Flags

Question 1

critical values

Answer 1

WBC <2000/cumm or >50,000/cumm
Hgb <7 g/dl
Hct <21 %
Plt <20,000/cumm or >1 million/cumm

Question 2

Pathology review numbers

Answer 2

blasts/lymphoma cells
absolute decrease in neut. (seg+bands): less than 1.5x 10*9/L
plt <50,000/cumm or >1 million/cumm
questionable cells/morphology- description included in report

Question 3

H or L flags on WBC and/or diff parameters count action

Answer 3

perform manual diff

Question 4

H or L on MCV/ RDW (or out of normal range) action

Answer 4

manual diff (or RBC morphology)

Question 5

H or L on MCHC (or outside normal range)

Answer 5

1. check for lipemia/icterus (if Hbg too high for Hct)- correct Hgb (plasma blank, saline replacement) recalculate MCH & MCHC
2. check for cold agglutins (low RBC, high MCV, high MCHC)- warm and re-run
3. spherocytosis (high MCHC, high Hgb)- manual smear for RBC shape
4. instrument malfunction- verify operation and QC data

Question 6

R or * on WBC

Answer 6

1. NRBCs- manual smear diff. IF >5 correct WBC count and differential values
2. large plt present- manual smear and NOTE presence
3. clumped plt- mamual smear and NOTE presence
4. clots- redraw sample

Question 7

R or * on WBC differential action

Answer 7

manual WBC differential and report

Question 8

R or * on Platelet count and/or MPV action

Answer 8

(if just next to MPV do nothing)

examine plt histogram and verify count (do slide estimate of plt count if matches report if not do manual plt count)

Question 9

Delta flag on Hgb or Hct action

Answer 9

check patient records for surgery (decrease)/transfusion (increase)
if no record call floor

Question 10

Delta flag on MCV action

Answer 10

redraw sample and re-run

Question 11

Other flags (lab specific flags, blasts, ab. lymph., scattergrams, distribution, etc) action

Answer 11

perform diff., review slide, as in SOP