Bluegrass Community Hospital
Laboratory
360 Amsden Avenue
Versailles, Kentucky 40383
Procedure Description:
Peripheral Smear Review
Prepared by:
Approved by:
_______________________________ ______
Norma J. Whitworth, BSMT(ASCP)
Date
Laboratory Manager
________________________________
Richard Lozano, M.D.
Medical Director
Effective Date:
_______
Date
Revised:
Annual Review:
Principle:
The Cell-Dyn 3200 uses two independent measurement channels to measure, count, and
calculate hematological parameters. The Optical channel uses flow cytometry to determine the
WBC, NOC, and RBC/PLT data. The Hemoglobin channel uses colorimetric determination for
hemoglobin. During each instrument cycle, the sample is aspirated, diluted, and mixed before
each parameter is measured. The Cell-Dyn 3200 monitors instrument conditions and data
criteria that may affect results and displays appropriate operational messages and flags for
operator review. Certain messages and flags prompt the lab technologist to perform a ‘SCAN”
or “Manual Differential (Man Diff)” of a peripheral blood smear. Findings after a “SCAN” may
designate a manual differential to be performed. The following protocol designates “SCAN” and
“Man Diff” criteria.
Precautions:
Blood and body fluids should always be tested using Universal Precautions. Gloves, spill-proof
gown, and protective eyewear may be needed. Reagents used for CBC and individual
parameters are not for invitro testing. Refer to each reagents MSDS sheet for specific
information regarding handling and hazards.
Storage and Stability:
Hematology specimens and peripheral smears are kept for 7 days before discarding. Whole
Blood EDTA specimens are stored at 2 – 8 C. Cell-Dyn 3200 reagents are stored at room
temperature.
Specimen Collection and Handling:
A 3 CC EDTA whole blood specimen is required. Refer to the Blood Smear Preparation
procedure in the Hematology SOP for details are preparing a peripheral blood smear for scan or
differential review.
Materials Needed:
Cell-Dyn 3200
EDTA vacutainer tube
Frosted slide
Diff-safe segment or heparinized capillary tube
Wright Stain
Microscope
Oil Immersion
Quality Control:
Peripheral smear review policy is reviewed annually and approved by MedExec. Technologists
are evaluated annually and quarterly on proficiency specimens.
Procedure:
1. Sample a 3 cc EDTA whole blood specimen with the Cell-Dyn 3200.
2. Review histogram for any interpretative messages and/or flags. Refer to the Cell-Dyn
3200 Operator’s Manual for detail discussion of histograms.
3. Refer to the chart below to evaluate results for the need for a peripheral smear scan or
differential.
TEST
CBC with Differential
CBC without Differential
FLAG/MESSAGE
NWBC
NRBC
WBC
FWBC
VAR LYMPH or VAR LYM
DFLT
IG (immature granulocytes)
TEST
FLAG/MESSAGE
ACTION
Scan: review for platelet
clumps, giant platelets, or
NRBC’s. If no other flags or
criteria for manual diff
present, report automated
WBC and diff.
Scan: review smear for
NRBC’s.
Confirm WBC by Unopette
method.
Repeat CBC test in FWBC
mode. The NOC result will
be reported for the WBC.
Scan: review smear to
confirm
lymph
count,
perform a manual diff if
variant/atypical lymphs are
noted.
Perform a manual
differential.
Perform a manual
differential.
ACTION
CBC with Differential
CBC without Differential
BLAST
BAND
RBC MORPH
Flag is triggered if
following
limits
exceeded:
MCV < 80 or > 100 fL
MCH < 25 or > 34 pg
MCHC < 29 or > 37 g/dL
RDW > 18.5 %
Perform a manual
differential.
Scan: review smear for
bands, perform a manual diff
if indicated.
Perform a RBC morphology
only.
Indicate platelet
the morphology and platelet
are estimate also.
CBC with Differential
CBC without Differential
H&H
RRBC
Repeat CBC test in RRBC
mode. If flag persist, scan
smear for NRBC’s.
CBC with Differential
CBC without Differential
Platelet Count
LRI
Cause: debris, contaminated
reagent, microbubbles, dirty
diluent/sheath filter
Repeat Platelet count. If flag
persists, review smear and
perform a Platelet estimate
and morphology.
Verify platelet background if
problem noted on subsequent
specimens.
URI
Repeat Platelet count and
Cause: Microcytic RBC’s, review smear if flag persists.
schistocytes, giant platelets, Perform a Platelet estimate
sickle cells, platelet clumps
and morphology.
LURI
Repeat Platelet count. If flag
persists, review smear and
perform a Platelet estimate
and morphology.
CBC
with
Differential
Manual
WBC
Manual Diff required.
< 2.0 or >20.0 K/uL
Manual Diff
15.0 – 19.9 K/uL
Scan: review smear for
immature granulocytes or
other diagnostic parameters,
perform a manual diff.
Lymphocytes
> 60.0 %
Manual Diff
Monocytes
> 15 %
Manual Diff
Neutrophil Absolute Count
> 10.0
Manual Diff
Lymphocyte Absolute Count
TEST
> 8.0
FLAG/MESSAGE
Manual Diff
ACTION
Hemoglobin (HGB)
< 8.0 or > 18.0 g/dL
RBC Morphology
Hematocrit (HCT)
< 24.0 or > 54.0 %
RBC Morphology
MCV
< 80.0 or > 100.0 fL
RBC Morphology
Platelet Count
< 100 or > 800 K/uL
Platelet Morphology
Estimate
RDW
> 18.5 %
RBC Morphology
and
Results and Interpretation:
A manual differential, scan, RBC morphology, or Platelet morphology will be performed when
any of the above stated criteria are met or the lab technician or physician suspects a clinical state.
Any result rechecked should be designated by an “*” with the comment “Results repeated and
verified.”
References:
1. Abbott Diagnostics: Cell-Dyn System 3200 Operator’s Manual, Abbott Park, IL, 60064,
2001-2002.