Rev. A (June 2013)Beckman Coulter Professional Development © 2013 Beckman Coulter, Inc. 1 of 50 THE...

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.


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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


• 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




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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




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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/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


• 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


• 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


• 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 2013)Beckman Coulter Professional Development © 2013 Beckman Coulter, Inc. 1 of 50 THE...

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