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2011

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BC-5800Auto Hematology Analyzer

5-part differentiation, 29 parameters, 2 histograms + 2

scattergrams

Up to 90 samples per hour

Laser scatter + Chemical dye + Flow cytometrytechnology

Independent channel and optical method for Basophil

measurement

Powerful capability to flag abnormal cells

Optional autoloader, barcode scanner

Large TFT touch screen

Large storage capacity: up to 40,000 samples

Recommended or customizable decision rules for re-exam

abnormal samples

Support uni- or bi-directional LIS

Preface to Clinical Case Study for Mindray Hematology Analyzer BC-5800

With microscope and Romanowsky dyes availability, has resulted in

accumulation of a vast pool of knowledge about cytological chang-

es seen in various blood disorders. This is applied prospectively to

not only suspect, but also diagnose or even differentiate hemato-

logical disorders. It is unthinkable today to practice hematology

without support from an expert morphologist. At the base of such

approach lies the process of pattern recognition i.e. first discerning

a set of test results (qualitative + quantitative) as not normal (or

abnormal) and then establishing its association with a known

hematological condition.

CBC+DIFF or ABC (i.e. Automated Blood Count & differentiation of

white cells into 5 common subtypes) is the most ordered blood test

worldwide. While Clinical laboratories world over test millions of

blood specimens daily on automated hematology analyzers; Lab

managers also have to grapple with a decreasing pool of expert

morphologists. Consequently, the newer entrants to medical

profession look for solutions that bridge the gap between newer

(not necessarily well known) technologies and known maladies.

Obviously, an interested user is looking for repositories of data

produced by automated devices that establishes link between the

data and diseases.

Mindray is a global healthcare manufacturer committed to bring

healthcare within reach of wider section of people. With a wide-

spread product portfolio and an established presence in over 165

countries; Mindray takes the task of supporting current healthcare

demands seriously.

Clinical case study for BC-5800 hematology analyzer is an example

of that effort. It is a compilation of BC-5800 hematology analyzer

results obtained on healthy individual and patients with commonly

seen hematological abnormalities. It is designed to introduce the

BC-5800 user to the benefits of pattern recognition. We wish to draw

user's attention to the 'screening' principle that is fundamental to

judicious & proper use of this Clinical case study book. Currently

available hematology analyzers are unable to classify all types of

morphological abnormalities, primarily due to the limitations of

technology which cannot match the accuracy of an expert morpho-

logist who observes visual attributes of a well stained cell and using

his past knowledge classifies the cell. However, the analyzers make

up for the lower accuracy by providing far greater reproducibility/

precision because they count large number of cells and consistency

to 'flag' an abnormality.

Hence, when BC-5800 analyzer 'flags' a result, an expert morpho-

logist is expected to review patient's blood film from before issuing

findings & opinion, of course only after correlating with patient's

medical history and clinical condition.

It is also our hope that with your feedback, suggestions and newer

observations; we will be able to bring out richer editions of Clinical

Case Study in future.

Dr. Vijay Parekh, Scientific Director in Mindray

1 2

For RBC/PLT numeration, the classical electrical impedance

method is used. when cell passing through the aperture by

vacuum, it will introduce the change on resistance. In a con-

stant current, the voltage change signal will be recorded and

accords with the volume of cell.

For HGB quantitative analysis, colorimetric method is used.

With the aid of a color regent, the concentration of HGB is

determined by the change of absorbance in 525nm.

LH lyse breaks down red blood cells, binds to hemoglobin and converts

it to a complex that is measurable at 525nm.

Chemical dye

For WBC analysis, chemical dye, flow cytometry and laser

scatter are applied.

LEO I lyse breaks down red blood cells and imposes on effect on white

blood cells.

LEO II lyse densifies the granules of Eosinophils.

Counting Principles for Hematology Analyzer BC-5800

EOS

Other WBC

RBC

DIFF Channel

LEOI LEOII

3 4

LBA lyse breaks down red blood cells and shrinks white blood cells

except basophils.

