Histosch cw ieng
- 1. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 1 Histogram- Interpretation 0 50 100 150 200 250 300 Lymphocytes Monocytes Basophiles Eosinophile s Neutrophils
- 2. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 2 NO. 4 Date: 9/10/95 15:11 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 LYMPH% 31,2 % MXD% 6,8 % NEUT% 62,0 % LYMPH# 1,8 x103 /µl MXD# 0,4 x103 /µl NEUT# 3,6 x103 /µl 250 RBC RDW-SD 40,0 fl 40 PLT PDW 13,1 fl MPV 10,4 fl P-LCR 28,1 % WBC 300 CBC Parameters Leukocyte Histogram Lymphocyte counts in % and absolut Eo, Mono, Baso counts in % and absolut Neutrophils counts in % and absolut Erythrocyte - Histogram RBC Distribution Width Thrombocyte Histogram PLT Distribution Width Mean PLT Volume Proportion of large PLT Normal Result
- 3. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 3 WBC Adults 4-10 x 103 /µl x 109 /l Children up to 12 x 103 /µl x 109 /l Newborns up to 15 x 103 /µl x 109 /l Lymph. Adults 25-40 % Children, Newborns up to 70 % MXD Adults 3-13 % Neutro. Adults 50-70 % Lymph. Adults 1-4 x 103 /µl x 109 /l Children up to 5 x 103 /µl x 109 /l Newborns up to 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 Parameter Age group Conv. Units SI- Units White Blood Cell Count Normal Values 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 at 20% of the peak´s height) RDW-CV 11-16 % (calc. width of the 68 % peak´s height) Parameter Gender Conv. Units SI- Units Red Blood Cell Count PLT 150-400 x 103 /µl x 109 /l PDW 9-14 fl (width at 20% of the peak´s height) MPV 8-12 fl P-LCR 15-35 % Parameter Age Conv. Units SI- Units Thrombocytes
- 4. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 4 RBC- and PLT-Histograms • The two distribution curves are separated from each other by a moving auto discriminator. • Platelets having a size between 8 and 12 fl are counted in the area between 2 and 30 fl. • Erythrocytes have a size of 80-100 fl and are counted in the area between 25 and 250 fl. 2 fl 25-30 fl 250 fl • The Size Distribution Curve should always start and end on the base line and fall between the lower and the upper discriminator. 2 fl 250 fl Basis line LD UD LD: Lower Discriminator UD: Upper Discriminator
- 5. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 5 Erythrocyte-Histogram Flagging Note: All results marked with “ RL “ should be reviewed. Possible causes: • Giant Platelets • Micro- Erythrocytes • Platelet Clumps Mark “ RL “, abnormal height at lower discriminator LD RBC PLT LD RBC The curve does not start at the base line. Mark “ RU “, abnormal height at the upper discriminator. UD RBC The curve does not end at the base line. UD RBC Note: The RBC-result and all results marked with “ RL “ should be reviewed. Possible causes: • Cold Agglutinins (check MCHC > 40 g/dl) • Erythroblasts / Normoblasts
- 6. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 6 Possible causes: • Iron deficiency under therapie • Infectious or tumor Anaemia (visceral iron deficiency) • Blood transfusion (different sizes of own RBC and donor RBC) “ MP “, multiple peaks RBCRBC “DW “, abnormal histogram distribution width RBCRBC • The overall height of the curve is always assumed as 100 %. The width is calculated based on the 20 % height of the curve. Both intersects are needed for the calculation of RBC-DW. • This distribution curve does not intersect the 20% level twice. • Indication for extreme aniso- or poikilocytosis. Erythrocyte-Histogram Flagging
- 7. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 7 RDW-CV = (L2-L1) / (L1+L2) x 100% 100 % σ σµ Turning points 68,26 % of all results RDW-CV 11 - 16 % RBC Distribution Curve can indicate anisocytosis 100 % 20 % RDW-SD 37 - 46 fl Clinically significant if > 60 fl Erythrocyte-Histogram Distribution width RDW- CV RDW- SD L1 L2
- 8. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 8 • 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 Curve is located within the two Discriminators Thrombocyte-Histogram Pct (%) PLT (x 103 /µl) MPV (fl) = 12 fl LD UD PLT P-LCR 100 % 20 % PDW Parameters of the Thrombocyte histogram – MPV, mean PLT volume Normal range: 8 - 12 fl – P- LCR, ratio of large platelets Normal range 15 - 35 % – Increased values can be an indication for: • PLT Clumps • Giant PLT • Microerythrocytes – PDW, platelet distribution width at 20 % of peak height Normal range: 9 - 14 fl Increased values can be an indication for: • PLT Clumps • Microerythrocytes • RBC Fragments fl
