CD16/CD66b detected 16 (25.8%) additional patients over CD55/CD59 (P<0.05) and was more sensitive in detecting the PNH clone with higher negative predictive value. Most of the patients (11/16) who were picked up by CD16/CD66b were of AA who had small clone sizes. Further, the PNH clones were more discreetly identified in CD16/CD66b plots than by CD55/CD59. Clone size assessed by CD16/CD66b which reflects the clinical severity of classical PNH (thrombosis/haemolysis), was more representative of the underlying clinical condition than CD55/59. INTERPRETATION & CONCLUSIONS: In our experience of 62 patients of PNH, CD16/CD66b proved to be more efficacious in detecting PNH. The new panel was especially useful in monitoring PNH associated with BMF which had small clone sizes.
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Anemia Aplásica/sangre , Anticuerpos Antiidiotipos/sangre , Enfermedades de la Médula Ósea/sangre , Hemoglobinuria Paroxística/sangre , Adulto , Anemia Aplásica/complicaciones , Anemia Aplásica/patología , Anticuerpos Antiidiotipos/aislamiento & purificación , Antígenos CD/sangre , Enfermedades de la Médula Ósea/complicaciones , Enfermedades de la Médula Ósea/patología , Trastornos de Fallo de la Médula Ósea , Antígenos CD55/sangre , Antígenos CD59/sangre , Moléculas de Adhesión Celular/sangre , Femenino , Citometría de Flujo , Proteínas Ligadas a GPI/sangre , Hemoglobinuria Paroxística/complicaciones , Hemoglobinuria Paroxística/patología , Humanos , Antígenos Comunes de Leucocito/sangre , Masculino , Valor Predictivo de las Pruebas , Receptores de IgG/sangre , Células Madre/patologíaRESUMEN
BACKGROUND: FNAC of intraosseous jaw lesions has not been widely utilized for diagnosis due to rarity and diversity of these lesions, limited experience and lack of well established cytological features. Aim of the study was to determine the role of FNAC in the diagnosis of intraosseous jaw swellings. MATERIAL AND METHODS: 42 patients underwent FNAC over a period of 7 years (2007-2013), of which 37 (88.1%) aspirates were diagnostic. Histopathology correlation was available in 33 cases and diagnostic accuracy of FNAC was calculated. RESULTS: Lesions were categorized into inflammatory 3, cysts/hamartomas 15 and neoplasms 19. Mandibular and maxillary involvement was seen in 21 and 16 patients respectively. Of these, benign cysts and malignant lesions were commonest, accounting for 27% lesions (10 cases) each. One case of cystic ameloblastoma was misdiagnosed as odontogenic cyst on cytology. Overall, sensitivity and specificity of FNAC were 94.7% and 100% respectively with a diagnostic accuracy of 97.3%. Definitive categorization of giant cell lesions, fibro-osseous lesions, odontogenic tumors and cystic lesions was not feasible on FNAC. CONCLUSIONS: FNAC is a simple, safe and minimally invasive first line investigation which can render an accurate preoperative diagnosis of intraosseous jaw lesions, especially the malignant ones in the light of clinic-radiological correlation.
