Automated Hematology Analyzer Research Articles

Intravenous iron sucrose when administered to moderately anemic pregnant women raises the hemoglobin concentration and replenishes body iron at 6 months

ABSTRACT Introduction: Intravenous iron sucrose (IVIS) is a rapidly acting, safe, and effective treatment for moderate anemia among pregnant women. The effectiveness of IVIS at 6 months post IVIS infusion was unknown. We, therefore, assessed the mean increase in hemoglobin concentration and body iron replenishment status at 6 months after the last dose of IVIS infusion. Methods: The study was conducted in 28 villages served by two primary health centers in district Faridabad, Haryana. The participants (n = 129), when originally recruited in 2020, were all moderately anemic (hemoglobin level 7.0 to 9.9 g/dL) pregnant women in either the second or third trimester of pregnancy. Their iron deficiency was calculated by Ganzoni’s formula with additional allowance of 500 mg of depot iron. The calculated deficit was rounded off to the nearest 100 mg. The dose of IVIS was 300 mg of iron diluted in 300 ml of normal saline administered intravenously every third day till the full calculated dose was administered. In this study, we collected the follow-up blood specimen 6 months after the last dose of IVIS and measured the hemoglobin concentration, C-Reactive protein (CRP), and serum ferritin level. Hemoglobin concentration was measured using an automated hematology analyzer (Sysmex XS-1000i). Serum ferritin and CRP were measured by enhanced chemiluminescence immunoassay and the enzymatic heterogeneous, sandwich immunoassay method, respectively (VITROS ECiQ, Ortho Clinical Diagnostics, New Jersey, USA). Results: The mean [standard deviation (SD)] duration of time elapsed since the administration of the last dose of IVIS infusion was 6.4 (0.9) months. The mean (SD) hemoglobin level at the time of original recruitment (baseline) was 8.7 ± 0.8 g/dL. The mean (SD) increase in the hemoglobin concentration at 6 months follow-up was 3.2 [95% confidence interval (CI): 3.0–3.4)] g/dL. The median [interquartile range (IQR)] serum ferritin level (ng/mL) at follow-up was 28.1 (12.7, 61.5). A total of 10.2% of the participants had a raised (>10 mg/L) CRP level. Adjusting for CRP level and based on serum ferritin level, the proportion of participants who were iron-deficient was 35.3%. The proportion of participants who had any degree of anemia was 70.5%. Conclusion: Administration of IVIS infusion was effective in raising the mean hemoglobin concentration and in replenishing the body iron reserve at 6 months post infusion.

The role of neutrophils-lymphocytes ratio (NLR), lymphocytes-monocytes ratio (LMR), platelets-lymphocytes ratio (PLR) in oral cancer and acute dental infections

Objectives: The present study was a cross-sectional observational study, which was carried out on patients reported to the Department of Oral Medicine and Radiology. This study aims to evaluate the hemogram parameters NLR, LMR, and PLR among 90 Patients. Methods: Patients were divided into 3 groups: Group A consists of 30 patients with histopathological confirmed oral cancer. Group B consists of 30 patients who presenting acute dental infections. Group C consists of 30 patients clinically healthy subjects. The hemogram parameters NLR, LMR and PLR were compared in the 3 groups and we studied their correlation to the clinical prognostic indicators like T stage, to the presence or absence of lymph node metastasis, and to differentiation of cancer. After obtaining personal informed consent, a thorough examination of the oral cavity and the lesion was conducted with an illuminated light and mouth mirror. Blood tests were performed on all the subjects before treatment. Under aseptic conditions, Venous blood (2 ml) was collected by venepuncture of the median cubital vein in the cubital fossa of the forearm using a disposable syringe with a 24-gauge needle. The withdrawn blood was transferred into an EDTA-containing test tube. Haematological parameters were analysed using an automated haematology analyzer. NLR, LMR, and PMR were calculated as the ratio of absolute peripheral neutrophil to lymphocyte, lymphocyte to monocyte, and platelet to lymphocyte count, respectively. Results: The present study revealed that NLR is significantly elevated in oral carcinoma compared to healthy individuals, but is lesser than in patiemts with acute dental infections. LMR is higher in oral carcinoma than in acute dental infections and healthy individuals, but no statisticaly significant difference was detected among the groups. PLR is higher in oral carcinoma than in Acute dental infections and healthy individuals, and it is statistaicaly significant. There are significant correlations in oral carcinoma between NLR, LMR, and PLR. NLR has a positive correlation with PLR and a negative correlation with LMR, which showed clinical significance as determined by the Spearman correlation coefficient. In Acute dental infections and healthy individuals, there is a significant correlation of NLR with LMR and PLR but no significant correlations between LMR and PLR and vice versa. NLR, LMR, and PLR were correlated to clinical prognostic indicators like T stage, presence or absence of lymph node metastasis, and differentiation of cancer. There is no significant difference in NLR, LMR, or PLR ratios concerning Clinical T staging since the p-value is greater than 0.05 for NLR, LMR, and PLR (p= 0.072, 0.446, 0.446, respectively). A statistically significant difference is found in LMR to the clinical presence or absence of Lymph node metastasis since the p-value is less than 0.05 only for LMR (p=0.018). The mean values of LMR in N0, N1, and N2 were 9.49, 5.65, and 4.40, respectively; this implies that the mean value of LMR decreases in advanced oral carcinoma as the nodal stage increases with lymph node metastases. A statically significant difference is found in NLR (p=0.011) and PLR (p =0.013) for differentiation of tumour (p-value is less than 0.05), which implies NLR & PLR values are elevated in moderate differentiated oral carcinomas when compared to well-differentiated oral carcinoma. Conclusions: A significant elevation exists in haematological parameters like NLR, LMR, and PLR in oral carcinoma and acute dental infections.

