Sir Ganga Ram Hospital, New Delhi, India

Haematology and Clinical Pathology

Introduction: 

From a relatively small Haematology laboratory about 10 years ago, to a composite Department of Haematology, with clinical and laboratory faculty working together under one roof for better service, resident training and research activities, we indeed have come a long way. Our mission is to provide state of the art investigative facilities for the comprehensive diagnosis of haematologic diseases and the highest quality of clinical care for our patients with the latest therapeutic tools. In addition, to impart training and mentor the next generation of academic Haematologists, through our Diplomate of National Board (DNB) programme, is a high priority. For Ph.D, Guru Gobind Singh Indraprastha University has accorded the status of Approved Research Centre to Sir Ganga Ram Hospital and the head of the department is an approved PhD guide. Department has its own SOPs and protocols and has accreditation for the laboratory services from the National Accreditation Board for Testing Laboratories (NABL).

Staff, faculty and Residents

Faculty:

  • Dr. (Col.) Jyoti Kotwal, Senior Consultant & Head.
  • Dr. Amrita Saraf, Senior Consultant.
  • Dr. Jasmita Das, Consultant.
  • Dr. Sabina Langer, Consultant.
  • Dr. Vandana Arya, Scientist.

Residents:

  • Non-DNB Senior residents - 2
  • D.N.B Sr. Residents - 1

Technologists: 24-Highly trained and competent senior technicians man the various stations for bench work.

II. Education:

Department of Haematology, Sir Ganga Ram Hospital started the DNB course in Haematology of the National Board of Examinations in 2008, the first such course in the country in the superspeciality of Haematology. It is equivalent to DM in Haematology. Two candidates enrolled in the first batch (2008) passed out in 2011. One passed out in 2012 and 2 are due to appear for examination in 2013.

Teaching on Multihead Microscope

Eligibility:

III. Haematology Services :

The laboratory is widely known as a centre of excellence for providing diagnostic facilities for a wide spectrum of Haematologic disorders using cutting edge technology. It is recognized as a referral centre for second opinion on difficult and rare cases by hospitals and institutions nationwide.

Equipment:

Beckman LH 780 two DxH 800 analysers, Excyte ESR equipment, chronolg platelet aggregometer, Biorad variant II, coagulometers-ACL TOP 500, Elite Pro, ACL 7000, Electrophoresis equipment Chorus, ELISA system, Flowcytometers BD Canto II and FC 500.

Routine and special investigations:

Complete blood counts : Hb, Hct, TRBC, MCV, MCH, MCHC, RDW, Platelet count, TLC, MPV and automated 5 - part differential & reticulocyte counts.

LH780 (beckman Coulter)

Haemorrhagic disorders

Prothrombin time (PT)*, Activated partial thromboplastin time (APTT), Thrombin time (TT) assays of factor VIII and IX. Platelet count, Fibrinogen estimation, Quantitative D-dimer (Fibrinogen degradation products), clot solubility test (factor-XIII), APTT mixing experiment, PT mixing experiment, (*=PT is reported in INR), Factor Xa assays. ACL Advance Coagnlometer (IL)

Thrombophilia :

Tests for antiphospholipid syndrome and lupus anticoagulants: APTT with lupus sensitive reagent, APTT –dependent inhibitor screen, Dilute Russell Viper Venom Time (dRVVT), Kaolin clotting time (KCT), Anti-cardiolipin antibodies, beta 2 GPIA antibodies (ANA), Anti-ds-DNA antibodies; Protein C, Protein S & Antithrombin (clot based functional assays), Factor V leiden (APC-R) estimation.

Thrombophilia panel:- Mutations of Factor V (Leiden) mutation of prothronibin gene and MTHFR gene, Protein C, Protein S, AT III, APCR, Lupus anticoagulant, Antiphospholipid antibody, β2 GPIG, β2 GPIM.

