FLAGS AND TROUBLESHOOTS

3 PART DIFFERENTIAL CELL

COUNTERS
DR. PRASAD P. SHENOY
CENTRAL CLINICAL LABORATORY
PANAJI GOA
drpshenoy@g!"#.$o
3 PART DIFFERENTIAL CELL COUNTER
COMMON INSTRUMENT IN A HEMATOLOGY LABORATORY
CBC BREAD AND BUTTER OF HEMATOLOGY LAB
RAPID, ACCURATE AND PRECISE BLOOD COUNTS (CONSISTENT)
3 PART DIFFERENTIAL CELL COUNTER

HYDRODYNAMIC FOCUSSING

ELECTRICAL IMPEDENCE

VOLUMETRIC METERING

COLORIMETRY (Hb)
3 PART DIFFERENTIAL CELL COUNTER
PARTICLE > 35 !" RBC
PARTICLE # #$ !" PLATELET
HEMOGLOBIN AND %BC COUNT IN SECOND CHAMBER
RBC AND PLATELET COUNTED IN ONE CHAMBER
3 PART DIFFERENTIAL CELL COUNTER
DIRECTLY MEASURED PARAMETERS AND HISTOGRAMS
HEMOGLOBIN CONCENTRATION
%BC COUNT
RBC COUNT
PLATELET COUNT
%BC HISTOGRAM
RBC HISTOGRAM
PLATELET HISTOGRAM
3 PART DIFFERENTIAL CELL COUNTER
PARAMETERS DERIVED FROM HISTOGRAMS
LYMPHOCYTE PERCENTAGE
MID&SI'E CELL PERCENTAGE
GRANULOCYTE PERCENTAGE
MCV
RD%
MPV
PD%
3 PART DIFFERENTIAL CELL COUNTER
CALCULATED PARAMETERS
LYMPHOCYTE (
MID&SI'ED CELL (
GRANULOCYTE (
HEMATOCRIT
MCH
MCHC
PCT
3 PART DIFFERENTIAL CELL COUNTER

MANUAL DIFFERENTIAL COUNT REMAINS A

DEFINITIVE TOOL FOR COMPLETE HEMATOLOGIC
ANALYSIS

PERIPHERAL BLOOD SMEAR REVIE% IS

MANDATORY
FLAG

SIGNAL TO THE OPERATOR

INDICATES A SIGNIFICANT
ABNORMALITY IN THE ANALYSED
SAMPLE ) ANALYSER ITSELF
*UESTIONABLE RESULT
ANALYSER
RELATED
SAMPLE
RELATED
TROUBLESHOOTING
+
TROUBLESHOOTING

SYSTEMATIC APPROACH

ISOLATE A SOURCE OF A PROBLEM AND FI, IT

THROUGH A PROCESS OF ELIMINATION

FI, THE MOST OBVIOUS ) EASIEST PROBLEM FIRST

*UESTIONABLE RESULT
ANALYSER
RELATED
SAMPLE
RELATED
*C ACCEPTABLE
SAMPLE
RELATED
*C IS
OUT OF RANGE
ANALYSER
RELATED
*C
ANALYSER RELATED ERRORS

ELECTRONIC (HARD%ARE ) SOFT%ARE)

PRESSURE ) HYDRAULIC

REAGENT
3 PART DIFFERENTIAL CELL COUNTER
FLAGS ARE FE%
OPERATOR MUST BE ALERT
Hb" -5./ 0)1L
RBC" 5.-2 3 -$/ ) 4L
HCT" 55.2 6
MCV" 77./ !
MCH" 3$.- 80
MCHC" 33.3 0)1L
RD%" -#.2 6
RULE OF 3
NORMOCYTIC
NORMOCHROMIC
%BC " 9.$ 3 -$3 ) 4L
L:;8<(" -.7 3 -$3)4L
M=1( " $.3 3 -$3)4L
G>?@( " 5.2 3 -$3)4L
L:;8<6" #5.2 6
M=16 " 5.3 6
G>?@6" /2.7 6
PLT " #/9 3 -$3 ) 4L
MPV " 2.5 L
PD% " -5.#
PCT " $.-73 6
INTERFERENCES

