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Alinity hq



This was a sample from a neonate.


Peripheral blood from neonates (representing the first four weeks of life), show some unique characteristics compared to that of older children and adults. This sample displayed leukocytosis, which is typical for newborns, with predominant lymphocytosis, exceeding the age-appropriate reference range, along with the presence of IG, NRBC, increased concentration of reticulocytes and a Left Shift morphological flag. The monocyte count was invalid due to the presence of the MONO boundary not found flag.


Neutrophil granulocytes predominate the WBC differential during the first days of life. Bands and occasional metamyelocytes are common findings in neonatal samples (Jacob). The number of neutrophil granulocytes, however, decreases rapidly, and lymphocytes become the most numerous WBC population during the first four weeks of life (Proytcheva). Monocyte numbers may also rise to up to 9% in the second and third week of life.


Finding 0 to 10 NRBC per 100 WBC in a term infant is typical, although these values are highly dependent on the total WBC count (Perrone). The number of NRBC also shows relationship with the gestational age, with higher NRBC counts seen in preterm babies. In addition, elevation in NRBC concentration may be a marker for asphyxia, stress and infection. The erythrocytes of newborn infants are usually markedly macrocytic as seen in this sample (MCV=106 fL). High RDW (18.7%) is considered a normal finding for a neonatal sample. The reticulocyte count is relatively high immediately after birth and through the first several days, indicating the persistence of considerable erythropoietic activity (Schiza).


Smear review and manual differential of this sample detected 5.5% band neutrophils, and confirmed the presence of metamyelocytes, myelocytes and NRBC. The RBC morphology correlated with the RBC indices, showing macro-ovalocytic RBCs with polychromasia, in line with the high reticulocyte counts.

Numerical Results

WBC 23.8 10e3/μL
NEU 6.39 10e3/μL 26.9 % Left Shift
LYM 14.5 10e3/μL 61.0 %
MONO 1.47X 10e3/μL 6.16X %
EOS .189 10e3/μL .793 %
BASO .022 10e3/μL 0.92 %
IG .1.21 10e3/μL 5.07 %
NRBC 3.42 10e3/μL
NR/W 14.4

RBC 4.42 10e6/μL
HGB 15.0 g/dL
HCT 47.6 %
MCV 106. fL
MCH 33.6 pg
MCHC 31.6 g/dL
RDW 18.7 %

RETIC 283. 10e3/μL 6.39 %
IRF .548
MCHr 31.8 pg

PLT 324. 10e3/μL
MPV 6.32 fL
%rP 5.86 %

FIGURE 1. CHC x Volume (RBC):
Cellular hemoglobin concentration vs. RBC volume plot
The position of the RBC cluster on this scatterplot is consistent with the high volume of the RBC, and also shows a spread along the x and y axes, due to anisocytosis and polychromasia.
Size vs. fluorescence plot
This plot shows the separation of nucleated cells (WBC and NRBC) from non-fluorescing events, represented by the gray dots next to the y axis. Although most samples contain a small amount of non-fluorescing events, on this scatterplot, the gray population (also visible on the IAS X ALL scatterplot) likely represents lysis-resistant RBC in this sample, which are commonly found in newborns. NRBC (red) are clearly visible in the lower portion of the plot, separated based on their smaller size and high fluorescence intensity compared to lymphocytes (cyan).
Intermediate angle light scatter vs. size plot
The notable findings on this scatterplot are the NRBC in the lower left corner (red), and the lysis-resistant RBC (gray). Although lysis-resistant RBC are of similar size as lymphocytes (cyan), they are separated from those based on fluorescence intensity, as shown on Figure 9.2, and do not interfere with the WBC analysis.
Alinity hq casebook. Neonatal Sample. ADD-00061876-v2; 2019. p.30-31

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