Venkat Raghavan A.T.M

Abstract

Aims and Objectives: To identify the different preanalytical errors encountered in the central laboratory and to adopt the corrective measures to overcome them. To identify the cause of the preanalytical errors. To evaluate the impact of corrective measures and their role on patients safety Materials and Methods: The study comprised of 500 samples over a period of one year in Central Laboratory, Mahatma Gandhi Medical College and Research Institute, Pondicherry. The study included all the samples collected from the patients that are sent to the Central laboratory, Mahatma Gandhi Medical College and Research Institute, departments like Pathology, Biochemistry and Microbiology. The samples were received along with the patients request form which included the patients details like name, age, sex, treating clinician, place of admission or where from the sample was collected, nature of the sample, the name of the test, clinical diagnosis etc. Results: Amongst 500 samples received, preanalytical errors were detected in 263(52.6%) samples. Majority 83.6% were from inpatient wards, whereas 16.4% samples were from outpatient departments.58.1% of samples were from Hematology, 21.6% of samples were from Biochemistry and 20.1% of samples were from Microbiology. 54.3% of samples were blood samples, 42.9% of were serum samples and 2.6% of were urine samples. The most common pre-analytical error encountered was insufficient volume accounting to 27.7% and least encountered pre-analytical error was Lipemic sample accounting to 7.2%. Failure Mode and Effects Analysis(FMEA) was applied and insufficient volume, diluted sample, mismatch name, clotted sample and lipemic sample were graded as very high with scale of 8. Insufficient information alone was graded as high grade with scale 7. Conclusion: It is the need of the hour to adopt adequate, effective corrective strategies to curb the preanalytical errors in the laboratory, thereby ensuring safety and satisfaction to the patients and clinicians, which would pave the way for an efficient heath care system. Keywords: Central laboratory, Corrective strategies.

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Abstract

Background: Tuberculous lymphadenitis is the most common cause of lymphadenopathy in India. Despite, availability of many literature on Daignosis and management of Tuberculosis in various parts of India, practically diagnosis of Tuberculosis sometimes pose a challenge to the pathologists and clinicians. A holistic diagnostic approach of cytology with aid of special stain and histopathological evaluation resolves this diagnostic dilemma. Aim: The present study was carried out to evaluate the different cytological patterns of tuberculous lymphadenitis in our settings along with utility of special stain like Acid fast stain and further histopathological evaluation Material and Methods: Five hundred and three cases of superficial lymphadenopathy were subjected to Fine Needle Aspiration Cytology (FNAC), and smears were prepared and stained with Hematoxylin and eosin (H and E), Giemsa, Papanicalou and Acid Fast stain and were categorized into three cytomorphological patterns. If the swelling underwent excision biopsy, they were correlated with histopathological examination also. Result: Out of 503 cases of lymph node swelling aspirated, 200 cases (39.7%), showed features of Tuberculous lymphadenitis. Majority of cases (72.2%) were in their second to fourth decades of life, with male-to-female ratio of 1:2. Cervical region was the most common site of involvement. Smears revealed epithelioid granulomas with caseous necrosis in maximum cases (55%).AFB positivity was seen highest in smears revealing necrosis only with or without epithelioid cell granulomas (76.3%). Conclusion: FNAC has been proved very safe, highly sensitive, and first line investigation in diagnosing tubercular lymphadenitis. Hence, the approach to tubercular lymphadenitis attains completeness with cytopathological and histopathological evaluation. Keywords: Cytological patterns, Tubercular lymphadenitis, Acid fast smear.

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Abstract

Coronary heart disease (CHD) occurs due to atherosclerosis of the coronary arteries. Although, other causes of coronary heart disease should always be taken into account. In our case, the patient presented as symptoms of coronary heart disease as a result of Acute Leukemia. The pathophysiological mechanisms of acute leukaemia leading to Coronary Heart Disease are discussed. Keywords: Acute leukemia, Acute coronary syndrome, Blasts.

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