Clinical Characteristics of Patients with a RBC Fragment Flag on the Advia® 2120 Automated Hematology Analyzer.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5153-5153
Author(s):  
Jonathan Ben-Ezra
Keyword(s):  
Iron Deficiency ◽  
Iron Deficiency Anemia ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Lymphoblastic Leukemia ◽  
Peripheral Blood Smear ◽  
Deficiency Anemia ◽  
Clinical Criteria ◽  
Hematology Analyzer ◽  
Automated Hematology Analyzer

The clinical diagnosis of thrombotic thrombocytopenia purpura (TTP) is a difficult one to make. It is based on clinical criteria, one of which is a microangiopathic hemolytic anemia, characterized morphologically by the presence of schistocytes on the peripheral blood smear. The ADVIA 2120 automated hematology analyzer is able to quantify the presence of red blood cell (RBC) fragments. We studied the ability of the ADVIA 2120 to be able to detect RBC fragments in the blood of TTP patients, and the characteristics of all patients in whom RBC fragments were obtained. During the study period, 6 TTP patients were studied. The initial numbers of RBC fragments ranged from 0.02–0.05 × 106 cells/μl. During the course of plasmapheresis, these numbers decreased to 0.00–0.02 × 106 cells/μl, corresponding to a rise in the platelet count. Figure Figure In the course of a month, 52 blood samples on 39 patients were flagged by the hematology analyzer to have RBC fragments (0.01–0.12 × 106 cells/μl). 52 Samples with RBC Fragment Flag Hemoglobin Platelets RDW Range 4– 14.3 g/dl 5–906 × 103/ul 13.9– 28.6% Number Abnormal 46 (<13.0 g/dl) 23 (<160 × 103/ul) 51 (>14.1%) Within this population, there were two patients with TTP, and one with DIC. Four of the samples did not have detectable schistocytes upon visual inspection of the peripheral blood smear. There were 19 samples from 14 patients who had RBC fragment counts ≥ 0.04 × 106 cells/μl. 19 Specimens with RBC Fragments ≥ 0.04 × 106/ul Hemoglobin Platelets RDW Range 8– 14.1 g/dl 59– 906 × 103/ul 16.4– 25.3% Number Abnormal 15 (<13 g/dl) 4 (<160 × 103/ul) 19 (>14.1%) The diagnoses in these 14 patients were iron deficiency anemia (4 patients), thalassemia trait (2), acute lymphoblastic leukemia (2), and one each with TTP, sickle cell anemia, heart failure, kidney stone, cerebrovascular accident (CVA), and end stage renal disease. We conclude that the RBC fragment flag on the ADVIA 2120 is nonspecific. Although it does detect schistocytes in TTP, these are often present in low numbers. Quantitatively, the most numerous RBC fragments are found in diseases with marked anisopoikilocytosis, such as iron deficiency anemia.

Usefulness of Peripheral Blood Smears in Identifying the Causes of Anemia in Adults.

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 5565-5565
Author(s):  
Peter McPhedran ◽  
Robert B. Hall
Keyword(s):  
Differential Diagnosis ◽  
Iron Deficiency ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Diagnostic Yield ◽  
Correct Diagnosis ◽  
Peripheral Blood Smear ◽  
Deficiency Anemia ◽  
Blood Smears ◽  
Complete Blood Counts

