Sysmex KX-21N Research Articles

Association of red cell distribution width, haematocrit and other RBC indices with coronay artery disease: A case control study

Background: Coronary artery disease (CAD) is mainly caused by atherosclerosis and its complications. Red blood cell distribution width (RDW) is a numerical measure of the variability in size of circulating erythrocytes. Several studies reported a strong, independent relation between higher levels of RDW, hematocrit (Hct), and the risk of death and cardiovascular events in people with prior CAD. We tested the hypothesis that RDW, Hct, and other red blood corpuscle (RBC) indices are associated with CAD. Hence, we measured RDW, Hct, and other RBC indices in AMI and stable CAD (SCAD) and compared them with age- and sex-matched controls.Objectives: To study the changes in RDW and RBC indices in acute myocardial infarction (AMI) and SCAD and compare them with age- and sex-matched controls.Materials and Methods: This was a comparative study of 128 subjects (39 patients with AMI, 24 patients with SCAD, and 65 controls). Venous sample were drawn from AMI subjects on admission (within 6 h of chest pain) and collected in standardized ethylenediaminetetraacetic acid (EDTA) sample tubes. RDW and RBC indices were assayed within 30 min of blood collection, using Sysmex KX21-N autoanalyzer. Venous samples were also drawn from stable CAD patients who were admitted for angiography and subject attending routine checkups.Results: There was no significant difference in RDW in patients with CAD (14.12 ± 1.31%) as compared to controls (15.62 ± 6.51%). There was no significant difference in RWD in patients with AMI (14.36 ± 1.4%) as compared to stable CAD (13.7 ± 1.09%) and controls (15.62 ± 6.51%). There was no significant difference in Hct in patients with CAD (43.16 ± 5%) as compared to controls (41.9 ± 6.9%).Conclusions: There was no association between RWD, Hct, and other RBC indices with CAD, AMI, and stable CAD.

Course of Hemoglobin and Hematocrit during and after Preparatory Plasmaphereses without and with Infusion of NaCl 0.9% 500 ml

Background: The aim of this study was to evaluate the course of hemoglobin (HGB) concentration and hematocrit (HCT) in donor blood during and after preparatory plasmaphereses (PP) without NaCl and with an infusion of 500 ml 0.9% NaCl during PP. Methods: After informed consent 32 plasma donors were studied in a crossover design. They underwent PP once without NaCl infusion and once, on a different day, with infusion of 500 ml 0.9% NaCl. HGB concentration and HCT values in donor blood were analyzed using a Sysmex KX-21N analyzer. The values of HGB concentration and HCT before PP were set to 100%. Changes in HGB concentration and HCT were calculated in percent directly after PP, and after 24 and 72 h. Results: During PP, there was a notable change in HGB concentration (11.2 ± 4.0%) and HCT (11.6 ± 3.9%) in donor blood. The difference between the 2 samples without and with NaCl was highly significant (p < 0.001). After 24 and 72 h, all differences were reduced. Conclusion: We observed significant changes in HGB concentration and HCT in donor blood during PP. We recommend a concomitant infusion of 500 ml 0.9% NaCl during PP to all donors.

Lower Sample Volumes Collected Into Spray-Dried K2EDTA Vacuitaner Bottles Are Suitable For Automated Complete Blood Count Analysis Including Differential Leukocyte Count

Collection of lower sample volumes into dipotassium ethylenediaminetetraacetic acid (K2EDTA) containers, according to the manufacturers' data and current Clinical and Laboratory Standards Institute, results in erroneous haematology results. To proof this we collected acceptable limit of lower sample volumes for haematology analyses into the 4.0ml standard spray-dried K2EDTA. 9.0ml of blood from 15 retroviral volunteers was collected and each donation was aliquot into the following volumes 4.0, 2.0, 1.5, 1.0, 0.5ml. These samples were analyzed within 4hrs of collection on Sysmex KX-21N haematology analyzer for complete blood count (CBC) including leukocytes differentials. T-test showed there was no significant difference between results of lower samples volumes and the standard volume and regression analysis showed excellent correlation for all parameters. Lower sample collection volumes compared to the standard volume showed negative bias for platelet count but the difference was considered insignificant with percentage differences of 4.6%, 3.0%, 2.9%, and 1.7% for 1.0, 1.5, 0.5, and 2.0ml collection volumes respectively. Flag messages were noticed in about 67.0% of the patients irrespective of collection volumes. Acceptable CBC values for spray-dried K2EDTA collection tubes containing lower sample volumes can be obtained with as little as 1.0ml in Nigerian subjects.

