K-Series: Histogram Interpretation

Histogram
Interpretation

After Lysis- Reagent

Lymphocytes

Neutrophils
Monocytes
Basophiles
Eosinophiles

0 50 100 150 200 250 300

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 K-Series: Histogram Interpretation
Normal Result

NO. 4
Date: 9/10/95 15:11 Parameter of CBC
MODE: Whole Blood
WBC 5,8 x 103/µl
RBC 4,84 x106/µl
HGB 13,7 g/dl
HCT 42,0 %
MCV 86,8 fl
MCH 28,3 pg
MCHC 32,6 g/dl
PLT 257 x103/µl
Leucocyte Histogram
WBC
 Lymphocytes in % and absolut
300  Eo, Mono, Baso in % and absolut
LYMPH% 31,2 %  Neutrophils in % and absolut
MXD% 6,8 %
NEUT% 62,0 %
LYMPH# 1,8 x103/µl
MXD# 0,4 x103/µl
NEUT# 3,6 x103/µl

Erythrocyte - Histogram
RBC

250  RBC Distribution Curve

RDW-SD 40,0 fl
Thrombocyte Histogram
PLT
PLT Distribution Curve
40
Mean PLT Volume
PDW 13,1 fl
MPV 10,4 fl Share of bigger PLT
P-LCR 28,1 %

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 K-Series: Histogram Interpretation
Normal Ranges

White Blood Cell Count

Parameter Age Units SI-Units
WBC Adults 4-10 x 103/µl x 109/l
Childs till 12 x 103/µl x 109/l
Newborns till 15 x 103/µl x 109/l

Lymph. Adults 25-40 %

Childs, Newborns till 70 %
MXD Adults 3-13 %
Neutro. Adults 50-70 %

Lymph. Adults 1-4 x 103/µl x 109/l

Childs till 5 x 103/µl x 109/l
Newborns till 6 x 103/µl x 109/l
MXD Adults 0,2-1 x 103/µl x 109/l
Neutro. Adults 2-7 x 103/µl x 109/l

Red Blood Cell Count

Parameter Age Units SI-Units

RBC Men 4,6-6,2 x 106/µl x 1012/l
Women 4,2-5,4 x 106/µl x 1012/l
HGB Men 14-18 g/dl 8,5-11,0 mmol/l
Women 12-16 g/dl 7,5-10,0 mmol/l
HCT Men 43-49 % 0,43-0,49 mmol/l
Women 36-46 % 0,36-0,46 mmol/l

MCV 85-95 fl
MCH 27-33 pg 1,68-2,05 fmol
MCHC 32-36 g/dl 19,9-22,4 mmol/l

RDW-SD 37-46 fl (Width in 20% of the Peak hight)

RDW-CV 11-16 % (calc. width of the 68 % Peak hight)

Thrombocytes
Parameter Age Units SI-Units
PLT 150-400 x 103/µl x 109/l

PDW 9-14 fl (Width in 20% of the Peak hight)

MPV 8-12 fl
P-LCR 15-35 %

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 K-Series: Histogram Interpretation
RBC- and PLT-Histograms

2 fl 25-30 fl 250 fl

• The two distribution curves are separated from each

other by a moving auto discriminator looking to the
Plateau.
• Platelets have a size between 8 and 12 fl and are
counted between 2 and 30 fl.
• Erythrocytes have a size of 80-100 fl and are counted
between 25 and 250 fl.

LD UD
LD: Lower Discriminator
UD: Upper Discriminator

Basis line

2 fl 250 fl

• The Size Distribution Curve should always start on the

base line and fall between the lower and the upper
discriminator.

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 K-Series: Histogram Interpretation
Erythrocyte-Histogram Flagging

Mark “ RL “, abnormal height at lower discriminator

LD
RBC

The curve does not start at the base line.

PLT

Possible causes:
• Giant Platelets
• Micro-Erythrocytes
• Platelet Clumps

Caution:
All results marked with “ RL “ should be controlled.

Mark “ RU “, abnormal height at the upper discriminator.

UD
RBC

The curve does not start at the base line.

Possible causes:
• Cold Agglutinins (check MCHC > 40 g/dl)
• Erythroblasts / Normoblasts

Caution :
RBC-result and all results marked with “ RL “ should be
controlled.

