Sysmex XN Research Articles

Role of Neutrophil-Lymphocyte Ratio in Predicting Severity of COVID-19

Background: Higher neutrophil-lymphocyte ratio (NLR) is considered as cardinal findings with prognostic potentials in identification of severe COVID-19 cases. However, whether baseline NLR could be a predictor of disease severity and outcome remained to be investigated. Hence, this study was conducted with an aim to evaluate the relation of NLR (on admission) with disease severity. Objective: The objective of the study was to estimate the neutrophil-lymphocyte ratio among COVID-19 patients and its role in predicting disease severity. Method: This cross-sectional study was conducted in Bangabandhu Sheikh Mujib Medical University (BSMMU) from July 2020 to June 2021. Ninety-four COVID-19 admitted patients were enrolled following inclusion & exclusion criteria. Informed consent was taken from the subjects. Ethical clearance was obtained from institutional review board (IRB) of BSMMU. Complete blood count for N-L ratio was done by standard procedure on admission by SYSMEX XN-2000 haematology analyser. Clinical and laboratory information were recorded with a semi-structured questionnaire. After collection of all the required data, analysis was done by SPSS 24.0. Results: Mean age of the patients was 56.59±12.25 years, wherein maximum patients were male (67%), non-smoker (80.9%), and retired/current service holder (51.1%). Maximum patients were hypertensive (61.7%) and diabetic (56.4%). Besides, maximum study patients (64.9%) were in severe category of COVID-19, followed by moderate (20.2%) and mild (14.9%) category according to National Guidelines on Clinical Management of COVID-19 criteria. Mean NLR was 5.40±4.35 (SD), wherein on admission NLR was significantly higher among severe COVID-19 patients compared to mild/moderate category (6.90±4.64 vs 2.61±1.53, p <0.05). 28-days hospital mortality was found to be significantly associated with NLR (p<0.05). Receiver operator curve analysis found highly significant cut-off value for NLR (3.42) with 75.4% sensitivity and 75.8% specificity in predicting severe COVID-19 patients (AUC= 0.841, p value <0.001). Multivariate logistic regression analysis found NLR as an independent predictor for severe COVID-19 (OR=4.68, 95% CI: 1.29-16.81, P=0.019). Pearson correlation analysis showed that NLR had significant positive correlation with CRP and D-dimer as p value <0.05. Conclusion: NLR can predict the disease severity and outcome of hospitalized COVID-19 patients. However, further larger study is recommended.

Inflammatory and neutrophil activation markers in Behcet's disease

Behcet's disease (BD) is a systemic vasculitis characterized by recurrent episodes of inflammation with aphthous stomatitis, genital ulcers, skin, joint and internal organ involvement. Currently, there are no reliable laboratory markers that can be used to monitor BD activity. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) have low sensitivity, so the search for new biomarkers continues. Neutrophil reactivity intensity (NEUT-RI), neutrophil granularity intensity (NEUT-GI), immature granulocytes (IG), neutrophil-to-lymphocyte ratio (NLR), systemic immune inflammation index (SII) are new inflammatory indicators whose role in BD is not well studied.Objective: to evaluate and compare the efficacy of the determination of NEUT-RI, NEUT-GI, IG, SII, NLR, ESR and CRP in the diagnosis of active BD.Material and methods. 84 patients with a reliable diagnosis of BD and 38 healthy controls were included in the study. BD activity was assessed using the Behcet’s Disease Current Activity Form (BDCAF). Patients with BD were divided into two groups according to activity: Group I included 41 patients with high activity (BDCAF >5) and Group II included 43 patients with low activity (BDCAF ≤5). A complete blood count with determination of NEUT-RI, NEUT-GI, IG, SII and NLR was performed in all patients and healthy donors using the Sysmex XN 1000 automated haematology analyzer (Sysmex Сorp, Japan). ESR was determined using the Westergren method. High-sensitivity serum CRP level was determined in all patients with BD (normal range ≤5) by immunonephelometric method.Results and discussion. Patients with active BD had significantly higher levels of neutrophils, SII, NLR, NEUT-RI, IG, ESR and CRP compared to patients with low disease activity. ROC analysis was performed to compare the significance of these inflammatory markers in the assessment of BD activity. The SII had the largest area under the ROC curve (AUC =0.816). The sensitivity and specificity of the SII at a value of 509.75 or higher for determining the active form of BD were 79.4% and 71.8%, respectively.Conclusion. The new inflammatory parameters (SII, NLR, NEUT-RI and IG) and the traditional inflammatory parameters (ESR, CRP, neutrophils) can serve as laboratory markers for BD activity. SII is the most informative parameter to determine BD activity with optimal sensitivity and specificity.