“Comparative evaluation of cytotoxicity of three herbal endodontic irrigants at three intervals of time” – An in vitro study

Aim: The aim of the study was to evaluate and compare the cytotoxicity of 25% of neem leaf extract (Azadirachta indica), 20% of guava leaf extracts (Psidium guajava), and 20% of cinnamon extract (Cinnamomum zeylanicum) irrigants at three intervals of time. Methodology: Four groups were formed (n = 15), Group 1 (control group) – normal saline solution, Group 2 – 25% of neem extract, Group 3 – 20% of guava extract, and Group 4 – 20% of cinnamon extract. Each group was further divided into three subgroups based on intervals (n = 5). Subgroup A – at 10 min, Subgroup B – at 20 min, and Subgroup C – at 30 min. One hundred microliters of each irrigant was added to 2 mL of the diluted red blood cells suspension obtained from a human volunteer. Hemoglobin (Hb) estimation was done with an automated hematology analyzer after incubating the test samples at 10, 20, and 30 min intervals. Results: The reduction in the mean Hb values was not statistically significant in the normal saline, guava, and cinnamon groups. However, in the neem extract group, the mean Hb values reduced significantly at P < 0.001. Among the subgroups, Subgroup A (10 min) showed the least cytotoxicity. Conclusion: In the present study, 20% guava extract had the lowest cytotoxicity and cytotoxicity increased with time. Hence, 20% guava extract can be used as an alternative to conventional irrigants as it has been shown to have the least cytotoxicity.

Rapid reagent-free anaemia screening using plant-derived “HemoQR” paper-strips and smartphone: A study on 200 human subjects

Detecting anaemia in resource-limited settings is challenging due to limited access to diagnostic tools, healthcare infrastructure, and trained personnel, often resulting in underdiagnosis and delayed treatment. This study aims to evaluate HemoQR, a novel point-of-care (POC) diagnostic method for haemoglobin (Hb) level detection using a smartphone-based system integrated with a paper strip without needing any reagent or additional auxiliary device. The goal is to assess the efficacy of this portable, user-friendly, rapid and accurate alternative for Hb measurement in large-scale intervention programmes such as Anaemia-mukt Bharat (AMB), which is crucial for diagnosing anaemia and monitoring various health conditions. The method involves the transfer of one drop of the blood sample to a paper strip that is made indigenously using plant based cellulosic sources for optimal functionality. The colour signal around the test spot is quantitatively analysed using a smartphone camera equipped with a custom application. The application processes the images through a machine learning algorithm to determine the Hb concentration. The system was evaluated in a clinical trial involving 200 participants, comparing its performance with the gold-standard laboratory Hb assay using automated haematology analyser. The smartphone-based method demonstrated high sensitivity (87.09 %) and specificity (96.11 %) for anaemia screening, as compared with laboratory results. The average detection time was significantly reduced to under q minute, and the system showed excellent user-friendliness and portability with no auxiliary device needed beyond the smartphone. Clinical trial results indicated that the device was accurate and reliable across different Hb levels. Summarily, HemoQR evidenced to be a promising tool for POC diagnostics. Its high accuracy, rapid results, and ease of use make it suitable for both clinical settings and remote areas with limited access to laboratory facilities. Future research will prioritize further validation and integration of the anaemia screening outcome with electronic health records from a large population cohort. This will help identify early indicators and signals of numerous emerging disease burdens that could escalate into secondary and tertiary health crises if not addressed in time.

Immuno-hematological parameters among adult HIV patients before and after initiation of Dolutegravir based antiretroviral therapy, Addis Ababa, Ethiopia.

