Title: Anticoagulant EDTA Induced Storage effect (Artifacts) on Peripheral Blood Cells
Author: Dr M.S. Koolwal
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.05
Abstract
Aims & Objectives: The EDTA induced RBC & WBC morphological storage artifacts. Identify the EDTA induced platelets related artifacts. Exclude the EDTA induced storage artifacts. Identify and exclude the misinterpretation of peripheral blood smears examination.
Material & Methods: Blood was collected in a sterile EDTA containing tube and processed following our established laboratory protocol. A complete blood counting including HB%, PCV, Red cell indices, platelet count and total white cell count and differential was done by Automated blood cell counter and peripheral blood smear examination then a sterile EDTA containing blood sample tube stored at room temperature. The all cell count indices including RBC, WBC count with differential along with morphological storage artifacts and platelet count with storages artifacts, was further confirmed by manual oil immersion smear study method. Peripheral smears study was done with field A and B stain and leishman stain.
Conclusion: EDTA cause the various storage artefacts encountered on peripheral blood smear examination when smear prepared from prolong stored sterile EDTA containing blood sample tube at room temperature. EDTA cause RBC, WBC morphological artifacts and platelets related artifacts. These artifacts lead to various misinterpretation of peripheral blood smear examination so exclude them.
Keyword: Burr RBC, Nuclear lobe, Platelets aggregation.
References
- Lewis SM, Stoddart CT. Effects of anticoagulants and containers (glass and plastic) on the blood Lab Pract. 1971;10(10):787-922.
- National Committee for Clinical Laboratory Tubes and additives for venous blood specimen collection; approved standard - fifth edition. Document H1-A5. Wayne, PA: NCCLS, 2003.
- Lampasso Error in hematocrit value produced by excessive ethylenediaminet-etraacetate. Am J Clin Pathol. 1965; 44(1):109-105.
- Rodak BF. Diagnostic Hematology. Philadelphia, PA: W. Saunders Company; 1995.
- White 2nd GC, Scarborough DE, Brinkhous Morphological study of early phases of platelet adhesion to foreign surfaces: effect of calcium.Ann. N.Y. Acad. Sci. 1983;416:351-62.
- Forscher CA, Sussman II, Friedman EW, et Pseudothrombocytopenia masking true thrombocytopenia. Am J Hematol. 1985;18:313-17.
- Kjeldsberg CR, Hershgold Spurious thrombocytopenia. JAMA. 1974;227 (6):628-30.
- Evans V. Platelet morphology and the blood smear. J Med T 1984;1:689-95.
- Shreiner DP, Bell Psueudothrombo-cytopenia: Manifestation of a new type of platelet agglutinin. Blood. 1973;42:541-4914.
- Reardon DM, Warner B, Trowbridge EDTA, the traditional anticoagulant of haematology: with increased automation is it time for a review Med Lab Sci. 1991;48:72-75.
- van Assendelft OW, Parvin Specimen collection, handling and storage. In: Lewis SM, Verwilghen RL, eds. Quality Assurance in haematology. London: Bailliere Tindall; 1988:5-32.
- Lloyd The deterioration of leukocyte morphology with time: Its effect on the differential count. Lab Perspect 1982;1(1):13-16.
- Gulati GL, Hyland LJ, Kocher W, Schwarting Automated CBC and differential result changes. Arch Pathol Lab Med. 2002:126:336-42.
- de Baca ME, Gulati G, Kocher W, Schwarting Effects of storage of blood at room temperature on hematologic parameters measured on Sysmex XE-2100. Lab Med. 2006;37(1):28-35.
- International Council for Standardization haematology. recommendations of the international council for standardization in haematology for ethylenediaminete-traacetic acid anticoagulation of blood for blood cell counting and Am J Clin Pathol. 1993:100:371-72.
- Gordan HG, Larson Use of sequestrene as an anticoagulant.Am J Clin Pathol. 1955;23:613-18.
- Kennedy JB, Machara KT, Baker AM. Cell and platelet stability in disodium and tripotassium EDTA. Am J Med Technol. 1981;47:89.