Complete blood count using VCS (volume, conductivity, light scatter) technology is affected by hyperlipidemia in a child with acute leukemia D. G. GOKCEBAY*, F. M. AZIK*, P. ISIK † , I. O. BOZKAYA*, A. KARA*, E. B. TAVIL*, N. YARALI*, B. TUNC* CASE REPORT She was a 5-year-old girl complaining of easy bruising. Blood count revealed severe anemia (5.1 g/dl) and thrombocytopenia (5 · 10 9 /l). Total leukocyte count was 6 · 10 9 /l, and on blood smear, 58% blast and 42% lymphocytes were seen. Bone marrow aspirate revealed diffuse infiltration with blast cells consistent with acute leukemia. Bone marrow flow cytometry on immuno- phenotyping with four-color, dual laser system (BD *Department of Pediatric Hematology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey † Department of Radiology, Ankara Children’s Hematology and Oncology Hospital, Ankara, Turkey Correspondence: Dilek Gurlek Gokcebay, MD, Department of Pediatric Hematol- ogy, Ankara Children’s Hematology and Oncology Hospital, Diskapi, 06110 Ankara, Turkey. Tel.: 90 312 5969696; Fax: 90 312 3472330; E-mail: drdilekgurlek@hotmail.com doi:10.1111/j.1751-553X.2011.01333.x Received 18 January 2011; accepted for publication 6 April 2011 Keywords Complete blood count (volume, conductivity, light scatter technol- ogy), hyperlipidemia, l -asparaginase SUMMARY 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 asparagin- ase-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 COUL- TER Ò GENÁSÔ 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. CASE REPORT INTERNATIONAL JOURNAL OF LABORATORY HEMATOLOGY Ó 2011 Blackwell Publishing Ltd, Int. Jnl. Lab. Hem. 2011, 33, 651–655 651 International Journal of Laboratory Hematology The Official journal of the International Society for Laboratory Hematology