Search Results (26)

Background: Reliable platelet (PLT) measurement is crucial for the accurate diagnosis of thrombocytopenia. Several methods exist for automated PLT counting, including the impedance method (PLT-I), as well as optical and fluorescence methods (PLT-F). The impedance method is cost-effective but susceptible to interference from small red blood cells and schistocytes. In contrast, fluorescent assessment offers higher specificity but is more expensive, as it requires additional dyes and detectors. Hybrid platelet counting (PLT-H) combines impedance with measurements from the leukocyte differentiation channel and is available without additional cost. Aim: The aim of this study was to evaluate the accuracy of hybrid PLT counting in anemic samples. Methods: In this retrospective study, PLT counts from 583 unselected anemic samples were analyzed using two different analyzers: the Sysmex XN3500, equipped with fluorescent PLT-F technology, and the Mindray BC6200, which uses both impedance (PLT-I) and hybrid (PLT-H) technologies. Agreement between PLT-I and PLT-F, as well as between PLT-H and PLT-F, was assessed using Bland–Altman plots. Correlation between the methods was evaluated using the Pearson correlation coefficient. Results: The hybrid method demonstrated better accuracy in PLT counting compared to the impedance method. Correlation between PLT-H and PLT-F was excellent, ranging from 0.991 to 0.999. In thrombocytopenic samples (PLT < 50 G/L), the hybrid method also provided more reliable PLT counts than the impedance method, reducing the number of falsely elevated PLT results by nearly fivefold. Conclusions: Hybrid platelet counting yields more accurate results than the impedance method in anemic samples and shows excellent correlation with the fluorescence method. Full article

Background/Objectives: The gold standard for cerebrospinal fluid leukocyte counting is manual counting in a Fuchs–Rosenthal chamber. Recent advances in automated body-fluid-counting systems, offering a time- and labor-saving solution, are challenging this dogma. Yet, the equivalence of diagnostic accuracy is still debated in the community. Methods: We compared manual and automated cell counting of cerebrospinal fluid samples of lumbar punctures and extraventricular drains with both low and high leukocyte counts, shedding light on the variability of results between man and machine. Results: Automated and manual cell counting showed a strong correlation across all samples, particularly in the subgroup of patients with fewer than 20 cells/µl, where outliers could become especially clinically relevant. Conclusions: We found the automated counting system to be highly accurate and not lacking in diagnostic sensitivity even at low cell counts, making it a powerful tool when used in the right clinical setting. Full article

Objective: Accurate total hemoglobin concentration (ctHb) measurement is critical for clinical decision-making, particularly in acute care, where immediate therapeutic decisions are required. This study evaluated previously established laboratory-based accuracy criteria for ctHb measurements in routine clinical practice at an interdisciplinary operative intensive care unit (IO-ICU), and with particular attention to significantly reduced hemoglobin concentrations. Method: Remaining blood from blood gas analysis (BGA) cuvettes was collected directly at the ICU bedside. From these initial samples, three clinically relevant measurement scenarios were established: direct bedside measurement (Group 01), elevated ctHb levels (Group 02), and lowered ctHb concentrations below 9 g/dl (Group 03). The samples were analyzed using the GEM 4000, GEM 5000 (Werfen GmbH, Muenchen, Germany), ABL90 Flex plus (Radiometer GmbH, Krefeld, Germany), HemoCue Hb 201+, and XN 9000/9100 (Sysmex Deutschland GmbH, Norderstedt, Germany) automatic hematology analyzers. Since each measurement device inherently possesses systematic deviations, no single analyzer was defined as an absolute reference. Instead, the mean value across all tested measurement systems was utilized as a best-fit reference (REF) value. Results: A total of 120 data pairs from 40 ICU patients were analyzed using regression analyses, Bland and Altman (B&A) methods, and tolerance level analysis (TLA). The results demonstrated strong concordance among the evaluated measurement devices across the examined ctHb spectrum (~1–18 g/dL). Moderate systematic deviations identified by B&A analysis were most pronounced at critically low ctHb levels (<6 g/dL). A key outcome was the determination of 95% prediction intervals (PIs), representing a quantifiable range of uncertainties for future bedside measurements. The PIs for Group 03 “low” were in the range of ±7% (relative difference) or ±0.38 g/dL (absolute difference). Conclusion: This study effectively translates previous laboratory findings into clinical practice, highlighting the practical utility of PIs to guide the accurate interpretation of bedside ctHb measurements under acute care conditions. Full article

