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Lai Y, Zeng W, Liao J, Yu Y, Liu X, Wu K. Retrospective analyses of routine preoperative blood testing in a tertiary eye hospital: could Choosing Wisely work in China? Br J Ophthalmol 2024; 108:897-902. [PMID: 37468212 DOI: 10.1136/bjo-2022-322431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 07/09/2023] [Indexed: 07/21/2023]
Abstract
AIMS To explore the possibility of implementing Choosing Wisely on ocular patients in China by investigating the prevalence of abnormalities in routine preoperative blood tests (RPBTs) and its turnaround time (TAT). METHODS Data from 102 542 ocular patients between January 2016 and December 2018, at Zhongshan Ophthalmic Center, were pooled from the laboratory information system. The test results were divided into normal and abnormal, including critical values. Ocular diseases were stratified into 11 subtypes based on the primary diagnosis. The TAT of 243 350 blood tests from January 2017 to December 2018 was categorised into transportation time and intralaboratory time. RESULTS RPBT was grouped into complete blood count (CBC), blood biochemistry (BBC), blood coagulation (BCG) and blood-borne pathogens (BBP), completed for 97.22%, 87.66%, 94.41% and 95.35% of the recruited patients (male, 52 549 (51.25%); median(IQR) age, 54 (29-67) years), respectively. Stratified by the test items, 9.19% (95% CI 9.07% to 9.31%) were abnormal results, and 0.020% (95% CI 0.019% to 0.022%) were critical; most abnormalities were on the CBC, while glucose was the most common critical item. Classified by the patients' primary diagnosis, 76.97% (95% CI 76.71% to 77.23%) had at least one abnormal result, and 0.28% (95% CI 0.25% to 0.32%) were critical; abnormal findings were reported in 45.29% (95% CI 44.98% to 45.60%), 54.97% (95% CI 54.65% to 55.30%), 30.29% (95% CI 30.00% to 30.58%) and 11.32% (95% CI 11.12% to 11.52%) for the CBC, BBC, BCG and BBP tests, respectively. The median transportation time and intralaboratory TAT of the samples were 12 min and 78 min respectively. CONCLUSION Blood abnormalities are common in ocular patients. With acceptable timelines, RPBT is still indispensable in China for patient safety.
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Affiliation(s)
- Yunxi Lai
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Weiting Zeng
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Jingyu Liao
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Yubin Yu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Xiuping Liu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
| | - Kaili Wu
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University; Guangdong Provincial Clinical Research Center for Ocular Diseases, Guangzhou, China
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2
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Cai Q, Lin H, Guo P. Performance evaluation of PLT-H (hybrid-channel platelet) under various interferences and application studies for platelet transfusion decisions. Platelets 2023; 34:2287064. [PMID: 38031975 DOI: 10.1080/09537104.2023.2287064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
The hybrid-channel platelet counting method (PLT-H) is a new platelet counting technique proposed by Mindray of China. In this study, we aimed to evaluate the accuracy of this technique in various situations and its reliability in platelet transfusion decision-making. A total of 378 venous blood samples were tested. Using the immunological PLT counting method recommended by the International Council for Standardization in Hematology as the reference method (PLT-IRM), Passing-Bablok regression and Bland-Altman analysis were performed on the PLT-H results. The anti-interference performance of PLT-H under different interference levels was explored using intergroup comparisons, and confusion matrices were analyzed at various transfusion cutoff values. In the absence of interference, there was a strong correlation between PLT-H and PLT-IRM (r = 0.993, 95% CI: 0.990-0.996). Under various interference conditions, the correlation between PLT-H and PLT-IRM was between 0.963 and 0.992, with an average deviation of -14.56 to -2.02. The performance of PLT-H against interference did not change significantly with increasing levels of small RBCs, large PLTs, and RBC fragments (P = .5704, 0.0832, 0.9893). In low-value samples (PLT <100 × 109/L), the coefficient of variation (CV) for PLT-H was less than 7.6%, regardless of the presence or absence of interfering substances. In addition, there was a high agreement between PLT-H and PLT-IRM (ICC = 0.972). Confusion matrice analysis at each medical decision level showed similarity to methods using the fluorescence channel (PLT-O) and superiority to the impedance channel (PLT-I). Compared with PLT-I, PLT-H has higher accuracy in PLT counting, stronger anti-interference ability, better performance in low-value samples at no extra economic cost and can be more useful for platelet transfusion decision-making. PLT-H is a novel method for platelet counting that offers higher accuracy, providing physicians with the ability to make better medical decisions, particularly in cases where values are low, or interference is present. As it does not require additional reagents, it is highly likely to replace PLT-I and become the mainstream method for platelet counting in the future.
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Affiliation(s)
- Qi Cai
- Clinical Laboratory, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Han Lin
- Clinical Laboratory, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
| | - Ping Guo
- Clinical Laboratory, Shanghai Jiao Tong University Medical School Affiliated Ruijin Hospital, Shanghai, China
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3
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Dickinson M, Abrams-Ogg A, Blois SL, Wood RD, Monteith G. Extended sample storage for platelet function testing in healthy dogs. Vet Clin Pathol 2023; 52:402-411. [PMID: 37385948 DOI: 10.1111/vcp.13226] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 09/13/2022] [Accepted: 11/27/2022] [Indexed: 07/01/2023]
Abstract
BACKGROUND Platelet function testing is important for monitoring the effects of antiplatelet therapy but is not readily used due to time constraints for testing and the need for specialized equipment. OBJECTIVES This study evaluated the effects of various storage methods on selected platelet function tests to determine if delayed platelet function testing is feasible in canine blood samples. Our hypotheses were that platelet function would not decline during storage and, thus, no differences in test results would be found over time. METHODS Thirteen healthy dogs were studied. Citrated blood samples were tested with a Platelet Function Analyzer-200 (PFA), which mimics high-shear conditions, using P2Y and CADP cartridges, after being held at room temperature for 2 h and refrigerated for 24 and 48 h. Plateletworks (PW), which measures aggregation based on platelet counting, was performed on an optical hematology analyzer using 10-min-old native samples, citrated samples held at room temperature for 3-4 h and refrigerated for 24 and 48 h, and samples stored in the preservative solution, AGGFix, up to 7 days. RESULTS PFA closure times increased with storage, especially with the P2Y cartridge. Median aggregation with fresh PW was 94%, and this was maintained at all time points (range of median values 88%-94%). Most samples showed decreased, yet still robust (>70%), aggregation with longer storage. Spontaneous aggregation in citrate was noted in most dogs. AGGFix stabilized platelet aggregates to allow for delayed testing. CONCLUSIONS Delayed platelet function testing is feasible, but ranges of expected values may differ from tests using fresh samples.
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Affiliation(s)
- Melanie Dickinson
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anthony Abrams-Ogg
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Shauna L Blois
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - R Darren Wood
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Gabrielle Monteith
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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4
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Ali K, Müller TH, Garritsen HSP, Harringer W, Doescher A. Digital polymerase chain reaction to monitor platelet transfusions in cardiac surgery patients. Vox Sang 2023; 118:384-391. [PMID: 36912154 DOI: 10.1111/vox.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Corrected count increment (CCI) measurements monitor the effectiveness of platelet transfusions in haemato-oncology, but they usually fail in patients undergoing cardiac surgery. We investigated whether polymerase chain reaction (PCR) of mitochondrial single-nucleotide polymorphisms (SNPs) is able to monitor the survival of transfused platelets in these patients. MATERIALS AND METHODS Leukocyte-free, platelet-rich plasma was prepared from patients' blood to measure platelet counts based on patient-/donor-specific SNPs by digital PCR after DNA extraction. Platelet counts in samples from patients with severe thrombocytopenia were analysed by both PCR and flow cytometry. Ten patients undergoing cardiac surgery with the use of heart lung machine and without overt bleeding received a single apheresis platelet concentrate because of either dual platelet inhibition during a non-elective intervention or a complex procedure. Blood samples were collected at nine defined intervals (0-120 h) post transfusion. RESULTS The digital PCR of the seven SNPs reliably quantified levels ≥0.6 G/L platelets, in good agreement with flow cytometry and without interference by other SNPs or by platelet activation. A mean 24-h CCI of 11.8 (range: 5.6-19.8) and a mean 120-h area under the curve (AUC) of 1386 (915-1821) hxG/L were observed for the transfused platelets. The mean AUC of 14,103 (3415-27,305) hxG/L for the patients' endogenous platelets indicates that transfused platelets represented only 11% (5-25) of the total platelet counts during 120 h post transfusion. CONCLUSION PCR of mitochondrial SNPs offers a tool to assess the survival of platelets from apheresis concentrates in cardiac surgery patients to facilitate the implementation of improved transfusion strategies.
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Affiliation(s)
- Khaldoun Ali
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Thomas H Müller
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Henk S P Garritsen
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany.,Department of Atmospheric Pressure Plasma Processes, Fraunhofer Institute for Surface Engineering and Thin Films IST, Braunschweig, Germany
| | - Wolfgang Harringer
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Andrea Doescher
- Department of Transfusion Medicine, Blood Donor Service NSTOB, Oldenburg, Germany
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Deng J, Xie S, Chen Y, Ma Q, He Y, Liu M, Wang D, Yu X. Application of the Fluorescence Method on Sysmex XN9000 Hematology Analyzer for Correcting Platelet Count in Individuals with Microcytosis. Lab Med 2023; 54:e10-e13. [PMID: 35713611 DOI: 10.1093/labmed/lmac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Although small red blood cells are a well-known analytical pitfall that could cause artifactual increase of the platelet count, limited information is available on the accuracy of impedance platelet counting in cases with microcytosis. The aim of this study is to assess the accuracy of impedance platelet counting in the presence of small red blood cells, and to establish the optimal mean corpuscular volume (MCV) cutoff to endorse fluorescence platelet counting. METHODS In this study, platelet counts estimated by the impedance method on the Sysmex XN9000 analyzer (Sysmex, Kobe, Japan) were compared with those provided by the fluorescence method. The accuracy of impedance platelet counting was assessed. Receiver operating characteristic curve was used to evaluate the performance of MCV in predicting falsely increased platelet counts. RESULTS There was a tendency for the impedance method to overestimate the platelet count in samples with 70 fL < MCV ≤ 80 fL, 60 fL < MCV ≤ 70 fL, MCV ≤ 60 fL. Receiver operating characteristic curve analysis showed that a 73.5fL cutoff of MCV was highly sensitive in predicting falsely increased platelet counts. CONCLUSION In cases with MCV < 73.5 fL, we strongly suggest that the platelet counts obtained by the impedance method on the Sysmex XN9000 analyzer should be checked and corrected by fluorescence counting.
