27 January 2017 (Friday) - ACL TOP 500

This week I’ve been learning how to use the ACL TOP500 coagulometer; it is very different to what I’ve been used to over the last ten years. At first sight I found the device rather daunting but I was surprised how quickly I got to grips with it. Using optical clot detection (rather than magnetic ball-wobbling) I’ve been looking at clotting curves and derivative curves. And in a few short days I’ve gone from complete novice to being able to set the analyser up, run QC and samples and even perform (limited) troubleshooting.

I’ve had a tutorial on the device and even passed a little test featuring some case studies.

I like the machine; having given the matter some thought (in my opinion) the device is far superior to what I have been used to. The analyser is *fast*, the software is logical and easy to follow, and isn’t constantly losing communication with the laboratory’s host computer.

25 January 2017 (Wednesday) - MCV ?

Here’s an interesting case which came up on a Facebook group I follow. Given the above result:

1, How would you proceed?
2, What do you think is causing these abnormal results?
3, What could the diagnosis be?

The obvious first step is to get a repeat sample; it looks disastrous. But apparently these results were repeatable.
So… the massive white cell count is probably CLL. I’d check a blood film looking for appropriate morphology and also looking to check that massive MCV. It turned out that the red cells didn’t look macrocytic.

The chap posing the question said “With such a high lymphocyte count and low RBC count, the small lymphs are counted in the RBC graph, and you would see a dimorphic population, and hence an erroneously elevated MCV.
After consulting with our hematology supervisor, we subsequently reported MCV, RBC and RDW as unavailable until this patient's RBCs and WBCs went back to reasonable numbers.”

Personally I’m intrigued as to what analyser mixes up red cells and lymphocytes. I’ve never noticed this before and I’ve regularly dealt with white cell counts over 200.