A parenthetical or footnoted statement with this additional information could also be included.Ī related strategy is to avoid manual review for low IG fractions alone when using analyzers that produce an IG count. One strategy used by our hospital-based laboratory to address rare IGs is to add a white blood cell morphology comment to the manual differential of “slight left shift.” This signals that immature granulocytes are present but that they represent less than one percent of WBCs-that is, less than one cell per 100 on a standard manual differential. For example, immature cells, because of their relatively large size, tend to concentrate at the feathered edge, so their distribution may be less random across a slide than in a fluid state. This discrepancy may occur not only because of significant differences in the total cell count but also because of other factors affecting the peripheral blood smear. Therefore, as noted in the question, a low proportion of IGs detected by automated differential may not be reflected in a random 100-cell manual differential. The total number of cells counted for differentials is, of course, much higher by automated methods (30,000 cells on Sysmex platforms, for example) compared with a manual method (standardly 100 cells). December 2019-The immature granulocyte (IG) fraction-metamyelocytes, myelocytes, and promyelocytes-can be quantified on modern peripheral blood analyzers as part of the six-part automated differential of the white blood cell count. How do you report the presence of the immature granulocytes? A. But when the 100-cell differential was performed, the immature granulocytes were not reflected. When reviewing a smear, we observed scattered (rare) immature granulocytes during a scan.
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