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Affiliation(s)
- Jiankai Deng
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhua Xie
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinghua Ma
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuting He
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuegao Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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6
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Smith J. How should we measure platelet count before central neuraxial blockade in parturients with thrombocytopenia? Br J Hosp Med (Lond) 2023; 84:1-2. [PMID: 36708349 DOI: 10.12968/hmed.2022.0224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Patients with low platelet counts are a concern to the obstetric anaesthetist as, although rare, there is a risk of a spinal epidural haematoma following central neuraxial blockade. Although conventional plasma-based tests are frequently used to guide central neuraxial blockade in patients with thrombocytopenia, interest in the use of viscoelastic haemostatic assays is increasing.
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Affiliation(s)
- Jennifer Smith
- Department of Anaesthesia and Critical Care, Chelsea and Westminster Hospital, London, UK
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7
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Beyan C, Beyan E. "Development and internal validation of a clinical prediction model for the diagnosis of immune thrombocytopenia": comment from Beyan and Beyan. JOURNAL OF THROMBOSIS AND HAEMOSTASIS : JTH 2023; 21:183-184. [PMID: 36695384 DOI: 10.1016/j.jtha.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Cengiz Beyan
- Ufuk University Faculty of Medicine, Ankara, Turkey.
| | - Esin Beyan
- Department of Internal Medicine, Ankara Ataturk Sanatorium Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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8
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Sahu N, Mohanty M, Adhya AK. Estimation of Total Platelet Count From Peripheral Blood Smear Needs a Correction Factor. Cureus 2022; 14:e28327. [PMID: 36168371 PMCID: PMC9506600 DOI: 10.7759/cureus.28327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2022] [Indexed: 11/05/2022] Open
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9
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Overall equipment effectiveness, efficiency and slide review analysis of high-end hematology analyzers. Pract Lab Med 2022; 30:e00275. [PMID: 35601458 PMCID: PMC9117814 DOI: 10.1016/j.plabm.2022.e00275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/24/2022] [Accepted: 04/06/2022] [Indexed: 11/29/2022] Open
Abstract
This study evaluated and compared the overall equipment effectiveness (OEE), sensitivity, specificity, and efficiency of the high-end hematology analyzers, Yumizen H2500, DxH 800, DxH 900 and XN-9000 (XN-10). A total of 400 anonymized left over’s K2 EDTA whole blood samples were analyzed for complete blood count. Of 400 samples, 200 were tested on Yumizen H2500; DxH 800 & DxH 900 while the other 200 were tested on Yumizen H2500 & XN-9000 (XN-10), respectively. The OEE was good and comparable for all the hematology analyzers except DxH 800 showing an average status. The sensitivity (%), specificity (%) and turnaround time (in minutes) for Yumizen H2500, DxH 800, DxH 900 and XN-9000 (XN-10) were 91.67, 61.11 & 103; 66.67, 54.55, & 149; 83.33, 27.27 & 136; 83.33, 28.57 & 122, respectively. Confusion matrix highlights the difficulty for DxH 800 and DxH 900 to discriminate left shift or blasts with large hyper-segmented neutrophils. The flags triggered by Yumizen H2500 were markedly changed to large hyper-segmented neutrophils. Lymphoblast caused more confusion for XN-9000 (XN-10), as it came out to be atypical lymphocytes, or hypersegmented neutrophils. Although comparable in OEE index to other analyzers, the Yumizen H2500 seems to be more reliable in detecting the abnormal cells as it has high sensitivity, specificity and less turnaround time. Thus, analysis adding specificity, sensitivity, and efficiency parameters to the OEE index provides more reliable information of the analyzers.
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10
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Habibabady ZA, Sendil S, Ellett F, Pollok F, Elias GF, French BM, Sun W, Braileanu G, Burdorf L, Irimia D, Pierson RN, Azimzadeh AM. Human erythrocyte fragmentation during ex-vivo pig organ perfusion. Xenotransplantation 2022; 29:e12729. [PMID: 35112383 PMCID: PMC8995366 DOI: 10.1111/xen.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/22/2021] [Accepted: 01/10/2022] [Indexed: 01/25/2023]
Abstract
Platelet sequestration is a common process during organ reperfusion after transplantation. However, instead of lower platelet counts, when using traditional hemocytometers and light microscopy, we observed physiologically implausible platelet counts in the course of ex-vivo lung and liver xenograft organ perfusion studies. We employed conventional flow cytometry (FC) and imaging FC (AMINS ImageStream X) to investigate the findings and found platelet-sized fragments in the circulation that are mainly derived from red blood cell membranes. We speculate that this erythrocyte fragmentation contributes to anemia during in-vivo organ xenotransplant.
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Affiliation(s)
- Zahra A. Habibabady
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD,Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA
| | - Selin Sendil
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Felix Ellett
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard School of Medicine, and Shriners Burns Hospital, Boston, MA
| | - Franziska Pollok
- Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA,Department of Anesthesiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriela F. Elias
- Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA
| | - Beth M. French
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Wenji Sun
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Gheorghe Braileanu
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD
| | - Lars Burdorf
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD,Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA
| | - Daniel Irimia
- Center for Engineering in Medicine and Surgery, Massachusetts General Hospital, Harvard School of Medicine, and Shriners Burns Hospital, Boston, MA
| | - Richard N. Pierson
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD,Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA
| | - Agnes M. Azimzadeh
- Department of Surgery, University of Maryland School of Medicine, Baltimore, MD,Center for Transplantation Sciences and Department of Surgery, Massachusetts General Hospital and Harvard School of Medicine, Boston, MA
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11
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Khodaiji S, Mansukhani D. Performance Evaluation of Fully Automated 5-Part Differential Hematology Analyzer ELite 580 (ERBA). Indian J Hematol Blood Transfus 2022; 38:99-105. [PMID: 35125717 PMCID: PMC8804059 DOI: 10.1007/s12288-021-01423-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 03/05/2021] [Indexed: 01/03/2023] Open
Abstract
The ELite 580 (Erba Lachema) Hematology Analyzer is a newly developed automated hematology analyzer that uses impedance and flow cytometry technologies. The analyzer provides 25 reportable parameters including a 5-part differential and additionally 4 research parameters with a throughput of 80 samples per hour. To evaluate the performance of the fully automated 5-part differential hematology analyzer ELite 580 as per the international standards and correlate the results with a reference analyser, LH 780 from Beckman Coulter. We evaluated the analyzer's performance by determining background noise, carryover, precision, linearity and correlation of complete blood cell count parameters between the ELite 580 from Erba Lachema and the LH 780 from Beckman Coulter at a tertiary care hospital, according to the Clinical and Laboratory Standards Institute guidelines. The ELite 580 showed minimal background noise and carryover, high precision, accuracy and linearity over a wide analytical range for white blood cells, hemoglobin, red blood cells, hematocrit, and platelet parameters. Correlation between the ELite 580 and the LH 780 was good for all parameters (R2 > 0.90) except for mean corpuscular hemoglobin concentration (MCHC) and the basophil count. ELite 580 Hematology Analyzer with its precise and accurate results and ease of operation is suitable for clinical use in medium to large sized hematology laboratories. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s12288-021-01423-y.
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Affiliation(s)
- Shanaz Khodaiji
- Department of Laboratory Medicine, P.D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016 India
| | - Dia Mansukhani
- Department of Laboratory Medicine, P.D. Hinduja Hospital and Medical Research Centre, Veer Savarkar Marg, Mahim, Mumbai 400016 India
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12
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Collins J, Astle WJ, Megy K, Mumford AD, Vuckovic D. Advances in understanding the pathogenesis of hereditary macrothrombocytopenia. Br J Haematol 2021; 195:25-45. [PMID: 33783834 DOI: 10.1111/bjh.17409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022]
Abstract
Low platelet count, or thrombocytopenia, is a common haematological abnormality, with a wide differential diagnosis, which may represent a clinically significant underlying pathology. Macrothrombocytopenia, the presence of large platelets in combination with thrombocytopenia, can be acquired or hereditary and indicative of a complex disorder. In this review, we discuss the interpretation of platelet count and volume measured by automated haematology analysers and highlight some important technical considerations relevant to the analysis of blood samples with macrothrombocytopenia. We review how large cohorts, such as the UK Biobank and INTERVAL studies, have enabled an accurate description of the distribution and co-variation of platelet parameters in adult populations. We discuss how genome-wide association studies have identified hundreds of genetic associations with platelet count and mean platelet volume, which in aggregate can explain large fractions of phenotypic variance, consistent with a complex genetic architecture and polygenic inheritance. Finally, we describe the large genetic diagnostic and discovery programmes, which, simultaneously to genome-wide association studies, have expanded the repertoire of genes and variants associated with extreme platelet phenotypes. These have advanced our understanding of the pathogenesis of hereditary macrothrombocytopenia and support a future clinical diagnostic strategy that utilises genotype alongside clinical and laboratory phenotype data.
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Affiliation(s)
- Janine Collins
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - William J Astle
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK
| | - Karyn Megy
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Dragana Vuckovic
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Imperial College London, London, UK
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
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13
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Velizarova M, Yacheva T, Genova M, Svinarov D. Evaluation of automated hematology analyzer DYMIND DH76 compared to SYSMEX XN 1000 system. J Med Biochem 2021; 40:367-377. [PMID: 34616226 PMCID: PMC8451233 DOI: 10.5937/jomb0-28836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background DYMIND DH76 (DYMIND BIOTECH, China) is a new automated hematology system designed to provide CBC count, including a 5-part WBC differential count, and its analytical performance should be assessed before adoption for clinical use. Methods The analyzer was evaluated according to the International Council for Standardization in Haematology guideline. The purposes of this study were to assess its analytical performance in comparison to SYSMEX XN 1000 hematology analyzer currently used in our laboratory, as well as to compare the automated and manual WBC differential. Results Within-run precision in all concentration ranges was very good with coefficients of variation (CVs) between 0.02% and 2.5% except for platelets over 500×109/L (CV 9.5%). Within-batch imprecision showed CVs lower the declared deviation ranges. Accuracy (defined as trueness) was excellent for all CBC and white cell differential parameters, compared with the state of the art%. Linearity was confirmed with excellent regression coefficients (0.999-1.000), even in the lowest values, and carryover was ≤ 1%. Comparison between DYMIND DH76 and SYSMEX XN 1000 was also very good with correlation coefficients (R2) for WBC (1.000), RBC (0.999), hemoglobin (0.999) and PLT over 50×109/L (0.994) and R2 was lower but still acceptable (0.910) for PLT<50×109/L. R2 for neutrophils, lymphocytes, eosinophils, basophils, and monocytes were 0.974, 0.982, 0.957, 0.625, and 0.836, respectively, in the comparison between the manual and DYMIND DH76 automated differential WBC counts. Conclusions With excellent analytical performance and acceptable comparative analysis, DYMIND DH76 hematology analyser covered the predefined international standards and requirements and is fully appropriate for clinical application.