- 9. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 9 Note: Check Blank value! If necessary perform Auto Rinse. Mark “ PL “, abnormal height at lower discriminator Possible causes: • High blank value • Cell fragments PLT The curve does not start at the base line. PLT Thrombocyte-Histogram Flagging Mark “ PU “, abnormal height at upper discriminator The curve does not end on the base line. PLT Note: Check PLT-Result (and all parameters marked with “ PU “!). Where applicable perform chamber count or check PLT result via Fonio count! Possible Causes: • PLT Clumps EDTA-Incombatibility Clotted sample • Giant Platelets • Microerythrocytes
- 10. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 10 Possible Cause: • Platelet transfusion (different sizes of patient PLT and donor PLT) Mark “ MP “, Multi Peaks Mark “ DW “, Distribution With PLT PLT • The distribution can not be detected because the histogram does not intersect the 20 % limit line twice. • This curve in only an example but could also show another course. • The overall height of the curve is always assumed to be 100 %. The width is calculated based on the 20 % height of the curve. Thrombocyte-Histogram Flagging
- 11. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 11 Lysis of RBC and partial lysis of WBC Electrolyte solution After addition of Lysis reagent Mitochondria Nucleus Cell membrane Ribosome Cytoplasm Leukocyte-Histogram Before addition of lysing reagent 0 2 4 6 8 10 12 14 16 18 20 22 Neutrophils Basophils Eosinophils Monocytes Lymphocytes Cell diameter in µm 10 - 15 9 - 14 11 - 16 12 - 20 7 - 12 µm After addition of lysing reagent 30 - 80 60 - 120 70 - 130 80 - 140 120 - 250 Cell diameter in fl Lymphocytes Monocytes Basophils Eosinophils Neutrophils0 50 100 150 200 250 300 Lymphocytes Monocytes Basophiles Eosinophils Neutrophils fl
- 12. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 12 Note: • The distribution curve should be located within the two discriminators. The curve should start and end at the base line. • The LD is flexible, but can not be lower than 30 fl. • In the WBC-channel Leukocytes and Thrombocytes are counted and discriminated by the lower discrimiator LD. Erythrocytes are lysed and therefore not counted. • The volume of the Thrombocytes is usually between 8 - 12 fl, therefore the LD at the WBC-Histogramm seperates the Leukocytes from the Thrombocytes. Curve within Two Discriminators 0 50 100 150 200 250 300 UD ( fixed)T2T1LD Leukocyte-Histogram
- 13. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 13 Note: Check WBC - Result and all parameters marked with “WL” Possible causes: • PLT Clumps EDTA-Incombatibility Coagulated Sample • high osmotic resistance (Erythrocytes not lysed) • Erythroblasts • Cold agglutinins Flag “ WL “, curve does not start at the base line Leukocyte-Histogram Flagging 2. Flag “ WU “, curve does not end at the base line. Note: Check WBC - Result and all parameters marked with “WL” Dilute sample 1:5 ? (high leukocyte count ? )
- 14. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 14 • The discriminators are flexible to a certain extend and will be set automatically according to the sample. • In certain cases a separation of the WBC populations by the valley discriminators is not possible. 0 50 100 150 200 250 300 UD ( fixed)T2T1LD Population 1 = F1 Population 2 = F2 Population 3 = F3 F = Fraction T1 and T2 are valley discriminators defined by the plateau. These discriminators separate the Leukocytes populations. 3. Flag “T1” and “T2” T2: T1 was detected but not T2 >T2 flag T1: T1 could not be detected No plateau was found. >T 1 flag Note: • Confirm the result of WBC pre-differentiation by microscopy if either the T1 or T 2 flag is given. • Nevertheless the total WBC result can be assumed to be correct if no flag behind WBC is indicated, because all Leukocytes are counted. Leukocyte-Histogram Flagging
