Clinical Cases Study

BC-3000Plus Auto Hematology Analyzer (V3.0)Automated Hematology Analyzer 3-Diff

3-Diff Clinical Cases Study

RBC Morphology and relative disease

WBC Morphology and relative disease

PLT Morphology and relative disease

Case presentation

Microcytic anemia

Normocytic anemia

Macrocytic anemia

Iron deficiency anemiaβ-Globin aplastic anemia

Aplastic anemia

Megaloblastic anemia

Nutrition deficiency anemia

Some liver disease anemia

MCV,RDW application

Anemia classification

MCV range

MCV / RDW phenomenon

Possible Pathology

Microcytic anemia (symmetrical)

MCV<80 MCV value is decreasingRDW value is normal

ThalassemiaSecondary anemia

Microcytic anemia (non-symmetrical)

MCV<80 MCV value is decreasingRDW value is increasing

Iron deficiency anemiaβ-Globin aplastic anemia HbH diseases

Microcytic Anemia :Characterized by small red cells

MCV,RDW diagnosis using

MCV range MCV / RDW phenomenon

Possible Pathology

Normocytic anemia (symmetrical)

80<MCV<100 MCV value is normal,RDW value is normal

Aplastic anemia; Leukemia; Chronic liver disease; Acute blood loss; Hereditary spherocytosis

Normocytic anemia

(non-symmetrical)

80<MCV<100 MCV value is normalRDW value is increasing

Nutrition deficiency anemia; Pre-iron deficiency; Hemoglobinopathy anemia ; Myelofibrosis,; Sideroblastic anemia

Normocytic anemia is when the overall Hb levels are decreased, but the red blood cell size (MCV) remains normal.

MCV range

MCV / RDW phenomenon

Possible Pathology

Macrocytic anemia(symmetrical)

MCV>100 MCV value increasing;RDW value is normal

Myelodysplastic syndromeMDS, Some aplastic anemia,

Macrocytic anemia(non-symmetrical)

MCV>100 MCV value increasing; RDW value increasing

Megaloblastic anemia,Some liver disease

anemia.

Iron Deficiency Anemia

Manual Differential SmearManual Differential Smear

RBC Morphology:

Microcytosis:+++

Anisocytosis:+++

Poikilocytosis:+

Hypochromic :++

Pm: possible presence of large platelet, platelet coagulation, small red blood cell, cell debris or fibrin. Pl: excessive large platelet

β-Globin Aplastic Anemia

Microcytosis :+++

Anisocytosis:+++

Target cell:++

Hypochromic :++

RBC Morphology:

Pm: possible presence of large platelet, platelet coagulation, small red blood cell, cell debris or fibrin.

Microcytic anemia (non-symmetrical)

MCV<80 MCV value is decreasingRDW value is increasing

Iron deficiency anemiaβ-Globin aplastic anemia

RDW-CV

RDW-SD

Iron Deficiency Anemia

β-Globin Aplastic Anemia

RDW-SD is the most reliable discrimination between IDA and β-Globin Aplastic Anemia

Iron Deficiency Anemia β-Globin Aplastic Anemia

(“H” Flag)

(“L” Flag)

(“H” Flag)

Differentiate Diagnosis

Megaloblastic Anemia

Macrocytic anemia (non-symmetrical)

MCV>100 MCV value is increasing RDW value is increasing

Megaloblastic anemia

Macrocytosis:++

RBC Morphology:

Anisocytosis

Anisocytosis:+++

RBC Morphology:

Pm: possible presence of large platelet, platelet coagulation, small red blood cell, cell debris or fibrin. Pl: excessive large platelet

leukemia

Neutrophilia

Parasitic infection

Infectious mononucleosis

Neutrophilia

Manual Differential (N=200)

Neutrophils 90.5%

Lymphocytes 5%

Monocytes 3.5%

Eosinophils 1%

Basophils 0%

Rm Indicates at least two R flags.

R2 Indicates abnormality between the lymphocyte hump and the mid-sized cell area.

R3 Indicates abnormality between the mid-sized cell area and the granulocytes.

Parasitic infection

Neutrophils 33.5%

Lymphocytes 32%

Monocytes 6.5%

Eosinophils 27.5%

Basophils 0.5%

R2: possible presence of abnormal lymphocyte, plasma cell, atypical lymphocyte, original granulocytes in the sample and eosinophilia or basophilia.R3: possible presence of immature granulocytes, abnormal sub-population in the sample, or eosinophilia.

R2 Indicates abnormality between the lymphocyte hump and the mid-sized cell area

Infectious mononucleosis

Neutrophils 20%

Bands 5%

Lymphocytes 19%

Atypiacl LYM 55%

Monocytes 0%

Eosinophils 1%

Basophils 0%

R2: possible presence of abnormal lymphocyte, plasma cell, atypical lymphocyte, original granulocytes in the sample and eosinophilia or basophilia.

Rm Indicates at least two R flags.

Chronic Granulocytic Leukemia

Promyelocyte 2%

Myelocyte 11%

Metamyelocyte 5%

Neutrophils 26%

Bands 26%

Lymphocytes 11%

Monocytes 7%

Eosinophils 1%

Basophils 11%

R2: possible presence of abnormal lymphocyte, plasma cell, atypical lymphocyte, original granulocytes in the sample and eosinophilia or basophilia.R3: possible presence of immature granulocytes, abnormal sub-population in the sample, or eosinophilia.

Lymphoblast 1%

Neutrophils 3%

Lymphocytes 95%

Monocytes 1%

Eosinophils 0%

Basophils 0%

Chronic Lymphocytic Leukemia

Acute myeloblastic leukemia

Myeloblast 87%

Neutrophils 2%

Lymphocytes 11%

Monocytes 0%

Eosinophils 0%

Basophils 0%

Acute monocytic leukemia

Hemocytoblasts 44%

Neutrophils 3%

Lymphocytes 10%

Monoblast 36%

Monocytes 6%

Eosinophils 1%

Basophils 0%

Therapy TraceAcute leukemia

Blasts 24%

Neutrophils 4%

Lymphocytes 28%

Monoblast 38%

Monocytes 6%

Eosinophils 0%

Basophils 0%

Period of chemotherapy

1th Day 5th Day 7th Day

Thrombocytosis

Excessive platelet no platelet coagulation

Other Abnormal Histograms

Histogram AlarmRm Indicates at least two R flags.

R1 Indicates abnormality on the left side of the lymphocyte hump.

R4 Indicates abnormality on the right side of the neutrophilic granulocyte hump.

Pm Indicates blur demarcation between the platelet and red blood cell area.

Ps Indicates excessive small PLTs.

Pl Indicates excessive large PLTs.

Parameter flags

”H” Exceed the upper limit of the reference range

“L” Exceed the lower limit of the reference range

The result is either unreliable or out of the operating range

WBC result is less than 0.5 109/L

No differential result

Abnormal histogram

No differential result because the WBC histogram is over-narrowly compressed.

No differential result because WBC count result is less than a certain value (WBC < 0.5)

Abnormal histogram

No differential result because the peak of WBC histogram lies in the middle of the histogram and

thus cannot identify the type of peak cells

Abnormal histogram

Increased nucleated erythrocytes or interference or inadequate lyse

Abnormal histogram

No lyse reagent or poor lyse

Severe interference in WBC channel

Abnormal histogram

Increased lymphocytes

Abnormal histogram

Increased mid-sized cells

Abnormal histogram

Increased neutrophilic granulocytes

Abnormal histogram

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