Saturday, May 6, 2023

#pcr#molecularbiology #moleculardiagnostics #pcr controls #negative cont...

Controls for PCR WHY DO WE NEED CONTROLS FOR PCR?? 

• PCR amplification is a highly error and contamination prone technique. 

• PCR controls ensure the accuracy and reliability of any PCR reaction. 
 What are Controls 
• Controls are some pre-set parameters using which we will interpret our PCR results. 
PCR controls are used to 
• Validate the performance of the test. 

• Validate the results of the test. 
• Evaluate reasons for false or negative results.
 • Troubleshooting the problems.
 • Give strength and scope to optimize other reactions.


 TYPES OF CONTROLS

 • Blank/No Template Control(NTC) • Positive control • Negative control • Standard control • Template control • Reaction control 

Blank/No Template Control(NTC) 

• Contains all the reagents, but no DNA template • To check for contamination/false positive results. • Instead of template DNA, nuclease-free water is added to the reaction which also validates whether the water is of high quality or not. • PCR enhancers can also be added, if they are used in the main reaction to validate the purity of enhancers. 

Negative control(NC) 

• Contains all the reagents and DNA template , but no target sequence. • Control for specificity (true negative). • Negative control reactions can also be used to check for primer selfdimers (homo-dimers).

 Positive control(PC) 

• Contains all the reagents and DNA template with target sequence. • Control for sensitivity (true positive), there are no PCR inhibitors 

Internal control 

• Internal control also known as internal positive control or internal amplification control (IAC) is a reactionindependent control. • The internal control is designed in a way that coamplifies the genomic region other than our target, using the same annealing temperature, reaction conditions and ingredients (except primers). 

Internal control types

• Exogenous controls and Endogenous controls. • The endogenous internal controls which are typically housekeeping genes amplify along with the template showing whether the starting template has a sufficient quantity or not. 

• Endogenous controls are targets within the studied sample, other than the region/regions of interest, such as constitutively expressed genes serving basal cell functions, and are therefore dependent on the type tissue being examined. Internal control • Exogenous controls are pipetted directly into the raw sample, or added to the isolated nucleic acid before the PCR reaction and will target a different species to the studied one. • They are mainly used for absolute quantification (i.e. number of gene copies per examined sample) and for the control of the relative amplification from a set of specific primers. • Another use for exogenous controls is the discrimination between negative samples (where the control will still amplify) and PCR inhibition (when no amplification will be observed). • Synthetic noncompetitive exogenous control is generally used for microbial detection.



 REFERENCES • https://geneticeducation.co.in/type-of-pcr-controls-negative-positiveand-internalcontrols THANK YOU

Tuesday, February 9, 2021

#chronicmyeloidneoplasm|#CML|#MYELOPROLIFERATIVENEOPLASM|#WHOCLASSIFICATION



INTRODUCTION

Chronic myeloid leukemia is a clonal hematopoietic neoplasm characterised by BCR-ABL Fusion resulting in the formation of PHILADELPHIA CHROMOSOME.

 

 

DEFINITION

 

Chronic myeloid leukaemia is a myeloproliferative neoplasm.

Characterized by granulocytic proliferation.

 

SYNONYMS

Chronic myelogenous leukaemia, BCR-ABL POSITIVE

Chronic myelogenous leukaemia, PHILADELPHIA CHROMOSOME POSITIVE (Ph+)

Chronic myelogenous leukaemia t(9;22)(q34;q11)

Chronic granulocytic leukaemia ,BCR-ABL positive

Chronic granulocytic leukaemia, Philadelphia positive(ph+)

Chronic granulocytic leukaemia t(9;22)(q34;q11)

 

EPIDEMIOLOGY

INCIDENCE: 1-2 cases per 100000 population.

 

Males are affected than females.

 

ETIOLOGY

UNKNOWN

Radiation exposure may be implicated due to increase incidence of cases in Atomic bomb survivors.

 

CLINICAL FEATURES

Approximately 50% of newly diagnosed cases are asymptomatic.