Immuno-hematological abnormalities are common among HIV infected individuals as well as patients with highly active antiretroviral therapy (HAART). However, the immuno-hematological outcome of Dolutegravir based antiretroviral therapy (ART) usage is not well investigated. To assess hematological and immunological parameters among adult HIV patients before and after initiation of Dolutegravir based ART regimen at St. Peter Specialized Hospital, Addis Ababa, Ethiopia. A cross-sectional study was conducted from May to July 2021 at St. Peter Specialized Hospital among adult HIV patients. A total of 422 HIV patients on Dolutegravir based ART (combination of Dolutegravir/lamivudine/tenofovir disoproxil fumarate (DTG/3TC/TDF)) for a minimum of 3 months were selected using convenient sampling methods. Socio-demographic as well as clinical data of the participants was obtained using pre-tested structured questionnaires and a review of medical records. Hematological parameters such as CBC was obtained using Beckman coulter automated hematology analyzer and immunological parameters such as CD4 count were determined using BD FACS presto. Statistical analysis of the data was done using SPSS version 21. Paired t-test was used to compare dependent variables before and after initiation of the new HAART and binary logistic regression was used to determine predictors of immuno-hematological abnormalities. P-value < 0.05 was considered as statistically significant. Of 422 adult HIV patients, about 273(64.7%) were females. The mean age of study participants was 42.2 years (±10.4SD). The mean white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb), platelet distribution width (PDW), CD4 count, as well as lymphocyte percentage, neutrophil percentage, and platelet counts (PLT) were increased significantly(P<0.05) after 3 months of the Dolutegravir based therapy. While, red cell distribution width (RDW) and mean cell hemoglobin (MCH) were decreased (P<0.05) after the treatment. Other hematological parameters such as mean cell volume (MCV), hematocrit (HCT), mean cell hemoglobin concentration (MCHC), mean platelet volume (MPV) and platelet distribution width (PDW) showed no significant change. On the other hand, the most common hematological abnormalities identified after the new HAART were anemia (12.1%); followed by Leucopenia (11.3%), neutropenia (6%), and thrombocytopenia (4%). Anemia was associated with female sex (AOR = 7.8, 95% CI: 1.9-32.2, P<0.005) and WHO clinical stage III/IV (AOR = 16, 95% CI: 10.63-66.46, P<0.01). There was a significant change in certain immuno-hematological parameters such as WBC count, RBC count, PLT count, Hb, PDW, CD4 count, lymphocyte and neutrophil percentage after initiation of the Dolutegravir based therapy. Anemia was the most common hematological abnormality. Further studies are required to fully comprehend the outcome of the new treatment regimen on immuno-hematological parameters.

Влияние на климатичните промени върху хематологичния и биохимичен статус на стадо крави от порода Лимузин в средата на два последователни пасищни сезона

The aim of the present study was to evaluate the status in the red and white blood count, together with the values of some enzymes and metabolites - ALT, AST, ALP, serum iron and glucose in selected animals from a herd of Limousine beef cattle in the middle of two consecutive grazing seasons, with large differences in the average daily temperature, the amount and distribution of precipitation and of the quantity and quality of the grass at the end of its vegetation. The study was conducted in the experimental base “Zlatusha” of the IAS-Kostinbrod with 15 pregnant cows equalized by BCS and age, from which blood samples were taken in July, 2022 and 2023, by venipuncture of the tail vein. The analysis of hematological indicators in whole blood was performed with a 5-Part-Diff Automated Hematology Analyzer URIT-5160, and the analysis of biochemical indicators - in plasma extracted from it with a Semi-automatic Biochemical Analyzer BTS-350. Results are expressed as mean values ± S.E.M. and were analyzed statistically by the analysis of variance (ANOVA) method. Although there was almost no difference in the levels of hematocrit and the number of erythrocytes in the middle of two grazing seasons, in July, 2022, the studied cows had a significantly higher level of hemoglobin than in July, 2023 (P&lt;0.001), which reflected also on the significance of the difference in mean corpuscular hemoglobin (MCH) and mean corpuscular hemoglobin concentration (MCHC) – also at P&lt;0.001. There were no significant differences in leukocyte counts and leukocyte subpopulations and in iron and glucose concentrations in the middle of two consecutive years. ALT and AST enzyme activities were significantly lower (P&lt;0.05), and ALP activity was significantly higher in July, 2022 (P&lt;0.01).

Definition of Significant Platelet Clumping: Should We Review All Samples With a Platelet Clumping Flag From Automated Hematology Analyzer?

This study aimed to determine a definition for significant platelet clumping (PC) and evaluate the performance of the Sysmex XN instrument for detecting platelet clumps. For part 1, 372 specimens with a 'PLT_clump?' flag in XN-9000 were classified into five groups according to the average number of PCs. We compared the initial platelet count (measured by XN-9000 using impedance method) and corrected platelet count (counted optically or re-analyzed by XN-9000 using vortexed or re-collected sample) of each group. For part 2, 1000 specimens with a PC flag divided into three subgroups {group N (PC = 0), Y (PC ≥ 1), and Z (microscopic fibrin clot)} and additional two groups {group S (PC(+) specimens without any flag and with flags of other categories) and group NC (negative control)} were collected. Positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity of PC detection of XN-9000 were obtained and the platelet counts and four indices (PDW, MPV, P_LCR, and PCT) of groups NC, N, Y, Z, and S were compared to detect PC more precisely. In part 1, all groups showed significant difference between the initial and corrected platelet counts. In part 2, PPV, NPV, prevalence, sensitivity, and specificity were 41.5%, 56.5%, 43.4%, 2.18%, and 98.3%, respectively. The platelet counts and four indices showed statistical differences for detecting PCs, and especially PDW and P_LCR were significantly smaller in group Z than group N or Y. We suggest the definition of significant PC by the presence of at least three platelets. In addition, utilizing platelet-related indices should be developed to improve the efficiency of the PC detection.

