Comparison of performance and abnormal cell flagging of two automated hematology analyzers: Sysmex XN 3000 and Beckman Coulter DxH 800

Performance evaluation of the new Sysmex XR-Series haematology analyser

Background

The new XR-Series haematology analyser from Sysmex provides increased throughput and automation, along with a new reagent in WDF channel for optimised WBC differential.

Methods

An analytical performance study for the XR analyser was conducted to evaluate the WDF channel parameters in comparison to the instrument specifications. Additionally, 7460 samples were measured on XR and XN analysers to compare selected parameters and flags, and 930 randomly selected samples were further evaluated with microscopy.

Results

All investigated aspects of the analytical performance study for the XR fell within the manufacturer specifications. The correlation coefficients between the two systems for the parameters tested were greater than 0.983 for the main CBC and DIFF parameters, greater than 0.909 for the Extended Inflammation Parameters, and greater than 0.932 for the parameters used in the workflow rulesets of the Extended IPU. Similarly high sensitivities for the detection of abnormal cells were observed for the 'Blasts/Abn Lympho?' flag (XN: 100%, XR: 99.0%) and WPC abnormal flags ('Blasts?' or 'Abn Lympho?') (XN: 97.0%, XR: 96.0%). XN with WPC channel had a 26% reduction of false positive smears compared to XR with 22% reduction, a statistically non-significant difference.

Conclusion

The XR analyser had very good analytical performance, and highly comparable results to the predecessor XN analyser in all investigated parameters, flags and workflow aspects.

Comparison of the performance of two automatic cell morphology analyzers for peripheral-blood leukocyte morphology analysis: Mindray MC-100i and Sysmex DI-60

INTRODUCTION

To compare the morphological classification ability of peripheral-blood leukocytes of the automatic cell morphology analyzers MC-100i and DI-60.

METHODS

(1) MC-100i and DI-60 were used to analyze leukocytes in 432 venous blood samples collected from three tertiary hospitals across China. The preclassification results were compared with the results reported by senior morphological experts (postclassification results) to evaluate the accuracy, sensitivity, specificity, and consistency of leukocyte preclassification for both instruments. (2) In 200 of the 432 blood samples, morphological experts conducted manual microscopic examination for various types of leukocytes. The correlation between the MC-100i and DI-60 leukocyte postclassification results and the expert microscopist results were analyzed.

RESULTS

(1) MC-100i preclassified leukocytes and nucleated red blood cells (RBCs). Compared with the postclassification results, the total leukocyte preclassification accuracy of MC-100i was 97.16%, while that of DI-60 was 87.24%. The sensitivity of MC-100i to abnormal cells (including blasts, promyelocytes, neutrophilic myelocytes, neutrophilic metamyelocytes, reactive lymphocytes, abnormal promyelocytes, plasma cells, abnormal lymphocytes and nucleated RBCs) was 90.24%, which was significantly higher than the 50.72% sensitivity of DI-60. (2) Comparing the postclassification results with manual microscopy, except for reactive lymphocytes and basophils, the MC-100i and DI-60 results had good correlations with various leukocyte types and nucleated RBCs (r > 0.85), and MC-100i was better than DI-60 in the recognition of basophils.

CONCLUSION

Both MC-100i and DI-60 have good detection ability for five normal types of leukocytes in peripheral blood. MC-100i has significantly better detection sensitivity for abnormal cells in peripheral blood than DI-60.

An artificial intelligence-assisted diagnostic platform for rapid near-patient hematology

Hematology analyzers capable of performing complete blood count (CBC) have lagged in their prevalence at the point‐of‐care. Sight OLO (Sight Diagnostics, Israel) is a novel hematological platform which provides a 19‐parameter, five‐part differential CBC, and is designed to address the limitations in current point‐of‐care hematology analyzers using recent advances in artificial intelligence (AI) and computer vision. Accuracy, repeatability, and flagging capabilities of OLO were compared with the Sysmex XN‐Series System (Sysmex, Japan). Matrix studies compared performance using venous, capillary and direct‐from‐fingerprick blood samples. Regression analysis shows strong concordance between OLO and the Sysmex XN, demonstrating that OLO performs with high accuracy for all CBC parameters. High repeatability and reproducibility were demonstrated for most of the testing parameters. The analytical performance of the OLO hematology analyzer was validated in a multicenter clinical laboratory setting, demonstrating its accuracy and comparability to clinical laboratory‐based hematology analyzers. Furthermore, the study demonstrated the validity of CBC analysis of samples collected directly from fingerpricks.