Usefulness of extended inflammatory parameters related to neutrophil activation reported by Sysmex XN-1000 hematology analyzer for predicting complicated acute appendicitis. Comparison with canonical inflammatory laboratory tests

AimAccurate diagnosis of complicated appendicitis is of importance to ensure that patients receive early and effective treatment, minimizing the risk of postoperative complications to promote successful recovery. Biochemical markers are a promising tool to identify complicated appendicitis. We aimed to evaluate the potential role of novel parameters related with neutrophil activation, known as “Extended Inflammation Parameters” (EIP), included in blood cell count reported by Sysmex XN-Series analyzers, compared to other canonical biomarkers in identifying complicated appendicitis. MethodProspective observational study including patients with confirmed diagnosis of acute appendicitis. C-reactive protein (CRP), procalcitonin, cell blood count, including white blood cell (WBC), absolute neutrophil (ANC) and immature granulocyte (IG) count and EIP (neutrophil reactivity [NEUT-RI] and granularity intensity [NEUT-GI]) were analyzed before surgery. Their accuracy to diagnose complicated appendicitis was tested in an ROC curve analysis. ResultsOur population study included 119 patients, and appendicitis was complicated in 58 (48.7%). NLR, CRP and procalcitonin levels, ANC and IG count and NEUT-RI and NEUT-GI were higher in patients with complicated appendicitis. Regarding accuracy for complicated appendicitis, CRP was the biomarker with the highest performance (ROC AUC: 0.829), with an optimal cutoff of 73.1 mg/L (sensitivity: 63.8%, specificity: 88.5%). NEUT-RI and NEUT-GI achieved both significant but poor accuracy, with ROC AUC of 0.606 and 0.637, respectively. ConclusionsNovel laboratory tests reported by Sysmex XN-Series analyzers have poor accuracy for identifying complicated appendicitis. In this study, CRP was the biomarker with the highest performance and may be useful as predictor of the severity of acute appendicitis.

Diagnostic Utility of Reticulocyte Hemoglobin Equivalent Parameter in the Evaluation of Microcytic Hypochromic Anemia – Our Experience from Northeast India

Background: Reticulocytes are red blood cell precursors with an average lifespan of 1–2 days. Reticulocyte hemoglobin equivalent (Ret-He) is an early marker of iron deficiency (ID) erythropoiesis and reflects real-time information regarding the synthesis of young erythrocytes in the bone marrow. The objective of this study is to determine the diagnostic utility of Ret-He in patients having microcytic hypochromic anemia in comparison with serum ferritin and iron studies. Objectives: The objective of this study is to determine the diagnostic utility of the Ret-He parameter in patients having microcytic hypochromic anemia in comparison with the serum ferritin, iron studies and its role in routine hematological screening for nutritional deficiency anemia like ID. Design and Settings: The design involves observational study. Materials and Methods: A hospital-based observational study was carried out in a referral hospital. Hematological parameters were processed using Sysmex XN1000 (Sysmex Corporation, Kobe, Japan) analyzer and were compared with Serum iron studies using biochemistry analyzer (VITROS® 250 Chemistry System) from 201 participants who presented with microcytic hypochromic anemia. Main Outcome and Measures: Relationship of Ret-He parameter and its diagnostic utility for screening of iron-deficient states. Sample Size: The sample size was 201. Results: When serum ferritin is taken as “the gold standard” to detect ID, with Ret-He cutoff of 27.15 pg/cell, we found a statistically significant positive correlation between Ret-He and serum ferritin (P < 0.001). We found a sensitivity of 57.37% and specificity of 75.95% with area under the curve of 0.681, positive predictive value of 100%, negative predictive value of 3.8%, and accuracy of 62.19% for Ret-He in detecting ID anemia (IDA). Also found a statistically significant negative correlation between Ret-He and total iron binding capacity (P < 0.001). There was no statistical correlation between Ret-He and serum iron levels in our study. Conclusions: The present study suggests Ret-He is one of the better and more reliable hematological parameters indicating ID and, when used along with biochemical parameters like serum ferritin, can give valuable inputs in a better screening and diagnosis of IDA; hence proper treatment is possible. Limitations: The multicentric study is required to standardize Ret-He reference values, and follow-up to therapy of the subjects was not done. Additional hemoglobin variant analysis data would have been favorable to the study.

