Rev. A (June 2014) Beckman Coulter Professional ... · Rev. A (June 2014) Beckman Coulter...

Rev. A (June 2014) Beckman Coulter Professional Development© 2014 Beckman Coulter, Inc.

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THE BECKMAN COULTER logo, COULTER, DxH, TruColor, and UniCel are trademarks of Beckman Coulter, Inc; COULTER and UniCel are registered in the USPTO.


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Objectives

FlagsCodes MessagesCBC ParametersCellular Interference

Differential ParametersNRBC ParametersRetic 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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MessagesMessages

– 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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MessagesException 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).

• 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

• Suspect messageRed 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 patternobserved


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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 requires review due to the possible presence of an interference with small platelets

• System message RBC-PLT Overlap


• 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 . . .

S H E A T H -F L U ID IN

S H E A T H -F L U ID IN

S A M P L E IN

F L O W C E L L

S A M P L E D IL U T IO N

S H E A T H F L U IDS E N S IN G

A R E A

WBCs are hydrodynamically focused


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Flow Cytometric Digital MorphologyMultiple 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

LYMPH

EOSNEUTS

BASO


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Abnormal Cell Distribution

1

2

3

4

5

6

7

8

1 MO Blasts2 NE Blasts3 Immature Granulocytes4 Band Neutrophils5 LY Blasts6 Variant Lymphocytes7 Small Lymps / Low Opacity8 Non-White Cells


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LY Blast

• Suspect message LY Blast• Blasts suspected in the LY area of the

dataplot• Data pattern consistent with possible

presence of very immature cells

5PD1 5PD2 Normal 5PD1


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MO Blast

• Suspect message MO Blast• Blasts suspected in the MO area of the





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NE Blast

• Suspect message NE Blast• Blasts suspected in the NE area of the





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Immature Granulocytes

• Suspect message Imm Grans• [Metamyelocytes, myelocytes &/or

promyelocytes] or [myelocytes & promyelocytes]

• Variable sensitivity with default set at high



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Left Shift

• Suspect message Left Shift• Metamyelocytes, without more immature

granulocytes• Variable sensitivity with default at high• Can be disabled



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Variant LY

• Suspect message Variant LY• Variant (viral), atypical or abnormal LY

suspected• Variable sensitivity with default at high



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Abnormal Diff Pattern

• System message Abn Diff Pattern• Results do not match any known template• All Diff results accompanied by R flag



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NRBC

• 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

• 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

• System message Excessive Debris: D• All Diff results accompanied by R flag

5PD1

5PD2


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NE-EO Overlap

• System message NE-EO Overlap• All Diff results flagged with R• Population shift observed (NE and EO not in

correct spatial location)

5PD1 5PD2


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MO-NE Overlap

• System message MO-NE Overlap• All Diff results flagged with R• Population shift observed (MO and NE not in

correct spatial location)

5PD1

5PD2


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Low Events: D

• System message Low Events: D• Not enough events available for differential

5PD1

5PD2


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High Opacity Events

• 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.

5PD1

5PD2


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Low RMALS Events

• System message Low RMALS Events• All Diff results flagged with R• RMALS mode value is too low

5PD1

5PD2


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NRBC Parameters

PLT/DEBRIS WBC

NRBC


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Abnormal NRBC Pattern

• System message Abn NRBC Pattern

• NRBC & associated parameters flagged with R

• Fits no known pattern

NRBC1 NRBC2

Normal nRBC


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NRBC-LY Overlap• System

message NRBC-LY Overlap


• Couldn’t separate NRBC from small LY during

• analysis

NRBC1 NRBC2

Normal nRBC


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NRBC Interference• System

message NRBC Inter


• Significant amount of interference in NRBC regions that are not NRBC

NRBC1 NRBC2

Normal nRBC


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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

MATURE RBC’S

WBC’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 abnormal hemoglobin

Normal Retic


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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 messageRET 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

• 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!

Rev. A (June 2014) Beckman Coulter Professional ... · Rev. A (June 2014) Beckman Coulter...

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