Abstract Anemia is common in hospital patients, being found in about half of the automated complete blood counts (CBCs) done on adults aged 20+ at our hospital. Often the reason for the anemia is immediately apparent (post-operative state, end stage renal disease without erythropoietin treatment), but often it is not. Many tests are available for the differential diagnosis of the causes of the anemia. Morphologic evaluation of a Wright-stained blood smear by a skilled observer is labor intensive, but sometimes useful in the differential diagnosis of anemia. When unexplained anemia is identified in a patient on the Medical Service at our teaching hospital, the ward team may also send an intern or a medical student to check out the smear. The potential diagnostic yield of any of these evaluations (the skilled observer, the intern, the student) is unknown. We did a prospective evaluation of 202 consecutive adults with initially unexplained anemia (Hb &lt;12 in men, &lt;11 in women). Using accepted, pre-established criteria for etiologic diagnosis of the causes of anemia, and available data (plus additional smear evaluations by ourselves, ferritins, free erythrocyte protoporphryns, and a few other tests) we felt we were able to establish the causes of anemia in 86% of the patients. We also referred to standard morphologic criteria for diagnosing specific blood disorders in order to see how much could be learned from the blood smears of these patients, alone. Of 147 patients whose blood smears were of acceptable quality, 30 (21%) of the blood smears were diagnostic (or close to diagnostic), and an additional 46% were supportive of the correct diagnosis. For example, iron deficiency anemia was considered the morphologic diagnosis if the blood smear showed severe hypochromia, “pencil-form” elliptocytes, and thrombocytosis. Hypochromia alone would be considered supportive of the diagnosis of iron deficiency, but require more consideration of alternatives (thalassemia trait, chronic disease, etc). Thus, in evaluating anemia in adults, a good peripheral blood smear, carefully evaluated by a trained observer, is likely to be diagnostic, or very helpful, in 20% or more of the patients.

scholarly journals Erythrocyte Morphology of Tuberculosis Patients

2019 ◽  
Vol 1 (1) ◽  
pp. 10-18
Author(s):  
Ahmad Rifa'i ◽  
Ahmad Muhlisin ◽  
Leka Lutpiatina
Keyword(s):  
Chronic Disease ◽  
Iron Deficiency ◽  
Chronic Diseases ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Deficiency Anemia ◽  
Morphological Description ◽  
Erythrocyte Morphology ◽  
Tuberculosis Patients

Tuberculosis is one of the causes of anemia in chronic diseases in addition to rheumatoid arthritis, urserative colitis, Crohn's disease, ovarian malignancy and Hodgkin's lymphoma. Chronic disease anemia also known as anemia due to inflammation, occurs in patients with chronic infections. This anemia also occurs in some patients with malignancy. The causes of anemia are based on cell size, namely iron deficiency (often), anemia of chronic diseases (often), Thalassemia (often in certain ethnicities) causing the size of cells to become microsytic. Cells turn macrocytic due to liver disease, excess alcohol, megaloblastic anemia (vitamin B12 deficiency or folate or exposure to certain drugs), hemolysis, and aplastic anemia. Whereas the normal cell factors are blood loss, the initial phase of iron deficiency, anemia, chronic disease, and kidney failure. The aim of this study was to determine the type of anemia based on the morphological description of erythrocytes in the form, color, and size of erythrocytes seen in the smear blood supply of tuberculosis patients based on treatment duration of 0-6 months. The type of research used was a descriptive survey with a population of 15 people taken by accidental sampling. Data collection is done by examining the blood smear smears. Based on the examination of peripheral blood smear preparations in pulmonary tuberculosis patients, the morphology of erythrocytes in the form of Normocytic normochrome was 74% and microsocytic normochrome was 26%. Suggestions in the research for further research can be carried out with support other than the examination of peripheral blood smear.

scholarly journals Comparison of peripheral blood smear examination with automated haematology analyzer for diagnosing different types of anemia.

2021 ◽  
Vol 28 (10) ◽  
pp. 1433-1437
Author(s):  
Rabiah Asghar ◽  
Javera Tariq ◽  
Nabeela Naeem ◽  
Anila Zafar ◽  
Khadija Qureshi ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Hypochromic Anemia ◽  
Peripheral Blood Smear ◽  
Smear Examination ◽  
Blood Smear Examination ◽  
Hematology Analyzer ◽  
Different Types ◽  
Automated Hematology Analyzer