Evaluation of the Sysmex XQ-320 three-part differential haematology analyser and its flagging capabilities.

Three-part differential (3PD) haematology analysers offer a quick, easy-to-use and economical way to acquire important information about a patient's physiology. In this study, we evaluated a new 3PD analyser, the Sysmex XQ-320, investigated its comparability with its predecessor (Sysmex XP-300) and the five-part differential analyser Sysmex XN-9000, and explored its flagging potential. Analytical performance studies were conducted for repeatability, within-laboratory precision, between-day precision, carry-over and linearity with fresh blood and QC material. Method comparison was performed in 493 samples comparing XQ-320 with XP-300, using the XN-9000 as the gold standard. The XQ-320 excelled manufacturer's specifications in the analytical performance studies, except for MXD in within-laboratory and between-day precisions using the QC material level 1. The XQ-320 showed correlation values greater than 0.94 with XN-9000 for the majority of the 20 reportable parameters (MXD# 0.891, MXD% 0.898 and MCHC 0.849). Improvements over the XP-300 were observed in WBC in the leucocytopenic range (bias -0.038 vs. -0.097) and PLT (bias 2.568 vs. -7.877, intercept 3.880 vs. -8.845). Concordance between XQ-320 and XP-300 was 91.9% for the WBC histogram abnormal distribution flag and 95.3% for the PLT flag. Patterns of increased neutrophils and decreased mixed cells on the XQ-320 were observed in samples that raised a flag on XN-9000. The XQ-320 showed excellent analytical performance, and very good to excellent correlation with XN-9000 with improvements over XP-300. Flagging combined with parameter patterns identified additional suspected abnormal samples, thus making the XQ-320 an excellent solution for laboratories utilising 3PD analysers.

Yearly intrasubject variability of hematological biomarkers in elite athletes for the Athlete Biological Passport.

Confounding factors including exercise and environments challenge the interpretation of individual Athlete Biological Passports (ABPs). This study aimed to investigate the natural variability of hematological ABP parameters over 1 year in elite athletes compared with healthy control subjects and the validity of a multiparametric model estimating plasma volume (PV) shifts to correct individual ABP thresholds. Blood samples were collected monthly with full blood counts performed by flow cytometry (Sysmex XN analyzers) in 20 elite xc-skiers (ELITE) and 20 moderately trained controls. Individual ABP profiles were generated through Anti-Doping Administration & Management System Training, a standalone version of the ABP's adaptive model developed by the World Anti-Doping Agency. Additionally, eight serum parameters were computed as volume-sensitive biomarkers to run a multiparametric model to estimate PV. Variability in ELITE compared with controls was significantly higher for the Abnormal Blood Profile Scores (P = 0.003). Among 12 Atypical Passport Findings (ATPF) initially reported, six could be removed after correction of PV shifts with the multiparametric modeling. However, several ATPF were additionally generated (n =19). Our study outlines a larger intraindividual variability in elite athletes, likely explained by more frequent exposure to extrinsic factors altering hematological biomarkers. PV correction for individual ABP thresholds allowed to explain most of the atypical findings while generating multiple new ATPF occurrences in the elite population. Overall, accounting for PV shifts in elite athletes was shown to be paramount in this study outlining the opportunity to consider PV variations with novel approaches when interpreting individual ABP profiles.

Reference intervals of cell population data parameters in Sysmex XN-Series and its patterns of changes from early adulthood to geriatric ages in South Korea.