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Biopsia con Aguja Fina , Enfermedades Óseas/patología , Enfermedades Maxilomandibulares/patología , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
OBJECTIVES: T-regulatory cells (Tregs) restrain the Th1-mediated immune response and thus may help in persistence and dissemination of childhood Tuberculosis. This study compared the percentage of Tregs in peripheral blood of paediatric TB patients (severe and non severe) with healthy individuals by flow cytometry. METHODS: Study enrolled 40 subjects, less than 12 years along with 20 age matched healthy controls. Cases were further classified as severe TB and non severe TB. Haematological work-up and flow-cytometry for Tregs was done. Tregs were quantified as CD4CD25 high and CD4FoxP3 cells and compared in different groups using the Mann-Whitney U test. RESULTS: In cases, CD4CD25 high Tregs (%) ranged from 0.55 to 12.8 with a Mean ± SD of 3.61 ± 2.98 and CD4FoxP3 Tregs (%) ranged from 0.02 to 13.44 with a Mean ± SD of 3.56 ± 2.76. In controls, CD4CD25 high Tregs (%) ranged from 0.3 to 6.5 with a Mean ± SD of 1.29 ± 1.4 and CD4FoxP3 Tregs (%) ranged from 0.33 to 2.59 with a Mean ± SD of 1.57 ± 0.58. Thus the percentage of both CD4CD25 high and CD4FoxP3 Tregs were significantly higher in cases as compared to controls (p value, 0.001 and 0.001 respectively), however the difference was not significant between severe versus non-severe TB (p value, 0.827 and 0.880 respectively). CONCLUSION: Children with TB (both pulmonary and extra-pulmonary) demonstrate increased number of T regulatory cells as compared to healthy controls. However, the number of Tregs are not significantly different between cases with severe versus non severe TB.
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Linfocitos T Reguladores , Tuberculosis , Humanos , Niño , Tuberculosis/microbiologíaRESUMEN
Introduction The objective of the present study was to identify gene expression in peripheral blood by a real-time polymerase chain reaction (PCR) technique in patients who have lung carcinoma. Material and methods Peripheral blood samples of patients with non-small cell and small cell lung cancer were collected. Target genes included survivin, CK7, ASH1, HMGB3, L587S, and CLCA2. ß-Actin was the reference gene. If the mean CT (threshold cycle) value for a target gene is ≥40, the gene expression is considered undetectable. Results Fifty patients with lung carcinoma were included and 30 healthy controls. Out of the six genes, survivin showed 26.8 times fold change as compared to controls; ASH1 and L587S were 0.54 and 0.06, respectively; and HMGB3, CLCA2, and CK7 had non-significant fold change in comparison to controls. The overall detection rate of the six target genes examined in lung cancer was 84%, with 42 out of 50 patients testing positive. Higher stages and ASH1 (p = 0.031), CK7 (p = <0.001), and HMGB3, p = 0.011 were associated significantly. CLCA2 had higher expression in patients without adrenal metastases (p = 0.044). Conclusions Lifestyle and geographical variation might be a probable cause of variable gene expression as compared to other studies. However, further research is needed to determine the clinical implication of these markers, especially in larger groups of early-stage patients.
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The relation between the severity of COVID-19 and coexisting undiagnosed underlying thrombophilic conditions is not yet established. It may be possible that undiagnosed thrombophilia exaggerates an already pro-thrombotic state in COVID-19 patients and may be responsible for severe disease in absence of any known co-morbidity. The aim was to analyze the association of underlying thrombophilia with the severity of COVID-19 infection in post-COVID patients after a minimum of 6 weeks of recovery and to compare thrombophilia profile in severe versus non-severe COVID-19 patients. Forty severe and 40 non-severe COVID patients at least 6 weeks post recovery were selected for thrombophilia profile and complete blood count evaluation. The data were analyzed using Stata software, USA; version 13. The Chi-square test and Student's t-test were used to compare proportions and mean respectively. A total of 14/80 (17.5%) were positive for the thrombophilia screen. Protein C deficiency was noted in 6/40 (15%) severe COVID patients but not in the non-severe group. The Protein S deficiency was seen in 7/40 (17.5%) severe patients and only 1 patient was deficient in the non-severe group (2.5%). The mean Protein C and Protein S levels of severe and non-severe COVID patients were statistically significant (P-0.002) and (P-0.007) respectively. The difference in mean anti-COVID IgG antibody titer of severe and non-severe COVID patients was also statistically significant (P-0.0001). To Conclude, Protein C & S deficiencies were the commonest abnormalities detected in severe COVID patients. Positive thrombophilia profile and higher titers of anti-IgG COVID-19 antibodies were seen in a significant number of patients who had suffered from Severe COVID-19 than in non-severe infection, even after 6 weeks of recovery. Thereby, suggesting that underlying thrombophilia might have affected the severity of the disease.
