Sysmex XE-2100 Research Articles

Development of simple equations for effective screening of spurious hemolysis in whole-blood specimens.

We aimed to identify simple but reliable indices for effective screening of spurious hemolysis in whole-blood specimens. 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. 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. 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.

Lack of harmonization of red blood cell distribution width (RDW). Evaluation of four hematological analyzers

ObjectivesTo assess analytical imprecision and comparability of red blood cell distribution width (RDW) on Abbott Sapphire, Mindray BC6800, Siemens Advia 2120 and Sysmex XE-5000. Design and methodsWithin-run imprecision was assessed on three pools and comparability using 132 inpatient samples. ResultsThe imprecision of RDW was comprised between 0.3 and 1.2%, but the values exhibited broad variation among different analyzers, with bias exceeding the desirable quality specifications. ConclusionsHarmonization of RDW is still an unmet need.

Automated Hematology Analyzers in Diagnosis of Plasmodium vivax Malaria: an Adjunct to Conventional Microscopy.

Malaria is one of the most pervasive parasitic diseases ever known to mankind affecting nearly 300 million people every year. The need for rapid diagnosis of malaria in tropical and subtropical malaria endemic areas is on the rise. In this study, we evaluated the usefulness of hematology autoanalyzers, Sysmex XE-2100 & XT-2000i in the presumptive diagnosis of malaria. Our study shows that abnormalities in WBC/BASO scattergram when combined with presence of thrombocytopenia had a high sensitivity and positive predictive value in the presumptive diagnosis of Plasmodium vivax (P.vivax) malaria.

Performance evaluation of the new hematology analyzer Sysmex XN-series.

The Sysmex XN-series is a new automated hematology analyzer designed to improve the accuracy of cell counts and the specificity of the flagging events. The basic characteristics and the performance of new measurement channels of the XN were evaluated and compared with the Sysmex XE-2100 and the manual method. Fluorescent platelet count (PLT-F) was compared with the flow cytometric method. The low WBC mode and body fluid mode were also evaluated. For workflow analysis, 1005 samples were analyzed on both the XN and the XE-2100, and manual review rates were compared. All parameters measured by the XN correlated well with the XE-2100. PLT-F showed better correlation with the flow cytometric method (r(2) =0.80) compared with optical platelet count (r(2) =0.73) for platelet counts <70×10(9) /L. The low WBC mode reported accurate leukocyte differentials for samples with a WBC count <0.5×10(9) /L. Relatively good correlation was found for WBC counts between the manual method and the body fluid mode (r=0.88). The XN made less flags than the XE-2100, while the sensitivities of both instruments were comparable. The XN provided reliable results on low cell counts, as well as reduced manual blood film reviews, while maintaining a proper level of diagnostic sensitivity.

Do immature platelet levels in chest pain patients presenting to the emergency department aid in the diagnosis of acute coronary syndrome?

Early and accurate identification of acute coronary syndrome (ACS) vs. noncardiac chest pain in patients presenting to the emergency department (ED) is problematic and new diagnostic markers are needed. Previous studies reported that elevated mean platelet volume (MPV) is associated with ACS and predictive of cardiovascular risk. MPV is closely related to the immature platelet fraction (IPF), and recent studies have suggested that IPF may be a more sensitive marker of ACS than MPV. The objective of the present study was to determine whether the measurement of IPF assists in the diagnosis of ACS in patients presenting to the ED with chest pain. In this single-center, prospective, cross-sectional study, adult patients presenting to the ED with chest pain and/or suspected ACS were considered for enrollment. Blood samples from 236 ACS-negative and 44 ACS-positive patients were analyzed in a Sysmex XE-2100 for platelet count, MPV, IPF, and the absolute count of immature platelets (IPC). Total platelet counts, MPV, IPF, and IPC were not statistically different between ACS-negative and ACS-positive patients. The IPF was 4.6±2.7% and 5.0±2.8% (mean±SD, P=0.24), and the IPC was 10.0±4.6 and 11.5±7.5×10(3) /μL (P=0.27) for ACS-negative and ACS-positive patients, respectively. In 280 patients presenting to the ED with chest pain and/or suspected ACS, no differences in IPF, IPC or MPV were observed in ACS-negative vs. ACS-positive patients, suggesting that these parameters do not assist in the diagnosis of ACS.