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 K-Series: Histogram Interpretation
Erythrocyte-Histogram Flagging

“ MP “, multiple peaks found

RBC

Possible causes:
• Iron deficiency in therapy
• Infection or Tumor Anemia (visceral iron deficiency)
• Transfusions

“DW “, abnormal histogram distribution

RBC

• Distribution curve does not cross 20% level twice.

• The overall height of the curve is always 100 %. The
width is calculated on the 20 % height of the curve.
• Hint for extreme Aniso- or. Poikilocytosis.

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 K-Series: Histogram Interpretation
Erythrocyte-Histogram Distribution width

RDW-CV

100 % RDW-CV (%) = 100 x s/µ

Turning points

RDW-CV = 11 - 16 %

s µ s
68,26 %
of all results

RDW-SD

100 %
RDW-SD = 37 - 46 fl
Clinical relevant > 60 fl

20 %

RBC Distribution Curve as a parameter for anisocytosis

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 K-Series: Histogram Interpretation
Thrombocyte-Histogram

Within Two Discriminators

• The histogram should lay within the

two discriminators and start and end
on the base line.
• PLT counted between 2 fl and 30 fl.
1 flexible Discriminator PL 2 to 6 fl.
1 flexible Discriminator PU 12-30 fl.
1 fixed Discriminator at 12 fl

fl
LD UD
100 %

PLT P-LCR

Pct (%)
MPV (fl) =
PLT (x 103/µl) 20 %

PDW12 fl

Parameters of the Thrombocyte histogram

– MPV (mean PLT volume) Ref range: 8 - 12 fl
– P-LCR (ratio of large platelets) Ref range: 15 - 35 %
– Increase could be a sign for:
• PLT Clumps
• Giant PLT
• Microerythrocytes

– PDW, (platelet distribution width at 20 % of peak height

Ref range: 9 - 14 fl
Increase could be a sign for:
• PLT Clumps
• Microerythrocytes
• Fragments

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 K-Series: Histogram Interpretation
Thrombocyte-Histogram Flagging

Mark “ PL “, abnormal height at lower discriminator

PLT
The curve does not start at the base line.

Possible cause:
• High blank value
• Cell fragments

Caution :
Check Blank! Auto Rinse

Mark “ PU “, abnormal height at upper discriminator

PLT

The curve does not end on the base line.

Possible Cause :
• PLT Clumps
EDTA-Incombatibility
Clotted sample
• Giant Platelets
• Microerythrocytes
Caution :
Check PLT-Result (and all parameters marked with “ PU “! In the
event of perform the counting chamber or check PLT via Fonio!

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 K-Series: Histogram Interpretation
Thrombocyte-Histogram Flagging

Mark “ MP “, Multi Peaks found

PLT

Possible Cause:
• Platelet transfusion

Mark “ DW “, Distribution With

PLT

• The distribution can not be detected because the

Histogram does not cross the 20 % limit twice.
• This curve in only an example but could also show
another course.
• The overall height of the curve is always 100 %. The
width is calculated on the 20 % height of the curve.

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 K-Series: Histogram Interpretation
Leukocyte-Histogram

Lyse of RBC and partial lyse of WBC

After Lysis

Mitochondria Electrolyte solution

Nucleus

Cell membrane

Ribosome

Cytoplasm

Before adding lysing reagent

Cell diameter in µm
Neutrophils 10 - 15
Basophils 9 - 14
Eosinophils 11 - 16
Monocytes 12 - 20
Lymphocytes 7 - 12
µm
0 2 4 6 8 10 12 14 16 18 20 22

After adding lysing reagent

Lymphocytes

Cell diameter in fl
Neutrophils
Monocytes Lymphocytes 30 - 80
Basophiles Monocytes 60 - 120
Eosinophils 70 - 130
Basophils
Eosinophils 80 - 140
0 50 100 150 200 250 300
Neutrophils 120 - 250
fl

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 K-Series: Histogram Interpretation
Leukocyte-Histogram

Within Two Discriminators

LD T1 T2 UD ( fixed)

0 50 100 150 200 250 300

Important :

• The distribution curve should be within the discriminators. The

curve should start and end at the basis line.

• The LD is flexible, but can not be lower than 30 fl.

• The WBC-channel shows Leukocytes and

Thrombocytes ( Erythrocytes are lysed).

• The volume of the Thrombocyts is usually between 8 - 12 fl,

therefore the LD at the WBC-Histogramm seperates the
Leukocytes from the Thrombocytes. (Thrombocytes were not
counted).

