Rajiv Gandhi University of Health Sciences, Karnataka, Bangalore s14

SYNOPSIS

Rajiv Gandhi University of Health Sciences, Bangalore , Karnataka .

“COMPARATIVE STUDY OF AUTOMATED CELL COUNTER

HISTOGRAMS AND PERIPHERAL SMEAR IN ANEMIAS”

Name of the candidate : Dr. Karishma A. Korgaonker

Guide : Dr. Aravind P.

Course and Subject : M.D. (Pathology)

Department of Pathology,

A J Institute of Medical Sciences,

Kuntikana, Mangalore. 2012

RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

BANGALORE, KARNATAKA.

PROFORMA FOR REGISTRATION OF SUBJECTS FOR

DISSERTATION

1 Name of the candidate and DR KARISHMA A. KORGAONKER,

address (in block letters) POST GRADUATE RESIDENT,(MD)

DEPARTMENT OF PATHOLOGY,

A J INSTITUE OF MEDICAL SCIENCES,

MANGALORE. 2 Name of the Institution A J INSTITUTE OF MEDICAL SCIENCES

MANGALORE. 3 Course of study and Subject MD PATHOLOGY. 4 Date of admission to course 24/05/2012

5 Title of the Topic

COMPARATIVE STUDY OF AUTOMATED CELL COUNTER

HISTOGRAMS AND PERIPHERAL SMEAR IN ANEMIAS

2 6 BRIEF RESUME OF THE INTENDED WORK:

6.1 Need for the study

Over the past few years complete blood count (CBC) by the automated

hematology analysers and microscopic examination of peripheral smear have

complemented each other to provide a comprehensive report on patients

blood sample. Numerous classifications for anaemia have been established

and the important parameters involved in the classifications are Hb, HCT,

MCV, RDW, MCH, MCHC, reticulocytes and IRF. Many of these values are

obtained only by automated heamatology analyzers 1 . Many times it is seen

that histogram patterns show varying features when a simultaneous

peripheral smear is reported. It is also seen that there are many limitations

when manual peripheral smears reporting is done for example: peripheral

smear reports are subjective, labor intensive and statistically unreliable.

However microscopic peripheral smear examination also have their

advantages. 2 This study intends to create a guide to laboratory personnel and

clinicians with sufficient accuracy to presumptively diagnose morphological

classes of anemia directly from the automated hematology cell counter forms

and correlate with morphological features of peripheral smear examination.

3 6.2 Review of Literature

The peripheral smear examination has always been the corner stone of diagnostic hematology. In the past three decades sophisticated hematology analyzers are being used in all large hospitals and most commercial laboratories to perform complete blood counts (CBC). It is rather unfortunate that ,because of automation in hematology ,peripheral smear examination is becoming impracticable. 3 , 4

There is also dramatic reduction in the number of medical technologists and technicians in medical laboratories which has been largely taken care of by automation, especially in hematology. However automation has also created problems relating to maintenance of expertise especially in the field of microscopic examination 5 . Several attempts have been made to create an expert system with sufficient accuracy to diagnose classes of anemia directly from the automated hematology form. 6

A study done to evaluate anisocytosis by comparing peripheral smear morphology and red cell distribution width (RDW), showed interesting results. Quantitative RDW results correlated very well with semi

4 quantitative microscopic reports and concluded that (RDW) can be considered a “gold standard” in evaluating anisocytosis. 6 The RBC histogram is frequently used along with peripheral smear examination as an aid in monitoring and interpreting abnormal morphologic changes , particularly dimorphic red cell population which should be correlated with numerical data for better interpretation of results as it is associated with numerous clinical conditions. 7

A fair knowledge of histogram pattern can also help to differentiate subclinical anemias. A study concluded that iron deficiency anemia is characterized by RBC’s with decreased hemoglobin concentration and can be distinguished from beta thalessemia trait which in comparison shows increase in microcytosis and preserved RBC Hemoglobin concentration. 8

Automated histograms have also been proven to identify red cell fragments more effectively than routine peripheral smear examination .RBC fragments are commonly seen in malignancies with cytotoxic chemotherapy and severe iron deficiency. 9

5 6.3 Objectives of the study

1. Interpretation of histograms in normal persons and patients with different

types of anemias.