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Background: Inflammation has several effects in the geriatrics with reference to iron deficiency anemia (IDA), anemia of chronic disease (ACD), and unexplained anemia (UA). Whether hyperinflammation is part of their pathogenesis or just incidental is unknown. Data are limited regarding inflammatory patterns in IDA, ACD, and UA in anemic geriatrics and inflammation as a component of UA. There is little known about the overlap of inflammation between ACD and UA. Objective: The study was undertaken to find the proportion of anemic geriatric patients, aged ≥60 years with raised serum levels of inflammatory markers and their study within IDA, ACD, and UA. Materials and Methods: Seventy-five anemic geriatric patients were evaluated for raised serum levels of inflammatory markers: high sensitive C-reactive protein (hsCRP), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-8 (IL-8) along with serum ferritin (SF). Results: Raised markers were seen in 94.7% of anemic geriatric patients.IL-8 was raised most frequently followed by TNF-α, IL-6, hsCRP, and SF. No distinct inflammatory profile could be elicited between ACD and UA. The hyperinflammatory profile irrespective of the underlying etiology of geriatric anemia suggests that aging per se is pro-inflammatory state. Conclusion: Geriatric anemia can be thought to develop on background of subclinical low-grade inflammation along with superimposed nutritional deficiencies or chronic diseases.
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INTRODUCTION: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Despite advancements in treatment, a significant proportion of children relapse. Recently, immunotherapy has gained momentum and is becoming popular, especially for relapsed and refractory cases. NK cells are an important part of tumor immunity and are involved in the direct killing of tumor cells. Their role in B-ALL has not been explored. Therefore, this study was conducted to correlate the number of NK cells with standard prognostic parameters in B-ALL. METHODS: 25 subjects with newly diagnosed B-ALL between 0-14 years were recruited for the study from Pediatric OPD or emergency of the hospital. Along with a complete hemogram and peripheral smear examination, immunophenotyping by flow cytometry was done at the time of diagnosis for NK cell enumeration. The number of NK cells was correlated with standard prognostic parameters using the spearman correlation coefficient. RESULTS: Baseline NK cell percentage demonstrated a significant negative correlation with Prednisone poor day 8 blast response (P value = 0.02, r value = -0.44) and positive MRD (P value = 0.01, r value = -0.49) at day 33. A negative correlation was also noticed between NK cell percentage and unfavorable cytogenetics (hypodiploidy), although it was not significant (P value = 0.06, r value = -0.38). The number of NK cells did not correlate with age, gender and WBC count. Therefore, evaluating NK cells at diagnosis may serve as a simple and useful parameter for prognostication and risk stratification. CONCLUSION: It may be assumed that a higher percentage of NK cells is associated with improved outcomes and probably a better prognosis. NK numbers may serve as an early independent parameter predicting prognosis and survival in children with B-ALL, thus helping to decide individual therapeutic regimens.
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OBJECTIVES: To assess the prevalence of coagulopathy in postoperative neurosurgical patients and correlate it with the outcome. MATERIALS AND METHOD: This longitudinal study was conducted in a tertiary care hospital in the Department of Pathology and Neurosurgery. Ethical approval was taken from the Institutional Ethical Committee - Human Research. Seventy-two (72) participants were recruited within 48 hours of surgery after obtaining consent. Complete clinical and surgical details were recorded. A 6.5 mL venous sample was collected and dispensed in two separate vials. The EDTA sample was run within 2 hours of collection on an automated hematology analyzer to obtain complete blood counts, including platelet count. The citrated sample was run on a fully automated coagulometer to determine PT, APTT, plasma fibrinogen, FVIII assay, and D-dimer levels. Subjects with a DIC-ISTH score of 5 or more were excluded. Coagulopathy was defined as three or more coagulation parameters deranged in a patient. All patients were followed up for the outcome. The outcome was correlated with coagulopathy, and a p-value less than 0.05 was considered statistically significant. RESULTS: The study found that the number of hemostatic parameters deranged correlated with outcome (P < 0.001). The proportion of patients with coagulopathy was 32/72 (44.4%), while those without coagulopathy were 40/72 (55.6%). Of patients with coagulopathy, 87.5% (28/32) had an adverse outcome, while 12.5% (4/32) had a favorable outcome. The difference was found to be statistically significant (P < 0.001). CONCLUSIONS: Coagulopathy, defined as the derangement of three or more parameters, is a predictor of poor outcomes in postoperative neurosurgical patients. This timely recognition of coagulopathy can help triage patients requiring appropriate blood products, significantly reducing morbidity and mortality associated with postoperative neurosurgical patients.
