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HEMATOLOGY CASE

STUDIES

Barbara J Connell MS,MT(ASCP)SH

Senior Product Manager

RBC Parameters

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SMALL PALE RED CELLSIRON DEFICIENCY

SMALL PALE RED CELLSANEMIA OF CHRONIC DISEASE

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SMALL PALE RED CELLSTHALASSEMIA MINOR

How Do You Tell Them Apart ?

You need some more info:

IronDeficiency

ThalassemiaMinor

Anemia of Chronic Disease

Iron Decreased Normal/Increased Normal/Increased

Ferritin Decreased Increased Increased

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RDW

Red Cell Distribution Width

Iron Deficiency

IRON 8 ug/dl (37 – 170)

FERRITIN 4 (10 – 200) F / 51

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Anemia of Chronic Disease

IRON 83 ug/dl (37 – 170)

FERRITIN 337 (10 – 200)M/64 - DIABETES, CHRONIC RENAL INSUFFICIENCY

Thalassemia Minor

IRON 70 ug/dl (37 – 170)

FERRITIN 422 (10 – 200)

HGB A2 4.1 ( 1.8 – 3.4)

M / 61

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Checkout the RDW-SD & RDW-CV

IRON DEFICIENCY ANEMIA OF CHRONIC DISEASE THALASSEMIA MINOR

RDW –SD 55.7 RDW –SD 57.9 RDW –SD 33.8

RDW-CV 22.1 RDW-CV 20.4 RDW-CV 14.8

RDW - CV

(L1) (L2)

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RDW-SD

Iron Deficiency

ThalassemiaMinor (or

RDW-CV(Normal 11 – 13)

Elevated Normal

RDW-SD (Normal 39 – 49)

Elevated Decreased

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Sometimes it Doesn’t Work

WHAT DOES THAT ALL MEAN ?

RDW – CV- VERY SENSITIVE TO IRON DEFICIENCY- NOT VERY SPECIFIC FOR THALASSEMIA MINOR

RDW – SD- NOT AS SENSITIVE TO EARLY IRON DEFICIENCY

- VERY SPECIFIC FOR THALASSEMIA MINOR

- CAN INDICATE COMBINED ABNORMALITIES

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Combined Iron Deficiency / Thalassemia

F / 66Iron – 30µg/dl (N: 37 – 170)Hgb A2 - 2.2

Exercise

NO IRON STUDIES or HGB ELECTROPHORESIS NO INFORMATION

M / 54

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M/90 ANEMIA

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F/37

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WNR Channel Scattergram - Normal Pattern

NRBC

WBC

BASO

Debris SFL

FS

C

Acute Erythroid Leukemia (AML-M6)

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Acute Erythroid Leukemia (AML-M6)

Platelet Cases

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PLT-F Channel

Reportable Parameters

PLT-FIPF

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Binding sites of Fluorocell PLT

open tubuleα granule

←glycogen granule

microtubule

deep dyeing granule

rough-surfaced endoplasmic reticulum

Fluorocell PLT stains nucleic acid rich organelle

• Rough-surfaced endoplasmic reticulum (ribosomal RNA)

• Mitochondria (MtDNA)

mitochondria

RBCRBC

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Fluorocell PLT Staining

PLT WBCRBCF

luor

ocel

l PLT

RE

T S

EA

RC

H II

Low RBC background

(because of using only one staining dye, oxazine) WBCs were stained by both dyes.

Dye binds diffusely spread throughout.

Dye binds some structures more strongly.

High RBC background WBCs were stained by both dyes.

Interference with Routine Impedance Count

ß-Thalassemia Major with numerous fragmented red cells

XN: PLT-FXE: PLT-O

PLT-I

XE: PLT-I

XEPLT-I = 477*109/L PLT-0 = 111*109/LPLT-CD61 =152.2*109/LIPF% = 13.9%

XNPLT-I = 514*109/L PLT-F = 140.8*109/LPLT-CD61 = 152.2*109/LIPF%= 12.9%

Microcytic RBC

Microcytic RBCMicrocyticRBC

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Improved Performance of PLT-FAcute Promyelocytic Leukemia / chemo: white blood cell fragments

XNPLT-I = 28*109/L PLT-F = 24.2*109/LPLT-CD61 = 24.2*109/L IPF% = 1.1%IPF# = 0.3*109/L

XEPLT-I = 25*109/L PLT-0 = 181*109/LPLT-CD61 = 24.2*109/LIPF% = 41.2%IPF# = 74.6*109/L

XN: PLT-FXE: PLT- O

WBC cytoplasm fragments

IPF

PLT-F

WBC cytoplasm fragments

PLT measurement over time in the severe burn injury patient.

Burn injury

The feature:Huge micro-spherical FRCs appeared because of the heat shock.

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PLT measurement over time in the sever burn injury patient.

Burn injury

Day 1

Day 2

PLT-F PLT-O

PLT-OPLT-F

PLT-I

PLT-I

PLT(x10^3/uL)

PLT-I 1118

PLT-O 515

PLT-F 228

CD61 204

PLT(x10^3/uL)

PLT-I 795

PLT-O 359

PLT-F 161

CD61 150XN Conference 2012 Kobe Japan

PLT measurement over time in the sever burn injury patient.

Burn injury

Day 3

Day 4

PLT-F PLT-O

PLT-OPLT-F

PLT-I

PLT-I

PLT(x10^3/uL)

PLT-I 632

PLT-O 211

PLT-F 116

CD61 115

PLT(x10^3/uL)

PLT-I 201

PLT-O 59

PLT-F 54

CD61 51

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CML Patient

• High WBC Count

• Voted out Differential Results

• Abnormal Platelet Morphology

CML

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CML

CML

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CML

CML

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CML

CML

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Giant Platelets

• Look at the histogram

• Look at the smear

• Look at the PLT-O upper discriminator

• Look at the RBC/PLT service screen

F/74 ANEMIA and THROMBOCYTOPENIA and…

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MORE TYPICAL ITP (idiopathic thrombocytopenic purpura)

F/48 ANEMIA and THROMBOCYTOPENIA

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DAY 3 TTP (THROMBOTIC THROMBOCYTOPENIC PURPURA)

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M/59 –Oncology DECREASED PLATELET PRODUCTION

Thank You