Flow cytometry

Cells are injected into a flow cell

which is located in the optical path

of a light source, usually a laser;

Surrounded with sheath flow, the

blood cell pass through the center

of flow cell in a single colume at a

fast speed.

Laser scatter

Light scattering occurs when a particle deflects laser light. The extent to

which this occurs depends on the physical properties of the particle:

Forward scatter (FS): cell volume

Side scatter (SS): cell granularity

BASO

Other WBC

RBC

BASO Channel

LBA

5 6

Analysis results are normal. The WBC populations are well

differentiated. The aggregations in the WBC DIFF scatter-

gram include ghost cells, lymphocytes, monocytes, neutro-

phils and eosinophils. The aggregations in the BASO scatter-

gram include basophils and non-basophils. The RBC and PLT

histograms are normal. No flag is displayed.

Volunteer, male, 30 years old, healthy.

Under the microscope, the morphology of the erythrocytes, platelets

and leukocytes was normal. No immature or atypical cell was observed.

1 Monocyte

2 Lymphocyte

3 Neutrophilic segmented granulocyte

Microscopic Differential

WBC DIFF Neutrophilic segmented granulocyte

Lymphocyte Monocyte Eosinophil Basophil

RBC morph

PLT morph

Screen Interpretation

Left side: Results derived from BC-5800

Middle: Flag information including WBC flag, RBC flag and PLT flag

Right side: Patient information, scattergrams and histograms

Scattergrams Interpretation

DIFF scattergram:

BASO scattergram:

lymphocytes monocytes neutrophils

non-basophils

eosinophils

basophils

(n=200)

56%36%

5.5% 2%

0.5%

Normal Normal

Normal Sample

7 8

The dimorphic RBC histogram in this case study indicates

anisocytosis and the presence of two populations of eryth-

rocytes with different cell size distributions. Dimorphic RBC

is commonly seen in patients with sideroblastic anemia. It

can also be seen in patients recovering from iron deficiency

anemia upon receiving iron therapy or patients who have

received massive blood transfusion.

Female, 58 years old, outpatient at Beijing University Shenzhen Hospital.

1 Large erythrocyte

2 Small erythrocyte

Two distinctive RBC populations with different cell sizes could be seen

under the microscope. In the microscopic field image, hypochromic

erythrocytes were also present.


WBC DIFFNeutrophilic segmented granulocyteLymphocyteMonocyteEosinophilBasophil

RBC morph

PLT morph

Report analysis

WBC and HGB counts decreased

The MCV result and related parameters HCT, MCV and MCHC might be

influenced

"R" flags appeared, and inaccurate RDW-CV and RDW-SD results

displayed as “**.*”, microscopic examination is recommended

RBC flag message: “Diamorphologic“

Histogram: two peaks could be observed in the RBC histogram,

indicating anisocytosis

(n=100)

56%40%

2%1%1%

The RBCs vary in size, the olistherozone in the center

of some RBCs expandedNormal

Diamorphic RBC

9 10

Iron deficiency anemia(IDA) occurs when the dietary intake

of iron or its absorption becomes insufficient. Iron is a

mineral necessary to form hemoglobin, an oxygen carrying

protein found in red blood cells. IDA is the most common

form of anemia. Approximately 20% of women, 50% of

pregnant women, and 3% of men are diagnosed with iron

deficiency anemia. About 30% of iron is also stored as

ferritin and hemosiderin in the bone marrow, spleen and

liver.

In the above microscopic view, anisocytosis with primarily microcytes

were present. Erythrocytes in elliptical, target and irregular shapes

could be seen. Notice that the olistherozone in the red blood cell center

expanded.

Female, 39 years old, had a routine CBC test at an outpatient clinic, result indicates typical small cell hypochromic anemia. Diagnosis: iron deficiency anemia.

