RDW has a limited specificity for diagnosis of IDA among children with microcytic hypochromic anemia.

Blood components have been in use in clinical practice for many decades now. In spite of fairly clear guidelines regarding their use, inappropriate prescriptions for components are still rampant. We undertook this work to assess the appropriateness of fresh frozen plasma (FFP) transfusions in our hospital. A prospective audit of 504 transfusion orders for 1761 FFP units was conducted over a 6-month period which was followed by a re-audit of 294 FFP prescriptions for 961 units. In the initial audit, we identified 304 (60.3%) prescriptions which were inappropriate according to the British Committee for Standardization in Hematology (BCSH) guidelines. The re-audit performed after an educational campaign among clinicians showed a reduction in inappropriate requests by 26.6%. The specific areas of misuse were FFP transfusions in patients with hypoproteinaemic states (40.5%), anaemia (36.5%), bleeding without coagulation factor deficiency (10.2%) and volume depletion (9.2%). A significant 50.3% of requests in the initial audit and 38.4% in the re-audit were for single- or two-unit transfusions, which were subtherapeutic. FFP transfusions carry the same risks to the patients as any other blood component. Prescribers of these transfusions need to be aware of the clinical setting where their use is appropriate. Local hospital transfusion committees can play a vital role in overseeing transfusion practices to ensure optimal use of blood/component therapy.

Egg albumen and propolis may be able to maintain PDL cell viability as well as HBSS.

Oral anticoagulation therapy is affected by the drug used, intensity of anticoagulation, physician's experience, patient compliance, laboratory testing and patient education. Patient education is a key factor in optimal anticoagulation and safety in patients on oral anticoagulant therapy. This study was done to assess the knowledge of patients regarding oral anticoagulant therapy in the outpatient setting. This prospective study was done over 2 months in 101 patients on outpatient oral anticoagulant therapy. A 20-point questionnaire on various aspects of oral anticoagulation therapy was administered to assess their knowledge. The answers were graded on a scale of 0-1. Scores were then added up to quantify the knowledge status in each patient. Descriptive statistics and Student's t test was used to analyse the data. The mean knowledge score among patients was 9.4/18 (52.2 %). More than half (52.8 %) of the patients had a score of <9. More than half (54.4 %) of the patients had adequate knowledge-(>80 % score-5.5/7) about the critical (must know) questions regarding OAT. Patients with age ≥60 years had lower mean scores compared to those <60 years of age (p = 0.028). Illiteracy was also associated (p < 0.0001) with poor scores. There are significant lacunae in the knowledge about oral anticoagulation among patients on outpatient treatment. Older age and illiteracy were associated with poor knowledge among patients. More emphasis needs to be given to the vital aspect of patient education to make this therapy safer for patients.

Worldwide, most hematology laboratories have now changed over from the labor intensive manual methods of testing to 3-or 5-part differential automated hematology analyzers. Although laboratory personnel and hematopathologists handling the automated data are familiar with the basic interpretation and benefits of numerical data, the seemingly complex graphical representation of the red cell data in the form of histograms and cytograms is often ignored. At times, these can provide vital information that may not even be apparent in the automated numerical data. 1 Characteristic red cell cytogram patterns indicative of common hematological conditions are being presented in this paper. Materials and MethodsThis study presents a compilation of characteristic red cell cytograms generated by Advia-120 (Siemens Healthcare Diagnostics, Deerfield, IL), 2 a 5-part differential system (Technicon H1 series) used in the hematology laboratory of a tertiary care teaching institution. The cytograms have been compiled over a 2-year period from blood samples (approximately 200 per day) received for routine complete blood counts (CBC) in the laboratory. Approximately 140,000 cytograms have been analyzed during the study period. Single test requests were not run through the Advia-120 and were done manually. Dipotassium ethylenediaminetetra-aceticacid (EDTA) blood was used for testing and the tubes for sample collection were prepared in-house. AbstractBackground: Graphical data output from automated hematology analyzers, especially those related to red blood cells, have been traditionally ignored in favor of the more frequently used numerical values. This study presents characteristic red cell cytograms generated by Advia-120, a 5-part automated hematology analyzer, as seen in common hematological conditions.