Comparative Study in the Diagnosis of Anemia by Sysmex Kx-21n Hematology Analyzer with Peripheral Blood Smear

In this era, automated peripheral blood count for the diagnosis of anemia is widely accepted in routine practice. Despite the sophistication of present day instruments, there is still need to depend on manual microscopic scan of peripheral blood smear for the diagnosis and appropriate treatment of different types of anemia. Also, the correlation between automated hematology analyzer and manual microscopic scan is rare and conflicting. Hence, the present study was designed to demonstrate a procedure that, the uses of manual scan is to validate rather than to replace automation. The benefit of manual microscopic scan is the ability to identify clinically significant cell type that are not quantifiable by instruments as it “flags” on such type of cells. Therefore, automated hematology analyzer are as reliable as standard manual scan, even though the latter gives additional diagnostic information through blood pictures and less imprecision and technical error over automation. Patient care and lab operations could be optimized as a validation procedure rather than as a reflexive substitute. Hence manual microscopic scan is still gold standard in the diagnosis and classification of anemia and other blood disorders. Whereas usage of automated method would ease our workload and save time for patients.

The prevalence of thrombocytopenia in &lt;i&gt;plasmodium falciparum&lt;/i&gt; malaria in children at the University of Uyo Teaching Hospital, Uyo, Nigeria

Background: Thrombocytopenia occurring in falciparum malaria infection has been documented worldwide. However, its prevalence varies from place to place, and among different population groups studied. There is paucity of data on this in Nigerian children.Objectives: To determine the prevalence of thrombocytopenia in children presenting with falciparum malaria at the University of Uyo Teaching Hospital, Uyo, Akwa Ibom State, Nigeria.Method: A prospective crosssectional study from October 2010 to March 2011 on one hundred and eighty children with microscopically confirmed malaria aged six months to fifteen years, compared with 180 healthy children without malaria parasitaemia matched for age and gender. Their platelet counts were evaluated using the auto-analyser Sysmex KX-21N.Results: The overall prevalence of thrombocytopenia was 5.0%, but it was higher in children with severe malaria. None of the children in the control group had thrombocytopenia.Conclusion: The prevalence of thrombocytopenia in falciparum malaria is low in our setting, but higher in children with severe manifestations of malaria.Keywords: Malaria, Thrombocytopenia, Prevalence, children.

Haematological Values at Moderate Altitude in a Low-Income Population

Aim: To illustrate haematological adaptation to moderate altitude in Rwanda. Study Design: A population-based cross-sectional study. Place and Duration of Study: The study was carried out at moderate altitude (1,6491,768 m) among students of the National University of Rwanda and blood donors from Buhanda, Ruhango and Nyaruteja centres, from August to December 2011. Methods : Healthy volunteers (238 males and 106 females, age range: 18-40 years) were recruited in the study. Complete blood count was performed on a Coulter AcT 5diff and for some samples on a Sysmex KX-21N automated haematology analyzer. Results: Results (mean ± SD) were: erythrocyte count: males: 5.28 ± 0.53 X 10 12 /L,

Methanolic crude leaf extract of Ocimum gratissimum reverses phenylhydrazine-induced anemia in albino wistar rats