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Affiliation(s)
- Milena Velizarova
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Teodora Yacheva
- UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Mariana Genova
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Dobrin Svinarov
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
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14
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Dickerson WM, Yu R, Westergren HU, Paraskos J, Schatz P, Tigerstrom A, Ekman A, Sánchez J, Cheng J, Li L, Chan EY. Point-of-care microvolume cytometer measures platelet counts with high accuracy from capillary blood. PLoS One 2021; 16:e0256423. [PMID: 34437590 PMCID: PMC8389400 DOI: 10.1371/journal.pone.0256423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 08/07/2021] [Indexed: 01/10/2023] Open
Abstract
Background Point-of-care (PoC) testing of platelet count (PLT) provides real-time data for rapid decision making. The goal of this study is to evaluate the accuracy and precision of platelet counting using a new microvolume (8 μL), absolute counting, 1.5 kg cytometry-based blood analyzer, the rHEALTH ONE (rHEALTH) in comparison with the International Society of Laboratory Hematology (ISLH) platelet method, which uses a cytometer and an impedance analyzer. Methods Inclusion eligibility were healthy adults (M/F) ages 18–80 for donation of fingerprick and venous blood samples. Samples were from a random N = 31 volunteers from a single U.S. site. Samples were serially diluted to test thrombocytopenic ranges. Interfering substances and conditions were tested, including RBC fragments, platelet fragments, cholesterol, triglycerides, lipids, anti-platelet antibodies, and temperature. Results The concordance between the rHEALTH and ISLH methods had a slope = 1.030 and R2 = 0.9684. The rHEALTH method showed a correlation between capillary and venous blood samples (slope = 0.9514 and R2 = 0.9684). Certain interferents changed platelet recovery: RBC fragments and anti-platelet antibodies with the ISLH method; platelet fragments and anti-platelet antibodies on the rHEALTH; and RBC fragments, platelets fragments, triglycerides and LDL on the clinical impedance analyzer. The rHEALTH’s precision ranged from 3.1–8.0%, and the ISLH from 1.0–10.5%. Conclusions The rHEALTH method provides similar results with the reference method and good correlation between adult capillary and venous blood samples. This demonstrates the ability of the rHEALTH to provide point-of-care assessment of normal and thrombocytopenic platelet counts from fingerprick blood with high precision and limited interferences.
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Affiliation(s)
| | - Rebecca Yu
- rHEALTH, Bedford, Massachusetts, United States of America
| | | | - Jonathan Paraskos
- Precision Medicine & Biosamples, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Philipp Schatz
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Tigerstrom
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Ekman
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - José Sánchez
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jamie Cheng
- rHEALTH, Bedford, Massachusetts, United States of America
| | - Lillian Li
- rHEALTH, Bedford, Massachusetts, United States of America
| | - Eugene Y. Chan
- rHEALTH, Bedford, Massachusetts, United States of America
- DNA Medicine Institute, Bedford, Massachusetts, United States of America
- * E-mail:
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15
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Lifson MA, Wakui M, Arai T, Mitsuhashi T, Lakos G, Murata M. Alinity hq platelet results are equivalent with the international reference method in thrombocytopenic samples. Int J Lab Hematol 2021; 43:1357-1362. [PMID: 34224209 DOI: 10.1111/ijlh.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/15/2021] [Accepted: 05/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Accurate and precise platelet (PLT) count is critical for the appropriate management of patients with thrombocytopenia. This study evaluated the performance of PLT counting with the Abbott Alinity hq hematology analyzer, which utilizes multi-dimensional optical technology. METHODS Imprecision, linearity, and accuracy were assessed per CLSI guidelines. Alinity hq PLT results were compared to the international flow cytometry reference method (IRM) in the concentration range of 6.3 to 103.0 × 109 /L. Additional comparisons were made with Sysmex XN-3000 PLT counts: impedance (PLT-I), optical (PLT-O), and optical fluorescent (PLT-F) methods. RESULTS The average within-run %CV was 4.7% on patient samples with PLT concentrations ranging from 13.1 to 41.7 × 109 /L, and the within-laboratory %CV was 3.6% at the level of 68.2 × 109 /L. Linearity evaluation indicated a maximum deviation of 3.1% from the linear fit in the range of 0.1 to 316.8 × 109 /L. Comparison between Alinity hq and the IRM PLT counts yielded a correlation coefficient of 0.99 and predicted bias of 0.0 and -0.5 × 109 /L at 10.0 and 20.0 × 109 /L transfusion thresholds, respectively. Alinity hq PLT counts also correlated well with Sysmex PLT counts, with strongest correlation obtained with PLT-F and PLT-O (r = .99) methods. CONCLUSION This study demonstrated excellent analytical performance of Alinity hq PLT counting in thrombocytopenic samples, equivalency with the IRM and strong agreement with Sysmex PLT-F and PLT-O methods. The Alinity hq multi-dimensional optical PLT count is available with every CBC without additional reagents and may help promote efficiency in clinical laboratories.
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Affiliation(s)
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Arai
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Takayuki Mitsuhashi
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
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16
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Yamade K, Yamaguchi T, Nagai Y, Kamisako T. Platelet count evaluation compared with the immunoplatelet reference method and performance evaluation of the hematology analyzer Celltac G. Int J Lab Hematol 2021; 43:927-938. [PMID: 33548102 DOI: 10.1111/ijlh.13481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 12/14/2020] [Accepted: 01/11/2021] [Indexed: 12/25/2022]
Abstract
INTRODUCTION The hematology analyzer, Celltac G (Nihon Kohden), designed to improve platelet count (Plt) accuracy, is equipped with new sheath flow control technology. Clinical evaluation of the Celltac G was assessed by comparability with XN-9000 (Sysmex Corporation) and CELL-DYN Sapphire (Abbott Diagnostics). The accuracy of all three analyzers, which use different measuring principles, was compared with the immunoplatelet reference method (FCM-Ref). METHODS Repeatability and within-laboratory imprecision were assessed using 10 clinical fresh whole blood samples and three control materials with differing levels. Carryover was evaluated using 6 clinical fresh whole blood samples. For method comparison between the three analyzers, 388 samples were used. Plt accuracy among the three analyzers was evaluated using 54 blood samples, including 42 samples with a platelet count less than 50x109 /L. The International Council for Standardization in Haematology method for Plt was used as the FCM-Ref. RESULTS The Celltac G showed sufficient performance with regard to imprecision, carryover, and comparability. The Analytical Measurement Interval (AMI) and linearity for all parameters of Plt were validated within 4.6 to 809.1 (×109 /L). All hematology analyzers showed some disagreement in Plt when compared with the immunoplatelet reference method. CONCLUSION The Celltac G hematology analyzer is suitable for clinical use. Platelet count evaluation of the three analyzers suggests the need to determine a reportable measurement interval (RMI) in the clinical laboratory for adequate reporting of a Plt from multiple different values.
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Affiliation(s)
- Kenji Yamade
- Department of Central Clinical Laboratory, Kindai University Hospital, Osakasayama, Japan.,Kindai University Graduate School of Medical Sciences, Osakasayama, Japan
| | - Toshihiro Yamaguchi
- Department of Central Clinical Laboratory, Kindai University Hospital, Osakasayama, Japan
| | - Yutaka Nagai
- Faculty of Clinical Laboratory, Kansai University of Health Sciences, Kumatori, Japan.,IVD Business Operations, Nihon Kohden Corp., Tokyo, Japan
| | - Toshinori Kamisako
- Department of Central Clinical Laboratory, Kindai University Hospital, Osakasayama, Japan.,Kindai University Graduate School of Medical Sciences, Osakasayama, Japan
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Wang J, Zhou P, Han Y, Zhang H. Platelet transfusion for cancer secondary thrombocytopenia: Platelet and cancer cell interaction. Transl Oncol 2021; 14:101022. [PMID: 33545547 PMCID: PMC7868729 DOI: 10.1016/j.tranon.2021.101022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 01/13/2021] [Accepted: 01/14/2021] [Indexed: 01/14/2023] Open
Abstract
Chemoradiotherapy and autoimmune disorder often lead to secondary thrombocytopenia in cancer patients, and thus, platelet transfusion is needed to stop or prevent bleeding. However, the effect of platelet transfusion remains controversial for the lack of agreement on transfusion strategies. Before being transfused, platelets are stored in blood banks, and their activation is usually stimulated. Increasing evidence shows activated platelets may promote metastasis and the proliferation of cancer cells, while cancer cells also induce platelet activation. Such a vicious cycle of interaction between activated platelets and cancer cells is harmful for the prognosis of cancer patients, which results in an increased tumor recurrence rate and decreased five-year survival rate. Therefore, it is important to explore platelet transfusion strategies, summarize mechanisms of interaction between platelets and tumor cells, and carefully evaluate the pros and cons of platelet transfusion for better treatment and prognosis for patients with cancer with secondary thrombocytopenia.
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Affiliation(s)
- Juan Wang
- Class 2016 Clinical Medicine, Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Pan Zhou
- Department of Laboratory Medicine, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China
| | - Yunwei Han
- Department of Oncology, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
| | - Hongwei Zhang
- Department of Blood Transfusion, The Affiliated Hospital of Southwest Medical University, Luzhou 646000, Sichuan, China.
