Required section · Section 4 of 6

Guided example

This specimen was analyzed on the primary hematology analyzer within the laboratory stability window. A Romanowsky-type stained film was prepared per local procedure after the immature-granulocyte flag met laboratory review criteria. The analyzer platform, software, stain protocol, and exact trigger are local variables.

The absolute neutrophil count (ANC), a calculated count of circulating neutrophils per liter, is WBC multiplied by neutrophil fraction: 14.2 × 0.78 = 11.1 × 10^9/L. The film finding of bands and rare metamyelocytes is a left shift, an increased proportion of less mature granulocytic forms in peripheral blood.

Postmitotic neutrophils may mature in marrow reserve before release, and reserve release can accelerate during demand. This supports increased output and earlier release, not a new cell type or a diagnosis. Report the observed left shift using local nomenclature and keep the clinical interpretation outside the morphology report.

Chart of absolute neutrophil count with a light-blue teaching range from 1.5 to 8.0 times ten to the ninth per liter and a coral case point at 11.1. — Figure 1The case ANC is above the teaching interval.

CBC and differential used for the guided calculation.
Analyte	Result	Teaching interval or note
WBC	14.2 × 10^9/L	4.0-11.0 × 10^9/L
Neutrophils	78%	ANC calculated
ANC	11.1 × 10^9/L	1.5-8.0 × 10^9/L
Hemoglobin	13.9 g/dL	generic adult teaching interval
Platelets	410 × 10^9/L	reported result

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Knowledge check 1

What ANC is calculated from WBC 14.2 × 10^9/L and neutrophils 78%?

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11.1 × 10^9/L

78 × 10^9/L

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