Context:: Head and neck squamous cell carcinomas (HNSCCs) are the sixth most frequent malignancy in the world. Epidermal growth factor receptors (EGFRs) are members of Erb B family of receptors. EGFR is known to act as a driver of tumorigenesis in various carcinomas. Over expression of EGFR in HNSCC is associated with poor prognosis and resistance to radiotherapy. It is a useful prognostic marker, marker for response to therapy, and also a therapeutic target. Aim:To study the association of the known prognostic variables with EGFR expression in HNSCCs and to correlate it with the clinical outcome. Settings and Design:Cross-sectional observational study. Materials and Methods:A total of 170 patients of HNSCC were evaluated for EGFR expression and followed up for at least two years, with correlation of EGFR expression with various histopathological factors and their clinical outcome. Statistical Analysis Used:: Chi-square test. Results:The expression of EGFR in HNSCC in this study population was 88.82%. Statistical significance was noted between EGFR reactivity and age of the patient, its histological grade and perineural invasion. Statistical significance was also noted between EGFR reactivity and recurrence of malignancy as well as the site of recurrence. Conclusion:EGFR expression in patients with HNSCC is a poor prognostic biomarker and has a comparatively lower survival outcome as compared to non-EGFR expressing HNSCC cases. Hence, it will be helpful for all those patients diagnosed with HNSCC to ideally undergo an additional EGFR immunohistochemical evaluation, which, in turn, will help the oncologists in management of the tumor with anti-EGFR therapy combined with radiotherapy, to obtain a better response and a survival outcome.

Daratumumab (DARA) is an anti-CD38 monoclonal antibody which has promising results in relapsed and refractory multiple myeloma (RRMM). DARA interferes with blood compatibility testing by causing incompatible results while crossmatching by antihuman globulin phase and presenting as a panagglutination picture in the indirect antiglobulin test. Immunohematology workup must be done to rule out allo- or autoantibody and to issue compatible unit to the patient as transfusion support is vital for all these patients and must not be delayed. Here, we present a case report of one such patient who was undergoing treatment with DARA for RRMM and had incompatibility found during crossmatching. Out of the available methods to resolve this problem, we utilized the treatment of red cells with 2-mercaptoethanol at our blood center which was effective, time saving, feasible, and less resource demanding. During the progressive course of disease, our patient required transfusion on a regular basis, and we were able to provide compatible units on each instance utilizing the same technique.

Background:Alloimmunization to red cell antigens during antenatal period is a serious complication. Antibody titration of maternal blood sample corroborates with severity of disease and helps in planning further management. Conventional Tube Testing (CTT) method is widely accepted for antibody titration in antenatal cases but it can be replaced by Gel Microcolumn Agglutination (GMA) as it offers many advantages. Critical titer levels have been recommended by CTT method, but corresponding levels by GMA are yet to be established due to lack of adequate data. Methods:Total of 1020 Rh negative antenatal females were evaluated over a period of four years and those found to be positive on antibody screening were further investigated. Antibody titration by CTT and GMA was carried out and the titers were correlated with the outcome of pregnancy. Results:Out of the 1020 cases screened for antibodies, 112 (10.98%) were detected to be positive by GMA while 40 (3.92%) cases were detected by CTT. Titration was performed by both methods and results were statistically correlated. A moderate correlation was observed where one or more than one antibodies were involved (Pearson's Coefficient 0.756), while a strong correlation (0.893) was observed between the two methods when single antibody (Anti-D) was involved. Titer values obtained by GMA were also higher than CTT. Conclusion:Gel microcolumn agglutination (GMA) was found to be more sensitive and precise method for titration. A titer of 512 by GMA (IgG only) mostly corresponded to the values of 16 by CTT and had good correlation with clinical outcome.