Cell population data (CPD) parameters may be putative biomarkers for the screening of various diseases including some infections and myelodysplastic syndrome. This study aimed to establish the age- and sex-specific reference intervals (RIs) for the CPD parameters in the Korean population. The reference population for the RIs of CPD parameters comprised 124 856 subjects aged 20-99 years. CPD parameters were obtained from Sysmex XN-2000 (Kobe, Japan) datasets from 17 health promotion centers in 13 South Korean cities. We determined significant partitions for age and sex, and calculated RIs according to Clinical and Laboratory Standards Institute C28-A3 guidelines. The side scattered light intensity in the neutrophil area and the lymphocyte area did not require sex-related partitioning except in those over the age of 50, among whom the lower limit (LL) and upper limit (UL) were lower in females. However, the side scattered light distribution width in the lymphocyte area required age- and sex-related partitioning, in which LL and UL were higher in females. The LL and UL of the fluorescent light distribution width were higher in males in the neutrophil area and higher in females in the lymphocyte area, but age-related partitioning was not required. The forward scattered light intensity in the neutrophil area, lymphocyte area, and monocyte area did not require age-related partitioning in males. This study has determined comprehensive age- and sex-specific RIs for CPD parameters, which could help to prove the clinical significance of these parameters in the Sysmex XN-2000.

Hematopoietic Progenitor Cell Counts of the Leukapheresis Product Determined Using Sysmex XN Analyzers Predict a Sufficient Number of CD34+ Stem Cells in a Peripheral Blood Stem Cell Harvest for Autologous Transplantation.

Objective Several institutions outsource CD34+ cell counting of leukapheresis products, limiting rapid measurements, as results are obtained the next day. This problem is compounded with plerixafor use, a stem cell-mobilizing drug that increases leukapheresis efficiency but requires administration the day before leukapheresis. Use of this drug for a second leukapheresis procedure before the first-day leukapheresis CD34+ count results are confirmed causes unnecessary leukapheresis and expensive plerixafor administration. We investigated whether or not measuring hematopoietic progenitor cells in leukapheresis products (AP-HPCs) using a Sysmex XN-series analyzer could resolve this problem. Methods We retrospectively compared the absolute AP-HPC value per body weight with the CD34+ (AP-CD34+) count in 96 first-day leukapheresis product samples obtained between September 2013 and January 2021. Comparisons were also conducted according to regimen: granulocyte colony-stimulating factor (G-CSF) monotherapy, chemotherapy plus G-CSF, or plerixafor mobilization. Results AP-CD34+ and AP-HPC counts correlated strongly (rs=0.846) overall and, in particular, under chemotherapy plus G-CSF (rs=0.92) but correlated mildly under G-CSF monotherapy (rs=0.655). AP-HPCs could not completely be dichotomized based on an AP-CD34+ threshold of 2×106/kg for any stimulation procedure. In most cases with AP-HPCs >6×106/kg, the AP-CD34+ count exceeded 2.0×106/kg, but in 5.7% of these cases, the AP-CD34+ count was <2.0×106/kg. A cut-off of AP-HPCs >4.843×106/kg yielded a sensitivity of 71% and specificity of 96% for predicting AP-CD34+≥2×106/kg. Conclusion AP-HPCs can identify cases in which sufficient stem cells have been collected.

Validation of the Sysmex XN analyser and Blood Bank mode for the quality and safety of donor blood and transfusion products.

Our objective was to compare the measurement of residual white blood cell (rWBC) and residual red blood cell (rRBC) counts in blood products using the XN Blood Bank mode and the laboratory standard operating procedures for manual counts. In addition, to compare the whole blood complete blood count (CBC) values of blood donors and the quality of blood products using the Sysmex XN analyser versus the XS-1000i analyser. For blood donors, 190 samples from blood or apheresis donors were analysed on both the Sysmex XS-1000i and XN-1000 analysers and the mean values of six CBC parameters were compared: the white blood cell count (WBC), the red blood cell count (RBC), haemoglobin (HGB), haematocrit (HCT), the mean corpuscular volume (MCV), the platelet count (PLT). For blood products, 164 samples were collected: 13 Plasma products - whole blood, 9 Plasma products - apheresis, 36 RBC concentrates - whole blood, 30 PLT concentrates - buffy coats, 36 PLT concentrates - buffy coats - pooled and 55 PLT concentrates - apheresis. All CBC parameters of the blood donors tested showed similar performance, with excellent correlation coefficients (r) ranging from 0.821 to 0.995. The majority of the blood products did not have a quantifiable number of residual cells, meaning the number of rWBC and rRBC, if present, was below the limit of quantitation (LoQ) of the different methods. rWBC were detected by Blood Bank mode in Plasma products - whole blood with a mean rWBC of 0.012 × 109 /L and in PLT concentrates - buffy coats with a mean rWBC of 0.19 × 109 /L. The correlation coefficient in both analysers for all three parameters (HGB, HCT, RBC) in RBC concentrates - whole blood was excellent, ranging from 0.95 to 0.99. For platelet count, r ranged from 0.98 to 0.99. The XN-Series analyser, equipped with a Blood Bank mode, demonstrated reliable performance when used for blood donor evaluation, rWBC enumeration and measurement of end blood products.

