Normal Differential Count Of White Blood Cells – Determining the blood cell count, i.e. red blood cells (RBC), white blood cells (WBC) or platelets from manual and automatic cell counters is central to the diagnosis and treatment of hematological diseases. With only a few exceptions, most manual methods are being replaced by automated particle counter methods. The choice of analyzers of different technical principles and techniques complicates the addition of new parameters and their particular utility throughout the entire patient care process. The current generation of hematological analyzers are equipped with new and improved special parameters that are useful to clinicians in addition to diagnostic information that also provide invaluable prognostic value to their patients. Many new hematological parameters have been added by instrument manufacturers, some of which only have different terminology but the same clinical value as before. Leukocyte differential count White blood cells, or leukocytes, are an important part of the body’s immune system because they are responsible for protecting the blood circulation. body against infections and invading organisms. The white blood cell differential determines the percentage of each type of white blood cell in the blood. The differential can also detect immature white blood cells and abnormalities, both of which are signs of potential problems. There are five types of leukocytes (lymphocytes, monocytes, neutrophils, eosinophils and basophils). With the exception of basophils, these can be visualized with the LMNE matrix of Yumizen hematology analyzers (Figure 1).
In this matrix, optical extinction (Y-axis) is plotted against volumes (X-axis), creating an image with multiple groups of cells. Yumizen hematology analyzers are characterized by their ability to accurately control whole blood volumes, which increases their high level of automation. This allows the accurate determination of two additional parameters for leukocyte populations: atypical lymphocytes (ALY) and large immature cells (LIC), reported as percentages as well as absolute numbers. What are large immature cells? LICs are a small fraction of white blood cells normally found in bone marrow tissue, where hematopoiesis occurs. This subset consists of various immature forms of myeloid or lymphoid cells combined. Under certain clinical or even physiological conditions, LIC cells that are not fully matured, especially in terms of their size and complexity, may be released into the peripheral blood. Thus, they are found to be larger than normal mature blood cells and immature in their nuclear complexity and extent of cytoplasmic granularity. These events occur in both benign (reactive stress, infection or bone marrow regeneration) or neoplastic diseases (myeloproliferative disorders, leukemias or lymphoproliferative disorders). LIC cells include (1): • Promonocytes • Monoblasts • Metamyelocytes • Myelocytes • Promyelocytes • Myeloblasts • Blasts (myeloid or lymphoid) • Prolymphocytes • Megakaryocytes LIC parameter With Yumizen hematological analyzers, LIC biologists have studied several blood diseases. parameter showed an acceptable correlation between automatic and manual counters. This parameter was used definitively for flag purposes. we must acknowledge that it is designed to detect and label abnormal cells in a sample based on electro-optical properties, and further cytological analyzes are needed to obtain more information about the patient’s condition. The total number of high-end Yumizen H series medical instruments is shown as the sum of IMM (Immature Monocyte), IML (Immature Lymphocyte) and IMG (Immature Granulocyte) (2). Such cells, when presented in the analyzer, are identified as a distinct group in the LMNE array (Figure 2).
Normal Differential Count Of White Blood Cells
The LIC parameter has therefore been used for samples that contain the above-mentioned cell subpopulations. Yumize’s H1500 and H2500 provide the LIC parameter and IMM, IML and IMG for research purposes only (RUO) and should be interpreted with care. However, we have tried to improve this additional information provided by the analyzer by defining a reference interval for a specific population. The study was conducted according to the CLSI C28-A3 guideline (Defining, Established, and Verifying Reference Intervals in the Clinical Laboratory). A total of 240 (120 male and 120 female, over 18 years) whole blood samples collected in EDTA from apparently healthy Caucasian donors were analyzed in duplicate on three instruments, two Yumizen H2500 and one Yumizen H1500. The samples were kept at room temperature between sampling and testing. The reference interval was defined to include lower and upper references that contain 95% of the values of subjects in the reference population. The results are shown in Table 1.
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Table 1: Study-defined lower and upper reference limits for the LIC parameter compared to values in bibliographic data (3, 4).
Since the values obtained vary by sample population and/or geographic location, it is strongly recommended that each laboratory determine its own normal ranges based on its local population. In this context, in accordance with ISO 15189:2012 section 5.5.2, the laboratory must define the biological reference intervals or clinical decision values for a certain parameter to validate the test result. The reference intervals must be based either on normal values observed after tests on a healthy population or, if it is not possible to use this method, on reliable scientific data. LIC Alert: A morphological alert for large immature cells is displayed when the number of counted particles in a specific region of the LMNE matrix (Figure 1) is greater than the LIC# or LIC% threshold of counted particles relative to total. of white blood cells. Based on our internal research and bibliographic information, LIC alert values have been set at both 3% and 0.30# (Table 2).
