BACKGROUND Prothrombin time (PT) is routinely used as a test of coagulation. Thromboplastin is the key ingredient in the reagent for this test. Prothrombin time international normalized ratio (INR) readings can vary according to the thromboplastin used in the reagent. The composition of thromboplastin reagents can influence the sensitivity of each batch of reagents. Various thromboplastin reagents having different international sensitivity index (ISI) values are available now. This study was intended to evaluate the effect of different thromboplastins on INR reading for mitral valve replaced patients under stable oral anticoagulant therapy. METHODS The study was conducted on the citrated plasma received from the mitral valve replaced patients having stable international ratio between 2 to 3 for three months. 62 samples were collected from the clinical pathology laboratory, Govt. Medical College, Trivandrum. Each sample was tested with different thromboplastin reagents having international sensitivity index 1.0, 1.1 and 1.6 by measurement of the prothrombin time and conversion into international normalized ratio. The INR obtained from the thromboplastin with international sensitivity index 1.0 was considered as the standard. INR results obtained from samples tested with thromboplastin reagents with ISI 1.1 and 1.6 were compared with the standard by using analysis of variance (ANOVA) and Dunnett’s post hoc tests. RESULTS Sixty-two samples were tested with the thromboplastin reagent having ISI – 1.0, the mean INR is 2.42, for ISI – 1.1 mean INR value is 2.53 and for ISI 1.6, the mean INR value is 3.19. While comparing the mean value of INR for different reagents using ANOVA, the F value was 14.86, which was significant. P value less than 0.01. In the Dunnett post hoc test, the P value of difference between ISI 1.0/1.6 was < 0.01. Between ISI 1.1/1.6 also the P value is < 0.01. Both of these were significant. The P value of difference between the reagents having ISI 1.0 and 1.1 is 0.838 which denotes no significant difference. CONCLUSIONS In conclusion, the thromboplastin reagent with ISI 1.0 or nearest to 1.0 is most desirable for accurate INR report. KEYWORDS Prothrombin Time, International Sensitivity Index, International Normalized Ratio
Introduction: Leishman stain has been used as the stain of choice for peripheral blood films since many decades .But it has a disadvantage of consuming 15 minutes for the procedure alone thereby increasing the turn around time of peripheral smear reporting. In this study modified Leishman stain was made by adding phenol to conventional Leishman to reduce the staining time to 3 minutes without interfering with the quality of stain. Aim: To study the quality of modified Leishman stain in comparison with conventional preparation on peripheral blood smears. Materials and Methods: The present cross-sectional study was carried out in Central Haematology laboratory of a tertiary health care centre in Southern India. A pilot study was done to determine the ideal ratio of phenol to Leishman powder in preparing modified stain without compromising the staining quality. After obtaining consent, the blood sample was collected in anticoagulated vials. Sample size was calculated to be 85.Two thin wedge smears were prepared from each sample and one was stained with conventional Leishman stain and other with modified Leishman stain. The staining characteristics were assessed and scored by an experienced pathologist in terms of 6 parameters- RBC pattern, nuclear pattern, neutrophil granules, eosinophil granules, platelets and background staining. The grades were 1, 2, 3 & 4 (poor, satisfied, good and excellent). Smears each with grades 2, 3 and 4 were selected for study. The results were analysed by Statistical Package for the Social Sciences (SPSS) software version 16.0. Result: The mean value for the staining quality using conventional method was 4.73 and for modified method was 5.39, and the total score possible is 6. Photomicrograph showed excellent results with modified Leishman stain. Thus from these values we can interpret that modified method gave much more acceptable results than that of conventional method. Conclusion: Unlike the conventional method which requires a total of 15 minutes, to complete the staining process, modified Leishman staining techniques takes only 3 minutes. Blood films can be stained within a short period of time thus aiding in rapid diagnosis and treatment of patients. Keywords: Leishman stain, Modified Leishman stain, Phenol.
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