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Alinity hq

HYPERTRIGLYCERIDEMIA

Description

This patient was diagnosed with hypertriglyceridemia. The CBC showed anemia, leukopenia and thrombocytopenia. HGB, MCH, MCHC and MCHr results were suspect. In addition, the rstRBC and HGB Interf flags were present.

 

The presence of lipemia led to a significant difference between the measured and calculated HGB results, resulting in the HGB Interf flag that rendered the HGB and related red cell indices suspect. A gray population was observed in the WBC scatterplots which suggests the presence of non-fluorescing cells/particles in the WBC assay. This may be consistent with lysis resistant RBCs; however, no confirmatory test exists for lysis resistant RBCs, and we cannot exclude the possibility that these events are accumulated lipoprotein particles in the sample. A gray population was also observed in the PLT scatterplots, indicating the presence of PLT-size particles that the algorithm was able to separate from the PLT population. The PLT count correlated well with the PLT concentration obtained by the CELL-DYN Sapphire ImmunoPlatelet method (Harrison), based on fluorescent labeling with CD61 monoclonal antibody; Alinity reported a PLT count of 55 x 10^9/L and the CD61 reference method reported a PLT count of 54.9 x 10^9/L.

 

The patient sample was extremely lipemic and the serum lipid profile showed a serum triglyceride of 1785 mg/dL (normal levels <200 mg/dL).

 

Lipemia results in turbidity and is a known interfering substance that could potentially impact measurements of HGB, WBC counts, WBC differential and PLT counts. (CLSI, Zandecki, Part I, Zandecki, Part II) It is caused by the presence of lipoproteins which consists of the smaller very low-density lipoproteins (VLDL) (27-200 nm) and larger chylomicrons (70-1000 nm). These particles may interfere with analytical methods by impacting light scatter, volume displacement or due to adsorption of substances to the lipid interior. (CLSI)

Numerical ResultsSuspect

 
WBC 2.60 10e3/μL
NEU 1.84 10e3/μL 70.7 %
LYM .503 10e3/μL 19.4 %
MONO .252 10e3/μL 9.68 %
EOS .006 10e3/μL .225 %
BASO 0.00 10e3/μL 0.00 %
IG .001 10e3/μL .033 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 3.31 10e6/μL rstRBC
HGB 10.5 g/dL HGB Interf
HCT 29.2 %
MCV 88.2 fL
MCH 31.7 pg
MCHC 35.9 g/dL
RDW 20.1 %

 
RETIC 64.7 10e3/μL 1.96 %
IRF .276
MCHr 36.6 pg

 
PLT 55.0 10e3/μL
MPV 6.63 fL
%rP 4.98 %

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
There is presence of a gray population on both scatterplots that are non-fluorescent events likely representing lipemia. This is separated from the WBC subpopulations by the algorithm and is not included in the WBC counts.
FIGURE 2. FL1 X ALL (WBC):
Fluorescence vs. size plot
There is presence of a gray population on both scatterplots that are non-fluorescent events likely representing lipemia. This is separated from the WBC subpopulations by the algorithm and is not included in the WBC counts.
FIGURE 3. IAS2 X ALL (PLT):
Intermediate Angle Scatter vs. Size
There is a population of gray events, presumubly respresenting the small VLDL particles, positioned to the left of the platelet population (yellow).
Alinity hq Casebook. Hypertriglyceridemia. ADD-00061876-v2 2019. p.20

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