Report analysis

M

RDW-CV result increased

HGB 75g/L indicated moderate anemia

RBC flag message: “anemia” and “ hypochromia”

PLT flag message: “Thromobocytosis”

CV, MCH and MCHC results were low

1 Target-cell

2 Hypochromic erythrocyte


WBC DIFFNeutrophilic segmented granulocyteLymphocyteMonocyte Eosinophil Basophil

RBC morph PLT morph

(n=200)

58%35%

3%3.5%0.5%

Vary in sizeNormal

IDA

11 12

Megaloblastic anemia (MgA), also known as macrocytic

anemia, is a type of anemia caused by nucleus eccyliosis in

which DNA synthesis is impaired. This is commonly seen in

patients with vitamin B12 and/or folic acid deficiency. A

diagnosis of megaloblastic anemia can be made based on

the presence of hypersegmented neutrophils and oval

macrocytes in the blood or typical megaloblasts in the

marrow. When MgA is found, the MCV value usually rises

above 100 fL and occasionally up to 120 fL.

Under the microscope, severe anisocytosis, macrocytes and elliptocytes

were present. Poly-segmented neutrophils could be seen. The micro-

scopic field image showed normal erythrocytes, large erythrocytes,

elliptocytes and a neutrophil with eight nuclear segments.

Male, 74 years old. admitted to the hospital for “edema in lower limb”. Three detectable criteria of anemia are identified: ferritin: 531.22ng/ml, serum folic acid: 3.60ng/ml, vitamin B12 <60pg/ml. Diagnosis: Vitamin B12 deficiency anemia.

Report analysis

RBC and HGB counts were low, MCV and MCH results increased

RDW-CV and RDW-SD results might be inaccurate, hence the results

were not displayed

RBC flag message: “Diamorphologic”, ”Macrocytosis” and ”Anemia”

Histogram: the width at the base of RBC histogram increased, two

peaks could be observed

WBC count and neutrophil percentage increased

1 Normal erythrocyte

2 Large erythrocyte

3 Elliptiocyte4 eight nuclear segments

Neutrophil with

WBC Differential

WBC DIFFNeutrophilic bandgranulocyte Neutrophilic segmented granulocyteLymphocyteMonocyteEosinophilBasophil

RBC morph PLT morph

(n=200)

5%

81%8%4%

1.5%0.5%

Vary in sizeNormal

MgA

13 14

Aplastic anemia(AA) is a hematopoietic depletion syndrome

which may be caused by chemical, physical, biological

factors or other idiopathic origin. The hematopoietic stem

cell dysfunction is prominent, which leads to the replace-

ment of hematopoietic red pulps by fat, resulting in the

decrease of healthy red blood cells and leading to progre-

ssive anemia, hemorrhage or infection. AA is usually seen in

adults.

Under the microscope, RBC, WBC and platelet counts decreased,

anisocytes, immature leukocytes at various stages could be seen. In the

microscopic image, a promyelocyte was present.

Report Analysis

WBC count decreased, RBC, HGB and PLT counts were extremely low

WBC flag message: ”Immature cell?” , “Left Shift?” , “Lymphopenia”

and “Leucopenia”

RBC flag message: “Anemia”

PLT flag message: “Thromobocytgosis”

DIFF scattergram: abnormal, results were not displayed for some

parameters

1 Promyelocyte

Female, 52 years old. Primary complaints: history of aplastic anemia diagnosed 20 years ago; bleeding spots on skin for one week. Physical examination results: severe anemia, obvious bleeding spots on skin, severe systolic murmur, a level of 3/6 could be heard at the apex of heart.


WBC DIFFPromyelocyte Myelocytes Metamyelocytes Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte Eosinophil

RBC morph PLT morph

(n=100)1%1%

10%

12%

44%30%

1%1%

Vary in sizeNormal

AA

15 16

Cold agglutinin is a nonspecific antibody, usually found in

patients with auto-immune diseases. The antibody, IgM

binds directly on the surface of red blood cells which causes

hemolysis. Clumping of erythrocytes at temperatures below

36°C is a clinical implication of cold agglutination. The phe-

nomenon does not manifest at body temperature. Cold

agglutination is associated with diseases such as mycoplas-

ma pneumonia, infectious mononucleosis and many

lymphoproliferative disorders.