Diagnostic Value of Osteopontin, Lymphocyte-to-Monocyte Ratio, and CA-125 in Ovarian Carcinoma Suspect

Osteopontin (OPN) is an important protein in cancer development and progressivity. Lymphocyte-to-Monocyte Ratio (LMR) as a systemic immunity and inflammatory indicator could be an ideal predictor biomarker because of its method’s simplicity and availability. Elevated CA-125 and OPN as well as decreased LMR were reported as signs of ovarian malignancy. Limited studies about OPN and LMR as diagnostic biomarkers, as well as various specificity and sensitivity of CA-125 intrigued the researcher to prove OPN, LMR, and CA-125 as diagnostic biomarkers for ovarian carcinoma. This study aimed to measure the diagnostic value of OPN, LMR, and CA-125 levels against histopathology results for ovarian carcinoma diagnosis. Eighty patients involved with suspected ovarian carcinoma who were referred to Dr. Kariadi Hospital, Semarang. Osteopontin and CA-125 levels were measured using ELISA, and LMR was calculated from absolute lymphocyte and monocyte counts using an automated hematology analyzer. The receiver operating characteristics curve was used to determine the cut-off and 2x2 table. The cut-off values for OPN, LMR, and CA-125 were 124 ng/mL, 3.7 and 45.4 U/mL, respectively. The sensitivity for OPN, LMR, and CA-125 was 67.24%, 62.07% and 60.34%. Specificity for OPN, LMR, and CA-125 were 68.18%, 54.55% and 59.09%. Osteopontin is the best parameter for determining the diagnosis of ovarian carcinoma but it is still not sufficient because OPN cut-off was still within the normal reference value.

Detection of Catalase and 4-Hydroxynonenal as Detective Biomarkers in Iraqi Breast Cancer

Breast cancer is the most common malignant tumor among women and a leading cause of cancer-related death. Early diagnosis is critical for improving treatment outcomes. The objective of this study is to determine and examine catalase (CAT) and 4-hydroxynonenal (4-HNE) markers as non-invasive biomarkers for early detection in Iraqi breast cancer. A case-control study of 150 participants was further divided into 75 women with a diagnosis of breast cancer and 75 healthy controls. In the present study, blood samples were collected for the determination of serum CAT and 4-HNE levels using an enzyme-linked immunosorbent assay technique. The biochemical markers urea and creatinine were determined by automated Cobas c311. Hemoglobin concentration (HB)-and total white blood cell (WBC) count was done by an automated hematology analyzer. Statistical analyses were performed using the SPSS version 24, where receiver operating characteristics (ROC) analysis was used to assess diagnostic performance. CAT activity was significantly reduced in the patient group (6.07±1.19 pg/ml) compared to controls (12.11±2.74 pg/ml), while 4-HNE was significantly elevated in the patient group (11.43±2.41 pg/ml) compared to control (3.83±1.02 pg/ml). Among hematology analyzer, there was a significant difference in HB and WBC between patients and controls. Roc analyses demonstrated a sensitivity of 100% for CAT and 98% for 4-HNE. Reduced serum levels of CAT and elevated 4-HNE levels in Iraqi breast cancer may serve as new diagnostic biomarkers for breast cancer, highlighting their role in disease progression.

Hematology instruments don’t speak the same language: a comparison study between flagging messages of sysmex XN-1000 and alinity H

Abstract Objectives While manual review is the gold standard, automated hematology analyzers are increasingly used. This study assessed the efficiency of white blood cell (WBC)-related flagging messages from the Sysmex XN-1000 and Alinity hq analyzers compared to peripheral blood smear (PBS) findings and evaluated their inter-platform agreement. Methods K3EDTA blood samples from hospitalized patients were analyzed using the Sysmex XN-1000. Samples triggering a morphology flag were reanalyzed on the Alinity hq, with PBS reviewed per CLSI protocol H20-A2-2007. Results Of 5530 samples, 196 had morphology-related flags requiring PBS review. Sysmex flagged 144 samples with leukocyte-related messages; Alinity flagged 120. The positive predictive value (PPV) for the Left Shift flag was 100 % for Sysmex and 77.5 % for Alinity; for Immature Granulocytes, it was 19.4 % for Sysmex and 94.6 % for Alinity. The Blast Flag’s PPVs were 9.3 % for Sysmex and 17.9 % for Alinity. Left Shift specificities were high (&gt;94 %), but sensitivities varied. Sysmex showed 100 % sensitivity for the Blast flag but moderate specificity (53 %), while Alinity performed well (77–82 %). Agreement between platforms ranged from poor to good. Conclusions Tailored SOPs are crucial for optimizing laboratory workflow based on different flagging performances. Understanding each analyzer’s strengths and limitations improves interpretation and workflow management.

