Therapeutic lessons from transfusion in pregnancy-effect on hematological parameters and coagulation profile.

INTRODUCTION: Transfusion is commonly done in clinical indications and complications arising due to Anemia, shock, blood loss, thrombocytopenia due to any cause, ineffective erythropoiesis. Pregnancy is a physiological condition characterized by Anemia, fluid overload, hypercoagulable state, and antifibrinolytic condition, which can cause various reactions that could be anticipated during a blood transfusion. With an aim to understand the effects of transfusions on hematological parameters in pregnancy. The results of whole blood and component transfusion were studied to understand increments and their effects so that rationalized transfusion decisions during pregnancy can be undertaken, considering the physiological changes in pregnancy on hemodynamics are present. METHODOLOGY: A prospective study with 80 pregnant females undergoing blood transfusion was studied. Their coagulation and hematological profile were correlated to derive a conclusion for the effect of transfusion of blood and its products. RESULTS: A mean increment of 0.55+0.07 g/dL hemoglobin (Hb) was noted along with a slight increase in RBC count (0.25+0.07 millions/mm3), hematocrit (HCT) (1.9+0.42%), TLC (400+565 cells/mm3). This statistically significant mean increase in hemoglobin, RBC count, and hematocrit was significantly lower than that compared to studies in the west and non-anemic patients. A mean increment of 7.79+1.51 µg/dL (statistically significant) in serum iron was seen. A significant improvement in their coagulation profile was achieved by plasma transfusion (FFP). Clotting time (CT) decreased by a mean value of 196.43+56.69 secs and prothrombin time (PT) by 2.64+0.63 secs (P<0.05). All transfusion reactions in our study were associated with PRBC transfusion, non-hemolytic immunological type, urticarial transfusion reactions (UTR) more common in multiparous women-0.2% in primigravida to 21.7% and 37.5% in 3rd and 4th parity similar to that observed in other studies. CONCLUSION: Although different researchers have done numerous studies, the physiological profile of pregnant females in India is markedly different in nutritional profile, ethnicity, environmental factors, and background. The availability of tertiary care medical facilities during ANCs is also known to affect pregnancy outcomes and the presentation of patients at term or in labor. The variety of factors affect the baseline hematological status of pregnant females and, hence, post-transfusion hematological factors. These are therefore markedly different from prior published studies. It is concluded that PRBC transfusion in pregnant women causes a lower increase in mean Hb and HCT values than in the west, and ferritin and serum iron are not reliable indicators of Anemia in transfusion. Due to lower increments in all values except platelets could be the reason for this could be contributed by confounding factors like Anemia, hyperfibrinogenemia, volume overload, and ethnicity.

Utility of Cytospin and Cell block Technology in Evaluation of Body Fluids and Urine Samples: A Comparative Study.

BACKGROUND: Cytologic examination of body fluids commonly involves the use of direct or sediment smears, cytocentrifuge preparations, membrane filter preparations, or cell block sections. Cytospin and cell block techniques are extremely useful in improving cell yield of thin serous effusions and urine samples, and ensure high diagnostic efficacy. MATERIALS AND METHODS: We studied cytospin preparations and cell block sections prepared from 180 samples of body fluids and urine samples to compare the relative efficiency of cell retrieval, preservation of cell morphology, ease of application of special stains, and diagnostic efficacy. Samples were collected and processed to prepare cytospin smears and cell block sections. RESULTS: We observed that overall, cell yield and preservation of individual cell morphology were better in cytospin preparations as compared to cell blocks, while preservation of architectural pattern was better in cell block sections. The number of suspicious cases also decreased on cell block sections, with increased detection of malignancy. It was difficult to prepare cell blocks from urine samples due to low cellularity. CONCLUSIONS: Cytospin technology is a quick, efficient, and cost-effective method of increasing cell yield in hypocellular samples, with better preservation of cell morphology. Cell blocks are better prepared from high cellularity fluids; however, tissue architecture is better studied, with improved rate of diagnosis and decrease in ambiguous results. Numerous sections can be prepared from a small amount of material. Special stains and immunochemical stains can be easily applied to cell blocks. It also provides a source of archival material.

Study of Hemolysis During Storage of Blood in the Blood Bank of a Tertiary Health Care Centre.