Objective: This study aims to determine diagnostic accuracy of peripheral blood smear and automated haematology analyzer and to determine frequency of different types of anemia diagnosed by peripheral blood smear and automated hematology analyzer. Study Design: Cross Sectional study. Setting: Department of Pathology, Rawal Institute of Health Sciences, Islamabad. Period: November 2015 to April 2016. Material & Methods: Sample size of 149 suspected anemia patients was calculated using WHO calculator with 95% confidence interval. Research approval was taken from hospital ethical board. Patients were approached through non probability consecutive sampling method. Both peripheral blood smear examination and automated haematology analysis of each sample was performed. Diagnostic accuracy and frequency of anemia types was measured. Data analysis was done with the help of SPSS version 25. Chi-square and fissure exact test and ROC curve analysis was applied and significant (p<0.05) results were reported. Results: Total 149 patients were included in study. There were 42(28.2%) male and 107(71.8%) female.  Mean age of patients was 35.1±2.1SD. Peripheral blood smear and automated haematology analyzer showed sensitivity (68% vs 92%), specificity (59% vs 88%), PPV (72% vs 92%), NPV (55% vs 88%) and diagnostic accuracy (64% vs 91) respectively. Most common type of anemia diagnosed with peripheral blood smear was microcytic hypochromic anemia with raised RDW 36.7% followed by normocytic normochromic anemia with raised RDW 13.3% and macrocytic anemia (p=0.001) while in automated haematology analyzer microc ytic hypochromic anemia with raised RDW54.4% followed by normochromic normocytic anemoia with normal RDW 11.1% (p=0.000). Conclusion: Automated haematyology analyzer had high diagnostic accuracy for diagnosis of anemia.  Microcytic hypochromic anemia and normocytic normochromic are most common anemias diagnosed by peripheral blood smear and automated hematology analyzer and peripheral blood smear cannot be completely replaced by automated haemolytic analyzer. However, if both methods are used simultaneously, more accurate results can be obtained.

scholarly journals Estimation and comparison of thrombocyte count by peripheral blood smear method and automated method in women with pregnancy

2019 ◽  
Vol 7 (6) ◽  
pp. 2052
Author(s):  
Vineet Chaturvedi ◽  
Abdul Mabood ◽  
Shalini Gupta ◽  
Shivani Gupta ◽  
Kiran K. S. ◽  
...  
Keyword(s):  
Standard Deviation ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Mean Value ◽  
Good Precision ◽  
Thrombocyte Count ◽  
Automated Method ◽  
Hematology Analyzer ◽  
Automated Hematology Analyzer

Background: Thrombocyte is important and very essential component of blood and have significant role in maintenance of hemostasis. Thrombocyte count is an important investigation done in various acquired and congenital coagulable states which include conditions like pregnancy. Thrombocyte count is routinely done by automated hematology analyzer method. The automated hematology analyzer counters are not usually available at all centres especially in peripheral and rural side though thrombocytes can also be assessed from the peripheral blood smears, which can be easily and precisely done at any set up. Aim and objective of this study was to compare the thrombocyte estimation by peripheral blood smear method and automated hematology analyzer in pregnant women.Methods: Thrombocyte estimation was done from samples taken from 120 normal pregnant women between December 2018 to March 2019, where samples were Ethylene Diamine Tetra Acetic acid (EDTA) anticoagulated. Thrombocyte was counted manually using PBS (Leishman stain) and hematology analyzer (Sysmex XN1000 series). Thrombocyte counts were expressed in Mean and standard Deviation. Statistical analysis was done by student’s t test using MS excel and SPSS version 17.Results: Thrombocyte count by PBS have mean value of 2.04 lacs/mm3 with standard deviation of 0.56 lacs/mm3 and by automated method have mean value of 1.89 lacs/mm3 and standard deviation of 0.71 lacs/mm3 with p value 0.010. Thus, there was no statistically significant difference found between two methods.Conclusions: Estimation of thrombocyte count on the basis of manual thrombocyte count is a reliable technique and can be used to validate automated thrombocyte counts. It can also be used in under resourced laboratories, where there are no automated counters of good precision available. In fact, all the tests showing abnormal thrombocyte counts must be reported only after cross examining on PBS.

scholarly journals Utility of peripheral blood smear in platelet count estimation