UTILITY OF AUTOMATED HEMATOLOGY ANALYZER IN THE DETECTION OF MALIGNANT CELLS IN SEROUS EFFUSIONS

Abstract Introduction/Objective Although microscopic examination is the gold standard for body fluid malignant cytology, it has a higher turnaround time and inter observed variability. Screening of serous effusions for malignant cells using haematology methods of automated analysis provides a rapid and objective result to the clinicians for initiating necessary treatment. Automated haematology analysers are equipped with body fluid (BF) mode that can detect high fluorescence cells body fluid (HF-BF) cells, mononuclear and polymorphonuclear (PMN) cells using flowcytometry laser scatter principles. The high fluorescence parameters useful for identifying malignant cells in the effusions Methods/Case Report The study was performed between February 2023to Februart 2024 at AIG Hospitals, Hyderabad after obtaining approval from the medical ethics committee of thehospital. Body fluidswere collected in K2 EDTA vaccutainer. Simultaneous preparation of smears for microscopic examination and morphometry wasdone and the smears were stained using Romanowsky stain (Leishmann &amp; Giemsa). Cytospin smears were prepared by cyto- centrifugation (Sakura cyto- tix). The slides were stained by Hematoxylin and eosin, May Grunwald Giemsa (MGG) and Papanicolaou (PAP) stains for morphological differentiation and detection of malignant cells. Cell blocks were prepared after through mixing of the fluid using direct sedimentation method and the slides were stained by haematoxylin and eosin stain. IHC was performed where ever necessary. Results (if a Case Study enter NA) A total of 258 fluid samples comprising of 223 ascitic and 35 pleural fluids. Medical statistical software version 20.2 was used for statistical analysisof the results. Considering fluid cell block analysis as the gold standard the patient population was divided into 2 groups, malignant (8 samples) and non- malignant cell group(250 samples). Cytological examination of cytospins smears has shown to have the highest specificity, PPV and NPV in the detection of malignant effusions. Conclusion Our study shows that cytology and histopathological examination of body fluids remains the gold standard for the detection of malignant cells. The HF-BF parameter acts as a rapid, useful tool to predict the presence of malignant cells in serous effusions and select samples for microscopic reviewing that would have otherwise gone undiagnosed. We believe that with defining cut off values for the HF-BF parameter may be used as an adjunct diagnostic tool.

RDW-SD - A more sensitive marker of anisocytosis than RDW-CV in patients with macrocytosis

Background: Anisocytosis is a variation in RBC size. This can be conventionally observed on peripheral blood smear microscopy and also by red cell distribution width, a RBC parameter obtained on automated hematology analyzers. Red cell distribution width is considered a quantitative measure of anisocytosis and does not carry subjective variation associated with microscopy and it is reported as RDW-CV % and RDW-SD. Both these values are calculated differently. Although it is one of the most frequently used hemogram parameters for anisocytosis, it is not well understood. This study aimed to compare the sensitivity of RDW-CV and RDW-SD as markers of anisocytosis in macrocytosis. Material and methods: This was a cross-sectional prospective observational study conducted in a laboratory of a tertiary care hospital in western India. The sample size of 138 was calculated at a precision 0.1 and 90% confidence interval. 138 blood samples each from patients with macrocytosis and normocytosis control group were analysed. Results: The range for RDW-CV &amp; RDW-SD was 12.59%-15.13% &amp; 40.05-47.81fl respectively in our population. Gender-wise distribution showed 72% male &amp; 28% female. The Z score value of 4.12 (&gt;1.96 is significant) reflected a significant difference in anisocytosis detection using RDW-SD compared to RDW-CV in macrocytosis. Conclusions: RDW-SD is a more sensitive marker of RBC anisocytosis than RDW-CV in macrocytosis.

Diagnostic accuracy of a non-invasive spot-check hemoglobin meter, Masimo Rad-67® pulse CO-Oximeter®, in detection of anemia in antenatal care settings in Kenya.

Point of care hemoglobin meters play key roles in increasing access to anemia screening in antenatal care especially in settings with limited access to laboratories. We aimed to determine the diagnostic accuracy of a non-invasive spot-check hemoglobin (SpHb) meter, Masimo Rad-67® Pulse CO-Oximeter®, in the diagnosis of anemia in pregnant women attending antenatal care clinics in Kilifi, Kenya. This was a diagnostic accuracy study that retrospectively evaluated SpHb against a validated reference standard of laboratory assessed hemoglobin (Lab Hb) by a SYSMEX XN-330 automated hematology analyzer. The study was nested within a prospective pregnancy cohort study that recruited unselected pregnant women from antenatal care clinics in two public hospitals in Kilifi County, coastal Kenya. Records with both SpHb and Lab Hb were selected from pregnancy visits between May 2021 and December 2022. Linear regression and Bland-Altman analysis were performed to compare the two tests and diagnostic accuracy parameters obtained for the diagnosis of anemia. A total of 2,975 records (from 2,203 unique participants), with paired SpHb and Lab Hb were analyzed. Linear regression showed a significant but weak positive correlation, a proportional bias of 0.44 (95% CI 0.41-0.47) and a constant of 7.59 (95% CI 7.30-7.87, p < 0.001). The median bias was 1.70 g/dl, with limits of agreement of -0.80 to 4.20. SpHb tended to be higher than Lab Hb on the low hemoglobin range but lower than Lab Hb on the high hemoglobin range. The sensitivity of SpHb in detecting anemia was 18.66%. Prevalence, specificity, positive predictive value, and negative predictive values were 46.37%, 96.77%, 83.33%, and 57.92% respectively. Overall, SpHb by Masimo Rad-67® Pulse CO-Oximeter® did not accurately identify pregnant women with anemia and many cases would be missed. We would not recommend its use in antenatal care settings.