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Background The increased risk of infections in transfusion-dependent ß-thalassemia major (TDT) patients is mainly due to underlying immune dysfunction; however, its cause is largely unidentified. There is sufficient evidence to suggest immune changes due to iron deficiency; however, similar studies demonstrating the effects of iron excess on immune cells in these cases are limited. Aim and objectives To analyze the correlation between T-regulatory cells and iron stores in ß-thalassemia major patients. Methods In this study, 20 ß-thalassemia major cases and 20 healthy controls were studied for complete hemogram, iron profile, and flow cytometric immunophenotyping for CD3+, CD4+, CD8+, and T-regulatory cells markers (CD4+CD25+ and CD4+CD25+FOXP3+). Result Significantly higher levels of serum iron, ferritin, transferrin saturation, and CD4+ cell percentage were observed in cases than in controls. In 70% of cases with serum ferritin cut-off levels of less than 1000 µg/L, the T-regulatory cell marker CD4+CD25+ and serum ferritin revealed a significant moderate positive correlation (p=0.031, r=0.627). These same 70% cases also demonstrated a moderately significant positive correlation between serum iron and absolute lymphocyte count (r=0.529, p=0.042). Conclusion The results suggest that serum ferritin in excess amounts can increase T-regulatory cells, which may further alter the immune status of TDT patients; however, the absence of such a correlation in cases with serum ferritin of more than 1000 µg/L remains unanswered. It is important to understand immune system alterations as this will help provide new modalities for managing thalassemia patients in the form of immunoregulatory therapies.
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Introduction Plasma antioxidant capacity in children receiving chemotherapy decreases due to the effect of the disease and chemotherapy. Increased oxidative stress (OS) predisposes to an increased risk for chemotherapy-related toxicity and febrile neutropenic episodes. Materials and methods We conducted this case-control study in the hematology-oncology unit of the department of pediatrics of a tertiary hospital in Delhi, India, from November 2017 to March 2019 to compare OS between children with acute lymphoblastic leukemia (ALL) and healthy controls. We estimated the trends in OS as measured by the plasma total antioxidant capacity (TAC) and thiobarbituric acid reactive substance (TBARS) levels at baseline and at the completion of induction I (four weeks), induction II (eight weeks), and induction IIA-consolidation (16 weeks) phases of chemotherapy in children with ALL. We also assessed the change in OS during different phases of initial treatment and studied the association between OS and the hematological toxicity of chemotherapy (determined by the need for blood component therapy and the number of febrile neutropenic episodes) and serum cobalamin and folate levels. Results OS was significantly higher in children with ALL at diagnosis (n=23) compared to controls (n=19). The median (interquartile range (IQR)) TAC levels (mM) were significantly lower (1.21 (1.05-1.26) versus 1.28 (1.26-1.32), P=0.006), and TBARS levels (nmol/mL) were significantly higher (312.0 (216.6-398.0) versus 58.5 (46.2-67.2), P<0.001) in children with ALL at diagnosis compared to controls. OS was highest at the end of the induction I phase (four weeks) despite the patients being in clinical and hematological remission. OS at the completion of intensive chemotherapy (16 weeks) was higher than at diagnosis. A significant correlation was found between serum folate levels and TAC levels at baseline (P=0.03). Serum cobalamin levels, the need for blood component therapy, and the number of febrile neutropenic episodes did not have any association with OS. Conclusion Children with ALL had significantly higher OS compared to controls, indicating that underlying disease affects the oxidative balance unfavorably. Chemotherapy itself increases oxidative stress.
