Reflex Testing

• A fluorescent platelet may be performed when:
  • Red cell fragments, microcytic RBC's or white cell cytoplasmic fragments may interfere with automated platelet counts.
  • If >10 megakaryocytes/100 WBC are seen on Slide examination
• Slide examination occurs when:
  • Instrument parameter flags indicate abnormal cell populations, requiring a technologist to review slides to verify cell identity and abnormal morphology.
  • WBC count of <2,000/µL or >25,000/µL
  • RBC count <2.5 x 10⁶ cells/µL or >7.5 x 10⁶ cells/µL
  • HGB <7gm/dL or > 18 gm/dL for 12Years -150Years; >24gm/dL for 0-15 days; and >21 gm/dL for 15Days -30Days
  • MCV <70 fL or > 108 fL for 60 Days -150 Years; >131 fL for 0D-30Days; and >110 fL for 30D-60Days
  • MCHC >37.5%
  • RDW-CV >20%
  • PLT <50,000/ µL or >700,000/ µL
  • ANC <1.0 10³/µL or >20 10³/µL
  • Lymph # Auto
    • 0 Days –30 Days: <0.6 10³/µL or >17.1 10³/µL
    • 30 Days- 1 Year: <0.6 10³/µL or >10.6 10³/µL
    • 1 Year-10 Years: <0.6 10³/µL or >8.1 10³/µL
    • 10 years- 15 Years:  <0.6 10³/µL or >7.0 10³/µL
    • 15 Years –150 Years: <0.6 10³/µL or >5.0 10³/µL
  • Mono # Auto
    • 0 Days –30 Days >3.2 10³/µL
    • 30 Days- 10 Years >2.1 10³/µL
    • 5 Years –150 Years >1.5 10³/µL
  • Eos # Auto >2.0 10³/µL
  • Baso # Auto >0.5 10³/µL
  • IG# >10³/µL or IG% >5%
• A Differential Manual will be performed when
  • If tech evaluation disagrees with the automated differential.
  • Presence of nucleated RBCs.
  • Presence of >1 band neutrophil.
  • ≥ 5% IG on instrument printout and/or the presence of any immature WBCs (i.e. metamyeloctyes, myelocytes, promyelocytes, blasts, etc.).
  • Presence of >10% atypical lymphocytes.
  • The following WBC Morphology will be noted if present
    • Toxic Granulation
    • Vacuoles (In neutrophils)
    • Döhle Bodies
    • Pelger-Huët
    • Auer Rods
    • Hypersegmentation
    • Smudge cells
  • Giant platelets will be noted only if >5 are observed throughout the smear.
  • Abnormal red blood cell quantitations.

• Abnormal Heme Smear Path Review will be performed for:
  • Unexplained Hgb <7 gm/dL if accompanied by abnormal RBC morphology or low or high MCV.
  • Unexplained presence of normoblasts
  • >2 metamyelocytes or earlier precursors, including blasts, present for no obvious reason such as infection.
  • Monocytosis or Eosinophilia with other abnormalities present.
  • 5.Any unexplained absolute deficiency of lymphs or granulocytes
  • Any unexplained absolute increase of lymphocytes.
  • Any bizarre cells
  • Atypical lymphs greater than 20/100 WBCs or greater than 10 % if accompanied by an absolute lymphocytosis.
  • MCV > 110 fL
  • MCH < 2 pcg or > 37 pcg
  • MCHC >37 gm/dL
  • RDW >22%
  • PLT <50,000/ µL or > 1,000,000/ µL (first time only).