FBCs

Question 1

What is the in house criteria for a blood film?

Answer 1

Neuts <1.0 or >30.0 x10^9/L
Lymphs >6.0 x10^9/L
Eosinophils >2.0 x10^9/L
Basophils =/> 0.3 x10^9/L
Platelets <50 or >800 x10^9/L
If blood film has been requested either by GP or haem team
If patient is a known oncology patient with an unexpected result e.g. blasts increased in remission
If significantly abnormal results
Suspicion of spherocytosis or hemolytic conditions e.f. TTP
If RDW votes out -> suspects anisocytosis
If EPU flags the sample and requests a film

Question 2

What EPU flags require a blood film?

Answer 2

Blasts
Neo lymphs
Monocytosis and dysplasia
Doubtful monocytosis
Nrbcs
Rbc fragments

Question 3

What neutrophil count requires a blood film

Answer 3

Neuts <1.0 or >30.0 x10^9/L

Question 4

What lymph count requires a blood film

Answer 4

Lymphs >6.0 x10^9/L

Question 5

What eosinophil count requires a blood film

Answer 5

Eosinophils >2.0 x10^9/L

Question 6

What basophil count requires a blood film

Answer 6

Basophils =/> 0.3 x10^9/L

Question 7

What in house platelet count requires a blood film

Answer 7

Platelets <50 or >800 x10^9/L

Question 8

What GP platelet count requires a blood film?

Answer 8

Platelets <80 or >800

Question 9

What is the general phoning criteria for all patients

Answer 9

Neutrophils <1.0 x10^9/L (if not expected)
Plasma haemoglobin >0.40 g/dl

Question 10

What is the phoning criteria for inpatients?

Answer 10

Haemoglobin <7.0 g/dL or unexpected drop >2.0 g/dL
Platelets <20 or >1000 x10^9/L (or change >50%)
WBC <1.0 or >30.0 x10^9/L
WBC

Question 11

What in house Hb level should you phone

Answer 11

Haemoglobin <7.0 g/dL or unexpected change >2.0 g/dL

Question 12

What in house platelet count would you ring

Answer 12

Platelets <20 or >1000 x10^9/L (or a change >50%)

Question 13

What in house WBC count would you ring?

Answer 13

WBC <1.0 or >30.0 x10^9/L

Question 14

What is the phoning criteria for GPs

Answer 14

Haemoglobin <8.0 or >20.0 g/dL
Platelets <80 or >800 x10^9/L
Total wbcs <2.0 or >20.0 x10^9/L
Neutrophils <1.0 x10^9/L
Lymphocytes >10.0 x10^9/L
D dimers > 0.50 mg/L

Question 15

What GP haemoglobin level would you phone?

Answer 15

Haemoglobin <8.0 or >20.0 g/dL

Question 16

What GP platelet level would you phone?

Answer 16

Platelets <80 or >800 x10^9/L

Question 17

What GP total wbc level would you phone?

Answer 17

Total wbcs <2.0 or >20.0 x10^9/L

Question 18

What GP neutrophil level would you phone?

Answer 18

Neutrophils <1.0 x10^9/L

Question 19

What GP lymphocyte level would you phone?

Answer 19

Lymphocytes >10.0 x10^9/L

Question 20

What GP D-dimer level would you phone?

Answer 20

D dimers > 0.50 mg/L

Question 21

When would a GP blood film require urgent referral to the haematology team?

Answer 21

Blast cells present
Schistocytes present
Platelet count <10 x 10^9/L

Question 22

What would you do with a Hb<7g

Answer 22

Check for clot
Rerun sample
If still low phone result

Question 23

What should you do with a platelet aggregate flag

Answer 23

Check sample for clot
Check smear for platelet clumps
Check smear for fibrin strands

Question 24

What is platelet F

Answer 24

A reflex test for all Vincent’s patients
This assays optically analysis the platelets to avoid picking up any fragments

Question 25

What does the WNR shatterplot show

Answer 25

WNR -> WBCC and NBCs

Separates into wbcs, nrbcs, basophils and debris

The debris is found in the bottom left corner
The nrbcs are middle left
The wbcs are middle right
The basophils are upper right

Question 26

What does the WPC scatterplot show?

Answer 26

White precursor cells
It’s a form of reflex testing used when abnormal cells are detected using the WNR and DIFF channels

Normal wbcs sit in the upper middle section in a line
Abnormal lymphocytes are found above this line
Blasts are found below this line