Poornima Baliga

Cytodiagnosis of Extramedullary Plasmacytomas

OBJECTIVE Extramedullary plasmacytoma (EMP) constitutes approximately 4% of all plasma cell neoplasms. It may present as the sole manifestation of plasma cell neoplasm, as a solitary plasmacytoma of the bone or as a consequence of multiple myeloma. This study was done to determine the role of fine needle aspiration cytology (FNAC) in the diagnosis of EMP. STUDY DESIGN In our study 8 cases of EMP at various sites were diagnosed on FNAC. In 3 patients EMP was the initial presentation of plasma cell neoplasm. In the remaining 5 patients the tumors occurred during the course of treatment for multiple myeloma. RESULTS The lesions were located at various anatomic sites, including lymph node, scalp, breast, jaw, rib, clavicle and soft tissue swelling in the retrosternal region. The smears prepared from the aspirates in all cases revealed numerous plasma cells at various stages of maturation, leading to a diagnosis of EMP. Radiologic and bone marrow findings also substantiated the diagnosis of multiple myeloma in all but 1 case. CONCLUSION FNAC offers a rapid, reliable and accurate diagnosis of EMP and thus allows initiation of appropriate treatment.

Microwave histoprocessing versus conventional histoprocessing

The aim of the study is to compare the histologic quality of the microwave histoprocessing with that of conventional method and to determine its positive impact on turnaround times and reduction of costs of tissue processing. One hundred and eighty-five paired tissue sections from different organs were taken. Each tissue sections were of size of 15 mm x 10 mm x 3 mm and divided into two; one set as experimental group and the other as control group. The tissues in the experimental group were further divided into six groups and processed by vacuum-microwave method according to six protocols from I to VI. Other tissues in the control group were processed by the conventional method and compared. Overall, the quality of microscopic tissue from both the methods was identical. Microwave processing shortened the time of processing without compromising the overall quality of the histologic section and was cost-effective.

Morphometric evaluation of endometrial blood vessels.

Five hundred endometrial specimens were studied to document the changes in blood vessels in various phases of menstrual cycle, menstrual disturbances and in unexplained infertility. Sixty-three cases were taken as control and 437 cases as study group which included cases of dysfunctional uterine bleeding (DUB), endometrial polyps, fibroids, adenomyosis, infertility and atrophic endometrium. Using light microscopy, the vascular morphology was studied. The blood vessels were concentrated more in basal layer in the proliferative phase and in functional layer in the secretory phase. Cases of complex hyperplasia and pill endometrium had significantly higher vessel concentration. Congestion and dilatation of blood vessels were significantly higher in cases of DUB. The present study showed a positive correlation between endometrial angiogenesis and menstrual disorders. The alteration in blood vessel morphology has significant role in prognosis and in various anti-angiogenic therapies.

Barcode error leading to sample misidentification during blood grouping

Patient safety associated with the transfusion process is extremely important due to the propensity of errors to cause catastrophic consequences. To aid blood banks in minimizing these errors, advanced computerized information systems and barcode labeling technology have been introduced. The barcode technology comprises machine readable symbols used to encode information to automate it. It simplifies and improves the patient identification system in laboratory and clinical transfusion practice. Currently barcode technology has become an indispensable advancement allowing the technical staff to bypass the tedious manual check of the sample labels. Our center is a 2032-bed tertiary care facility and administers approximately 30,000 blood components annually. We have a state-of-the-art immunohematology laboratory with fully automated grouping system with an annual load of 54,000 patient samples. Samples are barcoded at the site of reception at the blood bank, using a barcode printer of Zebra Technologies Corporation. Subsequently samples are loaded into automated blood grouping equipment, which has a software into which the patient details are fed manually and the labels are scanned by an built-in scanner. Recently we noticed a blood grouping error (O D1 instead of B D1) and on root-cause analysis it was found to be due to barcode printing error. As visualized in Video Clip S1 (available as supporting information in the online version of this paper), the barcode label printed in the above said barcode printer in our blood bank, for a particular hospital number, was read as a different number belonging to another patient, leading to the blood grouping error. While entering the patient’s blood grouping report to the blood bank software, a discrepancy was noted with the previous grouping report. To resolve the Fig. 1. Possible causes for barcode label error. The fishbone diagram indicates four major categories of causes resulting in a barcode label error. Three examples for such causes are listed per category. The root cause for the error shown in Video Clip S1 was a hardware problem with the printer resolution.

Implication of deferral pattern on the donor pool: Study at a Tertiary Care Hospital

Background and Objectives: Donor screening process is one of the most important steps in protecting the safety of blood supply. Donors who do not meet specified criteria are deferred either temporarily or permanently. These criteria are designed to protect both donors and patient safety. Due to the varied rates and reasons for deferrals in the existing literature, we aimed to evaluate the patterns and prevalence of deferrals in our institution. Materials and Methods: This retrospective study was conducted at a Tertiary Care Hospital, Karnataka, Southern India, to evaluate the various reasons for blood donor deferral from January 2011 to January 2014. Demographic data of blood donors was obtained through the blood bank database and secondary measures such as the type of deferral (permanent/temporary, pathogenic/nonpathogenic, and harmful to donor/recipient) were assessed. Results: A total of 54,653 subjects presented to our blood bank during this period out of which 2935 (5.6%) were deferred. The deferral to donor percentage was higher in females (36.54%) than males (3.64%). Low hemoglobin was the major deferral criterion seen in our participants (48.1%) followed by hypertension (16.4%), underweight (8.9%). Low pulse rate and fasting donor were the least prevalent reasons. A total of 36.8% of reasons for deferral were harmful to donors, 88.2% were nonpathogenic, and 98.1% were temporary causes. Conclusion: Variations in donor deferral may be attributed to different donor selection criteria in different regions and centers. Hence, it is important to know the common causes of donor deferral in a region so that measures may be taken to improve the donor pool.