DXH 500 Series Casebook
DXH 500 Series Casebook
DXH 500 Series Casebook
CASE STUDIES
DxH 500 SERIES HEMATOLOGY ANALYZER
TABLE OF CONTENTS
The DxH 500 Series System technology for Hematology incorporates the Coulter Principle
and Flow cytometric optical measurement to provide an effective and robust technology
for cellular analysis.
The Coulter Principle is an electronic method for counting and sizing particles. Although the Coulter
Principle can be used to calculate and size just about any particle, the specific application of this
principle in hematology is to count and size White Blood Cells (WBC), Red Blood Cells (RBC), and
Platelets (PLT).
VACUUM
Electrolyte
Aperture
Electrode
Detection area
VOLT
Proportional height to cell volume
TIME
Counting Impulse
4
DxH 500 SERIES SYSTEM OVERVIEW
The DxH 500 Series whole blood sample preparation and count process are detailed below.
› Small amount of whole blood sample is aspirated: DxH 500 - 12μL, DxH 520 and DxH 560 - 17μL
(precisely 16.7μL)
› Sample probe retracts, external probe surface is rinsed with DxH 500 Series Diluent
› Sample probe moves above the WBC bath 2.7μL of blood is ejected for the DxH 520 and DxH 560.
The sample probe’s external surface is rinsed again. The WBC bath is drained
› 1.25mL of DxH 500 Series Diluent is dispensed into the clean and empty WBC bath
› An additional 0.5mL of DxH 500 Series Diluent is dispensed through the sample probe, pushing the
sample into the bath and creating the initial dilution of 1: 125 (blood:diluent)
› The Lysed WBC dilution is air mixed in preparation for analysis, while the RBC Bath is drained
› The WBC dilution is used to count and differentiate the WBCs and hemoglobin measurements
› 2.0mL of DxH 500 Series Diluent is dispensed into the clean and empty RBC bath for the DxH 500
› Additional 2.0mL of DxH 500 Series Diluent is dispensed, pushing the 25µL of the initial WBC dilution
into the RBC bath, creating the final RBC dilution of 1:10125
› The RBC dilution is mixed and prepared for the counting and sizing of the RBCs and PLTs
› The system performs two count measurements: The DxH 500 series system Initially counts the CBC
(RBC/PLT/WBC) parameters for 3 seconds. The first count is followed by the second measurement of the
CBC (RBC/PLT/WBC) parameters + DIFF for 7 seconds
1. Coulter, WH. High speed automatic blood cell counter and cell size analyzer. Paper presented at National Electronics Conference,
Chicago, IL, 1956; October 3.
Also: Coulter, W. High speed automatic blood cell counter and cell size analyzer. In Cytometry (3rd edition). Waltham, MA: Elsevier, 1956.
COUNTING/SIZING
The RBC and WBC counts are determined using the Coulter Principle to count and size cells
accurately. The WBC differential is determined using a combination of the impedance WBC data
and the direct optical measurement data obtained using a blue Light-emitting diode (LED) focused
through the WBC aperture.
COINCIDENCE CORRECTION
More than one cell may occasionally pass through the aperture sensing zone simultaneously.
When cells coincide, only one combined pulse is counted. Because the frequency of coincidence is
proportional to the actual count, the system automatically corrects results for coincidence.
VOTING
The system prevents data errors due to statistical outliers or obstructions that may block an
aperture by voting on WBC, RBC, and PLT data. The system then verifies that the data produced is
within an established statistical range and is used to generate parameter results.
SCALING
Scaling adjusts for calibration and reportable format.
PARAMETER DERIVATION
WBC COUNT
The WBC count is measured directly by counting all
particles in the WBC dilution. The DxH 500 Series Lytic
reagent removes red blood cells. Platelets are removed
below a predefined threshold. After performing the
coincidence correction, voting, and multiplication by a
FIGURE 2. DxH 500 Series WBC Differential
calibration factor, the final WBC count is provided. identified with Coulter Principle technology
and Optical measurement
WBC DIFFERENTIAL
The WBC differential (5-part) is determined using the simultaneous measurements of impedance
(volume) and direct optical (Axial Light Loss) within the WBC aperture. The DxH 500 WBC differential
technology uses an aperture of proprietary design. The aperture optical assembly is placed
perpendicular to the aperture. The LED in the optical assembly projects a blue light through the
aperture wall and onto a sensor that detects axial light loss. As cells pass through the aperture,
the optical path is interrupted. The amount of light falling on a sensor can be measured and varies
depending on cell structure (see Figure 2).