INTRODUCTION:Approximately 55.52% of the Indian population had been fully vaccinated by Jan. 2022, since its first roll out on January 16, 2021. A few concerns were raised concerning the Covishield vaccination related to thrombotic thrombocytopenia. Apheresis-derived platelet concentrates are frequently required in a plethora of clinical situations and post-vaccination decrement of platelet counts might lead to increased deferral of the platelet-pheresis donors.OBJECTIVES:The aim of the study was to discover the effect of the Covishield vaccination on deferral rates of plateletpheresis donors.METHODS:Blood samples were collected from the potential platelet donors for the completion of the standard questionnaire for the complete blood count. The data collected were tabulated in the MS Excel spreadsheet and the biostatistical analysis was performed with the SPSS v23. A p-value of < 0.05 was taken as significant. We compared this data with age- and sex-matched controls.RESULTS:The mean age of cases and controls was 29.69 ± 8.57 and 30.15 ± 7.11, respectively. There was a significant difference in platelet counts of cases (188496.35 ± 72065.66/cumm) and controls (269524.50 ± 53981.60/cumm). Furthermore, donors who received one dose had higher platelet counts of 248676.47 ± 80075.24/cumm than those who received both doses of vaccine (179970.83 ± 66773.73/cumm) . The difference in deferral rates between the two groups was remarkable (34.7% vs. 0.9%, with the p-value < 0.001).CONCLUSION:Vaccination certainly increased the deferral rates of plateletpheresis donors due to low platelet counts. Average platelet counts were low in fully vaccinated individuals, however, the platelets returned to normal counts as the post-vaccination days progressed.

INTRODUCTION:Hepcidin is the key regulator of systemic iron homeostasis. In iron-loading anemias, hepcidin levels are regulated by opposite forces of erythropoiesis and iron overload. In β-thalassemia major patients, transfusions are the predominant cause of iron overload; in such chronically transfused patients, hepcidin concentrations are significantly higher than nontransfused patients, due to both increased iron load of transfusions and the suppression of ineffective erythropoiesis. AIM:This study aims to evaluate the effect of blood transfusions on serum hepcidin levels in chronically transfused patients of β-thalassemia major and correlate with hemoglobin and serum ferritin levels of pre- and posttransfusion. MATERIALS AND METHODS:Thirty-three β-thalassemia major patients requiring monthly transfusions were included in the study. Blood samples, collected pretransfusion and 7 days posttransfusion, were evaluated for hemoglobin, serum ferritin, and serum hepcidin using enzyme immunoassay. STATISTICAL ANALYSIS:Data were statistically analyzed through SPSS software and P < 0.05 is considered statically significant. RESULTS:Posttransfusion levels of hemoglobin, serum ferritin, and serum hepcidin increased. Posttransfusion levels of hepcidin were near normal levels. Pre- and posttransfusion hepcidin concentrations were significantly associated with hemoglobin levels. CONCLUSION:Serum hepcidin concentrations vary depending on the degree of erythropoiesis drive and level of anemia. We found that the serum hepcidin levels decrease over the inter-transfusion interval and transfusions cause suppression of ineffective erythropoiesis by the increase in hemoglobin. Posttransfusion values of hepcidin in our study were closer to normal levels which may be due to lower erythropoietic drive posttransfusion. We suggest that the measurement of serum hepcidin in chronically transfused β-thalassemia patients can be used as a follow-up investigation for better management of these patients.

BACKGROUND: Pregnancy is a hypercoagulable state increasing the risk of thrombosis and maternal mortality. Free protein S (FPS) levels are significantly reduced during pregnancy as compared to nonpregnant women. This study aims to ascertain the mean FPS levels for Indian pregnant women and study various factors like age, parity, trimester, hemoglobin (Hb) in relation to FPS. MATERIALS AND METHODS: 521 pregnant and equal number of nonpregnant women were included in the study. Blood samples were collected and evaluated for FPS and Hb levels. P < 0.05 was considered statically significant. RESULTS: Mean FPS levels in pregnant women were significantly lower than nonpregnant women and showed a statistically significant fall in all the three trimesters. Mean Hb levels were also lower in pregnant females however correlation between FPS levels and Hb, age, and parity were not found to be significant. CONCLUSION: This study found that the mean FPS levels in healthy pregnant females decrease with increasing gestational age. The mean FPS levels will be useful in the Indian scenario as our study found FPS levels to be much lower than other studies.