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 K-Series: Histogram Interpretation
Leukocyte-Histogram Flagging

Flag “ WL “, Curve does not begin at the basis line

Possible causes :
• PLT Clumps
EDTA-Incombatibility
coagulated Sample
• high osmotic resistant (Erythrocytes not lysed)
• Erythroblasts
• cold agglutinate

Caution : Check WBC – Result and all parameters marked with “WL”

2. Flag “ WU “, Curve does not end at the base line.

Caution: Check WBC – Result and all parameters marked with “WL”
Dilute sample 1:5 ? (high leukocyte count ? )

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 K-Series: Histogram Interpretation
Leukocyte-Histogram Flagging

3. Flag “T1” and “T2”

T1 and T2 are valley discriminators defined by the plateau.
This discriminators separates the Leukocytes populations.
LD T1 T2 UD ( fixed)

F = Fraction
Population 3 = F3

0 50 100 150 200 250 300

Population 1 = F1 Population 2 = F2

• The discriminators are flexible and will be set automatically

according to the sample.
• In special cases is a separation from the valley
discriminators not possible.

T1: T1 could not be detected

No plateau was found.
>T 1 flag

T2: T1 was detected but not T2

>T2 flag

Attention:
• Confirm the result with the microscope if T1 or T 2 flag
was indicated.
• The WBC result will be correct if no flag is indicated. All
Leukocytes are counted.

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 K-Series: Histogram Interpretation
Leukocyte-Histogram Flagging

3. Flag “F1” , “F2” and “F3”

The Histogram of the Leukocytes is limited from the

outer discriminators LD and UD.

F1: Lymph.
F2: MXD
F3: Neutro.

F1 F2 F3

• All Leukocytes are counted; WBC total is correct.

(Assumption: no other flags)
• T 1 and T 2 were detected.
• Conspicuous is:
The troughs are away from the basis line.

LD T1 T2 UD

Normal

0 100 200 300

There is a potential of mixing populations.

F 1 and F 2 move together, also F2 and F3.
To get a correct differential it is necassary to do a manual
differentiation.

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 K-Series: Histogram Interpretation
Summery of all flags

NO. 4
WL: Abnormal height at lower discriminator
DATE: 9/10/95 15:11 of WBC Histogram (LD)
MODE: WHOLE BLOOD
WBC 5,8 x 103/µl
WU: Abnormal height at upper discriminator
RBC 4,84 x106/µl of WBC Histogram (UD)
HGB 13,7 g/dl
HCT 42,0 %
T1: Valley 1 not found
MCV 86,8 fl T2: Valley 2 not found
MCH 28,3 pg
MCHC 32,6 g/dl
F1, F2, F3: Abnormal height at the points
PLT 257 x103/µl T1 or T2; adjacent fractions are marked

WBC
RL: Abnormal height at lower discriminator
300 of RBC Histogram (LD)
LYMPH% 31,2 %
RU: Abnormal height at upper discriminator
MXD% 6,8 % of RBC Histogram (UD)
NEUT% 62,0 %
LYMPH# 1,8 x103/µl
MP: Multiple peaks: Distinguish ?? of two
MXD# 0,4 x103/µl RBC Populations
NEUT# 3,6 x103/µl
DW:The distribution (RDW) can not be
detected because the Histogram does not
RBC
cross the 20 % limit twice.
PL: Abnormal height at lower discriminator
250
of PLT Histogram (LD)
RDW-SD 40,0 fl
PU: Abnormal height at upper discriminator
PLT
of PLT Histogram (UD)
MP: Multiple Peaks found
40 DW:The distribution (PDW) can not be
PDW 13,1 fl detected because the Histogram does not
MPV 10,4 fl
P-LCR 28,1 %
cross the 20 % limit twice.

The following cases are analysed with the SYSMEX KX-21.

Differences of the Histogram-Version are instrument specific and
have no analytical influence.

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 K-Series: Histogram Interpretation Cases
Elevated number of WBC

Neutrophilia Lymphocytosis

WBC-Histogram WBC-Histogram

Results Differential Results Differential

WBC + 23.8 x109/L Band 8% WBC 7.9 x109/L Band 4%
LYM% 8.1% Seg 77 % LYM% + 64.7% Seg 20 %
MXD% 7.9% Lymph 7% MXD% 15.8% Lymph 64 %
NEUT% 84.0% Mono 7% NEUT% – 19.5% Mono 4%
Eo 1% Eo 5%
Baso 0% Baso 0%
Aty-Lym 3%

(x 400)
(x 1000)

Clinical diagnosis: Neutrophilia Clinical diagnosis: Lymphocytosis

Prominent peak with broad distribution High, pointed peak in lympho area
(NEUT%) for large leukocytes. (LYM%).