HPLC and Hemolytic disorders: Screening/testing for beta-thalassemia & hemoglobinopathies by HLPC (bioRad Variant II) and hemoglobin electrophoresis at alkaline & acid pH (Beckman Coulter Appraise system): More than 30,000 antenatal screens have been analysed to date. Some of the interesting patterns are Hb Dlran, Hb QIndia, Hb E, Hb C, Hb J etc. G-6-PD screening Osmotic fragility test, Acidified serum (Ham) test, Autohaemolysis test, Heat instability test for unstable haemoglobin, Heinz bodies, Haemoglobin F Cytochemistry (Kleihauer test), Isopropanol stability test, Haemosiderin in urine, Sucrose lysis test, Methaemoglobin estimation, sickling test for Hb S.

Leukemias & lymphomas:

Detailed work-up by CBC, bone marrow examination, Cytochemistry and flow cytometry on acute and chronic leukemias, myelodysplastic syndromes (MDS), myeloproliferative disorders (MPD) and lymphoproliferative disorders (LPD).

Flowcytometry:

BD FacsCanto II and FC 500

  • Leukemia and lymphoma immunophenotyping (Acute leukemia panel,CLL panel, Lymphoma panel).
  • Four color single tube CD4 & CD8 counts (HIV panel).
  • Enumeration of B-, T-& NK cells.
  • PNH panel extended panel.(CD55, Cd66b,CD59 ,CD14 with gating markers).
  • Flowcytometric HLA Cross-Match (Donor specific).
  • Stem cell enumeration based on ISHAGE protocol.
  • MRD assay.

Platelet Aggregometry :Platelet function tests for qualitative platelet defects, von Willebrands disease, Drug resistance to aspirin and clopidogrel.

Molecular Haematology :Qualitative and quantitative assays for BCR-ABL. TEL-AML1, PML-RARa, JAK2, FLT-3 (D835 & ITD) mutations, NPM-1 mutation, AML1-ETO, inv 16, MTHFR, Factor V Leiden and Prothrombin gene mutations.

Autoimmune Markers : ANA-3 (Western blot), ds-DNA, p-ANCA, c-ANCA, Anti cardiolipin IgG & IgM, 2 GP1 IgG & IgM by ELISA

Electrophoresis : Haemoglobin electrophoresis, Serum protein electrophoresis (SPE), Immunofixation electrophoresis (IFE), Urinary protein electrophoresis (concentration by Minicon filter) by Helena system.

Free light chain assay : by minineph.

IV. Clinical Pathology :

Urine : Routine and microscopic examination.

Special : Urobilinogen, porphobilinogen, haemoglobin, myoglobin, chyle.

Body fluids : Apt test, Ascitic fluid, Cerebrospinal fluid, Gastric aspirate for neutrophils Hemosiderin in urine, Pericardial fluid, Pleural fluid, Synovial fluid.

V.Research projects :

1. Completed

  • Thalassemia mutations in subjects with borderline Hb-A2 values: a pilot study in North India.
  • A comparative study of bone marrow flowcytometric immunophenotyping, bone marrow aspirate and biopsy in evaluation of involvement by non Hodgkins lymphoma.

2. Ongoing projects

  • Clopidogrel and Aspirin Resistance in Indian Patients with Coronary Artery Disease and their associations with CYP2C19, CYP3A5 and GPIIa/GPIIIa gene polymorphisms.
  • To assess the role of prothrombotic genetic markers in Ischemic Cerebrovascular stroke.
  • Cytogenetic and molecular profile of Acute Myeloid Leukemia in India.
  • Evaluation of association between Thrombophilia and Unexplained Pregnancy Loss.
  • Safety and efficacy of Bortezomib+ dexamethasone in newly diagnosed patients of multiple myeloma.
  • Clinicomorphologic spectrum of myelodysplastic syndrome.

