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Rev. A (June 2013) Beckman Coulter Professional Development© 2013 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.
Rev. A (June 2013) Beckman Coulter Professional Development© 2013 Beckman Coulter, Inc.
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Objectives
FlagsCodes MessagesCBC Parameters
Cellular InterferenceDifferential 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 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
• 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 . . .
SHEATH-FLUID IN
SHEATH-FLUID IN
SAMPLE IN
FLOW CELL
SAMPLE DILUTION
SHEATH FLUIDSENSING
AREA
WBCs are hydrodynamically focused
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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
LYMPH
EOSNEUT
S
BASO
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Abnormal Cell Distribution
1
2
3
4
5
6
7
8
1 MO Blasts 2 NE Blasts 3 Immature Granulocytes 4 Band Neutrophils 5 LY Blasts 6 Variant Lymphocytes 7 Small Lymps / Low Opacity 8 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 dataplot• Data pattern consistent with possible presence
of very immature cells
5PD1 5PD2 Normal 5PD1
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NE Blast
• Suspect message NE Blast• Blasts suspected in the NE area of the dataplot• Data pattern consistent with possible presence
of very immature cells
5PD1 5PD2 Normal 5PD1
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Immature Granulocytes
• Suspect message Imm Grans• [Metamyelocytes, myelocytes &/or
promyelocytes] or [myelocytes & promyelocytes]• Variable sensitivity with default set at high
5PD1 5PD2 Normal 5PD1
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Left Shift
• Suspect message Left Shift• Metamyelocytes, without more immature
granulocytes• Variable sensitivity with default at high• Can be disabled
5PD1 5PD2 Normal 5PD1
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Variant LY
• Suspect message Variant LY• Variant (viral), atypical or abnormal LY
suspected• Variable sensitivity with default at high
5PD1 5PD2 Normal 5PD1
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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
5PD1 5PD2 Normal 5PD1
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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
5PD1 5PD2 Normal 5PD1
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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.
5PD1 5PD2 Normal 5PD1
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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/DEBRISWBC
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
• NRBC & associated parameters flagged with R
• Couldn’t separate NRBC from small LY during
• analysis
NRBC1 NRBC2
Normal nRBC
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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
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!