INTERPRETITION OF

HEMATOLOGY
ANALYSER REPORT
AUTOMATION IS PROCESS OF
REPLACEMENT OF TASK
PERFOMED BY HUMAN BY
COMPUTERISED METHODS
► SEMIAUTOMATED : REQUIRES
DILUTION BY TECHNOLOGIST

► AUTOMATED:
 REQUIRES ONLY BLOOD SAMPLE
 MEASURES 8-23 COMPONENTS
 HIGH LEVEL OF PRECISION FOR CELL
COUNTING
 PRINCIPLES OF WORKING
► ELECTRICAL IMPEDENCE
► LIGHT SCATTER
► FLOURESCENCE
► LIGHT ABSORPTION
► ELECTRICAL CONDUCTIVITY
 ADVANTAGES
► SPEED
► ACCURACY AND PRECISION
► MULTIPLE TESTS ON SINGLE PLATFORM
► REDUCTION OF MANPOWER
► ACCURATE DETERMINATION OF INDICES.
 DISADVANTAGES
► FLAGGING
► COMMENTS ON RED CELL MORPHOLOGY
CAN BE MADE
► ERRONEOUS RESUTLS DUTE TO
INTERFERING FACTORS.
► EXPENSIVE WITH HIGH RUNNING COST.
 PARAMETERS

- Red Blood Cell Count -Hematocrit

-Hemoglobin -MCV
-White Blood Cell Count -MCH
-MCHC
-Lymphocyte % -Red Cell Distribution
-Monocyte % Width
-Neutrophil %
-Eosinophil % -Platelet Count
-Basophil % -Mean Platelet Volume
• RBC (varies with altitude):
– M: 4.5 to 6 x10^12 /L
– F: 4.0 to 5.5 x10^12 /L
• Biconcave disc shape with diameter
of about 8 µm
• Life span 100-120 days.
PCV or Hematocrit

► 57% Plasma

► 1% Buffy coat – WBC

► 42% Hct (PCV)

Hemoglobin :

M: 13 to 17 gm/dL
F: 12 to 15 gm/dL
– MCV = mean corpuscular volume
HCT/RBC count= 80-100fL
• small = microcytic
• normal = normocytic
• large = macrocytic
– MCHC= mean corpuscular hemoglobin
concentration HB/RBC count= 26-34%
• decreased = hypochromic
• normal = normochromic
• MCH (mean corpuscular
hemoglobin)
HB/HCT = 27-32 pg

• RDW (red cell distribution width)

• It is correlates with the degree of

anisocytosis

-Normal range from 10-15%

• This important value is needed in the evaluation
of any anemia.
• Normal range 1-2% 
• Retic count goes up with
– Hemolytic anemia

• Retic goes down with 

– Nutritional deficiencies
_ Diseases of the bone marrow itself
 Mean Cell Volume (MCV)

MCV

Microcytic Normocytic Macrocytic

< 80 fl 80 -100 fl > 100 fl

< 6.5 µ 6.5 - 9 µ >9µ

 MCV
MCV

Microcytic Normocytic Macrocytic

Iron Deficiency IDA Chronic disease Megaloblastic anemias
Chronic Infections Early IDA Liver disease/alcohol
Thalassemias Hemoglobinopathies Hemoglobinopathies
Hemoglobinopathies Primary marrow disorders Metabolic disorders
Sideroblastic Anemia Combined deficiencies Marrow disorders
Increased destruction Increased destruction
 Microcytic Anemia
► MCV <80
► Reduced iron
availability
► Reduced heme
synthesis
► Reduced globin
production
 Macrocytic Anaemia
►Megaloblasticmacrocytic anaemia
►Normoblastic macrocytic anaemia
 Macrocytic Anaemias
A. Megaloblastic Macrocytic – B12 and Folate↓
B. Non Megaloblastic Macrocytic Anaemias
1. Liver disease/alcohol
2. Hemoglobinopathies
3. Metabolic disorders, Hypothyroidism
4. Myelodystrophy, BM infiltration
5. Accelerated Erythropoesis - ↑destruction
6. Drugs (cytotoxics, immunosuppressants, AZT,
anticonvulsants)
 Normocytic Anaemias

1. Chronic disease
2. Early IDA
3. Hemoglobinopathies
4. Primary marrow disorders
5. Combined deficiencies
6. Increased destruction
7. Anaemia of investigations -ICU
 Anaemia of Chronic Disease

► Thyroid diseases • IBD

► Malignancy – Ulcerative Colitis
► Collagen Vascular Disease – Crohn’s Disease
 Rheumatoid Arthritis • Chronic Infections
 SLE – HIV, Osteomyelitis
 Polymyositis – Tuberculosis
 Polyarteritis Nodosa • Renal Failure
 ‘Dimorphic’ Anaemia

► Folate & Fe deficiency (pregnancy, alcoholism)

