Global test 2023:3 - Agglutination

Case description

A 66-year-old female with a presumed inflammatory/musculoskeletal/autoimmune condition and an abnormal ESR.

Laboratory findings

Test Result Reference Interval Units
WBC 3.41 4.5-11.5 x 109/L
RBC 1.08 3.5-5.5 x 1012/L
HGB 10.9 14-17.5 mg/dL
HCT 10.9 40-54 %
MCV 100.9 80-100 fL
MCH 100.9 27-31 pg
MCHC 100.0 32-36 g/dL
PLT 162 150-450 x 109/L
RDW 12.9 11.5-15 %
Retic 1.70 0.5-2.5 %
18.4 20-80 x 109/L
ESR 92 0-20 mm/hr

Sample of cells classified in the Global Test 2023:3

Global test cells 2023 #3

RBC Overview

RBC results Global test 2023:3

Case Conclusion

The patient is slightly leukopenic with absolute lymphopenia. The absolute basophil and monocyte counts are normal. WBC counts and morphology are otherwise unremarkable.

Note. Calculations based on WBC = 3.41 x 109/L
  % x109/L
Neutrophils 60 2.05 (2 - 7)
Lymphocytes 23 0.78 (1 - 3)
Monocytes 12 0.41 (0.2 - 1)
Eosinophils 2 0.07 (0.02 - 0.5)
Basophils 3 0.1 (0.02 - 0.1)

Most RBC-related CBC abnormalities correlate with RBC agglutination seen on the blood film. There is a gross mismatch between HGB & HCT; and HGB & RBC. Also, the MCH and MCHC are markedly increased. As is, the RBC parameters would not be reportable in most labs. 

Rouleaux is also present. It is unusual to find rouleaux and agglutination in the same blood film.

The platelet count is near the low end of the reference interval, and a rare platelet clump was classified.

Global Test 2023:3 Results Webinar

Questions discussed during the webinar include:

  • Discuss causes of RBC agglutination and rouleaux and define conditions in which they can both be present at the same time.
  • Differentiate between true and pseudo agglutination.
  • Evaluate the effect of RBC agglutination and rouleaux on each CBC and reticulocyte parameter and discuss when and how to remediate.
  • Explain how to proceed when prewarming does not correct RBC agglutination.
  • Assess the relationship between ESR and rouleaux.
  • Assess Cellavision’s new feather edge scan capability.
  • Discuss differences in lab policies regarding feather edge review