Common clinical findings include-

Lethargy

Fatigue

Weight loss

Night seats

Anaemia

Palpable splenomegaly

 

MOLECULAR GENETICS

Phenotype of the disease depends on the site of breakpoint in the chromosome 22.

Major BCR :BCR in the exons 12-16 (b1-b5)-> abnormal fusion protein p210.

Minor BCR : BCR in the exons 1-2->short fusion protein p190 , associated with Ph+ ALL and monocytosis.

Micro BCR: BCR in the exons 17-20(c1-c4)->large fusion protein p230 associated with marked thrombocytosis and /or neutrophilic maturation.

 

GROSS PATHOLOGY

SPLEEN- solid with uniform bright red colour and light coloured regions indicate areas of infarction.

 

LIGHT MICROSCOPY

Leukemic cells are usually found in splenic cords and sinuses.

White pulp is obliterated by neoplastic cells.

 

 

DIAGNOSIS

PERIPHERAL BLOOD EXAMINATION

BONE MARROW EXAMINATION

CYTOGENETICS

MOLECULAR ANALYSIS – to identify the Ph chromosome or BCR-ABL 1 fusion.

 

 

PERIPHERAL SMEAR EXAMINATION

 

Marked leucocytosis ranging from 20-500X109/L. 

Myelocytes are more in number than Meta myelocytes (Myelocyte bulge). 

No or very minimal dysplasia. 

Low neutrophil/leukocyte alkaline phosphate. 

Absolute basophilia in almost all cases. 

Absolute eosinophilia in nearly all cases.


 

BONE MARROW

Hypercellular marrow

M:E ratio increased (up to 20:1)

15-20 cell thickness of immature para trabecular  cuff.

Low blast count

Megakaryopoiesis  increased , small hypolobated nucleus (dwarf megakaryocyte).

20-40% cases show pseudogaucher cells (characteristic crumpled tissue paper like cytoplasm which usually shows hemophagocytosis.

Thrombocytosis is commonly seen.

 

STAGES OF CML













 

 

ADJUNCTIVE TESTS

LAP score low , it can be used as screening test , however increased NAP score is seen in accelerated phase of CML.

 

Raised Vitamin B12 levels.

 

Raised Uric acid levels.

 

ANCILLARY TESTS

 

Demonstration of BCR-ABL 1 fusion gene

 

Conventional cytogenetic analysis

 

FISH with probes to BCR and ABL1

 

POLYMERASE CHAIN REACTION

 

 

 

DIFFERENTIAL DIAGNOSIS

Leukemoid reaction

 

Atypical CML (Ph negative , BCR-ABL1 negative)

 

Chronic Neutrophilic leukemia

 

CMML

 

Cellular phase of Myelofibrosis

PROGNOSIS AND PREDICTIVE FACTORS

SOKAL SCORE-Age , Spleen size , Platelet count , % blasts.

EUTOS SCORE-

 

 

REMISSION RATE IN CHRONIC MYELOID LEUKEMIA

COMPLETE HEMATOLOGICAL RESPONSE:

PARTIAL CYTOGENETIC REMISSION

COMPLETE CUYTOGENETIC REMISSION

MAJOR MOLECULAR RESPONSE

COMPLETE MOLECULAR RESPONSE

 

 

Thursday, January 28, 2021

RHINOSCLEROMA NOTES

 

INTRODUCTION

Chronic granulomatous infectious disease primarily affects upper respiratory tract.

 

EPIDEMIOLOGY



 

Affects all ages-young, first 3 decades, world wide distribution ,  low socioeconomic background with poor living conditions , malnutrition.


HISTORICAL IMPORTANCE

  • For the first time VON FRISH identified the causative organism of the disease RHINOSCLEROMA.
  • MIKULICZ has described the classical FOAMY cells in the histopathology of            RHINOSCLEROMA. 
  • VON HERBA discovered the disease , after his name HERBA NOSE.
  • VON MIKULICZ studied the histopathology of disease.


CAUSATIVE AGENT

KLEBSIELLA RHINOSCLEROMATIS ( Frisch bacillus ) – 2.5 um , capsulated ,gram negative , immotile organism belongs to ENTEROBACTERIACEAE FAMILY.


