Cytologic examination of hemorrhagic fluid by capillary centrifugation: a new technique

A comparative study of cytological processing techniques in hemorrhagic effusion

Objectives:

Fluids are one the most common specimens received in cytology laboratories. The presence of erythrocytes may obscure the cells in the smears, making the diagnosis, and identification of cells difficult. Many techniques are being used by laboratories to eliminate these erythrocytes. The present study was undertaken to improve the quality of cytology smears of hemorrhagic samples by comparing three different techniques, namely, Carnoy’s fixative (CF), modified CF, and normal saline rehydration technique (NSRT) to hemolysis red blood cells (RBC) present in the smear background for better cytological assessment. The present study was a prospective study done over 1 year 6 months from November 2012 to March 2014, in the Department of Pathology in a Tertiary Care Rural Medical College.

Materials and Methods:

All hemorrhagic effusions received in the department of pathology were processed using CF, modified CF, and NSRT. The background of the smear and cytomorphological details with two different stains was analyzed. The Chi-square test was used to find out the association of different techniques in the reduction of RBC.

Results:

More than 60% reduction of RBCs in the smear was noted in 85.40%, 14.60%, and 15.60% by NSRT, modified CF, and CF, respectively. Staining was better and nuclear features were best preserved in NSRT.

Conclusion:

NSRT is the best, simple, and cheaper technique to lyse RBC in the hemorrhagic fluid. It also shows better staining and well-preserved cytomorphological features of the cell.

Comparative study of processing of haemorrhagic body fluids by using different techniques

BACKGROUND

Haemorrhagic fluids are samples which are commonly received for cytological examination. The diagnostic efficacy suffers when large numbers of red blood cells are present in the sample. Haemorrhagic fluids are processed by a variety of techniques and the common goal of each technique is selection and concentration of an adequate number of tumour cells with intact cell morphologies, without losing them during processing.

AIM

Present study was undertaken to improve the quality of haemorrhagic fluid by using three different haemolysing agents, namely Carnoy's Fixative (CF), saline in Normal Saline Rehydration Technique (NSRT) and Glacial Acetic Acid (GAA) for haemolysis and to find out the most effective processing technique for better cytomorphological assessment.

MATERIAL AND METHODS

This study was carried out on 51 haemorrhagic fluids. Processing of haemorrhagic fluid was done by using haemolysing agents, namely CF, GAA and NSRT. After processing fluids with these three techniques, three smears were prepared from each of them, out of which one was air dried and two were wet fixed. Fourth type of smear made without application of haemolysing agent was used as control.The smears were stained with Leishman's stain and wet fixed smears were stained with Hematoxylin and Eosin (H and E) , and Papanicolou's stain (Pap) respectively.

RESULTS

NSRT showed lysis of red blood cells (RBCs) in 72.5% of cases, followed by that of CF in 60.8% cases and that of GAA in only 3.9% of cases. Retention of epithelial/mesothelial cells was seen in 70.5% cases with NSRT, followed by that of CF in 57.8% of cases and then by that of GAA in 50.9% of cases. Cytomorphological details were best preserved in CF in 60.6% of cases, followed by GAA in 58.8% of cases and NSRT in 52.9% of cases.

CONCLUSION

The most effective method for RBC lysis in smear background and cell retention is NSRT and cytomorphological details are best preserved with CF. But, considering the overall results and procedural simplicity, it was concluded that NSRT was a better technique for processing of haemorrhagic fluid.