Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia

Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase‐associated lipid abnormalities that are seen in children is 67–72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l ‐asparaginase‐associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER^® GEN·S? system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range ( Table 1 ). Thus, we thought it was a laboratory error, and the patient’s follow‐up especially for red cell parameters was made by red blood cell and hematocrit values.

Table 1. Patient’s complete blood count analysis according to the days of induction

Day of induction	Hb (g/dl)	Hct (%)	MCV (fl)	MCH (pg)	MCHC (g/dl)	RDW (%)	RBC (× 106/μl)	WBC (× 10³/μl)	Plt (× 10³/μl)
26	11.2	30.8	92	34	36.5	18	3.3	1.2	124
30	14.1	31	93	42	45	17.6	3.4	10.1	156
33	16.8	27	92	57	62	17	2.9	2.3	113
36	18.9	29	97	63	65	18.9	3.01	13.5	182
37	13.6	28.5	98	47	47	20	2.8	6.7	151
38	8.9	26.3	98	33	33	22	2.6	2.7	117

• Hb, hemoglobin; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin; Hct, hematocrit; RBC, red blood cell count; RDW, red cell distribution width; WBC, white blood cell count; Plt, platelet count.

Citing Literature

Number of times cited according to CrossRef: 2

• J. Yue, X. Lian, P. Yue, D. Xiang, C. Wang, Impact on major CBC parameters caused by different types of lipids in patient plasma, International Journal of Laboratory Hematology, 10.1111/ijlh.12706, 40 , 1, (e1-e3), (2017). Wiley Online Library
• Saeam Shin, Sung Ran Cho, Sinyoung Kim, Jong Rak Choi, Kyung-A Lee, Identification of cell morphology parameters from automatic hematology analyzers to predict the peripheral blood CD34-positive cell count after mobilization, PLOS ONE, 10.1371/journal.pone.0174286, 12 , 3, (e0174286), (2017). Crossref

Volume 33 , Issue 6 December 2011

Pages 651-655