Evaluation of the New Beckmann Coulter Analyzer DxH 900 Compared to Sysmex XN20: Analytical Performance and Flagging Efficiency

Efficiency and accuracy in automated hematology analyzers are very important for clinical laboratories. The purpose was to evaluate the flags and results reported by the newest Beckman Coulter analyzer DxH 900 compared to the Sysmex XN20 system. Samples were analyzed on the XN20 (Sysmex, Kobe, Japan) and on the Beckman Coulter DxH 900 (Beckman Coulter, Miami, Florida, USA). Slide reviews were performed microscopically. Morphologic criteria were used to identify abnormal cells as recommended by International Consensus Group for Hematology (ICSH): blasts, immature granulocytes (IG%), abnormal lymphocytes (ALs) and plasma cells. Results: there was a strong correlation between the analyzers in almost all clinical parameters tested. Both DxH 900 and XN20 showed an excellent degree of association for the leukocyte differential compared to the reference method (manual microscopy). When it comes to IG%, XN20 showed a positive bias for higher results. Related to platelets, there are no differences between the two methods for PLT count. For mean platelet volume (MPV), DxH 900 provided 100% results of the samples analyzed while XN20 while in the XN20 analyzer, 16% of the results were missing. From our results we came to the conclusion that both analyzers, DxH 900 and XN20 were clinically accurate and efficient. Abnormal Lymphocyte detection highlighted the differences between the two technologies as only minimal agreement was obtained. DxH 900 demonstrated higher sensitivity in detecting IG with good correlation with microscopic review. The DxH 900 for platelet clumps identification provides an excellent flag (PLT Clumps) with the highest sensitivity observed in our evaluation.

Basophil counting in hematology analyzers: time to discontinue?

Basophils (basophilic granulocytes) are the least abundant cells in blood. Nowadays, basophils are included in the complete blood count performed by hematology analyzers and therefore reported in practically all patients in whom hematologic investigations are requested. However, hematology analyzers are not reliable enough to report clinically useful results. This is due to a combination of very high analytical imprecision and poor specificity, because the chemical and physical methods used for basophil counting in hematology analyzers are ill-defined and thus basophils are not well recognized by the analyzers. As a result, false basophil counts are quite common. In view of increasing analytical performance demands, hematology laboratories should stop reporting basophil counts produced by hematology analyzers. Suggestions for alternative pathways are presented for those situations where basophils are of clinical relevance.

Evaluation and comparison of the new Mindray BC-6200 hematology analyzer with ADVIA 2120i

BACKGROUND

The Mindray BC-6200 is a new automatic hematology analyzer that quantifies the parameters of blood morphology and leukocyte differential in five populations (5-Diff). The aim of the study was to evaluate the BC-6200 and compare it with the Siemens ADVIA 2120i analyzer.

MATERIALS AND METHODS

The comparison between BC-6200 and ADVIA 2120i analyzers was performed using 390 whole blood samples collected on K₃ EDTA. For the BC-6200, the carryover effect, precision, and linearity were evaluated. 138 samples were used to assess the sensitivity and flag ability, suggesting the presence of abnormal cells such as blasts, immature granulocytes, or atypical lymphocytes. Flagging results were compared with microscopic evaluation of blood smears.

RESULTS

The BC-6200 analyzer showed a high correlation (r ≥ .97) with ADVIA 2120i for most of the compared parameters except RDW (r = .8350), MPV (r = .7634), Mon# (r = .8366), Baso# (r = .9205), and NRBC (r = .3768). The BC-6200 had better correlation with microscopic evaluation for NRBC (r = .8902) compared with ADVIA 2120i (r = .5677). The BC-6200 has shown high efficiency for flagging blasts (80.4%), immature granulocytes (80.5%), and atypical lymphocytes (69.0%).

CONCLUSION

The new Mindray BC-6200 hematology analyzer provides high measurements precision and good correlation with ADVIA 2120i for most of the morphology and 5-diff parameters.