6
Cells passing through the center of the aperture generate Gaussian pulses by impedance.
Cells that are not centered will produce non-Gaussian pulses (see Figure 3).
Gaussian pulses (T1, T2, and T3 in Figure 3) that pass through the center are positioned properly
within the aperture for the optical measurement. The DxH 500 series algorithm further analyzes
Gaussian pulses and axial light loss to generate the WBC differential, flagging, and messaging.
T3
T4
T2
T3
T1
T2
T1
Aperture
Reliable optical
measurement zone (T1, T2, T3)
T4
T3
T2
T1
Aperture
Proprietary pulse processing enables the recognition of data points that fall outside the optimal
counting zone. Recognizing these data points as outliers and subsequently removing the unreliable
data points enhances cellcount accuracy. Quality results are further improved with dual-count
apertures and a wide linearity range for a more comprehensive patient-care capability.
1 LYMPHOCYTE BLUE
2 MONOCYTE GREEN
3 NEUTROPHIL PURPLE
4 EOSINOPHIL ORANGE
5 BASOPHIL WHITE
FIGURE 4. A two-dimensional scatter plot is created with cell volume (Coulter Principle) on the Y-axis and Axial
Light Loss on the X-axis. WBC differential data is displayed in the diff plot. The WBC subpopulations are identified
by color and intensity (concentration) within the diff plot.
The DxH 500 Series uses simultaneous measurements of cell volume and Axial Light Loss within the
WBC aperture to count and size for five major classifications: Lymphocytes, Monocytes, Neutrophils,
Eosinophils and Basophils.
A two-dimensional scatterplot is created by placing cell volume on the Y-axis and Axial Light Loss on
the X-axis. The LED in the optical assembly projects blue light through the aperture onto a sensor that
detects Axial Light Loss when passing cells interrupt the optical path. The amount of light falling on the
sensor varies depending on cell structure. The DxH 500 series algorithm generates the WBC differential,
flagging and messaging.
8
HEMOGLOBIN CONCENTRATION
HGB concentration is a directly measured parameter. The released hemoglobin in the WBC bath is
converted into stable Oxyhemoglobin (Carboxyhemoglobin, if present). An LED is used to measure
the solution by spectrophotometry at λ=545nm. The absorbance of the sample is compared to a
blank reading, a calibration factor is applied, and the hemoglobin concentration result is reported.
RBC COUNT
The RBC count is a directly measured parameter, and the RBC dilution contains red blood cells,
white blood cells, and platelets. Thresholds separate the smaller platelet pulses from the red and
white blood cell pulses.
The white blood cells present in the dilution are included in the red blood cell count. However,
their interference is insignificant because there are only a few thousand white blood cells
compared to millions of red blood cells. After coincidence correction and voting, the analyzer
multiplies the RBC count by a calibration factor and reports the result.
RBC HISTOGRAM
The RBCs are categorized according to size by a pulse-height analyzer. Particles are sorted into
256 (volume) channels to develop a histogram. The display range is approximately 25 to 360fL, and
the system monitors the area at the lower end of the histogram for interferences. In interferences,
the algorithm will determine the degree of interference and correct the results. The system will flag
the results in cases of severe interference.
HEMATOCRIT
The HCT is a calculated parameter and is the relative volume of
packed erythrocytes to whole blood, expressed as a percentage. . HCT (%) = RBC X MCV
The formula is: 10
10
PLATELET COUNT
The platelet count is derived from an internal
continuous PLT/RBC histogram. Particles between
0 and 70 fL are counted and sized as they pass through
the RBC aperture. The raw data is evaluated using
proprietary DxH platelet algorithms to identify the
platelet population. The system also performs feature
analysis to identify patterns of interference at the low and
high ends of the PLT histogram. The algorithm uses both
the PLT raw data and the fitted histograms for this process
to determine PLT interference patterns, correcting or flagging
results, depending on the severity of the interference. The platelet
histogram’s evaluation improves accuracy by excluding interferences from
debris, micro bubbles, red cell fragments or exceptionally small red blood cells.