Conformity of Differential White Blood Cell (WBC) Examination Results on the Sysmex DI-60 And Sysmex XN-1000 at Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali

Conformity of Differential White Blood Cell (WBC) Examination Results on the Sysmex DI-60 And Sysmex XN-1000 at Prof. Dr. IGNG Ngoerah General Hospital, Denpasar, Bali

Expression of ZAP 70 in Chronic Lymphocytic Leukemia (CLL) and its Correlation with Clinical Stages

Objective: To ascertain the levels of ZAP-70 expression within the context of Chronic Lymphocytic Leukemia (CLL) patients and to subsequently analyze the potential correlations between ZAP-70 expression and the clinical staging of the disease. Study Design &amp; Setting: Cross-sectional, descriptive study. Department of Hematology, Armed Forces Institute of Pathology (AFIP), Rawalpindi from July 2021 to December 2021. Methodology: We included 73 CLL patients of various ages and both genders. and patients having lymphoproliferative disorders other than CLL were excluded. Sysmex XN-3000 was used to do complete blood counts. Diagnosis of CLL was confirmed immunophenotypically by flow cytometry. Samples were processed by standard methods for ZAP70 analysis. Descriptive statistics were expressed in terms of mean ± standard deviation (SD). A Chi-square test was conducted, with a significance level of p-value =0.05 being considered significant. Results: Among 73 patients, 24 were females (32.9%) and 49 were males (67.1%). Females had a mean age of 69.00±9.47 years, whereas males had a mean age of 65.73±11.12 years. ZAP-70 expression was positive in 8 (11%) and negative in 65 (89.0%) cases. The expression of ZAP-70 in CLL and its correlation with Binet Stages was significant (p=0.002). ZAP- 70 expression in males and females showed no significant difference (p 0.059). ZAP-70 analysis showed no significant difference in patients with age more than 60 years from = 60 years of age (p= 0.275) Conclusion: ZAP-70 gene expression should be used in routine laboratory settings and can be correlated with the clinical stages of CLL

Verification of a Benchtop Hematology Analyzer with a 5-Part Differential Count: There is Nothing Wrong with Being Small.

The benchtop ADVIA 560 AL hematology analyzer (Siemens Healthineers Tarrytown, NY, USA) offers a small footprint and ease of operation making it suitable for satellite laboratories and intensive care units. A verification study of this analyzer was performed. Between- and intra-run precision, carry-over, linearity, and throughput were evaluated on the ADVIA 560 AL. Accuracy was assessed on 94 patient samples by comparing the results obtained on the ADVIA 560 AL to the results on the reference Sysmex XN1000 analyzer (Sysmex Corporation, Kobe, Japan). The ADVIA 560 AL showed acceptable imprecision on control material and minimal bias in comparison to the XN 1000 on patient samples with a throughput of 60 samples per hour. The percentage carryover was not significant and the linearity was within acceptable limits. The ADVIA 560 AL bench-top analyzer is suitable for acute care centers and satellite laboratories owing to its small footprint, ease of use, and reproducible and accurate results.

