Automated Digital Cell Imaging Brochure by CellaVision - Flipbook - Page 1
NEWS
SPRING
2022
Case Study: Rouleaux
This adult patient’s initial CBC results suggests severe anemia
with macrocytosis and hyperchromia. Based on these results and
analyzer flags, the technologist should question the accuracy of
the values and perform further workup to evaluate for potential
interferences. Evaluating the MCHC together with the MCV result
can help to identify potential sources of interference and guide
troubleshooting.
Discrepant results such as these could be due to the presence of
rouleaux formation, RBC agglutination or spurious hemoglobin
and/or hematocrit results. This sample was drawn in a micro
collection tube from an adult identifying as Jehovah’s Witness
and there was no evidence of lipemia, hemolysis or icterus. In
the absence of these interfering substances and history of blood
transfusion, the high MCHC (above 37.5 g/dL) in conjunction with
the elevated MCV, could indicate the presence of an elevated or
abnormal protein. The presence of rouleaux was confirmed during
smear review.
Image courtesy of CellaVision®.
Red cell rouleaux is defined as a stacking of the RBCs as
demonstrated in the thin readable area of a smear or as visible
stacking of cells in a wet preparation (observed in blood
banking procedures). True rouleaux is primarily associated
with hyperglobulinemia and hyperfibrinogenemia and may be
present in conditions such as multiple myeloma, Waldenström
macroglobulinemia and inflammatory conditions.
When handling specimens that require complex troubleshooting,
it is important to follow local laboratory procedure to determine
the next steps. In this case, the sample may be diluted with
CELLPACKTM DCL to obtain more accurate RBC results; in severe
cases, it may be necessary to perform a plasma replacement. For
more information on how to process a specimen like this please
refer to the Sysmex XN-Series Flagging Interpretation Guide
located on the Customer Resource Center.n
www.sysmex.com/us
RESOURCE: Gulati G and Caro J. (2019). Blood Cells, Morphology and Clinical
Relevance (2nd ed.). ASCP Press.
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.
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