IMPORTANT
Histograms show only the relative, not actual, number of cells in each size range. Do not estimate
the number of cells from the histograms.
Selecting a histogram on the user interface displays a larger view of the histogram. Each histogram
is grey with a white background. Each cell population is shaded as follows.
› The smallest population to the right of › The internal PLT algorithm uses raw data and
the main population represents the RBC fitted histograms to determine the patterns.
doublets, triplets and WBCs. Normal characteristics – PLT Histogram
Normal characteristics – RBC Histogram › Log normal
› There is a clear baseline below 50 fL, and the › Low baseline at 2 fL, normally extending to
curve is between 50 and 200 fL approximately 25 fL
› The RBC curve has a slight skew to the right › Positive log-normal distribution
› There is a clear unimodal mode › Mode between 3 and 15 fL
› The width of the RBC curve is normal;
the RDW is likely normal
DYNAMIC GATING
The DxH 500 Series utilizes sophisticated Dynamic-gating technology improves the identification
of leukocyte cell sub-populations by adjusting thresholds in real time between cell-cluster
arrangements. With Beckman Coulter’s proprietary method, the gates move to more proper
cutoffs between cell populations
FIGURE 7A: Static-gating FIGURE 7B: Dynamic-gating
in a series of steps. Improved
cutoffs, and subsequently better
CELL VOLUME (COULTER PRICIPLE)
12
DIFFERENTIAL SCATTER PLOT (DIFF SCATTER PLOT) DEVELOPMENT
The digital information obtained from the WBC differential analysis is processed through the
WBC differential algorithm. This information is represented on a 2D scatter plot, with cell volume
plotted on the Y-axis and Axial Light Loss (ALL) plotted on the X-axis.
MO NE
BA
EO
Flags, codes, and messages are evaluated when the sample is analyzed. Review the results and pay
close attention to any flags, codes, or messages intended to alert you to issues with results or with the
instrument. Look for data patterns when examining flags, codes, and messages. Determine if individual
or sets of results (for example, WBC and differential results) exhibit flags, codes, and messages. Some
flagging occurs due to the flagging or editing of other parameters. In all cases, follow your laboratory’s
policy for reviewing results.
FLAGS
Flags appear to the right of the parameter result. Flagging occurs as a result of the flagging limits,
system messages, or editing of parameters. When flagging limits change, flags are not reevaluated
for results already in the database.
The flags shown in the following table are listed in order of priority, from highest to lowest. The
columns indicate the three positions where flags appear. It is possible to have flags in all or each of
the three positions.
1 2 3
R Review results
* Hemoglobin and Hematocrit (H&H) check failure (Hct - 3) < (Hgb*3) < (Hct + 3)
h Patient results above the reference interval, but less than the action limit (H)
l Patient results below the reference interval, but less than the action limit (L)
14
CODES
Codes are non-numeric characters that appear in place of values when the system cannot generate results.
IMPORTANT
Beckman Coulter recommends that you review all flags and codes according to your
laboratory’s protocol.
The codes in the following table are listed from highest to lowest priority.
Code Description
----- Total vote out (dashes). Inconsistent data between count periods.
Result is outside the range of values that can be formatted for display
????? (question marks).
SYSTEM MESSAGES
All messages are accompanied by R (Review) flags or other flags. A system message indicates an
event occurrence that may affect the operation of the system, require operator notification, or
entry into an Event Log.
IMPORTANT
Beckman Coulter recommends that you review and handle all messages according to your
laboratory’s protocol.
Multiple populations are overlapped. Cannot calculate BA%. The R flag appears next to
BA Interference
Diff % and # results. A non-numeric (…..) appears for BA% and BA#.
Poor separation between WBC population and interference in the lower lymphocyte area.
Cellular Interference The R flag appears next to WBC and/or Plt, and Diff %/# results. The number of cells is below
the WBC count threshold.
Evidence of the presence of at least two populations of red cells. The RBC Histogram flags
affect the RDW results. This flag is inhibited when both WBC and RBC are less than the
Dimorphic RBC
measuring range, or when the RBC result is non-numeric (+++++ or …..). The R flag appears
next to RDW and RDW-SD.
The ratio of HGB to HCT is not in the expected range (Hct - 3) < (Hgb*3) < (Hct + 3).