- 15. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 15 • All Leukocytes are counted; WBC total is correct. (If no further flags) • T 1 and T 2 were identified • But: The valleys are far away from the base line. 3. Flag “F1” , “F2” and “F3” The Histogram of the Leukocytes is located within the external discriminators LD and UD. F1 F2 F3 There is a possibility that the populations have been assigned wrongly. F 1 and F 2 come together, also F2 and F3. To obtain the correct differential it is necassary to perform a manual differentiation. 0 100 200 300 UDT2T1LD Normal F1: Lymphocytes F2: mixed (MXD) F3: Neutropiles Leukocyte-Histogram Flagging
- 16. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 16 Summary of all flags WL: Abnormal curve height at lower discriminator of WBC Histogram (LD) WU: Abnormal curve height at upper discriminator of WBC Histogram (UD) T1: Valley 1 not found T2: Valley 2 not found F1, F2, F3: Abnormal distance of T1 or T2 from the base line; adjacent fractions are marked RL: Abnormal curve height at lower discriminator of RBC histogram (LD) RU: Abnormal curve height at upper discriminator of RBC histogram (UD) MP: Multiple peaks: Identification of two RBC populations DW:The distribution (RDW) can not be detected because the histogram does not intersect the 20 % limit twice. PL: Abnormal curve height at lower discriminator of PLT histogram (LD) PU: Abnormal curve height at upper discriminator of PLT Histogram (UD) MP: Multiple Peaks found DW:The distribution (PDW) can not be detected because the histogram does not intersect the 20 % limit twice. NO. 4 DATE: 9/10/95 15:11 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 LYMPH% 31,2 % MXD% 6,8 % NEUT% 62,0 % LYMPH# 1,8 x103 /µl MXD# 0,4 x103 /µl NEUT# 3,6 x103 /µl 250 RBC RDW-SD 40,0 fl 40 PLT PDW 13,1 fl MPV 10,4 fl P-LCR 28,1 % WBC 300 The following cases are analysed with the SYSMEX KX-21. Differences in the Histogram presentation of other Sysmex K-series devices are instrument specific and of no analytical influence.
- 17. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 17 Neutrophilia Band Seg Lymph Mono Eo Baso 8 % 77 % 7 % 7 % 1 % 0 % Differential WBC LYM% MXD% NEUT% Results + 23.8 x 109 /L 8.1% 7.9% 84.0% Lymphocytosis Band Seg Lymph Mono Eo Baso Aty-Lym 4 % 20 % 64 % 4 % 5 % 0 % 3 % Differential WBC LYM% MXD% NEUT% Results 7.9 x 109 /L + 64.7% 15.8% – 19.5% (x 400) (x 1000) Elevated number of WBC WBC-Histogram WBC-Histogram Clinical Cases Clinical diagnosis: Neutrophilia Prominent peak with broad distribution (NEUT%) for large leukocytes. In case of Lymphocytopenia a similar curve is obtained. Clinical diagnosis: Lymphocytosis High, pointed peak in lympho area (LYM%). In case of Neutropenia a similar curve is obtained.
- 18. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 18 Clinical diagnosis : Eosinophilia Eosinophils and basophils, which are categorized as granulocytes together with neutrophiles, are smaller than neutrophils due to contraction under the influence of the lysing reagent. On the histogram, they are located in the middle cell ratio MXD% ( ) where also monocytes are present. A similar pattern can be seen in monocytosis. Both diseases must be differentiated from each other by manual differential. Monocytosis Stab Seg Lymph Mono Eo Baso Met Aty-Lym 8 % 37 % 17 % 35 % 1 % 0 % 1 % 1 % Differential WBC LYM% MXD% NEUT% Results 7.7 x 109 /L F1 * 13.2% F2 * 37.7% 49.1% Eosinophilia Stab Seg Lymph Mono Eo Baso My Met Aty-Lym 1 % 19 % 20 % 9 % 47 % 1 % 1 % 1 % 1 % Differential WBC LYM% MXD% NEUT% Results 4.3 x 109 /L 18,3% + 62,2% – 19.5% (x 1000) (x 1000) WBC-Histogram WBC-Histogram Clinical Cases Elevated number of WBC Clinical diagnosis: Monocytosis Monocytes, which are the largest leukocytes in normal peripheral blood, become smaller than neutrophils under the influence of the lysing reagent. In the histogram, they fall in the middle cell ratio (MXD%) ( ) . Similar patterns can be seen in eosinophilia. These two different clinical entities need to be differentiated from each other by manual differential.
