Required section · Section 4 of 6

Work the result set

The case has WBC 17.8 × 10^9/L with the displayed adult interval of 3.4–9.6 × 10^9/L and absolute neutrophil count of 14.1 × 10^9/L with interval 1.56–6.45 × 10^9/L. A 100-cell proportional differential is segmented neutrophils 68%, bands 12%, metamyelocytes 4%, lymphocytes 10%, monocytes 5%, and eosinophils 1%. Hemoglobin is 133 g/L, hematocrit 41%, and platelets 287 × 10^9/L.

The fresh Wright-Giemsa film has coarse dark granules in many neutrophils, occasional pale peripheral Döhle bodies, and small-to-moderate vacuoles. There are no blasts, abnormal promyelocytes, or uniform hypogranular population. The count and manual differential support neutrophilia with a left shift, while the morphology supports a reactive correlation rather than a diagnosis.

The analyzer’s automated differential and flag rules are method-specific, and the manual differential is a 100-cell visual classification with observer and sampling limits. Apply the laboratory’s validated grading, review, and comment policy rather than inventing a severity cutoff. Release the approved morphology comment only after the fresh film, distribution, CBC correlation, and local criteria agree.

Chart shows WBC 17.8, absolute neutrophil count 14.1, bands 2.1, and metamyelocytes 0.7 × 10^9/L. The WBC reference range is 3.4 to 9.6 and WBC is highlighted. — Figure 1WBC and selected absolute differential values.

Absolute values underlying the guided-case chart.
Measure	Result	Unit	Reference interval or calculation context
WBC	17.8	× 10^9/L	3.4–9.6
Absolute neutrophil count	14.1	× 10^9/L	1.56–6.45
Bands	2.1	× 10^9/L	12% of WBC
Metamyelocytes	0.7	× 10^9/L	4% of WBC

Ordering exercise

Put the actions in the order that protects the morphology interpretation.

1. Apply local review and comment policy

Release the approved comment, obtain a fresh smear, or escalate.
2. Correlate with CBC and flags

Compare morphology with differential, immature-granulocyte flag, and other lineages.
3. Describe and distribute findings

Record granules, Döhle bodies, vacuoles, maturation, and concerning cells.
4. Check specimen timing and film quality

Confirm collection-to-smear interval and whether the film is interpretable.

Knowledge checks

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Knowledge check 1

Which observations support neutrophilia with a reactive left shift in the guided case? Select all that apply.

Choose at least 3 options.

Absolute neutrophil count 14.1 × 10^9/L above the displayed interval

Bands 12% and metamyelocytes 4% on the manual differential

No blasts or abnormal promyelocytes on the film

Hemoglobin 133 g/L alone

Knowledge check 2

After the guided case review, what action is supported?

Choose one option.

Apply local grading and release the approved morphology comment.

Release a result diagnosing sepsis.

Assign a universal severe toxic-change grade.

Section status

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The module finishes after every required section is marked done and every check in those sections is correct.