In case of Lymphocytopenia a similar In case of Neutropenia a similar

curve is obtained. curve is obtained.

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 K-Series: Histogram Interpretation Cases
Increase number of WBC

Monocytosis Eosinophilia

WBC-Histogram WBC-Histogram

Results Differential Results Differential

WBC 7.7 x 109/L Stab 8% WBC 4.3 x109/L Stab 1%
LYM%F1 * 13.2% Seg 37 % LYM% 18,3% Seg 19 %
MXD%F2 * 37.7% Lymph 17 % MXD% + 62,2% Lymph 20 %
NEUT% 49.1% Mono 35 % NEUT% – 19.5% Mono 9%
Eo 1% Eo 47 %
Baso 0% Baso 1%
Met 1% My 1%
Aty-Lym 1% Met 1%
Aty-Lym 1%

(x 1000) (x 1000)
Clinical diagnosis: Monocytosis Clinical diagnosis : Eosinophilia
Monocytes, which are the largest Eosinophils and basophils, which are
leukocytes in normal peripheral blood, categorized as granulocytes together with
become smaller than neutrophils under the neutrophiles, are smaller than neutrophils
influence of the lysing reagent. On the due to contraction under the influence of
histogram, they fall in the middle cell ratio the lysing reagent.
(MXD%) ( ). On the histogram, they are located in the
Similar patterns can be seen in middle cell ratio MXD%( ) where also
eosinophilia. These two different clinical monocytes are present.
entities need to be differentiated from each A similar pattern can be seen in
other by manual differential. monocytosis. Both diseases must be
differentiated from each other by manual
differential.

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 K-Series: Histogram Interpretation Cases
WBC Agglutination

Case 1 Case 2

WBC-Histogram WBC-Histogram

Results Results
WBC – 2.3 x 109/L WBC – 2.1 x 109/L
LYM% 39.7% LYM% 41.9%
MXD% + 32.2% MXD% 17.5%
NEUT%– 28.1% NEUT%– 40.6%

(x 1000) (x 1000)

Case: WBC-Agglutination

This is a case of WBC agglutination, which occurs rather rarely. The

histogram does not shown a clear tri-modal pattern, with particles present in
the region above 250 fl ( ). The count of leukocytes is likely to be falsely
low. Depending on the nature of leucocytes antibodies, agglutination may be
dissolvable and measurement may become possible upon incubation the at
37 o C or upon washing the samples with isotonic saline.

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 K-Series: Histogram Interpretation Cases
Nucleated red blood cells (NRBC)

WBC-Histogram Results
WBC WL* 56.1 x 109/L
LYM% WL* 42.7%
MXD% WL -.---
NEUT% -.---

(x 1000)

Case: Orthochromatic Erythroblasts (NRBC‘s)

at a concentration of 1352/100 WBC

This is a sample with an extreme number of NRBC. The valley between the
erythrocytes ghost area and the small leucocytes area exceeds the limit, and WL
flags are given. NRBC are likely to contribute significantly to the population on
the WBC histogram ( ) ; therefore most of them are counted as leukocytes.
Measurement of samples having NRBC must be corrected by the following
equation:

corrected WBC Count = measured WBC-Count x 100

(100 + NRBC count *)

* NRBC Count: The number of NRBC per 100 leukocytes.

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 K-Series: Histogram Interpretation Cases
Anemia

Iron Deficiency Anaemia Suspected Thalassemia

RBC-Histogram Result RBC-Histogram Result

RBC 4.48 x1012/L RBC +5.97 x1012/L
HGB 8.8g/dl HGB 12.7g/dl
HCT 29.3% HCT 41.1%
MCV – 65.4fl MCV – 68.8fl
MCH – 19.6pg
MCH – 21.3pg
MCHC – 30.0g/dl
RDW-CV + 18.2% MCHC – 30.9g/dl
RDW-CV 14.7%
PLT-Histogram Result PLT-Histogram Result
PLT PU*235 x109/L PLT 391 x109/L
PDW 11.7fl PDW 12.0fl
MPV 9.4fl MPV 10.3fl
P-LCR 21.7% P-LCR 27.3%

(x 1000) (x 1000)

1. Case: 2. Case:

Results: Results:
MCV, MCH and MCHC shows low MCV, MCH and MCHC shows low
values and RDW-SD shows a high values
value. Differential:
Differential: no prominence in the smear
hypochromic RBC´s
Due to the increase in erythrocyte
Thus this case is identified as count and the low RDW value this
microcytic hypochromic anemia case is cassified as a
thalassaemia minor.

