Errors in Automated Cell Counter: Major Pitfall with Risk of Misinterpretation of Results

Introduction Currently available automated cell counters are capable of analyzing various parameters of complete blood count efficiently. We report 2 cases of hematological investigations which helped us to understand errors in automated cell counter readings which caused results misinterpretation. Material and Methods A 27years/Female presented with headache and weakness for 4months. Hemoglobin was12.6g/dl, total leucocyte count22.9X109/L, platelets271X109/L and reported as acute leukemia with 46%blasts. On day of bone marrow examination, peripheral blood findings did not correlate with previous findings. Bone marrow was normocellular (M:E ratio 3:1) with no evidence of leukemia/lymphoma. So all haemogram reports were reviewed which were done on same day when this sample was first received. Results Peripheral blood findings were found to be similar to those of a prior sample. Sampling/technical errors were ruled out and we concluded that automated cell counter might not be effective in autorinsing function. So some cells might have been transferred to next sample. Conclusions The erroneous result was due to error in autorinsing by the automated cell counter and due to improper wiping off of spreader while preparing peripheral blood films. Hence at every step, utmost care must be taken starting from sample collection, sample labeling, requisition form, sample processing, smear preparation, staining and other investigations.