2019 ◽  
Vol 7 (2) ◽  
pp. 434 ◽  
Author(s):  
Vyankatesh T. Anchinmane ◽  
Shilpa V. Sankhe
Keyword(s):  
Platelet Count ◽  
Peripheral Blood ◽  
Blood Smear ◽  
Peripheral Blood Smear ◽  
Severe Thrombocytopenia ◽  
Correlation Test ◽  
Hematology Analyzer ◽  
Pearson's Correlation ◽  
Automated Hematology Analyzer ◽  
Count Estimation

Background: There are several methods of platelet count used in hematology laboratory. These methods are manual counting, automated hematology analyzer counting, platelet count estimation by peripheral blood smear (PBS) method etc. Many diseases such as dengue, malaria, pregnancy induced hypertension etc. may leads to severe thrombocytopenia. Timely and precise diagnosis of platelet count plays very crucial role in critical care management of thrombocytopenia cases. The present study was undertaken to estimate platelet counts by PBS method and correlate them with results from automated hematology analyzer method.Methods: Study included one hundred randomly collected blood samples in EDTA anticoagulant vacutainer tubes. Each blood sample was processed for platelet count estimation with automated hematology analyzer and Leishman’s stained PBS examination. The statistical analysis was done by using Pearson's correlation test to access the agreement between both the methods.Results: The Pearson's correlation test showed significant positive correlation for platelet count estimation between both the methods. (r =0.9789).Conclusions: Platelet count estimation by PBS method is reliable and statistically significant when compared to hematology analyzer method. PBS platelet estimation method can be taken as early and rapid procedure for platelet assessment in critical severe thrombocytopenia cases. This method is simple, cheaper and can be done in rural hospital setup where automation is not available.

A CLINICOPATHOLOGICAL STUDY OF ACUTE AND CHRONIC LEUKEMIA IN A TERTIARY CARE HOSPITAL

2021 ◽  
pp. 72-74
Author(s):  
Sarat Das ◽  
Prasanta Kr. Baruah ◽  
Sandeep Khakhlari ◽  
Gautam Boro
Keyword(s):  
Acute Myeloid Leukemia ◽  
Acute Lymphoblastic Leukemia ◽  
Peripheral Blood ◽  
Myeloid Leukemia ◽  
Blood Smear ◽  
Lymphoblastic Leukemia ◽  
Peripheral Blood Smear ◽  
Care Hospital ◽  
Cytochemical Study ◽  
Acute Myeloid

Introduction: Leukemias are neoplastic proliferations of haematopoietic stem cells and form a major proportion of haematopoietic neoplasms that are diagnosed worldwide. Typing of leukemia is essential for effective therapy because prognosis and survival rate are different for each type and sub-type Aims: this study was carried out to determine the frequency of acute and chronic leukemias and to evaluate their clinicopathological features. Methods: It was a hospital based cross sectional study of 60 patients carried out in the department of Pathology, JMCH, Assam over a period of one year between February 2018 and January 2019. Diagnosis was based on peripheral blood count, peripheral blood smear and bone marrow examination (as on when available marrow sample) for morphology along with cytochemical study whenever possible. Results: In the present study, commonest leukemia was Acute myeloid leukemia (AML, 50%) followed by Acute lymphoblastic leukemia (ALL 26.6%), chronic myeloid leukemia (CML, 16.7%) and chronic lymphocytic leukemia (CLL, 6.7%). Out of total 60 cases, 36 were male and 24 were female with Male:Female ratio of 1.5:1. Acute lymphoblastic leukemia was the most common type of leukemia in the children and adolescents. Acute Myeloid leukemia was more prevalent in adults. Peripheral blood smear and bone Conclusion: marrow aspiration study still remains the important tool along with cytochemistry, immunophenotyping and cytogenetic study in the diagnosis and management of leukemia.

scholarly journals Red Cell Distribution Width (RDW) and Hb% in the Detection of Iron Deficiency Anemia in Pregnant Women