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 K-Series: Histogram Interpretation Cases
Anemia

Iron def. anaemia under treatment Macrocytic Anaemia (CML)

2nd Week of treatment WBC-Histogram Results

RBC-Histogram Results WBC + 17.3 x109/L

LYM% 16.4%
RBC 4.37 x1012/L
MXD% T2 -.---
HGB 10.4g/dl
NEUT T2 -.---
HCT 35.3%
%
MCV – 80.8fl
MCH – 23.8pg
MCHC – 29.5g/dl
RDW MP* + 35.7% RBC-Histogram Results
RBC – 1.64 x1012/L
HGB – 6.2g/dl
HCT – 18.2%
MCV + 110.0fl
MCH 37.8pg
MCHC 34.1g/dl
RDW 15.2%

(x 1000)

4nd week of treatment

RBC-Histogram Results
RBC 5.14 x1012/L
HGB 13.2g/dl
HCT 42.5%
MCV – 82.7fl
MCH – 25.7pg
MCHC – 31.1g/dl
RDW MP* + 31.9%

(x 1000)

(x 1000)

The initial effect of the treatment can be seen (x 1000)

in data of the 2th week, where the RBC
histogram indicates the appearance of This is a macrocytic anaemia with
normocytic cells while a large number of development of chronic myelogenous
microcytic cells still are visible in the smear. leukemia (CML). The RBC histogram
The RBC histogram of the 4th week still suggests the existence of macrocytes,
shows a 2-peak curve, but the peak of larger while the WBC histogram does not show,
cells became more prominent than the other the valley normally seen between the
peak. Compared to the top diagram, this MXD and the large cell ratio, suggesting
shows an further increase in the number of the appearance of leukocytes with
normocytes as a result of the treatment. various sizes.

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 K-Series: Histogram Interpretation Cases
Anisocytosis

Case1 Case2

RBC-Histogram Results RBC-Histogram Results

RBC 4.15 x1012/L RBC 2.95 x1012/L
HGB 14.0g/dl HGB 9.9g/dl
HCT 40.8% HCT 28.7%
MCV 98.3fl MCV 97.3fl
MCH 33.7pg MCH 33.6pg
MCHC 34.3g/dl MCHC 34.5g/dl
RDW + 22.7% RDW + 26.4%

PLT-Histogram Results PLT-Histogram Results

PLT 328 x109/L PLT PL* 98 x109/L
PDW 12.4fl PDW DW ---.-fl
MPV 10.2fl MPV PL ---.-fl
P-LCR 26.5% P-LCR PL -.---%

(x 1000) (x 1000)

Microcytes and macrocytes are visible The distribution width of the RBC
among normocytes in the smear, and the histogram is abnormally wide as seen in
distribution on the RBC histogram is case 1, but the proportion of erythrocytes
abnormally wide. This suggest the below 90 fl is higher in case 2. The PLT
appearance of various sizes of erythrocytes. histogram indicates abnormality and the PL
and DW flags are given. This suggest that
microcytes may have interferred with the
Platelet count. Such result needs to be
confirmed by other methods, like Fonio
method or counting chamber.

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 K-Series: Histogram Interpretation Cases
Poikilocytosis

Case 1 Case 2

RBC-Histogram Results RBC-Histogram Results

RBC 3.62 x1012/L RBC 2.67 x1012/L
HGB 11.1g/dl HGB – 6.2g/dl
HCT 31.9% HCT – 22.5%
MCV 88.1fl MCV – 84.3fl
MCH 30.7pg MCH – 23.2pg
MCHC 34.8g/dl MCHC – 27.6g/dl
RDW + 25.5% RDW + 20.1%

PLT-Histogram Results PLT-Histogramm Results

PLT 152 x109/L PLT 235 x109/L
PDW 16.2fl PDW 11.7fl
MPV 10.4fl MPV 9.4fl
P-LCR 31.4% P-LCR 21.7-%

(x 1000) (x 1000)

Two cases: Poikilocytosis with a lot of echinocytes

The abnormally wide distribution on the RBC histogram suggests the appearance
of various sizes of erythrocytes with a high percentage of microcytes.

