Transcript NRBC Parameters - Beckman Coulter

THE BECKMAN COULTER logo, COULTER, DxH, TruColor, and UniCel
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Objectives
Flags
Codes
Messages
CBC Parameters
Cellular Interference
Differential Parameters
NRBC Parameters
Retic Parameters
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Flags
* These Flags are also associated with System Messages. See System Messages in HELP for more information.
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Codes
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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
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Messages
Exception or System Status Messages
– Exception: anything with an exception may or
may not be released depending on your lab’s
release rules criteria. An exception is the
default test order.
– System Status: an event that may affect
system operation. Accompanied by operator
notification and entry into log.
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Examples
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CBC Parameters
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Data Fusion
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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 (June 2013)
• 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.
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Red Cell Messages
• Suspect message
Dimorphic Reds
• Data pattern
consistent with the
presence of multiple
red cell populations
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• Suspect message
Red Cell Agglut
• Data pattern
consistent with the
presence of
agglutinated red cells
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RBC Fragments/Microcytes
• Suspect message
RBC Frag/Micro
• Pattern observed
consistent with the
presence of RBC
fragments and/or
microcytic red cells.
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Giant Platelets
• Suspect message
Giant Platelet
• May be accompanied
by System message
specific to platelet
results
• Giant Platelet data
pattern
observed
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Platelet Clumps
• System message
Platelet Clumps
• PLT & associated
parameters flagged
with R
• Clumped platelet data
pattern observed
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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
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• System message
RBC-PLT Overlap
• PLT & associated
parameters flagged
with R
• PLT histogram
shows a possible
interference with
larger platelets
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WBC Interference from HGB
• System message WBC Inter: HGB
• HGB & associated parameters flagged with R
• HGB may not be adequately corrected for
WBC interference
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Differential Parameters
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One Cell at a Time . . .
WBCs are hydrodynamically focused
FLOW CELL
SHEATH-FLUID IN
SAMPLE DILUTION
SENSING
AREA
SHEATH FLUID
SHEATH-FLUID IN
SAMPLE IN
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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)
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Flow Cytometric Digital Morphology
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Differential Parameters
MONO
NEUTS
LYMPH
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EOS
BASO
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Abnormal Cell Distribution
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MO Blasts
NE Blasts
Immature Granulocytes
Band Neutrophils
LY Blasts
Variant Lymphocytes
Small Lymps / Low Opacity
Non-White Cells
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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
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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
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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
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Immature Granulocytes
5PD1
5PD2
Normal 5PD1
• Suspect message Imm Grans
• [Metamyelocytes, myelocytes &/or
promyelocytes] or [myelocytes &
promyelocytes]
• Variable sensitivity with default set at high
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Left Shift
5PD1
5PD2
Normal 5PD1
• Suspect message Left Shift
• Metamyelocytes, without more immature
granulocytes
• Variable sensitivity with default at high
• Can be disabled
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Variant LY
5PD1
5PD2
Normal 5PD1
• Suspect message Variant LY
• Variant (viral), atypical or abnormal LY
suspected
• Variable sensitivity with default at high
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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
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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
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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.
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Excessive Debris
5PD1
5PD2
• System message Excessive Debris: D
• All Diff results accompanied by R flag
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NE-EO Overlap
5PD1
5PD2
• System message NE-EO Overlap
• All Diff results flagged with R
• Population shift observed (NE and EO not in
correct spatial location)
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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)
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Low Events: D
5PD1
5PD2
• System message Low Events: D
• Not enough events available for differential
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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.
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Low RMALS Events
5PD1
5PD2
• System message Low RMALS Events
• All Diff results flagged with R
• RMALS mode value is too low
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NRBC Parameters
PLT/DEBRIS
WBC
NRBC
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Abnormal NRBC Pattern
NRBC1
NRBC2
• System
message Abn
NRBC Pattern
• NRBC &
associated
parameters
flagged with R
• Fits no known
pattern
Normal nRBC
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NRBC-LY Overlap
NRBC1
NRBC2
• System
message
NRBC-LY
Overlap
• NRBC &
associated
parameters
flagged with R
• Couldn’t
separate NRBC
from small LY
during Normal nRBC
• analysis
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NRBC Interference
• System
message
NRBC Inter
• NRBC &
associated
parameters
flagged with R
• Significant
amount of
interference in
NRBC regions
that are not
NRBC Normal nRBC
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NRBC1
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NRBC2
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Miscellaneous NRBC Messages
• Detected by Hardware, not algorithm
• Flow Cell Clog: N
• System Event: N
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Reticulocyte Parameters
WBC’S
MATURE RBC’S
RETICS
PLT/DEBRIS
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Abnormal Hemoglobin
• Suspect message
Abn Hemoglobin
• ‘Others’ category =
green (~ platelets) &
orange (not cleared)
particles.
• Indicates a possible
clearing problem in
the presence of
Normal Retic abnormal
hemoglobin
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Sickled Cells
• Suspect message
Sickled Cells
• Data pattern
consistent with
sickled cells
Normal Retic
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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.
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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
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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 [:::::].
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System Event During Retic
Examples include
(but are not limited to):
• Laser Offset Voltage
failure
• Temperature Out of
Range
Rev. A (June 2013)
• 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).
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THE END!
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