The aim of RBC storage system in a blood bank is to counteract damage to the metabolic machinery and the membrane, to improve post-transfusion viability. In recent years, the need for strict control over the quality of blood has been emphasised. Such quality indicator includes extend of hemolysis and morphological changes of RBC during storage. This study was design to see extend of hemolysis and level of plasma lactate dehydrogenase (LDH) and plasma potassium, during processing and storage at different intervals under blood bank condition. Forty-six donors were selected and blood units were collected and stored under blood bank conditions. Mean plasma haemoglobin of stored blood was estimated by tetra methyl benzidine method (TMB) and percentage hemolysis was calculated on day 0, 1, 7, 21, 28, 35 and 42 days. Similarly plasma LDH and plasma potassium level was also assessed during storage. It was noted that free haemoglobin level and percentage hemolysis progressively increased with storage along with the level of LDH and potassium. However, extend of hemolysis did not exceed the permissible limit of 0.8% up to 42 days of storage. 15 blood bags which showed visual hemolysis on day 28 did not exceeded the threshold of 0.8% hemolysis, when interpreted by TMB method. It was concluded that TMB method is better than visual method for determination of hemolysis. The reduced hemolysis at this centre may be accounted for the use of additive solution SAGM (Saline, Adenine, Glucose, Mannitol) and DEHP (di-2-ethyl hexyl phthalate) as plasticizer in blood bags for storage.

Image-guided fine-needle aspiration of retroperitoneal masses: The role of the cytopathologist.

BACKGROUND: Retroperitoneal tumors constitute a difficult diagnostic category as they are not easily accessible. The advent of image-guided fine-needle aspiration (FNA) has resolved this problem significantly. AIMS: We present a short study based on guided aspiration of retroperitoneal tumors, in which we have tried to assess the role of image-guided fine-needle aspiration cytology as a tool for pre-operative diagnosis. MATERIALS AND METHODS: The study was conducted on patients diagnosed with retroperitoneal masses. FNA was performed under image guidance with the help of ultrasonography and/or computed tomography; smears were prepared and meticulously screened according to a fixed protocol. The results were analyzed to determine sensitivity, specificity, and diagnostic efficacy of cytopathological diagnosis using image-guided FNA techniques. RESULTS: We assessed 38 patients with retroperitoneal masses. In all cases, adequate cellular material was obtained. No major complications were encountered. Statistical analysis was carried out in 35 cases; sensitivity, specificity, and diagnostic accuracy were 100% in these cases. CONCLUSION: FNA under image guidance should be considered a first-line diagnostic approach for retroperitoneal and other abdominal tumors, although caution should be exercised in case selection. In areas where advanced tests are not available, the cytotechnologist and cytopathologist have a very important role to play in ensuring accurate diagnoses.

Smear patterns and spectrum of premalignant and malignant cervical epithelial lesions in postmenopausal Indian women: a hospital-based study.

Cervical cancer is one of the leading causes of morbidity and mortality among women but can be prevented through simple cost-effective measures, such as creating awareness, and regular screening with the Pap smear, both in the premenopausal and postmenopausal age group. This study was carried out to study the cervical smear patterns and type of cervical epithelial lesions in a group of postmenopausal Indian females and the relationship with clinical profile of patients. Pap smears were taken from 320 postmenopausal Indian females and meticulously screened. Lesions were classified according to type of postmenopausal pattern. 120 smears showed varying degrees of premalignant and malignant changes, which were classified using the Bethesda system. The findings were correlated with duration of menopause, parity, and duration of sexual activity and significance was derived. Histopathological correlation was conducted in those cases where biopsies were available. It was found that as the age of the patients increased, the incidence of low-grade and high-grade squamous intraepithelial lesions and carcinoma also increased with the relationship being statistically significant. The occurrence of these lesions also showed an association with increasing parity and period of sexual activity. Thus, it can be concluded that it is important to create widespread awareness about the necessity of regular screening, including the postmenopausal period. Conventional cytology or the Pap smear is a cost-effective and efficient method for screening of patients but requires training and experience to minimize errors. It is suitable for developing regions where costlier techniques are not in routine use.

Ovarian steroid cell tumour: correlation of histopathology with clinicopathologic features.

Ovarian steroid cell tumours (not otherwise specified) are rare neoplasms of the ovary and are classified under lipid cell tumours. Their diagnosis can be considered as one of exclusion. Histopathologically, the tumour should carefully be evaluated for microscopic features of malignancy, but it is essential for the clinician and the pathologist to remember that in these tumours, pathologically benign histomorphology does not exclude the possibility of clinically malignant behaviour. Our case study focuses on the comparative findings in a postmenopausal female diagnosed with an ovarian steroid tumour (not otherwise specified). A careful correlation between clinical and surgical evaluation and microscopic analysis is necessary, as is a regular followup.

Intracranial chondroma: a rare entity.

