10/30/2015. XN Case Studies: Every Picture Tells a Story

Transcription

1 XN Case Studies: Every Picture Tells a Story Jill Crist MT(ASCP)Field Product Specialist OBJECTIVES Explain how scattergrams and histogram pictures can provide great insight into abnormal hematology samples Describe the technology and the operational benefits of the Sysmex XN automated hematology analyzer. Utilize case studies to demonstrate how enhanced technologies can benefit the patient and clinician, as well as provide efficiency in your hematology workflow FLUORESCENT FLOW CYTOMETRY Side Fluorescent Light DNA/RNA information Dichroic Mirror Side Scattered Light Cell inside structure information Forward Scattered Light Cell size information Laser Beam wavelength=633nm 1

2 CASE STUDY 1: OB PATIENT WITH GIANT PLTS Giant platelets in pregnant patients can be a normal phenomenon. The problem with this is the failure of impedance technology to accurately recover a reportable number resulting in the technologist needing to manually intervene. PLT-F CHANNEL Reportable Parameters PLT-F IPF. MICROSCOPIC IMAGES OF SLIDE Doc. No CFL, Rev 1, June

3 OB PATIENT WITH GIANT PLATELETS Printout Doc. No CFL, Rev 1, June 2014 OB PATIENT WITH GIANT PLATELETS XN-IPU Browser Doc. No CFL, Rev 1, June 2014 CASE STUDY 2: SEVERE BURN PATIENT Expected findings usually show spherocytosis and increased osmotic fragility of RBCs. Peripheral blood fibrocytes are adherent cells from peripheral blood mononuclear cells (PBMC). These are an important source for healing of burn wounds. 3

4 PLT MEASUREMENT OVER TIME IN A SEVERE BURN INJURY PATIENT PLT COUNT OVER TIME IN A BURN PATIENT Day 1 PLT-F PLT-I Day 2 PLT-F PLT-I PLT COUNT OVER TIME IN A BURN PATIENT Day 3 PLT-F PLT-I Day 4 PLT-F PLT-I 4

5 Doc. No CFL, Rev 1, June 2014 FYI : Manual plt estimate 200 Doc. No CFL, Rev 1, June 2014 CASE STUDY 3: ORGAN TRANSPLANT PATIENT Patient is a 2 year old male with a history of multiple organ transplants who presented with weakness and fevers. Patient was anemic, with elevated WBC, IG and NRBCs. 5

6 FSC 10/30/2015 WNR CHANNEL NRBC BASO Granulocyte MONO LYMPH Maximized efficiency NRBC with every CBC No additional steps or reagents Accurate WBC counts in the presence of NRBCs Virtually eliminates interferences from Lyse resistant RBCs Lipids Megakaryocytes Improves turn around times RBC Debris SFL CBC RESULTS FROM XN VERY HIGH NRBC, ABNORMAL INDICES 6

7 SFL 10/30/2015 CASE STUDY 4: HEART DEFECT PATIENT Patient is 7 year old male who was born with a heart defect. Presented with extremely elevated WBC count. WDF CHANNEL Atypical LYMPH MONO Immature WBC LYMPH EO Improved efficiency More reportable automated differentials 6-part differential with reportable IG% Rapid TAT Decreased manual interventions Enhanced Flagging Auto-correction of lymphs when NRBC are present NEUT SSC CBC RESULTS FROM XN 7

8 VERY HIGH WBC COUNT CASE STUDY 5: PATIENT WITH CML Patient is 17 year old male with CML. Patient is BCR/ABL Positive. CBC RESULTS FROM XN 8

9 Increased Basophil Count. INTERESTING CML FACTS Up to 5% will not have this 9;22 Philadelphia chromosome translocation BCR/ABL negative CML These patients have: A poorer prognosis Are generally older Lower platelet and basophil counts Lower rate of blast transformation, but shorter mean survial Martiat P, Michaux J, et al. Philadelphia-negative chronic myeloid leukemia: comparison with Ph+ CML and chronic myelomonocytic leukemia. 1991; 78: CASE STUDY 6: SICKLE CELL PATIENT Patient is 17 year old male with Sickle Cell Disease. What are some interferences we would expect to see? 9

10 RET CHANNEL RET RBC LFR MFR HFR IRF PLT CBC RESULTS FROM XN 10

11 RETIC ABNORMAL SCATTERGRAM CASE STUDY 7: PATIENT WITH ROULEAUX Rouleaux are stacks or aggregations of red blood cells (RBCs) which form because of the unique discoid shape of the cells in vertebrates. The flat surface of the discoid RBCs gives them a large surface area to make contact with and stick to each other; thus forming a rouleaux. They occur when the plasma protein concentration is high, and because of them the ESR (erythrocyte sedimentation rate) is also increased. ROULEAUX, RBC FRAGMENTS 11

12 ROULEAUX, RBC FRAGMENTS ROULEAUX, RBC FRAGMENTS CASE STUDY 8: CF PATIENT Patient is a newborn male with Down Syndrome and Cystic Fibrosis. Patient presented with decreased Platelet count. 12

13 PLT Abnormal Distribution Reflex PLT-F BODY FLUID ANALYSIS Body fluid mode (target species) HF-BF Cerebrospinal fluid (CSF) MN Pleural fluid Peritoneal fluid MO-BF LY-BF PMN Synovial fluid NE-BF EO-BF WDF Scattergram 13

14 Normal Body Fluid CASE STUDY 9: BACTERIAL MENINGITIS A 59 year old male with a craniotomy presented with subcutaneous leakage of CSF and it was determined that the patient had bacterial meningitis. Bacterial Meningitis: CSF Sample 14

15 CASE STUDY 10: LUNG CANCER PATIENT A 60 year old was receiving treatment for lung cancer when an accumulated amount of pleural fluid was noticed in the right lung. Lung Cancer: Pleural Fluid High Body Fluid Count 15

16 Questions??? References: New England Journal of Medicine Volume 229, No. 19 Lab Invest, :