Spurious Extreme Reticulocytosis with an Automated Reticulocyte Analyzer

Laurencet, F; Martinez, Thelmo; Beris, Photis

doi:10.1056/nejm199712253372615

Cited by 9 publications

(17 citation statements)

References 2 publications

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“…Leukemic cells were speculated to stain less intensely with polymethine than normal leukocytes and thus be spuriously identified as reticulocytes . More similar to our case, an erroneously high IRF was reported in a cases of high intra‐erythrocytic parasitemia in human malaria …”

Section: Discussionsupporting

confidence: 78%

“…In our case, parasite RNA was most probably falsely interpreted as reticulocyte RNA, explaining the incorrect reticulocyte count using the Sysmex and the Procyte . Careful gating of reticulocytes is crucial to determine accurate counts, because polymethine also stains RNA in platelets and WBC.…”

Section: Discussionmentioning

confidence: 79%

“…Specifically, the automated reticulocyte count from the Sysmex was higher than the manual count. The discrepancy between automated reticulocyte count obtained with different fluorescent dyes and the manual reticulocyte count based on a NMB‐stained blood smear has been previously reported in people with falciparum malaria infection, and the difference between the 2 was described as proportional to the parasitemia in some cases . The Sysmex and the ProCyte perform an optical reticulocyte count using the same fluorescent dye polymethine, whereas the LaserCyte uses the classical NMB to stain ribonucleic acid (RNA) in cells.…”

Section: Discussionmentioning

confidence: 99%

“…In our case, an abnormal isolated reticulocyte cluster was found at the location of LFR cells (73.8%) and MFR (22.6%). Other cases with abnormal reticulocyte profiles have been described in cases of canine and human acute myeloid and lymphoid leukemia, and in human beings with malaria . In leukemia, the discrepancy has been proposed to be due to leukemic cells and cell fragments .…”

Section: Discussionmentioning

confidence: 99%

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Spurious reticulocyte profiles in a dog with babesiosis

Piane

Théron

Aumann

et al. 2016

Veterinary Clinical Pathol

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A 9-year-old, female Maltese dog was referred to the Veterinary School of Toulouse with a 2-day history of anorexia and weakness. On clinical examination, the dog had hyperthermia (39.7°C), abdominal discomfort, and polypnea. Significant laboratory findings included pigmenturia, hyperbilirubinemia, hypercreatininemia, hyperfibrinogenemia, abnormal Snap canine pancreas-specific lipase, and pancytopenia with a nonregenerative anemia. A peripheral blood smear revealed numerous intraerythrocytic large Babesia but no polychromasia. There was a discrepancy between the absolute automated reticulocyte count (Sysmex reticulocyte count: 60 × 10 /L; RI 19.4-150.1 × 10 /L) and the manual reticulocyte count (3.6 × 10 /L) as well as the absence of polychromasia. The optical red blood cell scattergram showed an abnormal isolated reticulocyte cluster at the location of low-fluorescence ratio cells. These findings were interpreted as erythrocytes parasitized by large Babesia. The discrepancy between the Sysmex reticulocyte count and the manual reticulocyte count has been reported previously in people with falciparum malaria and numerous intra-erythrocytic Plasmodium falciparum organisms. This spurious reticulocyte profile and reticulocyte count were observed with the Sysmex XT-2000iV and the ProCyte using the same fluorescent dye polymethine but not with the LaserCyte using new methylene blue which does not stain Babesia organisms on a blood smear performed for manual reticulocyte counting.

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Section: Discussionsupporting

confidence: 78%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Spurious reticulocyte profiles in a dog with babesiosis

Piane

Théron

Aumann

et al. 2016

Veterinary Clinical Pathol

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“…Although they are only faintly stained using fluorescent dyes, intraerythrocytic parasites (malaria, babesia) may interfere with automated reticulocyte count, and value six times higher than the manual count was reported in a patient demonstrating 70% of RBC infected with plasmodium falciparum (Laurencet, Martinez & Beris, 1997).…”

Section: Reticulocytesmentioning

confidence: 98%

Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes

Zandecki

Geneviève

Gérard

et al. 2007

Int J Lab Hematology

151

133

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S U M M A R YHaematology analysers provide quick and accurate results in most situations. However, spurious results, related either to platelets (part I of this report) or to other parameters from the cell blood count (CBC) may be observed in several instances. Spuriously low white blood cell (WBC) counts may be observed because of agglutination in the presence of ethylenediamine tetra-acetic acid (EDTA). Cryoglobulins, lipids, insufficiently lysed red blood cells (RBC), erythroblasts and platelet aggregates are common situations increasing WBC counts. In most of these instances flagging and/or an abnormal WBC differential scattergram will alert the operator. Several situations lead to abnormal haemoglobin measurement or to abnormal RBC count, including lipids, agglutinins, cryoglobulins and elevated WBC counts. Mean (red) cell volume (MCV) may be also subject to spurious determination, because of agglutinins, excess of glucose or salts and technological considerations. In turn, abnormality related to one measured parameter will lead to abnormal calculated RBC indices: mean cell haemoglobin content (MCHC) is certainly the most important RBC indices to consider, as it is as important as flags generated by the haematology analysers (HA) in alerting the user to a spurious result. In many circumstances, several of the measured parameters from CBC may be altered, and the discovery of a spurious change on one parameter frequently means that the validity of other parameters should be considered. Sensitive flags now allow the identification of several spurious counts, but only the most sophisticated HA have optimal flagging and more simple HA, especially those without a WBC differential scattergram, do not possess the same sensitivity for detecting anomalous results. Reticulocytes are integrated now into the CBC in many HA, and several situations may lead to abnormal counts.

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