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Harrison P, Lordkipanidzé M, Frelinger AL, Thomas MR, Watson SP. Platelet count and disease – editorial policy. Platelets 2020; 31:969-970. [DOI: 10.1080/09537104.2020.1802002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Paul Harrison
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Marie Lordkipanidzé
- Faculty of Pharmacy, Université De Montréal, Montréal, Canada
- Research Center, Montreal Heart Institute, Montréal, Canada
| | - Andrew L. Frelinger
- Center for Platelet Research Studies, Dana-Farber/Boston Children’s Cancer and Blood Disorders Center, Harvard Medical School, Boston, MA, USA
| | - Mark R. Thomas
- Institute for Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Steve P. Watson
- Institute for Inflammation and Ageing, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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19
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Abstract
The most commonly performed blood test is complete blood cell count. This test includes hemoglobin, white blood cell count, platelet count, and detailed red blood cell indices. Automated complete blood count also give information for “differential” which gives information about percentages and absolute numbers of different subgroups of white blood cells. This test is necessary in diagnosing anemia, hematological cancers, infections, acute hemorrhagic states, allergies, and immunodeficiencies. Also it is used for monitoring side effects of certain drugs. A pediatrician is frequently challenged for evaluating complete blood count as a part patient’s assessment. An enhanced and complete understanding of this laboratory test is essential for providing quality care of sick and normal children. Here in this paper, we want to share key laboratory interpretation strategies for complete blood count and some clues for differentiating normal from deviations and true problems.
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20
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Gioia M, Da Rin G, Manenti B, Birindelli S, Ciardelli ML, Gentile R, Beretta G, Lorusso G, Avino D, Di Fabio AM, Dima F, Fanelli A, Lorubbio M, Francione S, Marincheva G, Marini A, Papa A, Giannelli E, Pajola R, Panzeri A, Pipitone S, Benegiamo A, Rolla R, Vidali M, Buoro S. Multicenter evaluation of analytical performances of platelet counts and platelet parameters: Carryover, precision, and stability. Int J Lab Hematol 2020; 42:552-564. [PMID: 32304271 DOI: 10.1111/ijlh.13204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The correctness of the results of automated platelet analysis is still highly debated. The aim of this multicenter study, conducted according to international guidelines, was to verify the analytical performance of nine different types of hematology analyzers (HAs) in the automated platelet analysis. METHODS Four hundred eighty-six peripheral blood samples (PB), collected in K3 EDTA tubes, were analyzed by ABX Pentra, ADVIA2120i, BC-6800, BC-6800 Plus, Cell-DYN Sapphire, DxH800, XE-2100, XE-5000, XN-20 with PLT-F App. Within-run imprecision and between-run imprecision were carried out using PB and material control, respectively. The carryover, low limit of quantification (LoQ), and the PB stability were evaluated. RESULTS The carryover was absent for all HAs. The LoQ of PLT ranged between 2.0 (Cell-Dyn Sapphire) and 25.0 × 109 /L (ADVIA 2120i), while immature platelet fraction (IPF) ranged between 1.0 (XN-20) and 12.0 × 109 /L (XE-5000). The imprecision (%CV) increases as the platelet count decreases. No HAs showed desirable CVAPS for PLT counts less than 50.0 × 109 /L, with the exception of Cell-DYN Sapphire (CV 3.0% with PLT-O mean value of 26.7 × 109 /L), XN-20 (CV 2.4% with PLT-F mean value of 21.5 × 109 /L), and BC-6800 Plus (CV 1.9% with PLT-O mean value of 26.5 × 109 /L). The sample stability ranged between under two hours for MPV by ADVIA2120i and 8 hours for other PLT parameters and HAs. CONCLUSION The findings of this study may provide useful information regarding carryover, precision, and stability of platelet counts and parameters, especially in thrombocytopenic samples. Moreover, the stability of sample for platelet analysis is conditioned by the HA and by temperature and storage time.
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Affiliation(s)
- Maria Gioia
- Clinical Chemistry Laboratory, Abele Ajello Hospital, Mazara del Vallo, Italy
| | - Giorgio Da Rin
- Medicine Laboratory, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sarah Birindelli
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Maria Laura Ciardelli
- Clinical Chemistry Laboratory, Policlinico San Matteo-IRCCS, University of Pavia, Pavia, Italy
| | - Roberto Gentile
- Clinical Chemistry Laboratory, Policlinico San Matteo-IRCCS, University of Pavia, Pavia, Italy
| | - Gianluca Beretta
- Clinical Chemistry Laboratory, Policlinico San Pietro - Istituti Ospedalieri Bergamaschi, San Pietro, Italy
| | - Giuseppe Lorusso
- Clinical Chemistry Laboratory, Policlinico San Pietro - Istituti Ospedalieri Bergamaschi, San Pietro, Italy
| | - Daniela Avino
- Hematological diagnostic Laboratory, P. O. "A. Tortora", Pagani, Italy
| | | | - Francesco Dima
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | | | - Maria Lorubbio
- Laboratory Department, Azienda Ospedaliera Careggi, Florence, Italy
| | - Sara Francione
- Department of Clinical Chemistry and Microbiology, ASL Novara, Borgomanero, Italy
| | - Galina Marincheva
- Department of Clinical Chemistry and Microbiology, ASL Novara, Borgomanero, Italy
| | - Alessandra Marini
- Department of Clinical Chemistry, Versilia Hospital, Lido di Camaiore, Italy
| | - Angela Papa
- Laboratory Medicine, Fondazione G. Monasterio CNR Regione Toscana, Pisa, Italy
| | - Elena Giannelli
- Laboratory Medicine, Fondazione G. Monasterio CNR Regione Toscana, Pisa, Italy
| | - Rachele Pajola
- Clinical Chemistry Laboratory, Ospedali Riuniti Padova Sud Schiavonia, Italy
| | - Andrea Panzeri
- Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Silvia Pipitone
- Clinical Chemistry and Hematology Laboratory, University Hospital of Parma, Parma, Italy
| | - Anna Benegiamo
- Clinical Chemistry and Hematology Laboratory, University Hospital of Parma, Parma, Italy
| | - Roberta Rolla
- Clinical Chemistry Laboratory, Department of Health Sciences, Maggiore Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Matteo Vidali
- Clinical Chemistry Laboratory, Department of Health Sciences, Maggiore Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Sabrina Buoro
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
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Nair AB, Parker RI. Hemostatic Testing in Critically Ill Infants and Children. Front Pediatr 2020; 8:606643. [PMID: 33490001 PMCID: PMC7820389 DOI: 10.3389/fped.2020.606643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 12/10/2020] [Indexed: 12/12/2022] Open
Abstract
Children with critical illness frequently manifest imbalances in hemostasis with risk of consequent bleeding or pathologic thrombosis. Traditionally, plasma-based tests measuring clot formation by time to fibrin clot generation have been the "gold standard" in hemostasis testing. However, these tests are not sensitive to abnormalities in fibrinolysis or in conditions of enhanced clot formation that may lead to thrombosis. Additionally, they do not measure the critical roles played by platelets and endothelial cells. An added factor in the evaluation of these plasma-based tests is that in infants and young children plasma levels of many procoagulant and anticoagulant proteins are lower than in older children and adults resulting in prolonged clot generation times in spite of maintaining a normal hemostatic "balance." Consequently, newer assays directly measuring thrombin generation in plasma and others assessing the stages hemostasis including clot initiation, propagation, and fibrinolysis in whole blood by viscoelastic methods are now available and may allow for a global measurement of the hemostatic system. In this manuscript, we will review the processes by which clots are formed and by which hemostasis is regulated, and the rationale and limitations for the more commonly utilized tests. We will also discuss selected newer tests available for the assessment of hemostasis, their "pros" and "cons," and how they compare to the traditional tests of coagulation in the assessment and management of critically ill children.
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Affiliation(s)
- Alison B Nair
- Pediatric Critical Care Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Robert I Parker
- Pediatric Hematology/Oncology, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, United States
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22
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Compare the accuracy and precision of Coulter LH780, Mindray BC-6000 Plus, and Sysmex XN-9000 with the international reference flow cytometric method in platelet counting. PLoS One 2019; 14:e0217298. [PMID: 31125378 PMCID: PMC6534315 DOI: 10.1371/journal.pone.0217298] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 05/08/2019] [Indexed: 12/11/2022] Open
Abstract
Objective The aim of this study is to evaluate the performance of different platelet counting methods (optical, impedance, fluorescence and hand counting) applied in different analysers by comparing with the international flow cytometric reference method (IRM). Methods A total of 333 blood samples from different subgroups (168 cases with thrombocytopenia, 136 cases with normal platelet counts and 29 cases with thrombocytosis) were tested. Regarding IRM as the gold standard, we compared the accuracy and precision of different platelet count methods; i.e. LH780 (impedance), BC-6000 Plus (optical (O) and impedance (I)), Sysmex XN-9000 (optical (O), impedance (I), fluorescence (F)), and hand counting. Results Sysmex XN-9000-F (r = 0.988) had the best correlation with IRM for thrombocytopenic samples; BC-6000 Plus-I (r = 0.966) was more relevant to IRM than any other method for samples with normal platelet counts. Correlation between Sysmex XN-9000-I (r = 0.960) and IRM was the highest among these methods for samples with thrombocytosis. For bias evaluation, the average bias of Sysmex XN-9000-F was -1.5 × 109/L (95% LA = -9.4 to +6.4) for samples with thrombocytopenia, compared with IRM. BC-6000 Plus-I had a small mean difference with IRM for samples with normal platelet counts or thrombocytosis. Moreover, all evaluated methods had acceptable sensitivity, specificity, and concordance rates as compared with IRM in the diagnosis of thrombocytopenia and thrombocytosis. Conclusions Platelet counting by Sysmex XN-9000-F is more accurate than other methods for thrombocytopenic samples. BC-6000 Plus-I has superior association and consistency for normal platelet counts. As for thrombocytosis patients, Sysmex XN-9000-I has the highest correlation with IRM while Sysmex XN-9000-O has the highest diagnosis efficacy.
