This document outlines a dissertation protocol that aims to study reticulocyte indices in patients with pancytopenia. The study hopes to correlate reticulocyte percentage, immature reticulocyte fraction, and mean reticulocyte volume with the underlying causes of pancytopenia. A total of 100 patients meeting the inclusion criteria of pancytopenia will be enrolled along with 50 healthy controls. Reticulocyte indices will be measured using an automated cell counter. The results will be analyzed to develop a diagnostic algorithm to better classify different causes of pancytopenia.

1. DISSERTATION
PROTOCOL

2. RETICULOCYTE INDICES
IN PANCYTOPENIA
DR.MIDHAT AEJAZ
DISSERTATION FOR THE COURSE OF MD PATHOLOGY
GUIDE: DR. S R NIVEDITHA
PROFESSOR,DEPARTMENT OF PATHOLOGY
KEMPEGOWDA INSTITUTE OF MEDICAL SCIENCES,BANGALORE

3. INTRODUCTION
• Pancytopenia is a term used to define a decrease in all three blood cell
types –red blood cells , white blood cells and platelets.
• Identifying the underlying cause is challenging as there are wide range
of conditions involved which include infections, drugs, autoimmune
conditions , malignancies and inherited conditions.

4. • Reticulocytes are immature red blood cells which are formed in the
bone marrow and later go in the peripheral blood for 1-2 days and
eventually mature in the spleen to become biconcaved red cell.
• The reticulocyte indices by the automated cell counters will help in
assessing the bone marrow activity and avoiding invasive and
expensive procedures .

5. NEED FOR STUDY
• Pancytopenia is not a disease by itself but a condition which involves a
number of causes primarily or secondarily involving the bone marrow.
• Reticulocyte indices will help in determining the cause of
pancytopenia and differentiating nutritional anemia from other causes
of pancytopenia , thereby helping in initiating presumptive treatment.
• In this pursuit an algorithmic approach will be helpful in the early
diagnosis and management of pancytopenia in correlation with the
clinical presentation.

6. AIM AND OBJECTIVES
• To study the reticulocyte indices like Reticulocyte percentage, Immature
reticulocyte fraction , Mean reticulocyte volume in pancytopenia.
• To correlate the reticulocyte indices with the etiological factors of
pancytopenia.
• To deduce a diagnostic algorithm to categorize pancytopenia effectively.

7. SUBJECT OR MATERIAL
• STUDY DURATION- 18 months
• STUDY DESIGN- Cross sectional study
• SAMPLE SIZE-100
• HEALTHY CONTROLS-50
• SAMPLING METHOD-Purposive
• INCLUSION CRITERIA-
Samples with Hb<13.5g/dl in males and <11.5g/dl in females.
Total leucocyte count<4000/cumm.
Platelet count<1.5lakh/cumm.
• EXCLUSION CRITERIA-
Hemolyzed samples.
Detailed clinical history not available.
Patient who have received recent blood transfusion(<3 weeks).

8. METHODS AND PROCEDURES
• The study will be conducted in Central laboratory ,Department of
pathology,KIMS Hospital.
• 2ml of blood samples will be collected in a lavender cap vacutainer
containing 1.2mg/ml of EDTA after taking all aseptic precautions.
• The blood samples will be fed to SYSMEX XN-1000 auto analyzer and
the printed reports will be collected.
• Relevant clinical history , biochemical investigations will be
documented.

9. APPROACH TO ETHICAL ASPECTS
• Patient’s confidentiality will be maintained.
• No extra financial burden on the patient.

10. THANK YOU