Standard medical laboratory

27/09/2023

Leukemoid Reaction 💉

Definition of Leukemoid Reaction

If there is a persistent increase in the neutrophils, reactive and excessive leucocytosis with a count of 30,000 to 50,000 / µL, with immature and mature white cells in the peripheral blood smear is called Leukemoid reaction. Sometimes lymphocytic reactions may be seen.
This is not a primary marrow disorder, and this is due to secondary infections.
The count varies from 50,000 to 100,000/cmm. With the presence of immature cells.
Blast cells in the peripheral blood smears are not seen, which helps differentiate from leukemia.
Extremely elevated counts >100,000/cmm are more suggestive of the myeloproliferative process, with some exceptions

Types of leukemoid reaction 💉

💉Neutrophilic reaction.
💉Lymphocytic reaction.
💉Monocytic reaction.

Significance of leukemoid reaction 💉

This term is used to differentiate between leucocytosis and leukemia.
In leukocytosis or neutrophilia, there is an increase in the count from 10,000 to 25,000 / µL (microliter).

Pathogenesis of leukemoid reaction 💉

Leucocytosis results from releasing the cells from the bone marrow under the influence of IL-1 and TNF.
There is a shift to the left of the neutrophils.
Prolonged infection induces in the bone marrow the proliferation of the precursor cells, and that is also produced by the cytokines like IL-1 and TNF.
Bacterial infections induce a selective increase in neutrophils, while par*asi*tic infestation induces eosinophilia.
Mumps, Rubella, and some vi*r*us*es lead to a selective increase in the lymphocytes and cause lymphocytosis

The differentiating point from leukemia 💉

In the leukemoid reaction, the neutrophils are mature and not clonally derived.
There is a persistent increase in TLC above 50,000/cmm and no evidence of leukemia.
Blood count comes to normal after treating the cause.
Increased blast cells are not seen in the leukemoid reaction.
A count above 100,000 /µL suggests a myeloproliferative disorder with few exceptions.
Granulocytes show toxic granulations and Dohle bodies.
NAP score is high, which is low in leukemia.
Leukemoid reaction shows:
Toxic granulations
Toxic vacuolization.
Presence of Dohle bodies. These are light blue to grey, oval, and basophilic inclusions in the neutrophils. Usually seen in the peripheral area of the cytoplasm of neutrophils. These consist of ribosomes and endoplasmic reticulum.

Causes of Leukemoid reaction (Neutrophilic type) 💉

A severe infection 💉
Septicemia.
Clostridium.
Tuberculosis.
Pertussis.
Infectious mononucleosis.
Endocarditis.
Pneumonia.
Tuberculosis.
Toxic conditions 💉
Eclampsia.
Burns.
Mercury poisoning.
Parasitic infestation 💉
Larval migration leads to eosinophilia.

Leukemoid lymphocytosis💉

It is seen in Tuberculosis, Whooping cough, and infectious mononucleosis.
Malignancy 💉
Carcinoma of the colon.
Embryonal carcinoma of kidneys.
Miscellaneous causes 💉
Severe hemorrhage.
Acute hemolysis.
Diabetic ketoacidosis.
Ischemic colitis.
Hepatic necrosis.
Drugs 💉
Like Sulfa, Dapsone, Glucocorticoids, and the G-CSF factor.

Lymphocytic leukemoid reaction is seen in 💉

Infections 💉
Infectious mononucleosis.
Pertussis.
Varicella.
Tuberculosis.
Malignancies 💉
Carcinoma of the stomach.
Carcinoma of the breast.
Others like Dermatitis herpetiformis

Monocytic leukemoid reaction 💉
It is seen in tuberculosis.

Dr. Shakirullah Hamid

08/11/2022

29/10/2022

𝘽𝙡𝙤𝙤𝙙 𝙂𝙧𝙤𝙪𝙥 𝙎𝙮𝙨𝙩𝙚𝙢

02/10/2022

Biopsy or tissue sample

Biopsy is a medical procedure in which a small sample of tissue is taken from the body, which is then examined under a microscope in a laboratory. Imaging tests such as X-ray, CT scan or MRI are very useful in diagnosing tumors or peripheral abnormalities; But they do not have the ability to differentiate between cancerous and non-cancerous tissues. The only way to definitively diagnose most cancers is to perform a biopsy. Biopsy is a low risk and painless procedure. When a lump is completely removed, it is called an excisional biopsy. In case a part of abnormal tissue is removed, without trying to remove all the damage or tumor, it is called incisional biopsy or core needle biopsy.

for performing biopsy
If the patient has symptoms of cancer, the doctor usually requests a biopsy of the body. Biopsy is usually requested in patients suspected of having cancer, but this does not mean that the patient is definitely diagnosed with cancer.
Doctors use biopsies to determine whether abnormalities in the patient's body are caused by cancer or other conditions. For example, if a woman has a lump in her breast that is confirmed by imaging, a biopsy is the only way to determine whether she has breast cancer or a non-cancerous disease.


