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HEMATOLOGY
HEMATOLOGY
ERRORS IN AUTOMATION
INSTRUMENTAL ERRORS:
Negative Errors - Excessive Lysis of RBC’s
Positive Errors
▪ Bubbles caused by shaking
▪ Extraneous electrical pulses from improperly grounded equipment
▪ Aperture plugs
▪ improper setting of aperture current (positive or negative)
CAUSED BY NATURE OF SPECIMEN:
Giant platelets: counted as RBC or WBC
Leukocyte cytoplasmic fragment: counted as platelets or RBC’s
Increased number of fragmented RBC’s: inaccurate RBC and platelet counts
Agglutination of cells: false decrease
Agglutinated RBC and platelets: false increase WBC count
Platelet satellitism: decreased platelet count
RBC’s that resists lysis: increased WBC count
Parameter Beckman Coulter UniCel Sysmex XN Series Abbot CELL-DYN Sapphire Siemens ADVIA 2120i
DxH 800
Modified
HGB cyanmethemoglobin (525 Sodium lauryl sulfate- Modified cyanmethemoglobin Modified cyanmethemoglobin (546
nm) HGB (555 nm) (540 nm) nm)
HCT (RBC X MCV)/10 Cumulative RBC pulse (RBC X MCV)/10 (RBC X MCV)/10
height detection
MCV Mean of RBC volume (HCT/RBC) x 10 Mean of RBC volume distribution Mean of RBC volume distribution
distribution histogram histogram histogram
MCH (HGB/RBC) x 10
Impedance; light
Impedance volume and scatter; fluorescent Dual-angle light scatter
Platelet conductivity and five-angle analysis; impedance count for Low-angle and high-angle light
Count staining, forward light scatter; refractive index
light scatter measurement scatter, and side verification; optional CD61
fluorescent light monoclonal antibody count
detection
RDW RDW as CV (%) of RBC RDW-SD (fL) or RDW- Relative value; equivalent to CV CV (%) of RBC histogram
histogram or RDW-SD (fL) CV (%)
Microcytosis
Shift to the Left
Presence of microcytosis - smaller RBCs
Discriminators - separates the distribution Macrocytosis
curve for the volume
Shift to the right
WBC Discriminator
More than the normal distribution
Lower Discriminator = 30-60 fL Macrocytosis
Upper Discriminator = fixed at 300 fL Dimorphic Population
RBC Discriminator There is a bimodal peak of the curve.
Two population of sizes of red blood cells.
Lower Discriminator = 25-75 fL
Upper Discriminator = 200-250 fL
WBC HISTOGRAM
Platelet Discriminator
Cells >35 fL - WBC in the WBC/Hb
Lower Discriminator = 2-6 fL chamber
Upper Discriminator 12-30 fL Lymphocytes = 35-90 Fl
MID cells = 90-160 fL
Fixed discriminator 12 fL Refers to monocytes, basophil, and
eosinophils
Neutrophils = 160-450 fL
RBC HISTOGRAM
WBC Scatterplot
Turbidity affects
spectrophotometric
reading for HGB
HGB x 3 ≠ HCT ± 3, abnormal
Lipemia, icterus HGB , MHC Plasma replacement
histogram/cytogram
(Increase turbidity
more absorbed light,
increase absorbance
and result)
Lysis-resistant RBCs RBCs with haemoglobin Interference at noise-WBC Perform manual dilutions, allow
with abnormal WBC á, HGB á S, C or F may fail to lyse; interface on histogram/cytogram incubation time for lysis
hemoglobins will be counted as WBCs
Large clumps counted as Platelet clumps/ N flag, Redraw specimen in sodium citrate,
Platelet clumps PLT â, WBC á WBCs and not as interference at noise- multiply result by 1.1
platelets lymphocyte interface on
histogram/ cytogram