It is anticipated that by November 2018 all LifeLabs laboratory locations will go-live with new Sysmex XN series hematology instrumentation. These new instruments offer a variety of new parameters that are useful in monitoring hematopoietic activity.
Ret-He and IRF: Both parameters provide a comprehensive picture of reticulocyte development and maturation.
- Ret-He: Reticulocyte hemoglobin provides a direct measurement of cellular iron that is available for hemoglobinization of the red cell. This parameter is a valuable tool for monitoring iron deficiency. A low reticulocyte hemoglobin content is an indication of poor iron supply relative to demand.
- IRF: Immature reticulocyte fraction can be used as a tool to monitor erythropoietic activity in the bone marrow. IRF levels rise as the bone marrow produces more reticulocytes. It’s most useful as an aid in the diagnosis and management of anemia and also the monitoring of erythropoietic stimulating agents.
IPF: Immature platelet fraction is a reflection of bone marrow platelet production. In a patient with thrombocytopenia, raised IPF levels are an indication of increased peripheral platelet destruction making this parameter particularly useful for supporting a diagnosis of ITP or TTP, and for distinguishing peripheral platelet destruction from bone marrow suppression. It can also be used as a tool for evaluating thrombopoietic activity in patients recovering from chemotherapy.
NRBC: Nucleated red blood cells are seen in the peripheral blood of normal infants up until the 5th day of life. NRBCs in the peripheral blood beyond the neonatal period are generally considered abnormal and are often seen in conditions causing hematopoietic distress.
IG: Immature granulocytes include metamyelocytes, myelocytes, and promyelocytes. IGs are typically not detected in the peripheral blood of healthy individuals. Elevated lG levels are often found in patients with bacterial infections, acute inflammatory disorders, steroid use, trauma, pregnancy, and some bone marrow disorders.
As the new instrumentation is implemented throughout the province, these new parameters will automatically be provided on the CBC report along with their corresponding normal reference ranges.
Miranda Wozniak, MD FRCPC
Deputy Ontario Medical Director
Discipline Head – Hematology
Medical-Scientific Department – Ontario
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