of biopsy
The doctor determines the type of biopsy based on the condition of the patient and the area of ​​the body that needs biopsy. Local anesthesia is used in all procedures and the patient does not feel pain.

marrow biopsy
Inside some bones of the elderly body, such as the heart or thigh bone, blood cells are reproduced in a spongy substance called bone marrow. If the doctor suspects hard bleeding in the patient himself, he may request a bone marrow biopsy.
This test can identify cancerous and non-cancerous cells; For example, it can also diagnose leukemias, anemias, infections or lymphoma. This test is also used to check bony metastasis. The spread of cancerous cells from other tissues of the body to bone tissue is called bone metastasis.
Bone marrow is easily accessible using a long needle inserted into the iliac bone. A bone marrow biopsy may be performed at a hospital or a hematologist. Considering that the edges of the bones cannot be anesthetized, some people may feel pain during the biopsy. However, due to local anesthesia the patient feels only one pain initially.

Endoscopic biopsy
An endoscopic biopsy is used to obtain tissue from inside the body, such as the bladder, colon or lungs. During this procedure, the doctor uses a delicate flexible tube called an endoscope. Finally, the endoscope tube consists of a very small chamber and a light source. The images are viewed on the monitor above the camera.
There are also very small surgical instruments in the endoscope tube, by using which, the doctor can carry out sampling in a selective manner. The endoscope can be inserted into the body through the invention of a small brush or through orifices such as the mouth, nose, a**s or trachea. Endoscopies usually last from 5 to 20 minutes. Endoscopy can be performed in an examination room or hospital. After endoscopy, the patient may have mild discomfort that is temporary and does not require monitoring.

biopsy
During a needle biopsy, the doctor uses a special needle to remove cells from the suspicious area. Different types of needle biopsy include:
· Fine-needle biopsy: In this examination, a long and delicate needle attached to a syringe is inserted into the target area. With fine needle aspiration, fluids and cells are removed.

· Core needle biopsy: In this examination, a medium-sized needle is used for external tissue.

· Guided imaging modalities under needle biopsy: needle biopsy with the help of diagnostic imaging modalities such as X-ray and CT scan can help the doctor to reach special areas such as lungs, liver and other organs.

· Biopsy vacuum (vacuum-assisted biopsy): In this type of examination, we can reduce the number of times the needle is inserted to collect the appropriate sample.

skin and species on
In a skin biopsy, cells are separated from the surface of the body. The doctor may request a biopsy from the affected area to diagnose the disease. A skin biopsy is usually used to diagnose problems early, including melanoma and skin cancer. Rashes that have an unknown cause or do not respond to the treatment recommended by the doctor are also an indication for performing a biopsy.
Biopsy is performed as soon as possible using local anesthesia and minimally invasive surgery. Later, the sample will be sent to the laboratory to check the risk of infection, cancer and inflammation of the urinary tract or blood vessels. Types of skin biopsies include:
· Shave biopsy: In shaving biopsy, the doctor uses tools like a blade to shave the skin.
Punch biopsy: During a punch biopsy, the doctor uses a circular tool to make a small incision in the patient's skin.
· Incisional biopsy: During an incisional biopsy, the doctor uses a small scalpel to remove a small portion of the skin. During this examination, stitches may sometimes be required.
· Excisional biopsy: This is a type of biopsy in which the doctor removes a lump or an abnormal area of ​​skin. Sutures are likely to be required during this examination.

# Operative biopsy
Sometimes the patient has no follow-up on the biopsy procedure or the biopsy results are not completely negative. Also possible biopsy of the desired tissue is not possible; For example, a cut in the abdomen is located near the artery. In this case, the surgeon may use a surgical procedure or perform surgery with a laparoscope to obtain the sample.

-risk biopsy
Any medical procedure that causes injury to the skin or body tissue can carry the risk of infection or bleeding. Although very small incisions during biopsy, especially the needle, have greatly reduced the risk.

for biopsy
Special preparations may be required to perform the biopsy; For example, in general biopsy, a special diet should be recommended to the patient before the examination.
Before performing any medical intervention, the doctor should be informed about the drug; Because sometimes it is necessary to stop the use of aspirin or non-steroidal anti-inflammatory drugs before performing the biopsy.

after biopsy
After the tissue sample is taken, the doctor will examine it as needed. In most cases, it is necessary to send the sample to the laboratory.
If the biopsy results show evidence of cancer, the doctor should be able to determine the type of cancer and its spread to other areas. If the biopsy is performed for non-cancerous reasons, the pathology report should be able to guide the doctor in the diagnosis and treatment of the disease. If the results of the biopsy are negative, but the doctor still has doubts about the tissue being cancerous, a repeat biopsy or the use of other types may be necessary.