Validacija epruveta male zapremine za prikupljanje krvi za rutinsko hematološko testiranje

Background: Low-volume blood tubes offer several advantages in facilitating blood collection, reducing iatrogenic anemia and spurious hemolysis, but their clinical reliability must be validated. We planned this investigation for establishing the reliability of routine hematologic testing in low-volume tubes before their implementation into clinical practice. Methods: Blood was drawn from 44 ostensibly healthy laboratory professionals into three blood tubes, as follows: 3.0 mL of blood into a 3.0 mL K2EDTA standard reference blood tube, 0.5 mL of blood into a second 3.0 mL K2EDTA standard blood tube, and 0.5 mL of blood into a 0.25-0.5 mL K2EDTA low-volume blood tube. Hematologic testing was performed on Sysmex XN-10 hematology analyzer. Results: Statistically significant differences were observed in total white blood cell count, neutrophil count, lymphocyte count, red blood cell count, platelet count, hemoglobin, hematocrit, mean corpuscular volume (MCV), mean corpuscular hemoglobin concentration (MCHC), and mean platelet volume in both 0.5 mL-filled 3.0 mL standard blood tubes and 0.5 mL-filled low-volume blood tubes. Although none of these variations was found to be clinically significant in the 0.5 mL-filled low-volume blood tube compared to the desirable specifications, hematocrit, MCV and MCHC displayed a clinically significant bias in the 0.5 mL filled 3.0 mL K2EDTA standard blood tube. Conclusions: These results suggests that K2EDTA low-volume blood tubes could safely replace standard blood tubes for preventing the receipt of insufficient samples, but also for facilitating blood collection in patients with difficult veins and reducing the risk of iatrogenic anemia and spurious hemolysis.

Performance analysis of point-of-care testing haemoglobin concentration methods with automated haematology analyser amongst blood donors

Abstract Background: In terms of rapidness, testing methodology and sensitivity, point-of-care (POC) testing devices provide quality in haemoglobin (Hb) check for safe donation of blood. Methods: This was a prospective observational study in a tertiary care centre. Capillary finger-prick samples obtained from 100 blood donors were analysed prior to donation using reagent-free cuvettes (DiaSpect Tm), digital haemoglobinometer (True Hb) and Hb photometer (HemoCue 301). Venous samples were drawn for analysis on haematology analyser. Donors were accepted based on copper sulphate method acceptance criteria. The performance of the devices was evaluated considering automated haematology analyser (Sysmex XN 1000) as the gold standard. Results: The mean Hb value using Sysmex XN 1000, HemoCue 301, DiaSpect Tm and True Hb were 14.8 ± 1.1 g/dL, 15.4 ± 1.8 g/dL, 15.3 ± 1.8 g/dL and 18.6 ± 2.8 g/dL, respectively. The sensitivity of True Hb, DiaSpect Tm, HemoCue 301 and copper sulphate method were 96.8%, 96.8%, 3.7% and 98.9%, respectively. DiaSpect Tm had a specificity of 60% whereas specificity of True Hb and copper sulphate method were 20% each. True Hb, HemoCue 301, DiaSpect Tm and copper sulphate had a positive predictive value of 95.8%, 94.7%, 97.9% and 95.9% and accuracy of 93%, 89%, 95% and 95%, respectively. The mean turnaround time was 1 sec for DiaSpect Tm whereas 35.3 sec and 2.6 sec for True Hb and HemoCue 301, respectively. The copper sulphate test provided the highest rate of donor’s acceptance, despite unacceptable Hb levels. Conclusions: DiaSpect Tm has the advantage of rapid turnaround time, high specificity and accuracy when compared to gold standard method.

Vortexing specimens to disaggregate platelet clumps in EDTA specimens.

To compare platelet count results of specimens that yield platelet clump flags to platelet count results on these specimens after vortexing. Specimens that generated platelet count flags on Sysmex XN 3000 instruments were vortexed and rerun. Only data from specimens demonstrating elimination of platelet clump flags were used in this study. Pearson r analysis was performed on data. Comparison of complete blood count results (white blood cell count, red blood cell count, hemoglobin, hematocrit, and platelet count) all yielded Pearson r scores >0.9. Additional patient comfort and safety concerns, as well as concerns over additional specimen collection and processing costs, may be avoided by vortexing and rerunning specimens flagged for platelet clumps when the platelet count is normal.

