CBC Parameters and QCCBC参数及质量控制19页PPT
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HCT Impedance (from histogram)
Impedance count X cal factor
Light Scatter , flow cytometry
M77221
CBC Adult Reference Ranges
Parameter WBC
RBC
HGB
HCT MCV MCH MCHC RDW PLT MPV
COMMON METHOD OF DETERMINATION
Impedance count X calibration (cal) factor
Impedance count X calibration factor
Colorimetric absorbance in proportion to hemoglobin
•some medications (such as methotrexate), •some autoimmune conditions •some severe infections •bone marrow failure
HIGH: >11.0 X103 /µL •Infections •Inflammation •cancer, leukemia
HIGH: >100 fL •B12
•Rigid RBCs
•Folate Deficiency
RDW Parameter Interfering substances and Implications
of triglycerides
•High bilirubin
LOW: Male: <14 g/dL Female: <12.0 g/dL •Anemia
HIGH: Male: > 17.4 g/dL Female: >16.0 g/dL •Polycythemia vera •fluid loss due to diarrhea, dehydration, burns
• With concentrations above or below the reportable range or Linearity range, the result does not correspond with the calibration curve in linear fashion.
Adult Reference Range 4.5-11.0 X 103/µL
Male: 4.5-5.5 X 106 /µL Female: 4.0-5.0 X 106 /µL
Male: 14-17.4 g/dL Female: 12.0-16.0 g/dL
Male: 42-52% Female: 36-46%
Automated CBC Parameters
and
Quality Control
Joanna Ellis, MLS(ASCP)
The Automated
Complete Blood Count
• Most common test in the Hematology lab. • Main Components of the CBC:
Female: < 4.0 X 106 /µL
•High concentration of very large platelets
•Anemia
Red •Agglutinated RBCs, rouleaux will break up
RBC
Blood when Istoton is added Cell •RBCs smaller than 36 fL
RBC Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW:
Male: < 4.5 X 106 /µL
•Very high WBC count (greater than 99.9)
CBC Quality Control
• Commercial Controls: • 3 levels (low, normal, high) • Values stored in instrument computer • Levey-Jennings graph generated and stored for each parameter
– Cell counts – Hgb – RBC indices – WBC differential absolute values and percent
• Indications for CBC:
– Fatigue – Weakness – Infection – Inflammation – Bruising – Bleeding
• Mode to Mode QC: • Most automated hematology instruments have a primary and secondary mode of sample aspiration. Controls must be run on BOTH and correlate. – Primary=Automated or Closed – Secondary=Manual or Open
80-100 fl 28-34 pg 32-36 g/dL or % 12.0-14.6% 150-450 X 103 /µL 6.8-10.2 fl
Linearity (Reportable Range)
• Instruments are calibrated for each analyte with a range that is clinically relevant.
• Delta Checks • When the Laboratory Information System (LIS) and the instrument are interfaced (connected) delta checks are conducted by the LIS on select parameters. – Current values compared to most previous result – Differences greater than the limits set within the LIS are flagged
Advia Linearity Instrument Codes
Code
Cause
Action Indicated
+++++
Result exceeds reportable range
Dilute 1:2 and rerun. Continue further dilutions until result is within linearity
HCT Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW:
Male: <42%
Female: <36%
•Anemia
•Known factors that interfere with the
WBC Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW <4.5 X103 /µL
WBC
White Blood Cell Count
•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
From RBC histogram, #of RBCs X size of RBCs X cal constant OR Calculated: HCT X 10
RBC Calculated: RBC X MCV
10 Calculated: HGB X 10
RBC Calculated: HGB X 100
Result higher than the
H
laboratory set patient highLeabharlann Review Result
action limit
Result is lower than the
L
laboratory set patient low
Review Result
action limit
(Cell) Volume
•High concentration of very large platelets •Agglutinated RBCs •RBC fragments that fall below the 36 fL threshold
•Iron deficiency anemia •Thalassemia
• Results outside of linearity are NOT acceptable.
• Linearity ranges vary by instrument.
– Example: Parameter
Coulter STKS
Advia
WBC
0.0 -99.9 X 103 /µL 0.02-400 X 103 /µL
•Severe lipemia
•Heparin
HGB
•Certain unusual RBC abnormalities
Or Hemoglobin that resist lysing
Hb
•Anything that increases the turbidity
of the sample such as elevated levels
MCV Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
•Very high WBC count
LOW: <80 fL
MCV
Mean Corpuscular
•fluid loss due to
diarrhea, dehydration,
buns
HGB Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
•Very high WBC count
HIGH: Male: > 5.5 X 106 /µL
Count •Specimens containing fibrin, cell fragments or Female: > 5.0 X 106 /µL
other debris (esp pediatric/oncology specimens •Polycythemia vera,
CBC Parameters
PARAMETER WBC RBC HGB
UNIT OF REPORTING X 103 /µL X 106 /µL g/dL
MCV
fL
HCT MCH MCHC RDW Platelet
WBC Diff
%
Pg
g/dL or % %
X 103 /µL Absolute: X103 /µL Percent of WBC : %
HCT Hematocrit parameters used for computation, RBC HIGH:
and MCV
Male: >52%
Female: <46%
•Polycythemia vera
•fluid loss due to diarrhea,
dehydration, burns
Impedance count X cal factor
Light Scatter , flow cytometry
M77221
CBC Adult Reference Ranges
Parameter WBC
RBC
HGB
HCT MCV MCH MCHC RDW PLT MPV
COMMON METHOD OF DETERMINATION
Impedance count X calibration (cal) factor
Impedance count X calibration factor
Colorimetric absorbance in proportion to hemoglobin
•some medications (such as methotrexate), •some autoimmune conditions •some severe infections •bone marrow failure
HIGH: >11.0 X103 /µL •Infections •Inflammation •cancer, leukemia
HIGH: >100 fL •B12
•Rigid RBCs
•Folate Deficiency
RDW Parameter Interfering substances and Implications
of triglycerides
•High bilirubin
LOW: Male: <14 g/dL Female: <12.0 g/dL •Anemia
HIGH: Male: > 17.4 g/dL Female: >16.0 g/dL •Polycythemia vera •fluid loss due to diarrhea, dehydration, burns
• With concentrations above or below the reportable range or Linearity range, the result does not correspond with the calibration curve in linear fashion.