H & H Check Failed
The * flag appears next to HGB, HCT, and the computed related results.
HGB blank reading is outside the internal threshold limits. The HGB and computed result
Hgb Blank Error
is non-numeric (…..).
Large Cells High number of events in the large cell area. The R flag appears next to Diff % and # results.
Not enough good white events during Diff analysis. The scatter plot total numbers of cells is
Low Diff Events
less than 500. The R flag appears next to Diff % and # results.
Lymphocyte and Monocyte populations are overlapped. The R flag appears next to Diff %
LY/MO Overlap
and # results.
Monocyte and Neutrophil populations are overlapped. The R flag appears next to Diff %
MO/NE Overlap
and # results.
Neutrophil and Lymphocyte populations are overlapped. The R flag appears next to Diff %
NE/LY Overlap
and # results.
Neutrophil and Eosinophil populations are overlapped. The R flag appears next to Diff %
NE/EO Overlap
and # results.
Interference with smaller platelets. Interference at the left side of the PLT histogram
PLT1 – Debris
between channel 0 and the CP1 threshold.
Interference with larger platelets. Interference at the right side of the PLT histogram
PLT2 – Debris
between the CP2 and P thresholds.
PLT3 PLT/RBC Overlap PLT and RBC populations are overlapped between the CP3 and CP3-2 thresholds.
The estimated WBC carryover, based on the WBC value from the preceding sample and
WBC/DIFF Carryover the expected WBC carryover percent, may significantly affect the WBC results for the current
specimen. The R flag appears next to WBC, Diff % and # results.
The estimated PLT carryover, based on the PLT value from the preceding sample and the
PLT Carryover expected PLT carryover percent, may significantly affect the PLT results for the current
specimen. The R flag appears next to PLT and related results.
MCH, RDW, and RDW-SD all exceed threshold limits. The R flag appears next to RBC, MCH,
RBC Aggregates
RDW, and RDW-SD.
16
SYSTEM MESSAGES – RBC AND PLT HISTOGRAMS
RBC
Dimorphic RBC
A B C
2 10 20 30 fL
FIGURE9:. PLT Histogram Threshold Limits FIGURE 10. PLT Histogram Messages
Maximum PLT/
7 34.0
CP3-2
7 Debris Debris
18
MESSAGES
Messages are displayed in the Messages box on the Sample Analysis - Patient Results screen.
Messages are generated when specimen results meet certain conditions or an event occurs that may
affect the operation of the system, the quality of results, or when operator intervention is required.
Messages may be accompanied by R (Review) flags, other flags, or codes.
Background Failed All Results R Specimen processed after Background has failed.
Daily Checks Failed All Results R Specimen processed after Daily Checks has failed.
HGB..... , HCT..... ,
HGB Blank Error MCH..... , MCHC..... , HGB blank reading exceeds the internal threshold limits.
RDW..... , RDW-SD.....
Instrument
Specimen processed when the instrument temperature is not
Temperature Out of All Results R
within specification.
Range
Low Diff Events Diff % R, Diff # R The scatter plot total number of cells is less than 500.
Optical Adjust Failed Diff %..... , Diff #..... Optical LED adjust failed (out of range 27,500 +/- 3%).
Axial Light Loss value for at least one count period is lower than
Optical LED Value Error WBC .....
the default limit.
PLT and RBC populations are overlapped between the CP3 and
PLT3: PLT/RBC Overlap PLT R, MPV R
CP3-2 thresholds.
20
DEFINITIVE MESSAGES
Definitive messages are displayed in the Messages box. Definitive messages appear based
on limits you have selected as reference intervals or action limits.
Message Description
LY 26.5 %
MO 8.6 %
NE 63.0 %
EO 1.8 %
BA 0.1 %
MCV 93.4 fL
MCH 32.0 pg
RDW-SD 40.4 fL
PLT
PLT RESULTS
MPV 8.4 fL
2 10 20 30 fL
22
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
BLASTS
PROMYELOCYTES
MYELOCYTES
METAMYELOCYTES
BANDS
SEGMENTED
61.0
NEUTROPHILS
EOSINOPHILS 3.0
BASOPHILS 2.0
PROLYMPHOCYTES
LYMPHOCYTES 29.0
ATYPICAL LYMPHOCYTES
PROMONOCYTES
MONOCYTES 5.0
PLASMA CELLS
NRBCS
SUMMARY RESULTS
› All values are within reference ranges
› This case illustrates a sample with normal results and no observed abnormalities
CBC parameters indicate leukocytosis and normocytic anemia with anisocytosis. WBC results show
lymphocytosis, monocytosis and neutrophilia. Differential scatter plot displays population of cells
extending from the Lymphocyte region into Cellular Interference region.
