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Posts posted by kimannez
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Hi! In the absence of a "RET Abn Scattergram" flag or a RBC Count action message, the retic count from the sample with the replaced plasma should be the most accurate result. The agglutinated RBCs falsely lower the RBC count which would affect the absolute retic count, also. You could also verify the retic count manually to determine the best results.
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We do that when troubleshooting stain and SP issues to help isolate the causes of issues. Basically use Coplin or other stain jars with undiluted Stain then another with 1:10 diluted stain/buffer then a water rinse. I’d start with the same stain times as you have on your SP then try it out with some normal and abnormal samples and adjust manual timing as needed to get desired staining. You would also need to decide how long you use the stain and stain/diluent mix before replacement. Since we are doing this for troubleshooting typically we dump it shortly after we're done, but you may be able to 1-2 days if you're keeping it covered.
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Sysmex doesn't have a sepsis protocol, but does offer the automated Immature Granulocyte parameter (% and #). There's lots of information about IG on the internet.
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Your experience may vary depending on how many samples are run, as well as how often you are running controls. It’s very reliable, especially with sparsely cellular samples, and far more precise than manual counts (lowest linear range of any FDA cleared cell counter on the market). I would recommend that you contact a Sysmex sale representative directly to discuss if it’s the right analyzer for your lab.
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I apologize--I meant formalin. Even with the biopsy cups being closed, if the slides were in the same bag, it would "fix" the smears.
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We experienced the same thing with our bone marrow smears, then we realized that it was because the marrow smears were being sent in the same container as the biopsies--xylene fumes fix blood smears, but cause them to resist staining. This may not be your issue, but who knows?
Also, age and storage of the smears may influence staining: we found that if smears were fixed they stained better if they were then stored in the dark after fixing.
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Thank you for asking for clarification and further information. As noted, The XW-100 is contraindicated for critically ill patients. CMS defines a critical illness or injury as one which “acutely impairs one or more vital organ systems such that there is a high probability of imminent or life-threatening deterioration in the patient’s condition.” (Medicare Claims Processing manual, Chapter 12, Section 30.6.12A.).
Additionally, the XW-100 is not for use in a clinical area which cares for only critically ill patients, such as intensive care units. However, in some environments, physicians will encounter critically ill patients as well as those who are not. In those cases, it is important for the physician to follow the IFU and only use the XW-100 for patients who are not critically ill. Use in critically ill patient populations is not only contraindicated, but is likely to result in suppression of a large portion of the results.
Please also visit www.sysmex.com/xwsafety to learn more.
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Just gathering information......
Do you perform RBC counts on all fluids (not just CSF)? If so, what is your lower reportable range and what is the clinical significance?
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If you feel the high MCHC is due to the lipemia, a 1:3 or 1:5 dilution may help. If not, plasma replacement or "wash" procedure should work. If the MCHC is still elevated, think about other reasons for this--cold agglutinin, abnormal hemoglobin, dehydration? Also, look at the other RBC indices: if the MCV & MCH are abnormal, I wouldn't expect the MCHC to be normal.
In the case of a severe cold agglutinin, a 1:5 dilution with pre-warmed diluent may be helpful.
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We were using the Sysmex analyzers as the time. They use a sodium laurel sulfate detergent in the hemoglobin channel which fully lyses the red cells and also breaks up lipids. I see your concern with uneven RBC distribution--I have heard of cases where the RBCs are so agglutinated that it doesn't even aspirate a uniform sample. I would guess in that case you might wash an aliquot of the sample before diluting?
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The cold agglutinin didn't interfere with the HGB result because it used a harsh lyse and light absorbance. I think our limit was +/- 0.4 g/dL, but I don't know the reference (I've been out of the lab for a couple of years).
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You may want to try a prewarmed 1:5 dilution and use the hemoglobin to determine if the dilution is acceptable. It always worked for us!
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Some of our techs would use New Methylene Blue on manual spinal fluid counts to make it easier to differentiate the lymphs from the RBCs on the hemacytometer. However, didn't CAP recommend this at one point for manual fluid counts that are being done on brightfield?
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I recommend concentrating your fluids for crystal analysis if none are seen on the straight sample. We make one Cytospin slide with hyaluronidase for staining and one without hyaluronidase for crystal checks.
Running CBC without WNR reagent?
in General Information
Posted
I don't think the XN will allow you to run without the WNR reagent. You wouldn't be able to get an automated differential because the basophil count comes from the WNR. Also, the NRBCs come from the WNR channel, so any WBC count from the WDF channel would also include NRBCs.