- 19. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 19 Case 1 Case 2 WBC agglutination (x 1000) (x 1000) WBC-Histogram WBC-Histogram Clinical Cases WBC LYM% MXD% NEUT% Results 2.3 x 109 /L 39.7% 32.2% 28.1% – + – WBC LYM% MXD% NEUT% Results 2.1 x 109 /L 41.9% 17.5% 40.6% – – 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 leukocytes 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.
- 20. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 20 Nucleated red blood cells (NRBC) (x 1000) WBC LYM% MXD% NEUT% Results 56.1 x 109 /L 42.7% -.--- -.--- WBC-Histogram WL* WL* WL Clinical Cases Case: Orthochromatic Erythroblasts (NRBC‘s) at a concentration of 1352/100 WBC This is a sample with an extremly high number of NRBC. The valley between the erythrocytes ghost area and the small leukocytes 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 + Count of NRBC‘s *) * NRBC-Count: The number of NRBC per 100 leukocytes. NRBC
- 21. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 21 Iron Deficiency Anaemia Anaemia RBC-Histogram Result RBC HGB HCT MCV MCH MCHC RDW-CV 4.48 x1012 /L 8.8g/dl 29.3% 65.4fl 19.6pg 30.0g/dl 18.2% – – – + Result PLT PDW MPV P-LCR 235 x109 /L 11.7fl 9.4fl 21.7% PLT-Histogram (x 1000) Clinical Cases 1. Case: Results: MCV, MCH and MCHC show low values and RDW-SD shows a high value. Differential: hypochromic RBC´s Thus, this case is identified as microcytic hypochromic anemia Suspected Thalassemia Result RBC HGB HCT MCV MCH MCHC RDW-CV 5.97 x1012 /L 12.7g/dl 41.1% 68.8fl 21.3pg 30.9g/dl 14.7% + – – – RBC-Histogram Result PLT PDW MPV P-LCR 391 x109 /L 12.0fl 10.3fl 27.3% PLT-Histogram (x 1000) 2. Case: Results: MCV, MCH and MCHC show low values Differential: no prominence in the smear Due to the increase in erythrocyte count and the low RDW value this case is cassified as a thalassaemia minor. PU*
- 22. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 22 Anaemia Clinical Cases Macrocytic Anaemia (CML) (x 1000) (x 1000) Results RBC HGB HCT MCV MCH MCHC RDW 1.64 x1012 /L 6.2g/dl 18.2% 110.0fl 37.8pg 34.1g/dl 15.2% – – – + RBC-Histogram WBC-Histogram Results WBC LYM% MXD% NEUT % + T2 T2 17.3 x109 /L 16.4% -.--- -.--- This is a macrocytic anaemia with development of chronic myelogenous leukemia (CML). The RBC histogram suggests the existence of macrocytes, while the WBC histogram does not show, the valley normally seen between the MXD and the large cell ratio, suggesting the appearance of leukocytes with various sizes. Iron def. anaemia under treatment 2nd Week of treatment RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 4.37 x1012 /L 10.4g/dl 35.3% 80.8fl 23.8pg 29.5g/dl 35.7% – – – MP* + 4nd week of treatment RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 5.14 x1012 /L 13.2g/dl 42.5% 82.7fl 25.7pg 31.1g/dl 31.9% (x 1000) (x 1000) The initial effect of the treatment can be seen in data of the 2th week, where the RBC histogram indicates the appearance of normocytic cells while a large number of microcytic cells still visible in the smear. The RBC histogram of the 4th week still shows a 2-peak curve, but the peak of larger cells became more prominent than the other peak. Compared to the top diagram, this shows an further increase in the number of normocytes as a result of the treatment. – – – MP* +
- 23. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 23 Case1 Case2 Anisocytosis RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 4.15 x1012 /L 14.0g/dl 40.8% 98.3fl 33.7pg 34.3g/dl 22.7%+ Results PLT PDW MPV P-LCR 328 x109 /L 12.4fl 10.2fl 26.5% PLT-Histogram (x 1000) RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 2.95 x1012 /L 9.9g/dl 28.7% 97.3fl 33.6pg 34.5g/dl 26.4%+ Results PLT PDW MPV P-LCR PL* DW PL PL 98 x109 /L ---.-fl ---.-fl -.---% PLT-Histogram (x 1000) Clinical Cases Microcytes and macrocytes are visible among normocytes in the smear, and the distribution on the RBC histogram is abnormally wide. This suggest the appearance of various sizes of erythrocytes. The distribution width of the RBC histogram is abnormally wide as seen in case 1, but the proportion of erythrocytes below 90 fl is higher in case 2. The PLT 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.
