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Bc-5300/5380 BC-5300/5380 深圳：(0755) 81886619 成都：(028) 85322230 南京：(025) 86618592 郑州：(0371) 69316601 青岛：(0532) 80996585 北京：(010) 65810066 哈尔滨：(0451) 53622438 广州：(020) 38107486 重庆：(023) 68603650 合肥：(0551) 5609671 武汉：(027) 85714714 呼和浩特: (0471) 6665621 石家庄：(0311) 86666326 沈阳：(024) 22790288 福州：(0591) 87878859 贵阳：(0851) 5280593 杭州：(0571) 86772633 长沙：(0731) 85178277 乌鲁木齐：(0991) 2837326 天津：(022) 23201536 长春：(0431) 88987811 南宁：(0771) 5501579 昆明：(0871) 31711101 上海：(021) 34619081 南昌：(0791) 6818819 西安：(029) 88360648 太原：(0351) 8308836 大连：(0411) 82529862 海口: (0898) 68575395 苏州：(0512) 69367190 兰州：(0931) 8115539 济南：(0531) 81663350 2013 深圳迈瑞生物医疗电子股份有限公司版权所有。 是深圳迈瑞生物医疗电子股份有限公司的注册商标 国食药监械（准）字2010第3300644号 深圳市南山区高新技术产业园区科技南十二路迈瑞大厦 产品规格如有变化，恕不另行通知，谨以最新技术资料及检验结果为准。 电话: 755 8188 8998 传真: 755 2658 2680 P/N: ENG-CCS-5300/5380-210145x36-20110804 www.mindray.com 美国纽交所股票代码MR BC-5300/5380 Auto Hematology Analyzer Full automatic 5-part differentiation of WBC, 27 parameters, 3 histograms and 1 scattergram Laser scatter, Advanced flow cytometry, Chemical dye method Independent Basophil channel Up to 60 samples per hour 2 Sampling modes: Autoloader and Closed tube Large storage capacity: 40,000 results with graphs Preface to Clinical Case Study for spread product portfolio and an established presence in over 165 Mindray Hematology analyzer BC-5300/5380 countries; Mindray takes the task of supporting current healthcare Dr. Vijay Parekh, Scientific Director in Mindray demands seriously. Microscope and Romanowsky dyes availability have resulted in Clinical case study for BC-5300/5380 hematology analyzer is an accumulation of a vast pool of knowledge about cytological chang- example of that effort. It is a compilation of BC-5300/5380 hemato- es seen in various blood disorders. This is applied prospectively to logy analyzer results obtained on healthy individual and patients not only suspect, but also diagnose or even differentiate haemato- with commonly seen hematological abnormalities. It is designed to logical disorders. It is unthinkable today to practice hematology introduce the BC-5300/5380 user to the benefits of pattern reco- without support from an expert morphologist. At the base of such gnition. We wish to draw user's attention to the 'screening' principle approach lies the process of pattern recognition i.e. first discerning that is fundamental to judicious & proper use of this Clinical case a set of test results (qualitative + quantitative) as not normal (or study book. Currently available hematology analyzers are unable to abnormal) and then establishing its association with a known he- classify all types of morphological abnormalities, primarily due to matological condition. the limitations of technology which cannot match the accuracy of an expert morphologist who observes visual attributes of a well CBC+DIFF or ABC (i.e. Automated Blood Count & differentiation of stained cell and using his past knowledge classifies the cell. How- white cells into 5 common subtypes) is the most ordered blood test ever, the analyzers make up for the lower accuracy by providing far worldwide. While Clinical laboratories world over test millions of greater reproducibility/precision because they count large number blood specimens daily on automated hematology analyzers; Lab of cells and consistency to 'flag' an abnormality. managers also have to grapple with a decreasing pool of expert morphologists. Consequently, the newer entrants to medical pro- Hence, when BC-5300/5380 analyzer 'flags' a result, an expert fession look for solutions that bridge the gap between newer (not morphologist is expected to review patient's blood film from before necessarily well known) technologies and known maladies. Obvi- issuing findings & opinion, of course only after correlating with ously, an interested user is looking for repositories of data produced patient's medical history and clinical condition. by automated devices that establishes link between the data and diseases. It is also our hope that with your feedback, suggestions and newer observations; we will be able to bring out richer editions of Clinical Mindray is a global healthcare manufacturer committed to bring Case Study in future. healthcare within reach of wider section of people. With a wide- 1 2 FS Counting Principles for LEO I lyse breaks down red blood Hematology Analyzer BC-5300/5380 cells and imposes on effect on white blood cells. For RBC/PLT numeration, the classical electrical impedance LEO II lyse densifies the granules of method is used. When cell passing through the aperture by eosinophils. vacuum, it will introduce the change on resistance. In a constant current, the voltage change signal will be recorded and accords with the volume of cell. SS Flow cytometry Cells are injected into a flow cell aperture + - which is located in the optical path vacuum electrode of a light source, usually a laser; Surrounded with sheath flow, the blood cell pass through the center of For WBC 4 parts(lymphocytes, monocytes, neutrophils and flow cell in a single colume at a fast eosinophils) differentiation, chemical dye, flow cytometry speed. and laser scatter are applied. Chemical dye LEO I LEO II Laser scatter Light scattering occurs when a particle EOS deflects laser light. The extent to which this occurs depends on the physical properties of the particle: Other Forward scatter (FS): cell volume WBC Side scatter (SS): cell granularity RBC DIFF Channel 3 4 For basophils and WBC total number count, the cells are first LH lyse is also used for HGB quantitative analysis. With the treated by chemical dye, and then numerated by the classical aid of a color reagent, the concentration of HGB is electrical impedance method. determined by the change of absorbance in 525nm using colorimetric method. LH LH BASO Other WBC RBC LH lyse breaks down red blood cells, binds to hemoglobin and converts it to a complex that is measurable at 525nm. WBC/BASO Channel LH Lyse breaks down red blood cell and shrinks other WBC cells except basophils while keeps the original volume of basophils 5 6 Flags Appendix Abnormal Suspect Flag Meaning Flag Meaning 1 Leucocytosis High WBC analysis results WBC numbers of BASO and DIFF channels 2 are inconsistent. The sample may 1 WBC Abn. ? Leucopenia Low WBC analysis results be abnormal, or the analyzer may be 1 abnormal Neutrophilia High neutrophils analysis results Neutropenia1 Low neutrophils analysis results WBC Abn Abnormal WBC scattergram Scattergram? Lymphocytosis1 High lymphocytes analysis results 1 WBC Abn. Lymphopenia Low lymphocytes analysis results Abnormal WBC histogram WBC Histogram? WBC 1 Monocytosis High monocytes analysis results Left Shift? Left shift may exist Eosinophilia1 High eosinophils analysis results 1 Immature cells may exist Basophilia High basophils analysis results Immature Cell? RBC Abn. Distribution Abnormal RBC scattergram Abn./Atypical Abnormal lymphocytes or atypical 1 Lym? lymphocytes may exist Anisocytosis Sizes of RBCs are dissimilar Microcytosis1 Small MCV RBC Lyse Resist? RBC hemolysis may be incomplete 1 Macrocytosis Large MCV RBC/HGB RBC or HGB Abn.?1 Results of RBC or HGB may be inaccurate 1 RBC/HGB Erythrocytosis Increased RBCs 1 PLT PLT Clump? PLT clump may exist Anemia Anemia Hypochromia1 Hypochromia Diamorphologic RBC dimorphic distribution 1 The criterions which trigger the flag information can be edited from the Thrombocytosis1 PLTs increase software version of V01.19. 2 For this flag, if the analyzer determines that it is resulted from fragile WBCs, or PLT Thrombocytopenia1 PLTs decrease the WBC result in the predilute mode is between 0.5x109/L and 2.0x109/L, the analysis result will be displayed; otherwise, the analysis result shows ”***”. PLT Abn Distribution PLT histogram distribution abnormal 7 8 Normal Sample Normal scattergram appearance; the WBC sub-populations are well differentiated from each other and aggregate with- Microscopic Differential in expected areas; no flag message for abnormal cells. The WBC DIFF (n=200) WBC/BASO, RBC and PLT histograms are normal. Neutrophilic band granulocyte 1% Neutrophilic segmented Lym granulocyte 54% Lymphocyte 37% Monocyte 4% Neu Eosinophil 3 .5% Basophil 0.5% RBC morph Normal PLT morph Normal Under microscope, the morphology of erythrocytes, platelets and all sub-populations of leukocytes were normal, and no atypical or imma- ture cells were observed. Screen Interpretation: Upper part: results, reference ranges and flag information areas Lower part: histograms and scattergram ( lymphocytes monocytes neutrophils eosinophils) Male, 27-year-old healthy volunteer. 9 10 Diamorphic RBC The dimorphic RBC population in this case indicates aniso- Microscopic Differential cytosis and evidenced by presence of two red cell popula- tions with different cell size distributions. Dimorphic RBC is WBC DIFF (n=200) Neutrophilic band commonly seen in patients with sideroblastic anemia. It can granulocyte 1% Large RBC also be seen in patients recovering from iron deficiency Neutrophilic segmented granulocyte 55% anemia upon receiving iron therapy or patients who have Small RBC Lymphocyte 35% received massive blood transfusion. Monocyte 4% Eosinophil 4.5% Basophil 0.5% RBC mor p h Vary in size, the pale area in the center of some RBC expanded PLT morph Normal Under microscope, the erythrocytes varied in size; All WBC sub- populations were within normal limits. Report Analysis: Inaccurate RDW-CV and RDW-D results displayed as “**.*”; MCV results might be affected; related parameters including HCT, MCV and MCHC were flagged with ”?” where microscopic
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