Sysmex XE2100 Flagging Flag Messages l Negative l

Sysmex XE-2100 Flagging

Flag Messages l Negative – l Positive – l No abnormality found One (or more) of the 39 IP messages generated Error – Classified as either “func” or “result” error messages

Positive and Error Messages POSITIVE Diff Morph Count Abnormality in Cell Differential Abnormality in Cell Morphology Abnormality in Cell Count ERROR Func Result Delta Analysis error other than ID Barcode Low Reliability of Data Abnormalities with Delta Check

Parameter Marks +, @ * “----” “++++” “ “ & Data Exceeding Reference Interval Data Outside Numerical Range Data is Doubtful Analysis can’t be done Data exceeds display capability No order given Corrected Data

Limit Flags l Mark limits + or – – – l Critical limits – – l User definable categories and ranges 7 age/sex related categories & 1 universal category Flags results outside of user defined limits. One set of user definable limits. or Flags results which fall outside of Critical limits. Stop limits – – One set of User definable limits Flags results outside Stop limits, stops Instrument and Alarms (if set to do so)

Interpretive Messages l Generated by a number of user definable and instrument generated criteria. l These can be: values assigned by the user to particular flags areas of abnormality found on the scattergrams or histograms. l l

Interpretive Messages l Draw attention to abnormalities of the sample. l These flags may need confirmation microscopic examination of a blood film manual differential. etc (? ) l l l

WBC Flagging

WBC Channels that generate flags DIFF WBC/BASO IMI NRBC

WBC ABN Scattergram Detected from dot counts on border line between cluster A and cluster B NLME: WBC except BASO Ly/Ne 2 Ly/Mo 2 Mo/Eo Ly/Mo 1 Mo/NE Ly/Ne 1 Bas/NLME Ne/Eo Ly/Ba Ly/Gst Ba/Gst Ne/Gst Gst/NLME

Fluorescen ce DIFF Channel – Abnormal Flags Side Scatter

DIFF abnormal scattergram Promyelo Myelo Blast Meta, Myelo Band

Immature Granulocytes

IMI Scattergram Platelet Clumps

NRBC Channel NRBC Present

Flagging WBC Abnormal (User defined) l l l l Neutropenia Neutrophilia Lymphopenia Lymphocytosis Monocytosis Eosinophilia Basophilia l l l Leukopenia Leukocytosis NRBC Present – Only Appears if NRBC count performed

Flagging WBC Suspect l l l l Blasts ? Immature Gran ? Left shift ? Atypical lymph ? ABN lymph/L-blasts ? RBC lyse resistance ? NRBC ?

WBC Suspect, BLASTS? Channels involved: IMI & DIFF Blasts/Atypical Lymph area in Diff Channel Blasts? Blasts area in IMI Channel IMI

WBC Suspect, Immature Granulocyte? DIFF Immature Granulocytes? IMI

WBC Suspect, LEFT SHIFT ? DIFF Left Shift?

WBC Suspect, Atypical LYMPH ? DIFF Atypical Lymph?

WBC Suspect, ABN Lymph/ L-Blasts DIFF Abn Lymph/L-Blasts? IMI

WBC Suspect & Abnormal Flag, NRBC DIFF Channels involved: DIFF & NRBC? NRBC Present? NRBC

RBC Lyse Resistance ? Channel involved: DIFF channel RBC Lyse Resistance? DIFF

RBC/Ret Suspect - Abnormal Flagging

RBC/RET Flag Abnormal and Suspect l Channels which generate RBC/Ret IP flags are: RBC_DC RET

RBC Abnormal Distribution Computation of numerical data and size comparison RBC DC l l RBC Lower Discriminator (RL) RBC Upper Discriminator (RU) Multi Peak (MP) RDW-SD not analysed (DW)

Dimorphic Population RBC DC l Multi Peak flag (MP)

RET Abn Scattergram From UPP Count UPP= 0. 02 x 1012/ RET-CH l RET-CH (Extend)

Flagging RBC/RET Abnormal l l l l Anisocytosis Microcytosis Macrocytosis Hypochromia Anemia Erythrocytosis Reticulocytosis All user definable

Suspect Flags – RBC Agglutination Computation of numerical data and size comparison – MCHC, MCH, RBC Upper Discriminator (%) – – Turbidity/Hgb Interf – – MCHC 36. 5 g/d. L Iron Deficiency Computation of numerical data and size comparison – MCV, MCHC, RDW-CV – – Hgb Defect Computation of numerical data and size comparison – RDW-CV, MCV –

RBC/RET Suspect, Fragments Computation of numerical data and size comparison RBC Fragment # = 550 l l l RDW-SD PLT Upper Discriminator MCV RBC Lower Discriminator MCHC

Platelet Suspect - Abnormal Flagging

PLT Flags Abnormal and Suspect l Channels involved in generating flags are: RET(Plt-O) DIFF IMI PLT DC RBC DC

PLT Abnormal Scatergram Detected from WBC fragment count WBC fragment # is =>20 RET-CH (PLT-O)

PLT Abnormal Distribution Computation of numerical data and size comparison PLT DC

PLT Suspect, PLT Clumps Channels involved: DIFF & IMI channels PLT Clumps? DIFF IMI

PLT Abnormal Flags l Thrombocytopenia Thrombocytosis l Both user defined l