The era of automation in haematology, although improving the accuracy and precision of results, has also introduced the laboratory haematologist to a vast array of spurious parameters. The identification of these results is important so that inappropriate management decisions are avoided. The case presented here illustrates a spuriously raised automated platelet count resulting from bacterial overgrowth in the blood sample.T he use of automated analysers in haematology laboratories is now the rule rather than the exception. These instruments have enhanced the precision of results and, with optimal quality control measures in the laboratory, have improved the accuracy of tests. However, there are a variety of conditions where automated parameters may be fictitious. Such situations demand careful attention, because vital management decisions may be taken based on these erroneous results.1 Both the laboratory operators of these instruments and clinicians must be aware of the possibility of spurious data from automated laboratories. A case of an artefactual rise in the automated platelet count is presented here.''The use of automated analysers in haematology laboratories is now the rule rather than the exception'' CASE REPORTA 39 year old woman was admitted to the coronary care unit of our hospital with sudden onset of breathlessness. On examination, she was tachypnoeic and restless. Respiratory examination revealed bilateral crepitations. Prosthetic valve sounds could be well heard. She had tachycardia but her heart rate was regular. A diagnosis of acute pulmonary oedema was made and supportive treatment was initiated. She was being followed up after mitral valve replacement, the surgery having been performed 11 years previously for chronic rheumatic valvular heart disease. The presentation with pulmonary oedema was attributed to her failure to increase the dosage of the prescribed diuretic (Furosemide) from 40 to 80 mg each day. As part of her initial investigation, a complete blood count was requested. The complete blood count reported by the Advia-60 (Bayer, Baroda, India), the three part differential automated analyser in use in our laboratory, revealed a haemoglobin of 128 6 10 9 g/litre; a total leucocyte count of 8.5 6 10 9 /litre, with a normal differential leucocyte count; mean corpuscular volume of 78 fl; mean corpuscular haemoglobin of 26.1 pg, and a mean corpuscular haemoglobin concentration of 33.6%. The platelet count was 1152 6 10 9 /litre. However, a review of the peripheral blood smear revealed a platelet count of approximately 130-150 6 10 9 /litre, a discrepancy of nearly 1000 6 10 9 /litre compared with the automated value. Numerous rod shaped bacteria were present in clumps and were also seen lying singly (fig 1). A few intraneutrophilic bacteria were also present. The white blood cells showed pronounced artefactual changes, with nuclear distortion and cytoplasmic vacuolation. The bacteria seen in the peripheral smear were thought to be responsible for the spuriously raised platelet count. Furt...

Congenital macrothrombocytopenia is being increasingly recognised because of the increasing availability of automated platelet counts during routine complete blood count. If not recognised, these patients may be unnecessarily investigated or treated. The study was done to assess the occurrence of macrothrombocytopenia in the North Indian population and the role of automated platelet parameters in its detection. This prospective study was done on patients whose blood samples were sent for CBC to the hematology laboratory of a tertiary care hospital. Samples were run on Advia-120, a 5-part differential automated analyzer. Routine blood parameters including platelet count, mean platelet volume (MPV), platelet cytogram pattern and platelet flagging was studied along with peripheral blood smear examination. ANOVA was used to compare difference in mean MPV in patients with macrothrombocytopenia, and those with secondary thrombocytopenia and ITP. Seventy five (0.6 %) patients with CBC evaluation were detected to have macrothrombocytopenia, majority (96 %) of North Indian origin. The MPV (fl) in the 75 patients ranged from 10.9 to 23.3 (mean 15.1 ± 3

Thrombotic thrombocytopenic purpura (TTP) and systemic lupus erythematosus (SLE) very rarely present simultaneously and pose a diagnostic and therapeutic dilemma to the critical care team. Prompt diagnosis and management with plasma exchange and immunosuppression is life-saving. A patient critically ill with TTP and SLE, successfully managed in the acute period of illness with plasma exchange, steroids and mycophenolate mofetil is described.