Obvious RBC agglutination could be seen under the microscope. In the

microscopic image, three RBC clumps were present.

Report Analysis

WBC count decreased, RBC and HGB counts were too low

MCV, MCH, MCHC, RDW-CV and RDW-SD were high, indicating the

possible occurrence of RBC agglutination

WBC flag message: “Lymphopenia” and ”Leucopenia”

RBC flag message: “HGB Abn./Interfere?” , “Anisocytosis” and “Anemia”

Histogram: number of visible spots in RBC histogram decreased

1 RBC clumps

1 RBC clumps

1 RBC clumps


WBC DIFFNeutrophilic band granulocyteNeutrophilic segmented granulocyte Lymphocyte Monocyte Eosinophil

RBC morph PLT morph

Female, 73 years old, CBC results showed RBC agglutination, indicating the potential presence of RBC cold agglutination.

(n=200)

14%

50%25%10%

1%

Obvious agglutinationNormal

RBC Cold Agglutination

17 18

Neutrophilia can be categorized into physiological neutro-

philia and pathological neutrophilia. Physiological neutro-

philia is generally not associated with a qualitative change

of leukocytes but with age, pregnancy, exercises, etc. Patho-

logical neutrophilia can be further divided into reactive

neutrophilia and hyperplastic neutrophilia. The former is an

acute reaction of human body towards various pathogenic

stimulations. The latter is a type of hematopoietic stem cell

clonal disease with severe granulocyte hyperplasia present

in the hematopoietic tissues.

Male, 45 years old, admitted to the hospital for “upper abdominal pain for one week”. Clinical diagnosis: 1. acute cholangitis 2. calculus of intrahepatic and extrahepatic duct 3. cholecystolithiasis, acute cholecystitis.

Report Analysis

Neutrophil count increased significantly

WBC flag message: “Neutrophilia”

PLT flag message: “Thrombocytosis”

DIFF scattergram: an intense aggregation of spots for neutrophils

could be observed in the DIFF scattergram

WBC count increased, RBC and HGB level decreased


WBC DIFF Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte

RBC morph

PLT morph

Under the microscope, most leukocytes were poly-segmented

neutrophils. In the microscopic image, two poly-segmented neutrophils

were present.

1 Neutrophilic granulocyte

segmented

1 Neutrophilic granulocyte

segmented

(n=200)

1%

85.5%7.5%

6%

The pale area in the center expanded

Normal

19 20

Lymphocytes provide cellular immunity and humoral

immunity. Lymphocytosis is an increase in the number or

proportion of lymphocytes in the blood and is categorized

into physiological lymphocytosis and pathological lympho-

cytosis. Physiological lymphocytosis is commonly found

among children. Pathological lymphocytosis is often seen in

viral or bacterial acute infectious diseases such as rubella,

epidemic parotitis, infectious lymphocytosis and pertussis.

It may also be present in chronic infections including tuber-

culosis, postoperative infection from renal transplantation

and leukemia.

Report Analysis

WBC flag message: “Lymphocytosis”

DIFF scattergram: an intense aggregation of spots for lymphocytes

could be observed in the DIFF scattergram

Lymphocyte count increased significantly

1 Small lymphocyte

2 Large lymphocyte


WBC DIFFNeutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte Eosinophil

RBC morph PLT morph

Male, 5 years old, admitted to the hospital for fever of unkn-own cause. Diagnosis: Febrile reaction (pathology to be determined) .

Under the microscope, elevated lymphocyte count could be seen.In the microscopic image, one small lymphocyte and one large lymphocyte were present.

