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3-Diff Clinical Cases Study

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Case presentation

RBC Morphology and relative disease

WBC Morphology and relative disease

PLT Morphology and relative disease

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RBC Morphology and relative disease


Microcytic anemia

MCV,RDW
application

Normocytic anemia

Macrocytic anemia

Iron deficiency anemia


-Globin aplastic anemia

Aplastic anemia
Nutrition deficiency anemia
Megaloblastic anemia
Some liver disease anemia

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MCV,RDW diagnosis using


Microcytic Anemia :Characterized by small red cells

Anemia
classification

MCV
range

MCV / RDW
phenomenon

Possible Pathology

Microcytic anemia MCV<80


(symmetrical)

MCV value is decreasing


RDW value is normal

Thalassemia
Secondary anemia

Microcytic anemia MCV<80


(non-symmetrical)

MCV value is decreasing


RDW value is increasing

Iron deficiency anemia


-Globin aplastic anemia
HbH diseases

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MCV,RDW diagnosis using


Normocytic anemia is when the overall Hb levels are decreased,
but the red blood cell size (MCV) remains normal.
Anemia
MCV range
classification
Normocytic anemia
(symmetrical)

Normocytic anemia
(non-symmetrical)

MCV / RDW
phenomenon

Possible Pathology

80<MCV<100 MCV value is normal,


RDW value is normal

Aplastic anemia;
Leukemia;
Chronic liver disease;
Acute blood loss;
Hereditary spherocytosis
80<MCV<100 MCV value is normal
Nutrition deficiency anemia;
RDW value is increasing Pre-iron deficiency;
Hemoglobinopathy anemia ;
Myelofibrosis,;
Sideroblastic anemia

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MCV,RDW diagnosis using

Anemia
classification

MCV
range

MCV / RDW
phenomenon

Possible Pathology

Macrocytic anemia
(symmetrical)

MCV>100

MCV value increasing;


RDW value is normal

Myelodysplastic syndrome
MDS,
Some aplastic anemia,

Macrocytic anemia
(non-symmetrical)

MCV>100

MCV value increasing;


RDW value increasing

Megaloblastic anemia,
Some liver disease
anemia.

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Iron Deficiency Anemia

Manual Differential Smear


RBC Morphology:
Microcytosis:+++
Anisocytosis:+++
Poikilocytosis:+
Hypochromic :++
Pm: possible presence of large platelet, platelet coagulation, small red blood cell,
cell debris or fibrin. Pl: excessive large platelet

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-Globin Aplastic Anemia

Manual Differential Smear


RBC Morphology:
Microcytosis :+++
Anisocytosis:+++
Target cell:++
Hypochromic :++
Pm: possible presence of large platelet, platelet coagulation, small red blood cell, cell debris or fibrin.

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Differentiate Diagnosis
Iron Deficiency Anemia
Microcytic anemia
(non-symmetrical)

VS -Globin Aplastic Anemia

MCV<80 MCV value is decreasing


RDW value is increasing

Iron Deficiency Anemia


-Globin Aplastic Anemia

Iron deficiency anemia


-Globin aplastic anemia

RDW-CV

(H Flag)

RDW-SD

(H Flag)

RDW-CV

(H Flag)

RDW-SD

(L Flag)

RDW-SD is the most reliable discrimination between IDA


and -Globin Aplastic Anemia
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Megaloblastic Anemia

Manual Differential Smear


RBC Morphology:
Macrocytosis:++

Macrocytic anemia (nonsymmetrical)

MCV>100

MCV value is increasing


RDW value is increasing

Megaloblastic anemia

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Anisocytosis

Manual Differential Smear


RBC Morphology:
Anisocytosis:+++

Pm: possible presence of large platelet, platelet coagulation, small red blood cell,
cell debris or fibrin. Pl: excessive large platelet

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RBC Morphology and relative disease

WBC Morphology and relative disease


Neutrophilia
Parasitic infection
Infectious mononucleosis
leukemia

PLT Morphology and relative disease

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Neutrophilia

Manual Differential (N=200)


Neutrophils

90.5%

Lymphocytes

5%

Monocytes

3.5%

Eosinophils

1%

Basophils

0%

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Parasitic infection

Rm Indicates at least two R flags.