PURPOSE: Assessment of residual white blood cell (rWBC) count is vital to ascertain the quality of leukodepleted (LD) blood components. Automated cell analyzers lack the sensitivity for the assessment of very few leukocytes as found in LD blood components. Flow Cytometry (FC) based methods and Nageotte hemocytometer are the most commonly used techniques for this purpose. The objective of this study was to compare the use of Nageotte hemocytometer and FC for quality control of LD red blood cell units. MATERIALS AND METHODS: A prospective, observational study was conducted in the Department of Immunohematology and Blood Transfusion of a tertiary care center from September 2018 to September 2020. About 303 LD-packed red blood cell units were tested by FC and Nageotte hemocytometer for rWBCs. RESULTS: The number of rWBC (mean) detected by flow cytometer and Nageotte's hemocytometer was 1.06 ± 0.43 white blood cell (WBC)/μL and 0.67 ± 0.39 WBC/μL, respectively. Coefficient of variation was 58.37% by Nageotte hemocytometer method and 40.46% by FC. Linear regression analysis did not show any correlation (R2 = 0.098, P = 0.001) whereas Pearson's correlation coefficient showed a weak relation (r = 0.31) between the two methods. CONCLUSION: Flow cytometric technique provides a more precise and accurate objective tool compared to Nageotte hemocytometer which is labor intensive, time consuming, and prone to errors arising out of subjectivity along with reported underestimation bias. In the absence of adequate infrastructure, resources, and trained workforce, Nageotte hemocytometer method is a reliable alternative. Nageotte's chamber could be best used in the resource-constrained setup as it offers a relatively inexpensive, simple, and viable means to enumerate rWBCs.

CONTEXT: Hemoglobinopathies are the most common heterogeneous group of monogenetic disorder in the world and its prevalence varies with geographical regions. India is developing country and many studies show a significant burden of hemoglobinopathies in India. AIMS: The aim of the present study was to check the prevalence of various hemoglobinopathies in anemic subjects using high-performance liquid chromatography (HPLC) method in Pune region which has multiple ethnic population groups from all parts of India. SETTINGS AND DESIGN: The present study was conducted at the department of IH and BT on anemic patients referred from different outpatient department and Wards of the hospital and informed consent were taken from all participants. SUBJECTS AND METHODS: The present study included a total of 2698 individuals’ age ranging from 1.5 to 67 years. The HPLC test was performed using Bio-Rad D-10 analyzer once a week. RESULTS: Out of a total of 2698 cases, we found 543 (20.12%) cases with abnormal hemoglobin fractions and 2155 (79.88%) cases free from hemoglobinopathies. Out of the total hemoglobinopathies detected 250 (46%) were male and 293 (54%) were female. The major abnormality detected was beta-thalassemia trait (BTT) with 425 (15.75%) cases, followed by sickle cell disorders 58 (2.15%), HbE 38 (1.41%), hereditary persistence of fetal hemoglobin 6 (0.22%), HbD Punjab 13 (0.48%), HbD Iran 2 cases and 4 cases of compound heterozygous for HbS beta-thalassemia. Forty (1.48%) cases were detected as borderline with HbA2 level ranges from 3.6% to 3.9%. CONCLUSIONS: In our study, we found a high prevalence of hemoglobinopathies among anemic subjects. The most common disorder detected was BTT. Most of the hemoglobinopathies found in our study could be accurately quantified by HPLC which is a rapid, sensitive, and reproducible method for the detection of different hemoglobinopathies.

BACKGROUND:Most of the red blood cell (RBC) storage lesions can be attributed to oxidative stress encountered by the RBCs throughout the duration of their storage. Various donor variables at the time of donation may be responsible for the total antioxidant capacity of the supernatant and thus, the "storability" and the magnitude of development of these RBC storage lesions. It is known that uric acid (UA) is responsible for more than 60% of the TAC of the blood. This study aims to explore the relationship between donor UA levels and the difference in percentage hemolysis, an important RBC storage lesion, on day 1 and day 21, in stored packed RBCs (PRBCs) units. MATERIALS AND METHODS:The serum UA of 100 healthy voluntary male blood donors was estimated at the time of blood donation. The percentage hemolysis in the supernatant of the leukoreduced citrate phosphate dextrose/saline-adenine-glucose-mannitol RBC units (n = 100) prepared from these donors was calculated on day 1 and day 21. The difference in percentage hemolysis between donors with high normal serum UA levels (>7 mg/dL) was compared to that of the donors with low normal serum UA levels (<5 mg/dL) to observe the effect of donor UA levels on the difference in percentage hemolysis. RESULTS:The mean of the differences in percentage hemolysis in the supernatant in low UA group (<5 mg/dL) was higher than the mean of the differences in percentage hemolysis in the supernatant in high UA group (>7 mg/dL) and this was statistically significant (P < 0.001). The donor serum UA level and difference in percentage hemolysis on day 21 and day 1 were found to be negatively co-related. CONCLUSION:Higher levels of serum UA of blood donors seem to have a protective effect on the stored PRBC units as shown in this study. Hence, the potential of UA as one of the constituents of RBC additive solutions might lead to the enhancement of the quality of stored PRBC units by decreasing the RBC storage lesions.