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24
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Shim MJ, Lee HA. Maintenance of Platelet Counts with Low Level QC Materials and the Change in P-LCR according to Hemolysis with XN-9000. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Moon-Jung Shim
- Department of Clinical Laboratory Science, Ansan University, Ansan, Korea
| | - Hyun-A Lee
- Department of Laboratory Medicine, Korea University Medical Center, Ansan Hospital, Ansan, Korea
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25
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Hummel K, Sachse M, Hoffmann JJML, van Dun LPJM. Comparative evaluation of platelet counts in two hematology analyzers and potential effects on prophylactic platelet transfusion decisions. Transfusion 2018; 58:2301-2308. [PMID: 30222860 DOI: 10.1111/trf.14886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/01/2018] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Decisions on prophylactic platelet (PLT) transfusions are generally based on the recipient's PLT count, but few clinicians are aware of precision and accuracy of the PLT counting methods used by the clinical laboratory. Each PLT counting technology has its specific inaccuracy, especially in thrombocytopenic samples and therefore may impact decisions on PLT transfusions. STUDY DESIGN AND METHODS Five routine PLT counting methods available in two hematology analyzers (Sysmex XN-2000 and Abbott CELL-DYN Sapphire) were investigated (impedance and optical on both analyzers and fluorescent on XN-2000), using the CD61 immunologic PLT method as a reference. The impact of counting inaccuracy on imaginary transfusion decisions was examined at various common PLT thresholds. RESULTS In total 341 samples were analyzed, 178 of which had PLT counts of less than 35 × 109 /L. Despite excellent overall correlation with the reference method (r > 0.99), thrombocytopenic samples showed only modest correlation for impedance and XN-2000 optical methods. Sapphire optical and XN-2000 fluorescent methods correlated very well with the reference, albeit with bias in the very low range. We noticed potential risk of undertransfusion (ranging from 2% to 90%), depending on the threshold used. The risk of overtransfusion was small (<10%). CONCLUSIONS The XN-2000 fluorescent PLT counting method showed excellent correlation with the CD61 reference count, closely followed by the CELL-DYN Sapphire optical method. XN-2000 impedance and optical and Sapphire impedance methods are not accurate enough for basing transfusion decisions on. Only XN-2000 fluorescent, Sapphire optical, and CD61 methods are sufficiently accurate for making appropriate clinical decisions in patients with severe thrombocytopenia.
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Affiliation(s)
- Kornelia Hummel
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics, Hamburg, Germany
| | - Michaela Sachse
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics, Hamburg, Germany
| | | | - Ludi P J M van Dun
- Hematology Support Group, Abbott Hematology, Wiesbaden-Delkenheim, Germany
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De la Salle B. Survey material choices in haematology EQA: a confounding factor in automated counting performance assessment. Biochem Med (Zagreb) 2017; 27:63-72. [PMID: 28392727 PMCID: PMC5382858 DOI: 10.11613/bm.2017.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/17/2017] [Indexed: 11/22/2022] Open
Abstract
The complete blood count (CBC) is one of the most frequently requested tests in laboratory medicine, performed in a range of healthcare situations. The provision of an ideal assay material for external quality assessment is confounded by the fragility of the cellular components of blood, the lack of commutability of stabilised whole blood material and the lack of certified reference materials and methods to which CBC results can be traced. The choice of assay material between fresh blood, extended life assay material and fully stabilised, commercially prepared, whole blood material depends upon the scope and objectives of the EQA scheme. The introduction of new technologies in blood counting and the wider clinical application of parameters from the extended CBC will bring additional challenges for the EQA provider.
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Affiliation(s)
- Barbara De la Salle
- UK NEQAS Haematology, West Hertfordshire Hospitals NHS Trust, operating UK NEQAS for Haematology and Transfusion, Watford, UK
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Larsen PB, Vikeså J, Friis-Hansen L. EDTA-induced pseudothrombocytosis and citrate-induced platelet agglutination in a patient with Waldenstrom macroglobulinemia. Clin Case Rep 2017; 5:1243-1247. [PMID: 28781833 PMCID: PMC5538042 DOI: 10.1002/ccr3.1035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2016] [Revised: 04/06/2017] [Accepted: 05/16/2017] [Indexed: 11/10/2022] Open
Abstract
Hematology analyzers sometimes generate spurious results. A patient had EDTA‐induced pseudothrombocytosis and platelet agglutination in citrate blood samples. This case verifies that addition of 1% paraformaldehyde to the citrate tubes can prevent platelet clumping. Further, it illustrates the advantages of having access to more than one platelet count method.
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Affiliation(s)
| | - Jonas Vikeså
- Department of Genomic Medicine Rigshospitalet Rigshospitalet Copenhagen Denmark
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Affiliation(s)
- Jonathan O Cullis
- Department of Haematology, Salisbury NHS Foundation Trust, Salisbury, SP2 8BJ, UK
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30
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Estcourt LJ, Birchall J, Allard S, Bassey SJ, Hersey P, Kerr JP, Mumford AD, Stanworth SJ, Tinegate H. Guidelines for the use of platelet transfusions. Br J Haematol 2016; 176:365-394. [DOI: 10.1111/bjh.14423] [Citation(s) in RCA: 266] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Lise J. Estcourt
- NHSBT and Radcliffe Department of Medicine; University of Oxford; Oxford UK
| | - Janet Birchall
- NHSBT and Department of Haematology; North Bristol NHS Trust; Bristol UK
| | - Shubha Allard
- NHSBT and Department of Haematology; Royal London Hospital; London UK
| | - Stephen J. Bassey
- Department of Haematology; Royal Cornwall Hospital Trust; Cornwall UK
| | - Peter Hersey
- Department of Critical Care Medicine & Anaesthesia; City Hospitals Sunderland NHS Foundation Trust; Sunderland UK
| | - Jonathan Paul Kerr
- Department of Haematology; Royal Devon & Exeter NHS Foundation Trust; Exeter UK
| | - Andrew D. Mumford
- School of Cellular and Molecular Medicine; University of Bristol; Bristol UK
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Al-Hosni ZS, Al-Khabori M, Al-Mamari S, Al-Qasabi J, Davis H, Al-Lawati H, Al-Riyami AZ. Reproducibility of Manual Platelet Estimation Following Automated Low Platelet Counts. Oman Med J 2016; 31:409-413. [PMID: 27974955 DOI: 10.5001/omj.2016.83] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Manual platelet estimation is one of the methods used when automated platelet estimates are very low. However, the reproducibility of manual platelet estimation has not been adequately studied. We sought to assess the reproducibility of manual platelet estimation following automated low platelet counts and to evaluate the impact of the level of experience of the person counting on the reproducibility of manual platelet estimates. METHODS In this cross-sectional study, peripheral blood films of patients with platelet counts less than 100 × 109/L were retrieved and given to four raters to perform manual platelet estimation independently using a predefined method (average of platelet counts in 10 fields using 100× objective multiplied by 20). Data were analyzed using intraclass correlation coefficient (ICC) as a method of reproducibility assessment. RESULTS The ICC across the four raters was 0.840, indicating excellent agreement. The median difference of the two most experienced raters was 0 (range: -64 to 78). The level of platelet estimate by the least-experienced rater predicted the disagreement (p = 0.037). When assessing the difference between pairs of raters, there was no significant difference in the ICC (p = 0.420). CONCLUSIONS The agreement between different raters using manual platelet estimation was excellent. Further confirmation is necessary, with a prospective study using a gold standard method of platelet counts.
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Affiliation(s)
| | | | - Sahimah Al-Mamari
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Jamal Al-Qasabi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hiedi Davis
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Hatim Al-Lawati
- Department of Medicine, Sultan Qaboos University Hospital, Muscat, Oman
| | - Arwa Z Al-Riyami
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
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van Dievoet MA, Louagie H, Ghys T. Performance evaluation of the Sysmex(®) XP-300 in an oncology setting: evaluation and comparison of hematological parameters with the Sysmex(®) XN-3000. Int J Lab Hematol 2016; 38:490-6. [PMID: 27321240 DOI: 10.1111/ijlh.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Sysmex XP-300(®) (XP-300) is a new, fully automated hematology analyzer, designed to generate complete blood counts (CBC) with 3-part differential. In our study, the XP-300 was evaluated as a point-of-care (POC) analyzer in an oncology setting. In which blood samples from patients with different pathologies and treatments, affecting hematopoiesis, were analyzed. METHODS Performance was evaluated according to the International Council for Standardization in Haematology (ICSH) guidelines and CLSI protocol H20-A2 . Beside precision, linearity and carry-over, a comparison study with the Sysmex(®) XN-3000 (XN-3000) and a manual reference leukocyte differential was performed. Flagging performance was also evaluated. RESULTS XP-300 showed excellent precision and linearity results. For within- and between-run precision, the criteria, according to Ricos et al. , were met for all parameters tested, except for platelets in the low level. Less than or equal to 0.5% carry-over was seen for all parameters tested. Comparison studies showed an acceptable correlation with both XN-3000 and the manual reference leukocyte count. A suboptimal flagging performance was demonstrated. CONCLUSION In the context of diagnosing cytopenia due to myelosuppressing agents or leukocytosis due to infection, the XP-300 showed good analytical performance. However, in the thrombocytopenic range, precision was suboptimal. In follow-up of hematological malignancies with the occurrence of abnormal cells, we advise verification with a more advanced analyzer or with microscopic review, although further studies with a higher prevalence of abnormal cells are needed.
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Affiliation(s)
| | - H Louagie
- Clinical laboratory AZ Sint-Lucas, Ghent, Belgium
| | - T Ghys
- Clinical laboratory AZ Sint-Lucas, Ghent, Belgium
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Crighton GL, Estcourt LJ, Wood EM, Stanworth SJ. Platelet Transfusions in Patients with Hypoproliferative Thrombocytopenia. Hematol Oncol Clin North Am 2016; 30:541-60. [DOI: 10.1016/j.hoc.2016.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Mannuß S, Schuff-Werner P, Dreißiger K, Kohlschein P. Magnesium Sulfate as an Alternative In Vitro Anticoagulant for the Measurement of Platelet Parameters? Am J Clin Pathol 2016; 145:806-14. [PMID: 27282617 DOI: 10.1093/ajcp/aqw066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES There are conflicting reports on the reliable measurement of platelet count and mean platelet volume (MPV) using EDTA or citrate. The anticoagulant properties of magnesium sulfate (MgSO4) are known from the literature. The aim of this study was to evaluate MgSO4 as an in vitro anticoagulant for platelet count, MPV, platelet distribution width, and platelet activation. METHODS Whole blood from volunteers was anticoagulated by EDTA, citrate, or MgSO4 Platelets were counted by the XE 5000 (Sysmex, Norderstedt, Germany) impedance and fluorescence optical technique. RESULTS The mean impedance platelet counts were 227.7, 197.0, and 201.1 × 10(9)/L in EDTA-, citrate-, or MgSO4-anticoagulated blood, respectively. The counts were 4.7% higher (EDTA) after 3 hours of storage but 4% lower in citrate-anticoagulated blood. The counts in magnesium samples remained stable. The MPV was 10.4 fL (EDTA), 9.5 fL (citrate), and 9.3 fL (MgSO4). EDTA samples showed cell swelling within the first 3 hours. This was lower in citrate and only marginal in magnesium samples. High activation of platelets was observed only in EDTA samples. CONCLUSIONS Magnesium anticoagulation might be advantageous for more reliable MPV measurements. Although platelet count is underestimated when the impedance method is used, the platelet count reveals similar results when measured by the fluorescent optical method.