2. Comparison of automated histogram patterns with morphological features

noticed on peripheral smear examination.

7. Material and methods:

7.1 Source of data.

The present study will be undertaken in the central diagnostic laboratory at

the AJIMS. A minimum of 500 patients with anemia will be included.

Further 300 cases of normochromic normocytic blood picture and normal

histogram patterns will be included as a control group in the study. 3 ml of

EDTA blood sample will be collected and a histogram will be obtained after

thorough mixing. The automated analyzer used in this hospital LABLIFE D5

SUPREME i.e. 5 part differential automated analyzer will be used for the

study. A simultaneous peripheral smear will also be prepared according to

6 standard operating procedures and stained by leishman stain .This peripheral smear will be reported by pathologist .The pathologist however ,will not be privy to histogram during the reporting of peripheral smear.

Inclusion criteria: 1)All anemic patients with hemoglobin percentage less than 11.5gm% will be included in the study.

2)Patient of all age groups will be included in the study .

Plan for data analysis:

The data will be collected and statistically comparative study will be done

Informed consent: The written consent is taken from the Medical

Superintendent of the college to carry out the study the copy of which is attached.

The identity of patients will not be revealed during the course of the study.

7.3 Does the study require any investigations or interventions to be conducted on patients or other humans or animals? If so, please describe briefly? – No.

7.4 Has ethical clearance been obtained from your institution:

7 8 LIST OF REFERENCES

1.Anemia diagnosis, Classification, and Monitoring Using Cell-Dyn Technology Reviewed

for the New Millennium VAN HOVE ,T.SCHISANO,L.BRACE.Laboratory Hematology

2. M. Aroon Kamath, M.D. Automated blood-cell analyzers. Can you count on them to

countwell?.DoctorLoungeWebsite.Availableat:

http://www.doctorslounge.com/index.php/blogs/page/17172. Accessed September 13 2012.

3. Wintrobe mm et al ,diagnosis and therapeutic approach to hematologic

problems. Wintrobe clinical hematology :Lippincot Williams and Wilkins

10 t h edition vol 2 1999:pg 3-7

4. Lewis sm, laboratory practice in Hoffbrand Lewis Tuddenham ,Post

graduate hematology :Butterworth –heinemann forth edition 1999:pg 706

5. Pierre RV.Peripheral blood film review.The demise of the eyecount

leucocyte differential .clin lab med.march 2002 22(1):279-297

6. Birndorf NI ,Pentecost JO,Coakley JR ,Spackman KA .An expert system

to diagnose anemia and repot results directly on hematology forms.Comput

Biomed Res.1996 Feb;29(1):16-26

7. http://labmed.ascpjournals.org/content/42/5/300.full

8 8. Simel DL, DeLong ER , Feussner JR ,Weinberg JB,Crawford J.Erythrocyte

anisocytosis. Visual inspection of blood films vs automated analysis of red

blood cell distribution width.Arch Intern Med .1988 Apr ;148(4):822-4

9. d’OnofrioG ,Zini G, Ricerca BM, Mancini S, Mango G.Automated

measurement of red blood cell microcytosis and hypochromia in iron

deficiency and beta thalassemia trait.Arch Pathol Lab Med.1992 jan ;

116(1):84-9

10. Bessman JD.Red blood cell fragmentation. Improved detection and

identification of causes.Am J Clin Pathol.1988Sep ;90(3):268-73

9 Signature of candidate

9 10 Remarks of the guide .

11 Name & Designation of

(in block letters) Dr. ARAVIND P. M.B.B.S, MD., 11.1 Guide ASSOCIATE PROFESSOR ,

A J INSTITUTE OF MEDICAL SCIENCES,

MANGALORE.

11.2 Signature

10 11.3 Head of Dr. UMARU N. M.B.B.S, MD., Department PROFESSOR AND HOD,

A J INSTITUTE OF MEDICAL SCIENCES,

MANGALORE

11.4 Signature

12 12.1 Remarks of the Chairman and Principal

12.2 Signature

11 12 PROFORMA

PATIENT DETAILS:

Serial Number:

Hospital Number:

Lab Number:

CLINICAL DIAGNOSIS :

LAB INVESTIGATION :

Hemoglobin:

Peripheral smear findings:

Histogram: