EXERCISE #8: Automated CBC
MLAB 1315 Hematology
AUTOMATED CBCS
(not including automated differential)
LAB OBJECTIVE
Dry lab
1.
The student will identify and interpret CBC parameters and histograms from previously run
CBCs as well as correlate CBC results with various disease states.
2.
The student will state methods of measurement and derivation of the CBC parameters.
Wet lab at CPL
1.
The student will observe the Coulter STKS in operation and identify the different components
of the instrument.
2.
The student will observe the specimen as it travels through the instrument and explain the
processes occurring.
3.
The student will perform 10 automated CBCs on the Coulter STKS and interpret the results. 7
tests will be done using the primary sampler and 3 tests will be done using the secondary
sampler.
PRINCIPLE
The counting of the cellular elements of the blood (erythrocytes, leukocytes, and platelets) is based on
the classic method of electrical impedance*. The aspirated whole blood specimen is divided into two
aliquots and mixed with an isotonic diluent. The first dilution is delivered to the RBC aperture bath, and
the second is delivered to the WBC aperture bath. In the RBC chamber, both the RBCs and the
platelets are counted and discriminated by electrical impedance as the cells are pulled through each of
three sensing apertures. Particles between 2 and 20 fL are counted as platelets, and those greater than
36 fL are counted as RBCs. A reagent to lyse RBCs and release hemoglobin is added to the WBC
dilution before the WBCs are counted by impedance in each of three sensing apertures in the WBC
bath. After the counting cycles are complete, the WBC dilution is passed to the hemoglobinometer for
hemoglobin determination (light transmittance read at a wavelength of 535 nm). The electrical pulses
obtained in the counting cycles are sent to the analyzer for editing, coincidence correction and digital
conversion. Two of the three counts obtained in both the RBC and the WBC baths must match within
specified limits for the counts to be accepted by the instrument.
Following are the parameters of the CBC and their method of measurement when using the Coulter
instruments:
(Parameter = a statistical term that refers to any numerical value that describes an entire population.)
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
Parameters and their derivation
Parameter
Unit of
reporting
Derivation
Calculation
WBC
n x 103
cells/µL
# of leukocytes measured directly, multiplied by the
calibration factor
NA
RBC
n x 106
cells/µL
# of red cells measured directly, multiplied by the
calibration factor
NA
Hemoglobin
g/dL
A beam of white light shines through the lysed WBC
solution and then through an optical filter. The
transmittance of light (525 nm) as compared to a
reagent blank is converted to absorbance, then
converted to g/dL using a calibration factor
NA
MCV
fL
Derived from the RBC histogram by multiplying the
# of RBCs by the size of RBCs and multiplied by a
calibration constant.
NA
Hematocrit
%
Calculated
RBC x MCV
10
MCH
pg
Calculated
Hgb X 10
RBC
MCHC
g/dL
Calculated
Hgb
Hct
RDW
%
Derived from RBC histogram
NA
Platelet
n x 103
cells/µL
# of platelets derived from the Plt histogram and
multiplied by a calibration constant
NA
MPV
fL
Derived from the platelet histogram
NA
LAB EXERCISES
X 100
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
*Principle of electrical impedance
This method of cell counting was originally developed by Coulter Electronics and is referred to as the
Coulter principle. Cell counting and sizing is based on the detection and measurement of changes in
electrical impedance (resistance) produced by a particle as it passes through a small aperture. Particles
such as blood cells are nonconductive but are suspended in an electrically conductive diluent. As a
dilute suspension of cells is drawn through the aperture, the passage of each individual cell momentarily
increases the impedance (resistance) of the electrical path between two submerged electrodes that are
located on each
side of the aperture.
The number of pulses generated during a specific period of time is proportional to the number of
particles or cells. The amplitude (magnitude) of the electrical pulse produced indicates the cell’s
volume.
The output histogram is a display of the distribution of cell volume and frequency. Each pulse on the x
axis represents size in femtoliters (fL); the y axis represent the relative number of cells.
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
NOTE: Instruments vary in their method of counting and measuring cells in the CBC. For this exercise,
we will refer to the Coulter method. Instrument manufacturers and their websites are listed below:
Manufacturer
Instruments available
Web address
Abbot
Cell-Dyn 1200, 3200, 4000
abbot.com
Bayer Diagnostics
Advia 60 and 120
bayerdiag.com
Beckman-Coulter
STKS, Gen-S
beckmancoulter.com
Sysmex
SE-Series
Sysmex.com
SPECIMEN
EDTA-anticoagulated blood
QUALITY CONTROL
Commercial low, normal and high controls
1.
Monitor the CBC and differential parameters. Latron controls monitor the performance of the
volume, conductivity and light scatter for the automated differential. Control values are stored
in the instrument computer and can be monitored with the generation of a Levey-Jennings graph
for each parameter.
XB analysis
2.
Patient results are monitored with continuous XB analysis (weighted moving averages), which
uses the patient’s own data to monitor population values and instrument performance. Batches
of 20 samples are used to track MCV, MCH, and MCHC values. This method can be used to
detect changes in sample handling, reagents, or instrument performance. Batches of 20 are
automatically printed out. The analyzer is considered to be in control when the MCV, MCH
and MCHC determined on a batch of 20 patients by use of the XB algorithm are within 3% of
the expected mean indices of the population.
Delta Checks
3.
Another method of quality control is the use of delta checks (delta means “difference”) which
compares a patient’s own values with their most previous results. If the difference between the
two is greater than laboratory-set limits, the current result is immediately flagged for review.
These can only be used if the instrument is interfaced with a host Laboratory Information
System (LIS).
Mode to Mode
4.
A selected specimen is run in both primary and secondary mode and results must fall within a
specified limit.
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
REAGENTS, SUPPLIES AND EQUIPMENT
Isoton III
Lyse S III diff
Clenz
Coulter Scatter-Pak (contains Erythrolyse II and StabiLyse)
Coulter STKS instrument
Gloves
COULTER STKS SYSTEM COMPONENTS
Main Unit
Automated, cassette-based transport for Primary mode
Open-vial secondary mode
Bubble/blood detector
Bar code reader
Sample handler
Diluter
Primary mechanical operating unit - aspirates, pipets, dilutes, mixes, lyses and senses
Control Module
Controls the timing and sequencing of the operating cycles. As it receives
pulses and raw data from both CBC and VCS (diff) diluters, it counts,
measures and computes parameters and then sends the information to the DMS
(Data Management System)
Electronic Power Supply
Supplies the necessary power for all instrument functions.
Pneumatic Power Supply
Supplies all air pressures and vacuums needed to operate the system
Prints results in the format designated by the user
Printer
Reagent System
Isoton Dilutes the whole blood sample
Stabilizes cell membranes
Conducts aperture current
Carries and focuses the sample stream in the flow cell to enable the WBC differential
measurements
Rinses the system between samples
Lyse III diff
Allows leukocytes to be counted because it disrupts erythrocytes, frees the hemoglobin
and reduces the size of cellular debris
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
Erythrolyse II Dilutes the blood samples
Rapidly lyses red cells
Reduces cellular debris to an insignificant level
StabiLyse
Preserves the leukocytes in near-native state so they can be differentiated into their
subpopulations through the volume, conductivity and light-scatter measurements
Coulter Clenz Cleans and rinses Diluter parts. Using it daily prevents protein buildup and eliminates
routine aperture bleaching.
OPERATION OF INSTRUMENT
At the beginning of the day, Daily Startup must be performed. During this operation, Coulter Clenz left
from Shutdown is flushed out and replaced with Isoton. At the end of startup, background counts for
WBC, RBC and PLT are performed and must be within acceptable limits. Electronic checks are also
performed. Both background and electronic checks are automatically printed out at the end of the
startup cycle. Acceptable background counts must be as follows:
WBC
RBC
Hgb
Plt
˜0.4
˜0.4
˜0.1
˜.3.0
After performing daily startup and controls, the instrument is ready for operation.
Operating cycle
Load blood tubes into the cassette and place the cassette into the loading bay. They are automatically
transported, mixed, aspirated and analyzed. Sample tubes can be identified by bar codes. Cassettes
are also identified by bar codes. Place cassettes in the right stack, then press [START/CONT] on the
Diluter keypad. The cycle begins.
Transport
The right lift platform beneath the stacked cassettes rises and the bottom cassette is deposited on the
transport. The platform lowers the cassette to the level of the rocker bed. The cassette is then moved
onto the rocker bed where it is rocked back and forth, mixing the samples. The cassette continues to
move toward the sensing station until it reaches the tube sensor. When the first tube is sensed, the
stripper plate locks onto the tube. After at least 14 rocks from the time the cassette was loaded, the
rocker bed locks in a 45° forward position.
At the sampling station the tube is locked in position and the piercing needle rotates upward. The tube
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
ram pushes the tube out from the cassette causing the needle to pierce the tube stopper. The bar-code
reader passes down over the tube to identify the patient. An aliquot is aspirated from the tube for
analysis. After aspiration, the piercing needle is flushed and the next sample is aspirated in the same
way. This continues until all tubes in the cassette have been sampled. The cassette then moves to the
left side of the instrument where it can be removed. Results appear on the computer screen and are
printed as they become available.
Red and White Blood Cell Counting
Each bath has one aperture. A precise volume of suspension is drawn through each aperture by the
regulated vacuum. At each aperture, the unit counts cells in three sequential periods of 4 seconds each.
During each counting period, the analyzer gathers and amplifies the cell pulses. It also checks that
WBC and RBC data accumulations are above a predetermined low cut-off value.
Extended Counting
If accumulations are too low, the unit extends the sensing period. This ensures that the size-distribution
curves accurately reflect the true cell population.
Coincidence Correction
Occasionally, more than one cell goes through the aperture at the same time. When cells coincide,
however, the analyzer counts only one pulse. As the frequency of coincidence is proportional to the
actual count, the system easily corrects results for coincidence.
Sweep Flow
The sweep flow is a steady stream of diluent that flows behind the RBC aperture during sensing
periods. This keeps cells from swirling back into the sensing zone. Because these swirling cells would
be peripherally sensed, their pulse height would be similar to Plt pulse heights.
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
INTERPRETATION OF RESULTS
Histogram characteristics
Histograms are graphic representations of cell frequencies versus size. In a homogeneous cell
population, the curve assumes a symmetrical bell-shaped or gaussian distribution. A wide or more
flattened curve is seen when the standard deviation from the mean is increased. Histograms provide
information about erythrocyte, leukocyte and platelet frequency and distribution as well as depict the
presence of subpopulations. Shifts in one direction or another can be of diagnostic importance.
RBC histogram
Erythrocyte histogram
This reflects the native size of erythrocytes or any other particles in the erythrocyte size range. The
RBC histogram displays cells as small as 24 fL, but only those between 36 and 360 fL are counted as
RBCs. The extension of the lower end of the scale from 36 to 24 fL allows for the detection of
erythrocyte fragments, leukocyte fragments and large platelets. Normal quantities of leukocytes are
present in the RBC bath and are included in the RBC count, but they are not significant. Only if the
leukocyte count is markedly elevated will the histogram and count be affected.
Larger than normal cells will cause the histogram to shift to the right and smaller than normal cells will
cause the histogram to shift to the left. A bimodal peak illustrating a dimorphic RBC population (camel
humps) can be seen in such situations as cold agglutinin disease, after transfusion of red blood cells into
a person with abnormally sized RBCs, treated iron deficiency anemia, as well as other conditions.
RDW
The RDW (red cell distribution width) is a measurement of the width of the bases of the RBC histogram
with exclusion of the extreme ends. It is calculated by dividing the standard deviation by the mean of
the red cell size distribution and is expressed as the coefficient of variation percentage. The RDW is
increased in treated iron deficiency, vitamin B12 deficiency, folic acid deficiency, post-transfusion.
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
Plt histogram
Platelet histograms
Platelet counting and sizing in both the electrical impedance and optical systems reflect the native cell
size. In the electrical impedance method, counting and sizing take place in the RBC aperture. In the
electrical impedance system, the analyzer’s computer classifies particles that are greater than 2 fL or
less than 20 fL as platelets, The raw data is sorted and histograms are then smoothed (smooth curve)
and tested against mathematical criteria that eliminate nonplatelet particles and finally fitted to a lognormal distribution curve. This distribution curve has a range of 0 to 70 fL (fitted curve). The final
platelet count is derived from the integrated area under this “best fit” log-normal curve.
The expected cell coincidence error (more than one cell passing through the aperture at a time) is
corrected based on mathematical probability. On the Coulter, a minimum of 400 particles per aperture
must be detected. If an insufficient number of particles are present in the 2–20 fL range, a “no-fit”
condition is reported. An alert is generated if the three generated histograms do not agree or if the
results are not within the range of 3 to 15 fL
Particles within the platelet size range can interfere with the platelet count and histogram. Small
particles, such as bubbles or dust, can overlap at the low end of the histogram. Microcytic erythrocytes
can interfere at the upper end. If the histogram does not return to the baseline at both the right and left
of the peak, either there is severe thrombocytopenia or nonplatelets are being counted. Either
erythrocyte or leukocyte fragments may be responsible. Is such cases, the platelet count and derived
parameters of MCV and PDW are not reliable.
MPV
The MPV is a measure of the average volume of platelets in a sample and is analogous to the
erythrocytic MCV. In EDTA, platelets undergo a change in shape by swelling. This alteration causes
the MPV to increase about 20% during the first hour. Afer an hour, the size is stable for at least 12
hours, however MPV values should be based on specimens that are between 1 and 4 hours old.
In normal patients, there is an inverse relationship between platelet count and size. The volume
increases as the platelet count decreases. Because of this inverse relationship, the MPV and the
platelet count must be considered together. No single normal range exists. Patients with a lower
platelet count normally have a high MPV and patients with a high platelet count have a lower MPV.
Young platelets are larger and cause an increased MPV. Analysis demonstrates that an MPV between
7.4 and 10.4 fL is in the normal range if the platelet count is normal.
Various disorders are associated with altered MPV values. The MPV is often decreased in aplastic
anemia, in megaloblastic anemia, or as the result of chemotherapy. Hypersplenism is associated with an
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
MPV that is inappropriately low for the platelet count. Platelet destruction associated with
disseminated intravascular coagulation causes an increase in the MPV proportional to the severity of
thrombocytopenia. The MPV is often increased in patients with myeloproliferative disorders or
heterozygous thalassemia.
NORMAL VALUES
REPORTING RESULTS
LAB EXERCISES
Parameter
Normal Range
WBC
4.8-10.8 x 103/µL
RBC
Male 4.7-6.1 x 106/µL
Female 4.2-5.4 x 106/µL
Hemoglobin
Male 14-18 g/dl
Female 12-16 g/dl
Hematocrit
Male 42-52%
Female 37-47%
MCV
Male 80-94 fl
Female 81-99 fl
MCH
27-31 pg
MCHC
32-36 g/dl or %
RDW
11.5-14.5%
Platelets
150,000 - 450,000/µL
MPV
7.4-10.4 fl
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
LINEARITY LIMITS
The instrument will be accurate as long as the results fall within a certain range known as the linearity
range. Linearity ranges very by instrument.
Linearity Range Table
Parameter
Coulter STKS
Bayer Advia
WBC
0-99.9 x 103/µL
0.02-400 x 103/µL
RBC
0-7.0 x 106/µL
0.0-7.0 x 106/µL
Hgb
0-18 g/dL
0-22.5 g/dL
MCV
50-200 fL
NA
Plt
0-999 x 103µL
5.0-3500 x 103µL
MPV
5-20 fL
NA
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
INSTRUMENT CODES
Code
Cause
Action indicated
..... for a single parameter
Incomplete computation
Repeat
..... for all parameters
Partial aspiration
Repeat
_____ and no histogram
Total voteout (2 out of 3
measurements do not agree
Repeat
+++++
Result exceeds printable
range
Dilute 1:2 and rerun. Continue
further dilutions if necessary
until the result falls within the
linearity range (See “Handling
Abnormal Results)
H
Result is higher than the
laboratory-set patient high
action limit
Review result
L
Result is lower than the
laboratory-set patient low
action limit
Review result
R next to Plt and MPV result
PDW > 20 or non-positive
curve detected, or
Review result
Plt < 20,000 or
Review result and correlate plt
with smear review
Total voteout of fitted
curve, or WBC is
overrange.
