Use of the XE-2100 in a Patient with Cold Auto-immune Hemolytic Anemia

• Use of the XE-2100 in a Patient with Cold Auto-immune Hemolytic Anemia

AUTHOR(S)

Gudrun STAMMINGER and Lothar BEIER

Klinikum Chemnitz gGmbH, Institut für Laboratoriumsmedizin

SUMMARY

The analysis of specimens, drawn from patients with cold auto-immune hemolytic anemia
( caused by elevated levels of anti-I on the red blood cell ( RBC ) membrane ) is, in general, a difficult problem for automated hematology analyzers. In such patients, because of aggregation of the RBCs, which occurs mainly at temperatures lower than 30°C, it is not possible to measure the RBC count and hematocrit accurately. During an evaluation of the XE-2100 in our laboratory we studied a patient with this disorder. During the first weeks after admission to the Haematology Clinic very marked aggregation was observed in all specimens from the patient despite pre-warming of the EDTA blood to 37°C. The patient received 13 transfusions of pre-warmed, leukocyte-poor red cells and cyclosporine A. Two weeks later the activity of anti-I decreased. The result was recovery from the hemolytic disease, detected very early by the system and accompanied by an improvement of the cell counts.

Erythropoietic activity was easily followed by the nucleated red blood cell ( NRBC ) counts and reticulocyte ( RET ) parameters generated by the XE-2100. During the first two weeks the NRBC counts were increased but the RETs remained low. During recovery the picture was completely reversed. RETs and especially their immature fractions increased very markedly and NRBCs disappeared.

EDTA associated platelet ( PLT ) clumping was detected by use of the IMI Channel. On using lithium heparin as anticoagulant the PLT count became normal.

In the XE-2100 newly developed principles for counting and characterization of blood cells are introduced as well as already well established methods. From our point of view, at this time, the XE-2100 is the most appropriate system for diagnosis of diseases associated with an elevated number of NRBC in the peripheral blood, e.g. the immune hemolytic anemias.

KEY WORDS

Automated Hematology Analyzer, XE-2100, Nucleated Red Blood Cell ( NRBC ),
Reticulocyte Count, Auto-Immune Hemolytic Anemia