Beckman Coulter Professional Development 2014 Beckman Coulter, Inc. 1of 50

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1 THE BECKMAN COULTER logo, COULTER, DxH, TruColor, and UniCel are trademarks of Beckman Coulter, Inc; COULTER and UniCel are registered in the USPTO. 1of 50

2 Objectives Flags Codes Messages CBC Parameters Cellular Interference Differential Parameters NRBC Parameters Retic Parameters 2of 50

3 Flags * These Flags are also associated with System Messages. See System Messages in HELP for more information. 3of 50

4 Codes 4of 50

5 Messages 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 5of 50

6 Messages Exception or System Status Messages Exception: anything with an exception may or may not be released depending on your lab s release rules criteria. An exception is the default test order. System Status: an event that may affect system operation. Accompanied by operator notification and entry into log. 6of 50

7 Examples 7of 50

8 CBC Parameters 8of 50

9 Data Fusion 9of 50

10 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 can t 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. 10 of 50

11 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 11 of 50

12 RBC Fragments/Microcytes Suspect message RBC Frag/Micro Pattern observed consistent with the presence of RBC fragments and/or microcytic red cells. 12 of 50

13 Giant Platelets Suspect message Giant Platelet May be accompanied by System message specific to platelet results Giant Platelet data pattern observed 13 of 50

14 Platelet Clumps System message Platelet Clumps PLT & associated parameters flagged with R Clumped platelet data pattern observed 14 of 50

15 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 15 of 50

16 WBC Interference from HGB System message WBC Inter: HGB HGB & associated parameters flagged with R HGB may not be adequately corrected for WBC interference 16 of 50

17 Differential Parameters 17 of 50

18 One Cell at a Time... WBCs are hydrodynamically focused FLOW CELL S H E A T H -F L U ID IN SAMPLE DILUTION SENSING AREA SHEATH FLUID SHEATH-FLUID IN SAMPLE IN 18 of 50

19 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) 19 of 50

20 Flow Cytometric Digital Morphology 20 of 50

21 Differential Parameters MONO NEUTS EOS LYMPH BASO 21 of 50

22 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 8 22 of 50

23 LY Blast 5PD1 5PD2 Normal 5PD1 Suspect message LY Blast Blasts suspected in the LY area of the dataplot Data pattern consistent with possible presence of very immature cells 23 of 50

24 MO Blast 5PD1 5PD2 Normal 5PD1 Suspect message MO Blast Blasts suspected in the MO area of the dataplot Data pattern consistent with possible presence of very immature cells 24 of 50

25 NE Blast 5PD1 5PD2 Normal 5PD1 Suspect message NE Blast Blasts suspected in the NE area of the dataplot Data pattern consistent with possible presence of very immature cells 25 of 50

26 Immature Granulocytes 5PD1 5PD2 Normal 5PD1 Suspect message Imm Grans [Metamyelocytes, myelocytes &/or promyelocytes] or [myelocytes & promyelocytes] Variable sensitivity with default set at high 26 of 50

27 Left Shift 5PD1 5PD2 Normal 5PD1 Suspect message Left Shift Metamyelocytes, without more immature granulocytes Variable sensitivity with default at high Can be disabled 27 of 50

28 Variant LY 5PD1 5PD2 Normal 5PD1 Suspect message Variant LY Variant (viral), atypical or abnormal LY suspected Variable sensitivity with default at high 28 of 50

29 Abnormal Diff Pattern 5PD1 5PD2 Normal 5PD1 System message Abn Diff Pattern Results do not match any known template All Diff results accompanied by R flag 29 of 50

30 NRBC 5PD1 5PD2 Normal 5PD1 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 30 of 50

31 Aged Sample 5PD1 5PD2 Normal 5PD1 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. 31 of 50

32 Excessive Debris 5PD1 5PD2 System message Excessive Debris: D All Diff results accompanied by R flag 32 of 50

33 NE-EO Overlap 5PD1 5PD2 System message NE-EO Overlap All Diff results flagged with R Population shift observed (NE and EO not in correct spatial location) 33 of 50

34 MO-NE Overlap 5PD1 5PD2 System message MO-NE Overlap All Diff results flagged with R Population shift observed (MO and NE not in correct spatial location) 34 of 50

35 Low Events: D 5PD1 5PD2 System message Low Events: D Not enough events available for differential 35 of 50

36 High Opacity Events 5PD1 5PD2 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. 36 of 50

37 Low RMALS Events 5PD1 5PD2 System message Low RMALS Events All Diff results flagged with R RMALS mode value is too low 37 of 50

38 NRBC Parameters PLT/DEBRIS WBC NRBC 38 of 50

39 Abnormal NRBC Pattern NRBC1 NRBC2 System message Abn NRBC Pattern NRBC & associated parameters flagged with R Fits no known pattern Normal nrbc 39 of 50

40 NRBC-LY Overlap System message NRBC-LY Overlap NRBC & associated parameters flagged with R Couldn t separate NRBC from small LY during analysis Normal nrbc NRBC1 NRBC2 40 of 50

41 NRBC Interference System message NRBC Inter NRBC & associated parameters flagged with R Significant amount of interference in NRBC regions that are not NRBC Normal nrbc NRBC1 NRBC2 41 of 50

42 Miscellaneous NRBC Messages Detected by Hardware, not algorithm Flow Cell Clog: N System Event: N 42 of 50

43 Reticulocyte Parameters WBC S MATURE RBC S RETICS PLT/DEBRIS 43 of 50

44 Abnormal Hemoglobin Normal Retic Suspect message Abn Hemoglobin Others category = green (~ platelets) & orange (not cleared) particles. Indicates a possible clearing problem in the presence of abnormal hemoglobin 44 of 50

45 Sickled Cells Suspect message Sickled Cells Data pattern consistent with sickled cells Normal Retic 45 of 50

46 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. 46 of 50

47 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 47 of 50

48 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 [:::::]. 48 of 50

49 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). 49 of 50

50 THE END! 50 of 50