Adult Reference Range 4.5-11.0 X 103/µL
Male: 4.5-5.5 X 106 /µL Female: 4.0-5.0 X 106 /µL
Male: 14-17.4 g/dL Female: 12.0-16.0 g/dL
Male: 42-52% Female: 36-46%
Automated CBC Parameters
and
Quality Control
Joanna Ellis, MLS(ASCP)
The Automated
Complete Blood Count
• Most common test in the Hematology lab. • Main Components of the CBC:
Female: < 4.0 X 106 /µL
•High concentration of very large platelets
•Anemia
Red •Agglutinated RBCs, rouleaux will break up
RBC
Blood when Istoton is added Cell •RBCs smaller than 36 fL
RBC Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW:
Male: < 4.5 X 106 /µL
•Very high WBC count (greater than 99.9)
CBC Quality Control
• Commercial Controls: • 3 levels (low, normal, high) • Values stored in instrument computer • Levey-Jennings graph generated and stored for each parameter
– Cell counts – Hgb – RBC indices – WBC differential absolute values and percent
• Indications for CBC:
– Fatigue – Weakness – Infection – Inflammation – Bruising – Bleeding
• Mode to Mode QC: • Most automated hematology instruments have a primary and secondary mode of sample aspiration. Controls must be run on BOTH and correlate. – Primary=Automated or Closed – Secondary=Manual or Open
80-100 fl 28-34 pg 32-36 g/dL or % 12.0-14.6% 150-450 X 103 /µL 6.8-10.2 fl
Linearity (Reportable Range)
• Instruments are calibrated for each analyte with a range that is clinically relevant.
• Delta Checks • When the Laboratory Information System (LIS) and the instrument are interfaced (connected) delta checks are conducted by the LIS on select parameters. – Current values compared to most previous result – Differences greater than the limits set within the LIS are flagged
Advia Linearity Instrument Codes
Code
Cause
Action Indicated
+++++
Result exceeds reportable range
Dilute 1:2 and rerun. Continue further dilutions until result is within linearity
HCT Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW:
Male: <42%
Female: <36%
•Anemia
•Known factors that interfere with the
WBC Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
LOW <4.5 X103 /µL
WBC
White Blood Cell Count
•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
From RBC histogram, #of RBCs X size of RBCs X cal constant OR Calculated: HCT X 10
RBC Calculated: RBC X MCV
10 Calculated: HGB X 10
RBC Calculated: HGB X 100
Result higher than the
H
laboratory set patient highLeabharlann Review Result
action limit
Result is lower than the
L
laboratory set patient low
Review Result
action limit
(Cell) Volume
•High concentration of very large platelets •Agglutinated RBCs •RBC fragments that fall below the 36 fL threshold
•Iron deficiency anemia •Thalassemia
• Results outside of linearity are NOT acceptable.
• Linearity ranges vary by instrument.
– Example: Parameter
Coulter STKS
Advia
WBC
0.0 -99.9 X 103 /µL 0.02-400 X 103 /µL
•Severe lipemia
•Heparin
HGB
•Certain unusual RBC abnormalities
Or Hemoglobin that resist lysing
Hb
•Anything that increases the turbidity
of the sample such as elevated levels
MCV Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
•Very high WBC count
LOW: <80 fL
MCV
Mean Corpuscular
•fluid loss due to
diarrhea, dehydration,
buns
HGB Parameter Interfering substances and Implications
Test Name
Interfering Agent
Clinical Implications
•Very high WBC count
HIGH: Male: > 5.5 X 106 /µL
Count •Specimens containing fibrin, cell fragments or Female: > 5.0 X 106 /µL
other debris (esp pediatric/oncology specimens •Polycythemia vera,
CBC Parameters
PARAMETER WBC RBC HGB
UNIT OF REPORTING X 103 /µL X 106 /µL g/dL
MCV
fL
HCT MCH MCHC RDW Platelet
WBC Diff
%
Pg
g/dL or % %
X 103 /µL Absolute: X103 /µL Percent of WBC : %
HCT Hematocrit parameters used for computation, RBC HIGH:
and MCV
Male: >52%
Female: <46%
•Polycythemia vera
•fluid loss due to diarrhea,
dehydration, burns