Transcript Document

Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
1 of 50
Objectives
Flags
Codes
Messages
CBC Parameters
Cellular Interference
Differential Parameters
NRBC Parameters
Retic Parameters
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
2 of 50
Flags
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
3 of 50
Codes
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
4 of 50
Messages
Messages
– Results related:
• Suspect: messages are generated by internal algorithms to
convey that a clinical condition may exist with a specimen
based on an abnormal cell population or distribution.
• System: messages indicate an event that may affect the
operation of a system, requires operator notification and or
entry into a History Log.
– Most accompanied by an R (review) flag
– Some are accompanied by N or P flags
• Definitive: defined by the Operator
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
5 of 50
Messages
Exception or System Status Messages
– Exception: anything with an exception won’t be
released, for example – default test order
– System Status: an event that may affect system
operation. Accompanied by operator notification and
entry into log.
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
6 of 50
Examples
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
7 of 50
CBC Parameters
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
8 of 50
Data Fusion
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
9 of 50
Cellular Interference
• System message Cellular
Inter
• WBC & associated
parameters, or TNC, flagged
with R
• The results are only flagged if
we are uncertain of the
correction, or can’t correct (not
just because a correction
occurred).
Rev. A (May 2012)
• Suspect message Cellular
Inter
• WBC & associated
parameters, or TNC, flagged
with R
• For CBC or CBC/Retic panels
only, when NRBC are detected
but not reported.
Professional Development
© 2012 Beckman Coulter, Inc.
10 of 50
Red Cell Messages
• Suspect message
Dimorphic Reds
• Data pattern consistent
with the presence of
multiple red cell
populations
Rev. A (May 2012)
• Suspect message
Red Cell Agglut
• Data pattern consistent
with the presence of
agglutinated red cells
Professional Development
© 2012 Beckman Coulter, Inc.
11 of 50
RBC Fragments/Microcytes
• Suspect message
RBC Frag/Micro
• Pattern observed
consistent with the
presence of RBC
fragments and/or
microcytic red cells.
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
12 of 50
Giant Platelets
• Suspect message
Giant Platelet
• May be accompanied by
System message specific
to platelet results
• Giant Platelet data
pattern
observed
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
13 of 50
Platelet Clumps
• System message
Platelet Clumps
• PLT & associated
parameters flagged with
R
• Clumped platelet data
pattern observed
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
14 of 50
Platelet Messages
• System message
PLT Inter: Debris
• PLT & associated
parameters flagged with
R
• PLT requires review due
to the possible presence
of an interference with
small platelets
Rev. A (May 2012)
• System message
RBC-PLT Overlap
• PLT & associated
parameters flagged with
R
• PLT histogram shows a
possible interference with
larger platelets
Professional Development
© 2012 Beckman Coulter, Inc.
15 of 50
WBC Interference from HGB
• System message WBC Inter: HGB
• HGB & associated parameters flagged with R
• HGB may not be adequately corrected for WBC
interference
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
16 of 50
Differential Parameters
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
17 of 50
One Cell at a Time . . .
WBCs are hydrodynamically focused
FLOW CELL
SHEATH-FLUID IN
SAMPLE DILUTION
SENSING
AREA
SHEATH FLUID
SHEATH-FLUID IN
Rev. A (May 2012)
SAMPLE IN
Professional Development
© 2012 Beckman Coulter, Inc.
18 of 50
Flow Cytometric Digital
Morphology
Multiple angles of light scatter,
captures 10X more data than
previously possible
–
–
–
–
–
AL2 (axial light loss)
LALS (lower angle LS)
LMALS (lower med angle LS)
UMALS (upper med angle LS)
MALS (median angle LS)
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
19 of 50
Flow Cytometric Digital Morphology
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
20 of 50
Differential Parameters
MONO
NEUTS
LYMPH
Rev. A (May 2012)
EOS
BASO
Professional Development
© 2012 Beckman Coulter, Inc.