BACKGROUND:Hematopoietic stem cell transplantation (HSCT) has emerged as a curative measure for life-threatening hematological disorders. It can be autologous or allogeneic depending on the disease characteristics. Providing transfusion support to the transplant patients can be challenging, especially in AB-mismatched allogeneic HSCT. In this study, we investigated the impact of ABO incompatibility in patients undergoing allogeneic HSCT. MATERIALS AND METHODS:A retrospective review was conducted in 76 patients with hematological diseases who underwent allogeneic HSCT. Transfusion requirements, engraftment profile, incidence of graft versus host disease (GvHD), and mortality for a period of 1 year were analyzed. RESULTS:ABO incompatibility between donor and the patient did not significantly affect the neutrophil and platelet (PLT) engraftment time (P = 0.389, 0.349, respectively), packed red blood cells transfusion requirement, and duration of initial hospital stay. However, patients of ABO-incompatible HSCT received more PLT transfusions posttransplant which was statistically significant. 29.1% of ABO compatible and 16.7% incompatible HSCT patients developed GVHD. Mortality rates in the two groups were 16.7% and 8.3%, respectively. However, differences in both the parameters were not statistically significant. CONCLUSION:Our study showed that ABO incompatibility does not significantly affect the outcome and should not be a limiting factor for selection of donor. Donor availability and human leukocyte antigen (HLA) matching remain the critical selection criteria.

Introduction Synovium has been documented as a primary site of inflammation and a major effector organ in a variety of joint diseases. Study of simple technique like synovial biopsy can help in early diagnosis and treatment of diseases significantly improving outcome of patient in cases of rheumatoid arthritis, osteoarthritis, etc., Only limited data exist on utility of synovial biopsies. Aim and Objectives To analyze the pattern of synovial lesions to differentiate between different kinds of arthritis. Also, to identify early stages of arthritis so as to prevent unnecessary invasive surgical procedure. Materials and Methods It's a retrospective study to analyze 103 cases of synovial lesions diagnosed in last five years at a tertiary care orthopedic center. All synovial biopsies obtained mainly by open method and few by arthroscopic method, that came to the Dept of Pathology were included. Lesions were classified into four categories that is, inflammatory joint diseases, degenerative joint diseases, tumor-like conditions and tumors. Results Age group most affected was between 61 and 70 years, with male predominance. Osteoarthritis (OA) was the most common histopathological diagnosis. Early OA tissues showed greater lining layer thickness, vessel proliferation, and inflammation, while surface fibrin deposition along with fibrosis was noted in later stages. Conclusion The histo-morphological observations made in this study may have important therapeutic implications for some patients during the early evolution of arthritis and could prevent unnecessary operative intervention of later stages.

MHC class I related chain A (MICA) antibodies, especially those directed against the donor in absence of donor-specific anti-HLA antibodies have been reported to be possibly associated with renal allograft rejection in sensitized recipients. We are the first ones to present a case series of five patients who underwent primary live related donor renal transplantation in non-sensitized recipients either in the presence of donor-specific MICA antibodies (MICA-DSA) or developed de novo. Four of them presented characteristics of either accelerated, acute or chronic antibody-mediated rejection (AMR) attributable to the presence of MICA DSA. This case series emphasizes that AMR due to MICA-DSA is amenable to treatment with conventional regimens for treatment of AMR and there is a need for screening of MICA antibodies especially those directed against the donor on case to case basis.

Anti-tubercular therapy (ATT) drugs are the mainstay of management of tuberculosis worldwide. These medicines are used extensively across the globe in treating tubercular infections of any organ. The life-threatening complications of pseudomembranous enterocolitis (PMC) associated with ATT, especially with capsule Rifampicin is not known to most practitioners. An early suspicion during the onset of loose stools in a patient on ATT is essential for managing this life-threatening condition. This fatal case report is to create awareness among the healthcare professionals and sensitize the clinicians, about the possibility of PMC in patients on ATT. We discuss our case and the lessons learnt in this case report.