English

Dengue has become a major health concern globally in recent decades. Dengue infected patients manifest a spectrum of symptoms and in severe cases the fate is mortality. A hallmark of dengue infection is thrombocytopenia which causes concern for the patients and treating doctors. This study aimed to evaluate the incidence of thrombocytopenia in seropositive dengue patients. Bleeding manifestation was also investigated in dengue patients to evaluate its association with the severity of thrombocytopenia. In this study, 750 individuals were screened for dengue infection by detecting immunoglobulin M (IgM) against dengue virus in their serum. Enzyme-linked immunosorbent assay (ELISA) was performed for detection of IgM antibody and 250 individuals were found to be seropositive. Platelet counts were performed on whole blood of seropositive patients using Sysmex XE-5000 Automated Hematology Analyzer. Among 250 dengue patients, 2% had severe thrombocytopenia, 65.2% were found to have mild to moderate thrombocytopenia and 32.8% had normal platelet counts. Bleeding was related to the severity of thrombocytopenia as 80% of patients having platelet count lower than 25000/&mu;l showed bleeding manifestations. &nbsp; Key words:&nbsp; Dengue, thrombocytopenia, seropositive, immunoglobin M (IgM), enzyme-linked immunosorbent assay (ELISA), platelet count.

Optimal flagging combinations for best performance of five blood cell analyzers.

Corelab automation needs increasingly more efficient hematology analyzers and algorithms to adequately detect abnormal samples. The aim of this study is to assess the effect of combining flags or to adjust their trigger level to identify positive samples for further detection within a smear. Five hundred and seventeen EDTA samples from patients followed for hematological malignancies were randomly analyzed on Sysmex XE2100 and XN2000, Abbott Cell-Dyn Sapphire, Beckman Coulter DXH800 and Siemens ADVIA 2120. A blood smear as well as a buffy coat was further performed for each of them. Our results shows that depending on the flags, the combinations of them and the thresholds we use, analyzers can provide extremely variable results in their performances for detecting abnormal cells. ADVIA and XN2000 show remarkable performance for blasts detection. DXH800 is the most sensitive for the detection of abnormal lymphocytes, while XN outperforms the market for immature granulocytes and nucleated red blood cell. Flagging performances have been shown to be inconsistent among the different manufacturers. This article should help laboratory professionals in their quest for the best flagging schemes and give them a baseline in the selection of the most appropriate analyzer.

Analysis of scatter plots and alarm information in 288 cases of newly diagnosed hematologic malignancies

This study was aimed to explore the role of full-automatic blood analyzer Sysmex XE-2100 in early screening and diagnosing the hematologic malignancies. A total of 288 samples of the patients with hematologic malignancies was examined. Then, the scatter plots, alarm information and blood smears were analyzed. The results indicated that 76% of these samples showed abnormal scatter plots. CMML and AML-M3 patients had their own characteristic scatter plots, while others hadnt's. The coincident rate of CMML and AML-M3 determined by scatter plots with practical diseases was 100%; the coincident rate of ALL determined by scatter plots with practical disease was 67%. The coincident rate of alarm information of blast cells was 92.5%, the coincident rate of immature granulocytes was 77.1%, the coincident rate of nucleated red blood cells was 33.3%, the coincident rate of atypical lymphocytes was 31.3%. It is concluded that the abnormal scatter plots and alarm information are very important for finding the patients with hematologic malignancies and determining the disease type. The alarm information has high reliability for blast cells and immature granulocytes, but has only mirror value for nucleated red blood cells and atypical lymphocytes.

G530(P) Spuriously elevated white cell count with paraffin

AimTo identify and report the falsely elevated white cell count associated with the use of soft paraffin and avoid unnecessary anxiety associated with this.MethodWe analysed the blood samples collected with...

Haematological reference intervals in a multiethnic population.