Nosological Pattern of Diseases Accompanied by Chronic Cough in Dogs

Introduction. A practicing veterinarian usually faces difficulties in both diagnosing and treating coughing in dogs. The unsolved problem in diagnosing entails doubts in the efficacy of the prescribed therapy. This is especially relevant for small dog breeds of middle and old age that often suffer from the chronic respiratory diseases and mitral insufficiency due to endocardiosis, and each of these diseases can lead to chronic cough. The aim of the research is to reveal the nosological pattern of the diseases accompanied by chronic cough in dogs.Materials and Methods. The research was based on the analysis of the medical records of 145 dogs with chronic cough that have attended to the network of veterinary clinics “Vita” (Rostov region) in the period from September 1, 2021 to July 31, 2024. The research was carried out using the following equipment: Karl Storz video bronchoscope (PAL colour system, working channel 2.3 mm, gaze direction 0°, aperture angle 120°, up/down deviation 180°/100°, depth of field 3–50 mm, working length 61 cm, outer diameter 6.2 mm); premium ultrasound scanner with improved image quality on the ZST+Mindray Vetus 9 platform; Maxivet 400 veterinary X-ray digital DR system; Poli-Spectrum–8/B computerassisted electrocardiograph; automatic hematology analyzer Idexx ProCyte Dx; automatic biochemistry analyzer Idexx Catalyst One; digital microscope Celestron.Results. The conducted research allowed us to find out the main causes of coughing in dogs. The most common cause of chronic cough found in these animals was chronic bronchitis, including that occurring simultaneously with the collapse of the upper respiratory tract. The rarest revealed cause of chronic cough was endocardiosis.Discussion and Conclusion. Coughing in dogs is not a characteristic sign of endocardiosis: even when the disease was clinically evident, coughing was observed only in the cases of lung congestion and interstitial pulmonary edema. As a rule, dogs with endocardiosis that have a pronounced loud cough intensifying after exertion, have a concomitant disease of the upper respiratory tract. Coughing in dogs with endocardiosis and upper respiratory tract lesion does not go away upon getting merely a specific endocardiosis treatment.

In vitro evaluation of the automated hematology analyzer XN-31 for rapid diagnosis of equine piroplasmosis.

In this study, we demonstrated that the automated hematology analyzer, XN-31, can detect red blood cells infected with Babesia caballi and Theileria equi in about 1 minute. We evaluated the diagnostic performance of the XN-31 analyzer for equine piroplasmosis, providing evidence of its potential as a diagnostic tool for this disease.

A-147 Comparative Precision of Platelet Counting by Optical, Fluorescent, and Impedance Techniques in Thrombocytopenia and Microcytosis Patients

Abstract Background In today's era of automation driven by Artificial Intelligence, even the most efficient automated hematology analyzer may struggle to accurately determine platelet count in patients with low platelet count and microcytosis. The Sysmex XN-series analyzer (Sysmex, Kobe, Japan) uses optical density, fluorescence, and electronic impedance methods for platelet counting. This study aimed to evaluate the accuracy of optical, fluorescence, and electrical impedance methods in estimating precise platelet counts in thrombocytopenic and microcytic patient samples. Methods A cross-sectional study was conducted in the Department of Laboratory Medicine at AIIMS, New Delhi, for 30 days consecutively. A total of 200 blood samples collected, of which 100 samples were of thrombocytopenia (&amp;lt;100x10^9/L) and 100 samples were of microcytosis (Mean corpuscular volume &amp;lt;76 femtoliters). MCV&amp;lt;76 fl was further categorized into 2 groups- MCV 60-70 fl and MCV 71-76 fl accordingly. Males and females were categorized and analyzed distinctly for thrombocytopenia and microcytosis. Statistical analysis was performed using SPSS 16.0 for Windows (SPSS Inc., Chicago, IL, USA) and the Bland Altman plot was analyzed. Results Of the 100 patients with thrombocytopenia (platelet&amp;lt;1 lakh/L) females were predominantly 54% while males were 46% and the median age was 29 years (0.02-70). Of the 100 patients with low MCV (&amp;lt;76 fl) females were 53%, while males were 47% and the median age was 29 years (0.3-69). The findings were compared against the standard manual platelet count method in peripheral smears verified by two expert pathologists. The Bland Altman plot for Platelet &amp;lt;1 lakh/L and MCV &amp;lt;76 fl were compared with standard manual platelet count method and the following findings were obtained i) In female with PLT- &amp;lt;1 lakh/L, PLT-O showed least bias (9.8) followed by PLT-F (10.4) and PLT-I (12.1) ii) In males with PLT-&amp;lt;1 lakh/L, PLT-O showed least bias(14.1) followed by PLT-F(16.5) and PLT-I(17.0) iii) For MCV 61-70fl, PLT-O showed the least bias (4.4) followed by PLT-F (6.7) and PLT-I (28.5) iv)For MCV 71-76fl, PLT-F showed least bias (-0.2) followed by PLT-O (1.5) and PLT-I(31.2). Conclusions Platelet count by optical method (PLT-O) detects platelet count more accurately with minimum bias when compared with PLT-F and PLT-I in patients with thrombocytopenia. In patients with microcytosis, PLT-I is less reliable in comparison to PLT-O and PLT-F. A limitation of the automated hematology analyzer is the inability to detect platelet clumps which is appreciated in peripheral smears.