Background: The therapeutic and culinary applications of Ocimum gratissimum leaf have been practiced in Central and West Africa for decades. This study was designed and conducted to investigate the haematinic and haemopoietic activities of phenylhydrazine-induced anaemia in Albino wistar rats. Materials and Methods: Twenty-four (24) Albino wistar rats were grouped into four (A, B, C and D) with six rats per cage. Groups B, C and D served as the test groups, while group A was the control. The test groups were gavaged with graded doses (4, 8 and 12mg/kg body weight respectively) of Ocimum gratissimum methanolic crude leaf extract once daily for 9 days. Two (2) mls of venous blood was collected from the ocular plexus from each animal into tripotassium ethylene diamine tetra-acetic acid anticoagulant bottle. This was used to determine complete blood count using automated haematology autoanalyzer (Sysmex KX-21N). Results: Red blood cell (RBC) mean value recorded a dose and duration-related statistically significant decrease (P < 0.05) in group D on day 3. However, there was statistically significant increase (P < 0.05) in the RBC indices. In addition, total white blood cell (WBC) recorded a marginal increase in the mean values throughout the study period though not statistically significant (P > 0.05). Furthermore, lymphocyte recorded both dose and duration-related statistically significant increase (P < 0.01). Conclusion: From the result of this study, it can be concluded that the methanolic crude leaf extract of Ocimum gratissimum possesses both haemopoetic and haematinic potentials which are dose and duration-related.

Prevalence of hypoxemia among children with sickle cell anemia during steady state and crises: A cross-sectional study

Patients with sickle cell anemia (SCA) are prone to recurrent pain crises related to red blood cell sickling and vaso-occlusion with subsequent tissue hypoxia. Alveolar hypoxia has been shown to be associated with entrapment of sickle cells in the pulmonary microcirculation which may propagate a cycle of further hypoxemia and sickling. Pulmonary complications are common in sickle cell disease (SCD) and may exacerbate microvascular occlusive phenomena. Thus, detecting hypoxemia is of particular importance in SCD. This study was designed to determine the prevalence of hypoxemia among children with SCA and compare the oxygen saturation of those in crises with those in steady state. This is a prospective observational study involving 46 children with SCA in steady state, 42 with crises, and 42 with HbAA genotype carried out between August and December 2010. The study compared the oxygen saturation of sickle cell anaemic children in steady state and in crises with normal hemoglobin genotype using Nellcon pulse oximeter while the hemoglobin concentration was analyzed using automated Sysmex KX-21N model. A total of 130 participants aged 6 months to 18 years were recruited. The overall prevalence of hypoxemia in this study was 13.8%. Hypoxemia was highest among SCA patients in the crisis state (23.8%) compared to 13% and 0% for those in the steady state and in those with normal hemoglobin genotype, respectively (χ² = 6.425, P = 0.04). Hypoxemia was higher among those with hemoglobin less than 5 g/dl (30%) and least among those whose hemoglobin levels were 10 g/dl and above. Hypoxemia was significantly higher among children with SCA during Vaso-occlusion crises. We recommend that one should have a high index of suspicion and take prompt action in managing these individuals especially those with acute chest syndrome.

Mean platelet volume and other platelet volume indices in patients with stable coronary artery disease and acute myocardial infarction: A case control study

Background:Coronary artery disease is mainly caused by atherosclerosis and its complications. Platelets and their activity have an important role in initiation of atherosclerotic lesions and coronary thrombus formation. Larger platelets are enzymatically and metabolically more active and have a higher potential thrombotic ability as compared with smaller platelets.Aims:To study the changes in platelet volume indices and platelet count in acute myocardial infarction, stable coronary artery disease and compare them with controls to assess their usefulness in predicting coronary events.Materials and Methods:This was a comparative study of 128 subjects; 39 patients with acute myocardial infarction (AMI), 24 patients with stable coronary artery disease (SCAD) and 65 controls. Venous sample were drawn from AMI subjects on admission (within 4 hours of chest pain) and collected in standardized EDTA sample tubes. Platelet count and volume indices were assayed within 30 minutes of blood collection, using Sysmex KX21-N autoanalyzer. Venous samples were also drawn from SCAD on who were admitted for angiography and subject attending routine checkups.Results:The mean platelet volume was significantly higher in patients with AMI (9.65 ± 0.96) as compared to SCAD (9.37 ± 0.88) and controls (9.21 ± 0.58). The best cut-off values for MPV when predicting AMI and SCAD in patients were 9.25 fl (sensitivity 56.4%; specificity 45.9%) and 9.15 fl (sensitivity 54.2%; specificity 42.23%), respectively.Conclusions:Measurements of MPV may be of some benefit in detecting those patients at higher risk for an AMI and CAD.