Not all anti‐HLA donor‐specific antibodies (HLA‐DSAs) are detrimental to renal allograft. In this context, the C1q complement activating ability of antibodies appears to be an important parameter to distinguish clinically inert versus detrimental DSAs. We evaluated sera of 206 consecutive primary live donor renal transplant recipients before transplant and at post‐operative day 7, 30, 90, 180 and at the time of graft dysfunction for quantifying HLA‐DSAs using single antigen bead assay on a Luminex platform. Patients positive for these antibodies with an MFI >500 were further screened for C1q fixing nature of DSA. Fourteen of the 18 antibody‐positive patients had C1q fixing DSA with MFI value >5000. Only 4 antibody‐positive patients did not have C1q fixing DSA. The MFI values of DSA detected by C1q assay were generally higher at least by 25% than those detected by the conventional IgG‐SAB assay. Twelve of the 14 patients (85.71%) with C1q+ DSA developed antibody‐mediated rejection during the mean follow‐up period of 21.43 ± 8.03 months as compared to none of the four C1q‐negative DSA (85.71% vs 0%; P = .001). These results suggest deleterious effect of C1q+ DSA vis‐à‐vis C1q‐negative DSA on renal allograft.

Overview Mesenchymal tumors of the breast are rare. Few epithelial tumors also have mesenchymal components. It is crucial to identify these as per histogenesis. This can be facilitated by markers of epithelial-mesenchymal transition (EMT). Objectives The aim of this study was to categorize the breast lesions with mesenchymal morphology and to study EMT on immunohistochemistry (IHC). Materials and Methods This is a retrospective study of 5-year duration from January 2015 to December 2019. Inclusion criteria: all breast lesions showing mesenchymal/nonepithelial morphology, complete or partial, on histology. Exclusion criteria: Mammary carcinomas without any mesenchymal/nonepithelial morphology, fibroadenomas, and lymphomas. Demographics, clinical, gross examination, histology, and IHC findings of selected cases were reviewed and recorded. Three additional markers p53, E-cadherin, and β-catenin were performed. Statistical Analysis Used Frequency calculation for each variable (IHC). Results Thirteen (2.5%) out of total 510 breast specimens showed mesenchymal histology. Of these, five (38.5%) were metaplastic breast carcinomas (MBC), four (31%) were phyllodes tumor (PT), and one (7.7%) case each of malignant peripheral nerve sheath tumor, primary stromal sarcoma of breast, pseudoangiomatous stromal hyperplasia, and myofibroblastoma. Loss of E-cadherin was seen in 4/5 (80%) MBCs and was retained in ductal component of PTs. p53 was not expressed in any of the tumors except 3/5 (60%) MBCs. β-Catenin was aberrant in all MBCs. Conclusions Primary breast tumors with mesenchymal morphology present a spectrum ranging from benign mesenchymal, fibroepithelial neoplasms to malignant tumors of mesenchymal and epithelial origin. Loss of E-cadherin, expression of p53, and aberrant expression of β-catenin are suggestive of EMT and molecular heterogeneity of MBCs.

Background: Bone marrow is the site of origin for primary haematological malignancies and is the third common preferred site metastasized by the solid tumors. The malignant infiltration of the hematopoietic tissue alters the clinical course of disease, response of the treatment and influences the overall survival. The aim of this study was to assess pattern of bone marrow involvement by different solid tumors and their correlation with hematological parameters. Methods: In this retrospective study, 8064 bone marrow examinations from Jan 2011-Aug 2017 at tertiary health and research centre of Northern India were evaluated to access spectrum of different solid tumors infiltrating the bone marrow alongwith their clinical, hematological and histopathological findings. Result: Total 38 cases of non-hematological malignancies metastasizing to bone marrow were evaluated with main indications of lytic lesions, cytopenia and Pyrexia of Unknown Origin. The most common metastasis were adenocarcinoma of prostate and lung. In 33 cases, the clinical, cytomorphological and immunohistochemical analysis findings were correlated to know primary site, while in remaining five patients, even after complete diagnostic evaluation, the definitive origin could not be ascertained, therefore categorized as Carcinoma of Unknown Primary Site (CUPS). Conclusion: Our series showed that anemia as commonest parameter, followed by leukopenia, thrombocytopenia. Many cases were misdiagnosed as multiple myeloma due to lytic lesion, anemia and hypercalcemia. We concluded that unexplained cytopenia are strong indicators of bone marrow examination; an easy, convenient, sensitive, effective procedure of staging of tumor, monitoring the course and prognosis of solid tumors.