IntroductionSimilar to other populations, full blood count reference (FBC) intervals in Malaysia are generally derived from non-Malaysian subjects. However, numerous studies have shown significant differences between and within populations supporting the need for population specific intervals.MethodsTwo thousand seven hundred twenty five apparently healthy adults comprising all ages, both genders and three principal races were recruited through voluntary participation. FBC was performed on two analysers, Sysmex XE-5000 and Unicel DxH 800, in addition to blood smears and haemoglobin analysis. Serum ferritin, soluble transferrin receptor and C-reactive protein assays were performed in selected subjects. All parameters of qualified subjects were tested for normality followed by determination of reference intervals, measures of central tendency and dispersion along with point estimates for each subgroup.ResultsComplete data was available in 2440 subjects of whom 56% (907 women and 469 men) were included in reference interval calculation. Compared to other populations there were significant differences for haemoglobin, red blood cell count, platelet count and haematocrit in Malaysians. There were differences between men and women, and between younger and older men; unlike in other populations, haemoglobin was similar in younger and older women. However ethnicity and smoking had little impact. 70% of anemia in premenopausal women, 24% in postmenopausal women and 20% of males is attributable to iron deficiency. There was excellent correlation between Sysmex XE-5000 and Unicel DxH 800.ConclusionOur data confirms the importance of population specific haematological parameters and supports the need for local guidelines rather than adoption of generalised reference intervals and cut-offs.

Ethylenediaminetetraacetate-dependent pseudothrombocytopenia accompanied by morphological changes

A 65-year-old female patient was referred to our hospital for diabetes mellitus, diabetic nephropathy, pulmonary infection, and hypertension on November 6, 2012. Following admission, findings from laboratory tests were as follows: white blood cell count, 14.76 9 10/L; hemoglobin, 123 g/L; platelet count, 28 9 10/L; creatinine, 272 lmol/L; fasting glucose, 14.26 mmol/L; prothrombin time, 14.6 s; D-dimer, 4800 lg/L. Tests for antinuclear and antineutrophil cytoplasmic antibodies were negative, but were positive for platelet-associated IgG. Dipotassium EDTA, sodium citrate, and heparin sodium were selected as the anticoagulants for blood cell counts, to exclude the influence of EDTA salt. We performed whole-blood cell counts measured by a Sysmex XE-2100 complete blood count analyzer, followed by blood smears and staining with a Sysmex sp1000i automated hematology slide preparation unit. The platelet and white blood cell counts were 12 9 10 and 6.9 9 10/L for EDTA-2K anticoagulants, 242 9 10 and 4.3 9 10/L for sodium citrate anticoagulants, 250 9 10 and 4.6 9 10/L for heparin sodium anticoagulants, respectively. The blood smear results are shown in Figs. 1 and 2. The International Committee for Standardization in Hematology recommends dipotassium EDTA for anticoagulation of peripheral blood cells for analysis [1]. Blood specimens that met the review criteria after detection by the blood cell analyzer were smeared, stained, and observed under a microscope. When the platelet aggregation occurred, a cluster of platelets with uneven sizes was observed. However, the aggregated platelets retained their individual morphologies (Fig. 3). Microscopic examination of the blood smear revealed clumps of violescent material

Enhanced Accuracy of Optical Platelet Counts in Microcytic Anemia

To determine whether microcytic erythrocytes influence the accuracy of automated platelet (PLT) counting. We divided a total of 206 K2 ethylenediaminetetraacetic acid (EDTA)-anticoagulated blood samples into 4 groups, as follows: In group 1 (control group), normal mean corpuscular volume (MCV > 80 fL) and PLT count equal or greater than 140,000/microL (n = 45); group 2, normal MCV, reduced PLT count (< 140 x 10(3)/microL, n = 41); group 3, microcytic samples with normal PLT count (n = 68); and group 4, microcytic samples with reduced PLT count (n = 49). We also compared the platelet counting using electroimpedance (PLT-EI), platelet count using fluorescent optical (PLT-FO), and platelet-count manual (PLT-M) methods, using the Sysmex XE 2100 automatic analyzer. Despite highly significant overall correlations between PLT-EI and PLT-FO, PLT-EI and PLT-M, and PLT-FO and PLT-M (r = 0.95 [all P < .001]), use of the PLT-EI method resulted in widely overestimated PLT counts in microcytic samples (MCV < 80 fL), compared with use of PLT-FO and PLT-M. Our results identify an MCV of 70 fL as the critical threshold below which PLT-EI became unreliable. The PLT-EI mode overestimated PLT counts compared with PLT-FO and PLT-M modes in microcytic blood. Therefore, PLT-FO is the preferred method for PLT counting in patients with microcytic anemia when using an automated analyzer.