21 of 50
Abnormal Cell Distribution
2
1
3
4
5
6
7
1
2
3
4
5
6
7
8
MO Blasts
NE Blasts
Immature Granulocytes
Band Neutrophils
LY Blasts
Variant Lymphocytes
Small Lymps / Low Opacity
Non-White Cells
8
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
22 of 50
LY Blast
5PD1
5PD2
Normal 5PD1
• Suspect message LY Blast
• Blasts suspected in the LY area of the dataplot
• Data pattern consistent with possible presence of
very immature cells
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
23 of 50
MO Blast
5PD1
5PD2
Normal 5PD1
• Suspect message MO Blast
• Blasts suspected in the MO area of the dataplot
• Data pattern consistent with possible presence of
very immature cells
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
24 of 50
NE Blast
5PD1
5PD2
Normal 5PD1
• Suspect message NE Blast
• Blasts suspected in the NE area of the dataplot
• Data pattern consistent with possible presence of
very immature cells
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
25 of 50
Immature Granulocytes
5PD1
5PD2
Normal 5PD1
• Suspect message Imm Grans
• [Metamyelocytes, myelocytes &/or promyelocytes] or
[myelocytes & promyelocytes]
• Variable sensitivity with default set at high
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
26 of 50
Left Shift
5PD1
5PD2
Normal 5PD1
• Suspect message Left Shift
• Metamyelocytes, without more immature
granulocytes
• Variable sensitivity with default at high
• Can be disabled
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
27 of 50
Variant LY
5PD1
5PD2
Normal 5PD1
• Suspect message Variant LY
• Variant (viral), atypical or abnormal LY suspected
• Variable sensitivity with default at high
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
28 of 50
Abnormal Diff Pattern
5PD1
5PD2
Normal 5PD1
• System message Abn Diff Pattern
• Results do not match any known template
• All Diff results accompanied by R flag
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
29 of 50
NRBC
5PD1
5PD2
Normal 5PD1
• Suspect message NRBC
• NRBC suspected in the signature position of the
dataplot
• Only in condition where the NRBC module is disabled
and the panel includes a Diff
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
30 of 50
Aged Sample
5PD1
5PD2
Normal 5PD1
• System message Aged Sample
• All Diff results accompanied by R flag
• The results are only flagged if we are unable to give
a correct differential, not just because aging is
present.
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
31 of 50
Excessive Debris
5PD1
5PD2
• System message Excessive Debris: D
• All Diff results accompanied by R flag
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
32 of 50
NE-EO Overlap
5PD2
5PD1
• System message NE-EO Overlap
• All Diff results flagged with R
• Population shift observed (NE and EO not in correct
spatial location)
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
33 of 50
MO-NE Overlap
5PD1
5PD2
• System message MO-NE Overlap
• All Diff results flagged with R
• Population shift observed (MO and NE not in correct
spatial location)
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
34 of 50
Low Events: D
5PD1
5PD2
• System message Low Events: D
• Not enough events available for differential
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
35 of 50
High Opacity Events
5PD1
5PD2
• System message High OP Events
• All Diff results accompanied by R flag
• Interference in Opacity that has been observed with
bone marrow samples or specimens with platelet
clumps.
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
36 of 50
Low RMALS Events
5PD1
5PD2
• System message Low RMALS Events
• All Diff results flagged with R
• RMALS mode value is too low
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
37 of 50
NRBC Parameters
PLT/DEBRIS
WBC
NRBC
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
38 of 50
Abnormal NRBC Pattern
NRBC1
NRBC2
• System message
Abn NRBC
Pattern
• NRBC &
associated
parameters
flagged with R
• Fits no known
pattern
Normal nRBC
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
39 of 50
NRBC-LY Overlap
NRBC1
NRBC2
• System message
NRBC-LY
Overlap
• NRBC &
associated
parameters
flagged with R
• Couldn’t
separate NRBC
from small LY
during analysis
Normal nRBC
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
40 of 50
NRBC Interference
NRBC1
NRBC2
• System message
NRBC Inter
• NRBC &
associated
parameters
flagged with R
• Significant
amount of
interference in
NRBC regions
that are not
NRBC
Normal nRBC
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
41 of 50
Miscellaneous
NRBC Messages
• Detected by Hardware, not algorithm
• Flow Cell Clog: N
• System Event: N
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
42 of 50
Reticulocyte Parameters
WBC’S
MATURE RBC’S
RETICS
PLT/DEBRIS
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
43 of 50
Abnormal Hemoglobin
• Suspect message
Abn Hemoglobin
• ‘Others’ category =
green (~ platelets) &
orange (not cleared)
particles.
• Indicates a possible
clearing problem in the
presence of abnormal
hemoglobin
Normal Retic
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
44 of 50
Sickled Cells
• Suspect message
Sickled Cells
• Data pattern consistent
with sickled cells
Normal Retic
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
45 of 50
Retic System Messages
• System message
RET-RBC Overlap
• RET & associated parameters
flagged with R.
• Unclear separation of retics &
mature red cells.
• System message
RET Inter: PLT
• RET & associated parameters
flagged with R.
• The platelet population may have
interfered with the RET.
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
46 of 50
Nucleated Cells
• System message
Nucleated Cells
• RET & associated
parameters flagged with
R
• NRBC or small WBC
(especially small LY as in
CLL) are visible in the
dataplot (blue) and may
have interfered with RET
measurement
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
47 of 50
Flow Cell Clog
• System message
Flow Cell Clog: R
• RET and associated
parameters flagged with
R
• Hardware detected a flow
cell clog during analysis
• It is possible to have a
flow cell clog that is
severe enough to inhibit
data [:::::].
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
48 of 50
System Event During Retic
Examples include
(but are not limited to):
• Laser Offset Voltage
failure
• Temperature Out of
Range
Rev. A (May 2012)
• System message
System Event: R
• RET & associated
parameters flagged with
R
• Hardware parameters
were out of limit for an
item that could affect RET
analysis (e.g. voltage,
temperature, pressure).
Professional Development
© 2012 Beckman Coulter, Inc.
49 of 50
Rev. A (May 2012)
Professional Development
© 2012 Beckman Coulter, Inc.
50 of 50