Review result and repeat
Excessive asymmetry in
RBC histogram or
Review result
WBC or MCV overrange
Repeat
R next to MCV; R next to RBC, Hct,
MCH, MCHC, RDW, Plt, and MPV
MCV < 50 fL
Repeat
R next to WBC
Check of WBC lower
threshold failed
Repeat, review smear
R next to RDW result
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
INTERFERENCES THAT MAY CAUSE ERRONEOUS RESULTS
Parameter
Interfering agent
WBC
Unusual RBC abnormalities that resist lysis
Nucleated RBCs
Fragmented WBCs
Unlysed particles greater than 35 fL
Very large or aggregated plts
Specimens containing fibrin, cell fragments or other debris (esp
pediatric/oncology specimens
RBC
Very high WBC (greater than 99.9)
High concentration of very large platelets
Agglutinated RBCs, rouleaux will break up when Istoton is added
RBCs smaller than 36 fL
Specimens containing fibrin, cell fragments or other debris (esp
pediatric/oncology specimens
Hgb
Very high WBC count
Severe lipemia
Heparin
Certain unusual RBC abnormalities that resist lysing
Anything that increases the turbidity of the sample such as
levels of triglycerides
High bilirubin
MCV
Very high WBC count
High concentration of very large platelets
Agglutinated RBCs
RBC fragments that fall below the 36 fL threshold
Rigid RBCs
RDW
Very high WBC
High concentration of very large or clumped platelets
RBCs below the 36 fL threshold
Two distinct populations of RBCs
RBC agglutinates
Rigid RBCs
Plt
Very small red cells near the upper threshold
Cell fragments
Clumped platelets
Cellular debris near the lower platelet threshold
LAB EXERCISES
elevated
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
Parameter
Interfering agent
MPV
Known factors that interfere with the platelet count and shape of the
histogram
Known effects of EDTA
Hct
Known factors that interfere with the parameters used for computation, RBC
and MCV
MCH
Known factors that interfere with the parameters used for computation, Hgb
and RBC
MCHC
Known factors that interfere with the parameters used for computation, Hgb,
RBC and MCV
Diff
parameters
Known factors that affect the WBC count as listed above, high triglycerides
that affect lysing
HANDLING ABNORMAL RESULTS
Plts < 40,000
Check the integrity of the specimen (look for clots, short draw, etc.)
Confirm count with smear review for clumps, RBC fragments, giant platelets,
very small RBCs
WBC ++++
Dilute 1:2 with Isoton or further until count is within linearity (for final result, multipy
diluted result by dilution factor); subtract final WBC from RBC; perform spun hct,
calculate MCV from correct RBC & Hct (MCV = Hct/RBC x 10), do not report
HGB, MCH, MCHC. Plt counts are not affected by high WBC. Add comment,
“Unable to report Hgb, MCH, MCHC due to high WBC.”
Plt ++++
Check smear for RBC fragments or microcytes.
1. If present, perform plt estimate. If they do not agree, perform manual plt count.
2. If not present, dilute specimen 1:2 with Isoton or further until count is within
linearity, multiply diluted result by dilution factor.
RBC > 7.0
Dilute 1:2 with Isoton or further until count is within linearity, multiply dilution result
by dilution factor; perform spun hct, review Hgb, recalculate MCH, MCHC
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MCHC >
36.5
MLAB 1315 Hematology
Perform manual hct.
1. If it stays the same, check plasma for lipemia, icteremia or other color
interference. If present, perform Isoton replacement. Pour 3 ml blood into 10x75
tube. Mark level of top of blood. Centrifuge at high speed for 10 minutes. Pipette
off plasma being careful not to disturb red cells. Replace plasma with Isoton to
mark. Mix well and rerun to obtain correct Hgb and MCH, MCHC. RBC should
be within ± 0.2 of previous result. Add comment, “results corrected for lipemia”.