LY 21.09 %
MO 10.53 %
NE 67.66 %
EO 0.49 l %
BA 0.24 %
MCV 95.3 fL
MCH 31.5 pg
RDW-SD 63.2 h fL
PLT
PLT RESULTS
MPV 10.52 fL
2 10 20 30 fL
24
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 62.2
LYMPHOCYTES 22.6
MONOCYTES 8.4
EOSINOPHILS 3.4
BASOPHILS 0.5
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
SUMMARY RESULTS
› The blood film confirms the leukocytosis and NRBC 1.0
CBC parameters indicate leukocytosis and microcytic hypochromic anemia with anisocytosis.
Thrombocytosis, platelet histogram demonstrates population of cells beyond 30 fl, which corresponds
to microcytic RBC. WBC results show neutrophilia and monocytosis. Differential scatter plot displays
population of cells extending from the Lymphocyte region into Cellular Interference region
LY 18.31 %
MO 10.80 %
NE 68.97 %
EO 1.29 l %
BA 0.63 %
MCV 64.3 L fL
MCH 19.2 l pg
RDW-SD 44.5 fL
PLT
PLT RESULTS
MPV 7.62 fL
2 10 20 30 fL
26
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 64.0
LYMPHOCYTES 19.05
MONOCYTES 11.8
EOSINOPHILS 1.0
BASOPHILS
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC 1.0
SUMMARY RESULTS
› The peripheral blood film shows hypochromic, microcytic RBCs alongside abundant target cells
and thrombocytosis
CBC parameters indicate leukocytosis and normocytic anemia with anisocytosis. RBC histogram is wide,
with some macrocytic RBC. Thrombocytopenia with abnormal Plt histogram, but Plt count is reported
without flags. Differential scatterplot displays single population of cells extending from the Lymphocyte
region into the Monocyte region, and from the Lymphocyte region into the Cellular Interference region,
as indicated by multiple instrument messages. Presence of abnormal large cells can be suspected as
indicated by the message “Large cells”. Differential results are flagged for review.
LY 17.42 R %
MO 81.94 Rh %
NE 0.46 Rl %
EO 0.10 Rl %
BA 0.07 Rl %
RBC RESULTS
FLAGS AND MESSAGES
RBC 2.33 I x106/μL
FLAGS: Abnormal Diff | Suspect Diff | LY/MO Overlap | Large Cells
HGB 7.45 L g/dL
HCT 22.4 I %
RBC
MCV 96.1 fL
MCH 32.0 pg
RDW 19.4 h %
30 100 150 200 fL
RDW-SD 69.3 h fL
PLT
PLT RESULTS
MPV 9.78 fL
2 10 20 30 fL
28
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 0.5
BAND NEUTROPHILS
LYMPHOCYTES 17.8
MONOCYTES 1.7
EOSINOPHILS 0.8
BASOPHILS
METAMYELOCYTES 0.2
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST 70.6
NRBC
COMMENTS
1+ Aniso, 1+ Macro, 1+ Poikilocytosis
SUMMARY RESULTS
Critical thrombocytopenia with almost no platelets observed under the microscope. The manual
differential confirms a very high percentage of blasts and critical neutropenia.
CBC parameters indicate leukocytosis and microcytic anemia with anisocytosis. WBC results show
monocytosis and neutrophilia. Differential scatterplot appears normal although with predominant
population of neutrophils. Thrombocytosis, platelet histogram appears normal.