28/12/2021

TYPES OF BLOOD CELLS


A large phagocytic white blood cell with a simple oval nucleus and clear, grayish cytoplasm; they have the ability to digest large foreign particles in a wound and dead cells in the body
A large phagocytic white blood cell with a simple oval nucleus and clear, grayish cytoplasm; they have the ability to digest large foreign particles in a wound and dead cells in the monocytes
A large phagocytic white blood cell with a simple oval nucleus and clear, grayish cytoplasm; they have the ability to digest large foreign particles in a wound and dead cells in the body


A type of white blood cell (leukocyte) with coarse, bluish-black granules of uniform size within the cytoplasm; they have the ability to secrete anticoagulants and antibodies that have function against hypersensitivity reactions in the bloodstream


A type of white blood cell, a granulocyte that is filled with microscopic granules, little sacs containing enzymes that digest microorganisms; Neutrophils function by attaching to the walls of the blood vessels, blocking the passageway of germs that try to gain access to the blood through a cut or infectious area


A normal type of white blood cell that has coarse granules within its cytoplasm; Eosinophils work by releasing toxins from their granules to kill pathogens


A small colorless disk-shaped cell fragment without a nucleus, found in large numbers in blood and involved in clotting; the main function is to prevent bleeding


A red blood cell that (in humans) is typically a biconcave disc without a nucleus; they function in the transportation of oxygen and carbon dioxide.


A form of small leukocyte (white blood cell) with a single round nucleus, occurring especially in the lymphatic system; lymphocytes make antibodies, which is one of the final steps in disease resistance

12/01/2021

Blood collection

05/01/2021

WIDAL TEST:
INTRODUCTION:
- Widal test is an agglutination test which detects the presence of antibodies in patient’s serum produced against the causative agents of enteric fever (Salmonella Typhi and Salmonella Paratyphi A, B and C).
- It is one of the common methods employed for serological diagnosis of typhoid and paratyphoid fever especially in the endemic regions.

PRINCIPLE:
- Individual infected with Salmonella Typhi or S. paratyphi produce antibodies against either somatic (O) antigens and/or flagellar antigens (H). These produced antibodies in serum, if exposed to bacterial suspension carrying homologous antigens, result in agglutination. The agglutination reaction can be seen as visible clumping.

- In the test, the patient’s serum is mixed with killed bacterial suspension of Salmonella carrying specific O, H, AH and BH antigens and observed for agglutination reaction. If the patient’s serum contains specific antibodies against the antigens, clumping is evident which indicates positive test. Absence of agglutination indicates a negative result.

REQUIRMENTS:
- Fresh serum,
- kit containing Salmonella antigen (O, H, AH and BH antigens),
- positive control,
- Widal test card or slide,
- Applicator stick.

PROCEDURE:
- Widal test can be done in two ways-

1. Rapid slide test: It may be qualitative or quantitative and performed on slide.
2. Tube test: It is performed in tubes, is quantitative and requires incubation. It is considered more reliable than slide test.

1. SLIDE TEST:
1. Place one drop of positive control on one reaction circles of the slide.
2. Pipette one drop of Isotonic saline on the next reaction cirlcle. (Negative Control).
3. Pipette one drop of the patient serum to be tested onto the remaining four reaction circles.
4. Add one drop of Widal TEST antigen suspension ‘H’ to the first two reaction circles. (PC & NC).
5. dd one drop each of ‘O’, ‘H’, ‘AH’ and ‘BH’ antigens to the remaining four reaction circles.
6. Mix contents of each circle uniformly over the entire circle with separate mixing sticks.
7. Rock the slide, gently back and forth and observe for agglutination macroscopically within one minute.

2. TUBE METHOD:
1. Take 4 sets of 8 Kahn tubes/test tubes and label them 1 to 8 for O, H, AH and BH antibody detection.
2. Pipette into the tube No.1 of all sets 1.9 ml of isotonic saline.
3. To each of the remaining tubes (2 to 8) add 1.0 ml of isotonic saline.
4. To the tube No.1 tube in each row add 0.1 ml of the serum sample to be tested and mix well.
5. Transfer 1.0 ml of the diluted serum from tube no.1 to tube no.2 and mix well.
6. Transfer 1.0 ml of the diluted sample from tube no.2 to tube no.3 and mix well. Continue this serial dilution till tube no.7 in each set.
7. Discard 1.0 ml of the diluted serum from tube No.7 of each set.
8. Tube No.8 in all the sets, serves as a saline control. Now the dilution of the serum sample achieved in each set is as follows: Tube No. : 1 2 3 4 5 6 7 8 (control) Dilutions 1:20 1:40 1:80 1:160 1:320 1:640 1:1280.
9. To all the tubes (1 to 8) of each set add one drop of the respective WIDALTEST antigen suspension (O, H, AH and BH) from the reagent vials and mix well.
10. Cover the tubes and incubate at 37° C overnight (approximately 18 hours).
11. Dislodge the sedimented button gently and observe for agglutination.

RESULT:
1. POSITIVE:
Agglutination within a minute

2. NEGATIVE:
No agglutination indicative of absence of clinically significant levels of the corresponding antibody in the patient serum.

ADVANTAGES:
- It is a rapid test for screening enteric fever in endemic areas.
- When culture facilities are not available, Widal test is handy.
- It can detect infection caused by both Salmonella Typhi and Salmonella Paratyphi.

05/01/2021

02/01/2021

Simplified WBCs differential Roles in physiology and pathologic states.