Platelet Turnover in Stable Coronary Artery Disease – Influence of Thrombopoietin and Low-Grade Inflammation

BackgroundNewly formed platelets are associated with increased aggregation and adverse outcomes in patients with coronary artery disease (CAD). The mechanisms involved in the regulation of platelet turnover in patients with CAD are largely unknown.AimTo investigate associations between platelet turnover parameters, thrombopoietin and markers of low-grade inflammation in patients with stable CAD. Furthermore, to explore the relationship between platelet turnover parameters and type 2 diabetes, prior myocardial infarction, smoking, age, gender and renal insufficiency.MethodsWe studied 581 stable CAD patients. Platelet turnover parameters (immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell-ratio) were determined using automated flow cytometry (Sysmex XE-2100). Furthermore, we measured thrombopoietin and evaluated low-grade inflammation by measurement of high-sensitive CRP and interleukin-6.ResultsWe found strong associations between the immature platelet fraction, immature platelet count, mean platelet volume, platelet distribution width and platelet large cell ratio (r = 0.61–0.99, p<0.0001). Thrombopoietin levels were inversely related to all of the platelet turnover parameters (r = −0.17–−0.25, p<0.0001). Moreover, thrombopoietin levels were significantly increased in patients with diabetes (p = 0.03) and in smokers (p = 0.003). Low-grade inflammation evaluated by high-sensitive CRP correlated significantly, yet weakly, with immature platelet count (r = 0.10, p = 0.03) and thrombopoietin (r = 0.16, p<0.001). Also interleukin-6 correlated with thrombopoietin (r = 0.10, p = 0.02).ConclusionIn stable CAD patients, thrombopoietin was inversely associated with platelet turnover parameters. Furthermore, thrombopoietin levels were increased in patients with diabetes and in smokers. However, low-grade inflammation did not seem to have a substantial impact on platelet turnover parameters.

Novel Parameters of Extended Complete Blood Cell Count under Fluorescence Flow Cytometry in Patients with Sepsis

We first describe a patient who developed urosepsis from an ordinary urinary tract infection. In this case, the new hematological parameters of immature leukocytes, that is, the high-fluorescence lymphocyte cell (HFLC) and immature granulocyte (IG) counts peaked early, whereas the established infection parameters, that is, C-reactive protein (CRP) and total white blood cell count showed less dynamic regarding infection and therapy. To investigate this phenomenon in greater detail, the novel parameters HFLC and IG counts are investigated retrospectively in a cohort of 38 patients who were admitted to the anesthesia intensive care unit. Three groups of patients have been analyzed and compared: patients without signs of infection, patients with limited infections, and patients with sepsis. Data were collected with a Sysmex XE-5000 hematological analyzer. In patients (n = 22) without any signs of infection, both values are very low. In patients with limited local infections (n = 10), moderate elevations of the IG and HFLC counts are seen. In patients with sepsis (n = 6), the IG and HFLC counts are significantly higher. The total IG count seems to be useful for distinguishing a septic patient from a nonseptic (P < 0.004). Hematological parameters have the advantage of being measured easily during routine blood cell analysis.

Investigation on Reference Intervals and Regional Differences of Platelet Indices in Healthy Chinese Han Adults

Reference intervals are important for interpretation of clinical laboratory tests. The platelet (PLT) indices such as the mean platelet volume (MPV) and platelet distribution width (PDW) are newer hematological parameters, which have been recently reported as clinically valuable biomarkers. However, there are not many studies that have estimated the reference intervals for these parameters in healthy Chinese Han adults. The objectives of this study were to establish reference values of PLT indices [including PLT count, MPV, PDW, platelet-large cell ratio (P-LCR), and plateletcrit (Pct)] for healthy Chinese Han adults. We also aimed to determine the region-based differences of PLT indices in China. A total of 4,642 volunteers with a mean age of 43 were recruited from six regions of China. PLT indices were performed on Sysmex XE-2100 hematology analyzers, whose traceability was well verified. There were significant region-based differences for all PLT indices. Reference people in Chengdu had the lowest mean PLT count and Pct, but the highest MPV, PDW, and P-LCR among the six regions. Therefore, we derived the reference intervals in Chinese Han population excluding Chengdu reference people for PLT indices as PLT count: (127-341) × 10(9)/l; MPV: (9.20-13.30) fl; PDW: 9.90-19.00%; P-LCR: 18.10-52.00%; Pct: 16.00-41.00%. Region-specific reference intervals are essential as there were statistically significant region-related differences in the PLT parameters. The reference intervals established in this study differed from the existing reference values. Chengdu region may need proper specific reference ranges, which apply to their people, for all PLT parameters.

