PROFICIENCY TESTING SERVICE AMERICAN ASSOCIATION OF BIOANALYSTS 205 West Levee St. w Brownsville, TX 78520-5596 800-234-5315 w 956-546-5315 w Fax 956-542-4041

PARTICIPANT STATISTICS FIRST QUADRIMESTER 2016 ADVANCED HEMATOLOGY WITH MANUAL DIFF

Specimen 1 Specimen 2 Name Line No.Range & Type Mean SD Range & Type Mean SD No. of Labs PBS, Basophils % 1 0 - 4 C 0 0 0 - 4 C 0 0 12 PBS, Eosinophils % 1 0 - 5 C 0 0 0 - 8 C 3.3 1.5 12 PBS, PMN (Bands/Segs) % 1 63 - 73 C 68 0 55 - 65 C 60 0 12 PBS, Lymphocytes % 1 7-42 S 24.7 5.8 27 - 29 C 28 0 12 PBS, Monocytes % 1 0 - 20 S 6.7 4.4 2-12 C 7.3 1.5 12 PBS, Abnormal/Other % 1 0 - 4 C 0 0 0 - 5 S 0.7 1.5 12

RBC Morphology Specimen 1 Specimen 1 Schistocyte (bite, blister, helmet) 3 Burr Cell (echinocyte, cren) 6 Acanthocytes (spur) 2 Eosinophil, any stage 1 *** Erythrocyte, normal RBC 1 *** RBC Fragments 1 Total Population 7 Total Population 7 Intended result - Schistocyte Intended result - Echinocyte WBC Morphology Specimen 1 5 Specimen 2 PMN with Pelger-Huet Nucleus 1 Blast, undifferentiated 4 Segmented Neutrophil (PMN, poly) Myeloblast 1 Lymphocyte, reactive 1 Total Population 6 Total Population 6 Intended result - Pseudo Pelger-Huet Syndrome Intended result - Blast

Platelet Estimate Platelets decreased 6 Platelets adeqate 0 *** Platelets increased 0 *** Total Population 6 Intended result - Platelets Decreased

Correct responses are defined as those reflecting agreement among 80% or more of all participants or referees. Unacceptable responses are indicated by "*****" on the Flagging line of each specimen.

Quad 1 2016

RBC Morphology – Specimen 1 The cells to be identified are schistocytes. Schistocytes are fragmented red cells, varying in size from as large as a normal red cell to small pieces (fragments). Typically, they have little structure to them, no central pallor, and display inconsistent shapes throughout the smear. They are sometimes called helmet cells, bite cells, and horn cells – all terms designed to describe the bizarre shape of the fragment. Schistocytes should not be confused with acanthocytes or spur cells. Acanthocytes have the normal round shape of a red cell, but have a varying number of spiny projections scattered over the surface. Schistocytes may have spiny projections, and often do, however they exist as fragments rather than intact RBCs. Schistocytes occur as a result of fragmentation of abnormal red cells or following mechanical or heat-induced trauma to the cells. Conditions associated with the presence of schistocytes include disseminated intravascular coagulation (DIC), thrombotic thrombocytopenic purpura (TTP), severe burns, malignant hypertension, prosthetic heart valves, carcinomas, myelodysplastic syndromes, septicemia, and certain hemoglobinopathies, to mention a few. RBC Morphology – Specimen 2 The cells to be identified are echinocytes. Echinocytes are red cells which have lost their biconcave shape whose surface is covered with multiple (up to 20), evenly distributed, short, blunt projections. They have also been called burr cells. The most common cause of echinocyte formation is a delay in making blood smears from anticoagulated blood. This “lesion of storage” results in crenated red cells, likely due to a fall in ATP or lysolecithin formation. Echinocytosis that is not artefactual is distinctly rare. It can occur in liver disease, early stages of hemolytic uremic syndrome (HUS), vitamin E deficiency, burns, heparin therapy, myeloproliferative disorders, and in extremely ill patients with multiorgan failure. Interestingly, transient echinocytosis can occur in patients receiving parenteral feeding and is attributed to a fall in ATP concentration. PARTICIPANT STATISTICS ADVANCED HEMATOLOGY WITH MANUAL DIFF FIRST QUADRIMESTER 2016

WBC Morphology – Specimen 1 The cells to be identified are hypolobated PMNs with a Pelger-Huët nucleus. Typically, only two round nuclear lobes (bilobed) are present; the thin chromatin filament between the lobes may or may not be apparent. This gives the nucleus the appearance of spectacles (“pince-nez”) or a peanut lying within the cytoplasm of the neutrophil. The Pelger- Huët anomaly can be the result of either a congenital or acquired condition. Congenital Pelger-Huët anomaly has an autosomal dominant inheritance pattern. Heterozygous individuals are clinically normal without any functional defects of their neutrophils; approximately half of their neutrophils will exhibit the characteristic bilobed nucleus. Individuals who are homozygous for the anomaly likewise have a clinically benign course, with almost all neutrophils demonstrating the characteristic pince-nez nuclei. Acquired Pelger-Huët anomaly (also called pseudo-Pelger-Huët anomaly) can be seen in association with myelodysplastic syndrome (MDS) as well as leukemia, particularly AML and CML. Many physicians regard the Pelger-Huët anomaly as a marker for underlying myelodysplasia and associate this finding with a poor prognosis. WBC Morphology – Specimen 2 The cells to be identified are blasts. These are large cells with a high N:C ratio. The round or slightly indented nucleus is composed of fine nuclear chromatin and contains one or more prominent nucleoli. A thin rim of very basophilic cytoplasm surrounds the nucleus. These are most likely myeloblasts, however Auer rods are not apparent and a bone marrow biopsy and aspirate, combined with flow cytometry studies would be required for a definitive characterization. Normally confined to the bone marrow, the presence of myeloblasts in the peripheral blood is associated with AML and myelodysplastic syndromes, but may also be seen in individuals receiving G-CSF or GM-CSF. Blasts may be confused with reactive lymphocytes. Although both cells are large, the nuclear chromatin of the reactive lymphocyte is typically much more condensed and the cytoplasm is abundant.

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