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Affiliation(s)
- Steffen Mannuß
- From the Rostock University Medical Centre, Institute of Clinical Chemistry and Laboratory Medicine, Rostock, Germany
| | - Peter Schuff-Werner
- From the Rostock University Medical Centre, Institute of Clinical Chemistry and Laboratory Medicine, Rostock, Germany.
| | - Katrin Dreißiger
- From the Rostock University Medical Centre, Institute of Clinical Chemistry and Laboratory Medicine, Rostock, Germany
| | - Peter Kohlschein
- From the Rostock University Medical Centre, Institute of Clinical Chemistry and Laboratory Medicine, Rostock, Germany
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Boulassel MR, Al-Farsi R, Al-Hashmi S, Al-Riyami H, Khan H, Al-Kindi S. Accuracy of Platelet Counting by Optical and Impedance Methods in Patients with Thrombocytopaenia and Microcytosis. Sultan Qaboos Univ Med J 2015; 15:e463-8. [PMID: 26629371 DOI: 10.18295/squmj.2015.15.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 05/28/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Obtaining accurate platelet counts in microcytic blood samples is challenging, even with the most reliable automated haematology analysers. The CELL-DYN(™) Sapphire (Abbott Laboratories, Chicago, Illinois, USA) analyser uses both optical density and electronic impedance methods for platelet counting. This study aimed to evaluate the accuracy of optical density and electrical impedance methods in determining true platelet counts in thrombocytopaenic samples with microcytosis as defined by low mean corpuscular volume (MCV) of red blood cells. Additionally, the impact of microcytosis on platelet count accuracy was evaluated. METHODS This study was carried out between February and December 2014 at the Haematology Laboratory of the Sultan Qaboos University Hospital in Muscat, Oman. Blood samples were collected and analysed from 189 patients with thrombocytopaenia and MCV values of <76 femtolitres. Platelet counts were tested using both optical and impedance methods. Stained peripheral blood films for each sample were then reviewed as a reference method to confirm platelet counts. RESULTS The platelet counts estimated by the impedance method were on average 30% higher than those estimated by the optical method (P <0.001). The estimated intraclass correlation coefficient was 0.52 (95% confidence interval: 0.41-0.62), indicating moderate reliability between the methods. The degree of agreement between methods ranged from -85.5 to 24.3 with an estimated bias of -30, suggesting that these methods generate different platelet results. CONCLUSION The impedance method significantly overestimated platelet counts in microcytic and thrombocytopaenic blood samples. Further attention is therefore needed to improve the accuracy of platelet counts, particularly for patients with conditions associated with microcytosis.
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Affiliation(s)
- Mohamed-Rachid Boulassel
- Departments of Allied Health Sciences, College of Medicine & Health Sciences, Sultan Qaboos University; ; Haematology, College of Medicine & Health Sciences, Sultan Qaboos University
| | - Raya Al-Farsi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Sulaiman Al-Hashmi
- Genetics, College of Medicine & Health Sciences, Sultan Qaboos University
| | - Hamad Al-Riyami
- Genetics, College of Medicine & Health Sciences, Sultan Qaboos University
| | - Hammad Khan
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Salam Al-Kindi
- Haematology, College of Medicine & Health Sciences, Sultan Qaboos University
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Estcourt LJ, Stanworth SJ, Doree C, Hopewell S, Trivella M, Murphy MF. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in people with haematological disorders after myelosuppressive chemotherapy or stem cell transplantation. Cochrane Database Syst Rev 2015; 2015:CD010983. [PMID: 26576687 PMCID: PMC4717525 DOI: 10.1002/14651858.cd010983.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Platelet transfusions are used in modern clinical practice to prevent and treat bleeding in people who are thrombocytopenic due to bone marrow failure. Although considerable advances have been made in platelet transfusion therapy in the last 40 years, some areas continue to provoke debate, especially concerning the use of prophylactic platelet transfusions for the prevention of thrombocytopenic bleeding.This is an update of a Cochrane review first published in 2004, and previously updated in 2012 that addressed four separate questions: prophylactic versus therapeutic-only platelet transfusion policy; prophylactic platelet transfusion threshold; prophylactic platelet transfusion dose; and platelet transfusions compared to alternative treatments. This review has now been split into four smaller reviews looking at these questions individually; this review compares prophylactic platelet transfusion thresholds. OBJECTIVES To determine whether different platelet transfusion thresholds for administration of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect the efficacy and safety of prophylactic platelet transfusions in preventing bleeding in people with haematological disorders undergoing myelosuppressive chemotherapy or haematopoietic stem cell transplantation (HSCT). SEARCH METHODS We searched for randomised controlled trials (RCTs) in the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library 2015, Issue 6, 23 July 2015), MEDLINE (from 1946), Embase (from 1974), CINAHL (from 1937), the Transfusion Evidence Library (from 1950), and ongoing trial databases to 23 July 2015. SELECTION CRITERIA We included RCTs involving transfusions of platelet concentrates, prepared either from individual units of whole blood or by apheresis, and given to prevent bleeding in people with haematological disorders (receiving myelosuppressive chemotherapy or undergoing HSCT) that compared different thresholds for administration of prophylactic platelet transfusions (low trigger (5 x 10(9)/L); standard trigger (10 x 10(9)/L); higher trigger (20 x 10(9)/L, 30 x 10(9)/L, 50 x 10(9)/L); or alternative platelet trigger (for example platelet mass)). DATA COLLECTION AND ANALYSIS We used the standard methodological procedures expected by Cochrane. MAIN RESULTS Three trials met our predefined inclusion criteria and were included for analysis in the review (499 participants). All three trials compared a standard trigger (10 x 10(9)/L) versus a higher trigger (20 x 10(9)/L or 30 x 10(9)/L). None of the trials compared a low trigger versus a standard trigger or an alternative platelet trigger. The trials were conducted between 1991 and 2001 and enrolled participants from fairly comparable patient populations.The original review contained four trials (658 participants); in the previous update of this review we excluded one trial (159 participants) because fewer than 80% of participants had a haematological disorder. We identified no new trials in this update of the review.Overall, the methodological quality of the studies was low across different outcomes according to GRADE methodology. None of the included studies were at low risk of bias in every domain, and all the included studies had some threats to validity.Three studies reported the number of participants with at least one clinically significant bleeding episode within 30 days from the start of the study. There was no evidence of a difference in the number of participants with a clinically significant bleeding episode between the standard and higher trigger groups (three studies; 499 participants; risk ratio (RR) 1.35, 95% confidence interval (CI) 0.95 to 1.90; low-quality evidence).One study reported the number of days with a clinically significant bleeding event (adjusted for repeated measures). There was no evidence of a difference in the number of days of bleeding per participant between the standard and higher trigger groups (one study; 255 participants; relative proportion of days with World Health Organization Grade 2 or worse bleeding (RR 1.71, 95% CI 0.84 to 3.48, P = 0.162; authors' own results; low-quality evidence).Two studies reported the number of participants with severe or life-threatening bleeding. There was no evidence of any difference in the number of participants with severe or life-threatening bleeding between a standard trigger level and a higher trigger level (two studies; 421 participants; RR 0.99, 95% CI 0.52 to 1.88; low-quality evidence).Only one study reported the time to first bleeding episode. There was no evidence of any difference in the time to the first bleeding episode between a standard trigger level and a higher trigger level (one study; 255 participants; hazard ratio 1.11, 95% CI 0.64 to 1.91; low-quality evidence).Only one study reported on all-cause mortality within 30 days from the start of the study. There was no evidence of any difference in all-cause mortality between standard and higher trigger groups (one study; 255 participants; RR 1.78, 95% CI 0.83 to 3.81; low-quality evidence).Three studies reported on the number of platelet transfusions per participant. Two studies reported on the mean number of platelet transfusions per participant. There was a significant reduction in the number of platelet transfusions per participant in the standard trigger group (two studies, mean difference -2.09, 95% CI -3.20 to -0.99; low-quality evidence).One study reported on the number of transfusion reactions. There was no evidence to demonstrate any difference in transfusion reactions between the standard and higher trigger groups (one study; 79 participants; RR 0.07, 95% CI 0.00 to 1.09).None of the studies reported on quality of life. AUTHORS' CONCLUSIONS In people with haematological disorders who are thrombocytopenic due to myelosuppressive chemotherapy or HSCT, we found low-quality evidence that a standard trigger level (10 x 10(9)/L) is associated with no increase in the risk of bleeding when compared to a higher trigger level (20 x 10(9)/L or 30 x 10(9)/L). There was low-quality evidence that a standard trigger level is associated with a decreased number of transfusion episodes when compared to a higher trigger level (20 x 10(9)/L or 30 x 10(9)/L).Findings from this review were based on three studies and 499 participants. Without further evidence, it is reasonable to continue with the current practice of administering prophylactic platelet transfusions using the standard trigger level (10 x 10(9)/L) in the absence of other risk factors for bleeding.