LY 9.53 l %
MO 7.68 %
NE 79.83 h %
EO 2.51 %
BA 0.45 %
MCV 79.5 fL
MCH 25.4 pg
RDW-SD 54.2 h fL
PLT
PLT RESULTS
MPV 8.45 fL
2 10 20 30 fL
30
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 78.1
BAND NEUTROPHILS
LYMPHOCYTES 9.8
MONOCYTES 6.0
EOSINOPHILS 3.0
BASOPHILS
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC
COMMENTS
Giant platelets, 1+ Micro, 1+ Aniso
SUMMARY RESULTS
› The white blood cell differential confirms the analyzer’s results
› The peripheral blood smear confirms the thrombocytosis and presence of several large and giant platelets
DIAGNOSIS: THROMBOCYTOSIS
CBC parameters indicate slight macrocytosis. RBC histogram appears normal. The PLT histogram
displays cells at approximately 30 fL. Differential scatterplot displays population of cells extending from
the Neutrophil region into the Lymphocyte region and into the Cellular Interference region. Due to this
severe interference PLT results and differential results are flagged for review.
LY 29.25 R %
MO 9.30 R %
NE 58.11 R %
EO 3.12 R %
BA ..... %
MCV 98.9 h fL
MCH 35.3 H pg
RDW-SD 47.3 h fL
PLT
PLT RESULTS
MPV 11.59 Rh fL
2 10 20 30 fL
32
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 48.0
BAND NEUTROPHILS
LYMPHOCYTES 30.0
MONOCYTES 10.0
EOSINOPHILS 7.0
BASOPHILS 0.5
METAMYELOCYTES
MYELOCYTES 0.5
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC
COMMENTS
Platelet Clumps 3+
SUMMARY RESULTS
› Severe thrombocytopenia due to platelets’ aggregation
› The blood film confirms the aggregates and, thus, the
false thrombocytopenia
CBC parameters indicate a critical microcytic hypochromic anemia and anisocytosis. WBC histogram
shows predominant population in the Neutrophil region with good subpopulations’ separation.
LY 10.26 l %
MO 2.21 l %
NE 87.16 h %
EO 0.28 ll %
BA 0.08 l %
MCV 68.5 I fL
MCH 22.9 l pg
RDW-SD 35.8 l fL
PLT
PLT RESULTS
MPV 8.00 fL
2 10 20 30 fL
34
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 92.1
BAND NEUTROPHILS
LYMPHOCYTES 6.2
MONOCYTES 0.8
EOSINOPHILS
BASOPHILS 0.50
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC 0.5
COMMENTS
1+ Anisocytosis, 1+ Microcytosis
SUMMARY RESULTS
Manual differential results indicate a marked neutrophilia and microcytic, hypochromic red blood cells.
CBC parameters indicate leukocytosis, anisocytosis of RBC without anemia and thrombocytosis. RBC
histogram and Platelet histogram appear normal. WBC results show neutrophilia and monocytosis.
Differential scatter plot displays population of cells extending from the Lymphocyte region into Cellular
Interference region.
LY 6.56 l %
MO 7.42 %
NE 84.32 h %
EO 1.33 %
BA 0.37 %
MCV 86.9 fL
MCH 27.5 pg
RDW-SD 60.4 h fL
PLT
PLT RESULTS
MPV 7.95 fL
2 10 20 30 fL
36
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 77.68
LYMPHOCYTES 1.66
MONOCYTES 10.21
EOSINOPHILS 1.19
BASOPHILS 1.66
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC 1.0
COMMENTS
1+ Anisocytosis, 1+ Microcytosis
SUMMARY RESULTS
› Leukocytosis with neutrophilia and few immature granulocytes
› Marked thrombocytosis with some giant platelets
› The blood film shows one NRBC
DIAGNOSIS: LEUKOCYTOSIS WITH THROMBOCYTOSIS | LHS-046 81 FEMALE COLON CANCER
CBC parameters indicate leukocytosis and normocytic anemia with slight anisocytosis. RBC histogram
appears normal. Thrombocytopenia with abnormal platelet histogram, which exceeds the limits at PLT2
initiating the PLT 2: Debris message and PLT “R” flag. Differential scatterplot shows single population
extending from the Lymphocyte region into the Monocyte region. Presence of large abnormal cells can
be suspected as indicated by instrument message. Differential results are flagged for review.