ROUTE OF TRANSMISION

Through droplet spread.


 

LOCALIZATION

Nasal cavity

Palpebral conjunctiva


Middle ear

Nasopharynx

Tracheobronchial tree

Esophagus

Larynx

Pharynx


DIAGNOSIS

Biopsy of the involved site , demonstration of bacilli with special stains ,supplemented by immunohistochemistry.

 


IMAGING

  • Intracranial extension of the disease due to destruction of posterior wall of left sphenoidal         sinus by CT SCAN.
  • MRI detects nasal mass extending into nasopharynx.


GROSS PATHOLOGY

Infected mucosa is pale in appearance & demonstrates diffuse nodular thickening(FLORID PHASE).

 

MICROSCOPY

1.Squamous metaplasia with inflamed granulation  tissue is seen in early stages of the disease.

 

2.FLORID/PROLIFERATIVE PHASE:

submucosal granulomatous infiltrate composed of macrophages with clear foamy cytoplasm (MIKULICZ CELLS) intimately associated with admixture of lymphocytes & numerous plasma cells.rod shaped gram negative organisms can be demonstrated in MIKULICZ cells.

3.FIBROTIC/RESOLUTION PHASE: 

no Mikulicz cells , extensively replaced by fibrosis and lymphocytes and plasma cells (russel bodies – accumulation of immunoglobulins).


HIGH POWER IMAGE SHOWA MIKULICZ CELLS WITH ABUNDANT FOAMY CYTOPLASM.

 

SPECIAL STAINS

GIEMSA , WARTHIN STARRY STAIN, Dieterle stain    & PAS positive (inclusion bodies ).



IMMUNOHISTOCHEMISTRY

MIKULICZ CELLS-CD68 positive.

Langerin,S100,CD1a negative.


ELECTRON MICROSCOPY

Bacilli and granular material is seen in large phagosomes.

 

DIFFERENTIAL DIAGNOSIS

Syphilis- plasma cells ,detection of Treponema pallidum by dark field microscopy.

Rosai dorfmann disease - sinus histiocytosis with massive lymphadenopathy , emperiploesis.

Inflammatory pseudotumour/plasma cell granuloma-along with mixed inflammatory infiltrate , plasma cells , vascular proliferation there is storiform pattern of arrangement of fibroblasts/myofibroblasts.

Wegners granulomatosis( triad of focal glomerulonephritis , vasculitis and necrosis of Upper respiratory tract) now named as GRANULOMATOSIS WITH POLYANGIITIS.

Malignant lymphoma - clonal disorder , absence of mikulicz cells , Immunohistochemistry helps in doubtful cases.


MANAGEMENT

Long term antibiotics followed by surgical debridement

Surgical resection

Co2 laser surgery


OUTCOME

Slowly progressive disease with relapses and recurrences.

Fatal if obstructs trachea.

 

Saturday, January 23, 2021

KIMURA DISEASE

NTRODUCTION

A chronic inflammatory disorder  of uncertain etiology with distinctive histologic features mainly affecting the head and neck that appears to represent an aberrant immunologic reaction characterized by eosinophilia , increased serum IgE and angiolymphoid proliferation.


SYNONYMS

Kimura lymphadenopathy , Eosinophilic lymphogranuloma


INCIDENCE uncommon


GENDER,RACE, AND AGE DISTRIBUTION

Most patients are young adult males, Asians are more commonly affected than whites or blacks.


ETIOLOGY –unknown.

 

CLINICAL FEATURES




Patients typically have  painless unilateral or bilateral cervical lymphadenopathy.

One or more  slowly growing , large , painless lesions in subcutaneous and deep soft tissue which may persist or recur over a period of months or years.

Some patients may have proteinuria , nephrotic syndrome or asthma.


MORPHOLOGY

Lesions generally poorly demarcated.

Lymph nodes and other involved sites show an infiltrate of lymphocytes, eosinophils, plasma cells, mast cells, reactive follicles, and fibrosis.

Eosinophilic abscesses and polykaryocytes, especially in follicles.