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Affiliation(s)
- Lise J Estcourt
- NHS Blood and TransplantHaematology/Transfusion MedicineLevel 2, John Radcliffe HospitalHeadingtonOxfordUKOX3 9BQ
| | - Simon J Stanworth
- Oxford University Hospitals NHS Foundation Trust and the University of OxfordNational Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe Hospital, Headley WayHeadingtonOxfordUKOX3 9BQ
| | - Carolyn Doree
- NHS Blood and TransplantSystematic Review InitiativeJohn Radcliffe HospitalOxfordUKOX3 9BQ
| | - Sally Hopewell
- University of OxfordCentre for Statistics in MedicineWolfson CollegeLinton RoadOxfordOxfordshireUKOX2 6UD
| | - Marialena Trivella
- University of OxfordCentre for Statistics in MedicineWolfson CollegeLinton RoadOxfordOxfordshireUKOX2 6UD
| | - Michael F Murphy
- Oxford University Hospitals and the University of OxfordNHS Blood and Transplant; National Institute for Health Research (NIHR) Oxford Biomedical Research CentreJohn Radcliffe HospitalHeadingtonOxfordUK
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Frotscher B, Salignac S, Muller M, Latger-Cannard V, Feugier P, Lesesve JF. Interference of blast cell fragments with automated platelet counting. Int J Lab Hematol 2015; 37:613-9. [DOI: 10.1111/ijlh.12371] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 03/03/2015] [Indexed: 11/30/2022]
Affiliation(s)
- B. Frotscher
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Haemophilia Treatment Centre; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - S. Salignac
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - M. Muller
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Laboratory of Genetics; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - V. Latger-Cannard
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Flow Cytometry Plateform; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - P. Feugier
- Department of Clinical Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
| | - J. F. Lesesve
- Department of Laboratory Haematology; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
- Flow Cytometry Plateform; University Hospital of Nancy; Vandoeuvre-lès-Nancy France
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Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O'Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AA. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2015; 162:205-13. [PMID: 25383671 DOI: 10.7326/m14-1589] [Citation(s) in RCA: 563] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients. METHODS These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RECOMMENDATION 1 The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 109 cells/L or less to reduce the risk for spontaneous bleeding. The AABB recommends transfusing up to a single apheresis unit or equivalent. Greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective. (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2 The AABB suggests prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count less than 20 × 109 cells/L. (Grade: weak recommendation; low-quality evidence). RECOMMENDATION 3 The AABB suggests prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 4 The AABB suggests prophylactic platelet transfusion for patients having major elective nonneuraxial surgery with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 5 The AABB recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. The AABB suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 6 The AABB cannot recommend for or against platelet transfusion for patients receiving antiplatelet therapy who have intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain recommendation; very-low-quality evidence).
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Affiliation(s)
- Richard M. Kaufman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Benjamin Djulbegovic
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Terry Gernsheimer
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Steven Kleinman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Alan T. Tinmouth
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Kelley E. Capocelli
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Mark D. Cipolle
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Claudia S. Cohn
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Mark K. Fung
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Brenda J. Grossman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Paul D. Mintz
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Barbara A. O'Malley
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Deborah A. Sesok-Pizzini
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Aryeh Shander
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Gary E. Stack
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Kathryn E. Webert
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Robert Weinstein
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Babu G. Welch
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Glenn J. Whitman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Edward C. Wong
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Aaron A.R. Tobian
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
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O'Shea CM, Werre SR, Dahlgren LA. Comparison of platelet counting technologies in equine platelet concentrates. Vet Surg 2014; 44:304-13. [PMID: 25307726 DOI: 10.1111/j.1532-950x.2014.12290.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Accepted: 02/01/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE (1) To compare the performance of 4 platelet counting technologies in equine platelet concentrates and (2) to evaluate the ability of the Magellan platelet rich plasma (PRP) system to concentrate equine platelets. STUDY DESIGN Experimental study to assess method agreement. ANIMALS Adult mixed breed horses (n = 32). METHODS Acid citrate dextrose-A anti-coagulated whole blood was collected and PRP produced using the Magellan system according to the manufacturer's instructions. Platelets were quantified using 4 counting methods: optical scatter (Advia 2120), impedance (CellDyn 3700), hand counting, and fluorescent antibody flow cytometry. Platelet concentrations were compared using Passing and Bablok regression analyses and mixed model ANOVA. Significance was set at P < .05. RESULTS Platelet concentrations measured in identical PRP samples were consistently higher for the Advia 2120 than the CellDyn 3700. Systematic and proportional biases were observed between these 2 automated methods when analyzed by regression analysis of the larger sample size. No bias (systematic or proportional) was observed among any of the other counting methods. Despite the bias detected between the 2 automated systems, there were no significant differences on average among the 4 counting methods evaluated, based on the ANOVA. The Magellan system consistently generated high platelet concentrations as well as higher than expected WBC concentrations. CONCLUSIONS The Magellan system delivered desirably high platelet concentrations; however, WBC concentrations may be unacceptably high for some orthopedic applications. All 4 platelet counting methods tested were equivalent on average and therefore suitable for quantifying platelets in equine PRP used for clinical applications.
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Affiliation(s)
- Caitlin M O'Shea
- Department of Large Animal Clinical Sciences, Virginia-Maryland College of Veterinary Medicine, Virginia Tech, Blacksburg, Virginia
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Park IJ, Ahn S, Kim YI, Kang SJ, Cho SR. Performance evaluation of Samsung LABGEO(HC10) Hematology Analyzer. Arch Pathol Lab Med 2014; 138:1077-82. [PMID: 25076297 DOI: 10.5858/arpa.2013-0439-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Samsung LABGEO(HC10) Hematology Analyzer (LABGEO(HC10)) is a recently developed automated hematology analyzer that uses impedance technologies. The analyzer provides 18 parameters including 3-part differential at a maximum rate of 80 samples per hour. OBJECTIVE To evaluate the performance of the LABGEO(HC10). DESIGN We evaluated precision, linearity, carryover, and relationship for complete blood cell count parameters between the LABGEO(HC10) and the LH780 (Beckman Coulter Inc) in a university hospital in Korea according to the Clinical and Laboratory Standards Institute guidelines. Sample stability and differences due to the anticoagulant used (K₂EDTA versus K₃EDTA) were also evaluated. RESULTS The LABGEO(HC10) showed linearity over a wide range and minimal carryover (<1%) for white blood cell, hemoglobin, red blood cell, and platelet parameters. Correlation between the LABGEO(HC10) and the LH780 was good for all complete blood cell count parameters (R > 0.92) except for mean corpuscular hemoglobin concentration. The bias estimated was acceptable for all parameters investigated except for monocyte count. Most parameters were stable until 24 hours both at room temperature and at 4°C. The difference by anticoagulant type was statistically insignificant for all parameters except for a few red cell parameters. CONCLUSIONS The accurate results achievable and simplicity of operation make the unit recommendable for small to medium-sized laboratories.
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Affiliation(s)
- Il Joong Park
- From the Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
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Lippi G, Pavesi F, Avanzini P, Chetta F, Aloe R, Pipitone S. Development of simple equations for effective screening of spurious hemolysis in whole-blood specimens. Int J Lab Hematol 2014; 37:253-8. [PMID: 25041897 DOI: 10.1111/ijlh.12277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 06/24/2014] [Indexed: 12/01/2022]
Abstract
INTRODUCTION We aimed to identify simple but reliable indices for effective screening of spurious hemolysis in whole-blood specimens. METHODS Thirteen inpatient whole-blood samples were divided in two aliquots. The former was left untreated, whereas the latter was mechanically hemolyzed by forced aspiration with an insulin syringe. All aliquots were tested on Siemens Advia 2120 and Sysmex XE-2100. The hemolysis index (HI) was also assessed in centrifuged plasma. RESULTS The mechanical hemolysis generated a 4-40% decrease in red blood cells (RBCs). A statistically significant decrease was observed for hematocrit (Ht) and mean corpuscular volume (MCV), whereas mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, and platelet count were increased. The values of hemoglobin (Hb) and white blood cells remained substantially unchanged. Two specific equations ([Ht/Hb] × √MCV and [Ht/Hb] × 100) were developed. Both equations displayed an area under the curve of ≥0.99 for identifying spurious hemolysis, much greater than that of both RBC ghosts and immature platelet fraction. A highly significant correlation was also observed between results of these equations and percentage reduction in RBCs or HI increase. CONCLUSION Provided that these results will be confirmed in further studies, these equations may provide a reliable means for screening spurious hemolysis in whole-blood samples.
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Affiliation(s)
- G Lippi
- Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
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Tanaka Y, Tanaka Y, Gondo K, Maruki Y, Kondo T, Asai S, Matsushita H, Miyachi H. Performance evaluation of platelet counting by novel fluorescent dye staining in the XN-series automated hematology analyzers. J Clin Lab Anal 2014. [PMID: 24648166 DOI: 10.1002/jcla.21691.[epubaheadofprint19mar2014]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Conventional automated hematology analyzers have limitations in platelet measurements such as poor accuracy and precision in the low count range and interference by nonplatelet particles. In order to improve it, the newly developed XN-Series automated hematology analyzers (Sysmex Corporation, Kobe, Japan) have been installed with a new dedicated channel for platelet analysis (PLT-F), which is based on a fluorescence flow cytometry method with uses of a novel fluorescent dye specifically staining platelets. We evaluated the basic performance of this new PLT-F channel. METHODS Basic performance of the PLT-F channel in within-run reproducibility and assay linearity was studied using standard methods. Correlation was studied between PLT-F and a conventional automated hematology analyzer (XE-2100) and immunoplatelet analysis using anti-CD61 monoclonal antibody (Cell-Dyn Sapphire; Abbott Laboratories). The assay interference by nonplatelet particles such as fragmented red and white blood cells was evaluated by using clinical samples, respectively, from burn injury and acute leukemia. RESULTS Basic performance of the PLT-F platelet counting was satisfactory in within-run reproducibility, linearity and correlation with the conventional analyzer. The correlation was satisfactory also with the immunoplatelet analysis, even for samples from a patient with burn injury, and those with white blood cell fragments displayed, platelet abnormal flag and low platelet counts (<50 × 10(9)/l). CONCLUSION The platelet counting performance of the PLT-F channel of the XN Series had improved accuracy and precision in the low range and in abnormal samples, avoiding the interference by nonplatelet particles.