Intracranial chondroma is a rare benign cartilaginous tumour with an incidence of less than 1% of all primary intracranial tumours. The authors are reporting here a case of intracranial chondroma in a 40-year-old man who presented with 5-month history of headache and gradual diminution of vision. A tentative diagnosis of chondroma was made on imprint cytology which was confirmed on histopathological examination.

Image-guided fine-needle aspiration cytology of ovarian tumors: An assessment of diagnostic efficacy.

BACKGROUND: Image-guided fine-needle aspiration cytology (FNAC) of ovarian lumps is being increasingly used for the successful diagnosis of ovarian tumors, although borderline cases may be difficult to diagnose by this method. AIM: To demonstrate the efficacy of image-guided FNAC in diagnosing ovarian tumors (benign and malignant) and to evaluate the usefulness of cytology as a mode of easy and rapid diagnosis of ovarian lumps. MATERIALS AND METHODS: The study was conducted on 42 female patients. Clinical evaluation and relevant investigations were carried out. Diagnosis was established by FNAC performed under image guidance (ultrasonography/computed tomography). The cytological diagnosis was confirmed by histopathological examination. RESULTS: Cytological diagnosis was rendered on all the 42 ovarian lesions, with a correct diagnosis in 34 cases, resulting in a diagnostic accuracy of 80.9%. Most of the cases with discordant diagnoses were surface epithelial tumors of low malignant potential and required histopathological examination for a final diagnosis. CONCLUSIONS: Image-guided FNAC is an inexpensive, rapid and fairly accurate procedure for the diagnosis of ovarian lesions. It provides a safe alternative to the more expensive, time consuming and cumbersome surgical route to diagnosis.

FNAC diagnosis of medullary carcinoma thyroid: A report of three cases with review of literature.

Medullary carcinoma of the thyroid is an unusual neoplasm, which is associated with specific supportive diagnostic markers. Despite this, its cytological diagnosis is often difficult. We report herewith three cases of medullary thyroid carcinoma. The diagnosis was established on fine-needle aspiration cytology. Plasmacytoid cell pattern was observed in two cases and spindle cell pattern in the third case.

Modified fine-needle aspiration technique for diagnosis of granulomatous skin lesions with special reference to leprosy and cutaneous tuberculosis.

Skin infections are commonly assessed by slit skin or scrape methods. Fine-needle aspiration biopsy (FNAB) is highly effective especially with blanching of skin to ensure good yield and reduced bleeding. The aim of this study was to assess usefulness of cytology, especially modified FNAB technique, in diagnosis of leprosy and cutaneous tuberculosis and to identify specific cytological characteristics for diagnosis and classification. The study was conducted on 40 patients-25 cases of leprosy and 15 cases of cutaneous tuberculosis. Smears were prepared using modified FNAB technique, slit skin, and scrape methods (depending on type of lesion). Cytological diagnosis was confirmed by histopathology where the Ridley-Jopling system was used to classify cases of leprosy. A similar attempt was made for diagnosis and classification of leprosy on cytology. Diagnoses rendered by both modalities were compared to assess the efficacy of cytological examination. Cytological diagnosis was made in 23 cases of leprosy and 12 cases of cutaneous tuberculosis. The smears showed good cellularity. A broad division into tuberculoid and lepromatous leprosy could be made fairly accurately on cytology. Maximum agreement among clinical, cytological, and histopathological diagnosis was observed in cases of tuberculoid leprosy. Smears of cutaneous tuberculosis were characterized by epithelioid cell granulomas with caseation. Overall accuracy of diagnosis was 92% in leprosy and 80% in tuberculosis. FNAB is an inexpensive and accurate procedure for diagnosis of leprosy and cutaneous tuberculosis. The modified technique yields good results. However, clinical correlation, acid-fast staining, and culture are essential as they provide valuable supportive information.

Small Cell Carcinoma in the Mammary Gland: Primary or Metastatic? A Diagnostic Challenge.

Metastatic tumours to the mammary gland are relatively uncommon as compared to primary breast malignancies. Such lesions can pose diagnostic dilemmas for both the clinician and the pathologist because it is often difficult to categorize the tumour as primary or secondary and to determine the site of origin. We present the case of a thirty year old female who was diagnosed with small cell neuro-endocrine carcinoma in the mammary gland, probably of pulmonary origin. The diagnostic challenges posed by such a case are highlighted.

Apoptosis in premalignant and malignant squamous cell lesions of the oral cavity: a light microscopic study.