VI. Some Recent Publications:

  • Sharma L.M., Kashyap R., Gupta S., Bhargava M. B-Cell Acute Lymphoblastic Leukemia in a child with Ataxia Telangiectasia. Pediatric Hematology and Oncology (2008 25 (5), 473-476.
  • Rangan A, Handoo A, Sinha S, Saxena R, Verma I.C., Kumar S., Sood S.K. and Bhargava M. Utility of Family Studies in Diagnosing Abnormal Hemoglobins. Thalassemia states. Indian J. Pediatrics (2009) 76, 615 621.
  • Dadu T., Rangan A, Handoo A, Bhargava M. Primary non-secretory plasma cell leukemia with atypical morphology a case report. Indian J Hemat Blood. Tranfuse (2009) 25 (2) : 81-83.
  • Rangan A, Choudhry D.R., Sinha S., Handoo A., Bhargava M. Secondary Myelofibrosis in a case of Aplastic Anemia. Journal of Clinical and Diagnostic Research (2009) 3 (3), 1587-1596.
  • Mir Sadaqat, Hasan Zafar, Manorama Bhargava, Prashant Sharma. In diagnostic pursuit of a non-secretory myeloma. In Agarwal MB (Ed.) Multiple myeloma 2010. Ranbaxy Superspecialities (Mumbai) 2010:53-60.
  • Afaq Ahmad Khan, Prashant Sharma, Manorama Bhargava. The serum protein electrophoresis and immunofixation electrophoresis: Recent advances and continuing relevance. In Agarwal MB (Ed.) Multiple myeloma 2010. Ranbaxy Superspecialities (Mumbai) 2010:31-41.
  • Manorama Bhargava, Upadrasta Sindhuri, Satish Saluja, Amrita Saraf, Suchita Dayanan, Ramon Simon-Lopez. Volume, Conductivity and Scatter properties of leucocytes (VCS Technology) is a highly sensitive and specific blood culture proven neonatal sepsis. Published online in Blood, December 2010 (http://bloodjournal.Hematologylibrary,org/misc/ASH_meeting_Abstracts_info.dtl).
  • Aruna Rangan, Swasti Sinha, Anil Handoo, Manorama Bhargava. Ascitic fluid cytology and flow cytometry in the primary diagnosis of lymphoma a case Report. Indian Journal of Hematology and Blood Transfusion, 2010; 26(1):15-18.
  • Tina Dadu, Aruna Rangan, Manorama Bhargava. CD4+/NKa+/CD8dim+ T-Cell large granular lymphocytic leukaemia: a rare entity. Journal of Postgraduate Medicine. 2010;56(3):223-224.Tina Dadu, Aruna Rangan, Manorama Bhargava. The utility of lymph node flow cytometry in the diagnosis of lymphomas. Haematology 2010:935.
  • Tina Dadu, Aruna Rangan, Manorama Bhargava. The utility of lymph node flow cytometry in the diagnosis of lymphomas. Haematology 2010:935.
  • Swasti Sinha, Manorama Bhargava. Application of flow cytometry in myeloid malignancies: Relevance in the current scenario. Haematology 2010: 921.
  • Atul Gogia, Atul Kakar, SP Byotra, Manorama Bhargava. Aggressive natural killer cell leukemia. Journal of Association of Physicians of India. 2010;58:704-706.
  • Aruna Rangan, Tina Dadu, Prashant Sharma, Renu Saxena, Ishwar C. Verma, Manorama Bhargava. -Thalassemia Mutations in Subjects with Borderline HbA2 Values: A Pilot Study in North India. Clinical chemistry and laboratory medicine. 2011; 49 (12)1-4.
  • Prashant Sharma, Sanjay Gogia, Mir Sadaqat, Amrita Saraf, Manorama Bhargava. Glanzmann Thrombasthenia in pregnancy: The value of a probing bleeding history. Clinical and applied thrombosis / hemostasis. 2011 (In-Press).