Collagen deposition may be seen , on long standing  diffuse hyalinization changes may be seen.


EXTENSIVE SUBCUTANEOUS INVOLVEMENT BY KIMURA DISEASE IN A YOUNG MALE - LOW POWER VIEW



SCANNER VIEW SHOWING REACTIVE FOLLICLES WITH EOSINOPHILS WITHIN THEM.




LOW POWER VIEW SHOWING HYPERPLASTIC FOLLICLE WITH NUMEROUS EOSINOPHILS WITH IN AND AROUND THE FOLLICLE




HIGH POWER VIEW SHOWING PREDOMINANCE OF EOSINOPHILS IN KIMURA LYMPHADENOPATHY



IMMUNOPHENOTYPE

Ig E positive follicular dendritic networks in follicles.

Vascular endothelial cells – factor VIII , Ulex europaeus agglutinin (UEA-1).


DIAGNOSIS

Biopsy of involoved tissue


DIFFERNETIAL DIAGNOSIS



 

PROGNOSIS AND THERAPY

The lymphadenopathy and other mass lesions do not require specific therapy , although large and persistent can be excised.

 

CONCLUSION

Chronic inflammatory disease of uncertain etiology , commonly seen in young Asian males with involvement of lymphnodes , salivary glands and kidneys, hyperplastic germinal centers with abundant eosinopilic infiltration  involving germinal centers and microabscess ,peripheral blood eosinophilia and increased IgE levels.


EXTRA EDGE



https://youtu.be/mhsNWo6Lwm8I



Thursday, January 21, 2021

KIKUCHI FUJIMOTO DISEASE

DEFINITION

Benign disease  characterized by lymphadenopathy with distinctive  histological features.

SYNONYMS :





INCIDENCE   Worldwide distribution, however high incidence in Asians.



EPIDEMIOLOGY -  Most patients are  young women , the average age at presentation 27years.



ETIOLOGY – unknown.



CLINICAL FEATURES -  Unilateral tender post cervical lymphadenopathy, fever, rash, anemia, and leukopenia. rarely presents with the atypical lymphocytosis.



MORPHOLOGY:


  • Patchy Lymph node involvement , usually centered  in paracortical areas
  • Atleast occasional crescentic histiocytes
  • Fibrinoid necrosis surrounded by immunoblasts , histiocytes and plasmacytoid dendritic cells.
  • Extracellular apoptotic/karyorrhectic debri
  • Absence of eosinophils,polymorphonuclear cells and plasma cells




EXTENSIVE LYMPH NODE INVOLVEMENT WITHOUT EFFACEMENT OF LYMPH NODE ARCHITECTURE AND RESIDUAL FOLLICLES (SCANNER VIEW).








PROLIFERATIVE TYPE WITHOUT NECROSIS (LOW POWER)









NECROTIZING TYPE WITH ABUNDANT NECROTIC FOCI ( LOW POWER VIEW )









HIGH POWER VIEW SHOWING ABUNDANT KARYORRHECTIC DEBRI WITH ABSENCE OF NEUTROPHILS










HIGH POWER VIEW SHOWING CRESCENTIC HISTIOCYTES








HISTOLOGIC SUBTYPES :









IMMUNOPHENOTYPE






plasmacytoid dendritic cells express CD 2 , CD4 , CD 43 , CD68  and CD123.





DIAGNOSIS

LYMPH NODE BIOPSY



DIFFERNTIAL DIAGNOSIS








PROGNOSIS

Some  patients develop recurrent lymphadenopathy

Rare patients, usually with an underlying immunodeficiency , have a severe illness with a poor outcome.


MANAGEMENTnearly all patients have a self limited illness requiring no specific therapy. 



https://youtu.be/nxlCK6wkOmQhttps://youtu.be/nxlCK6wkOmQ


https://youtu.be/nxlCK6wkOmQhttps://youtu.be/nxlCK6wkOmQ


#pcr#molecularbiology #moleculardiagnostics #pcr controls #negative cont...

Controls for PCR WHY DO WE NEED CONTROLS FOR PCR??  • PCR amplification is a highly error and contamination prone technique.  • PCR control...