Required section · Section 1 of 6
A flagged film at the bench
A fresh EDTA specimen was collected at 09:12 and analyzed at 09:48. The analyzer reports WBC 18.6 × 10^9/L, hemoglobin 9.8 g/dL, and platelets 42 × 10^9/L against adult training intervals of 4.0-11.0, 12.0-16.0, and 150-400. An immature-granulocyte/blast review flag accompanies an abnormal WBC scattergram. No numeric result is called a critical value here.
At 10:05, a Wright-Giemsa peripheral-blood film is acceptable for review at 1000x oil immersion. The routine 100-cell manual differential contains 12% large immature cells, and two cells contain sharply defined reddish-purple needle-like cytoplasmic inclusions. Several neutrophils are hypogranular with hyposegmented nuclei. The question is what can be released now and what requires immediate local escalation.
A routine manual smear differential is a local patient-result method; it is not automatically the standardized reference leukocyte differential described in CLSI H20. A standardized reference differential is a separately controlled method used to evaluate instrumental differential methods. An analyzer flag identifies a specimen needing review, not a morphology diagnosis. Start with visible evidence, then correlate the CBC and the review pathway. A flag starts a disciplined review; it does not finish the interpretation.
| Measurement | Result | Training interval or status |
|---|---|---|
| WBC | 18.6 × 10^9/L | 4.0-11.0 × 10^9/L |
| Hemoglobin | 9.8 g/dL | 12.0-16.0 g/dL |
| Platelets | 42 × 10^9/L | 150-400 × 10^9/L |
| Analyzer | Immature-granulocyte/blast flag | Abnormal WBC scattergram |
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