Consensus Guidelines: Rules


Rule #
Parameter
Primary
and/or
Secondary
and/or
Tertiary
and/or
fourth
Action 1
Action 2
Action 3
1
Neonate First sample





Slide Review

2
WBC, RBC, HGB, PLT, Retics Exceeds linearity





Dilute sample and rerun

3
WBC, PLT Lower than Lab verified instrument linearity

 




Follow lab SOP  

4
WBC, RBC, HGB, PLT Vote Out





Check sample for clot Rerun sample If persists, perform alternate counting method
5
WBC <4.0 OR > 30.0 and first time



Slide Review

6
WBC <4.0 OR > 30.0 and delta failed and within 3 days

Slide Review

7
PLT <100 OR >1000 and first time  
 
 
 
Slide Review  
 
8
PLT Any value and Delta Check Fail



Slide Review

9
HGB <7g/dl or > 2g/dl above upper reference range for age and sex and first time
 
 

Slide Review Verify sample integrity if indicated
10
MCV <75fl or > 105fl (Adult) and first time and specimen is < 24 hours old

Slide Review

11
MCV >105 fl and adult and specimen is >24 hrs old

Slide Review for macrocytic associated changes Request fresh sample if NO macrocytic associated changes seen Report with comment if fresh sample is not available
12
MCV Any value and delta fails and specimen is <24 hours old

Verify sample integrity/identity

13
MCHC >=2 units above upper limit of reference range





Check for lipemia, hemolysis, RBC agglutination, spherocytes.

14
MCHC <30 and normal/high MCV



Investigate possible IV contamination or other sample specific cause.

15
RDW >22 and first time



Slide Review

DIFFERENTIAL
16
No diff or incomplete diff






Manual Diff and Slide Review

17
Neut # <1.0 or > 20.0 and first time



Slide Review

18
Lymph # >5.0 (adult) or >7.0 (<12 yrs old) and first time



Slide Review

19
Mono # >1.5 (Adult) or >3.0 (<12 yrs old) and first time



Slide Review

20
Eos # >2.0 and first time



Slide Review

21
Baso # >0.5 and first time



Slide Review

22
NRBC # any value and first time



Slide Review

 
RETICS  
 
 
 
 
 
 
 
 
 
23
Retic Absolute # >0.100 and first time



Slide Review

SUSPECT FLAGS
24
Suspect flag (except ImmG/Band) Flag + and first time and adult

Slide Review

25
Suspect flag Flag + and first time and child

Slide Review

26
WBC unreliability Flag Flag + any




Check sample integrity and rerun sample If persists, review instrument output Slide review with manual diff if indicated
27
RBC fragment Flag + any




Slide Review

28
Dimorphic RBC Flag + and first time



Slide Review

29
Lyse resistant RBC Flag + any




Review WBC histogram/cytogram Validate by lab SOP (consider incorrect retic count) eg. Review smear for abnormal RBC morphology
30
PLT clump flag any count





Check sample for clots Slide review (PLT estimate) If clumps persist, follow lab SOP
31
Platelet Flags PLT & MPV flags except plt clumps





Slide Review

32
Immature granulocyte flag Flag + and first time



Slide Review

33
Immature granulocyte flag Flag + and previous confirmed result and positive delta fail for WBC

Slide Review

34
Left shift flag Flag +





Follow lab SOP

35
Atypical/Variant lymphs Flag + and first time



Slide Review

36
Atypical/Variant lymphs Flag + and previous confirmed result and positive delta fail for WBC

Slide Review

37
Blast flag Flag + and first time



Slide Review

38
Blast flag Flag + and previous confirmed result and delta pass or negative delta for WBC and within 3-7 days Follow lab SOP

39
Blast flag Flag + and previous confirmed result and positive delta fail for WBC

Slide Review

40
NRBC flag Flag +





Slide Review If positive, enumerate NRBC count, correct WBC if appropriate
41
Retics Abnormal pattern





Look at instrument output Repeat if aspiration problem If persists, review slide








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