RBC rouleaux formation in peripheral smear

Stacking of red blood cells, known as rouleaux formation, accelerates their sedimentation rate and can often be observed on a peripheral blood smear. However, this finding may occasionally be artificial, resulting from improper smear preparation or examination of the thick region of the slide.

When rouleaux formation is genuinely present, it usually reflects an elevated concentration of cathodal plasma proteins—notably fibrinogen and immunoglobulins. While conditions such as multiple myeloma and macroglobulinemia are classic associations, rouleaux may also be seen in more common disorders including acute and chronic infections, connective tissue diseases, chronic liver disease, and severe anemia, where alterations in plasma protein composition and red cell morphology promote this distinctive stacking pattern.

66 years old female patient with hemoglobin 2.9 gm showed rouleaux formation in peripheral smear. Rouleaux formation also interfered with blood grouping, which was cleared after saline washing the rbcs.

Ascaris Lumbricoids egg in stool

 This is fertilized ova of Ascaris lumbricoids. It has thick dark outer layer and inner colourless layer. Inside contains an embryo which appears brownish due to bile staining

EDTA induced clumping of platelets

 EDTA induced clumping of platelets leading to underestimation of platelets on automated cell counters (pseudo thrombocytopenia) is a common occurrence. The pathologist must check smear to rule out this. The peripheral smear shows large clumps of platelets particularly at the periphery of smear. 

Fig: EDTA induced clumps of platelets seen on peripheral smear. (Pseudo thrombocytopenia)

For such patients a repeat sample in heparin should be taken for estimation of platelets count.

Candida in urine

 Budding yeast of candida species are often seen in long standing acidic urine particularly in diabetic patients with glycosuria

Patient Instructions for Blood Sugar Testing

Varad Pathology Lab
Patient Instructions for Blood Sugar Testing

English Version

1. Fasting Blood Sugar (FBS)

• Do not eat or drink anything (except plain water) for 8 to 10 hours before the test.

• Do not chew gum or consume tea or coffee before sample collection.

• Take your regular medicines only if advised by your doctor.

• Sample is usually collected in the morning before breakfast.

2. Postprandial Blood Sugar (PPBS or 2-hour sugar)

• Eat your normal meal, do not skip or overeat.

• Note the exact time when you start eating.

• Come to the lab for blood collection exactly 2 hours after the first bite of food.

• Note: At Varad Pathology Lab, Postprandial Blood Sugar (PPBS) sample is collected 1 hour 30 minutes after finishing the meal (approximately 2 hours after starting the meal), in accordance with standard practice.

• Do not eat or drink anything (except water) in this period.

3. Random Blood Sugar (RBS)

• No special preparation is needed.

• The sample can be taken at any time of the day, regardless of meals.

4. Oral Glucose Tolerance Test (OGTT) if prescribed

• Come to the lab fasting for 8 to 10 hours.

• A fasting blood sample will be taken.

• You will be asked to drink a glucose solution.

• Further blood samples will be taken at specific time intervals, usually 1 hour, 1.5 hours, and 2 hours after drinking.

• Do not eat, drink (other than water), smoke, or exercise during the test.

General Tips

• Inform the lab technician about any medications you are taking, especially for diabetes, steroids, or thyroid.

• Avoid alcohol and smoking for at least 24 hours before the test.

• Relax and avoid physical exertion before and during the test.

रक्तातील साखर तपासणीसाठी रुग्ण सूचना

1. उपाशी रक्तातील साखर (FBS)

• तपासणीपूर्वी 8 ते 10 तास काही खाऊ किंवा प्या (फक्त पाणी वगळता).

• नमुना घेण्यापूर्वी च्युइंग गम, चहा किंवा कॉफी घेऊ नका.

• डॉक्टरांनी सांगितल्यासच नियमित औषधे घ्या.

• नमुना सामान्यत: सकाळी नाश्त्यापूर्वी घेतला जातो.

2. जेवणानंतरची रक्तातील साखर (PPBS किंवा 2 तास साखर)

• आपले नेहमीचे जेवण करा, जेवण वगळू नका किंवा जास्त खाऊ नका.

• जेवण सुरू केल्याचा अचूक वेळ नोंद करा.

• नमुना घेण्यासाठी जेवणाचा पहिला घास घेतल्यानंतर नेमके 2 तासांनी लॅबमध्ये या.

• टीप: Varad Pathology Lab मध्ये, जेवणानंतरची रक्तातील साखर (PPBS) नमुना जेवण पूर्ण झाल्यानंतर 1 तास 30 मिनिटांनी (सुमारे 2 तास जेवण सुरू झाल्यानंतर) घेतला जातो, ही मानक पद्धती आहे.

• या वेळेत काही खाऊ किंवा प्या (फक्त पाणी वगळता) करू नका.

3. रँडम रक्तातील साखर (RBS)

• यासाठी कोणतीही विशेष तयारी आवश्यक नाही.

• नमुना दिवसभर कोणत्याही वेळी घेतला जाऊ शकतो, जेवणानुसार फरक पडत नाही.

4. ओरल ग्लुकोज टॉलरन्स टेस्ट (OGTT) जर दिलेली असेल

• तपासणीपूर्वी 8 ते 10 तास उपाशी या.

• उपाशी नमुना घेतला जाईल.

• तुम्हाला ग्लुकोज सोल्युशन प्यायला सांगितले जाईल.

• नंतर 1 तास, 1.5 तास आणि 2 तासानंतर पुढील नमुने घेतले जातील.

• तपासणी दरम्यान खाऊ नका, प्या (फक्त पाणी वगळता), धूम्रपान किंवा व्यायाम करू नका.

सामान्य सूचना

• तुम्ही घेत असलेल्या औषधांविषयी लॅब तंत्रज्ञांना सांगा, विशेषतः डायबेटीस, स्टिरॉइड्स किंवा थायरॉईडसाठी.

• तपासणीपूर्वी किमान 24 तास मद्यपान आणि धूम्रपान टाळा.

• तपासणीपूर्वी आणि दरम्यान शांत राहा आणि जास्त हालचाल टाळा.

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Crystals in urine

Calcium oxalate crystals are formed in acidic urine. They may be envelope shaped (more common) or dumbell shaped (less common)

Fig 1: Dumbell shaped calcium oxalate crystals 

Fig2: Envelope shaped calcium oxalate crystals

Triple phosphate crystal (struvite) in urine are typically formed in long standing alkaline urine with pH usually > 8.0. The triple phosphate crystals are clasically described as "coffin lid shaped" of varying sizes.

Fig: Coffin lid shaped triple phosphate crystals 

A place for all kind of pathological tests

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