Complete blood count reference intervals and age- and sex-related trends of North China Han population

Defining common reference intervals (RIs) are encouraging. The aim of this study is to establish RIs for complete blood count (CBC) in a Chinese Han population and probe their age- and sex-related CBC trends. Additionally, we will compare the CBC RIs of Han with those of other races. In total 1259 Han individuals (584 male and 675 female) were recruited in North China. CBC was processed on Sysmex XE-2100, Coulter LH750 and Mindray BC5800 whose traceability was well verified. The non-parametric 2.5th-97.5th percentiles RIs were calculated. The RIs for CBC parameters did not show apparent analyzer-specificity, apart from mean cellular volume (MCV), mean platelet volume (MPV), plateletcrit (PCT) and platelet distribution width (PDW). Red blood cell (RBC), hemoglobin (HBG), hematocrit (HCT), mean cellular hemoglobin (MCH), and mean cellular hemoglobin concentration (MGHC) are higher in males; and their male mean values tend to drop after 40 years; conversely, the female mean values tend to rise. Platelet (PLT) is higher in females and tends to drop after 40 years in both sexes. White blood cell (WBC) and absolute count of neutrophils (NE) and monocytes (MO) are higher in males, but there is no apparent change with age. Lymphocytes (LY) absolute count declines with age in males, but the same change in females is not obvious. RIs for HBG and HCT are similar among Han, Nordic, US European and US Mexican populations and are lower in US Africans. WBC RIs for Han and US African populations are lower than that for US Europeans and US Mexicans. RIs for major blood cell parameters are not method-dependent; variations obviously exist in age, sex and race. Consequently, common RIs for most CBC parameters appear inapplicable.

Platelet Volume Indices are Associated with High Residual Platelet Reactivity after Antiplatelet Therapy in Patients Undergoing Percutaneous Coronary Intervention

It is well known that platelet volume indices are associated with adverse outcomes following percutaneous coronary intervention(PCI). In this study, we investigated the hypothesis whether the association between platelet size and clinical outcomes is the result of high residual platelet reactivity after antiplatelet therapy in patients with large platelets. Between February 2010 and December 2011, a total of 462 consecutive patients with coronary artery disease who were scheduled to undergo planned PCI were enrolled in this study. The degree of platelet aggregation induced by arachidonic acid(AA) and adenosine diphosphate(ADP) was assessed using the Multiple Electrode Platelet Aggregometry(Multiplate(®), Dynabyte, Munich, Germany)(MEA) test. We simultaneously measured the mean platelet volume(MPV) in the same period(Sysmex XE-2100, Mundelein, IL). The study population consisted of 462 consecutive patients, including 371 stable angina patients and 91 acute coronary syndrome patients. The patients with large platelets(upper quintile of MPV ≥10.6 fL) had significantly high residual platelet reactivity after both aspirin(MEA ASP 9 [5-14] Units vs. 13 [8-18.5] Units, p < 0.001) and clopidogrel(MEA ADP 21 [15-30] Units vs. 24 [18.5-40] Units, p=0.003) treatment. According to a multivariate analysis, having large platelets was independently associated with high residual platelet reactivity after both aspirin (OR 2.52, 95% CI 1.50-4.24, p < 0.001) and clopidogrel(OR 2.86, 95% CI 1.59-5.15, p < 0.001) treatment. Platelet volume indices were not associated with any differences in the incidence of major adverse cardiac events during follow-up. Platelets with a higher volume are associated with high residual platelet reactivity after conventional dual antiplatelet therapy.

Hematology Reference Intervals in Moroccan Population

Laboratory reference intervals are important for both clinical orientations and therapeutic decisions. In Morocco, no reference ranges are available for local population. The ranges commonly used in clinical laboratories and by physicians are those of Caucasian population. We have decided that it is relevant to undertake an epidemiological investigation on local adult healthy population, with the aim of establishing hematology reference intervals in Moroccan population. Blood samples were taken from healthy adult volunteers of the regional transfusion center and measured on a Sysmex XE-2100 analyzer. We have grouped our data samples with regard to gender and retained donors aged between 18 and 45 years old according to ICSH guidelines 1982. Leucocyte, erythrocyte, and platelet parameters were analyzed. For any sample flagged by the automate or thrombopenia with platelets < 100000/microL, a systematic smear was done and checked. A significant difference between male and female was found with regard to the values for leucocyte, erythrocyte, and platelet parameters as well as for hemoglobin and hematocrit. These data were compared to normal values reported for Arabic, Caucasian, and African population. As part of this study, we have given a descriptive approach of normal blood cell count and its peculiarities in North African Arabian and Berber population not explored until now. We have established similarities and differences between our population and other African, Arab, and Caucasian populations.

