Choose the next laboratory action

You have the analyzer result, the first-time atypical lymphocyte flag, and the manual 200-cell result. The manual lymphocyte total agrees with the analyzer at 24%; 10 cells are reactive-appearing and remain included in that total lymphocyte percentage. Document the morphology observation and follow the locally validated review and reporting procedure.

The manual differential provides both relative proportions and visible morphology. Its relative count is calculated as category count divided by total cells counted times 100. An absolute count is total WBC multiplied by the decimal differential fraction. In this case, 5% reactive-appearing lymphocytes produces the calculated estimate 0.49 × 10^9/L, but the report's own reference interval and local escalation rules govern interpretation.

A mismatch does not automatically mean an analyzer failure or a manual-count error. Review specimen quality, smear distribution, counting path, cell classification, analyzer flags, controls, calibrator status, reagent lot records, and local delta check criteria before release when results conflict. The first response should be evidence-based, then retries can correct the reasoning without changing the specimen facts. Release a morphology finding as an observation and route any unresolved discrepancy through the local review process.