Eva Raik

Capnocytophaga canimorsus septicemia associated with cat scratch

Summary A case is reported of Capnocytophaga canimorsus (formerly CDC group DF‐2) septicemia following cat scratch in a patient with congenital asplenia. The case is of interest in that (1) the clinical presentation provided no indication as to the cause of the patients illness. (2) C. canimorsus infection following cat bite or scratch has been reported far less frequently than following dog bite. (3) The clinical course of the illness may have been modified by previous and concurrent warfarin therapy.

Hemoglobin setif and in vitro pseudosickling noted in a family with co-existent α and β thalassemia

Summary A Turkish Cypriot family was investigated for suspected heterozygous sickle cell disease, which had been reported in a maternal branch of the family resident in England. Two maternal grandparents were of African Negro origin. Pseudosickling was noted in members of the family who were found to have an abnormal hemoglobin fraction. This abnormal fraction proved to be Hemoglobin Setif (α 94 Asp→Tyr). Family studies demonstrated the presence of this hemoglobin in varying proportions in the mother and 2 of the 4 children, α and β thalassemia traits are also present in several family members.

Changing clinical, morphological and immunological patterns in chronic lymphocytic leukaemia

Summary Two cases of chronic lymphocytic leukaemia are presented in which, in the terminal phase of the disease, a population of abnormal lymphocytes similar to those seen in lymphosarcoma cell leukaemia replaced the morphologically normal small lymphocytes observed previously. Immunologically, this change coincided with a striking alteration in the pattern of surface immunoglobulin markers. In both cases, most cells initially carried IgM and in both cases these were replaced by cells carrying IgG as the number of abnormal lymphocytes increased. In addition, the use of anti‐5 antiserum in the second case revealed the coexistence of large numbers of IgD‐bearing lymphocytes as well. Calculations showed that more than half the cells present at that time must have been carrying both IgD and IgG surface markers.

An evaluation of the ELT-8 hematology analyzer

Summary The ™ELT‐8 Hematology Analyzer is a fully automated cell counter which utilizes laser light scattering and hydro‐dynamic focusing to provide an 8 parameter whole blood count. The instrument consists of a sample handler with ticket printer, and a data handler with visual display unit. It accepts 100 μl samples of venous or capillary blood and prints the values for WCC, RCC, Hb, Hct, MCV, MCH, MCHC and platelet count on to a standard result card. All operational and quality control functions, including graphic display of relative cell size distribution, can be obtained from the visual display unit and can also be printed as a permanent record if required. In a limited evaluation of the ELT‐8, precision, linearity, accuracy, lack of sample carry‐over and user acceptance were excellent. Reproducible values were obtained for all parameters after overnight storage of samples. Reagent usage and running costs were lower than for the Coulter S and the Coulter S Plus. The ease of processing capillary samples was considered to be a major advantage. The histograms served to alert the operator to a number of abnormalities, some of which were clinically significant.

The past becomes the future: requirements for medical pathology services

Concern about so-called ‘shonky’ laboratories was the catalyst prompting the Royal College of Pathologists of Australasia (RCPA) to become the driving force in the establishment of the National Pathology Accreditation Advisory Council (NPAAC) which commenced developing standards for pathology laboratories. The first, titled Laboratory Assessment Checklists, were published in 1981. It is interesting to note the prophetic use of the word ‘assessment’ before the establishment of an assessment/ accreditation body in 1984. Originally there were ten documents targeting a general section, limited service laboratories and the specific disciplines as well as an overarching document called Standards for Pathology Laboratories. Since then the documents have evolved through standards and guidelines and have been through many iterations. The number has increased to 21, reflecting the growth of pathology and associated issues, e.g., quality assurance, IT, retention of records and specimens, etc. In the process, as they were developed by individual expert committees, they have become somewhat cumbersome and repetitive with minor inconsistencies creeping in. Consequently NPAAC decided that the entire suite should be streamlined for ease of use. An overarching document, to be called Requirements for Medical Pathology Services, would state general requirements for quality and safety applicable to all pathology services. This would be supported by detailed and technical requirements in specific areas of pathology practice. A brief outline of the proposed document and how it was constructed will be presented.

Organisation of the pathology laboratory

Prior to planning an organisational approach for the laboratory it is useful to define what is leant by a pathology service and «hat the objectives of that service should be. It is important that the provider and the consumer (i.e. the clinician requesting the investigation) both see the service and its objectives the same way - if the former provides X service, yet the latter expects Y then no amount of organisational skill «ill achieve the desired result, that of optimal overall patient care. A pathology service could be variously defined, however, simplistically it should provide diagnostic assistance in establishing the cause of disease by the examination of tissues, cells and body fluids utilising diverse scientific leans usually in a laboratory setting. Laboratories can be classified in many ways - there are laboratories in the private sector, in the public hospital system and in acadeiia. These may be stall or large, single or multidisciplinary, teaching or non-teaching, solely research or highly specialised etc. With such diverse categories it is self-evident that objectives lust also differ, however all laboratories lust include amongst their objectives the production of timely and accurate reports and provision for consultation and assistance with interpretation. Additional objectives «ill be dictated by the scope of the laboratory, by the population it services and lay be Influenced by the interests and expertise of the director and senior staff. Once objectives are defined, further organisation and documentation should relate to: • an organisational chart indicating lines of authority and areas of responsibility • policies and procedures - these will include quality control and safety guidelines as well as determining appropriate methodology. • lines of communication with other professionals and organisations as well as with patients In a well organised laboratory the staff should be highly motivated, enthusiastic and contented in order to achieve the objectives and thereby provide an effective and efficient clinical service.

Cerebrospinal fluid involvement in patients with adult acute leukaemia and non-hodgkin’s lymphoma

An attempt has been made to establish the incidence of proven cerebrospinal fluid (C.S.F.) involvement in patients with adult acute leukaemia and non-Hodgkin’s lymphoma seen by the 2 clinical units of the Sydney Hospital Combined Haematology Division in the 4 yr period 1975-8 inclusive. The Cytocentrifuge (CYTOSPIN) has been used in the Haematology Department to detect the presence of malignant cells in the C.S.F. since 1975. This technique has occasionally enabled a positive diagnosis to be made with only a few such cells present. Concurrent cell counts performed by the Microbiology Department utilizing the established counting chamber method has, in these cases, failed to indicate any involvement. In the early part of the period studied, only patients showing neurological signs or symptoms were subjected to lumbar puncture. Latterly more routine lumbar punctures are being performed on patients with haematological malignancy. Twenty-three (16%) of the 144 patients with acute leukaemia showed blast cells in the C.S.F. Eleven (5%) patients out of 216 with non-Hodgkin’s lymphoma showed positive C.S.F. findings. Even though the population studied consists of adults only, the incidence of central nervous system involvement is considerably higher in patients with leukaemia than those with non-Hodgkin’s lymphoma.

Study of a Large Anglo-Saxon Family with β-Thalassaemia Trait

Study of a large Anglo-Saxon family with -thalassaemia trait revealed evidence of consanguinity, moreover both branches of the family shared a Spanish ancestor. The manifestations of the disorder were