A-156 Comparison of blast and variant lymphocyte flagging between the Alinity hq from Abbott and XN-1000 from Sysmex

Abstract Background Blast cells are immature white blood cells (WBC). The presence of blasts in the peripheral blood may be associated with certain diseases such as myelodysplastic syndrome and acute myelogenous leukemia. Variant lymphocytes (i.e., reactive lymphocytes, atypical lymphocytes) are WBCs produced by the immune system in reaction to infections caused by pathogens such as Epstein-Barr virus, cytomegalovirus, etc. It is clinically useful that the automated hematology analyzer is capable of flagging these cells. In this study, the blast (shown as ‘BLAST’ on the Alinity hq and ‘Blast/Abn Lympho?’ or ‘Blast?’ on XN-1000) and variant lymphocyte (shown as ‘VAR LYM’ on the Alinity hq, and ‘Atypical Lympho?’ on XN-1000) flagging was compared between the Alinity hq from Abbott and XN-1000 from Sysmex. Alinity hq has different sensitivity settings available for BLAST and VAR LYM flagging. In this study, the default setting for Alinity hq was used. For XN-1000, the Q-Flag default setting is 100. In this study, the setting was 120 for ‘Blast/Abn Lympho’ and 100 for “Atypical lympho?’. Methods Blood specimens were tested on the Alinity hq and XN-1000 analyzers. Two smears per specimen were made manually or by the Alinity hs slide maker stainer and read by two independent readers. The specimens showing any of the following flagging were included in the analysis: ‘BLAST’ on Alinity hq, ‘VAR LYM’ on Alinity hq, ‘Blast/Abn Lympho?’ or ‘Blast?’ on XN-1000, ‘Atypical lympho?’ on XN-1000. The flagging reports of these samples from both analyzers were compared to the smear review to determine if each analyzer's blast and variant lymphocyte flagging were true positive, false positive, true negative, or false negative. Results A total of 520 specimens were tested, yielding 41 specimens for blast flagging analysis and 80 specimens for variant lymphocyte flagging analysis. Due to the scarce availability of true positive samples from the manual review, true positive and false negative rate were not compared. For blast flagging using smear results of &amp;gt;=1% or &amp;gt;=5% as the positive criterion, Alinity hq yielded a 9.8% (=4/41) false positive rate and 87.8% (=36/41) true negative rate. XN-1000 yielded a 75.6% (=31/41) false positive rate and 22.0% (=9/41) true negative rate. For variant lymphocyte flagging using smear results of &amp;gt;=5% as the positive criterion, Alinity hq yielded a 6.3% (=5/80) false positive rate and 92.5% (=74/80) true negative rate. XN-1000 yielded a 91.3% (=73/80) false positive rate and 7.5% (=6/80) true negative rate. Conclusions This study demonstrated that Alinity hq achieved a much lower false positive rate and much higher true negative rate for both blast and variant lymphocyte flagging when compared to the XN-1000. Manual blast and variant lymphocyte morphology classification is laboratory- and technician-dependent. Both analyzers allow different sensitivity/specificity levels to flag blasts and variant lymphocytes. Each individual laboratory should evaluate and choose the setting that is most suitable for their specific patient populations to obtain the desired flagging rate.

A-158 Multi-site verification and performance of body fluids in-between Horiba Medical Yumizen h2500 with Sysmex XN-10 automated hematology analyzers and manual microscopy for morphology assessment

