Morphological appearance and abnormalities of hemolysis-resistant red blood cells in CELL-DYN Sapphire

Abstract

The automatic blood cell analyzer CELL-DYN Sapphire (Abbott) causes the eruption of hemolysis-resistant red blood cells (RRBCs) in the lower part and right lateral of the lymphocyte area of a scattergram. We reviewed the scattergram pattern of RRBCs and its association with erythrocyte malformation. We further divided an RRBC-positive group (156 specimens) into three groups. GroupⅠappears in the lower part of the lymphocyte area. Group Ⅱ appears in the right lateral of the lymphocyte area. Group Ⅲ appears in the lower part and right lateral of the lymphocyte area. We confirmed whether a specimen is significantly different on the basis of the prevalence of erythrocyte malformation in each group and the RRBC-negative group, and a high frequency of erythrocyte malformation was found in the RRBC-positive group (chi-square test, p < 0.01). As for groups Ⅰ and Ⅲ that appeared downward of the lymphocyte area, the number of leptocytes was high. In groups Ⅱ and Ⅲ, which appeared in the right lateral of the lymphocyte area, the number of Howell–Jolly corpuscles was high. In addition, it was considered that acanthocytes were found at a high frequency during the Howell–Jolly corpuscle eruption, and the configuration of cytomembrane changed into acanthocytes after the Howell–Jolly corpuscle enucleation. The eruption of RRBCs suggests erythrocyte malformation, and it was possible to determine the cause of the erythrocyte malformation. Because erythrocytes could be seen under a microscope, we understood the required performance and characteristics of the device to be used and felt the need to count the cells by visual observation if necessary.