Introduction: Thrombocytopenia is very common in dengue and other haematological disorders and the aetiology is multifactorial. Immature Platelet Fraction (IPF) is a novel parameter which is a measure of reticulated platelets and it reflects the rate of regeneration of platelets. Aim: To evaluate the relationship between the IPF and platelet recovery and the consistency of its expression. Materials and Methods: The present study was a retrospective observational study done at Institute of Pathology, Madras Medical College between November 2018 to December 2018. Total 37 patients having fever with thrombocytopenia in dengue and other haematological causes were included for analysis. The platelet count, IPF, Mean Platelet Volume (MPV), Platelet Distribution Width (PDW) and Plateletcrit (PCT) was evaluated at the time of admission and once in every 24 hours and plotted in excel spread sheet. Results: About 86.4% were recovered in 24 hours after attaining the peak, 89.1% showed recovery in 24-48 hours of the rise of the IPF compared to the previous value and 94.5% recovered within 24 hours after the fall in the IPF value. It was observed that 81.8% were recovered when the IPF value ≥10% within 24- 48 hours. IPF readings are able to appreciate even in low platelet count levels but the other platelet recovery parameters did not. Conclusion: IPF is a consistent and reliable marker which can be measured even when the platelet count is low and it also predicts the platelets recovery. It is a promising marker that helps in guiding the decision towards platelet transfusion.
BACKGROUND Non neoplastic lesions of appendix outnumber the neoplastic counterparts and appendicitis is the frequently encountered lesion in day to day clinical practice. Both non-neoplastic and neoplastic lesions of appendix present with abdominal pain and thus imaging & histopathological examination of the specimen play an important role in diagnosing the specific entities. In this study, we analysed the macroscopic and microscopic features of the appendicectomy specimen during the study period and ascertained the frequency of non-neoplastic and neoplastic lesions of the appendix. METHODS During the study period i.e. from January 2017 to December 2017, patients who underwent appendicectomy either as an emergency, or an elective procedure, in Madras Medical College & Rajiv Gandhi Government General Hospital, Chennai, were included in the study population. The patient particulars and the histopathological diagnosis were retrieved from the surgical pathology records. RESULTS We received 1100 appendicectomy specimens and all were subjected to routine histopathological examination. The histopathological spectrum of appendiceal lesions ranged from non-neoplastic to neoplastic lesions. Non-neoplastic lesions accounted for 99.4% of cases (1093 cases) and remaining 0.6% of cases (7 cases) were neoplasms. Various non-neoplastic conditions like acute appendicitis, acute suppurative appendicitis, chronic appendicitis, eosinophilic appendicitis, fibrosing appendicitis, granulomatous lesion, appendicitis with worm infestation were reported. In this study, primary appendiceal neoplasms like carcinoid tumour, low grade appendiceal mucinous neoplasm (LAMN) and mucinous adenocarcinoma of the appendix were encountered. CONCLUSIONS All appendicectomy specimens should be subjected to routine histopathological examination as certain incidental findings might be missed if histopathological examination of the specimens was not performed.
Haemophagocytic lymphohistiocytosis (HLH) is a clinicopathologic syndrome, characterised by hyperinflammation due to inherited or acquired defects in the immune function, leading to unchecked proliferation of histiocytes and lymphocytes resulting in multiorgan dysfunction. HLH can be primary (familial) occurring in young children caused by underlying genetic defects in natural killer cells/cytotoxic T cells or secondary HLH occurring in older children or adults following infections, rheumatological disorders or malignancies. HLH is a medical emergency, having varied clinical presentations and lacks a pathognomonic clinical or laboratory abnormality. Clinical presentations include unexplained fever, hepatomegaly, splenomegaly, skin rash, cytopenias, liver dysfunction, coagulation abnormality and neurological manifestations. It carries a poor prognosis. Early diagnosis based on HLH 2004 criteria and initiation of treatment is crucial in the management strategy, which is likely to improve the outcome of this life-threatening disease. The treatment strategies include immunosuppressive drugs, immunomodulatory therapy and autologous hematopoietic stem cell transplant in selected cases. Here with authors report a case of young adult, presenting with fever, thrombocytopenia, splenomegaly, and multi organ dysfunction, diagnosed as a case of secondary HLH based on the HLH 2004 guidelines.
Mixed phenotype acute leukaemias (MPALs), a varied group of disorders pose a diagnostic challenge to the physicians and pathologists alike. This rare subset of acute leukaemias are characterised by the presence of blasts which express markers of more than one lineage (B-lymphoid / T-lymphoid / Myeloid lineage), making the essentiality of immunophenotyping more pertinent. MPALs are included in the acute leukaemias of ambiguous lineage under the World health organization (WHO) classification of tumours of haematopoietic and lymphoid tissues. We describe here a case report of mixed phenotype acute leukaemia (T-Lymphoid/Myeloid).
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