Abstract Background The analysis of body fluids plays an important role in the diagnosis and management of a wide variety of conditions. As standards for method validation and laboratory developed tests evolve, the body fluids analysis is receiving increased attention from both laboratories and regulatory bodies. We present the evaluated result of the validation and clinical performance accuracy of HORIBA Medical Yumizen H2500 analyzers as compared to SYSMEX XN-10 analyzers and to manual slide microscopy examination as a reference method for differential analysis for body fluids samples. Methods Depending on each laboratory collected procedures, synovial samples were collected with Sodium Heparin or K2EDTA or without anticoagulant and the other samples were collected with K2EDTA or without anticoagulant. As recommended, most (94%) of the synovial fluids were treated with the hyaluronidase. For the comparison of Yumizen H2500 versus XN-10 analyzers, the study was performed in 2 US sites and 1 French site collecting 390 samples totally: 138 serous fluids (Ascites, Pleural, Peritoneal, Pericardial), 169 synovial fluids and 83 CSF fluids. Samples were analyzed as soon as possible after collection (with a limit of 24 hours for serous and synovial fluids and 4 hours for CSF) and within 2 hours between both instruments. For the comparison of Yumizen H2500 versus reference method (manual microscopy), the study was performed in 2 US sites collecting 58 samples: 34 serous fluids (Ascites, Pleural, Peritoneal, Pericardial), 12 synovial fluids and 12 CSF fluids. Two qualified morphology examiners made the manual microscopy analysis and the average of the results of the 2 slide readings was used for the analysis. Results Considering all types of body fluids, the H2500/XN results are very well correlated for BFWBC (0.969), BFRBC (0.999), BFMN% (0.912), BFMN# (0.89), BFPN% (0.912), BFPN# (0.97). Similarly, the statistical analysis per body fluids type shows very good correlation. For serous type, all results are higher than 0.876, for synovial type all results are higher than 0.879 and for cerebrospinal fluids type, all results are higher than 0.788. Among all samples, less than 8 samples (&amp;lt;2%) were out of the 95% interval. The comparison Yumizen H2500 versus manual microscopy, all the correlation results (r²) are very good: 0,9705 for Polynuclear and 0,9742 for Mononuclear. The study demonstrated better results of Yumizen H2500 versus manual microscopy than versus XN-10 for BFPN% (0.9705 versus 0.912) and BFMN% (0.9742 versus 0.912). Among 58 samples, only 4 (6.9%) were out of the 95% interval for BFPN% and BFMN%. Conclusions The Yumizen H2500 results for body fluid WBC differentiation (Polynuclear and Mononuclear) are very well correlated with the results from manual slide microscopy evaluation. The comparison of the results analyzed on Yumizen H2500 and on XN does not show any significant difference.

The Diagnostic Value of Ret-He in Predicting Latent Iron Deficiency in Female Blood Donors

To explore the application value of reticulocyte hemoglobin equivalent (Ret-He) for diagnosing latent iron deficiency in female plateletpheresis donors. A total of 230 female plateletpheresis donors in Fujian Blood Center from January to February 2022 were selected as the research group and divided into three groups: normal group, iron depletion (ID) group and iron deficient erythropoiesis (IDE) group, according to the severity of iron deficiency. The level of hemoglobin (HGB), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), coefficient of variation of red cell distribution width (RDW-CV) and Ret-He were measured by using the Sysmex XN automated hematology analyzer. Chemiluminescence immunoassay was used to detect iron biochemical indexes. Receiver operating characteristic(ROC) curve analysis was performed to evaluate the diagnosic value of relevant indicators in female blood donors with latent iron deficiency. Ret-He in ID group was 32.55 (31.15,33.10)pg, which was significantly lower than that in the normal group ［33.80(32.73，34.70)pg］ （P <0.05）, and significantly higher than that in IDE group ［30.40(28.70,31.50)pg］ （P <0.05）. ROC analysis in diagnosis of IDE demonstrated that the area under the curves (AUCs) of HGB, MCV, MCH, RDW-CV and Ret-He were 0.892, 0.843, 0.909, 0.890, 0.931, respectively. When the critical value of Ret-He was 32.05 pg, its sensitivity and specificity were 85.90% and 92.60%, respectively. However, all red blood cell parameters had poor diagnostic value for ID. Ret-He is a perfect predictor for latent iron deficiency in female blood donors. Detection of Ret-He can advance the diagnosis of iron deficiency in female blood donors to the IDE stage.

Comparing Absolute Eosinophil and Monocyte Counts in Critical and Non-Critical COVID-19 Patients

Emerging evidence suggests that variations in immune cell counts, particularly absolute eosinophil and monocyte counts may be important in predicting the clinical course and severity of the disease in COVID-19 patients. Objective: To compare the absolute eosinophil and monocyte counts ‘between critical and non-critical COVID-19 patients to elucidate potential associations with disease severity and prognosis. Methods: Between March 19th and June 6th, 2021, peripheral blood samples were taken from 26 ‘critical COVID-19 patients and 26 non-critical COVID-19 patients. Standard laboratory procedures were used to determine the immunological and haematological parameters for every participant. Whole blood samples were taken in ethylenediaminetetraacetic acid (EDTA) tubes and processed per the manufacturer's instructions using an automated haematology analyser (XN-1000, Sysmex, Japan). Results: Critical patients of COVID-19 exhibited significantly reduced absolute eosinophil, absolute monocyte, and lymphocyte count compared to non-critical patients. Additionally, critical patients were significantly older. However, there is no significant differences in the two groups' basophil counts, neutrophil counts, WBC counts, RBC counts, HCT percentage, HGB levels, MCH levels, MCV, MCHC levels, and MPV or platelet counts. Conclusions: Critical patients exhibited significantly reduced absolute eosinophil and monocyte counts suggesting a potentially weaker immune response in these subgroups. The significance of immune cell counts in assessing the severity of COVID-19 is highlighted by these results which may aid in developing targeted therapeutic interventions and prognostic indicators. Validating these results and clarifying their therapeutic significance will require more investigation.