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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 & 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 . . .
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
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/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
• 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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