Hematology Case Study - High WBC Count with Blasts

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This patient (see PDF) presented with abdominal pain and a CBC showing a high WBC count, mild anemia and thrombocytopenia. The automated differential shows asterisks on all parameters with multiple WBC flags and a very abnormal WDF scattergram (shown to the right with normal populations and flagging areas labeled).

The XN-Series™ Automated Hematology Analyzer identified about 7% Immature Granulocytes (IG) and a large number of abnormal cells; this abnormal pattern triggered review flags for blasts and abnormal lymphocytes. The manual differential shows blasts and more lymphocytes than the automated differential. Because of the poor separation of cells (indicated by the WBC Abn Scattergram flag), some of the lymphocytes were included in the automated monocyte count. Due to the high number of blasts, follow-up testing such as flow cytometry studies are indicated to con rm and stage an acute leukemia diagnosis.

The automated IG is a standardized result which uses fluorescent flow cytometry to enumerate metamyelocytes, myelocytes, and promyelocytes. When used according to lab protocol it may help reduce the number of manual reviews and diferentials performed by the laboratory which can improve work flow efficiency.

The clinical applications or uses presented in these materials, including case studies, are provided for illustration purposes only. Prior to using any Sysmex device, please review the manufacturer’s instructions use. It is the healthcare provider’s responsibility to determine applicability in routine clinical practice.

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