Required section · Section 5 of 6
Choose the next review step
A second case: EDTA venous blood collected 45 minutes ago is run on a Sysmex XN configuration. QC and calibration records are acceptable for the run, but that status does not resolve an individual result. The specimen is not visibly clotted, lipemic, or hemolyzed; that appearance does not exclude an analytic or morphology concern. The result table supplies every CBC component, the flag, and the RBC-histogram observation for this discrepant case. A prior result from 2 days ago was RBC 4.55 × 10^12/L, hemoglobin 11.7 g/dL, hematocrit 35.0%, MCV 77 fL, and MCHC 33.4 g/dL.
A delta check is a locally defined comparison of a current result with a prior comparable patient result using an allowed interval and time window. Here the discordant RBC/hematocrit and extreme MCHC make a delta review appropriate, not an automatic rejection. First verify identity and specimen integrity, then review flags/histograms and the smear. RBC clumps support the agglutination branch and a validated warming/repeat procedure; turbid plasma with disproportionate photometric hemoglobin supports the lipemia branch; visibly hemolyzed plasma supports the hemolysis/specimen-acceptability branch and recollection when required; spherocytes on smear support morphology documentation and the local morphology-review path. If none is supported, repeat or recollect only as local policy directs.
| Parameter or evidence | Current result | Illustrative interval, calculation, or review meaning |
|---|---|---|
| RBC | 2.60 × 10^12/L | 4.2–5.7 × 10^12/L; low |
| Hemoglobin | 11.8 g/dL | 13.0–17.0 g/dL; low |
| Hematocrit | 24.5% | 39–50%; low |
| MCV | 94.2 fL | 80–100 fL; calculated from hematocrit and RBC |
| MCH | 45.4 pg | 27–33 pg; calculated from hemoglobin and RBC |
| MCHC | 48.2 g/dL | 32–36 g/dL; calculated from hemoglobin and hematocrit |
| RDW-CV | 18.9% | 11.5–14.5%; distribution width relative to MCV |
| RDW-SD | 54 fL | 37–54 fL; histogram width at analyzer-defined height |
| WBC | 6.8 × 10^9/L | 4.0–11.0 × 10^9/L |
| Neutrophils | 60% (4.1 × 10^9/L) | 40–70% (1.5–7.5 × 10^9/L); absolute = 6.8 × 0.60 |
| Lymphocytes | 30% (2.0 × 10^9/L) | 20–45% (1.0–4.0 × 10^9/L); absolute = 6.8 × 0.30 |
| Monocytes | 7% (0.5 × 10^9/L) | 2–10% (0.2–0.8 × 10^9/L); absolute = 6.8 × 0.07 |
| Eosinophils | 2% (0.1 × 10^9/L) | 0–6% (0.0–0.5 × 10^9/L); absolute = 6.8 × 0.02 |
| Basophils | 1% (0.1 × 10^9/L) | 0–2% (0.0–0.2 × 10^9/L); absolute = 6.8 × 0.01 |
| Platelets | 230 × 10^9/L | 150–400 × 10^9/L |
| MPV | 9.6 fL | 7.5–11.5 fL |
| Plateletcrit | 0.22% | 0.15–0.40%; 230 × 9.6 ÷ 10,000 = 0.2208% |
| Analyzer flag and histogram | RBC distribution abnormality; irregular, broadened RBC histogram | Review evidence, not a diagnosis |
| Specimen appearance | No visible clot, lipemia, or hemolysis | Inspect again with identity and smear evidence; a visually clear specimen does not exclude all interference |
Ordering exercise
Place the review actions in a defensible sequence for the discrepant second CBC.
1. Perform smear review
Assess clumps, spherocytes, and other morphology only when local criteria or evidence support it.
2. Repeat, warm, or recollect by branch
Use the locally validated agglutination, interference, or specimen-acceptability procedure.
3. Verify identity and inspect specimen
Check identifiers and visible clot, agglutination, lipemia, hemolysis, or dilution concerns.
4. Review analyzer evidence
Review flags, histograms, method card, QC/calibration status, and prior comparable result.
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The module finishes after every required section is marked done and every check in those sections is correct.