Hematology analyzer channels-modes- handling errors For Lab.students

1. Hematology analyzer
• Channels
• Overview of analysis modes
• Handling abnormal results
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Diagnostic Hematology - Dr.Alagbare
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contentDeveloped by-Dr.Abdulrazzaq Othman Alagbare
M.D M.S.c C.P - Lecturer of Hematology and Immunohematology
Hematology analyzer -Chanels-Modes- Handling abnormal results
Errors

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Hematology analyzer Channels
Channel for  Red blood cells and platelets analyzing ,
 RBCs and platelets using the same dilution
Channel for  WBC and hemoglobin measurement:
 Lytic agents lyse red cells first before analysis.
Channel for  WBC differential count.
Channel for  Reticulocyte count.
Diagnostic Hematology - Dr.Alagbare

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Other channels:
A. nucleated red blood cell (NRBC) channel,
B. separate hemoglobin (Hb) channel,
C. WBC/basophil counting channel,
D. and immature granulocyte counting channel.
Diagnostic Hematology - Dr.Alagbare

4. Small volume of EDTA blood
 sample is aspirated and diluted
in an electrically conductive
diluent.
1. RBC/PLT chamber
2. WBC/Hgb chamber
• RBCs lysed, Hgb directly
measured by spectrophotometry
and WBCs counted
1. Mixing chamber – differential
2. Reticulocyte dilution chamber
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Diagnostic Hematology - Dr.Alagbare

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In the channel of RBC/PLT counting
• Particles between 2 and 20 fL are counted as
platelets,
• and particles larger than 35 fL are counted as
RBCs.
Diagnostic Hematology - Dr.Alagbare
They fall in the overlap area between platelets
and RBCs, generating a warning flag.
Why

6. Errors in platelet counts
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Falsely high platelet
counts
Microcytic red cells
Red cell fragments
White cell fragments of
leukaemic blast cells
Contaminated blood
sample (Bacteria Malaria,
fungus)

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 Microcytic red cells that notched in IDA,
 if the RBC have very low volume fall in the platelets counting zone
 and they counted as platelets,
 for that we have slight increase of platelets count in IDA

8. Errors in platelet counts
Falsely low platelet counts
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Diagnostic Hematology - Dr.Alagbare
giant plateletsclumped platelets

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Diagnostic Hematology - Dr.Alagbare

10. Needs 30-40 µl
This is the mode of analyzing collected blood sample in the
whole blood status
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USES
For Paediatric specimens.
 This mode is used in analyzing a minute amount of child’s
blood, for example, collected from the earlobe or fingertip.
Diagnostic Hematology - Dr.Alagbare
Overview of analysis modes
1-Whole blood mode
2-Pre-diluted mode
HOW?
In this mode, blood sample diluted into 1:26 before
analysis is used.
The sample aspiration procedure is the same as in the
whole blood mode.

11. 1-Plts < 40,000
How solved?
1. Check the integrity of the specimen (look for clots, short draw, etc.)
2. Confirm count
with smear review for clumps, RBC fragments, giant platelets, very small RBCs
HANDLING ABNORMAL RESULTS
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Diagnostic Hematology - Dr.Alagbare

12. 2-Plt ++++
How solved?
HANDLING ABNORMAL RESULTS
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Diagnostic Hematology - Dr.Alagbare
 If present,
o perform plt. estimate.
o If they do not agree, perform
manual plt count.
 If not present,
o dilute specimen 1:2 with Isoton or
further until count is within linearity,
multiply diluted result by dilution
factor.
 Do PBS
 Check smear for RBC
fragments or microcytes.

13. Diagnostic Hematology - Dr.Alagbare
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CASE
A 44-year-old woman comes in for a complete blood count (CBC) as part of a routine physical exam. The
results from the hematology analyzer,, are:
PLEASE answer the following
1. What is abnormal about her CBC?
2. Which parts can be reported?
3. What procedures can be done regarding the abnormal result?
4-Which cells included in MID and Gran?

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Questions
1. What is abnormal about the blood count?
2. Which parts of the CBC can be reported?
3. What would you do to investigate the
abnormal result?
4-write the situation which cause low false
PLT count?

15. Diagnostic Hematology - Dr.Alagbare
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1 2
3
Answer the following
What called each image?
Describe and write a small paragraph for each image how developed, and what effect on the platelets count?
How solved each problem of them if present?

16. 3-WBC ++++
How solved?
 Dilute 1:2 with Isoton or further until count is within linearity (for final result,
multiply diluted result by dilution factor.
 Plt counts are not affected by high WBC.
 Add comment, “Unable to report Hgb, MCH, MCHC due to high WBC.”
HANDLING ABNORMAL RESULTS
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Diagnostic Hematology - Dr.Alagbare

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In some printouts use the following symbols
UWBC represents uncorrected WBC count
WBC represents corrected WBC count
In some printouts use the following symbols
“&”WBC represents corrected WBC count
Plt & represents corrected PLT count
Diagnostic Hematology - Dr.Alagbare

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Diagnostic Hematology - Dr.Alagbare

19. HANDLING ABNORMAL RESULTS
4-RBC > 7.0
How solved?
1. Dilute 1:2 with Isoton or further until count is within linearity, multiply dilution
result by dilution factor;
2. perform spun Hct,
3. review Hgb,
4. recalculate MCH, MCHC
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Diagnostic Hematology - Dr.Alagbare

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Normal White blood cells volume
Cells with volume Designated as
 35-90 fl Lymphocytes,
 90-160 fl Monocyte, Eos, BAS
 160-450 Neutrophils,
Diagnostic Hematology - Dr.Alagbare

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‫هلل‬ ‫الحمد‬
‫رب‬
‫العالمين‬
Diagnostic Hematology - Dr.Alagbare
‫العمل‬ ‫بهذا‬
‫ابتغاء‬ ‫ارجو‬
‫هللا‬ ‫مرضات‬