(n=200)

1%

33.5%55.5%

9%1%

NormalNormal

Lymp

ho

cytosis

21 22

Monocytes and phagocytes in tissues form a defense

mechanism by phagocytizing or killing damaged cells and

antigens. Monocytosis is an increase in the number of

monocytes circulating in the blood. Physiological mono-

cytosis is commonly found among children and infants,

while pathological monocytosis is usually seen in patients

with subacute infectious endocarditis, malaria, kala-azar,

active tuberculosis (such as severe infiltration tuberculosis

or miliary tuberculosis). It may also present during the

convalescence of an acute infection or hematological disea-

ses such as malignant histocytosis, lymphomatosis and

agranulocytosis.

Report Analysis

WBC count increased and Monocyte count increased significantly

WBC flag message: “Monocytosis”

DIFF scattergram: an intense cluster spot for monocyte was observed

in the DIFF scattergram

1 Lymphocyte

2 Neutrophilic band granulocyte

3 Monocyte


WBC DIFFNeutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte Eosinophil

RBC morph PLT morph

Under the microscope, high monocyte count could be seen. Lympho-cyte, neutrophilic band granulocyte and monocyte could be seen in the microscopic image shown above.

Male, 34 years old, admitted to the hospital for “recurrent knee and hip pain for 13 years”. The pain episodes became more severe. Diagnosis: Ankylosing spondylitis, femoral head necrosis.

(n=200)

4%

68.5%12%15%

0.5%

NormalNormal

Mo

no

cytosis

23 24

Eosinophil is capable of inhibiting allergic responses,

phagocytizing, and is involved in immunological reactions

to parasites. Eosinophilia, elevated eosinophil count, is

commonly seen in patients with parasitic diseases, allergic

reactions and dermatological diseases. Increased eosinophil

count in chronic granulocytic leukemia, polycythemia vera,

multiple myeloma is not unusual. Eosinophilia may also be

seen in patients with malignant tumors, infectious diseases,

rheumatic diseases, pituitary gland anterior lobe deterior-

ation, adrenal cortex deterioration and allergic interstitial

nephritis.

Report Analysis

significantly

WBC flag message: “Eosinophilia”

DIFF scattergram: an intense cluster spots of eosinophils could be

observed in the DIFF scattergram

WBC count increased slightly and Eosinophil count increased

1 Eosinophilic granulocyte




WBC DIFF Neutrophilic bandgranulocyte Neutrophilic segmented granulocyte Lymphocyte MonocyteEosinophil

RBC morph PLT morph

Under the microscope, eosinophil count appeared significantly

increased. The microscopic image here displayed three eosinophilic granulocytes.

Male, 51 years old. Investigations for presence of parasites revealed presence of Angiostrongylus cantonensis, IgM antibody weakly positive.

(n=200)

4.5%

17%15.5%

6%57%

NormalNormal

Eosin

op

hilia

25 26

Immature cells, normally absent from peripheral blood, are

detected or increased in conditions such as bacterial

infections, acute inflammatory diseases, cancer (particularly

with marrow metastasis), acute transplant rejection, surg-

ical and orthopedic trauma, myeloproliferative diseases,

steroid intake and pregnancy. Immature cells include pro-

myelocyte, myelocyte, metamyelocyte, premonocyte and

prelymphocyte.

Immature cell and platelet count elevation could be seen under the

microscope. In the above microscopic image, a neutrophilic myelocyte

was present.

Report Analysis

RBC and HGB levels were normal, PLT count increased

WBC flag message: “Immature Cell?” and “Left Shift?”


DIFF and BASO scattergram: an aggregation of spots in the immature

cell area

WBC count increased slightly

Male, 31 years old, admitted to the hospital due to “fever over four days, coughing since two days”. Chest X-ray indicated infectious pathological changes in the left lung. The result of fiberoptic bronchoscopy examination showed inflammation. Sputum culture result: 2+Candida yeast presence. Diagnosis: 1.severe pulmonary infection 2.electrolyte imbalance3.hypoproteinemia

1 Neutrophilic myelocyte


WBC DIFFMyelocyte Metamyelocyte Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte

RBC morph PLT morph

(n=200)3%2%

3.5%

65%18.5%

8%

NormalNormal

IC

27 28

Atypical lymphocytes, also known as reactive lymphocytes,

are enlarged and elongated white with an elliptical nucleus.

