title: Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia.
abstract: Asparaginase, an effective drug in the treatment of childhood acute lymphoblastic leukemia (ALL), has become an important component of most childhood ALL regimens during the remission induction or intensification phases of treatment. The incidence range of asparaginase-associated lipid abnormalities that are seen in children is 67-72%. Lipemia causes erroneous results, which uses photometric methods to analyze blood samples. We describe a case of l-asparaginase-associated severe hyperlipidemia with complete blood count abnormalities. Complete blood count analysis was performed with Beckman COULTER(®) GEN·S™ system, which uses the Coulter Volume, Conductivity, Scatter technology to probe hydrodynamically focused cells. Although an expected significant inaccuracy in hemoglobin determination occurred starting from a lipid value of 3450 mg/dl, we observed that triglyceride level was 1466 mg/dl. Complete blood count analysis revealed that exceptionally high hemoglobin, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration levels vs. discordant with red blood cell count, mean corpuscular volume, and hematocrit levels. Total leukocyte count altered spontaneously in a wide range, and was checked with blood smear. Platelet count was in expected range (Table 1). Thus, we thought it was a laboratory error, and the patient's follow-up especially for red cell parameters was made by red blood cell and hematocrit values.
authors.affiliation: Department of Pediatric Hematology, Ankara Children's Hematology and Oncology Hospital, Ankara, Turkey. drdilekgurlek@hotmail.com
authors.forename: D G
authors.initials: DG
authors.lastname: Gokcebay
authors.forename: F M
authors.initials: FM
authors.lastname: Azik
authors.forename: P
authors.initials: P
authors.lastname: Isik
authors.forename: I O
authors.initials: IO
authors.lastname: Bozkaya
authors.forename: A
authors.initials: A
authors.lastname: Kara
authors.forename: E B
authors.initials: EB
authors.lastname: Tavil
authors.forename: N
authors.initials: N
authors.lastname: Yarali
authors.forename: B
authors.initials: B
authors.lastname: Tunc
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D001215:Asparaginase / Q000009:adverse effects / Q000627:therapeutic use; D001772:Blood Cell Count / Q000295:instrumentation / Q000379:methods; D002675:Child, Preschool; D019411:Clinical Laboratory Techniques / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006403:Hematologic Tests / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood* / Q000139:chemically induced; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood* / Q000188:drug therapy
chemical_list: D001215:Asparaginase