Manual Differential (N=200)

Rm
R2
R3

Neutrophils

33.5%

Lymphocytes

32%

Monocytes

6.5%

Eosinophils

27.5%

Basophils

0.5%

R2: possible presence of abnormal lymphocyte, plasma


cell, atypical lymphocyte, original granulocytes in the
sample and eosinophilia or basophilia.
R3: possible presence of immature granulocytes,
abnormal sub-population in the sample, or eosinophilia.

Indicates at least two R flags.


Indicates abnormality between the lymphocyte hump and the mid-sized cell
area.
Indicates abnormality between the mid-sized
cell Auto
area Hematology
and the granulocytes.
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Infectious mononucleosis

R2: possible presence of abnormal


lymphocyte, plasma cell, atypical
lymphocyte, original granulocytes in the
sample and eosinophilia or basophilia.
Manual Differential (N=200)

R2

Neutrophils

20%

Bands

5%

Lymphocytes

19%

Atypiacl LYM

55%

Monocytes

0%

Eosinophils

1%

Basophils

0%

Indicates abnormality between the lymphocyte hump and the mid-sized cell area
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Chronic Granulocytic Leukemia

Manual Differential
(N=200)
Promyelocyte

2%

Myelocyte

11%

Metamyelocyte

5%

Neutrophils

26%

Bands

26%

Lymphocytes

11%

Monocytes

7%

Eosinophils

1%

R2: possible presence of abnormal lymphocyte, plasma


cell, atypical lymphocyte, original granulocytes in the
sample and eosinophilia or basophilia.
R3: possible presence of immature granulocytes,
abnormal sub-population in the sample, or eosinophilia.

Basophils
11%
Rm Indicates at least two R flags.
R2
Indicates abnormality between the lymphocyte hump and the mid-sized cell area.
R3
Indicates abnormality between the mid-sized cell area and the granulocytes.

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Chronic Lymphocytic Leukemia

Manual Differential
(N=200)
Lymphoblast

1%

Neutrophils

3%

Lymphocytes

95%

Monocytes

1%

Eosinophils

0%

Basophils

0%

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Acute myeloblastic leukemia

Manual Differential (N=200)


Myeloblast

87%

Neutrophils

2%

Lymphocytes

11%

Monocytes

0%

Eosinophils

0%

Basophils

0%

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Acute monocytic leukemia

Manual Differential (N=200)


Hemocytoblasts

44%

Neutrophils

3%

Lymphocytes

10%

Monoblast

36%

Monocytes

6%

Eosinophils

1%

Basophils

0%

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Therapy Trace
Acute leukemia
Manual Differential
(N=200)

1th Day

Blasts

24%

Neutrophils

4%

Lymphocytes

28%

Monoblast

38%

Monocytes

6%

Eosinophils

0%

Basophils

0%

Period of chemotherapy

WBC

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RBC Morphology and relative disease

WBC Morphology and relative disease

PLT Morphology and relative disease


Thrombocytosis

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Thrombocytosis

Manual Differential Smear


Excessive platelet
no platelet coagulation

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Other Abnormal Histograms

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Histogram Alarm
Rm

Indicates at least two R flags.

R1

Ps

Indicates abnormality on the left side of the lymphocyte


hump.
Indicates abnormality between the lymphocyte hump and
the mid-sized cell area.
Indicates abnormality between the mid-sized cell area and
the granulocytes.
Indicates abnormality on the right side of the neutrophilic
granulocyte hump.
Indicates blur demarcation between the platelet and red
blood cell area.
Indicates excessive small PLTs.

Pl

Indicates excessive large PLTs.

R2
R3
R4
Pm

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Parameter flags

Exceed the upper limit of the reference range

Exceed the lower limit of the reference range

***

The result is either unreliable or out of the


operating range
WBC result is less than 0.5 109/L

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Abnormal histogram
No differential result

No differential result because the WBC


histogram is over-narrowly compressed.

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Abnormal histogram
No differential result

No differential result because WBC count


result is less than a certain value (WBC < 0.5)
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Abnormal histogram
No differential result

No differential result because the peak of WBC


histogram lies in the middle of the histogram and
thus cannot identify the type of peak cells
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Abnormal histogram
Increased nucleated erythrocytes or
interference or inadequate lyse

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Abnormal histogram
No lyse reagent or poor
lyse

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Abnormal histogram
Severe interference in WBC channel

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Abnormal histogram
Increased lymphocytes

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Abnormal histogram
Increased mid-sized cells

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Abnormal histogram
Increased neutrophilic granulocytes

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