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 K-Series: Histogram Interpretation Cases
Large Platelets

Case 1 Case 2

PLT-Histogram Results PLT-Histogram Results

PLT 237 x109/L PLT PU 71 x109/L
PDW + 18.0fl PDW DW ---.-fl
MPV 12.4fl MPV DW ---.-fl
P-LCR + 44.1% P-LCR DW -.---%

(x 1000) (x 1000)

Case 1: Giant platelets Case 2: large platelets

The abnormally wide distribution on Although the wide distribution on the

the PLT histogram suggests the PLT histogram suggests the
appearance of giant platelets. The appearance of large platelets, the
distribution curve intersects the distribution curve intersects the
discriminator line at a low point, which discrimination line at a high point.
shows that the platelet count has This result needs to be confirmed by
been measured correctly. other methods i.e Fonio method or
counting chamber.

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 K-Series: Histogram Interpretation Cases
Platelet Aggregation

Case 1 Case 2

WBC-Histogram Results WBC-Histogram Results

WBC 6.0 x109/L WBC WL* 6.4 x109/L

LYM% 27.5% LYM% WL* 41.4%
MXD% 7.9% MXD% WL* 14.0%
NEUT 64.4% NEUT WL* 44.6%
% %

PLT-Histogram Results PLT-Histogram Results

PLT 86 x109/L PLT PU 55 x109/L
PDW + 18.6fl PDW DW ---.-fl
MPV 12.8fl MPV DW ---.-fl
P-LCR + 43.7% P-LCR DW -.---%

(x 400)
(x 400)

Case 1: Platelet Aggregation Case 2: Platelet Aggregation

The smear clearly shows that platelets are This sample contains larger aggregation
aggregating. The WBC histogram shows a clusters as shown in the smear. These
peak in the ghost area clusters are considered affect the leukocyte
( ) , while the PLT histogram shows a counts, because the distribution curve on
wide distribution. Although these large the WBC histogram intersects the
particles usually affect the leucocyte discriminator line between the ghost and
counts, the leukocytes distribution of case the Small cell ratio at a high point, and the
1 is well separated from the ghost area on WL flags are given. The PLT histogram
the WBC histogram, probably without any suggests the presence of large particles.
effect of small particles in the ghost area. Analysis of a fresh blood sample is required
There is no WL Alarm given . to obtain correct platelet values.

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 K-Series: Histogram Interpretation Cases
Cold Agglutinins

Incubation 30 min

RBC-Histogram Results RBC-Histogram Results

RBC RU* 2.23 x1012/L RBC 4.35 x1012/L
HGB 14.4g/dl HGB 14.5g/dl
HCT RU* 24.9% HCT 43.5%
MCV RU* 111.7fl MCV 100.0fl
MCH RU* 64.6pg MCH 33.3pg
MCHC RU* 57.8g/dl MCHC 33.3g/dl
RDW * 25.4fl RDW 14.7fl

(x 1000) (x 1000)

Case: Cold agglutinins

Because in this case erythrocytes have passed through the detector as clusters
of several cells, the RBC, HCT,MCH, MCV, MCHC and RDW values are
abnormal. The RBC histogram shows a second peak.

After the clusters have been dissolved by incubation, all erythrocytes are
detected as single cells. Therefore the second peak on the RBC histogram does
not appear and the RBC, HCT, MCV, MCH, MCHC and RDW values are
normal.

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 K-Series: Histogram Interpretation
Insufficient Lysing of Erythrocytes

WBC-Histogram Results

WBC WL* 49.4 x109/L

LYM% WL -.---
MXD% WL -.---
NEUT WL -.---
%

(x 1000)

Case: Lyse Resistance RBC

The histogram show a pattern typically seen in insufficient lysing of

erythrocytes. On the WBC histogram the distribution curve intersects the WBC
lower discrimination line at an abnormally high point. The WL flag is output and
asterisk marks are put to the leucocyte value, warning of low reliability of the
data.
This is frequently seen with blood samples taken from hepatic disease patients
or very early newborns. These problems are solvedby diluting the sample or
replacing plasma with cellpack (blood cell washing).

The smear photo shows large platelets and acantocytes, suggesting hepatic
diseases.

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