RBC FRAGMENTS, VERY SMALL RBCA

NUCLEATED RBCA, LYSE RESISTANT RBCA

COLD AGGLUTININS

HIGH LEUBOCYTE COUNTS (>5$ 3 -$3)4L)

GIANT PLATELETS, PLATELETS CLUMPS

LIPEMIC SAMPLE

CRYOGLOBULINS

CLOTTED SAMPLE

AIR BUBBLES
CASE" -
#$ :C?>A ) FC;?!C
B>C?D<!CAA@CAA, C?A: ?D=04?b=!=D:
L?EF G EG@EC@D>?D=G@, 0=11=@CAA
Hb" L 5.# 0)1L
RBC" L 3.$2 3 -$/ ) 4L
HCT" L -5.3 6
MCV" L 55.$ !
MCH" L -3.5 80
MCHC" L #5.7 0)1L
RD%" H #5.5 6
%BC" 5.5 3 -$3 ) 4L
PLT" H 5/- 3 -$3 )4!
MICROCYTIC HYPOCHROMIC
ANEMIA

IDA

THALASSEMIA

ANEMIA OF CHRONIC
DISORDERS
MENT'ERS INDE, (M. I.)
M. I . H MCV ) RBC
I M. I. > -3" IDA
I M. I. I -3" T<?!?AAC;=?
S400CAD=JC G I>G@ 1C=E=C@E: A@C;=?
A1J" S>. I>G@, TIBC, FC>>=D=@
I>G@" -#.3$ 39 & -55 40)1L
TIBC" 5/3 #-5 & 535 40)1L
6 T>?@AC>>=@" 3.#3 -3 & 55 6
FC>>=D=@" -.7$ -3 & -5$ @0);L
M. I. H 55)3.$2
H -9.7
CASE" #
#3 :C?>A ) FC;?!C
P>C0@?@D, -# KCCFA
TGD?! B=! " -.- ;0)1L
CG@L40?DC1 B=!" $.3 ;0)1L
T>?@A?;=@?ACA" NG>;?!
Hb" L -$.- 0)1L
RBC" 5.72 3 -$/ ) 4L
HCT" L 3-.2 6
MCV" L /5.$ !
MCH" L ##.7 80
MCHC" L 3$.5 0)1L
RD%" H -9.# 6
%BC" 9.5 3 -$3 ) 4L
PLT" 5-7 3 -$3 )4!
M. I. H /5)5.72
H -3.#2
MICROCYTIC HYPOCHROMIC ANEMIA
A1J" S>. I>G@, TIBC, FC>>=D=@
HC;G0!Gb=@ C!CED>G8<G>CA=A
HC;G0!Gb=@ E!CED>G8<G>CA=A
HbA = 93.7 94.3 98.5
HbF = 0.9 0.2 2.0
HbA2 = 5.7 1.5 3.5
I>G@" #-.5$ 39 & -55 40)1L
TIBC" 5$5.-$ #-5 & 535 40)1L
6 T>?@AC>>=@" 5.#7 -3 & 55 6
FC>>=D=@" 7.-2 -3 & -5$ @0);!
M T<?!?AAC;=? D>?=D K=D<
I>G@ 1C=E=C@E:
CASE" 3
5/ :C?>A ) FC;?!C
%C?F@CAA, P?>CAD<CA=?
NG G>0?@G;C0?!:
Hb" L 9.- 0)1L
RBC" L -.7$ 3 -$/ ) 4L
HCT" L #-.5 6
MCV" H --2.2 !
MCH" H 32.5 80
MCHC" 35.$ 0)1L
RD%" H #$./ 6
%BC" 3.7 3 -$3 ) 4L
PLT" -#9 3 -$3 )4!
MACROCYTIC
ANEMIA
MACROCYTIC ANEMIA, FAVOUR
MEGALOBLASTIC
A1J" S>. V=D?;=@ B&-# ?@1 FG!=E ?E=1
V=D?;=@ B&-# --3.#3 #-- 25/ 80);!
FOLIC ACID -.-# >5.37 @0);!
MEGALOBLASTIC ANEMIA
THERAPEUTIC TRIAL
RETICULOCYTE RESPONSE

V=D?;=@ B -# N FG!=E ?E=1 1C=E=C@E:

M:C!G1:A8!?AD=E A:@1>G;CA

HC;G!:D=E ?@C;=?A

M:C!G8<D<=A=E ?@C;=?A

A8!?AD=E ?@C;=?

