A person receiving parenteral nutrition that includes a lipid emulsion may have a number of changes in white blood cell parameters reported from an automated analyzer. The impact differs from that seen with lipemia.
Patient selection: parenteral nutrition with a lipid emulsion
Analysis: automated hematology analyzer using VCS (volume, conductivity, light scatter) technology
Parameters unchanged:
(1) total WBC count
(2) percent lymphocytes
Parameters increased:
(1) percent monocytes
(2) mean volume of neutrophils
(3) mean volume of monocytes
(4) conductivity of monocytes
(5) light scatter of monocytes
Parameters decreased:
(1) percent neutrophils (misread as monocytes)
(2) mean light scatter of neutrophils (associated with degranulation)
(3) conductivity of lymphocytes
If the machine provides scatter plot patterns, then it is important to visually examine these for evidence of spurious patterns.
