Manual Differential - Fairbanks Memorial Hospital

Additional Codes

Cerner	NextGen
Diff Man	Differential Manual

Methodology

Manual microscopy

Patient Preparation

None

Collection Instructions

Standard phlebotomy practices.

Specimen Requirements

Preferred Volume	12 x 75 mm tube EDTA-2K or EDTA-3K Lavender filled to capacity
Minimum Volume	1mL of whole blood in 12 x 75 mm tube EDTA-2K or EDTA-3K Lavender 250 μL of whole blood in microtube EDTA-2K or EDTA-3K Lavender
Container	12 x 75 mm tube EDTA-2K or EDTA-3K Lavender or Microtube EDTA-2K or EDTA-3K Lavender
Stability	Sample stability at room temperature is 24 hours. Stored at 2-8^oC, EDTA blood samples with normal results may be analyzed up to 48 hours
Rejection Criteria	Clotted samples or those containing clots, fibrin strands, or platelet clumps. All specimens will be checked visually for obvious clots prior to sampling by the analyzer. Grossly hemolyzed samples. Samples drawn above an IV line.

Result Reporting and Reference Values

Reference Range

TEST	UNITS	SEX	AGE	REFERENCE RANGE
TEST	UNITS	SEX	AGE	REFERENCE RANGE
Metamyelocyte	%	All	0D-150Y	0	--	0
Myelocyte	%	All	0D-150Y	0	--	0
Promyelocyte	%	All	0D-150Y	0	--	0
Blasts	%	All	0D-150Y	0	--	0
Plasma cell	%	All	0D-150Y	0	--	1
Prolymphocyte	%	All	0D-150Y	0	--	0
Atypical Lymph	%	All	0D-150Y	0	--	4

Metamyelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Myelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Promyelocyte	10^3/µL	All	0D-150Y	0	--	0.1
Blasts	10^3/µL	All	0D-150Y	0	--	0.1
Plasma cell	10^3/µL	All	0D-150Y	0	--	1
Prolymphocyte	10^3/µL	All	0D-150Y	0	--	0.1
Atypical Lymph	10^3/µL	All	0D-150Y	0	--	4

Other Reporting Notes

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.

Reflex Testing

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).

Useful For

Examination of the numerical and/or morphological findings of the complete blood count by the physician are useful in the diagnosis of disease states such as anemias, leukemias, allergic reactions, viral, bacterial, and parasitic infections.

The white blood cell differential assesses the body's ability to respond to and eliminate infection. It also detects the severity of allergic and drug reactions, plus the response to viral, parasitic, and other types of infection. It is essential in identifying various stages of leukemia and monitoring response to chemotherapy.

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