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Alinity hq

BLASTS (SUSPECTED ACUTE LEUKEMIA)

Description

CBC results show a normal WBC count, anemia and thrombocytopenia. The variant lymphocyte and blast flags were triggered, and the lymphocyte, monocyte and basophil counts were invalidated.

 

A manual differential found 12% neutrophils, 50% lymphocytes, 3% monocytes, 35% blasts and confirmed the presence of 1 NRBC per 100 WBC. The blasts were large with moderate to high nuclear, cytoplasmic ratio, smooth chromatin and had large prominent nucleoli. A smear estimate of the platelet count agreed with the Alinity hq platelet count of 28 (x10e3/uL), and the analyzer reported 1.4 NRBC/100 WBC.

 

These results are consistent with a diagnosis of acute leukemia. While the blast morphology suggested myeloid lineage, further diagnostic tests including flow cytometry and genetic testing are needed to further characterize the disease.

Numerical ResultsInvalid Data

 
WBC 4.58 10e3/μL
NEU 0.46 10e3/μL 10.0 %
LYM 2.23 10e3/μL 48.6 % VAR LYM
MONO 1.83X 10e3/μL 40.0X % BLAST
EOS .015 10e3/μL .336 %
BASO .048X 10e3/μL 1.04X %
IG 0.00 10e3/μL .004 %
NRBC 0.64 10e3/μL
NR/W 1.40

 
RBC 3.09 10e6/μL
HGB 9.93 g/dL
HCT 29.2 %
MCV 94.3 fL
MCH 32.1 pg
MCHC 34.0 g/dL
RDW 16.3 %

 
RETIC 75.3 10e3/μL 2.44 %
IRF .665
MCHr 33.0 pg

 
PLT 27.7 10e3/μL
MPV 7.66 fL
%rP 9.33 %

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
In this scatterplot, the positioning of the lymphocyte (cyan) and monocyte (purple) populations is abnormal with significant overlap. This pattern contributed to the BLAST flag, suggesting the presence of abnormal cells.
FIGURE 2. IAS2 x IAS3 (RBC/PLT):
Intermediate angles of light scatter plot
This scatterplot of two angles of intermediate light scatter shows the RBC (red) and platelet (yellow) populations. A small number of events can be seen trailing down the x-axis, representing small sized RBC, however they do not appear to interfere with the platelet count.
FIGURE 3. FL1 x ALL (WBC):
Size vs. fluorescence plot
The same overlap/fusion of the monocyte (purple) and lymphocyte (cyan) population can be observed on this scatterplot, suggestive of the presence of blasts, which exhibit some of the morphological characteristics of both lymphocytes and monocytes. In addition, there is a sizeable lymphocyte population exhibiting a high level of fluorescence. Underneath the highly fluorescent lymphocyte population (cyan), NRBC (red) are observed. While the nuclei of NRBC and some of the lymphocytes exhibit similar fluorescence intensity, the two populations are separated along the x-axis, due to differences in cell size.
Alinity hq Casebook. Blasts (Suspected Acute Leukemia). ADD-00061876-v2 2019. p.38-39

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Alinity h-series is available in select countries, not including the US.