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4. Iron Profile Includes: Serum iron Serum ferritin TIBC Transferrin saturation Useful in diagnosing iron deficiency anaemia and anaemia of chronic disease. 5. Vitamin Tests Serum vitamin B12 Serum folate Useful in megaloblastic anaemia. 6. Other Investigations Depending on the suspected cause: Stool examination for occult blood/parasites Bilirubin LDH Haptoglobin Direct antiglobulin test Hb electrophoresis Bone marrow examination Conclusion: Laboratory investigations help identify the type, severity and cause of anaemia. --- (b) Blood Transfusion — Indications, Procedure and Adverse Effects Indications Blood transfusion may be required in: 1. Severe or symptomatic anaemia. 2. Acute blood loss. 3. Major surgery with significant blood loss. 4. Trauma and haemorrhage. 5. Severe bleeding disorders. 6. Replacement of specific blood components when clinically indicated. Procedure 1. Confirm the doctor's order and indication. 2. Obtain informed consent where required. 3. Identify the patient correctly. 4. Determine ABO and Rh blood group. 5. Perform compatibility testing/cross-matching. 6. Check the blood bag, expiry date and component. 7. Record baseline vital signs. 8. Start transfusion using a proper blood administration set. 9. Observe the patient closely, especially during the initial period. 10. Monitor pulse, BP, temperature and symptoms. 11. Stop transfusion immediately if a serious reaction is suspected and follow the transfusion-reaction protocol. Adverse Effects Acute reactions: Fever and chills Allergic reactions Acute hemolytic transfusion reaction Respiratory distress Circulatory overload Bacterial contamination/sepsis Delayed effects: Delayed hemolytic reaction Alloimmunization Iron overload after repeated transfusions Transfusion-transmitted infections --- (c) Examination of Cerebrospinal Fluid (CSF) CSF examination is useful in the diagnosis of diseases of the central nervous system. 1. Collection CSF is usually collected by lumbar puncture under appropriate clinical conditions. Commonly, samples are distributed into separate sterile tubes for: Biochemistry Microbiology Cell count/cytology 2. Physical Examination Observe: Colour Normal: Clear and colourless Turbid: May indicate increased cells/protein or infection Bloody: Trauma or subarachnoid haemorrhage may be considered Yellowish (xanthochromia): May occur with previous bleeding or increased bilirubin 3. Microscopic Examination Includes: Total cell count Differential cell count Normal CSF contains very few cells. Neutrophil predominance: Suggestive of bacterial infection. Lymphocyte predominance: Common in viral and some chronic infections. 4. Biochemical Examination Important tests include: Protein Glucose Chloride, where clinically indicated Lactate, where indicated In bacterial meningitis: Protein usually increases and glucose decreases. In viral meningitis: Glucose is often relatively preserved, with a lymphocytic response. 5. Microbiological Examination Gram stain Bacterial culture Other appropriate microbiological tests Antigen/PCR-based tests when indicated 6. Cytological Examination CSF may be examined for malignant cells when a CNS malignancy or leptomeningeal involvement is suspected. Conclusion: CSF examination includes physical, microscopic, biochemical, microbiological and cytological examination, and is important in diagnosing meningitis, haemorrhage and other CNS disorders.

नीचे दिए गए प्रश्नों के exam-oriented answers सरल भाषा में दिए गए हैं। 1. MCQ (d) Programmed cell death is: ✅ (ii) Apoptosis (e) Which of the following elicits inflammation? ✅ (i) Necrosis --- 2. Short Answer Questions (a) Different types of cellular adaptations with examples Cellular adaptation is the reversible change in cells in response to stress. 1. Hypertrophy – Increase in size of cells. Example: Enlargement of cardiac muscle in hypertension. 2. Hyperplasia – Increase in number of cells. Example: Proliferation of glandular cells during pregnancy. 3. Atrophy – Decrease in size and function of cells. Example: Muscle wasting after prolonged immobilization. 4. Metaplasia – One mature cell type changes into another mature cell type. Example: Squamous metaplasia in respiratory epithelium of smokers. --- (b) Difference between Transudate and Exudate Transudate Exudate Non-inflammatory fluid Inflammatory fluid Low protein content High protein content Few cells Many inflammatory cells Specific gravity usually < 1.012 Specific gravity usually > 1.020 Caused by increased hydrostatic pressure or decreased oncotic pressure Caused mainly by increased vascular permeability Example: Heart failure Example: Pneumonia --- (c) Short notes on Vacutainers and Anticoagulants Vacutainer: A vacutainer is a sterile evacuated blood collection tube used for collecting and transporting blood samples. Common tubes: EDTA (lavender/purple): CBC and hematology Sodium citrate (light blue): Coagulation tests such as PT and APTT Fluoride oxalate (grey): Blood glucose Heparin (green): Plasma chemistry Plain/serum tube (red): Serum biochemical tests Anticoagulants: Substances that prevent clotting of blood. Examples: EDTA Sodium citrate Heparin Oxalates --- (d) Importance of Partial Thromboplastin Time (PTT/APTT) APTT measures the intrinsic and common pathways of the coagulation system. Importance: 1. Monitoring unfractionated heparin therapy. 2. Detecting deficiencies of factors VIII, IX, XI and XII. 3. Detecting deficiencies of common pathway factors. 4. Screening for coagulation disorders. 5. Helps in diagnosis of hemophilia. 6. May be prolonged in DIC and severe liver disease. --- (e) Short note on Tissue Fixation in Histopathology Fixation is the process of preserving tissue immediately after removal to prevent decomposition and maintain its structure. Purpose: Prevents autolysis and putrefaction. Preserves cellular and tissue architecture. Hardens tissue. Prevents loss of cellular components. Helps in proper staining. Common fixative: 10% neutral buffered formalin is commonly used. General procedure: 1. Collect tissue immediately. 2. Cut into small pieces. 3. Place in adequate volume of fixative. 4. Allow proper fixation. 5. Process the tissue for dehydration, clearing and embedding. --- (f) Difference between Necrosis and Apoptosis Necrosis Apoptosis Usually pathological Usually programmed/regulated cell death Often affects groups of cells Usually affects individual cells Cell swelling occurs Cell shrinkage occurs Cell membrane ruptures Cell membrane remains largely intact Inflammation is usually present Usually no inflammation Nuclear changes: pyknosis, karyorrhexis, karyolysis Nuclear fragmentation occurs in apoptotic bodies Example: Cell death due to severe ischemia Example: Removal of unwanted cells during development --- 3. Long Answer Questions (a) Laboratory Investigations in Anaemia Anaemia is a condition in which the haemoglobin level is below the normal range for age and sex. 1. Complete Blood Count (CBC) Haemoglobin (Hb) RBC count Haematocrit/PCV MCV MCH MCHC RDW Total WBC and platelet count 2. Peripheral Blood Smear Examines: RBC size RBC shape Colour Abnormal cells WBC morphology Platelets It helps classify anaemia as: Microcytic Normocytic Macrocytic 3. Reticulocyte Count Shows bone marrow response to anaemia. Increased reticulocytes → increased RBC production. Low reticulocytes → inadequate marrow response.

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Vvi question in ALLBUG 2024-28 KE LIYE 1.TYPES OF VIALS & BLOOD COLLECTION 2.WBC 3. PLATELETS 4.HEMOGLOBIN 5.PCV(HCT) 6.ANEMIA 7.URINE EXAMINATION 8.SEMEN EXAMINATION 9.STOOL EXAMINATION 10. TISSUE PROCESSING

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