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Affiliation(s)
- Yuzo Tanaka
- Clinical Laboratory, Tokai University Hospital, Isehara, Japan
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Tanaka Y, Tanaka Y, Gondo K, Maruki Y, Kondo T, Asai S, Matsushita H, Miyachi H. Performance evaluation of platelet counting by novel fluorescent dye staining in the XN-series automated hematology analyzers. J Clin Lab Anal 2014; 28:341-8. [PMID: 24648166 DOI: 10.1002/jcla.21691] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 09/12/2013] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Conventional automated hematology analyzers have limitations in platelet measurements such as poor accuracy and precision in the low count range and interference by nonplatelet particles. In order to improve it, the newly developed XN-Series automated hematology analyzers (Sysmex Corporation, Kobe, Japan) have been installed with a new dedicated channel for platelet analysis (PLT-F), which is based on a fluorescence flow cytometry method with uses of a novel fluorescent dye specifically staining platelets. We evaluated the basic performance of this new PLT-F channel. METHODS Basic performance of the PLT-F channel in within-run reproducibility and assay linearity was studied using standard methods. Correlation was studied between PLT-F and a conventional automated hematology analyzer (XE-2100) and immunoplatelet analysis using anti-CD61 monoclonal antibody (Cell-Dyn Sapphire; Abbott Laboratories). The assay interference by nonplatelet particles such as fragmented red and white blood cells was evaluated by using clinical samples, respectively, from burn injury and acute leukemia. RESULTS Basic performance of the PLT-F platelet counting was satisfactory in within-run reproducibility, linearity and correlation with the conventional analyzer. The correlation was satisfactory also with the immunoplatelet analysis, even for samples from a patient with burn injury, and those with white blood cell fragments displayed, platelet abnormal flag and low platelet counts (<50 × 10(9)/l). CONCLUSION The platelet counting performance of the PLT-F channel of the XN Series had improved accuracy and precision in the low range and in abnormal samples, avoiding the interference by nonplatelet particles.
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Affiliation(s)
- Yuzo Tanaka
- Clinical Laboratory, Tokai University Hospital, Isehara, Japan
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Vinholt PJ, Hvas AM, Nybo M. An overview of platelet indices and methods for evaluating platelet function in thrombocytopenic patients. Eur J Haematol 2014; 92:367-76. [PMID: 24400878 DOI: 10.1111/ejh.12262] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/29/2013] [Indexed: 12/17/2022]
Abstract
Thrombocytopenia is associated with bleeding risk. However, in thrombocytopenic patients, platelet count does not correlate with bleeding risk and other factors are thus likely to contribute to this risk. This review presents currently available platelet-related markers available on automated haematology analysers and commonly used methods for testing platelet function. The test principles, advantages and disadvantages of each test are described. We also evaluate the current literature regarding the clinical utility of the test for prediction of bleeding in thrombocytopenia in haematological and oncological diseases. We find that several platelet-related markers are available, but information about the clinical utility in thrombocytopenia is limited. Studies support that mean platelet volume (MPV) can aid diagnosing the cause of thrombocytopenia and low MPV may be associated with bleeding in thrombocytopenia. Flow cytometry, platelet aggregometry and platelet secretion tests are used to diagnose specific platelet function defects. The flow cytometric activation marker P-selectin and surface coverage by the Cone-and-Plate[let] analyser predict bleeding in selected thrombocytopenic populations. To fully uncover the clinical utility of platelet-related tests, information about the prevalence of platelet function defects in thrombocytopenic conditions is required. Finally, knowledge of the performance in thrombocytopenic samples from patients is essential.
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Affiliation(s)
- Pernille J Vinholt
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
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Estcourt LJ, Stanworth S, Doree C, Trivella M, Hopewell S, Murphy MF, Tinmouth A. Comparison of different platelet count thresholds to guide administration of prophylactic platelet transfusion for preventing bleeding in patients with haematological disorders after chemotherapy or stem cell transplantation. Cochrane Database Syst Rev 2014:CD010983. [PMID: 25722651 PMCID: PMC4338576 DOI: 10.1002/14651858.cd010983] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This is the protocol for a review and there is no abstract. The objectives are as follows: To determine whether different platelet transfusion thresholds for administration of prophylactic platelet transfusions (platelet transfusions given to prevent bleeding) affect the efficacy and safety of prophylactic platelet transfusions in preventing bleeding in patients with haematological disorders after chemotherapy with or without stem cell transplantation.
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Affiliation(s)
- Lise J Estcourt
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Simon Stanworth
- Haematology/Transfusion Medicine, NHS Blood and Transplant, Oxford, UK
| | - Carolyn Doree
- Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK
| | | | - Sally Hopewell
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | | | - Alan Tinmouth
- Medicine (hematology) and Pathology Centre for Transfusion Research, The Ottawa Health Research Institute and the University of Ottawa, Ottawa, Canada
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Lozano M, Mahon A, van der Meer PF, Stanworth S, Cid J, Devine D, Fung MK, de la Salle B, Heddle NM. Counting platelets at transfusion threshold levels: impact on the decision to transfuse. A BEST Collaborative - UK NEQAS(H) International Exercise. Vox Sang 2013; 106:330-6. [PMID: 24330101 DOI: 10.1111/vox.12110] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/08/2013] [Accepted: 10/09/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Obtaining accurate and precise platelet enumeration in automatic platelet analysers at low platelet counts is a challenge. To explore the performance of current haematology analysers in counting platelet concentrations usually used as platelet transfusion threshold. MATERIAL AND METHODS An international exercise where four blood samples with platelet levels near usual platelet transfusion thresholds was prepared and distributed. RESULTS The samples shipped had a platelet count of 6·3, 13·3, 21·6 and 53·0 × 10(9) /l according to the international reference method. We received 82 sets of results from nine countries. Instruments from six different manufacturers were represented. Although the mean count for each of the four samples was very similar to the values, according to the reference method (9·0, 16·2, 23·0 and 57·6 × 10(9) /l), significant variability in the results was found. Assuming that these were patient samples and the result of the count used to indicate a prophylactic platelet transfusion, undertransfusion would have occurred for 24·5% of the LP1 samples at a transfusion threshold of 10 × 10(9) /l and, at a threshold of 20 × 10(9) /l, undertransfusion would have occurred for 7·2% of the LP1 and 16·2% of the LP2 samples and overtransfusion would have occurred with 23·1% of the LP3 samples. CONCLUSION The results suggest that significant inaccuracy exists in counting low levels of platelets and that this inaccuracy might have a significant impact in under- and overtransfusion of platelet concentrates to patients.
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Affiliation(s)
- M Lozano
- University Clinic Hospital, Barcelona, Spain
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Vaughan J, Wiggill T, Munster M. Immature platelet fraction levels in a variety of bone marrow pathologies in South African HIV-positive patients with thrombocytopenia. ACTA ACUST UNITED AC 2013; 19:417-23. [PMID: 24295040 DOI: 10.1179/1607845413y.0000000143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES Thrombocytopenia is common in HIV-infected individuals and often requires a diagnostic bone marrow examination. Interpretation may, however, be limited due to the multifactorial nature of HIV-associated thrombocytopenia and the difficulty in assessing megakaryocyte function morphologically. The immature platelet fraction (IPF) is a parameter which reportedly reflects megakaryocyte activity, with an IPF >7.7% suggesting increased platelet production. The aim of this study was to correlate the IPF with the bone marrow findings as well as other clinical variables of interest in South African patients with HIV-associated thrombocytopenia. METHODS Seventy-eight HIV-positive patients with thrombocytopenia were enrolled from the Charlotte Maxeke Johannesburg Academic Hospital. The IPF levels were measured using a Sysmex XE-5000 haematology analyzer and were correlated with bone marrow and other findings. RESULTS The median IPF was 7.6%, ranging from 1.3 to 44%. It was raised in 78% of patients with immune thrombocytopenia (ITP) (median = 16.3%) and low in 79% of patients with hypocellular marrow (median = 6.5%). Surprisingly, it was highly variable among patients with malignant marrow infiltration and mycobacterial infection of the bone marrow (BMTB) (median = 8.4 and 7.1%, respectively). Multivariate linear regression analysis confirmed a significant independent inverse relationship between the IPF and hypocellular marrow (P < 0.0001), a marginally significant positive association with ITP (P = 0.059), and the absence of any relationship with malignant infiltration or BMTB. The IPF had a significant inverse association with the platelet count (P = 0.0006), but was unrelated to the CD4 count and exposure to anti-retroviral therapy. Unexpectedly, it showed a significant positive association with the HIV viral load (P = 0.005). We speculate this to reflect increased megakaryocyte activity in compensation for accelerated platelet clearance due to HIV-driven platelet activation. CONCLUSION This study investigates the role of the IPF in HIV-associated thrombocytopenia, and emphasizes the limitations of morphological analysis in determining megakaryocyte function.
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Marionneaux S, Francisco N, Chan V, Hanenberg J, Rafael J, Chua C, Jia R, Yao J, Lynch J, Chan V, Maslak P. Comparison of automated platelet counts and potential effect on transfusion decisions in cancer patients. Am J Clin Pathol 2013; 140:747-54. [PMID: 24124156 DOI: 10.1309/ajcp58intitvgqzi] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVES To evaluate the accuracy of platelet counts from various hematology analyzers using a reference immunologic method. METHODS We tested 403 samples with platelet counts less than 50 × 10(9)/L with the Advia (Siemens, Tarrytown, NY), Sysmex (Mundelein, IL), and Abbott (Santa Clara, CA) analyzers. RESULTS All methods showed a positive bias, especially at less than 20 × 10(9)/L and less than 10 × 10(9)/L. Undertransfusion risk ranged from 9.1% to 43.3 % in the groups below 20 × 10(9)/L and below 10 × 10(9)/L, respectively. For patients with optical counts more than 10 × 10(9)/L and CD61 less than 10 × 10(9)/L, 64.5% were transfused within 24 hours of the reported count, while 35.5% were transfused in more than 24 hours, after a subsequent optical platelet count of 10 × 10(9)/L or less was reported. CONCLUSIONS Although optical and impedance methods were shown to be falsely increased in severely thrombocytopenic samples, further studies are needed to determine if more accurate methods would be clinically useful.
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Affiliation(s)
| | | | - Virgil Chan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | | | | | - Conchita Chua
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Rachel Jia
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jingqui Yao
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Jean Lynch
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Vicky Chan
- Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Peter Maslak
- Memorial Sloan-Kettering Cancer Center, New York, NY
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Dijkstra-Tiekstra M, Rondeel J, Slomp J, Smid W, de Wildt-Eggen J. A positive effect of immune suppression on corrected count increment after platelet transfusion at 1 but not at 24h. Transfus Apher Sci 2013; 49:189-92. [DOI: 10.1016/j.transci.2013.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Revised: 01/17/2013] [Accepted: 02/13/2013] [Indexed: 12/01/2022]
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