Required section · Section 4 of 6
Guided Case: Resolve the Interference
Initial CBC and smear show the instrument flag “abnormal RBC distribution,” a fragmented/abnormal RBC histogram, an RBC delta-check failure, EDTA at room temperature for 55 minutes, and irregular monolayer clumps with surrounding single RBCs. Hemoglobin is plausible while RBC, hematocrit, MCH, and MCHC are not numerically coherent, so do not release the initial RBC-associated indices.
Under the validated local warming procedure, the specimen is warmed, mixed, and rerun promptly. The repeat has RBC 4.56 × 10^6/µL, hemoglobin 13.7 g/dL, hematocrit 41.3%, MCH 30.0 pg, and MCHC 33.2 g/dL. A newly prepared monolayer smear shows absent clumps; the repeat histogram and delta check are acceptable and specimen stability meets local criteria.
Release the repeat only because the demonstrated acceptance conditions are all met: absent clumps, acceptable flags, numerical consistency, specimen stability, and local criteria. If clumps persist or any correction/acceptance condition fails, hold the result; recollect if stability or integrity failed, otherwise obtain qualified review and escalate.
Illustrative drawing — this picture was drawn rather than captured.
| Analyte | Initial | Warm rerun | Teaching interval | Unit |
|---|---|---|---|---|
| RBC | 2.41 | 4.56 | 4.20-5.80 | × 10^6/µL |
| Hemoglobin | 13.8 | 13.7 | 13.5-17.5 | g/dL |
| Hematocrit | 24.8 | 41.3 | 41.0-53.0 | % |
| MCV | 103 | 90.6 | 80-100 | fL |
| MCH | 57.3 | 30.0 | 27-33 | pg |
| MCHC | 55.6 | 33.2 | 32-36 | g/dL |
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