COMPATIBILITY BETWEEN PLATELET HISTOGRAM WITH IP MESSAGE AND PLATELET MORPHOLOGY IN THROMBOCYTOPENIA PATIENTS

Thrombocytopenia is a condition characterized by low levels of platelets in the blood. The platelet count can be checked using a Hematology analyzer, which is an automatic tool for checking a Complete Blood Count (CBC). The principle of this tool is to detect a signal that is comparable to the cell size that has been set on the tool. The results of the CBC examination are accompanied by a histogram and IP Message if there are abnormal cells, so a confirmatory test using a peripheral blood smear is necessary. The purpose of this study was to determine the suitability of the results of the platelet histogram with the IP Message on the platelet morphology of peripheral blood smears of thrombocytopenia patients. This research is a quantitative descriptive study of 54 samples taken using the Saturation Sampling technique at Grati Pasuruan Hospital using the Sysmex XN-1000 from April 1–30, 2023. The variables in this study are histogram results accompanied by IP Messages and platelet morphology on peripheral blood smears. The results of this study are that the histograms that often appear are abnormal heights on the PU Flag and the IP Messages that often appear are “PLT Clumps?”, with a suitable level of platelet morphology on peripheral blood smear examination reaching 90.7%, so it can be concluded that there is a compatibility between the results of the platelet histogram accompanied by the IP Message on the platelet morphology of the peripheral blood smear of thrombocytopenia patients.

Immature granulocyte and other markers in prediction of the short-term and long-term prognosis of patients with acute ischemic stroke

Background &amp; Objectives: To evaluate immature granulocytes, a new inflammatory biomarker, and other markers in short- and long-term prognosis in patients with acute ischemic stroke (AIS). Methods: Laboratory information system data from a tertiary hospital in Turkiye were used in this retrospective study. Of the 327 patients with the diagnosis of AIS, 275 recovered, and 52 died. It was determined that 31 of these 275 patients, who were followed up retrospectively, died within 12 months after discharge. Routinely measured immature granulocyte (IG), other hemogram parameters in the Sysmex XN 1000 (XN-1000-Hematology-Analyzer-Sysmex Corporation, Japan), and demographic data were statistically compared in both groups. We tried to estimate the short- and long-term mortality from the blood samples of these patients at their first admission to the hospital. Results: Of the patients included in the study, 150 (45.9%) were female, and 177 (54.1%) were male. National Institutes Of Health Stroke Scale (NIHSS) (AUC=960), length of stay (AUC=791), red blood cell distribution width – standard deviation (RDW-CV) (AUC=728), and IG (AUC=712) were the most effective parameters in predicting short-term mortality, while age (AUC=764) in predicting long-term mortality was the most effective parameters. Conclusion: IG, together with NIHSS and length of stay, shows moderate and high predictive properties in prognosticating short-term mortality but is ineffective in prognosticating long-term mortality. Age was found to be the most predictive marker for long-term mortality.

Diagnostic Values of Immature Granulocytes Detected by the Sysmex XN 9000 Hematology Analyzer in Children with Urinary Tract Infections.

Immature granulocytes (IGs) are used as markers of infection and systemic inflammation. We aimed to investigate the diagnostic value of IGs in children with urinary tract infections (UTIs). Children with their first UTIs were included in this observational study. Blood samples were obtained before antibiotic therapy. The blood analysis was repeated 2 weeks after the treatment ended. In total, 194 children (95 with febrile UTI, 58 with cystitis, and 41 controls) were included. The percentage of IGs (IG%) and IG count (IGC) measured at the time of admission were higher in the patients with febrile UTI than in the patients with cystitis and the controls (P = 0.000). The IGC and IG% after treatment were higher in patients with renal scarring than in those without scarring (P = 0.012 and P = 0.021, respectively). Cox's regression analysis showed the significant associations of renal scarring with both IGC and IG% (hazard ratio: 8.181, P = 0.002; hazard ratio: 5.106, P = 0.033, respectively). Both IGC and IG% were positively associated with severe vesicoureteral reflux (VUR) [odds ratio (OR): 22.235, P = 0.025; OR: 15.597, P = 0.038, respectively]. In conclusion, the IG% and IGC, which can be easily measured in a routine complete blood count without the need for additional effort, could be used as biomarkers for predicting febrile UTI, renal scarring, and severe VUR in children.