Coagulation/Complement Activation and Cerebral Hypoperfusion in Relapsing-Remitting Multiple Sclerosis

Introduction

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system with an underlying immune-mediated and inflammatory pathogenesis. Innate immunity, in addition to the adaptive immune system, plays a relevant role in MS pathogenesis. It represents the immediate non-specific defense against infections through the intrinsic effector mechanism “immunothrombosis” linking inflammation and coagulation. Moreover, decreased cerebral blood volume (CBV), cerebral blood flow (CBF), and prolonged mean transit time (MTT) have been widely demonstrated by MRI in MS patients. We hypothesized that coagulation/complement and platelet activation during MS relapse, likely during viral infections, could be related to CBF decrease. Our specific aims are to evaluate whether there are differences in serum/plasma levels of coagulation/complement factors between relapsing-remitting (RR) MS patients (RRMS) in relapse and those in remission and healthy controls as well as to assess whether brain hemodynamic changes detected by MRI occur in relapse compared with remission. This will allow us to correlate coagulation status with perfusion and demographic/clinical features in MS patients.

Materials and Methods

This is a multi-center, prospective, controlled study. RRMS patients (1° group: 30 patients in relapse; 2° group: 30 patients in remission) and age/sex-matched controls (3° group: 30 subjects) will be enrolled in the study. Patients and controls will be tested for either coagulation/complement (C3, C4, C4a, C9, PT, aPTT, fibrinogen, factor II, VIII, and X, D-dimer, antithrombin, protein C, protein S, von-Willebrand factor), soluble markers of endothelial damage (thrombomodulin, Endothelial Protein C Receptor), antiphospholipid antibodies, lupus anticoagulant, complete blood count, viral serological assays, or microRNA microarray. Patients will undergo dynamic susceptibility contrast-enhanced MRI using a 3.0-T scanner to evaluate CBF, CBV, MTT, lesion number, and volume.

Statistical Analysis

ANOVA and unpaired t-tests will be used. The level of significance was set at p ≤ 0.05.

Discussion

Identifying a link between activation of coagulation/complement system and cerebral hypoperfusion could improve the identification of novel molecular and/or imaging biomarkers and targets, leading to the development of new effective therapeutic strategies in MS.

Clinical Trial Registration

Clinicaltrials.gov, identifier NCT04380220.

Haematocrit in <35 weeks preterm infants who received at least 60 seconds of delayed cord clamping: a retrospective observational study

OBJECTIVE

To describe haematocrit at birth in preterm infants who received ≥60 s of delayed cord clamping (DCC).

DESIGN

Retrospective observational study.

SETTING

A California public hospital with an American Academy of Pediatrics level 4 neonatal intensive care unit, with 3500-4000 deliveries annually.

PARTICIPANTS

467 preterm infants born at <35 weeks' gestational age (GA) between January 2013 and December 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Haematocrit reference ranges for 0-4 hours after birth and paired haematocrit differences between 0-4 and 4-24 hours.

METHODS

Haematocrits were obtained when clinically indicated and collected from arterial, venous and capillary sources. Haematocrits obtained after packed red blood cell transfusions were excluded. We summarised the first available haematocrit between 0 and 4 hours by GA strata. We used mixed-effects linear regression to describe the associations between haematocrit and predictor variables including GA, male sex and hours after an infant's birth. We also compared paired haematocrits at 0-4 and 4-24 hours after birth.

RESULTS

The median GA of the 467 included infants was 33.3 weeks, birth weight was 1910 g and DCC duration was 60 s. The mean (95% CI) first haematocrit at 0-4 hours was 46.6 (45.0% to 48.1%), 51.2 (49.6% to 52.8%), 50.6 (49.1% to 52.1%), 54.3 (52.8% to 55.8%) and 55.6 (54.6% to 56.6%) for infants 23-29, 30-31, 32, 33 and 34 weeks' GA strata, respectively. The subanalysis of 174 infants with paired haematocrits at 0-4 and 4-24 hours showed that for each additional hour after birth, the mean (95% CI) haematocrit increased by 0.2 (0.1% to 0.3%), 0.2 (0.1% to 0.4%) and 0.1 (0.0% to 0.2%) for infants in 23-29, 30-31 and 32 weeks' GA strata, respectively. The subanalysis showed no change between the paired haematocrits in the 33 and 34 weeks' GA strata.

CONCLUSIONS

Our study describes haematocrit in preterm infants who received ≥60 s DCC as standard of care. Haematocrit during the first 0-4 hours in our study is higher than the previously described reference ranges prior to DCC becoming routine clinical practice. The paired second haematocrit at 4-24 hours is higher than haematocrit at 0-4 hours.