O Troubleshooting

What Do I Do to Correct the CBC When the White Count Is Out of Linearity Range?

CBC results Flags

WBC 194.1 X 109/L + + +WBC beyond reportable range, upper

RBC 3.89 X 1012/L linearity limit is 99.9 X 109/L

Hct 34.0% on entire CBC

MCV 91.0 fL

MCH 29.1 pg

MCHC 32.0 g/dL

Platelets 41 X 109/L

The entire CBC and differential was "flagged" and considered nonreportable.

1. Which of these CBC results are unacceptable to report out to the clinician without further workup? ALL: WBC out-of-range, inaccurate RBC/HCT/RBC indices, questionable inaccurate platelets

2. What are the next steps that should be taken to provide accurate results? Resolution steps

• Dilute blood 1:10 with diluent, re-run

• Calculate to get accurate WBC

• Subtract RBC from WBC, i.e., RBC - WBC = accurate RBC

• Perform microhematocrit (spun HCT)

• Report only WBC, RBC, platelets

• Perform manual WBC differential, verify platelet count (or perform manually)

Example:

1. 1:10 dilution of blood—WBC result was 24.9 X 109/L

• Calculate to get accurate WBC:

24.9 X 10 (dilution factor) = 249 X 109/L = accurate WBC count

2. Subtract WBC from original RBC, as WBCs are included in original count, to obtain accurate RBC

3.89 (original RBC) - 0.249 (WBC count expressed in millions unit of measure) = 3.64 X 1012/L = accurate RBC count

3. Microhematocrit = 33.5%

• Be careful to exclude the buffy coat when reading the microhematocrit

4. Perform manual WBC differential and platelet estimate

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