Evaluation of Iron Status in Anemia of Chronic Disease Among Patients With HIV Infection

In HIV-infected populations from developing countries, it is unclear what proportion of anemia is attributable to iron deficiency (ID). The objective of this study was to evaluate the iron status in anemia of chronic disease of patients with Human Immunodeficiency Virus (HIV) infection attending Federal Medical Centre, Makurdi. A total of 312 subjects comprising of 207 confirmed HIV positive patients and 105 apparently healthy subjects as control were evaluated for indices of anemia using SYSMEX KX 21N hematology analyzer machine (Kobe, Japan), CD4 count using CYFLOW SL machine (Artec, Germany), and total iron binding capacity and serum iron using colorimetric method. While results showed that Serum Iron, Transferrin Saturation, PCV, RBC, MCV, MCH, MCHC and RDWCV are within normal reference range but statistically different (p < 0.05) compared to the controls. Stratifying them on the basis of CD4 count showed that in AIDS patients the indicators are generally lower with Hb, PCV, MCH and RDWCV showing statistical significance (p < 0.05) compared with patients with CD4 > 200 cells/mm3. Serum iron (50%) and transferring saturation (47.9%) contributed highest to anemia prevalence especially in males while Hb concentration (47.2%) is the major contributor to anemia in females. It was concluded therefore that albeit, on average, the parameters of iron status did not indicate iron deficiency or iron overload in the HIV-status groups and AIDS patients, a large percentage of patients did have anemia of chronic disease with HIV-infected women afflicted more often. The anemia is generally normocytic hypochromic in AIDS patients.

Plasmodium falciparum malaria in children at a tertiary teaching hospital: ABO blood group is a risk factor

ABO blood group antigens are formed by terminal glycosylation of glycoproteins and glycolipid chains present on cell surfaces. Glycosylation modulates all kinds of cell-to-cell interactions and this may be relevant in malaria pathophysiology, in which adhesion has been increasingly implicated in disease severity. This study was done to determine the association between ABO phenotypes and the severity of P. falciparum malaria in children. One hundred and twenty one children were assessed at the Department of Child Health, KBTH from May to August 2008. ABO blood groups were determined by agglutination. The haemoglobin measurement was done with the haematology analyzer, Sysmex KX-21N. Malaria parasites were enumerated and the presence of malaria pigment noted. Identification of P. falciparum was done. Statistical tests used were odds ratio and chi square at a significance level of p<0.05. 24.3% of the 121 children had severe falciparum malaria, and their mean haemoglobin was 4.49 g/dl (SD ± 1.69). No significant association was found between the ABO phenotypes and malaria infection (p > 0.05). Blood group A was associated with more severe malaria as compared to the blood group O individuals (Odds ratio = 0.79, p > 0.05); blood group AB (Odds ratio = 0.14, p > 0.05) and also there was a significant difference in severity of malaria between blood group O and blood group B (Odds ratio = 1.28, p > 0.05). Non-O blood group children are more prone to severe malaria caused by P. falciparum malaria than the group O, despite the lack of significant association between ABO blood groups and falciparum malaria.

Hemoglobin estimation by the HemoCue® portable hemoglobin photometer in a resource poor setting