  • Aruna Rangan, Bhavna Arora, Pooja Rangan, Tina Dadu. Florid plasmacytosis in a case of acute myeloid leukemia: A diagnostic dilemma. Indian J Med Paediatr oncol. 2010; 31:36-38.
  • Afaq Ahmad Khan, Prashant Sharma, Manorama Bhargava. Atypical CML, BCR- ABL1 Negative. In Agarwal MB (Ed.) Hematology update (Volume 3) Chronic myeloid leukemia. 2011. Mumbai hematology group (Mumbai)13-16
  • Vandana Arya, Prashant Sharma, Manorama Bhargava. Technical issues in qualitative and quantitative RT-PCR for the bcr-abl fusion transcript. In Agarwal MB (Ed.) Hematology update (Volume 3) Chronic Myeloid Leukemia. 2011. Mumbai hematology group (Mumbai) 23-28
  • Afaq Ahmad Khan, Prashant Sharma, Manorama Bhargava. Downstream effects of bcr-abl fusion and their contributions to CML leukaemogenesis. In Agarwal MB(Ed.) Hematology update (Volume 3) Chronic Myeloid Leukemia. 2011. Mumbai Hematology Group (Mumbai) 4-8
  • Prashant Sharma, Manorama Bhargava. MDS: Pathogenesis and Molecular Biology. In Agarwal MB (Ed.) Hematology update (Volume 2) Myelodysplastic Syndromes. 2011. Mumbai Hematology Group (Mumbai):13-19.
  • Manorama Bhargava, U.Sindhuri, Satish Saluja, Amrita Saraf, Suchita Dayanand, Ramon Simon Lopez. Volume, conductivity and scatter properties of Leucocytes (VCS technology) as a highly sensitive and specific predictor of blood culture proven neonatal sepsis. Int. J. of Lab. Hematology vol 33 (suppl 1), May 2011.
  • Manorama Bhargava, Prashant Sharma, Sukhachev. Discriminant value of volume, conductivity and scatter properties of leucocytes (VCS Technology) for rapid and reliable diagnosis of malaria and dengue fever.(Abstract). Blood on line at http://bloodjournal.hematologylibrary.org/site/misc/ASH Meeting Abstracts Info.xhtml.
  • Aggarwal S, Arya V, Agarwal S. Establishing RHD zygosity in India: a step into the future of foetal and neonatal haemolytic disease prevention. Transfusion Medicine, 21(3): 190-3 (2011)
  • Arya V, Agarwal S & Pradhan M. Association of Polymorphic pattern of the (AT)x(T)y motif of beta-globin gene in North Indian thalassemia patients with variable clinical expression. Indian Journal of Hematology & Blood Transfusion 26(1): 21-23 (2010)
  • Arya V and Agarwal S. Beta Thalassemia:Diagnosis and Prevention. Drugs & Pharmaceuticals Current R & D Highlights; (2010)
  • Arya V, Kumar R, Yadav RS, Dabargaon P & Agarwal S. Rare Hemoglobin Variant Hb I Philadelphia in North Indian Family. Annals of Hematology 88(9):927-929 (2009)

Useful links

Accreditation:

The laboratory is NABL accredited.

Quality assurance:

Quality assurance is a major concern of the department. It covers all aspects of laboratory functioning i.e. pre-analytical, analytical and post-analytical; turn around time; maintenance of equipment; selection of tests & reagents; standardization & validation of tests before they are introduced; and training of personnel.

Contact us:

Working hours
Routine 8 AM to 5 PM.
Emergency Round the clock
Laboratory 42252105 & 42252106.
Dr. (Col.) Jyoti Kotwal 42252104
Dr. Amrita Saraf 42252101
Dr. Jasmita Das  
Dr. Sabina Langer 42252103
Dr Vandana Arya 42251854
Resident’s room 42252117
Senior Technical Assistants 42252107
Fax +91-11-42252148
Email Haematology@sgrh.com