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INTRODUCTION: Thrombocytopenia is a common complication in many disorders (such as aplastic anemia, ITP, dengue fever,), the etiology being multifactorial. Immature platelet fraction (IPF) is a new parameter which is a measure of reticulated platelets that reflects the rate of thrombopoiesis. We tried to evaluate IPF as an indicator to predict the recovery of platelets in patients with dengue. METHODS: A total of 32 patients suffering from dengue fever (as confirmed by NS1 antigen or IgM antibody positivity for dengue) were taken for the study. The platelet count and IPF value of all these patients were evaluated on a daily basis. RESULTS: It was found out that IPF has a strong correlation with the recovery of platelet counts in patients with dengue. 84.3% patients showed recovery within 24 h after attaining the peak IPF, 93.75% of the patients showed recovery within 24-48 h of the rise of the IPF compared with the previous day's value, and 100% patients showed a recovery within 24 h of the fall of the IPF compared with the previous days. It was also observed that 93.75% of the patients show platelet recovery within 24-48 h if the IPF was more than 10%. CONCLUSION: Based on our study, we concluded that IPF can be used to evaluate the recovery of platelets in patients with dengue. It holds a great promise of becoming a reliable future guide for decisions concerning platelet transfusions.

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INTRODUCTION: Heparin-induced thrombocytopenia (HIT) is an immune-mediated complication of heparin therapy. Our objective was (i) to compare various laboratory assays for HIT against clinical probability (4-T score) and (14) C-serotonin release assay (SRA), which was the composite gold standard and (ii) to determine the incidence of HIT in the ICU. METHODS: The study group (n = 217) consisted of consecutive ICU patients with heparin exposure followed by thrombocytopenia. The clinical probability (4-T score) was applied to the study group. Enzyme-linked immunosorbent assay (ELISA), particle gel immunoassay (PGIA), SRA, and platelet aggregation assay (PAA) were performed. RESULTS: The 4-T score showed that 1/217 patients had high probability, 48 had intermediate probability, and 168 had low probability for HIT. One patient was positive by SRA, three by PGIA, and 33 by ELISA. The incidence based on a combination of clinical features and laboratory findings was 1.8%. CONCLUSIONS: A greater number of false positives were observed by ELISA than by PGIA when compared to a composite gold standard of SRA and clinical probability. The incidence of SRA-positive HIT was 0.46% (1/217).

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Improving specimen quality as well as healthcare worker (HCW) safety poses significant concerns for today's laboratories. With an increasing number of diagnostic tests requested, laboratory professionals are faced with challenges to reduce laboratory errors, improve the quality of laboratory results to assure accurate diagnosis and implement initiatives to ensure healthcare worker safety and minimize risk of exposure to bloodborne pathogens. A prior study conducted in 2008 reported that variations in blood collection methods for clinical chemistry assays may affect overall specimen quality. As a follow up, the current study assessed the quality of 22563 patient specimens for cell counting in EDTA blood collection tubes that were obtained with needle and syringe collection (open) using either disposable tubes or re-washed glass vials or with an evacuated blood collection system (closed). Based on the observations, the use of the evacuated blood collection system resulted in better preanalytical specimen quality as compared with needle and syringe collection. The findings also showed an approximately 70-fold reduction in the incidence of clotting as well as fewer instrument-generated flags using the evacuated collection system. In addition, the use of an evacuated collection system for venous blood collection demonstrated lesser chance of blood exposure to healthcare workers.

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Over a period of 3 years, 13 patients with Macrophage Activation Syndrome were seen. Most had underlying connective tissue disease or malignancy. High-grade fever, cytopenia and elevated transaminases were the common presenting manifestations. Elevated LDH and ferritin were characteristic. Due to low index of suspicion the diagnosis was delayed in majority of cases. Five of the 13 expired. Macrophage Activation Syndrome is associated with a high mortality and should be considered in the differential diagnosis of unexplained pancytopenia in-patients with connective tissue disease and malignancy.

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Immunosuppressive therapy related secondary haematologic malignancy is well reported. A 52 years lady with established rheumatoid arthritis developed reactive amyloidosis. This was initially treated with colchicine and cyclophosphamide and later with chlorambucil. Ten months after stopping chlorambucil she developed pancytopenia and vitamin B12 deficient megaloblastic anaemia. The pancytopenia was refractory to vitamin B12 supplements and a repeat bone marrow confirmed myelodysplasia (FABI RAEB-T). Within three weeks of this diagnosis she evolved into acute myeloid leukaemia and expired due to refractory thrombocytopenia and uncontrolled bleeding. This case stresses the need for long term follow up of RA patients treated with alkylating agents.

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