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

Gokcebay D., Azik F., Isik P., Bozkaya I., Kara A., Tavil E., ...More

International Journal of Laboratory Hematology, vol.33, no.6, pp.651-655, 2011 (Journal Indexed in SCI Expanded) identifier identifier

  • Publication Type: Article / Article
  • Volume: 33 Issue: 6
  • Publication Date: 2011
  • Doi Number: 10.1111/j.1751-553x.2011.01333.x
  • Title of Journal : International Journal of Laboratory Hematology
  • Page Numbers: pp.651-655
  • Keywords: Complete blood count (volume, conductivity, light scatter technology), Hyperlipidemia, l-asparaginase


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 3450mg/dl, we observed that triglyceride level was 1466mg/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. 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 (×10 6/μl) WBC (×10 3/μl) Plt (×10 3/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. © 2011 Blackwell Publishing Ltd.