Red Cell Cytograms Generated by an ADVIA 120 Automated Hematology Analyzer: Characteristic Patterns in Common Hematological Conditions

Abstract

Worldwide, most hematology laboratories have now changed over from the labor intensive manual methods of testing to 3-or 5-part differential automated hematology analyzers. Although laboratory personnel and hematopathologists handling the automated data are familiar with the basic interpretation and benefits of numerical data, the seemingly complex graphical representation of the red cell data in the form of histograms and cytograms is often ignored. At times, these can provide vital information that may not even be apparent in the automated numerical data. 1 Characteristic red cell cytogram patterns indicative of common hematological conditions are being presented in this paper. Materials and MethodsThis study presents a compilation of characteristic red cell cytograms generated by Advia-120 (Siemens Healthcare Diagnostics, Deerfield, IL), 2 a 5-part differential system (Technicon H1 series) used in the hematology laboratory of a tertiary care teaching institution. The cytograms have been compiled over a 2-year period from blood samples (approximately 200 per day) received for routine complete blood counts (CBC) in the laboratory. Approximately 140,000 cytograms have been analyzed during the study period. Single test requests were not run through the Advia-120 and were done manually. Dipotassium ethylenediaminetetra-aceticacid (EDTA) blood was used for testing and the tubes for sample collection were prepared in-house. AbstractBackground: Graphical data output from automated hematology analyzers, especially those related to red blood cells, have been traditionally ignored in favor of the more frequently used numerical values. This study presents characteristic red cell cytograms generated by Advia-120, a 5-part automated hematology analyzer, as seen in common hematological conditions.

The Red Cell Histogram and The Dimorphic Red Cell Population

“…31 This is probably because graphical representation of results, such as scatter plots or histograms, have been largely ignored in favor of the RDW, hemoglobin distribution width, and reticulocyte hemoglobin content that provide very useful information along with the red cell indices that have been traditionally used. 5,32,33 In fact, in some laboratories histograms are not being used when evaluating red cell morphology.…”

“…5,15 For example, in megaloblastic anemia with developing iron deficiency, some of the hypochromic and microcytic red cells can be identified in the histogram but may not be reflected in the numerical data, and this may well be the first clue to a not uncommon occurrence. Likewise, iron deficiency may develop insidiously during the process of some other disease (eg, essential polycythemia), with normal cell counts and indices, except the RDW, which is elevated.…”

Cold agglutinin activity in 2 dogs

“…7 False-negative PCR results can occur and PCR from the spleen is considered to be more sensitive for the detection of organisms than from blood. 8 Because spleen samples were not available from this dog, the serum samples that were submitted were of lower diagnostic value and could have contributed to a false-negative finding. Therefore, the Ehrlichia status of this dog was considered unconfirmed.…”

“…The dog in this report received a lower dose of doxycycline than the currently recommended dose of 10 mg/kg SID to clear an Ehrlichial infection, but it was within the range reported to clear active acute infections . False‐negative PCR results can occur and PCR from the spleen is considered to be more sensitive for the detection of organisms than from blood . Because spleen samples were not available from this dog, the serum samples that were submitted were of lower diagnostic value and could have contributed to a false‐negative finding.…”

What is your diagnosis? Cytogram triple threat

“…It can also provide additional information in patients with agglutination or a history of transfusion. In such cases, the reported indices can be erroneous and may inaccurately represent the patient's hematopoietic status . In this case, the reported MCV and MCHC suggested an iron‐deficient state (which was present), but the cytogram also identified a regenerative response and the persistence of transfused cells.…”