short note

Question
Write notes on the following:

(a) Leukemoid Reaction

(b) Solubility Test

(c) Hb Electrophoresis

(d) Cryoprecipitate

(e) Chemotherapy

(f) Bone Marrow Aspiration

Answer
a. Leukemoid Reaction
• Definition: A leukemoid reaction is a marked increase in the white blood cell
(WBC) count, often exceeding 50 × 109 /L, resembling leukemia but caused by an
exaggerated response to infection or stress.

• Causes:

– Severe infections (e.g., tuberculosis, sepsis).

• Laboratory Features:

– Elevated WBC count with a left shift (increased immature neutrophils like
bands).
– Toxic granulations in neutrophils.
– Normal cytogenetics (absence of Philadelphia chromosome distinguishes it
from CML).

• Clinical Importance: It is crucial to differentiate leukemoid reactions from leukemia

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b. Solubility Test
• Purpose: A screening test for the detection of sickle hemoglobin (HbS).

• Principle: When HbS is deoxygenated, it forms insoluble polymers, causing tur-

• Procedure:

– Mix blood with a reducing agent (e.g., sodium dithionite).

• Advantages:

– Quick and inexpensive.

• Limitations:

– Cannot distinguish between sickle cell trait (HbAS) and sickle cell disease
(HbSS).
– False negatives can occur in severe anaemia.

c. Hb Electrophoresis
• Purpose: A diagnostic test to identify and quantify various haemoglobin types
based on their charge and mobility in an electric field.

• Procedure:

– Hemolysate is placed on a gel medium (e.g., cellulose acetate or agar).

• Applications:

– Diagnosis of haemoglobinopathies (e.g., sickle cell disease, thalassaemia).

• Advantages:

– Accurate and reliable for detecting and quantifying haemoglobin variants.

• Limitations:

– Requires specialised equipment and technical expertise.

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d. Cryoprecipitate
• Definition: Cryoprecipitate is a blood product derived from thawing fresh frozen
plasma (FFP) and collecting the precipitate.
• Components:
– Factor VIII.
– Fibrinogen.
– von Willebrand factor (vWF).
– Factor XIII.
• Uses:
– Treatment of hypofibrinogenaemia.
– Management of haemophilia A and von Willebrand disease (when factor con-
centrates are unavailable).
– Adjunct in massive transfusion protocols.
• Advantages:
– Easy to prepare and store.
• Limitations:
– Risk of infection transmission (if not screened properly).
– Volume-related complications in some patients.

e. Chemotherapy
• Definition: Chemotherapy refers to the use of cytotoxic drugs to treat cancer by
targeting rapidly dividing cells.
• Mechanisms of Action:
– Inhibition of DNA replication (e.g., alkylating agents like cyclophosphamide).
– Disruption of mitosis (e.g., microtubule inhibitors like vincristine).
• Applications:
– Treatment of haematological malignancies (e.g., leukaemias, lymphomas).
– Solid tumours (e.g., breast cancer, lung cancer).
• Side Effects:
– Bone marrow suppression (anaemia, neutropenia, thrombocytopenia).
– Nausea and vomiting.
– Alopecia.
• Limitations:
– Resistance to chemotherapy.
– Severe systemic toxicities.

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Bone marrow Aspiration
Bone marrow aspiration is a medical procedure used to extract a small amount of bone
marrow, the spongy tissue inside bones where blood cells are produced. It is commonly
performed to diagnose or monitor haematological and systemic disorders.

Indications
Bone marrow aspiration is indicated for:
• Diagnosis of anaemia, leukaemia, lymphoma, multiple myeloma, and myelodysplas-
tic syndromes.
• Evaluation of unexplained cytopenias (low blood cell counts).
• Investigation of metastatic cancers.
• Assessment of iron stores and sideroblastic anaemia.
• Monitoring treatment response in haematological disorders.
• Diagnosis of infections such as tuberculosis or fungal diseases affecting the bone
marrow.

Procedure
Preparation:
• Informed consent is obtained.
• The patient is positioned, usually lying on their side or stomach, exposing the
posterior iliac crest.
• Local anaesthesia is administered at the site of aspiration.
Steps:
1. A sterile trocar or needle is inserted into the bone, typically the posterior iliac crest
or sternum in adults.
2. A syringe is attached to the needle to aspirate the liquid marrow.
3. The sample is transferred onto glass slides for microscopic evaluation.

Complications
While generally safe, bone marrow aspiration may be associated with:
• Mild pain or discomfort at the site of aspiration.
• Bleeding or hematoma formation.
• Rare infections at the puncture site.
• Risks of complications increase in patients with bleeding disorders.

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Uses in Haematology
Bone marrow aspiration is a critical diagnostic tool for haematological disorders, includ-
ing:

• Leukaemia: Assessment of blasts and identification of subtypes.

• Anaemias: Evaluation of cellularity and iron stores.

• Lymphoma: Detection of bone marrow involvement.

• Multiple Myeloma: Analysis of plasma cell proliferation.

References
Hoffbrand, A. V., & Moss, P. A. H. (2016). Hoffbrand’s Essential Haematology (7th ed.).
Wiley-Blackwell.