They are usually associated with viral illnesses when normal

lymphocytes are stimulated by the viral antigens. They are

commonly seen in infectious mononucleosis, infectious

hepatitis, measles, viral pneumonia, pertussis-like syndro-

me, influenza, epidemic hemorrhagic fever and common

cold.

Elevated atypical lymphocyte count could be observed under the

microscope. In the microscopic image, one atypical lymphocytes was

present.

Report Analysis

WBC count increased slightly

RBC, HGB and PLT counts were normal

R flag appeared before Lym%, Lym#, Mon%, Mon#, Bas% and Bas#,

indicating the need for a microscopic review of ample

WBC flag message: “Abn/Atypical lym?” and “Lymphocytosis”

DIFF and BASO scattergram: abnormal spots in the abnormal/atypical

lymphocyte area

“ ”

1 Atypical lymphocyte


WBC DIFF Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Atypical lymphocyte Monocyte

RBC morph PLT morph

Female, 6 years old, with confirmed diagnosis of “infectious mononucleosis”.

(n=200)

4%

30%48.5%

9.5%8%

NormalNormal

ALY

29 30

Chronic myelocytic leukemia (CML), a clonal proliferative

disease, originates from the hematopoietic stem cells with

primary changes in myelocyte proliferation. The disease is

typically detected in people aged between 20 and 50. One of

the most distinctive features is enlarged or swollen spleen.

From the cytogenetic perspective, a positive CML diagnosis

is confirmed when the test for Philadelphia chromosome is

positive and the BCR/ABL fusion gene is detected.

Report Analysis

WBC count increased greatly, RBC and HGB counts decreased

WBC flag message: “Immature Cell?” , “Left Shift?”, “Abn./Atypical

Lym?”, “Basophilia”, “Eosinophilia”, “ Monocytosis”, “L ymphocytosis”,

“Neutrophilia” and “Leucocytosis”

RBC flag message: “RBC Abn. Distribution”, “Hypochromia” and ”Anemia”

DIFF scattergram: abnormal, the clusters were not clearly differentiated,

a great amount of spots could be observed in immature cell area

BASO scattergram: abnormal, a great number of spots could be

observed in the abnormal cell area

1 Basophilic granulocyte

2 Neutrophilic metamyelocyte

1 Basophil granulocyteic

3 Neutrophilic band granulocyte

4 myelocyte

Neutrophilic

Under the microscope, a large number of immature granulocytes could

be seen, most of which were myelocytes and metamyelocytes. The

erythrocytes showed severe anisocytosis and hypochromia. In the

microscopic image, neutrophilic myelocyte, neutrophilic metamyelo-

cyte, neutrophilic band granulocyte and basophilic granulocytes were

present.

Male, 44 years old, hospitalized for fatigue, anorexia and weight loss for over 3 months. Bone marrow examination results: active hyperplasia, CML features found NAP positive rate 9%, integral 13. BCR/ABL fusion gene test result: positive rate 65%. Bone marrow pathological indication: consistent with CML.


WBC DIFFPromyelocyte Myelocytes Metamyelocytes Neutrophilic bandgranulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte EosinophilBasophil

RBC morph PLT morph

(n=200)2%

16%21%

18.5%

15.5%10%

2%2%

13%

Vary in sizeNormal

CM

L

31 32

Acute promyelocytic leukemia (FAB M3) is a type of acute

myeloblastic leukemia. In FAB M3, there is an abnormal

accumulation of immature granulocytes called promyelo-

cytes. The disease presents a chromosomal translocation

involving the retinoic acid receptor alpha (RARα or RARA)

gene and is unique from other forms of AML in its responsi-

vεness to all-trans retinoic acid (ATRA) therapy.

Under the microscope, many promyelocytes with increased cytoplasmic

granules could be seen. In the microscopic image, three promyelocytes

were present.

