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Alinity hq

LYSIS RESISTANT RBC

Description

This patient presented with anemia: the RBC count, HGB and HCT were below the reference range. The RDW was slightly increased, whereas the MCV was normal. In addition, the reticulocyte count was elevated, and a low number of NRBC were reported. The WBC and PLT counts were in the normal range. A resistant RBC (rstRBC) flag was present.

 

The enumeration of WBC by Alinity hq involves lysing RBC prior to counting the WBC. When not all RBC are lysed by the WBC reagent, the advanced MAPSS technology identifies and separates the remaining RBC from WBC, and indicates their presence by displaying the rstRBC flag. When lyse resistant RBC are present, the WBC count is valid and accurate, and no correction or reflex testing are needed. Lyse resistant RBC are a sign of increased osmotic resistance, and may be seen in neonates, in patients with liver disease or uremia or can be a sign of hemoglobinopathies such as sickle cell disease or Hemoglobin C disease (Booth, Dorner). This patient was diagnosed with sickle cell disease, and the blood smear revealed anisocytosis with a few sickle cells.

Numerical Results

 
WBC 7.43 10e3/μL
NEU 3.66 10e3/μL 49.3 %
LYM 1.91 10e3/μL 25.7 %
MONO 1.11 10e3/μL 14.9 %
EOS .713 10e3/μL 9.60 %
BASO .037 10e3/μL .502 %
IG 0.00 10e3/μL .004 %
NRBC .065 10e3/μL
NR/W .874

 
RBC 2.78 10e6/μL rstRBC
HGB 8.26 g/dL
HCT 24.4 %
MCV 87.2 fL
MCH 29.5 pg
MCHC 33.8 g/dL
RDW 16.5 %

 
RETIC 141. 10e3/μL 5.05 %
IRF .329
MCHr 29.4 pg

 
PLT 365. 10e3/μL
MPV 8.47 fL
%rP 1.86 %

 
FIGURE 1. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
A gray population of cells appears to overlap with the lymphocyte population (cyan) on this scatterplot, due to their similar size. The gray color indicates that these events are non-fluorescent events and are not included in the total WBC count. This scatter pattern is typical when lyse resistant RBC are present.
FIGURE 2. ALL x PSS (WBC):
Size vs. polarized side scatter plot
This scatterplot confirms the discrete separation of lyse resistant RBC (gray) from the WBC subpopulations. The WBC count is valid in this sample.
FIGURE 3. FL1 x ALL (WBC):
Size vs. fluorescence plot
The WBC subpopulations show strong fluorescence signal. The position of the gray lyse resistant RBC (next to the y axis) population is consistent with lack of fluorescent dye uptake. The y-axis (ALL) indicates that lyse resistant RBC are similar in size to some of the lymphocytes; however, the x-axis (FL1) measurement provides clear separation between them. A small population of NRBC (red) is visible on the lower portion of the scatterplot.
Alinity hq casebook. Lysis Resistant RBC. ADD-00061876-v2 2019. p.28-29

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