Blood Routine Test Experience Sharing - Interesting Scatter Plot

01 Preface

In the work of blood cell analysis, the automatic blood analyzer is a good helper for our inspectors, which uses flow laser scattering, VCS and other technologies to classify white blood cells into five types of cells, and the use of this high-tech reduces the pressure and mistakes

The data after instrument detection includes two major types of data, numerical and scatter plots, of which scatter chart data plays a very important role

Scatterplots can not only intuitively indicate whether abnormal cells exist in the patient's blood [1-3], but also have the effect of

02 Case passed

In the daily blood routine result review, the author encountered a patient specimen with a malignant tumor of the liver, and the abnormal scatter in the lower left corner of the patient's white blood cell scatter map increased significantly.

Microscopic examination showed that no special substances

Typically, this model typically counts 8,192 white blood cells for white blood cell sorting, and the specimen counts 50,000 cells! So what exactly is causing this result?

We consulted with professional engineers and it is possible that many red blood cells are counted

Engineers say jaundice is the most common cause, and the presence of high bilirubin makes it impossible for red blood cells to be completely dissolved when treated with hemolytics, so that this part of the red blood cells enter the leukocyte channel to participate in the counting

Combined with the patient's diagnosis of "liver malignancy", it is very likely that the patient does have jaundice, and to verify that this is true, we performed centrifugation

Driven by curiosity, the author checked the results of the patient's biochemical project, and sure enough, the total bilirubin was very high!

03 Case study

So the question is, why is this happening?

High bilirubin in jaundice will change the phospholipid structure of the red blood cell membrane, resulting in increased hardness of the membrane, hemolysin is difficult to destroy or completely destroy its structure, hypotonic solution is difficult to enter the red blood cell membrane and cause red blood cells to be difficult to destroy

04 Summary

Therefore, when we encounter scatter plot abnormalities, we should be vigilant, especially when there are many abnormal scatters in the lower left of the scatter chart, we should conduct re-examination, including the patient's disease understanding, specimen traits, instrument raw data observation, smear microscopy, etc

05 Expert reviews

Re-inspection is one of the indispensable contents of the work of professional inspectors for temporary inspection, and the re-inspection of scatter chart is the top priority, which requires inspectors to have keen observation, solid basic skills, and rich clinical experience in order to correctly identify, accurately analyze, and report in time

References:

Zhou Fuxian.

[2] MA Wenyuan,LIANG Qin.

Chen Mengrui.

Liu Lingling, Wei Lijing, Liu Juan, et al.

Luo Xiaocheng, Cao Cunwei, Ma Qiuying, et al.