Spurious Counts and Spurious Results on Hematology Analyzers: White Blood Cells, Red Blood Cells, Hemoglobin, Red Cell Indices, and Reticulocytes

Zandecki, Marc; Geneviève, Franck; Gérard, J; Godon, Alban

doi:10.1002/9781444398595.ch8

Cited by 7 publications

(13 citation statements)

References 89 publications

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“…While examining under higher magnification, it is important to note if red cell fragments, organisms (bacteria and fungi), and/or giant platelets are present in significant number (more than occasional). The presence of significant number of red cell fragments is frequently associated with falsely high platelet count whereas the presence of significant number of giant platelets is often associated with falsely low platelet count [11, 12]. The presence of bacteria and/or fungi has been associated with falsely high platelet counts [13-16].…”

Section: Three Types Of Smear Examinationmentioning

confidence: 99%

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

et al. 2013

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A microscopic examination of an appropriately prepared and well-stained blood smear by a knowledgeable laboratory professional is necessary and clinically useful in a number of circumstances and for a variety of reasons. In this article, an attempt is made to delineate the purpose and criteria for blood smear examination in a variety of circumstances that are encountered in everyday laboratory hematology practice. A blood smear scan serves to at least (a) verify the flagged automated hematology results and (b) determine if a manual differential leukocyte count needs to be performed. Blood smear examination/manual differential leukocyte count with complete blood count (CBC) provides the complete hematologic picture of the case, at least from the morphologic standpoint. Blood smear review with or without interpretation serves to ensure that no clinically significant finding is missed, besides providing diagnosis or diagnostic clue(s), particularly if and when interpreted by a physician.

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Section: Three Types Of Smear Examinationmentioning

confidence: 99%

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

et al. 2013

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“…Notably, except for the Sysmex XN90001A, all analyzers reported a basophilia, but for different reasons. In the CellaVision, basophils were, in fact, monocytes and lysed cells, whereas in the Advia 2120 and Sysmex XT2000iV, pseudobasophils were presumably immature NRBCs that were resistant to the lysing agent, as has been reported in human medicine 6 . The newest Sysmex XN90001A analyzer reported a low number of basophils, which was consistent with the manual differential counts.…”

Section: Figurementioning

confidence: 99%

“…Apparently, new image analysis systems designed for human hematology might overcome this problem. However, until these are available in veterinary, 6 laboratories and clinicians will have to rely on the oldest hematologic method—the blood smear evaluation (Figure 1).…”

Section: Figurementioning

confidence: 99%

Blood from a “half‐fish” dog: How modern analyzers deal with nucleated red blood cells

Simões

Costa

Santos

et al. 2020

Veterinary Clinical Pathol

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“…The complete blood count (CBC) is commonly ordered as part of the clinical examination. The CBC results can be influenced by the site of collection, the type of tube used, and sedation as well as by the patient's clinical condition [16,17].…”

Section: Introductionmentioning

confidence: 99%

How Much Does the Platelet Aggregate Influence the Total Leukocyte Count? Comparison Between Manual and Automated Impedance Methods in Domestic Cats

Zanfagnini

Kassab

Campos

et al. 2021

Acta Scientiae. Vet.

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Background: Automated hematology analyzers have been developed to optimize the time between analyses and have promising precision and accuracy. Complete blood count (CBC) is often requested as part of veterinary clinical examination. Automated analyzers are often used to determine CBCs, since processing as well as container-related errors may occur owing to variable sizes, aggregates, white or red blood cell fragments, and effects of EDTA on cell morphology. Platelet aggregates frequently occur in felines, with studies reporting a prevalence of approximately 71%. The aim of the present study was to evaluate the influence of exercise aggregates on the global white blood cell count of domestic cats using automated hematological counters with the impedance method.Materials, Methods & Results: Blood samples of 140 cats, irrespective of age, sex, and breed, were collected into EDTA-containing tubes. The samples were obtained via routine clinical examinations at the Veterinary Hospital of the Federal Rural University of Rio de Janeiro (UFRRJ) and processed at the Veterinary Parasitology Experimental Chemotherapy Laboratory (LQEPV), belonging to the same institution. All the samples were processed on the Sysmex pocH-100iV Diff automated hematology apparatus according to the manufacturer's recommendations. Leukocyte counts were also manually determined using a duplicate Neubauer chamber. Standard dilutions were prepared immediately after the automated analysis. To identify the occurrence of platelet aggregates, a blood smear was made and visualized under a brightfield microscope at a magnification of 10× and scored 0 to 3 (G1, G2, G3, and G4) based on the aggregation intensity. In case of changes, the groups were subdivided according to the intensity of occurrence. Of the 140 samples analyzed, 76.4% (107/140) showed some degree of platelet aggregation. The maximum variation in leukocyte counts determined by the automatic and the manual technique in G1 was 2,500 cells. In G2, it was possible to identify a variation of 6,500 nucleated cells, whereas in G3, this value was 7,100 cells. In G4, where platelet aggregation was intense, the variation between counts was up to 15,000 nucleated cells. A significant difference of variation in total white blood cell count between manual and automated methods was observed when compared to animals that did not show any degree of platelet aggregation (P < 0.05). Of the total samples, 23.57% (33/140) comprised G1, 24.28% (34/140) G2, 22.14% (31/140) G3, and 30% (42/140) G4. Of the 140 samples analyzed, 107 showed aggregates, pseudo-thrombocytopenia, and changes in the total number of leukocytes.Discussion: Samples with higher platelet aggregate formation showed greater interference in global leukometry when analyzed using the hematological counter. White blood cell counts determined by automated analyzers should be interpreted with caution and compared to manual counts when there is significant platelet aggregation in the sample. The findings reinforce the importance of reconfirming the results obtained using an automated equipment in order to avoid misinterpretations that may influence diagnosis and therapy. It is essential to re-check the values obtained from an automated equipment with traditional methods in order to minimize possible errors generated by the equipment, since such errors may affect the clinical diagnosis and subsequently, the therapeutic approach chosen.

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Spurious Counts and Spurious Results on Hematology Analyzers: White Blood Cells, Red Blood Cells, Hemoglobin, Red Cell Indices, and Reticulocytes

Cited by 7 publications

References 89 publications

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

Purpose and Criteria for Blood Smear Scan, Blood Smear Examination, and Blood Smear Review

Blood from a “half‐fish” dog: How modern analyzers deal with nucleated red blood cells

How Much Does the Platelet Aggregate Influence the Total Leukocyte Count? Comparison Between Manual and Automated Impedance Methods in Domestic Cats

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