2. If it is significantly higher, check the specimen for cold agglutinin by looking for
RBC clumping. If present, warm the specimen at 37C for 5 minutes, mix well and
repeat. If results are acceptable, report. If cold agglutinin persists, report the spun
hct and mark through the RBC, MCV, MCH, MCHC results. Add comment,
“specimen warmed before running”.
3. If the above conditions are not found, check the smear for spherocytes or lyseresistant red cells. If present, ensure correct instrument operation by running
controls and report result.
MCHC <
36.5
Perform spun hct. Verify proper instrument operation by running a previous patient.
Decreased MCHC may be caused by swollen hyperglycemic red cells. Perform
isoton replacement or correct values using spun hct.
Low plts,
“Giant plts”
or EDTA
clumpers
Confirm with smear review.
1. If clumps are present, check with phlebotomist to see if the phlebotomy was
difficult. If not, recollect in blue top tube (Na citrate anticoagulant). If platelet
clumps disappear and platelet count is acceptable, multiply plt result by 1.1 to
account for the dilution factor.
2. If there are no clumps, but giant platelets are present, perform plt estimate from
smear. Perform manual platelet count if smear estimate and instrument count do not
agree.
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
PROCEDURE NOTES
1.
The approximate relationship of the hemoglobin level to hematocrit is 1:3, a ratio that may vary
with the cause of the anemia and the effect of that cause on the RBC indices, particularly the
MCV. This is referred to as the rule of 3.
Hct (±2) = 3 x Hgb
Also, the RBC is usually about a the hemoglobin. If the ratios are not appropriate, there is
either something wrong with the instrument or there is something unusual with the specimen
which must be resolved before reporting results. Some typical instrument problems that cause
the H&H not to match include inadequate delivery of lysing reagent, inadequate delivery of
diluent, clogs in tubing or blood sampling valve, inadequate draining of baths, etc. To
differentiate between an instrument problem and a specimen problem, run a control or repeat a
specimen from earlier in the day.
REFERENCES
Harmening., Denise, Clinical Hematology and Fundamentals of Hemostasis, 3rd edition, pp. 593-599.
Turgeon, Mary Louise, Clinical Hematology - Theories and Procedures, 3rd edition, pp373, 376-382.
Rodak, Bernadette, Diagnostic Hematology, 1st edition, p.605-606.
Coulter STKS Operating Manual
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
STUDY QUESTIONS
Name ________________________________
Date_________________________________
1.
State the principle of electronic impedance. (2 pts)
2.
Label the cell populations on the following histograms: (6 pts)
3.
Sketch the appearance of histograms associated with each of the following: (6 pts)
macrocytosis MCV 120 fl
Microcytosis MCV 65 fl
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
Dimorphic red cell population
4.
List the parameters provided by automated analysis and the derivation (direct measurement or
calculated). (10 pts)
5.
What is coincidence correction? (2 pts)
6.
How is the RDW derived? List three causes of an increased RDW. (5 pts)
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
MLAB 1315 Hematology
For each of the following conditions, state whether the test would be falsely 8, 9 or not affected at all:
7.
WBC count (6 pts)
hemolysis
NRBCs
lipemia
giant plts
8 RBC
clumped plts
8.
9.
RBC count (6 pts)
cold agglutinin
greatly 8 WBC
rouleaux
clotted specimen
lipemia
8 background count
Hemoglobin (4 pts)
lipemia
greatly 8 WBC
icteremia
8 background count
LAB EXERCISES
MLAB 1315
EXERCISE #8: Automated CBC
10.
MLAB 1315 Hematology
Calculate indices from the following results and state the expected RBC morphology (macro,
micro, normocytic and hypo or normochromic). (24 pts)
Show your calculations below and on back..
RBC
X 106/:L
Hgb
g/dL
Hct
%
A
4.66
17.7
52.3
B
2.95
9.1
29.9
C
3.64
10.8
32.0
D
4.90
15.1
43.8
E
3.50
8.0
26.2
F
5.04
10.0
30.1
LAB EXERCISES
MCV
fL
MCH
pg
MCHC
%
Expected RBC
morphology
MLAB 1315