horiba ABX MICROS ES60, User Manual

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ABX Micros ES60 OT/CT
2–14 User Manual - RAB237AEN
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Multiple myeloma - The precipitation of proteins in multiple myeloma patients may give elevated
WBC counts.
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Hemolysis - Hemolyzed specimens contain red cell stroma which may elevate WBC counts.
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Leukemia - A very low WBC count may result in this disease state because of possible increased
fragility of the leukocytes leading to some destruction of these cells during counting. These white
cell fragments will also interfere with the white cell partial differential parameters: LYM% and #,
MON% and #, GRA% and #. A suspiciously low WBC count may also be seen in patients with
lymphocytic leukemias due to the presence of abnormally "Small" lymphocytes which may not be
counted by the instrument.
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Chemotherapy - Cytotoxins and immunosuppressive drugs may increase the fragility of the
leukocytes which may cause low WBC counts.
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Cryoglobulins - Increased levels of cryoglobulins that may be associated with myeloma,
carcinoma, leukemia, macroglobulineima, lymphoproliferative disorders, mestastic turmors, auto-
immune disorders, infections, idiopathic disease, aneurism, pregnancy, thromboembolic
phenomena, diabetes, etc... which can elevate the WBC, RBC and PLT counts along with the HGB
value. The specimen can be warmed up to 37°C and re-analyzed immediately. If warming the
specimen has no effect on the count, a manual WBC, RBC,and or PLT count can be performed.
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Increased turbidity - May also be seen in cases where the red blood cells are resistant to the
lysing action. This condition will cause a falsely elevated hemoglobin result, but may be detected
by observing the abnormal MCH and MCHC values, also the increased baseline on the left leading
edge of the WBC histogram. Erroneous hemoglobin results will also cause the results of the MCH
and MCHC to be erroneous as well.
3.3.2. RBC Red Blood Cells (Erythrocytes)
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The red blood cell dilution contains all the formed elements in the blood: erythrocytes, leukocytes
and platelets. During the counting of the RBCs, platelets are below the RBC size minimum
threshold, therefore they are not counted as RBCs.
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Leukocytes - (white blood cells) on the other hand, are included in the RBC count. However, since
the normal ratio between red blood cells and white blood cells is so extreme, the influence of
counting the WBCs during the RBC count is negligible.
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High WBCs - In rare cases where the WBCs are extremely high, the RBC count may be corrected,
especially if the RBC count is extremely low in comparison to the high WBC count.
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Agglutinated red blood cells - May cause a falsely low RBC count. Blood samples containing the
agglutinated red blood cells may be identified by observing abnormal MCH and MCHC values, as
well as examination of a stained blood smear.
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Cold agglutinins - IgM Immunoglobulins which are elevated in cold agglutinins disease, may
lower RBC and PLT counts and increase the MCV.
3.3.3. HGB (Hemoglobin)
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Turbidity of the blood sample - Any number of physiologic and/or therapeutic factors may
produce falsely elevated hemoglobin results. To obtain accurate HGB results when increased
turbidity of the blood sample occurs, determine the cause of the turbidity and follow the
appropriate method below:
1- Elevated WBC: an extremely elevated WBC will cause excessive light scatter from the L.E.D. In
these cases, use reference (manual) methods. The diluted sample should be centrifuged and the
supernatant fluid measured with a spectrophotometer.
2- Elevated Lipids: elevated lipids in the blood will give the plasma a "milky" appearance. This
condition can occur with hyperlipidemia, hyperproteinemia (as in gammapathies) and
hyperbilirubinemia. Accurate hemoglobin measurement can be achieved by using reference (manual)
methods and a plasma blank.
Increase in turbidity may also be seen in cases where the red blood cells are resistant to the lysing
action. This condition will cause a falsely elevated HGB result, but may be detected by observing
the abnormal MCH and MCHC values and the increased baseline on the left leading edge of the WBC
histogram. Erroneous HGB results will cause the results of the MCH and MCHC to be erroneous as well.
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Fetal bloods - The mixing of fetal and maternal bloods may produce a falsely elevated hemoglobin
value.