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Alinity hq

Red Blood Cell Fragments (Schistocytes)

Description

The numerical results show anemia, thrombocytopenia, and a borderline low WBC count. In addition, the MCV and reticulocyte count elevated. A significant finding regarding RBC and platelet parameters was the RBC Fragment flag, the presence of which has rendered the RBC and platelet counts and associated results suspect. Scatterplot review, however, indicated good separation between RBC and platelet populations, and a smear estimate provided confirmation of the Alinity hq platelet count.

 

Smear review also found a mild increase in polychromasia and anisocytosis, consistent with the elevated reticulocyte count, MCV and increased red blood cell distribution width (RDW). The smear review also revealed a moderate number of schistocytes, acanthocytes and burr cells.

 

These observations are consistent with anemia, thrombocytopenia and a borderline low WBC count, associated with Left Shift. The presence of schistocytes can often be seen in patients with microangiopathic hemolytic anemia (MAHA), such as thrombotic thrombocytopenic purpura (TTP), hemolytic uremic syndrome (HUS) and disseminated intravascular coagulopathy (DIC) (Greer).

Numerical Results

SUSPECT
 
WBC 4.42 10e3/μL
NEU 3.52 10e3/μL 79.6 % Left Shift
LYM .475 10e3/μL 10.7 %
MONO .254 10e3/μL 5.73 %
EOS .107 10e3/μL 2.41 %
BASO .003 10e3/μL .065 %
IG 0.64 10e3/μL 1.45 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 2.11 10e6/μL
HGB 7.52 g/dL
HCT 21.4 %
MCV 101. fL
MCH 35.5 pg
MCHC 35.2 g/dL
RDW 22.0 %

 
RETIC 101. 10e3/μL 4.80 %
IRF .465
MCHr 41.6 pg

 
PLT 67.5 10e3/μL RBC Frag
MPV 6.82 fL
%rP 4.87 %

 
FIGURE 1. IAS2 x IAS3:
Size vs. Intermediate angle light scatter plot
The presence of RBC fragments can be seen in the IAS2 x IAS3 and ALL x IAS3 scatterplots. In the IAS2 x IAS3 scatterplot, there is an overlap along the x-axis between the RBC (red) and platelet (yellow) clusters, suggesting the presence of RBC fragments that are similar in size to platelets. However, the RBC and platelet populations are clearly separated along the y-axis as a result of differences in their internal complexity and light scatter characteristics.
FIGURE 2. ALL x IAS3:
Size vs. Intermediate angles of light scatter plot
The presence of RBC fragments can be seen in the IAS2 x IAS3 and ALL x IAS3 scatterplots. In the IAS2 x IAS3 scatterplot, there is an overlap along the x-axis between the RBC (red) and platelet (yellow) clusters, suggesting the presence of RBC fragments that are similar in size to platelets. However, the RBC and platelet populations are clearly separated along the y-axis as a result of differences in their internal complexity and light scatter characteristics.
FIGURE 3. Volume (RBC):
RBC volume histogram plot
In the RBC volume histogram, the population mean is skewed to the right of the x-axis due to the presence of macrocytic RBC. Also noticeable is the wide basis of the curve, which is consistent with the high RDW and variability in size of the RBC (anisocytosis). The reticulocytosis seen in this patient is a contributing factor to elevations in both the MCV and RDW.
FIGURE 4. ALL x FL1 (RETIC/PLT):
Size vs. fluorescence plot
The population of reticulocytes (green) as shown in the scatterplot of size (ALL) vs fluorescence (FL1) is more prominent as compared with a normal sample. The increased reticulocyte count in this patient indicates the bone marrow’s response to the anemia.
Alinity hq casebook. Red Blood Cell Fragments (Schistocytes). ADD-00061876-v2 2019. p.26-27

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