Abstract Aberrant T-cell phenotype or aberrant B-cell phenotype in B-cell non-Hodgkin’s lymphoma or T-cell non-Hodgkin’s lymphoma, respectively, are uncommon phenomenon and a diagnostic challenge. Multiple T-cell antigen, including CD3 expression in large B-cell lymphomas, which is considered a specific marker for T cells, is extremely rare and have scattered instances in the literature; however, none of those showed myc and bcl2 rearrangement. This is a case of stage IV NHL, previously diagnosed as T-cell NHL, which on detailed immunohistochemical and molecular diagnostic workup, later was confirmed as “Double hit” B-cell lymphoma with aberrant T-cell phenotype. With the 1st ever-reported case, we wish to bring into the notice of such aberrancy so as to not misdiagnose or wrongly classify high-grade lymphomas.
Abstract Introduction COVID‐19 usually presents with upper respiratory tract infection in varying severity which can lead to sepsis. Early prediction of sepsis may reduce mortality by timely interventions. The intended purpose of this study was to determine whether the advanced parameters like the extended inflammation parameters (EIPs) can predict prognosis and early progression to sepsis as a sequel of COVID‐19 infection and can be used as a screening profile. Also, to evaluate the Intensive Care Infection Score (ICIS) and the COVID‐19 prognostic score and validate the scores for our population. Methods Prospective observational study of 50 reverse transcription‐ polymerase chain reaction (RT‐PCR) proven admitted COVID‐19 patients. The data assessed included complete blood counts (CBC) with EIP measurements, from Day 1 of admission to Day 10. The following groups were studied: noncritical (NC) and critical illness (CI) in COVID‐19 positive cases, COVID negative sepsis and nonsepsis cases, and healthy volunteers for reference range. Results The parameters that showed statistically significant higher mean in CI group compared to the NC group are reactive lymphocyte number and percentage (RE‐LYMPH#, RE‐LYMPH%), antibody synthesizing lymphocyte number and percentage (AS‐LYMPH#, AS‐LYMPH%), Reactive monocyte count and percentage (RE‐MONO#, RE‐MONO%/M), ICIS, COVID‐19 prognostic score ( p ‐value <0.05). The AUC confirmed the diagnostic accuracy of all these parameters. From the multivariate logistic regression, the significant risk factor was RE‐LYMPH# with cut‐off >0.10 ( p value: 0.011). Conclusion The new EIP parameters, RE‐MONO#, RE‐MONO%/M, ICIS score and COVID‐19 prognostic score are useful for early prediction of critical illness. AS‐LYMPH is the most useful predictor of critical illness on multivariate analysis. RE‐MONO# and RE‐MONO%/M parameter are useful in distinguishing critical and noncritical non‐COVID and COVID‐19 patients.
Summary Introduction Peripheral blood and bone marrow smear examination is an important basic tool for the diagnosis of different haematological conditions including haematological malignancies. We created a newer modification of the conventional Leishman and Giemsa stains as Leishman and Giemsa (L&G) stain and compared the efficacy and reliability of this stain with conventional stains. The study was performed to evaluate the staining efficacy, feasibility, time and cost of L&G stain over the conventional Leishman and Giemsa stains. Methods A pilot study was carried out in the Department of Haematology of our hospital from October 2013 to December 2013. Hundred selected cases, each with peripheral blood and bone marrow smears were taken, and three sets of the smears were prepared from each sample – one for L&G stain and other two – one each for conventional Leishman and Giemsa stains. This staining is further incorporated in our routine standard operating protocols for staining of all the peripheral blood smears in automated stainer, Sysmex SP 10. Result The average grading score from each staining methods from all the three experts was compiled. The average grading score of L&G staining method was noted to be significantly higher than the other two methods (analysis of variance test, P value < 0.05). When modified L&G stain (C) was compared with stain conventional stains (A and B), a P value of <0.001 was noted in all parameters except between Leishman stain and L&G stain in mature RBC and WBC nucleus and RBC inclusions ( P value between 0.05 and 0.001). Conclusion L&G staining is a newer staining technique of immense help in high‐throughput haematology laboratories by offering a time‐saving, cost‐effective and better staining option to conventional staining methods. It gives a better nuclear and cytoplasmic differential staining and can also be used in automated blood counters/stainer.
TO THE EDITOR: Paraprotein is an abnormal immunoglobulin (Ig) or part of an Ig in the blood or urine that is produced by a clonal population of B cells and plasma cells. Production of a monoclonal Ig paraprotein is associated with various types of B-cell non-Hodgkin's lymphomas (NHLs). Paraproteinemia is associated with about 20% of patients with indolent types of NHL, whereas it appears to be rare in aggressive lymphomas [1]. Immunofixation (IFX) and conventional serum protein electrophoresis (SPEP) are useful tools to detect even low levels of monoclonal Igs. Herein, we report a case of diffuse large B cell lymphoma with a very high level of IgG kappa monoclonal gammopathy, which was rarely reported in the literature [2].
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