BACKGROUND Thrombocytopenia may either be due to increased destruction or impaired production of platelets. Platelet count alone is not enough to determine the mechanism of low platelets. Platelet indices like mean platelet volume (MPV), platelet distribution width (PDW), platelet large cell ratio (P-LCR) and platelet crit (PCT) can help determine the cause and we aimed at finding their role and function in cases of thrombocytopenia. METHODS An observational cross-sectional study of 155 patients with thrombocytopenia and 71 controls was done for a period of six months in SGT Hospital, Gurugram, to determine the mechanism behind the low platelet count with the help of these indices. RESULTS The mean values of the platelet indices (PDW, P-LCR and PCT) were found to be higher in accelerated destruction group (P < 0.05) in comparison to hypoproductive group, whereas, mean MPV values were higher in the former, but was not statistically significant. On comparison with the controls, both the groups of thrombocytopenia showed a statistically significant difference with P < 0.005 in all the four indices. Mean PCT values showed a highly significant difference between the two groups as well as with controls (P < 0.001) and also the relationship of PCT with severity of thrombocytopenia showed a direct relationship which was also significant (P < 0.001). CONCLUSIONS In distinguishing between the cause of thrombocytopenia i.e., hypoproductive or hyper destruction, platelet parameters play an important role. These platelet indices are easily available with the help of automated haematology analysers and can reduce the need for costly and invasive tests for evaluation of thrombocytopenia. KEY WORDS Mean Platelet Volume, Platelet crit, Platelet Distribution Width, Platelet Large Cell Ratio, Thrombocytopenia
Gastrointestinal stromal tumours (GISTs) are mesenchymal tumours of alimentary tract comprising 0.2% of gastrointestinal tumors and only 0.04% of small intestinal tumours. Jejunal GISTs are one of the rarest subtypes. GISTs display various morphological forms like spindle and epitheloid cells in a variety of patterns and can be submucosal, intramuscular or subserosal in location. Grossly they are solid and cyst with variable hemorrhage and necrosis. Most of the gastrointestinal stromal tumors have mutations in either KIT (CD117) or PDGFRα gene. DOG 1 is a sensitive and specic marker of GIST independent of CD117 or PGDFRα expression. Here we present a case of malignant jejunal GIST with missed diagnosis on CECT abdomen.
Introducion: Tuberculosis (TB) is still prevalent in developing countries, and one of the most common cause of tuberculous lymphadenopathy. Quick diagnosis is necessary for adequate treatment. Fine needle aspiration cytology (FNAC) is an efcient and rapid primary diagnostic technique as an alternative to excision. Cytomorphologic features of well-formed epithelioid granulomas and the presence of caseous necrosis are sufcient for cytological diagnosis. Mycobacteriological conrmation however, is essential to rule out other causes of granulomatous inammation. Material and methods: This study was aimed at evaluating and correlating the role of FNAC, mycobacterium recognition by Ziehl-Neelsen staining (ZN staining) with Cartridge based nucleic acid amplication test (CBNAAT) positivity to diagnose tuberculous lymphadenitis. FNA material was collected from 97 patients and was analysed by cytomorphology, ZN stain and CBNAAT. Result: Out of 97 cases, 66 cases had cytological features consistent with TB. 40.9% of the smears showed epithelioid granulomas with caseous necrosis, followed by 31.8% smears showing epithelioid granuloma without necrosis and necrosis with polymorphs without granuloma in 27.3% of the smears. Amongst the 27 cases showing granuloma with necrosis, there was 44.4% AFB positivity and 48.1% CBNAAT positivity while 21 cases of granuloma without necrosis showed 52.3% AFB positivity and 47.6% CBNAAT positivity. In the 18 cases showing necrosis there was 72.2% AFB positivity and 83.3% CBNAATpositivity. Conclusion: The presence of caseous necrosis and granulomas are strongly suggestive of tubercular etiology, especially in developing countries with high incidence of TB. AFB smear CBNAATcan supplement cytomorphometry for rapid and accurate diagnosis.
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