C<>G@=E L=JC> 1=AC?ACA

MACROCYTIC ANEMIA
MACROCYTIC ANEMIA
A1J" S>. V=D?;=@ B&-# ?@1 FG!=E ?E=1
V=D?;=@ B&-# 795.72 #-- 25/ 80);!
FOLIC ACID #9.5/ >5.37 @0);!
+
MACROCYTIC ANEMIA
WITH FEATURES OF
DYSPASTIC HEMATOPOIESIS
BONE MARRO%
N
CYTOGENETIC STUDIES
CASE" 5
/3 :C?>A ) M?!C
Hb" L 2.$ 0)1L
RBC" L 3.7/ 3 -$/ ) 4L
HCT" L #9.2 6
MCV" L 9#.3 !
MCH" L #3.3 80
MCHC" 3#.# 0)1L
RD%" H #2.# 6
%BC" 7.3 3 -$3 ) 4L
PLT" #57 3 -$3 )4!
DUAL PEAB
M. I. H 9#.3 ) 3.7/
H -7.93
POST BLOOD TRANSFUSION
CASE" 5
53 :C?>A ) FC;?!C
+ FEVER
%BC" H 3-$./ 3 -$3 )
4L
L:;8<(" H 3-.5 3 -$3)4L
M=1( " H 53.7 3 -$3)4L
G>?@( " H #35./ 3 -$3)4L
L:;8<6" L -$.- 6
M=16 " -5.- 6
G>?@6" H 95.7 6
Hb" L 2.5 0)1L
PLT" H /72 3 -$3)4L
FC?D4>CA EG;8?D=b!C K=D< ?
M:C!G8>G!=C>?D=JC @CG8!?A;"
CHRONIC MYELOID LEUBEMIA IN CHRONIC
PHASE
A1J" MG!CE4!?> ) C:DG0C@CD=E AD41=CA G>
P<=!?1C!8<=? E<>G;GAG;C
Hb" L 2.5 0)1L
RBC" L -.99 3 -$/ ) 4L
HCT" L -/./ 6
MCV" 25.- !
MCH" H 53.- 80
MCHC"H 5/./ 0)1L
RD%" H ##.3 6
PLT" H /72 3 -$3)4L
HEMOGLOBIN PERFORMED BY MANUAL
(CYANMETH) METHOD
7.3 0)1L
9.- 0)1L (?DC> EC@D>=40?D=G@)
CASE" /
/3 :C?>A ) FC;?!C
O8C>?DC1 E?AC G C?&OJ?>:,
G@ C<C;GD<C>?8:, G>
G!!GK 48
Hb" -#.5 0)1L
RBC" 5.59 3 -$/ ) 4L
HCT" 35.2 6
%BC " /.9 3 -$3 ) 4L
PLT " L 5/ 3 -$3 ) 4L
MPV " H -5.5 L
PD% " H -2
G=?@D P!?DC!CDA
P!?DC!CD E!4;8A
EDTA =@14EC1 8!?DC!CD E!4;8=@0
SPURIOUS
THROMBOCYTOPENIA
A!"#$%&'()'*'#+
D>. P. R. M?!4>, D>. A@=D? BG>0CA
D>. C. N. N?=>, D>. S4;CCD G4L>?!
D>. MG@? A@?@1, D>. M?@=
D>A" A>E<?@?, A@A<4;?@, A1=D=, S4@=D?, B=>?@,
B?@E<?@, M?@4, S?@=E?.
E@D=>C SD? G HC;?DG8?D<G!G0: L?bG>?DG>:,
TMH, M4;b?=
MA. S?!=@= GG8=@?D<?@
D,. P,-.-( P. S/'#$0
C'#+,-& C&1#1!-& -b$,-+$,0
P-#21* 3$-
thank you