Background: The significance of cell population data (CPD) and leukocyte scattergrams in COVID-19 has not been fully established, partly due to the absence of serial leukocyte monitoring before and after SARS-CoV-2 infection. This study first examined changes in these parameters in non-immunosuppressed subjects over the course of infection. Subsequently, these findings were compared with those observed in patients who were immunosuppressed to assess the impact of immunosuppression. Methods: In total, 48 patients with COVID-19 were analyzed. Complete blood count (CBC) results and CPD were assessed using a Sysmex XN-9000 hematological analyzer. Results: The control and IST groups had similar clinical characteristics regarding COVID-19 severity and baseline CBC and CPD. WBC and neutrophil counts showed no significant changes immediately post onset; however, they decreased in the control group and increased in the IST group. Platelet counts decreased transiently on days 3–5 in both groups. The control group’s lymphocyte counts significantly dropped, but their lymphocyte-related CPD remained unchanged. The IST group experienced delayed lymphocyte recovery and showed reduced DNA/RNA content and cell size diversity. Scattergrams immediately after onset showed an increase in lymphocyte clusters, particularly juvenile lymphocytes, in the control group, while they decreased in the IST group. In the control group, mature neutrophils decreased while immature neutrophils increased. Conversely, the percentage of mature neutrophils increased in the IST group. Both groups showed minimal plasmacytoid lymphocyte clusters after onset. Conclusions: Immunosuppression impairs juvenile cell mobilization, which may increase susceptibility to viral impacts and potentially worsen prognosis by increasing the risk of infection. Full article

Hematological studies provide essential information about the health of animals, which is crucial for veterinary medicine, scientific research, and aquaculture. Automatic hematological analyzers are an alternative to manual methods, offering faster and more reliable results. The objective of this study was to validate the Sysmex XN-1000V automatic hematology analyzer for blood samples from rainbow trout (Oncorhynchus mykiss), examine the effects of two anticoagulants (K₂EDTA and lithium heparin), and establish normal blood reference values for this fish species. Additionally, comparative studies were conducted between the Sysmex XN-1000V and manual methods (hemocytometer cell count and blood smear estimation), and reference intervals were established. Ninety-nine heparinized blood samples were analyzed for validation and sample stability tests. The results showed extremely good precision, with a coefficient of variation (CV) below 3% for RBCs, HGB, and HCT and less than 5% for non-RBC cells (leukocytes plus thrombocytes). However, heterophils (%) exhibited higher variability, with a CV of 15.08%. Linearity was excellent, and the carry-over was below 1% for all parameters. The sample stability test indicated that samples could be analyzed for up to 48 h when stored at 4 °C and up to 24 h at room temperature. Non-RBC cells were the first to degrade over time. The automated and manual methods demonstrated good correlation and agreement, validating the analyzer’s accuracy. The effects of two anticoagulants, K₂EDTA and lithium heparin, on the blood samples were also studied. Heparin was the preferred anticoagulant for routine hematological analysis of rainbow trout blood with the Sysmex XN-1000V analyzer. In conclusion, the Sysmex XN-1000V enables complete hemogram analyses to be performed quickly and accurately, standardizing techniques, harmonizing results, and providing reliable reference intervals with O mykiss blood. Full article

The objective of this study was to assess the performance characteristics of the new automated haematology analyser from Sysmex Corporation, the Sysmex XR-Series, compare its performance to the Sysmex XN-Series through method comparison, and compare our results to previously published literature. Analytical performance of the new Sysmex XR-20 consisting of precision, bias, and total error, a method comparison with the Sysmex XN-2000, and the flagging performance evaluation were conducted on a Sysmex XR-20 analyser in the AZ Sint-Lucas Hospital (Bruges, Belgium) several months before its launch in Europe. We conclude that the Sysmex XR-Series is an excellent successor to the Sysmex XN-Series for routine haematology analysis. Analytical performance and flagging efficiency are comparable to the Sysmex XN-analyser. Full article

The Sysmex XN-1000V provides a percentage and concentration of basophils from the WNR scattergram, as for human samples, but this method has been shown to be irrelevant in cats. This study aimed to characterize the feline basophil distribution on the WDF channel and to preliminarily evaluate the performance of a new basophil gate on the WDF channel. Cases of feline basophilia were retrospectively retrieved and the scattergram from the WDF and WNR channels were evaluated for any consistent pattern. A new gating setting for the WDF channel was created to include the suspected basophil region. This new gating was applied retrospectively to identified basophilia cases and prospectively to randomly selected feline cases. Manual, WNR, and new WDF methods for basophil identification were compared. Nine cases of feline basophilia were identified. A characteristic WDF scattergram was identified in seven of the nine cases. A new gate was created on the WDF channel and applied to these and 34 additional cases. The comparison study showed that the new method of basophil quantification using the WDF scattergram correlated better with the manual method than the Sysmex XN-1000V method using the WNR scattergram. Basophil concentration in feline peripheral blood can be determined using a new gate on the WDF channel of the Sysmex XN-1000V, which provides better performance than the WNR channel and is comparable to the manual method. Full article