Blood Count Scattergrams Are Fingerprints of Blood: Using AI to Inform Health Status

Introduction: Blood count analysers are routinely used to assess health status and for disease monitoring. The major analysers generate more than 300 red cell, leukocyte and platelet parameters. However, in clinical practice, only 10-20 are utilised; a greater number are reviewed by laboratories but some are merely for ensuring instrument stability and quality assurance. Although there are hundreds more measurable parameters available through extended analytical channels, these are not assessed due to the complexity of the numerical analysis and questions as to the clinical utility. However, these extended analytical parameters have potential to be used to generate real-time ‘3-Dimensional (3-D)‘ details of blood cells. Aim: In this study we assessed 312 parameters generated from 5,800 patient samples (of all ages and genders) at a tertiary care hospital (National Institute of Blood Disease, Karachi-Pakistan). These were anonymously outputted and processed by machine learning (ML). Method: The methodology of the present study was based on the waterfall model. The output data from a haematology analyser (Sysmex XN-1000, Kobe Japan) in CSV format, having a total 433 columns, was pre-processed to remove unnecessary features (such as date, analysis details, rack position, receiving time, alerts and others) using Pandas and Numpy libraries, and where required scaling was performed. Data labeling was conducted on conclusions reported on their respective confirmatory tests. The processed data (which included 312 features of the total 433 columns) was labeled (with 67 conclusions on their confirmatory tests). The extracted data was fed to the artificial intelligence Machine Learning models through Python modules and libraries for training, testing, and validation purposes. The web application was developed on modern Python framework (Flask) to automate and provide an option of ‘drag and drop’ the CSV file exported from analyser, we connected pre-processing (data engineering), Machine Learning, and Prediction view by set of different tools (majorly JavaScript libraries). This generated various metrics including accuracy, precision, recall and the mean of precision and recall (F1 score) in relation to the prediction (results) from the CSV file submitted to our system. For each forecast the entire precision report and prediction box were added an optional visualisation on our web panel. Results: Analysis of 1.8 million data points (312 parameters x 5,800 samples) presented promising predictive potential, as, on principal component analysis (PCA) pilot the total variance was remained 41.6% showing that a linear combination of parameters can explain much variability. On a heat map the clustering and visualisation advocated the predictive potential and signatory deviational trends (fingerprints) respectively of these 3-D blood cell features. Examples included separation of myeloid from lymphoid, chronic from acute, bacteria from viral, deficiency of iron from deficiency from vitamin B12 / Folic acid, and differentiation of haemoglobinopathies. The patterns of normal, immature and abnormal blood cells under the title of cell population data was well demonstrated from results of our machine learning models. Of note, we observed an accuracy of 85.6% along with 91.2% precision for one of the ML models used (Random Forest Classifier). Conclusion: The opportunities and challenges of such high dimensional cell population data derived from a complete blood count can provide a novel patient-specific haematological fingerprint. This extended deviational patterning (fingerprint) can provide interpretive diagnostic data with practical disease-specific patterns. This pilot study shows that complete blood count data driven machine learning applications has great potential to uncover disease-associated patterns which could be applied in practice. It also has capacity to provide baseline testing would could assist in sequential health monitoring and potentially the generation of personal reference ranges.

Comparison of results of two hematological analyzer systems: Dirui BF-7200 and Sysmex XN-1000

Abstract Objectives Complete blood count (CBC) is performed using automated hematology analyzers. It is important that CBC results are comparable, reproducible, and reliable. In this study, our aim is to compare the results of Sysmex XN-1000 and Dirui BF-7200 hematology analyzers. Methods Patient samples randomly selected from the routine workflow for each instrument were measured 20 consecutive times to assess reproducibility. The mean, standard deviation, and coefficient of variation (CV%) were calculated for each hematological parameter. A comparison of results from the evaluated Dirui BF-7200 system with those from the current hematology analyzer Sysmex XN-1000 system was made for all of the samples included in the study. The compatibility between the parameters was evaluated using Passing–Bablok and Bland–Altman analyses. Results The within-run CV% values were outside the desirable biological variation database (European Federation of Clinical Chemistry and Laboratory Medicine) specification for CV% for eosinophil, basophil, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, mean platelet volume and platelet distribution width expressed as standard deviation in the Sysmex XN-1000 instrument and eosinophil, basophil, hematocrit and indexes of red blood cell and platelet in the Dirui BF-7200 instrument. When the Bland–Altman and Passing–Bablok analysis results were evaluated together, most parameters showed poor agreement; only white blood cells and lymphocytes showed good agreement between the two instruments. Conclusions As there is variability between results from different hematology analyzers, we recommend analyzing patient samples in the same laboratory using the same analyzer to avoid different results that could be misinterpreted.