Reflex Testing

• Manual Differential if flagged by analyzer
• Peripheral Smear will be sent to Pathologist for review if one or more of the following criteria are met:

  Based on CBC Results	WBC count greater than 30,000 RBC greater than 6.5 for male or greater than 6.0 for female Hemoglobin less than 6.0 or greater than 18.0 Platelet count less than 35 or greater than 1000 MCV less than 60 or greater than 110 for adult
  Based on Absolute Numbers	Neutrophils less than 0.5 Lymphocytes greater than 7 (over 14 years); greater than 10 (1-14 years) Monocytes greater than 3 Eosinophils greater than 2 Basophils greater than 0.5
  Based on Manual Differential	Blasts, unclassifiable – any Promyelocytes greater than 3 Myelocytes greater than 5 Metamyelocytes greater than 10 NRBC (per 100 WBC) greater than 3 Any unusual or questionable hematological findings that one or more techs are not confident in classifying.
  New Significant RBC Morphologic Abnormalities	3+: anisocytosis, poikilocytosis, elliptocytes, hypochromia, polychromasia, basophilic stippling, stomatocytes 2+: target cells, rouleaux 1+: schistocytes, spherocytes, acanthocytes, tear drop cells Any: sickle cells, Howell Jolly bodies, Pappenheimer bodies, agglutination, intraerythrocytic organisms
  New Significant WBC Morphologic Abnormalities	3+: Dohle bodies 2+: hyposegmented PMNs 1+: hypersegmented, hypogranular PMNs Any: Auer Rods
  Platelet Morphologic Abnormalities	2+: giant, agranular platelets 1+: bizarre platelets, satellitosis
  When Ordered by a Provider	If the CBC has not been performed at MHCC, perform a CBC on the hematology analyzer. If only slides have been sent from the ordering provider, contact testing location for copy of instrument print-out.
  Newborn Criteria	Hemoglobin less than 14.0 MCV less than 85 Lymphocyte absolute count greater than 14 Nucleated RBC greater than 50 for patients less than 7 days old
  Frequency of Path Review	Patients with chronic problems that have values that repeatedly fall within these criteria need only be reviewed by a pathologist one time in each 180-day period, unless a distinct change occurs.