Report analysis

WBC result increased

RBC, HGB, HCT and PLT results decreased

WBC flag message:”Immature Cell?”, “Left Shift?”, “Neutrophilia”, and “

Leucocytosis”

RBC flag message: “Anemia”


DIFF scattergram: the monocyte and neutrophil clusters were not

clearly differentiated, a number of abnormal spots could be observed

BASO scattergram: a great amount of abnormal spots appeared on

the top of scattergram

1 Promyelocyte

1 Promyelocyte

1 Promyelocyte


WBC DIFFPromyelocyteMyelocytes Metamyelocytes Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte NRBC count

RBC morph PLT morph

Female, 24 years old, hospitalized for ”dizziness, fatigue and skin hematoma of 2 weeks duration”. Bone marrow examina-tion results: severe hyperplasia, increased number of abnor-mal granules in 97% of promyelocytes, hyper-granular cells, PML-RARA fusion gene 36% positive, PML-RARA/ABL 191%. Clinical diagnosis: acute promyelocytic leukemia M3b.

(n=200)72.5%

8%4%

3%

3.5%9%

2/100 WBCs

Vary in sizeNormal

FAB

M3

33 34

Acute myelo-monocytic leukemia (M4) is a form of acute

myeloid leukemia that involves a proliferation of CFU-GM

myeloblasts and monoblasts. It is a common type of pedia-

tric AML. The symptoms may be non-specific: weakness,

pallor, fever, dizziness and respiratory symptoms. More

specific symptoms include bruises and/or bleeding, DIC,

neurological disorders and gingival hyperplasia.

Under the microscope, immature granulocytes of all stages and

anisocytes could be seen. In microscopic image, promyelocyte and

promonocyte were present.

1 Promyelocyte

2 Promonocyte

Report analysis

WBC, HGB and PLT counts were low

WBC flag message: “WBC Abn Scattergram?”

RBC flag message:”Diamorphologic"and “Anemia”


DIFF scattergram: comet formation”, indicating the presence of a

large number of immature cells

BASO scattergram: a great number of spots were observed in the

abnormal cell area, indicating there were a large number of abnormal

cells in the sample

“


WBC DIFF Promyelocyte Myelocytes Metamyelocytes Promonocyte Neutrophilic band granulocyte Neutrophilic segmented granulocyte Lymphocyte Monocyte Basophil

RBC morph

PLT morph

In this case, the patient was hospitalized for recurrent fever and fatigue for more than one month. Bone marrow morph-ology indicated active hyperplasia, 49.5% blast. Clinical diagnosis: bone marrow hyperplasia metastasizes to acute myelo-monocytic leukemia.

(n=200)3%8%5%9%

2%

14.5%45.5%

11%2%

Vary in size, the pale area in the center of some

erythrocytes increasedNormal

FAB

M4

35 36

Acute Lymphocytic Leukemia (ALL) is a malignant clonal

disease in the hematopoietic system. It is caused by the

abnormal proliferation of primitive and immature lympho-

cytes in the hematopoietic tissue. It originates from the

bone marrow, spleen or lymph node and infiltrates to

various tissues or organs. Though ALL can be found in

individuals of all age; it is the most common type of cancer

found in children and adolescents.

Under the microscope, a high proportion of lymphoblasts could be

seen, prolymphocytes could also be seen. In the microscopic image, four

lymphoblasts were present.

Report analysis

WBC count greatly increased

RBC, HGB and PLT counts markedly decreased

WBC flag message: “WBC Abn Scattergram?” and “Leucocytosis”

RBC flag message: “Hypochromia” and “Anemia”

PLT flag message: “Thrombocytopenia”

DIFF scattergram: abnormal, almost all white cells aggregated in the

lymphocyte area

BASO scattergram: a large number of spots were observed in the

abnormal cell area, indicating presence of abnormal cells in the sample

Male, 38 years old, hospitalized for enlarged lymph node and elevated WBC count for over 10 days. Bone marrow examina-tion: severe hyperplasia, lymphoblast count is 96%. MPOX was negative, part of PAS was weakly positive.

