2021-Fall-Newsletter-FINAL - Flipbook - Page 1
Case Study: A Rare Case of Pyruvate
This case is from a patient that is known to have pyruvate
kinase deficiency (PKD). Pyruvate kinase is an enzyme present
in RBCs that is required for ATP generation within the cells. The
ATP produced serves as the energy source for the mature,
non-nucleated red cells.
Deficiency of pyruvate kinase produces compromised RBC
membranes that cannot effectively regulate intracellular
potassium and sodium concentrations. As a consequence,
the patient’s red cells dehydrate and are destroyed in vivo,
causing a hemolytic anemia. This patient's CBC shows the
typical hemolytic picture: red blood cell fragments,
dramatically increased reticulocyte count, nucleated RBCs
and severe anemia.
Figure 1 on the second page shows the initial sample results
for this patient when seen in the Hematology/Oncology clinic.
These results are from an XN-Series™ analyzer.
The fluorescent platelet (PLT-F) channel on the XN-Series
analyzers is useful in obtaining an accurate platelet count in the
presence of the fragmented red cells. The PLT-F channel uses
fluorescent stains that attach to platelet substructures; this
minimizes interference from RBC and WBC fragments, resulting
in a more accurate platelet count in samples with schistocytes
such as this one.*
Furthermore, the RET(EXT) scattergram (Figure 3 on second
page) available on XN-Series and XN-L Series™ analyzers shows
the Upper Particle Plateau (UPP) region, which contains cells
with slightly more nucleic acids than typical reticulocytes—this
may include NRBCs or RBCs containing Howell-Jolly bodies
or parasites. These cells are not included in the automated
reticulocyte count, but increased activity in the UPP region
will generate the ‘RET Abnormal Scattergram’ message due
to questionable discrimination of these cells by the analyzer.
Dilution of the sample
with CELLPACK DCLTM may
reduce the activity in the
UPP region, allowing the
analyzer to more easily
differentiate these particles
and obtain a more accurate
retic count. The RET(EXT) is
for research use only.
Refer to the XN-Series Automated Hematology Systems
Flagging Interpretation Guide or Sysmex XN-L Series
Flagging Interpretation Guide for more information on
sample handling in the presence of the ‘RET Abnormal
Scattergram’ flag. To access more Sysmex case studies, go to
crc.sysmex.com, click ‘Scientific Resources,’ then select
‘Case Studies.’ (Continued on page 2)n
*Availability of PLT-F and RET analysis depends on system configuration.
Disclaimer: The clinical applications or uses presented in these
materials, including case studies, are provided for illustration purposes
only. Prior to using any Sysmex device, please review the manufacturer’s
instructions for use. It is the healthcare provider’s responsibility to
determine applicability in routine clinical practice.