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Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 1 of 50.

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Presentation on theme: "Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 1 of 50."— Presentation transcript:

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2 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 1 of 50

3 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 2 of 50 Objectives Flags Codes Messages CBC Parameters Cellular Interference Differential Parameters NRBC Parameters Retic Parameters

4 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 3 of 50 Flags

5 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 4 of 50 Codes

6 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 5 of 50 Messages –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

7 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 6 of 50 Messages Exception or System Status Messages –Exception: anything with an exception wont be released, for example – default test order –System Status: an event that may affect system operation. Accompanied by operator notification and entry into log.

8 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 7 of 50 Examples

9 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 8 of 50 CBC Parameters

10 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 9 of 50 Data Fusion

11 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 10 of 50 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 cant 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.

12 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 11 of 50 Red Cell Messages Suspect message Dimorphic Reds Data pattern consistent with the presence of multiple red cell populations Suspect message Red Cell Agglut Data pattern consistent with the presence of agglutinated red cells

13 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 12 of 50 RBC Fragments/Microcytes Suspect message RBC Frag/Micro Pattern observed consistent with the presence of RBC fragments and/or microcytic red cells.

14 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 13 of 50 Giant Platelets Suspect message Giant Platelet May be accompanied by System message specific to platelet results Giant Platelet data pattern observed

15 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 14 of 50 Platelet Clumps System message Platelet Clumps PLT & associated parameters flagged with R Clumped platelet data pattern observed

16 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 15 of 50 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

17 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 16 of 50 WBC Interference from HGB System message WBC Inter: HGB HGB & associated parameters flagged with R HGB may not be adequately corrected for WBC interference

18 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 17 of 50 Differential Parameters

19 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 18 of 50 One Cell at a Time... WBCs are hydrodynamically focused

20 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 19 of 50 Flow Cytometric Digital Morphology Multiple 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)

21 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 20 of 50 Flow Cytometric Digital Morphology

22 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 21 of 50 Differential Parameters MONO LYMPH EOS NEUTS BASO

23 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 22 of 50 Abnormal Cell Distribution MO Blasts 2 NE Blasts 3 Immature Granulocytes 4 Band Neutrophils 5 LY Blasts 6 Variant Lymphocytes 7 Small Lymps / Low Opacity 8 Non-White Cells

24 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 23 of 50 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

25 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 24 of 50 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

26 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 25 of 50 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

27 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 26 of 50 Immature Granulocytes Suspect message Imm Grans [Metamyelocytes, myelocytes &/or promyelocytes] or [myelocytes & promyelocytes] Variable sensitivity with default set at high 5PD1 5PD2 Normal 5PD1

28 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 27 of 50 Left Shift Suspect message Left Shift Metamyelocytes, without more immature granulocytes Variable sensitivity with default at high Can be disabled 5PD1 5PD2 Normal 5PD1

29 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 28 of 50 Variant LY Suspect message Variant LY Variant (viral), atypical or abnormal LY suspected Variable sensitivity with default at high 5PD1 5PD2 Normal 5PD1

30 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 29 of 50 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

31 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 30 of 50 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 5PD2Normal 5PD1

32 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 31 of 50 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

33 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 32 of 50 Excessive Debris System message Excessive Debris: D All Diff results accompanied by R flag 5PD1 5PD2

34 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 33 of 50 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

35 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 34 of 50 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

36 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 35 of 50 Low Events: D System message Low Events: D Not enough events available for differential 5PD1 5PD2

37 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 36 of 50 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

38 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 37 of 50 Low RMALS Events System message Low RMALS Events All Diff results flagged with R RMALS mode value is too low 5PD1 5PD2

39 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 38 of 50 NRBC Parameters PLT/DEBRIS WBC NRBC

40 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 39 of 50 Abnormal NRBC Pattern System message Abn NRBC Pattern NRBC & associated parameters flagged with R Fits no known pattern NRBC1NRBC2 Normal nRBC

41 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 40 of 50 NRBC-LY Overlap NRBC1NRBC2 System message NRBC-LY Overlap NRBC & associated parameters flagged with R Couldnt separate NRBC from small LY during analysis Normal nRBC

42 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 41 of 50 NRBC Interference NRBC1NRBC2 System message NRBC Inter NRBC & associated parameters flagged with R Significant amount of interference in NRBC regions that are not NRBC Normal nRBC

43 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 42 of 50 Miscellaneous NRBC Messages Detected by Hardware, not algorithm Flow Cell Clog: N System Event: N

44 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 43 of 50 Reticulocyte Parameters MATURE RBCS WBCS RETICS PLT/DEBRIS

45 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 44 of 50 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

46 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 45 of 50 Sickled Cells Suspect message Sickled Cells Data pattern consistent with sickled cells Normal Retic

47 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 46 of 50 Retic System Messages System message RET-RBC Overlap RET & associated parameters flagged with R. Unclear separation of retics & mature red cells. System message RET Inter: PLT RET & associated parameters flagged with R. The platelet population may have interfered with the RET.

48 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 47 of 50 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

49 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 48 of 50 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 [:::::].

50 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 49 of 50 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).

51 Rev. A (May 2012)Professional Development © 2012 Beckman Coulter, Inc. 50 of 50


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