Background:Autoimmune hemolytic anemia (AIHA) results from red cell destruction due to circulating autoantibodies against red cell membrane antigens. They are classified etiologically into primary and secondary AIHAs. A positive direct antiglobulin test (DAT) is the hallmark of diagnosis for AIHA.Methods and Results:One hundred and seventy-five AIHA cases diagnosed based on positive DAT were included in the study. The cases showed a female predilection (M: F = 1:2.2) and a peak incidence in the third decade. Forty cases were found to be due to primary AIHA, while a majority (n = 135) had AIHA secondary to other causes. The primary AIHA cases had severe anemia at presentation (65%) and more often showed a blood picture indicative of hemolysis (48%). Forty-five percent of primary AIHAs showed positivity for both DAT and indirect antiglobulin test (IAT). Connective tissue disorders were the most common associated etiology in secondary AIH A0 (n = 63).Conclusion:AIHAs have a female predilection and commonly present with symptoms of anemia. AIHA secondary to other diseases (especially connective tissue disorders) is more common. Primary AIHAs presented with severe anemia and laboratory evidence of marked hemolysis.

A positive direct Coombs test (DCT) is the hallmark of diagnosis of immune hemolytic anemias. The reagent used for the test is the Antihuman globulin (AHG), which may be either 'Polyspecific' or 'Monospecific'. The advent of the Gel card systems has made the procedure and interpretation of DCT simpler. Aim of this study is to evaluate three of the various techniques used for the performance and interpretation of DCT. A total of 96 EDTA samples were included in the study. DCT was performed by (i) polyspecific AHG manual tube method (ii) polyspecific AHG Gel card method and (iii) monospecific AHG (Anti IgG and Anti Complement) manual tube method. In our study we considered positivity by monospecific AHG as the standard for diagnosis. Of the total 96 samples evaluated, 44 cases positive by Gel card method, were also positive for either one or both the monospecific AHG reagents. 17 cases positive by Gel card were negative by all manual methods. These false positive cases were attributed to reasons such as increased ESR, macrocytosis and marked leucocytosis. Nine cases were negative by Gel card but were positive with the Monospecific AHG. The sensitivity of DCT done by the Gel card technique was 83.01% and the specificity was 60.46%. Use of Gel card technique to perform and interpret DCT is easier than manual tube methods, but positivity by Gel card needs to be correlated with clinical presentation of the patient and other laboratory findings. Monospecific antisera can be used to confirm cases that are positive by the Gel card systems.

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Background: Most cancer patients with metastatic disease have abnormal coagulation parameters. Although many abnormal blood coagulation tests have been reported in malignancies, there is little agreement regarding which tests are most useful to predict disease progression and hence this study was undertaken. Methods: In this prospective study, baseline and special coagulation tests were performed on 23 patients with ovarian adenocarcinoma. The baseline tests were PT, APTT, TT and platelet count. The special tests included factor VIII, factor IX and fibrinogen assay and semiquantitative measurement of D-dimer and FDP levels The cases were grouped into early and advanced disease groups. The results of the coagulation tests were analysed using suitable statistical methods. The results were compared between limited and advanced disease by chi square and Mann Whitney U test Results: The percentage of cases with increased D-dimer and fibrin degradation products (FDP) values were higher in the advanced disease compared to early disease. Two cases in stage IV had DIC. The PT, APTT, TT and platelet count did not show any statistically significant differences between the early and advanced disease groups. Factor VIII, factor IX and fibrinogen levels were not significantly different between two groups. Conclusion: Elevated D dimer& FDP are associated with advanced stage ovarian adenocarcinoma.

Dear Editor, Hb D is a b chain haemoglobin variant. It was first described by Itano in 1951 [1]. It differs in structure from Hb A at 121 position on b chain where glutamine replaces glutamic acid [2]. Hb D is known variously as Hb D Punjab, Hb D Los Angeles. It is the fourth most frequently occurring Hb variant [3].Hb D Punjab occurs with greatest prevalence (2 %) in Sikhs of Punjab and in Gujarat (1 %). It is also found sporadically in blacks and Europeans, the latter usually seen in countries that have close association with India in the past [3].HbD heterozygotes are clinically normal and homozygotes have a clinically mild phenotype. Hb D attains clinical significance in association with either b thalassemia or HbS.We describe 12 patients, 9 from South Indian population (three cases of Hb D trait and six cases of Hb SD) and 3 from West Bengal (one case homozygous HbDD, one case of HbD b thalassemia and one case of HbD trait).Blood samples collected in EDTA were subjected to complete blood counts, reticulocyte count and red cell indices on the Sysmex XT 1800i/XT 2000i/XT 4000i. Peripheral blood smears were prepared stained with Leishman's stain and examined. Sickling test was done where indicated by using 1 % sodium metabisulphite. G6PD screening was done using dye reduction test. The HPLC was done on BioRAD Variant II. The clinical data was retrieved from the medical records department.HPLC was done on 1,460 cases over a period of 2 years from September 2009 to February 2012. Five hundred and eighty-nine cases of haemoglobinopathies were detected. b Thalassemia trait was most common with 373 cases (63 %) being detected. b Thalassemia major was seen in 36 cases (6.1 %) and b thalassemia intermedia in 13 cases (2.2 %). Sickle cell disease was the next common with 28 cases of Sickle cell trait (4.7 %), 25 cases of sickle cell anemia (4.2 %) and 18 cases of sickle b thalassemia (3 %). HbE was seen significantly in the migrant population from Bengal with 24 cases of HbEE disease (4 %), 27 cases of HbE trait (4.5 %) and 14 cases of HbE b thalassemia (2.3 %). Twelve cases (2.0 %) showing Hb D were detected of which six cases were double heterozygous HbSD, one case of homozygous HbDD, one case of HbD b thalassemia and four cases of HbD trait. Eleven cases (1.8 %) of hereditary persistence of foetal haemoglobin (HPFH), four cases (0.6 %) of HPFH trait and four cases (0.6 %) of a thalassemia were also seen.