A few questions in my mind and I expect a few of my friends too

DNB
#1

A few questions in my mind and I expect a few of my friends too.

  1. How to calculate or measure nucleo-cytoplasmic ratio? We say increased in our reports sometimes. Is there a range or limit above which we say increased? What’s the normal NCR for say a lymphocyte or a benign ductal cell ?

  2. Types of chromatin in a nucleus? Open, closed , seive like :disappointed_relieved:, stippled ? Please guide.

  3. Nucleoli identification features vs intranuclear inclusion ? Basically how to identify a prominent nucleoli in a cell?

  4. Asked by my juniors mostly - How do you say this cell is a blast and that cell is not? I say immature cell, they say how do you say this? I say :thinking::thinking::grinning:.

  5. Types of background in a cytology smear.

Other questions will be added as I remember. Also please free to add your own questions.

Hope for some positive response friends

The spicules though rich in cells are too overcrowded to evaluate.:robot:

Sometimes due to degenerative effect, stripped nuclei can be seen while marrow examination which can be easily confused as foci of metastatic cells by a novice (:raised_hand: I did that recently).

Q1) Post streptococcal glomerulonephritis manifests commonly as Rapidly Progressive Glomerulonephritis.
True or False?:man_teacher:

Q2) Immune complex deposition is seen at following position in post streptococcal glomerulonephritis?
a) Sub endothelial
b) Membranous
c) Sub Epithelial
d) All

Answer💡 Q1) False
Q2) All

A1) Post streptococcal GN only rarely manifests as RPGN approx. 5%. Majority of the patients recover rapidly with conservative therapy.

A2) Though classical subepithlial hump are characteristically seen in post streptococcal GN. :face_with_monocle:They are only seen in later stages of the disease. Initially the immune complexes are sub endothelial then membranous and later they become sub epithelial.

The ORDER of draw💉"
Whoever coined the saying “What you don’t know , cant hurt you” :billed_cap:was surely not thinking about collecting blood specimens for clinical lab testing.

Apart from patient identification, patient care and patient handling there is one more important thing that phlebotomist or a pathologist must look into is the order of draw.

The image below👇 shows the exact order of draw of blood requiring variety of tests especially in an admitted patient.

The blood :bulb:culture tubes are the first to be used for obvious reasons that is to prevent contamination from the other vials which might be not that sterile.

The light blue :blue_heart:stopper used for anti-coagulation assays is used before all other as it has a desirable amount of anticoagulant for the purpose of allowing blood to coagulate on its own, while the other vials having a clot activator like yellow/red might result in rapid coagulation and an error in testing.

The lavender tube :purple_heart:contains EDTA which contains potassium, and many cases occurred when erroneous increase in K+ was seen in a hypokalemic patient as K+ is measured via serum red/gold vial.

Clenching✊🏻 of hand or increased duration of tourniquet bound also increases potassium levels

Similarly oxalate also increases K nd hence to be used only after serum vials have been used

The specific order has been given by CLSI (Clinical and Laboratory standards Institute):office: