Hypersegmentation in a routin laboratory– a common finding or not?

Anna Maj Ericsson1,*, Helena Orre-Ekdahl2, Stefan Jacobsson2

1Clinical Chemistry, Sahlgrenska University hospital, Mölndal, 2Sahlgrenska University hospital, Gothenburg, Sweden

Introduction: The morphologic definition of hypersegmented neutrophils, eosinophils and basophils is well established. There is also general concensus on when to deem a blood sample as hypersegmentation. The finding of hypersegmentation may have important medical consequenses.

The finding of hypersegmentation in blood slides seem to have increased during recent years. This may be due to laboratories not adhering strictly to the standards.

Objectives: The goal of the study is to measure if routine hematology laboratories perform hypersegmentation analysis according to the international standards.  More specifically 100 random normal patient samples, will be evaluated strictly according to the standardized method.

If the result points to under- or overreporting of hypersegmentation, a corrective educational program will be launched.

Methods: The preparations are made from freshly drawn autovalidated samples of patients at Mölndal Hospital.
The smears are prepared primarily on Cellavision Hemaprep, even though manual smears may occur.
The slides are scanned with DM96 (DiffMaster), assessed and counted in Mölndal and Sahlgrenska Clinical Chemistry laboratory by laboratory technicians qualified to manual review of diffslides.

To avoid subjective assessment the laboratory technicians use a standardized protocol where the amount of lobes per neutrophilic cells is noted. 

Results: The study is in progress.

Conclusion: Standardized Operating Procedures are important but equally important is the daily adherence to the standards.


Keywords: Blood, Method