- 24. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 24 Case 1 Case 2 Poikilocytosis RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 3.62 x1012 /L 11.1g/dl 31.9% 88.1fl 30.7pg 34.8g/dl 25.5%+ Results PLT PDW MPV P-LCR 152 x109 /L 16.2fl 10.4fl 31.4% PLT-Histogram (x 1000) RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 2.67 x1012 /L 6.2g/dl 22.5% 84.3fl 23.2pg 27.6g/dl 20.1% – – – – – + Results PLT PDW MPV P-LCR 235 x109 /L 11.7fl 9.4fl 21.7-% PLT-Histogramm (x 1000) Clinical Cases 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.
- 25. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 25 Case 1 Case 2 Large platelets Results PLT PDW MPV P-LCR + + 237 x109 /L 18.0fl 12.4fl 44.1% PLT-Histogram (x 1000) Results PLT PDW MPV P-LCR PU DW DW DW 71 x109 /L ---.-fl ---.-fl -.---% PLT-Histogram (x 1000) Clinical Cases Case 1: Giant platelets The abnormally wide distribution on the PLT histogram suggests the appearance of giant platelets. The distribution curve intersects the discriminator line at a low point, which shows that the platelet count has been measured correctly. Case 2: Large platelets Although the wide distribution on the PLT histogram suggests the appearance of large platelets, the distribution curve intersects the discrimination line at a high point. This result needs to be confirmed by other methods i.e Fonio method or counting chamber.
- 26. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 26 Case 1 Case 2 Platelet aggregation WBC-Histogram Results WBC LYM% MXD% NEUT % 6.0 x109 /L 27.5% 7.9% 64.4% Results PLT PDW MPV P-LCR + + 86 x109 /L 18.6fl 12.8fl 43.7% PLT-Histogram (x 400) WBC-Histogram Results WBC LYM% MXD% NEUT % WL* WL* WL* WL* 6.4 x109 /L 41.4% 14.0% 44.6% Results PLT PDW MPV P-LCR PU DW DW DW 55 x109 /L ---.-fl ---.-fl -.---% PLT-Histogram (x 400) Clinical Cases Case 1: Platelet Aggregation The smear clearly shows that platelets are aggregating. The WBC histogram shows a peak in the ghost area ( ) , while the PLT histogram shows a wide distribution. Although these large particles usually affect the leukocyte counts, the leukocytes distribution of case 1 is well separated from the ghost area on the WBC histogram, probably without any effect of small particles in the ghost area. There is no WL Alarm given . Case 2: Platelet Aggregation This sample contains larger aggregation clusters as shown in the smear. These clusters are considered to affect the leukocyte counts, because the distribution curve on the WBC histogram intersects the discriminator line between the ghost and the small cell ratio at a high point, and the WL flags are given. The PLT histogram suggests the presence of large particles. Analysis of a fresh blood sample is required to obtain correct platelet values.
- 27. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 27 Cold agglutinins RBC-Histogram Results RBC HGB HCT MCV MCH MCHC RDW 2.23 x1012 /L 14.4g/dl 24.9% 111.7fl 64.6pg 57.8g/dl 25.4fl RU* RU* RU* RU* RU* * (x 1000) ResultsRBC-Histogram RBC HGB HCT MCV MCH MCHC RDW 4.35 x1012 /L 14.5g/dl 43.5% 100.0fl 33.3pg 33.3g/dl 14.7fl Incubation 30 min (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 at 37 o C, 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. Clinical Cases
- 28. K-Series: Histogram-Interpretation Histo.05.01/CWI Page 28 (x 1000) Incomplete lysis of erythrocytes Clinical Cases WBC LYM% MXD% NEUT % WL* WL WL WL 49.4 x109 /L -.--- -.--- -.--- WBC-Histogram Results Case: Lyse-resistance RBC The histogram shows a pattern typically seen after insufficient lysis of erythrocytes. In the WBC histogram the distribution curve intersects the WBC lower discrimination line at an abnormally high point. The WL flag is given and asterisk marks are added to the leukocyte value, thus warning of low reliability. This is frequently seen with blood samples from hepatic disease patients or premature birth newborns. These problems can be solved by diluting the sample or replacing plasma by cellpack (blood cell washing). The smear photo shows large platelets and acantocytes, suggesting a hepatic disease. Incomplete lysis of RBC