CBC Counter Basic.pdf

Basic Training For Cell Counter

1. Automated Blood Cell Counter
Prof. (Brig. Gen.) Dr MA Mohsin
MBBS, MCPS, MPhil (Path)
Professor & Head
Dept. of Applied Laboratory Sciences
Advisor, Dept. of Pathology
Bangladesh University of Health Sciences

2. “How can I have possibly come so far,
And still have so far to go ?”
Blood has always fascinated man, being
regarded as the essence of life.

3. Evolution of Automated Cell Counter
Traditional cytometer –manual
Kart Principle –Coulter Counter
A advanced haematology analyzer.
A simple instrument can analyze more parameters of
multiple sample.

4. Haemocytometer

5. Neubaur’s Chamber

6. Automated Blood Cell Counter

7. Automated Blood Cell Counter
Sysmex XT i2000
Cell DYN Ruby

8. Automation minimizes or does away with the need for
manual intervention.
Even semi-automation involves steps like the dilution
of blood samples and allows for the measurement of
only fewer variables.
With a fully automated system, all that is required is
an appropriate blood sample.
Errors are a major issue with manual counting. There
are problems with cell recognition such as
distinguishing lymphocytes from monocytes and these
may be overestimated or underestimated.

9. Othersourcesoferrorwithmanualcountspertainto
distributionofcellsontheslideandstatistical
samplingerror.Onetheotherhand,automatedcell
countersensureahighlevelofprecisionandaccuracy
forcellsizing.
Automatedleukocytedifferentialssignificantlyreduce
thetimeandcostofperformingroutineexaminations.

10. State of the Art Hematology Analyzers
Hematology analyzers also come with on-
board storage for thousands of patient reports
and even allow for customization of these
reports with patient identification and color
histogram.

11. Advantages of Automated Hematology Analyzers
Modernautomatedhematologysystemsaredesignedtomeet
theneedsofhighvolumelaboratories.Theycanmeasure
severalanalyticalparameterssuchasWBCorleukocytecount,
lymphocytepercentandnumber,mononuclearcellpercentand
number,granulocytepercentandnumber,RBC,hemoglobin
concentration,hematocrit,meancorpuscularvolume,
hemoglobinconcentration,redcell,plateletcount,andmore.
Incorporatingawiderangeofparametersononeinstrument
minimizestheneedtorunonesampleonseveralparameters.
Noslidedistributionerror
Manyparametersnotavailablefromamanualcount
Moreefficientandcosteffectivethanmanualmethod

12. Principles of Automated Cell Counters
Impedance (conductivity) System
(coulter)
Optical System (Light Scattering)
Flow Cytometry
Selective Lysis
Special Stains

13. Analytic Goals
CBC Count
Leukocytes
Erythrocytes
Hemoglobin
Mean cell volume
Platelets
Leukocyte Differential Count
Neutrophils
Lymphocytes
Monocytes
Eosinophils
Basophils
Reticulocyte Count

14. Whole Blood Reportable Parameters
WBC
RBC
HGB
HCT
MCV
MCH
MCHC
PLT
MPV

15. Leukocyte Differential Count
Extended Differential Count
-Immature Granulocytes
-Nucleated RBCs
Immature ReticulocyteFraction
ReticulocyteIndices
RBC Distribution Width
Schistocytes(FRBCs)
Platelet Indices
Reticulated Platelets and Immature Platelet
Fraction

16. Clinical Applications of Reticulocyte Parameters
Guidance of iron and EPO therapy in
hemodialysis patients
Diagnosis of iron deficiency in patients with
inflammation or chronic disease
Diagnosis of iron deficiency in early childhood

17. Cell Identification Error in Manual Counting
Mostly associated with distinguishing lymphocytes
from monocytes, bandsfromsegmented forms and
abnormal cells (variant lymphocytes from blast )
Lymphocytes overestimated, monocytesunderestimated
Slide Cell Distribution Error
Increased cell concentration along edges and in the
feather edge, also bigger cells found there i.e.
monocytes, eosinophilsand neutrophils
Statistical Sampling Error

18. WBC Differential Ordered
Automated differential performed
No flags -automated differential is reported
Flags -Slide made, labeled, stained &
reviewed
Review with Microscope

19. Review Rate
Whenever the automated cell counter flags a
specimen, the technologist has to-
Retrieve the tube
Make a slide
Stain the slide
Review the slide
Either release the results from the cell counter or
perform a manual differential
These steps consume time, labor and money !!!

20. Blood Films

21. Blood Cells

22. Peripheral Blood Film (Typical)

23. Peripheral Blood Film (Atypical)

24. Peripheral Blood Film (Atypical)

25. Thetechnologicalevolutionasappliedtohematology
analyzershasprovidednewopportunities.
Thepossibilityofdeterminingthefractionofimmature
plateletsbyusingasimplifiedmethodopensthedoortonew
applications.
Itshouldberememberedthatdespitetheessentialroleof
automationinthemodernhematologylaboratory,microscopic
controlofpathologicsamplesremainsindispensible,somuch
sothatincertaincases,italoneisdiagnostic.
Moreover,knowledgeofthelimitsofthespecificanalyzerin
useisofparamountimportanceforthecorrectinterpretationof
results.

26. Thanks To All
For Patient Hearing