4-Hematology Analyzer - Detecting Erroneous Blood Counts

Hematology analyzer - Detecting erroneous blood Counts
Developed by-Dr.Abdulrazzaq Othman Alagbare BACK to

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M.D - Dr.Alagbare
M.S.c C.P - Lecturer of Hematology and Immunohematology
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Diagnostic Hematology
Automation in white blood cells diagnosis
White blood cells on the 1. WBC count

blood cells analyzer 2. Differential WBC count (Derived
Give 2 parameters through WBC histogram)
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Diagnostic Hematology - Dr.Alagbare
Automated instruments are able to
1
Count a greater amount of
cells of WBC vs a manual
count by a technologist 2
Counted over 8,000 cells for 3
detecting WBC differential
Remark the falsely increased
or decreased count
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 All the result must be correlated to
the patient`s history
 For example, cytopenia could be
accepted without further review in
a patient known to have had recent  Similarly, an increased white blood cell count
(WBC) with a „left shift‟ flag could be
chemotherapy accepted in a postpartum or postoperative
patient
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Counts the WBC that have ‘flags’ indicating the
presence
 of blast cells,
 atypical lymphocytes
 or nucleated red blood cells (NRBC)
How solved?
o Require microscopic review By blood film
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Sickle cells and HbC resistant to lysis
 Sickle cells are often resistant to lysis within the limited time frame (less than 1
minute), during which the RBCs are exposed to the lysing reagent and the
WBCs are subsequently counted.
 As a result, the non-lysed RBCs are counted along with the WBCs, thus falsely
increasing the WBC count.
 When an automated cell counting analyzer indicates a review flag for the
WBC count, and sickle cells are noted on peripheral smear analysis,
 a manual WBC count must be performed.
 The manual method allows best time for sickle cell lysis and accurate
enumeration of the WBCs.
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WBC Diagnostic Alerts
Higher in the afternoon Neutrophils
Higher during pregnancy Neutrophils
Higher during exercise Neutrophils
Lowest in the morning Lymphocytes
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Errors in haemoglobin concentration and red cell indices
Turbidity resulting from
• High WBC over (50,000)
• Cryoglobulinaemia
• Non-lysis of red cells (AS, SS, AC, AE)
• Hyperlipidaemia, endogenous
Which parameter the Hb value effect ?
• MCH and MCHC
Why?
• their calculation depended on the Hb value
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Lipemia and the hematology analyzers results
 Lipemia interferes
with the accurate  hemoglobin..
determination of
 Does not generally  red blood cell count,

interfere with  white blood cell count,
determinations of  and platelet count.
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 an inaccurate Hb  MCH and MCHC those
affects the derived from the Hb value
hematology result of
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How correct the CBC result with lipemia
Method 1
When lipemia interferes with hemoglobin determination,
multiple approaches are commonly used to report the complete blood count.
The first is to report only
 The hematocrit,
 RBC,
 MCV,
 WBC,
 and platelet count
and indicate that an accurate Hb is not available due to lipemia,
IF the Hb NEEDED to rule out anemia , The patient must be fasted for 2-3 hrs and do the Hb
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Method 2
A second approach is to perform a saline replacement procedure that involves
1. centrifuging the specimen,
2. removing the plasma,
3. and replacing it with an equal amount of saline,
4. re-mixing the sample,
5. and running it on the analyzer.
Obtaining accurate results using this approach requires great care in removing the plasma and
replacing it with saline,
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Refer to the following scatterplot, histograms,
and automated values on a 33-year-old woman.
What follow-up verification procedure is
indicated before releasing these results ?
Answer: correct for lipemia
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Correcting the Count for Nucleated Red Blood Cells
 When nucleated red blood cells (NRBC) are

 “total nucleated
present, they will be included in the total
cell count”
WBC, which called a “total nucleated cell
(TNCC).?
count” (TNCC).
 NRBC Must
 included in the differential  The WBC should be
count, as a percentage and corrected to obtain the
absolute count as the WBC true total WBC
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NUCLEATED RED BLOOD CELLS – NRBC Error correction
WHERE TO USE NRBC
1. In healthy adult patients, NRBC count should be
zero!
2. The estimation of the NRBC used to correct
WBC numbers , to exclude a false high in the
WBC count
3. Is so important to corrected the WBC COUNT
In all cases which appear
4. This could lead to an incorrect diagnosis and
treatment, especially in
 Neonatal and young infants patients
with sepsis and low WBC counts.
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Correction for presence of nucleated RBCs—Manual Method
Correction for presence of nucleated
RBCs in the WBC Must correct white cell
count by using the following formula
Example
• WBC: 6000/CUM
• NRBC: 50/100 WBC
Correct the WBC count
 = 50/100+50=0.33
 0.33x 6000=2000
Corrected count=6000-2000= 4000/cum
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Malaria and blood cells counting
Malaria is a mosquito-borne infectious disease caused by parasites of the Plasmodium genus
The four most common species that infect humans
All four species are capable of digesting hemoglobin and causing hemolysis
Malaria effect on the blood cells counting
 False Increase the WBC during malaria parasites infection ,because the gametocytes and
merozoites counted as WBC
 In RBC/PLT channel may be counted as platelets if fall in the platelets counting zone and
they counted as platelets lead to false increase count
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Falsely high CASES
MCV Cold agglutinins
WBC very high
MCH  elevation of Hb
MCHC elevation of Hb
reduction in Hct
• Autoagglutination at room temperature may cause a low RBC count and high MCV from an
electronic counter.
• The Hct will be low because it is calculated from the RBC count.
• Low RBC count and low Hct cause falsely high calculations of MCH and MCHC, respectively.
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RBC Diagnostic Alerts -RBC, Hb and PCV/Hct increased
A change in the Hb must be 1.5 g% or more to be considered definitely significant.
 at higher altitude
 in men than in women
 vigorous exercise
 During the first week of life
 in the morning than the evening
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Platelets Diagnostic Alerts -
 The platelet count is higher in the afternoon and evening
 The platelet count has been observed to fall during pregnancy
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‫الحمد هلل‬
‫رب‬
‫العالمين‬
‫بهذا العمل‬
‫ارجو ابتغاء‬
‫مرضات هللا‬
‫‪23‬‬
‫‪Diagnostic Hematology - Dr.Alagbare‬‬

4-Hematology Analyzer - Detecting Erroneous Blood Counts

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4-Hematology Analyzer - Detecting Erroneous Blood Counts

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Hematology analyzer - Detecting erroneous blood Counts

Developed by-Dr.Abdulrazzaq Othman Alagbare BACK to

White blood cells on the 1. WBC count

Higher in the afternoon Neutrophils

Higher during pregnancy Neutrophils

Higher during exercise Neutrophils

Lowest in the morning Lymphocytes

 Does not generally  red blood cell count,

 When nucleated red blood cells (NRBC) are

 The platelet count is higher in the afternoon and evening

 The platelet count has been observed to fall during pregnancy

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