LY 8.47 Rl %
MO 91.19 Rh %
NE 0.30 Rl %
EO 0.00 Rl %
BA 0.04 Rl %
RBC RESULTS
FLAGS AND MESSAGES
FLAGS: Abnormal Diff | Suspect Diff | PLT2 Debris | Large Cells RBC 2.77 I x106/μL
HCT 25.8 I %
MCH 31.3 pg
RDW 16.1 %
30 100 150 200 fL
RDW-SD 47.9 h fL
MPV 12.40 Rh fL
2 10 20 30 fL
38
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 0.255
BAND NEUTROPHILS
EOSINOPHILS 0
BASOPHILS 0/1 0
METAMYELOCYTES 0
MYELOCYTES 0/1 0
PROMYELOCYTES 0/5 0
ARTEFACT 5/4
GIANT THROMBOCYTE
CBC parameters indicate leukocytosis and normocytic anemia with anisocytosis. Platelets histogram
appears normal. Differential scatterplot displays abnormal pattern with predominant population of
neutrophils, extending into the Large cells’ region, suggesting presence of abnormal immature cells.
WBC differential results are flagged for review due to presence of multiple flags.
LY 2.82 Rl %
MO 3.28 Rl %
NE 93.34 Rh %
EO 0.27 Rl %
BA 0.29 R %
MCV 92.5 fL
MCH 29.3 pg
RDW-SD 56.4 h fL
PLT
PLT RESULTS
MPV 10.39 fL
2 10 20 30 fL
40
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 38.4
BAND NEUTROPHILS 50.0
LYMPHOCYTES 2.0
MONOCYTES 2.5
EOSINOPHILS 0.3
BASOPHILS 0.3
METAMYELOCYTES 2.2
MYELOCYTES 2.7
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC 3.0
COMMENTS
1+ Aniso, 1+ Poikilocytosis
SUMMARY RESULTS
› The blood film shows 50% of band Neutrophils some of which with mild toxic granulations
› Few metamyelocytes and myelocytes and few NRBCs confirm the suspicion of a leukemoid reaction
following the pancreatitis
LY 44.48 h %
MO 21.72 h %
NE 33.17 l %
EO 0.46 l %
BA 0.17 l %
RBC RESULTS
MCV 113.7 H fL
MCH 36.3 pg
RDW-SD 72.1 h fL
PLT
PLT RESULTS
MPV 11.38 fL
2 10 20 30 fL
42
BLOOD SMEAR (CELLAVISION™) MANUAL DIFFERENTIAL
NEUTROPHILS 30.5
BAND NEUTROPHILS
LYMPHOCYTES 46.5
MONOCYTES 21.5
EOSINOPHILS 1.0
BASOPHILS 0.5
METAMYELOCYTES
MYELOCYTES
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC
COMMENTS
RBC: macrocytosis | PLT: very rare PLT clumps
SUMMARY RESULTS
› Marked macrocytic normochromic anemia with thrombocytopenia
› WBC differential provided by the hematology analyzer is very similar to the manual differential
DIAGNOSIS: PLASMACELLULAR DYSCRASIA
CBC parameters indicate leukocytosis, macrocytic anemia with anisocytosis. Platelet histogram appears
normal although platelet count is slightly elevated. WBC results show monocytosis and eosinophilia.
Differential scatterplot displays population of cells extending from the Lymphocyte region into the
Cellular Interference region.
LY 22.17 %
MO 14.37 h %
NE 54.44 %
EO 8.73 h %
BA 0.28 %
HCT 22.5 I %
MCV 117.8 H fL
MCH 39.1 H pg
30 100 150 200 fL MCHC 33.2 g/dL
RDW 13.9 %
RDW-SD 63.9 h fL
PLT
PLT RESULTS
MPV 7.42 fL
2 10 20 30 fL
44
BLOOD SMEAR (CELLAVISION™)
MANUAL DIFFERENTIAL
NEUTROPHILS 53.1
LYMPHOCYTES 20.3
MONOCYTES 11.0
EOSINOPHILS 9.3
BASOPHILS 1.5
METAMYELOCYTES 1.5
MYELOCYTES 1.5
PROMYELOCYTES
ARTEFACT
SMUDGE CELL
GIANT THROMBOCYTE
BLAST
NRBC 3.0
COMMENTS
2+ Anisocytosis, 1+ Microcytosis, 1+ Macrocytosis
SUMMARY RESULTS
› The manual differential confirms the eosinophilia and the macrocytic anemia
› The presence of very abundant spherocytes explains the hyperchromia (MCH = 39.1 pg)
DIAGNOSIS: EOSINOPHILIA | CLS-051 65 MALE ANEMIA
*RUO parameters are not available for use in the United States.
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