► B12 & Fe deficiency (PA with atrophic gastritis)
► Thalassemia minor & B12 or folate deficiency
► Fe deficiency & hemolysis (prosthetic valve)
► Folate deficiency & hemolysis (Hb SS disease)
► Peripheral smear exam is critical to assess these
► RDW is increased very much
Red cell Distribution Width - RDW
RDW

Normal High

Population Population
Uniform Double
 Peripheral Smear Study
► Are all RBC of the same size ?
► Are all RBC of the same normal discoid shape ?
► How is the colour (Hb content) saturation ?
► Are all the RBC of same colour/ multi coloured ?
► Are there any RBC inclusions ?
► Are intra RBC there any hemo-parasites ?
► Are leucocytes normal in number and D.C ?
► Is platelet distribution adequate ?
• WBCs are involved in the immune response.
• The normal range: 4 – 11x10^9 /L
• Two types of WBC:
1) Granulocytes consist of:
– Neutrophils: 50 - 70%
– Eosinophils: 1 - 5%
– Basophils: up to 1%
2) Agranulocytes consist of:
- Lymphocytes: 20 - 40%
– Monocytes: 1 - 6%
The type of cell affected depends upon its primary
function:

In bacterial infections, neutrophils are most

commonly affected

In viral infections, lymphocytes are most

commonly affected

In parasitic infections, eosinophils are most

commonly affected.
• polymorphneuclear leukocytes
(PMN,s)

• Nucleus 3-5 lobes.

• Diameter 10-14 µm

• 50-70% WBC
=2.5-7.5x10^9/ L

• Function: Phagocytosis of bacteria

and cell debris

• Numbers rise with all manner of

stress, especially bacterial infections
– Neutropenia – this may result from
1-Decreased bone marrow production
e.g. BM hypoplasia.

2-Ineffective bone marrow production

– E.g. megaloblastic anemias and
myelodysplastic syndromes.

3- post acute infection

_ e.g. typhoid fever, brucellosis.
• Bilobed nucleus
• 1-5% of WBC
=0.04-0.4x10^9/L

• Diameter about 10-14 µm

• Function: Involved in allergy,

parasitic infections

• Contains: eosinophilic granules

– Eosinophilia may be found in
• Parasitic infections
• Allergic conditions and
hypersensitivity reaction
• No specific granules
• 20-40% of WBC
=1.55-3.5x10^9/ L
• Diameter 8-10 µm

• T cells: cellular
• (for viral infections)

• B cells: humoral
(antibody)

• Natural Killer Cells

• Lymphocytosis – may indicate
_ Viral infection
e.g. Infectious mononucleosis, CMV or pertussis.

_ Bacterial infection
e.g. TB

• Lymphopenia – caused by
_Stress.
_Steroid therapy
_ Irradiation
• (Leukocytosis) may indicate:
_ Infectious diseases
_Inflammatory disease (such as rheumatoid
arthritis or allergy)
_Leukemia
_Severe emotional or physical stress
_Tissue damage (e.g. necrosis,or burns)

• (Leukopenia) may result from:

_ Decreased WBC production from BM.
_ Irradiation.
_ Exposure to chemical or drugs.
•Small granular non-nucleated
discs.
•Diameter about 2-4 µm
•Normal range; 150-400x10^9 /L
•Destroyed by macrophage cells in
the spleen.
•Function; involved in coagulation
and blood haemostasis.
•Life span 7-10 days
 
• Numbers of platelets
– Increased (Thrombocythemia)
• Pregnancy.
• Exercise.
• High attitudes.
• splenectomy

– Decreased (Thrombocytopenia)
• Menstruation.
• Haemorrhage.
• Bone marrow destruction or suppression e.g. leukemia
• Infections 
ERRORS
 Types Of Errors
► Fault in specimen collection or storage
► Faulty sampling
► Faulty calibration
► Faulty maintenance, instrument malfunction
or reagent failure
► Inaccuracy inherent in specific methodologies
► Inaccuracy due to unusual characteristics of
specimen
 Inaccurate Estimate Of RBC
► Falsely high RBC:
 Numerous large platelets
 WBC very high

► Low RBC
 EDTA dependant agglutination
 In vitro RBC lysis due to mishandling of
specimen
 Inaccurate Estimate Of WBC
► Falsely high WBC
 Presence of nucleated RBCs
 Numerous giant cells
 Non lysis of RBCs
► Falsely low WBCs:
 Blood > 3 days old
 Antibody mediated leucocyte aggregation
 Inaccurate Differential WBC
Count
► Storage of blood for >24 hrs at room
temperature
► Neutrophil aggregation
► Malarial parasite
► Giant platelets
 Inaccurate Platelet Count
► Falsely low platelet count
 Partial clotting of sample
 EDTA induced platelet aggregation
 Activation of platelets during venepuncture
 Falsely high platelet count
 Hypertriglyceridemia
 Heating of blood sample
 EQAS
► ESSENTIAL FOR CORRECT FUNCTIONING
AND GENERATING ACTIONABLE REPORT
► DONE FROM DEPT OF HEMATOLOGY AIIMS
NEW DELHI
THANK YOU