BackgroundIn resource poor settings where automated hematology analyzers are not available, the Cyanmethemoglobin method is often used. This method though cheaper, takes more time. In blood donations, the semi-quantitative gravimetric copper sulfate method which is very easy and inexpensive may be used but does not provide an acceptable degree of accuracy. The HemoCue® hemoglobin photometer has been used for these purposes. This study was conducted to generate data to support or refute its use as a point-of-care device for hemoglobin estimation in mobile blood donations and critical care areas in health facilities.MethodEDTA blood was collected from study participants drawn from five groups: pre-school children, school children, pregnant women, non-pregnant women and men. Blood collected was immediately processed to estimate the hemoglobin concentration using three different methods (HemoCue®, Sysmex KX21N and Cyanmethemoglobin). Agreement between the test methods was assessed by the method of Bland and Altman. The Intraclass correlation coefficient (ICC) was used to determine the within subject variability of measured hemoglobin.ResultsOf 398 subjects, 42% were males with the overall mean age being 19.4 years. The overall mean hemoglobin as estimated by each method was 10.4 g/dl for HemoCue, 10.3 g/dl for Sysmex KX21N and 10.3 g/dl for Cyanmethemoglobin. Pairwise analysis revealed that the hemoglobin determined by the HemoCue method was higher than that measured by the KX21N and Cyanmethemoglobin. Comparing the hemoglobin determined by the HemoCue to Cyanmethemoglobin, the concordance correlation coefficient was 0.995 (95% CI: 0.994-0.996, p < 0.001). The Bland and Altman's limit of agreement was -0.389 - 0.644 g/dl with the mean difference being 0.127 (95% CI: 0.102-0.153) and a non-significant difference in variability between the two measurements (p = 0.843). After adjusting to assess the effect of other possible confounders such as sex, age and category of person, there was no significant difference in the hemoglobin determined by the HemoCue compared to Cyanmethemoglobin (coef = -0.127, 95% CI: -0.379 - 0.634).ConclusionHemoglobin determined by the HemoCue method is comparable to that determined by the other methods. The HemoCue photometer is therefore recommended for use as on-the-spot device for determining hemoglobin in resource poor setting.

Comparison of haematological parameters determined by the Sysmex KX - 2IN automated haematology analyzer and the manual counts

BackgroundThis study was designed to determine the correlation between heamatological parameters by Sysmex KX-21N automated hematology analyzer with the manual methods.MethodSixty (60) subjects were randomly selected from both apparently healthy subjects and those who have different blood disorders from the University of Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria. Three (3)mls of venous blood sample was collected aseptically from each subject into tri-potassium ethylenediamine tetra-acetic acid (K3EDTA) for the analysis of haematological parameters using the automated and the manual methods.ResultsThe blood film report by the manual method showed that 50% of the subjects were normocytic-normochromic while the other 50% revealed different abnormal blood pictures. Also, there were statistically significant differences (p < 0.05) in mean cell hemoglobin concentrations (MCHC) between the two methods. Similarly, the mean (S.E) values of hemoglobin, packed cell volume, platelet and total white cell counts demonstrated statistically significant difference (p < 0.001) and correlated positively when both methods were compared.ConclusionFrom the present study, it can be concluded that the automated hematology analyzer readings correlated well with readings by the standard manual method, although the latter method gave additional diagnostic information on the blood pictures. While patients' care and laboratory operations could be optimized by using manual microscopic examination as a reflective substitute for automated methods, usage of automated method would ease our workload and save time for patients.

Significance of platelet volume indices and platelet count in ischaemic heart disease

Background:Ischaemic heart disease is mainly caused by atherosclerosis and its complications. Platelets and their activity have an important role in initiation of atherosclerotic lesions and coronary thrombus formation. Larger platelets...

