O Troubleshooting continued

count. The manual white count and platelet count were 5.6 X 109/L and 166.0 X 109/L, respectively. The technologist left a message for future shifts that a manual white count and platelet would be necessary for this patient. This case offers an insight into the level of interference possible with the increased IgM globulin in patients with Waldenstrom's macroglobulinemia. Because the level of IgM monoclonal antibody is so elevated (paraprotein), it is seen as an interfering sub stance with significant consequences to the white count and differential primarily. Many hours of investigation and trying alternatives were spent in obtaining results on this patient. An observant technologist combined with reliable information from the family eventually led to actions that would contribute to the credibility of the patient's hematology samples. The next day, the patient underwent plasmapheresis and the CBC was run through the instrument with no interferences.

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