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Alinity hq

LEUKOCYTOSIS WITH LEFT SHIFT AND IMMATURE GRANULOCYTES (IG), AND MACROCYTOSIS

Description

CBC results showed leukocytosis with absolute neutrophilia, IG, a Left Shift flag, mild anemia and a slightly decreased platelet count. The MCV and RDW were both significantly elevated, and reticulocytes were also increased.

 

The manual differential found a high percentage of band neutrophils, consistent with the Left Shift flag. The number of IG (metamyelocytes, myelocytes and promyelocytes) seen on the smear agreed with the Alinity hq IG count. RBC morphology correlated with the RBC indices. Many RBC were larger than the size of the nucleus of a small lymphocyte, suggesting macrocytosis.

 

Neutrophilic Left Shift is most often associated with infection, inflammation or malignancy, particularly in myeloproliferative neoplasms such as chronic myelocytic leukemia (CML). Diagnosis of CML can be confirmed through genetic testing and identification of the BCR-ABL gene (t9:22) (Elliott, Riley).

 

Common causes of macrocytosis include vitamin B12 and folate deficiency, liver disease, exposure to certain drugs and reticulocytosis.

Numerical Results

 
WBC 42.8 10e3/μL
NEU 35.2 10e3/μL 82.3 % Left Shift
LYM 2.78 10e3/μL 6.50 %
MONO .811 10e3/μL 1.89 %
EOS .423 10e3/μL .987 %
BASO .126 10e3/μL .293 %
IG 3.46 10e3/μL 8.07 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 2.63 10e6/μL
HGB 10.9 g/dL
HCT 33.9 %
MCV 125. fL
MCH 40.1 pg
MCHC 32.2 g/dL
RDW 22.2 %

 
RETIC 89.8 10e3/μL 3.41 %
IRF .467
MCHr 37.1 pg

 
PLT 126. 10e3/μL
MPV 7.16 fL
%rP 3.90 %

 
FIGURE 1 IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
The neutrophil population (yellow) predominates on this scatterplot. The shape of the neutrophil cluster differs from the normal appearance in size, exhibited by increased spread along both axes. These changes are detected and measured by the software algorithm, which triggers the Left Shift flag, and quantitates the number of IG.
FIGURE 2. CHC x Volume (RBC):
Cellular hemoglobin concentration vs. RBC volume plot
The population of macrocytic RBC are evident on this plot. A large portion of the cluster exceeds the 120 fL hash mark, which correlates with an MCV of 125 fL.
FIGURE 3. ALL x PSS (WBC):
Size vs. polarized side scatter
In this scatterplot, the neutrophil population (yellow) is expanded toward the right along the x-axis due to the presence of immature granulocytes, which are generally larger than more mature neutrophils.
FIGURE 4. Volume (RBC):
RBC volume histogram plot
The histogram is shifted to the right, indicating the presence of macrocytes. The large breadth of the histogram along the y-axis correlates with the elevated RDW.
TABLE 1:
Manual Differential Results
Alinity hq casebook. Leukocytosis With Left Shift And Immature Granulocytes (IG), And Macrocytosis. ADD-00061876-v2 2019. p.34-35

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