CORE LABORATORY
Don't have an account? Sign Up

Alinity hq

NUCLEATED RED BLOOD CELLS AND IMMATURE GRANULOCYTES

Description

This patient presents a complex case with leukocytosis, absolute neutrophilia, Left Shift flag, thrombocytopenia, a significant number of immature granulocytes and nucleated red blood cells. In addition, normocytic anemia is present with an increased RDW. The platelet count parameters were rendered suspect due to the presence of the Platelet Clump flag. Several abnormalities are present, but this case will focus on the presence of IG and NRBC.

 

Note: the platelet-related abnormalities are discussed in a separate case.

 

The manual differential found a high percentage of band neutrophils, in line with the Left Shift flag. The number of IG (metamyelocytes, myelocytes and promyelocytes) seen on the smear is consistent with the Alinity hq count. The manual and automated NRBC counts agreed. Importantly, Alinity hq can differentiate NRBC from WBC, and enumerates them separately. There is no need to correct the WBC count for the presence of NRBC, as NRBC do not interfere with the WBC count.

 

NRBC do not circulate in peripheral blood beyond the neonatal period; their presence often indicates a very high demand for the bone marrow to produce RBC. NRBC in peripheral blood almost always appear in the setting of anemia. Several etiologies are possible, including hemolysis, hemoglobinopathy/thalassemia, trauma/acute bleeding; as well as myelodysplasia, leukemia and myeloproliferative neoplasm.

Numerical Results

SUSPECT
 
WBC 27.6 10e3/μL
NEU 23.7 10e3/μL 86.0 % Left Shift
LYM .844 10e3/μL 3.06 %
MONO 1.05 10e3/μL 3.82 %
EOS .111 10e3/μL .401 %
BASO 0.01 10e3/μL .035 %
IG 1.84 10e3/μL 6.69 %
NRBC 1.54 10e3/μL
NR/W 5.58

 
RBC 2.54 10e6/μL
HGB 7.55 g/dL
HCT 23.2 %
MCV 89.4 fL
MCH 29.1 pg
MCHC 32.6 g/dL
RDW 19.1 %

 
RETIC 144. 10e3/μL 5.67 %
IRF .624
MCHr 33.2 pg

 
PLT 55.6 10e3/μL  PLT Clump
MPV 11.6 fL
%rP 25.7 %

 
FIGURE 1. FL1 x ALL (WBC):
Fluorescence vs. size plot
In this scatterplot the cluster of NRBC (red) are found in the lower portion of the plot. NRBC are smaller and express high fluorescence, which enables distinct separation from leukocytes. NRBC are not present in the peripheral blood under normal circumstances. Therefore the red population would be absent.
FIGURE 2. ALL x PSS (WBC):
Size vs. polarized side scatter plot
IG and band neutrophils are detected through subtle changes in the size and positioning of the neutrophil population within the WBC scatterplots. In this case, the neutrophil cluster (yellow) is wider than normal along the x-axis (ALL) which indicates cell size. Band neutrophils and IG are generally larger than mature segmented neutrophils. The neutrophil population is also wider than normal along the y-axis (PSS).
FIGURE 3. IAS x ALL (WBC):
Intermediate angle light scatter vs. size plot
The differential scatterplot based on size (ALL) vs. intermediate angle light scatter (IAS) shows the NRBC (red) in the lower left portion of the plot. They are separated from other non-WBC events (gray).
TABLE 1:
Manual Differential Results
Alinity hq casebook. Nucleated Red Blood Cells and Immature Granulocytes. ADD-00061876-v2 2019. p.32-33

Alinity h-series is available in select countries, not including the US.
©2021 Abbott, Abbott Park, Illinois, U.S.A.

Privacy Policy| Terms and Conditions

Unless otherwise specified, all product and service names appearing in this Internet site are trademarks owned by or licensed to Abbott, its subsidiaries or affiliates. No use of any Abbott trademark, trade name, or trade dress in this site may be made without the prior written authorization of Abbott, except to identify the product or services of the company.

All Alinity hq, CELL-DYN Ruby and CELL-DYN Sapphire instruments are Class I laser products. ACCELERATOR a3600 is a Class II laser product. 

The Alinity, ACCELERATOR and CELL-DYN systems are intended for performing in vitro diagnostic assays on samples of human origin (blood, urine). Read the instructions in the system manuals and labeling and/or reagent instructions carefully. Manufacturer or Authorized Representative: Abbott Germany.

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