BACKGROUND: Oral cancers are a major health problem in India. Recently, parameters of cell proliferation and cell death have emerged as important diagnostic and prognostic tools. AIMS: The aim was to study apoptosis in premalignant and malignant squamous cell lesions of the oral cavity and to evaluate its prognostic role in oral cancers. MATERIALS AND METHODS: The study included 175 patients presenting with oral lesions. Evaluation of apoptotic index (AI) (using light microscopy) was performed on hematoxylin and eosin-stained sections. STATISTICAL ANALYSIS USED: Student's t test was performed. RESULTS: The mean AI increased progressively with increasing dysplasia, with the maximum AI in well-differentiated (WD) squamous cell carcinoma, and a fall was noted with progression toward higher grades. The difference between WD SCC and poorly-differentiated SCC was significant (P < 0.05). Cases with lymph node metastasis had significantly (P < 0.05) lower mean AI values. CONCLUSION: Apoptosis can be fairly accurately assessed using light microscopy. Tumors that exhibit less apoptosis tend to show aggressive behavior and have a greater potential for metastasis.

Imprint smear cytology of chondroblastic osteosarcoma: a case report.

Imprint cytology is gaining increasing popularity in the diagnosis of musculoskeletal lesions and in many patients; a definitive diagnosis can be rendered from aspiration smears alone. However, evaluation of tissue architecture is a major limitation and therefore cytological diagnosis has to be confirmed on histopathology. The authors take this opportunity to report a case of chondroblastic osteosarcoma occurring in the middle 1/3rd of the left thigh in a 35 year old male, diagnosed on imprint cytology and confirmed on histopatholgy.

Cytological diagnosis of multiple myeloma presenting as a jaw swelling.

Multiple myeloma is a systemic B-cell lymphoproliferative disease with varied manifestations. Its diagnosis can therefore pose difficulties for both the clinicians and pathologists. Jaw lesions, though not uncommon, rarely present as the first sign in multiple myeloma. We present here the case of a 45 year-old female who presented with a swelling of the jaw and on subsequent work-up, was diagnosed with multiple myeloma. Recent research regarding this disease has also been highlighted.

Orbital amelanotic melanoma in xeroderma pigmentosum: a rare association.

Xeroderma pigmentosum (XP) is an autosomal recessive genetic disorder of DNA repair in which the body's normal ability to repair damage caused by ultraviolet light is deficient. This leads to a 1000-fold increased risk of cutaneous and ocular neoplasms. Ocular neoplasms occurring in XP in order of frequency are squamous cell carcinoma, basal cell carcinoma and melanoma. Malignant melanomas occur at an early age in patients with XP. We report a case of XP with massive orbital melanoma in an eight-year-old boy which is unique due to its amelanotic presentation confirmed histopathologically.

Microfilariae in thyroid aspiration smear--an unexpected finding.

Lymphatic filariasis is a major health problem in tropical countries including India. Despite its high incidence it is difficult to find microfilariae in blood and fine-needle aspirates due to the nocturnal periodicity of species endemic in India. Lymphatic filariasis can manifest as asymptomatic microfilaremia, hydrocele, lymphangitis, and lymphadenitis. The presence of microfilariae in thyroid aspirates is a rare finding. A case of microfilariae in a thyroid aspirate is being reported to emphasize the significance of careful screening of smears in endemic areas.

Ocular manifestations of cysticercosis: a case report.

Ocular and extraocular cysticercosis is a commonly encountered manifestation of the disease caused by the cysticercus cellulosae. Any region of the eye may be afflicted including the subconjunctival space. We present the case ofa young female who developed a small mass at the medial canthus of the left eye, which was diagnosed as conjunctival cysticercosis subsequent to excision and histopathological examination.

Diagnosis of recurrent synovial sarcoma by fine needle aspiration cytology--a case report.

Cytodiagnosis of synovial sarcoma can be a daunting task, owing to the varied cytomorphological appearances possible, depending on whether the tumour is monophasic or biphasic in architecture. We report herewith a case of recurrent synovial sarcoma in a young male who presented with a swelling in the neck. The diagnosis was established by fine needle aspiration cytology.

Cytology of anaplastic giant cell carcinoma of the thyroid with osteoclast-like giant cells--a case report.

Anaplastic carcinoma of the thyroid is known for its highly aggressive behaviour and rapid spread. While the giant cell variant is a well recognized morphologic pattern, the presence of osteoclast-like giant cells is a rare occurrence. We report a case of anaplastic carcinoma of the thyroid with focal presence of osteoclast-like giant cells occurring in an elderly male patient, diagnosed on aspiration cytology.