Various coagulation tests like Prothrombin Time (PT) and Activated Partial Thromboplastin Time (APTT) are estimated by automated coagulation analyzers. The newer fully automated analyzers generate clot wave forms aPTT-CWA for these parameters are derived. In this study, the objective was to analyze clot wave form characteristics morphology and its first and second derivative values in cases with abnormal APTT. ACL TOP 300 generated curves for APTT in a total 125 patients with 20 normal controls are included. First derivative, second derivative, morphology of curve: sigmoid, biphasic, prolonged pre-coagulation phase, second derivative morphology like early and late shoulder, biphasic peak, delayed deceleration were the analyzed parameters. Wave clot forms of 125 patients were included in this study. Patients (M:F - 2.2:1, mean age: 46.9 ± 20 years). A spectrum of clinical conditions was Covid (20%), liver disease (23%), polytrauma (10.4%), cardiac diseases (8.8%), sepsis/DIC (7.2%), thromboembolism (7.2%), renal diseases (6.4%), bacterial infections (4%), dengue (4%), snake bite (1.6%) and factor deficiency (1.6%). Liver and heart disease showed a significant difference in acceleration and deceleration peaks followed by sepsis, dengue, polytrauma and sepsis/DIC. Deceleration peak was prolonged in patients of Covid (p<0.05). Sepsis and liver diseases showed prolonged first derivative peak (p<0.05). CWA is very easily available on all automated coagulation analyzers. It is inexpensive with fast turn round time. Both quantitative as well as qualitative informations such as velocity, acceleration of clot formation and wave pattern details were recorded. Our study highlights importance of quantitative and qualitative CWA parameters acquired by performing APTT test for the automated analyzers.
Introduction: Reduced numbers of all three types of peripheral blood cells characterise the hematologic condition known as pancytopenia. Practical distinction among various causes of pancytopenia is usually clear but some processes are so closely related that the diagnosis may get complicated and bone marrow examination aids in diagnosis of such cases.It is important to recognise marrow failure syndromes causing pancytopenia. Pancytopenia is a common finding, its explicit discussion is lacking even in major textbooks and has led many authors to highlight the spectrum of causes of pancytopenia. Aim: To evaluate the various causes of pancytopenia and to evaluate clinical signs and symptoms, hematological parameters along with bone marrow cellularity and other morphological features on aspiration and trephine biopsy in patients presenting with pancytopenia. Materials and Methods: In the present cross-sectional study for a period of 3.5 years from August 2018 to April 2022, a total 157 patients were included having pancytopenia in a tertiary care centre, Pune, Maharashtra, India. Clinical history was taken for all the cases of pancytopenia. The blood samples were collected for hematological analysis including hemogram and Peripheral Blood Smear (PBS) examination; also Bone Marrow (BM) samples were collected. Aspirates were stained with Leishman and Giemsa. Special stains like myeloperoxidase (MPO) and Periodic acid schiff stain (PAS) were used wherever required. Bone marrow biopsy was fixed in Bouin’s fluid and processed and stained with Haematoxylin and eosin (H&E) and reticulin stain after decalcification. Results were analysed using Statistical Package for the Social Sciences (SPSS) software (version 26.0) and calculated as frequencies and percentages. P-value of <0.05 was considered significant. Results: Out of 157 patients, majority (n=120) belonged to adult age group (18-86 years) (76.43%), with the mean age of 40.68±23.34 years. The male to female ratio was 1.34:1. Study showed megaloblastic anaemia encompassing majority of the causes of pancytopenia followed by acute leukemia, hypersplenism, hypocellular marrow, Hemophagocytic lymphohistiocytosis (HLH), myelodysplastic syndrome (MDS) and Aplastic anaemia. Out of 86 (54.78%) of total majority of hypercellular bone marrow patients, 51 (59.3%) had haemoglobin levels of <7 g/dL, while 45 (52.32%) hypercellular bone marrow patients had platelet count of <50000 cells/cumm. Patients with low TLC weresignificantly associated with hypo (p=0.0067) and hypercellular marrow (p=0.0291) compared to normocellular marrow. For reticulocyte count an increasing trend with low reticulocyte count was seen from normocellular (n=4, 6.9%) to hypocellular (n=12, 20.7%) to hypercellular (n=19, 32.8%) bone marrow,though it was not statistically significant. Conclusion: It was concluded in the present study that megaloblastic anemia was the most common etiology of pancytopenia and the commonest clinical symptoms observed was fever.
Background: Hemophagocytic lymphohistiocytosis is characterized by an unremitting activation of CD8+ T lymphocytes and macrophages that leads to organ damage.Methods: 40 patients diagnosed of having HLH secondary to infections admitted in the last 5 years in a tertiary hospital in Western Maharashtra, were studied retrospectively. The data was collected from the indoor patient records and files, detailed clinical profile and all relevant investigations were noted.Results: 40 cases of diagnosed HLH were studied. Age group of 30-40 years was involved more (25%), followed by age group of 61-70 years. The condition was more common in males (64%). Dengue was more common having more chance of secondary HLH. Early diagnosis and treatment was effective in 90% cases.Conclusions: HLH was seen to occur more in tropical fevers. The mortality rate was more in haematological malignancies. Early diagnosis and rapidly initiated treatment had a positive effect in decreasing the mortality rate of the condition.
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