IntroductionThe extracellular matrix protein hyaluronan acid plays an active in role in tumor cell proliferation and invasion. Hyaluronan acid receptors, namely CD168 or the receptor for hyaluronan acid-mediated motility (RHAMM) and CD44 have been implicated in promoting malignancy. There is a lacuna in data on the expression of the receptor in pediatric leukemias.MethodsPediatric patients with acute leukemia who were diagnosed, treated and followed up in our center were enrolled. The bone marrow biopsies performed prior to treatment were subjected to immunohistochemical staining (54 biopsies: acute lymphoblastic leukemia – 45, acute myeloid leukemia – 9). Blast counts were carried out at diagnosis, end of the induction phase and end of chemotherapy, the minimal residual disease was assessed and follow up details were collected. Positivity was correlated with initial blast count, post-induction blast count, minimal residual disease and patient survival.ResultsThere was no correlation between the initial blast count and the percentage of blasts with RHAMM expression. The positive correlation between percentage of blasts expressing RHAMM and the post-induction blast count was moderate in acute myeloid leukemia (0.74) and mild in acute lymphoblastic leukemia (0.48). There was a statistically significant difference in RHAMM expression between the two minimal residual disease risk groups (p-value = 0.012) with a negative prognostic effect of RHAMM expression. Moreover, a negative prognostic effect of RHAMM expression was noted when patient survival was considered.ConclusionThis study shows that blasts in acute myeloid leukemia show more RHAMM positivity than those of acute lymphoblastic leukemia indicating the aggressive nature of this type of leukemia. In acute leukemias, patients with high percentages of RHAMM-positive blasts had more post-induction blasts, blasts in minimal residual disease and poorer prognosis.

Background: Prompt diagnosis of neonatal sepsis at an early stage is essential to initiate therapy as well as to avoid unnecessary usage of antibiotics. Therefore the search for an ideal marker including antigenic expression on inflammatory cells is still continuing. The aim of the study was to identify an ideal early laboratory marker for diagnosis of neonatal sepsis. Methods: The samples sent for complete blood count were processed for Haematologic Scoring System (HSS) and flow cytometry for expression of CD64. The volume, conductivity and scatter of neutrophils and monocytes were retrieved from the analyzer. C Reactive protein (CRP) and culture reports were retrieved from Lab Information System. The samples were grouped as controls from normal babies, suspected sepsis with negative blood culture and proven sepsis with positive blood culture. Statistical analysis was done and compared among groups. A score of 3 and above HSS had sensitivity of 87% and specificity of 85%. Results: Mean fluorescent nCD64 at a cutoff of >105 can be considered as an ideal marker for early diagnosis of neonatal sepsis. It showed a higher sensitivity (97%) and higher specificity (>95%) for detecting neonatal sepsis. Conclusion: HSS and mean volume of neutrophils or a combination of mean scatter and conductivity of neutrophils may be utilized as markers when flow cytometry facility is not available.

Introduction: Bone marrow Aspirate (BMA) and bone marrow trephine biopsy (BMB) are the two diagnostic procedures done to evaluate various hematologic and non-hematologic conditions. Though both the procedures done on the same day are complementary to each other, discrepancies do occur. In few instances aspirate alone is done without a biopsy. This study is aimed to statistically analyze the diagnostic value of both the procedures and the lacuna observed.Methods: A retrospective laboratory record based analysis was done on the bone marrow investigations reported during a period of 5 years (Jan.2011 -Dec.2015. The bone marrow investigations with simultaneous BMA and BMB done during the period of study were included. Descriptive statistical analysis was done for correlation of BMA and BMB diagnosis.Results: Aspirate and biopsy were done on 934 cases. The diagnostic sensitivity of BMB was 94.74% and BMA was 86.14%. BMB and BMA were complementary to each other in 53.21% cases. BMB alone was diagnostic in 33.61% cases and BMA alone was diagnostic in 9.31% cases. Inadequate material for diagnosis was noted in 8.35% of BMB cases and 27.41% of BMA cases. Good positive correlation was noted in cases of immune thrombocytopenic purpura, multiple myeloma, anemia, reactive marrow and chronic lymphocytic leukemia. Conclusion:Though both the procedures were complimentary to each other, inadequate aspirates due to disease conditions and faulty techniques were major drawbacks. It is preferable to perform both the procedures simultaneously for a more conclusive diagnosis.

We describe a very rare case of paediatric female patient of acute promyelocytic leukemia (APL) with negative promyelocytic leukemia-retinoic acid receptor-α (PML-RARα) and normal karyotype co existing with autoimmune haemolytic anemia(AIHA) for the rarity, diagnostic and management challenges. The clinical outcome with arsenic trioxide (ATO) and all-trans-retinoic acid (ATRA) regime is good without relapse or residual disease with a close follow up of 6 months.

Background: Bone Marrow Biospy (BMB) often needs ancillary tests like Immunohistochemistry (IHC) to confirm the morphological diagnosis, to categorize malignant conditions. Methods:A retrospective study was done on BMB with IHC done on the sections are reviewed and analysed correlating the clinical, Bone marrow aspirate(BMA) and BMB interpretations.Result: A 5 year study on 934 BMB required IHC as an adjunct on 16.2% of the biopsies. It was done on 10.6% of cases. The distribution of cases was 43% of Acute leukemia(AL), 19% multiple myeloma, 8& lymphomas, 9% metastasis. 20 % of other cases which included chronic lymphocytic leukemia(CLL), myelodysplastic syndrome (MDS), megaloblastic anemias, infective conditions and reactive marrows. Conclusion:IHC is a reliable method to confirm and categorize AL, to differentiate reactive and neoplastic plasmacytosis, to confirm, categorize and stage lymphomas, to detect metastasis.