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The role of chromosomal instability (CI) in oncogenesis is very well described in solid tumours, but there are a lack of studies on haematology malignancy, especially with multiple morphological markers. The study aims to analyze seven morphological markers of CI- chromatin bridges (CB), multipolar mitosis (MPM), nuclear budding (NB), micronuclei (MN), nuclear heterogeneity (NH), laggards, chromatin strings (CS) in bone marrow aspirate (BMA) and biopsy of acute leukaemia (AL), and myelodysplastic syndrome (MDS). It is a retrospective cross-sectional analytical study where BMA and biopsy were reviewed for CI markers. We compared CI markers in five categories. CI markers were further correlated with clinical manifestations and outcomes of patients. The study included 54 samples of 37 patients. Overall, the median (IQR) of markers were as follows: MN 3.5 (1,7), NB 5 (1,18), MPM 1 (0,4), CB 1(0,2), Laggards 0 (0,1), and CS 2.5 (0,6). NH was noted in 65.4% of samples. All CI markers except laggards were significantly increased in B-ALL, AML, and MDS compared to other categories. Many CI markers were significantly raised with a few clinical features. The MN, MPM, Laggard, and NH markers were significantly increased in the dead patients compared to those who survived. The study, one of the first to analyze multiple CI markers, revealed that the CI markers were significantly increased in AL and MDS patients and significantly associated with clinical manifestations and outcomes. Morphology markers of CI are valuable and cost-effective in diagnostic strategy, type of malignancies, and assessing prognosis.
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Leucemia Mieloide Aguda , Síndromes Mielodisplásicos , Humanos , Médula Ósea/patología , Estudios Retrospectivos , Estudios Transversales , Leucemia Mieloide Aguda/genética , Leucemia Mieloide Aguda/diagnóstico , Leucemia Mieloide Aguda/patología , Síndromes Mielodisplásicos/genética , Síndromes Mielodisplásicos/patología , Biopsia , Inestabilidad Cromosómica , Cromatina , BiomarcadoresRESUMEN
INTRODUCTION: T ALL may show variable morphological features and immunophenotypic analysis for characterisation of immature nature of these cells is needed to establish a diagnosis and distinguish from reactive conditions and mature T cell leukemias. Sometimes immaturity markers-CD34, TdT and HLA DR may not be expressed by blasts. The aim of the present study was to analyse immunophenotype of T ALLs especially with respect to absence of immaturity markers. METHODS: Thirty-eight cases of T ALL diagnosed over a period of two and half years were analysed retrospectively with respect to clinical features, haematological features and flow cytometric immunophenotyping for T, B, Myeloid and immaturity markers. Student's T-test was used for comparing quantitative data and Chi-square test/Fishers exact T-test for qualitative variables. P value less than 0.05 was considered significant. RESULTS: The most common T-lineage marker expressed was cCD3 and CD7 which were expressed in 100% cases followed by CD5 in 86.8% cases. The most common immaturity marker expressed was TdT (39.5% cases) followed by CD34 (34.2% cases). Thirteen cases (34.2%) were negative for all three of the immaturity markers i.e. TdT-/CD34-/HLADR. Absence of CD34 was associated with absence of expression of HLA DR (P<0.05) and aberrant expression of B lineage markers (P<0.05). CONCLUSION: T-ALL is a rare and aggressive disease. Many cases lack immaturity markers viz, TdT, CD34 and HLADR. In such cases a comprehensive approach taking into account the clinical presentation, cytomorphology and immunophenotyping is diagnostic in experienced hands. Further, molecular studies may be needed to aid diagnosis.