Major histocompatibility complex (MHC) represents the most polymorphic gene dense region of the human genome, which reflects several inherent features. Based on its evolving biological relevance in health and disease, the human leukocyte antigen (HLA) system can be considered as a "mini genome model" and can also be termed as "self-surveillance complex." Recent research suggests that HLA allele–specific expression puts an additional layer of complexity and polymorphism beyond the genomic diversity. Although attempts are being made to reveal mechanistic insights of HLA association with various infectious and autoimmune diseases, the novel mechanisms defining this allele-specific expression variability and its importance in the context of disease development and/or immune aberrations are largely unknown. In the post-genomic era impressive technological advancements have been made toward identifying novel alleles thus paving the way for developing robust diagnostic and therapeutic approaches, particularly in the field of transplantation medicine. HLA matching, antibody detection, and involvement of other hitherto unexplored factors are relevant in long-term acceptance of the organ and hematopoietic stem cell graft. Designing individualized immunosuppressive regimens based on immunological stratification (HLA and non-HLA factors) will be helpful for evading chronic allograft loss in long term.

Antibody‐mediated rejections (AMR) in the absence of circulating anti‐HLA‐DSA have highlighted the role of non‐HLA antibodies, particularly those directed against endothelial cells. Of these, MICA (major histocompatibility complex class I chain–related molecule A) antibodies are the most notable and important because of their potential in promoting graft rejections. Limited studies have focused on the impact of MICA donor‐specific antibodies (DSA) on graft outcome as compared to those that are not donor‐specific (NDSA). We evaluated pre‐ and post‐transplant sera at POD 7, 30, 90, 180 and the time of biopsy from 206 consecutive primary live donor renal transplant recipients for anti‐MICA and anti‐HLA antibodies using single antigen bead assay on a Luminex platform. Recipients who developed MICA antibodies and their donors were phenotyped for MICA alleles. For the purpose of antibody analysis, patients were categorized into three major groups: biopsy‐proven AMR, acute cellular rejection (ACR) and those with no rejection episodes (NRE). During the mean follow‐up period of 17.37 ± 6.88 months, 16 of the 206 recipients developed AMR, while ACR was observed in only 13 cases. A quarter (25%) of the AMR cases had anti‐MICA antibodies as compared to 7.7% of those experiencing ACR and 6.2% of the NRE group. Allelic typing revealed that all MICA Ab +ve AMR cases were due to the presence of donor‐specific antibodies. MICA‐DSA even in the absence of HLA‐DSA was significantly associated with AMR but not with ACR when compared with the NRE group (P = <.01).

Background: Bone marrow is the site of origin for primary haematological malignancies and is the third common preferred site metastasized by the solid tumors. The malignant infiltration of the hematopoietic tissue alters the clinical course of disease, response of the treatment and influences the overall survival. The aim of this study was to assess pattern of bone marrow involvement by different solid tumors and their correlation with hematological parameters. Methods: In this retrospective study, 8064 bone marrow examinations from Jan 2011-Aug 2017 at tertiary health and research centre of Northern India were evaluated to access spectrum of different solid tumors infiltrating the bone marrow alongwith their clinical, hematological and histopathological findings. Result: Total 38 cases of non-hematological malignancies metastasizing to bone marrow were evaluated with main indications of lytic lesions, cytopenia and Pyrexia of Unknown Origin. The most common metastasis were adenocarcinoma of prostate and lung. In 33 cases, the clinical, cytomorphological and immunohistochemical analysis findings were correlated to know primary site, while in remaining five patients, even after complete diagnostic evaluation, the definitive origin could not be ascertained, therefore categorized as Carcinoma of Unknown Primary Site (CUPS). Conclusion: Our series showed that anemia as commonest parameter, followed by leukopenia, thrombocytopenia. Many cases were misdiagnosed as multiple myeloma due to lytic lesion, anemia and hypercalcemia. We concluded that unexplained cytopenia are strong indicators of bone marrow examination; an easy, convenient, sensitive, effective procedure of staging of tumor, monitoring the course and prognosis of solid tumors.