2018 ◽  
Vol 9 (2) ◽  
pp. 137-141
Author(s):  
Gazi Sharmin Sultana ◽  
Syed Aminul Haque ◽  
Ayatunnesa ◽  
Md MA Muttalib ◽  
Md Quddusur Rahman
Keyword(s):  
Iron Deficiency ◽  
Pregnant Women ◽  
Iron Deficiency Anemia ◽  
Red Cell Distribution Width ◽  
Deficiency Anemia ◽  
Red Cell ◽  
Cell Distribution ◽  
Distribution Width ◽  
Latent Iron Deficiency ◽  
Automated Hematology Analyzer

Background: Detection of iron deficiency early during pregnancy is essential for correct management. Red cell distribution width (RDW) is a new routine parameter in fully automated hematology analyzer that can give the idea of early iron deficiency before Hb%. This study was aimed to see the role of red cell distribution width and Hb% in determining early iron deficiency in pregnant women.Methods: In this study 190 pregnant women were included. CBC including Hb% and RDW and iron profile were done. RDW were compared with Hb% in various stages of iron deficiency.Results: RDW was more significant than Hb level in latent iron deficiency when Hb level was normal (p<0.05). In mild and moderate iron deficiency anemia, RDW was increased progressively though Hb level was reduced. In this study RDW had sensitivity 82.3% and specificity 97.4%. Whereas Hb level had sensitivity 56.6% and specificity 90.9% for iron deficiency.Conclusion: Latent iron deficiency without other complicating disease could be screened out early by increased RDW when Hb% was normal.Anwer Khan Modern Medical College Journal Vol. 9, No. 2: Jul 2018, P 137-141

scholarly journals ACQUIRED β−THALASSEMIA IN CHILDREN WITH ACUTE LYMPHOBLASTIC LEUKEMIA (ALL)

2016 ◽  
Vol 20 (1) ◽  
pp. 58
Author(s):  
Maria Christina Shanty Larasati ◽  
Mangihut Rumiris ◽  
Mia Ratwita Andarsini ◽  
I Dewa Gede Ugrasena ◽  
Bambang Permono
Keyword(s):  
Peripheral Blood ◽  
Blood Smear ◽  
Lymphoblastic Leukemia ◽  
Genetic Disorders ◽  
Globin Gene ◽  
Maintenance Phase ◽  
Peripheral Blood Smear ◽  
Altered Expression ◽  
First Case ◽  
Thalassemia Trait

Thalassemias are heterogeneous group of genetic disorders. β-thalassemia is existed due to impaired production of beta globins chains, which leads to a relative excess of alpha globin chains. The abnormalities of haemoglobin synthesis are usually inherited but may also arise as a secondary manifestation of another disease, most commonly haematological neoplasia. This article presenting two cases of acquired β-thalassemia in children with ALL focusing on the diagnosis and the possible relationship between the two haematological diseases. The first case is a four (4) year old boy with ALL-L1 type at maintenance phase of chemotherapy, he suffered from anaemia with Hb 8.0 g/dL, WBC 22,600/mm3 and platelets count of 200,000/mm3, peripheral blood smear revealed anisocytosis, polychromes, hypochromia, basophilic stippling, and normoblastocytes. The result of Hb electrophoresis of Hb A of 54.9%, Hb F of 29.4%, Hb E of 13.4% and Hb A2 of 2.3%. The patient was diagnosed as ALL-L1 type and β-thalassemia. The second case, is a 13 year old girl with remission ALL-L1 type after chemotherapy, she suffered from anaemia with Hb 6.7 g/dL, WBC 12,400/mm3, platelet count was 200,000/mm3, and peripheral blood smear obtained anisocytosis, hypochromia, normoblastocytes, myelocytes and basophilic stippling. The result of Hb electrophoresis are: Hb F 0.41%, Hb A1c 0.78%, Hb A2 2.95% with the conclusion of a β-thalassemia trait, this patient was diagnosed with ALL-L1 type remission + β-thalassemia trait. The case reviewers assume that acquired β-thalassemia which happened in those patients were the altered expression of globin chain which mechanism for this syndrome might be the acquisition of a mutation that affects RNA or proteins involved in β-globin gene regulation and resulting the reduction of the (α/β)-globin biosynthetic ratios, or/and associated with chemotherapy-inducement.

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