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Background Neonatal sepsis is considered a ubiquitous worldwide cause of mortality and morbidity in newborn infants. The incidence is 10-50 per 1000 live births. Neutrophil to lymphocyte ratio (NLR) is an easily accessible and cost-effective hematological marker for prompt diagnosis of neonatal sepsis. Aim and objectives The purpose of this study was to analyze the clinical significance of NLR in neonates clinically diagnosed with sepsis and its impact on the management. Methods This retrospective study was conducted on 265 neonates diagnosed with sepsis and compared with 341 healthy controls. The statistical analysis was performed by using the Student's t-test to compare the variables. Result Median NLR levels were significantly higher in patients than in controls. NLR had a modest power of predicting neonatal sepsis, as suggested by an area under a curve of 0.569. Conclusion NLR is an important predictor of neonatal sepsis. There is a significant modest positive correlation between NLR and sepsis.
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Background - Smear-negative TB (SNTB) may remain undetected for a long duration and new bio-markers are needed for diagnosis. Our study investigated monocyte parameters in this regard.Thirty cases each of SNTB, sputum positive cases and healthy controls were included. Full blood count and immune-phenotyping for 'monocyte parameters' by flow cytometry were performed using CD45, CD16, CD14, CD64 and HLA-DR The percentage of monocyte subsets and MFI of CD64 and HLA- DR noted and data statistically compared.The monocyte to lymphocyte ratio, percentage of intermediate monocytes, expression of CD64 on total as well as intermediate monocytes were significantly elevated in cases with SNTB as compared to healthy controls (p value, 0.07, 0.07, 0.001, 0.001 respectively). The cut off value for MFI CD64 on total and intermediate monocyte was >18 and >19.6 respectively.Thus monocyte parameters can serve as useful biomarkers for diagnosing tuberculosis in the sputum negative group.
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Monocitos , Tuberculosis Pulmonar , Biomarcadores , Antígenos HLA-DR/metabolismo , Humanos , Inmunofenotipificación , Monocitos/metabolismo , Receptores de IgG/metabolismo , Esputo , Tuberculosis Pulmonar/diagnósticoRESUMEN
Improvement in technology and inclusion of new parameters in automated hematology analyzers allows for better and faster detection of anemias. These parameters along with histograms provide details and clues that help to diagnose the etiology of anemia and help bridge the time lag in detection and treatment. Timely and expert interpretation of complete blood counts should not be limited to the pathologist but should also interest the clinician to allow for efficient patient care.
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Anemia , Anemia/diagnóstico , Recuento de Células Sanguíneas , HumanosRESUMEN
Introduction and Aim Increased angiogenesis in BM is one of the characteristics of chronic myeloid leukemia (CML) implicated in its progression. Vascular endothelial growth factor (VEGF) one of the most potent regulator of angiogenesis is increased in CML. The prognostic impact of serum VEGF in CML is largely unknown with sparse literature from India. So the present study aimed to measure serum VEGF levels in different phases of CML and to assess its prognostic significance using Hasford score. Methods Forty Ph + patients of CML were enrolled in the study. Complete clinical history and physical examination was done. Hemogram was done by Beckman Coulter LH 500. Peripheral smear (Wright's stain) was done by microscopy. Serum VEGF (plain vial) using ELISA was calculated. Statistical analysis was performed using SPSS software version 20. Results The mean serum VEGF levels were significantly higher in patients than in controls (p < 0.0001). The patients in accelerated/blast phase demonstrated significantly higher levels of serum VEGF (mean 151 pg/mL) than those in the chronic phase (mean 90.87 pg/mL) (p = 0.02). Serum VEGF levels showed a significant positive correlation with the overall Hasford prognostic score (p = 0.023). Conclusion Serum VEGF levels can serve as an independent prognostic marker in CML patients irrespective of phase of CML. Also, S. VEGF levels can be used to monitor patients on imatinib therapy and identify those who might benefit from antiangiogenesis therapy. However, larger studies are needed with a larger number of patients in different phases of CML to validate our findings and thus pave the way for future research.