1 Lymphoblast 1 Lymphoblast

1 Lymphoblast

1 Lymphoblast


WBC DIFF Lymphoblast ProlymphocyteNeutrophilic segmented granulocyte Lymphocyte

RBC morph PLT morph

(n=200)89%

9%

1%1%

The central pale areaincreased

Normal

ALL

37 38

Flags Appendix

Abnormal Suspect

*For this flag, if the analyzer determines that it is resulted from fragile WBCs, or the 9 9WBC result in the predilute mode is between 0.5x10 /L and 2.0x10 /L, the analysis

result will be displayed; otherwise, the analysis result shows “***”.

Judgment criterion

WBC

Leucocytosis

Leucopenia

Neutrophilia

Neutropenia

9WBC > 18.0×10 /L9WBC < 2.5×10 /L

9NEUT# > 11.0×10 /L9NEUT# < 1.0×10 /L

High monocytes analysis results

High eosinophils analysis results

High basophils analysis results

Flag Meaning

High WBC analysis results

Low WBC analysis results

High neutrophils analysis results

Low neutrophils analysis resultsHigh lymphocytes analysis resultsLow lymphocytes analysis results

Lymphocytosis

Lymphopenia

Monocytosis

Eosinophilia

Basophilia

9LYMPH# < 0.8×10 /L9MONO# > 1.5×10 /L

9EO# > 0.7×10 /L9BASO# > 0.2×10 /L

9LYMPH# > 4.0×10 /L

RBC/HGB

Microcytosis

Macrocytosis

Erythrocytosis

Anemia

Hypochromia

MCV < 70fL

MCV > 110fL12RBC# > 6.50×10 /L

Small MCV

Large MCV

Increased RBCs

Anemia

Hypochromia

RBC Abn. Distribution

Abnormal RBC scattergram RBC scattergram is abnormalRDW-SD> 64 or RDW-CV>22Sizes of RBCs are dissimilarAnisocytosis

Diamorphologic RBC dimorphic distributionTwo or more peaks in the RBC histogram

HGB < 90g/L

MCHC < 29.0g/dL

PLT

Thrombocytosis

Thrombocyto-penia

PLT Abn Distribution

PLTs increase

PLTs decrease

PLT histogram distribution abnormal

9PLT > 600×10 /L

9PLT < 60×10 /L

PLT histogram is abnormal

Judgment criterion

WBC

Flag Meaning

RBC/HGB

PLT

Asp. Abn./Abn. Sample?

WBC Abn. ? *

Left Shift?

Immature Cell?

Abn./Atypical Lym?

RBC Lyse Resist?

The aspiration may be abn-ormal, or the sample itself may be abnormal

WBC numbers of BASO and DIFF channels are inconsis-tent. The sample may be abnormal, or the analyzer may be abnormal

Abnormal WBC scattergram

Left shift may exist

Immature cells may exist

Abnormal lymphocytes or atypical lymphocytes may exist

RBC hemolysis may be incomplete

WBC Abn Scattergram?

Results of primary para-meters are severely low simultaneously

WBC numbers of BASO and DIFF channels are inconsistent

Abnormal scattergram of the DIFF channel or BASO channel Many scatter-points exist in the left shift area of the scattergramThe proportion of im-mature cells is greater than 2.5%The proportion of abno-rmal/atypical lympho-cytes is greater than 2%

Scatter-points are thick between the lymphocy-tes and ghost cells areas of the scattergram

RBC or HGB Abn.?

HGB Abn./Interfere?

Results of RBC or HGB may be inaccurateHGB results may be abnormal, or interference may exist

Analyzing and comparing results of HGB and RBCCalculating and compa-ring special analysis parameters

PLT Clump? PLT clump may exist Calculating and compa-ring special analysis parameters

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DISTRIBUTOR: Mindray is listed on the NYSE under …...Analysis results are normal. The WBC...

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Transcript of DISTRIBUTOR: Mindray is listed on the NYSE under …...Analysis results are normal. The WBC...