INSTRUCTOR: BETH RAWSON
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
RESULTS INTERPRETATION Worksheet STUDENT NAME: __________________
SECTIONS 1 AND 2: Given the following results, identify the abnormal or questionable results, and provide at least one explanation for them (there may be multiple explanations possible). The first thing you have to decide is whether the values presented are valid or spurious (i.e. inaccurate due to either specimen quality or handling). The second consideration is what could explain the abnormalities you are seeing (what kind of clinical situation OR specimen problem is suspected).
The time listed in the “Previous” column refers to the interval between the current results and the most recent previous values. If no values are listed in the “Previous” column, assume there is no known history. Generic reference ranges are provided.
NOTE: A key ability for any laboratory professional is to be able to distinguish spurious results (those due to improper specimen collection methods) from true clinical variation due to a pathological condition. SECTION 1: CBC Testing
For each example, note which parameter(s) are pertinent to your explanation. An asterisk next to a value indicates that it has been flagged by the instrument. Delta flags are indicated by [%D] next to the value.
CBC #1: 57-year old Caucasian male, presented to the ED with chest pain, diagnosed with myocardial infarction and admitted to the ICU 2 days earlier.
CURRENT PREVIOUS (8 hours)
REFERENCE RANGE
UNIT
WBC 4.8 5.4 4.5 – 11.5 103/uL RBC 2.87 4.65 4.60 – 6.00 (m) 106/uL HGB 10.1 [%D] 14.2 14.0 – 18.0 (m) g/dL HCT 29.1 [%D] 42.4 40.0 – 54.0 (m) % MCV 101 [%D] 91 80 – 98 fL MCH 35.1 30.5 26 – 32 pg MCHC 34.7 33.4 32 – 36 g/dL RDW 12.5 13.3 11.5 – 14.5 % PLT 224 292 150 – 450 103/uL MPV 7.9 8.1 6.8 – 10.2 fL
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
CBC #2: 27-year old Greek female, presented for prenatal evaluation (20 weeks pregnant).
CURRENT PREVIOUS REFERENCE RANGE
UNIT
WBC 6.6 4.5 – 11.5 103/uL RBC 5.13 4.00 – 5.40 (f) 106/uL HGB 10.7 12.0 – 15.0 (f) g/dL HCT 34.9 35.0 – 49.0 (f) % MCV 68 80 – 98 fL MCH 20.9 26 – 32 pg MCHC 30.7 32 – 36 g/dL RDW 27.3 11.5 – 14.5 % PLT 309 150 – 450 103/uL MPV 7.4 6.8 – 10.2 fL
CBC #3: 19-year old African American male, presented to the outpatient draw station subsequent to his yearly physical examination; he did not have any complaints.
CURRENT PREVIOUS REFERENCE RANGE
UNIT
WBC 5.6 4.5 – 11.5 103/uL RBC 3.58 4.60 – 6.00 (m) 106/uL HGB 11.0 14.0 – 18.0 (m) g/dL HCT 46.4* 40.0 – 54.0 (m) % MCV 130 80 – 98 fL MCH 30.7 26 – 32 pg MCHC 23.7* 32 – 36 g/dL RDW 22.4 11.5 – 14.5 % PLT 8* 150 – 450 103/uL MPV 9.7 6.8 – 10.2 fL
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
CBC #4: 21-year old Filipino female, diagnosed 10 days earlier with walking pneumonia due to Mycoplasma pneumoniae.
CURRENT PREVIOUS (10 days)
REFERENCE RANGE
UNIT
WBC 3.8 5.6 4.5 – 11.5 103/uL RBC 2.37 3.91 4.00 – 5.40 (f) 106/uL HGB 12.0 11.0 12.0 – 15.0 (f) g/dL HCT 22.3 [%D] 32.5 35.0 – 49.0 (f) % MCV 94.1 [%D] 83.1 80 – 98 fL MCH 50.5* 28.0 26 – 32 pg MCHC 53.6* 33.7 32 – 36 g/dL RDW 15.3 12.2 11.5 – 14.5 % PLT 306 284 150 – 450 103/uL MPV 9.9 9.6 6.8 – 10.2 fL
CBC #5: 41-year old Caucasian female, presented to the ED 12 hours earlier with multiple compound fractures and major blood loss subsequent to a car accident, and was admitted to the SICU following surgery.
CURRENT PREVIOUS (8 hours)
REFERENCE RANGE
UNIT
WBC 18.4 [%D] 10.6 4.5 – 11.5 103/uL RBC 2.85 2.00 4.00 – 5.40 (f) 106/uL HGB 8.62 [%D] 6.58 12.0 – 15.0 (f) g/dL HCT 26.1 [%D] 19.2 35.0 – 49.0 (f) % MCV 91.4 [%D] 96.3 80 – 98 fL MCH 30.2 32.9 26 – 32 pg MCHC 33.1 34.2 32 – 36 g/dL RDW 17.6 13.1 11.5 – 14.5 % PLT 124 [%D] 245 150 – 450 103/uL MPV 8.4 8.5 6.8 – 10.2 fL
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
SECTION 2: Coagulation Testing For each scenario the relevant screening test results are given (PT/INR, PTT, Fibrinogen, D-Dimer values), and any anticoagulant therapy is noted. Mixing studies or additional coagulation studies are noted as appropriate.
