This study can be a useful guide to neonatologists, hematopoietic stem cells transplant hematologists and future analysis.

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.

Introduction: Umbilical cord blood (UCB), a source of hematopoietic stem cells, represents neonatal blood and reflects the health of the newborn to a great extent. Establishing biological reference intervals is essential to discard samples before submitting for expensive investigations and storage. Also neonatal anemia has to be recognised early. Hence this study is undertaken to establish a biological reference interval for the UCB hemogram and to study the effect of maternal anemia on the fetus. Materials and methods: This is a prospective study conducted in two steps after Institutional Ethics Committee approval. In each step, 100 full term infants with normal birth weight and APGAR score delivered by spontaneous vaginal delivery were enrolled. In the first step, the mothers had hemoglobin (Hb) above 12 g/dL and no co-morbid conditions. In the second step, maternal hemoglobin cut offs of 12 g/dL and 10.9 g/dL were established. UCB was collected after clamping the cord in a K₂-EDTA evacuated tube. The blood was processed in Beckman Coulter LH 780 hematology analyzer. Delta check and manual count of RBC precursors was done by peripheral smear and reticulocyte count. Data was analysed using SPSS IBM statistics software version 19. The RBC parameters (RBC count, Hb, packed cell volume (PCV), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW)) and RBC precursors between groups were compared. The changes according to the grade of anemia were analysed and compared with the biological reference interval. The maternal Hb was grouped in 1 g/dL differences and the Hb in the UCB of the respective neonates was correlated. Results: The biological reference interval for UCB hemogram was established. No significant difference was found in the RBC parameters in the UCB of neonates born to anemic and non-anemic mothers. Reticulocyte parameters namely reticulocyte count, absolute reticulocyte count, reticulocyte index and reticulocyte proliferation index showed significant increase in the UCB of neonates born to anemic mothers. No significant difference was found in the nucleated RBC (nRBC) count between the groups. When compared to the biological reference interval, MCH and MCHC were lower and reticulocyte parameters were higher in the UCB of neonates born to anemic mothers. A significant positive Pearson correlation was found between cord blood Hb and maternal Hb. Discussion: Through the UCB Hb correlated positively with maternal Hb, it has been found that maternal anemia does not cause fetal anemia. This may be due to high iron transfer from mother to fetus and maximally stimulated erythropoiesis at the end of gestation. However, significantly low MCH and MCHC values were seen in the UCB of neonates born to anemic mothers in comparison with the biological reference interval. This may be due to early decreased hemoglobin content within the cell which is compensated by the high RBC count. This is further confirmed by the significant elevation of reticulocyte parameters in the UCB of neonates born to anemic mothers. Conclusion: Maternal anemia depending on the severity causes chronic hypoxia so that the fetal bone marrow reacts to the effect of erythropoietin by increased erythropoiesis and RBC precursor release. Severe maternal anemia may cause neonatal anemia which needs further ferrokinetic studies. Maternal anemia in developing countries needs to be corrected. Also the biological reference interval established serves as a tool for neonatologists, transplant hematologists and future studies in UCB. Disclosures No relevant conflicts of interest to declare.

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.

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