Overview
Analyzer flags are software alerts generated when results, histograms, or scattergrams exceed validator limits or classification uncertainty thresholds.
Classification
Common flags, educational; exact names vary by platform
| Flag type (generic) | Typical action | Line |
|---|---|---|
| Blast / abnormal lympho? | Mandatory smear; escalate if blasts confirmed | WBC |
| Left shift / IG present | Smear; manual diff; calculate ANC | WBC |
| Neutropenia / WBC low | Verify ANC; critical value per policy | WBC |
| NRBC present | WBC correction; smear review | WBC |
| PLT clump / PLT abnormal | Smear; citrate recollection per protocol | PLT |
| Giant PLT | Smear estimate; optical PLT if available | PLT |
| RBC agglutination? | Warm specimen; repeat; smear | RBC |
| Abnormal RBC histogram | Smear; investigate interference | RBC |
Morphologic Features
Flags require morphologic correlation, not silent override in LIS.
Laboratory Characteristics
- Reflex smear rules, institutional
- Multiple flags may share one root cause (e.g., EDTA clumping)
- Neutrophil-specific flags . Neutrophils Academy applied depth
Reference Intervals
Flags are qualitative alerts, not numeric reference intervals.
Clinical and Laboratory Significance
Unresolved blast or clump flags block verified release until documented resolution.
Differential Considerations
Flags indicate verification need, not disease classification.
Comparison Tables
Flag resolution sequence
| Resolution step | When |
|---|---|
| Specimen inspection | Always first for flagged results |
| Histogram/scattergram review | Before smear preparation |
| Repeat analysis | Suspected cold agglutinin or unstable specimen |
| Alternate tube | EDTA PLT clumping |
| Manual differential | Validator failure or IG/left shift flags |
Classification Frameworks
Not applicable.
Laboratory Notes
- Map manufacturer flag codes to institutional reflex table during instrument validation.
References
Authoritative textbooks, guidelines, and reviews supporting this reference entry. Verify reference intervals, critical limits, and reflex criteria against institutional protocols and current guideline editions.
Textbooks
- McPherson RA, Pincus MR. Henry's Clinical Diagnosis and Management by Laboratory Methods. 24th ed. Elsevier; 2021.
- Rodak BF, Carr JH. Rodak's Hematology: Clinical Principles and Applications. 6th ed. Elsevier; 2020.
- McKenzie SB, Williams JL. Clinical Laboratory Hematology. 4th ed. Pearson; 2022.
Professional Monographs
- Barnes PW, McFadden SL, Machin SJ, Doig K. Laboratory Hematology Practice. Wiley-Blackwell; 2012.
CLSI and Professional Guidelines
- Clinical and Laboratory Standards Institute. Reference Leukocyte (WBC) Differential Count (Proportional) and Evaluation of Instrumental Methods; Approved Standard. CLSI document H20-A2. CLSI; 2007.
- Clinical and Laboratory Standards Institute. Defining, Establishing, and Verifying Reference Intervals in the Clinical Laboratory; Approved Standard. CLSI document EP28-A3c. CLSI; 2010.
- Clinical and Laboratory Standards Institute. Management of Critical- and Significant-Risk Results. CLSI guideline GP47-Ed1. CLSI; 2015.
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