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Alinity hq

SEPSIS

Description

This patient was diagnosed with sepsis. The CBC showed leukocytosis, absolute and relative neutrophilia, significant number of immature granulocytes (8.69%) and a Left Shift flag. In addition, normocytic anemia was present with increased RDW.

 

The WBC scatterplots showed predominance of neutrophils (yellow), the population of which was wider than normal along the ALL axis and shifted downwards along the PSS axis suggesting the presence of immature granulocytes (IG).

 

The peripheral smear review showed neutrophil granulocyte predominance with 36% band neutrophils which explains the triggering of the Left Shift flag. There was also presence of more immature granulocytic forms such as metamyelocytes and myelocytes, that constituted about 8% of WBC differential. These numbers are consistent with %IG results on the Alinity hq.

 

Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection (Singer). It is a medical emergency and is the leading cause of death in hospitals (Liu). There are many signs, symptoms and laboratory findings for the diagnosis of sepsis, none of those being definitive by themselves (Singer, Evans, Sepsis Alliance). Neutrophils, including IGs, are considered to be an important component in the pathophysiology of sepsis, and both absolute and relative IG concentrations have been shown to be a useful early diagnostic marker in patients suspected of sepsis (Kovach, Fan, Nierhaus, Ansari-Lari).

Numerical ResultsSuspect

 
WBC 21.9 10e3/μL
NEU 16.6 10e3/μL 75.9 % Left Shift
LYM 1.38 10e3/μL 62.8 %
MONO 1.98 10e3/μL 9.05 %
EOS .011 10e3/μL .048 %
BASO .014 10e3/μL 0.62 %
IG 1.90 10e3/μL 8.69 %
NRBC 0.00 10e3/μL
NR/W 0.00

 
RBC 2.46 10e6/μL
HGB 7.85 g/dL
HCT 22.8 %
MCV 92.5 fL
MCH 31.9 pg
MCHC 34.4 g/dL
RDW 20.0 %

 
RETIC 70.1 10e3/μL 2.85 %
IRF .625
MCHr 29.9 pg

 
PLT 530. 10e3/μL
MPV 6.77 fL
%rP 4.04 %

 
FIGURE 1. IAS X ALL (WBC):
Intermediate angle light scatter vs. size plot
There is predominance of the neutrophil population (yellow). The neutrophil cluster shows an increased spread along the x-axis which triggers the Left Shift flag.
FIGURE 2. ALL VS PSS (WBC):
Size vs. polarized side scatter plot
Because band neutrophils and immature granulocytes are larger than mature segmented neutrophils with lesser nuclear lobulation, the neutrophil population (yellow) is slightly wider than normal along the x-axis and is also shifted lower along the y-axis.
FIGURE 3:
Representative image from patient’s smear
Patient’s smear shows the presence of band neutrophils (1) as well as other immature forms of neutrophil granulocytes including metamyelocyte (2) and a myelocyte (3).
Alinity hq Casebook. Sickle Cell Disease. ADD-00061876-v3 2020. p.44-45

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