Coagulation #1: 22-month old male presented to the pediatrician for evaluation of history of easy bruising and right knee swelling after the child ran into an end table during play.
CURRENT PREVIOUS (2 hours)
REFERENCE RANGE UNIT
PT 10.6 10.2 12.6 – 14.6 seconds INR 1.0 0.9 0.9 – 1.2 PTT 48.5 52.1 23.8 – 34.2 seconds
Fibrinogen 422 160 – 455 mg/dL D-Dimer 0.21 <0.50 mg/L
Anticoagulant None None None None A mixing study was performed; results are as follows: Coagulation #2: 42-year old Hispanic male presented to the ED with lower left leg pain. Patient has a history of DVT (3 years prior).
CURRENT PREVIOUS REFERENCE RANGE UNIT PT 15.8 12.6 – 14.6 seconds
INR 1.5 0.9 – 1.2 PTT 23.8 23.8 – 34.2 seconds
Fibrinogen 115 160 – 455 mg/dL D-Dimer 32.7 <0.50 mg/L
Anticoagulant None None None
PTT MIX Initial, 1:1 mix with PNP
60 minutes, 37º, 1:1 mix with PNP
UNIT
PATIENT 27.6 26.9 seconds CONTROL 28.5 29.1 seconds
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
Coagulation #3: 73-year old Asian-American female, presented to primary care physician for routine examination and anticoagulant medication management.
CURRENT PREVIOUS (14 days)
REFERENCE RANGE UNIT
PT 72.2 20.7 12.6 – 14.6 seconds INR 6.4 2.0 0.9 – 1.2 PTT 35.4 23.8 – 34.2 seconds
Fibrinogen 160 – 455 mg/dL D-Dimer <0.50 mg/L
Anticoagulant Coumadin Coumadin None None Coagulation #4: 67-year old Indian male, admitted for removal of right foot abscess.
CURRENT PREVIOUS (24 hours)
REFERENCE RANGE UNIT
PT 9.4 13.1 12.6 – 14.6 seconds INR 0.8 1.0 0.9 – 1.2 PTT 16.4 28.7 23.8 – 34.2 seconds
Fibrinogen 160 – 455 mg/dL D-Dimer <0.50 <0.50 mg/L
Anticoagulant None None None None
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
SECTION 3: Hemoglobinopathy Testing For each of 8 patient examples you are given the citrate agar (acid pH); the cellulose acetate (alkaline pH); the hemoglobin, hematocrit, and MCV; and patient demographics.
For each patient example, given the agar/acetate and CBC results, determine ALL possible hemoglobin phenotypes. If there are multiple options, which one is most likely? (HINT: look at ethnicity) Refer to the “Hgb Electrophoresis Interpretation” lecture on Canvas for more guidelines and examples.
List the hemoglobin fractions that travel with each of the 4 control fractions. Only consider A, A2, F, S, C, D, G, E, and O for this exercise. Acid agar: Alkaline acetate: F: ________________ A: _______________
A: ________________ F: _______________
S: ________________ S: _______________
C: ________________ C: _______________
Patient #1: 4-month old Caucasian male Hgb 14.2 g/dL Hct 45.1 % MCV 100 fL
Final phenotype: ______________________________ (HINT: Is this normal for age?)
Patient #2: 24-year old Asian-American female
Hgb 12.5 g/dL Hct 38.7 % MCV 89 fL
Final phenotype: ______________________________
Patient #3: 45-year old Egyptian male Hgb 13.3 g/dL Hct 39.3 % MCV 87 fL
Final phenotype: ______________________________
MLSC-382A INSTRUCTOR: BETH RAWSON
7
Results Interp Wksht Updated: 8/20/2020
Patient #4: 7-year old African-American male Hgb 12.0 g/dL Hct 34.5 % MCV 68 fL
Final phenotype: ______________________________
Patient #5: 29-year old African-American male Hgb 11.9 g/dL Hct 36.5 % MCV 82 fL
Final phenotype: ______________________________
Patient #6: 36-year old Thai male
Hgb 12.4 g/dL Hct 37.0 % MCV 74 fL
Final phenotype: ______________________________
Patient #7: 41-year old Indian female
Hgb 13.1 g/dL Hct 38.6 % MCV 84 fL
Final phenotype: ______________________________
Patient #8: 18-year old Israeli female
Hgb 11.3 g/dL Hct 32.6 % MCV 82 fL
Final phenotype: ______________________________
MLSC-382A INSTRUCTOR: BETH RAWSON
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Results Interp Wksht Updated: 8/20/2020
Citrate Agar – Acid pH Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6
Patient 7
Patient 8
CONTROL
C S A F
Cellulose Acetate – Alkaline pH
Patient 1
Patient 2
Patient 3
Patient 4
Patient 5
Patient 6
Patient 7
Patient 8
CONTROL
C S F A