235 Quality ART Scale Up Through Regionalization of Laboratory Services In Nigeria

Issues: Setting up of standard lab infrastructure and provision of free laboratory tests by PEPFAR has improved health care delivery system and services to PLWHAs in Nigeria. We here describe the challenges and successes of the tier laboratory infrastructure established by the Institute of Human Virology - University of Maryland PEPFAR funded AIDS Care and Treatment in Nigeria (ACTION) program to support the diagnosis, care and treatment of HIV infected Nigerians. Description: The ACTION program currently treats over 80,000 and cares for another 150,000 HIV-infected Nigerians; also, about 300,000 are screened. To support this, the laboratory infrastructure expanded from 12 to a regionalized tier system with 22 tertiary, 25 secondary and 12 primary laboratories all linked with appropriate oversight and referral system. Choice of laboratory equipment was based on ease of use, in country vendor/service provider, ease of purchase of reagents, and overall manufacturer's support. Implementation included: 1) Decentralization of laboratory field services into regions with central oversight 2) Detailed site assessments/renovations 3) Step wise site activation in HIV Rapid Testing, Pregnancy Testing, Manual CD4 Count, HbAg screening, CyFlow SL (tertiary) or Counter (secondary) for CD4, Sysmex KX 21N for Hematology, Vitros V250 (tertiary) DT 60 II (tert/sec) or Reflotron (sec/prim) for Chemistry assays. 4) Monitoring and mentoring of site personnel through an aggressive QA/QC program. 5) Hub and spoke linkage between comprehensive and satellite sites. Lessons learned: Tier lab network with adequate mentoring and referral led to a successful lab expansion to 59 (22 tertiary, 25 secondary and 12 primary) sites performing HIV Serology, CD4, Pregnancy, Hematology, Chemistry, Hepatitis B, Cryptococcus, and TB tests. Also, 57 HCT/PMTCT sites performing HIV Serology Tests. Improved proficiency at sites from 40-60% to 80-95%. Recommendations: Regionalization and tier lab system is critical for scale up. Defined roles for lab personnel creates a good network to support rapid scale up. QA/QC program involving site monitoring is critical for sustained high quality lab results.

Estudo da correlação entre os níveis de hemoglobina fetal e o prognóstico dos pacientes com anemia falciforme

Os niveis de hemoglobina fetal (HbF) foram analisados em 47 pacientes com anemia falciforme, residentes em Fortaleza, capital do Ceara, com a finalidade de fornecer informacoes sobre a influencia da HbF no prognostico desta doenca. A determinacao dos valores hematologicos foi realizada em contador automatico de celulas sanguineas (modelo Sysmex KX-21N, Roche) e os niveis de HbF foram determinados pela tecnica da desnaturacao alcalina. Dentre os resultados foi demonstrada uma tendencia de menor numero de pacientes com crises vaso-oclusivas (p=0,0405) e ulceras de perna (p=0,0076) com o aumento dos niveis de HbF. Nao houve diferenca estatisticamente significativa na comparacao entre os niveis de HbF e os valores de hemacias, hemoglobina, hematocrito, leucocitos e plaquetas. Os resultados demonstram que os niveis de hemoglobina fetal podem ser utilizados como fator prognostico nos pacientes com anemia falciforme, no entanto nao deve ser a unica ferramenta diagnostica para prever o quadro clinico destes pacientes.

Performance Evaluation of the Sysmex pocH-100i Automated Hematology Analyzer

The Sysmex pocH-100i automated hematology analyzer was evaluated at St. John's Regional Health Center, Springfield, Missouri, USA, and compared with the Sysmex KX-21N. The pocH-100i is a compact, fully automated hematology analyzer with the capability for simultaneous analysis of 17 parameters in the whole-blood mode. The touch screen liquid crystal display presents results, and the 3 histograms for white blood cell (WBC), red blood cell (RBC), and platelet (PLT) counts can be printed along with numerical results. This study was performed to provide necessary information for the US Food and Drug Administration study of allowing the product's use in the North American marketplace. The pocH-100i processes approximately 25 samples/hour, uses 2 reagents, and provides for testing in a closed-tube environment, while using only 15 microL in the whole-blood mode and 20 microL in the predilute mode. Using hydrodynamic focusing on the pocH-100i improves the accuracy for RBC and PLT measurements. Our evaluation included studies of correlation, carryover, reproducibility, linearity, and stability. Results with the pocH-100i showed good correlation with those from the KX-21N for the following parameters: WBC; numbers and percentages of lymphocytes, mixed cells (monocytes, eosinophils, and basophils), and neutrophils; RBC; hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; mean corpuscular hemoglobin concentration; PLT; red cell distribution width SD (RDW-SD); RDW coefficient of variation; and mean platelet volume. Carryover and reproducibility were well within the manufacturer's specifications. The pocH-100i showed linearity over the entire range for all parameters studied. A reference range for a healthy population was also established. We conclude that the overall performance of the pocH-100i is excellent and compares favorably with that of the KX-21N.