What is their clinical significance? A small number of blasts and poorly differentiated monocytes are commonly found in the peripheral blood of healthy individuals (5). During the study, we also observed more large immature cells in men than in women. However, their number is small, even if the results obtained from the same individual sometimes vary. Care must be taken when interpreting LIC readings in pediatric patients, especially neonates, because their immune systems are immature and there are more immature cells in the bloodstream. Immature myeloid populations such as promyelocytes-myelocytes, metamyelocytes, band neutrophils, monocyte precursors, and activated monocytes are released in infectious disease, especially in early response. In this context, “shift to the left” is the term used to indicate that young/immature white blood cells are present. It indicates that the infection/inflammation present has caused a bone marrow response with increased production of white blood cells, followed by early release into the blood even before they are fully matured. The clinician should be alerted if such an LIC-labeled specimen originates from an immunocompromised or critically ill individual. The sensitivity to mark the left shift on Yumizen hematological analyzers increases with the increase of neutrophil bands, metamyelocytes, myelocytes, and promyelocytes (6, 10). Myelodysplastic syndrome (MDS) is a condition in which the stem cells in the bone marrow do not mature normally into red blood cells, white blood cells, and platelets. Circulating micromegakaryocytes, multiple small nuclei separated by strands of nuclear material, and large mononuclear cells with dysmorphic nuclear features have been described in the peripheral blood of MDS patients. Although there are several parallel criteria that help confirm the diagnosis of MDS, including flow cytometry, bone marrow histology, and immunohistochemistry or molecular marker studies, the LIC flag can be the first warning sign of a serious clinical problem (7, 8). Conclusion Ten years ago, Medical introduced an expanded 5-part distinction that includes counts of immature granulocytes, monoblasts, and lymphoblasts based on volumetric and optical extinction measurements, as well as two additional populations, LICs and ALYs. Since then, the LIC parameter has been used to label samples with abnormal leukocytes. When immature or abnormal white blood cells are present, automated differential results warrant review of a manual blood test. Compared to similar products, Yumizen hematology analyzers have good performance in 5-part leukocyte differential analysis and LICs, which correlates strongly with microscopic cytology analysis (9, 10). Taken alone, the LIC parameter gives little information, but which nevertheless remains valuable additional information that can be obtained quickly, without additional reagents and thus without additional costs. References 1. DP.Lokwani, The ABC of CBC, Interpretation of Complete Blood Count & Histograms, JP Medical Ltd, 2013 2. Clinical Case Studies, Interpretation Guide for the ABX Series 5-Part Hematology Analyzers 3. C. Sultan / M. Gouault – Helman / M. Imbert, AIDE MEMOIRE D’HEMATOLOGIE. Service Central d’Hématologie de l’Hôpital Henri Mondor, Faculté de médecine de Créteil (Paris XII). 1998 Troussard X, Voi S, 4. E. Cornet, V. Bardet, JP. Couaillac, C. Fossat, JC. Luce, E. Maldonado, V. Siguret, J. Tichet, O. Lantieri, J. Corberand. Complete blood count normal reference values for adults in France. Journal of Clinical Pathology (2014) 67(4): 341-4. 5. J. Oertel, B. Oertel, J. Schleicher, D. Huhn, Detection of a small number of immature cells in the blood of healthy subjects. Journal of Clinical Pathology, 1998; 51:886????890 6. R Siekmeier 1, A Bierlich, W Jaross, The white blood cell differential: three different methods, Clinical Chemistry and Laboratory Medicine, 2001 May;39(5) :432-45. 7. G. A. Hamid, A. W. Al-Nehmi and S. Shukry, Diagnosis and Classification of Myelodysplastic Syndrome. Book: Recent Developments in Myelodysplastic Syndromes, 30 Jan 2019, IntechOpen. 8. Peter L. Greenberg, James E. Thompson, MD, and Peter Westervelt, MD, PhD, Myelodysplastic Syndromes. Oncology clinical practice guidelines. Journal of the National Comprehensive Cancer Network. 2011 January ; 9(1): 30???56 9. M. Mateckaa and O. Ciepielaa,
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