Establishing biological reference intervals for novel platelet parameters (immature platelet fraction, high immature platelet fraction, platelet distribution width, platelet large cell ratio, platelet-X, plateletcrit, and platelet distribution width) and their correlations among each other.

This study aims to establish biological reference interval for novel platelet parameters. A total of 945 healthy individuals, age ranges from 18 to 64 years (881 males and 64 females) coming for voluntary blood donation from June to August 2012 (3 months) were enrolled after exclusion of rejection criteria. The samples were assayed by running in complete blood count + reticulocyte mode on the Sysmex XE-2100 hematology analyzer and the reference interval for the population was calculated using Clinical and Laboratory Standards Institute guidelines. Tests were performed using SPSS (Statistical Product and Service Solutions, developed by IBM corporation), version 13. Student t test and pearsons correlation analysis were also used. The normal range for various parameters was platelet count: 150-520 × 10(3)/cu mm, immature platelet fraction (IPF): 0.3-8.7%, platelet distribution width (PDW): 8.3-25.0 fL, mean platelet volume (MPV): 8.6-15.5 fL, plateletcrit (PCT): 0.15-0.62%, high immature platelet fraction (H-IPF): 0.1-2.7%, platelet large cell ratio (P-LCR): 11.9-66.9% and platelet-X (PLT-X) (ch): 11.0-22.0. Negative correlation was observed between platelet count (r = -0.468 to r = -0.531; P < 0.001) and PCT (r = -0.080 to r = -0.235; P < 0.05 to P < 0.001) with IPF, PDW, MPV, H-IPF, P-LCR, and platelet-X. IPF/H-IPF showed a positive correlation among them and also with PDW, MPV, P-LCR, platelet-X (r = +0.662 to r = +0.925; P < 0.001). These novel platelet parameters offer newer avenues in research and clinical use. Establishing biological reference interval for different platelet parameters would help determine true high and low values and help guide treatment decisions.

Laboratory reference intervals of complete blood count for apparently healthy elderly people in Shuyang, China.

Currently, there are no appropriate RIs of blood cells available for the elderly in most clinical laboratories in China. The aim of this study is to establish the RIs of complete blood cell count for apparently healthy elderly people. Blood specimens were collected from elderly residents by standard procedures. Complete blood counts were determined by Sysmex XE-2100 analyzer. The RIs and 95% confidence intervals were calculated by the robust method recommended by CLSI C28-A3 guideline. RIs established for healthy elderly include: total WBC 3.63 - 10.3 x 10(9)/L for males and 3.64 - 10.3 x 10(9)/L for females; RBC 3.74 - 5.49 x 10(12)/L for males and 3.74 - 5.53 x 10(12)/L for females; Hb 109 - 167 g/L for males and 109 - 168 g/L for females; HCT 36.0 - 51.8% for males and 35.7 - 51.8% for females; MCV 86.0 - 105 fL for males and 86.2 - 106 fL for females; MCH 26.4 - 33.6 pg for males and 26.4 - 33.8 pg for females; MCHC 293 - 333 g/L for males and 291 - 335 g/L for females; RDW-SD 39.3 - 53.7 fL for males and 39.6 - 54.5 fL for females; RDW-CV 11.7 - 15.1% for males and 11.7 - 15.2% for females; PLT 122 - 355 x 10(9)/L for males and 122 - 350 x 10(9)/L for females; PCT 14.1 - 37.6 x 10(-1) mL/L for males and 13.9 - 37.9 x 10(-1) mL/L for females; MPV 11.3 - 15.5 fL for males and 11.3 - 15.5 fL for females; PDW 9.74 - 17.0% for males and 9.72 - 17.0% for females; platelet-LCR (P-LCR) 21.3 - 51.2% for males and 21.1 - 51.4% for females. We established scientific and reasonable RIs of blood cell analysis for the healthy elderly in our region.