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led the medical and scientific community to explore the pathogenesis and clinical manifestations of coronaviruses. In felines, a widespread coronavirus known as feline coronavirus (FCoV) can lead to feline infectious peritonitis (FIP), a highly fatal disease characterised by severe systemic inflammation. Diagnosing FCoV remains challenging due to the limited accuracy of the available methods. The present study introduces the FIP Effusion Index, a novel diagnostic method that combines the albumin-to-globulin (ALB/GLOB) ratio with the delta total nucleated cell (∆TNC) count obtained via flow cytometry using the Sysmex XN-1000V^® analyser in effusions. Samples from cats (n = 50) with suspected FIP were analysed for ∆TNC, with findings showing that a ∆TNC ≥ 2.1 is highly indicative of FIP and a ∆TNC ≥ 4.9 can be considered diagnostic. The FIP Effusion Index enhanced diagnostic precision in our group of samples, achieving 96.3% sensitivity and 95.7% specificity for values ≥ 5.06, and reaching perfect specificity (100%) with 96.3% sensitivity for values ≥ 7.54. This combined approach surpasses the accuracy of individual parameters, establishing the FIP Effusion Index as a superior diagnostic tool for FIP, with potential applications in both veterinary and human medicine for related coronavirus diseases. Full article

Chronic hemorrhagic anemia (CHA) and anemia of chronic inflammation (ACI) are difficult to differentiate in small animals using hematology. Advanced hematological parameters (RET-He, Delta-He and %Hypo-He) are used in humans to discriminate between types of non-regenerative anemia. Whether they could be useful in the diagnosis of CHA and ACI in small animals is unknown. We evaluated these parameters in the Sysmex XN-1000V analyzer in a population of non-anemic and anemic dogs and cats. Delta-He was significantly different between dogs with CHA and ACI. Moreover, Delta-He and RET-He were different between healthy and non-anemic dogs with inflammation. Neither of these two statements was true for cats. We also report the reference ranges for these parameters using the Sysmex XN-1000V. Although additional clinical and laboratory information should always be considered, the measurement of these parameters using this analyzer can help clinicians to classify type of anemia. Full article

Background: In EDTA-induced pseudothrombopenia, citrate or MgSO₄ are recommended for platelet counting. Pre-analytical conditions are poorly defined for tubes containing MgSO₄ or citrate. In this study, we analyzed the impact of agitation of these tubes on platelet counts. Methods: K2EDTA, citrate, and MgSO₄ tubes from 70 patients were gently agitated on a wheel rotating at 20 rpm. Platelets were analyzed on the Sysmex XN analyzer at different times, and the percentage of platelet deviation from T0 was assessed and compared with the desirable bias of the EFLM. Results: at 180 min in fluorescence, the relative variation of platelets after shaking is 1.17% for K2EDTA, −29.76% for citrate, and −33.18% for MgSO₄, while for unshaken MgSO₄ platelets the variation is −1.3%. The reduction in platelet numbers when citrate or MgSO₄ tubes are shaken is linked to the appearance of platelet clusters. Conclusions: agitation of MgSO₄ and especially citrate tubes led to a decrease in platelet counts due to the formation of platelet aggregates; on the other hand, platelet counts on EDTA are virtually stable. During transport, we recommend putting sodium citrate and MgSO₄ tubes in an upright position and avoiding shaking them to avoid giving an erroneous platelet result. Full article

The neutrophils evaluation seems interesting in the initial qualifications of patients with various inflammatory processes. In this study, we presented analysis of neutrophils and new parameters of the complexity (NEUT-GI, NE-WX), maturation (IG), size (NE-FSC, NE-WZ), and neutrophil activities (NEUT-RI, NE-WY) in coronavirus disease 2019 (COVID-19), lung cancer (LC), sarcoidosis (SA), and healthy controls (HCs). Peripheral blood (PB) was collected. The new parameters were examined by the Sysmex XN-1500. The mean absolute value for the IG parameter was the highest in the LC group. The differences in NEUT-RI value between COVID-19 and the HC group were observed. No significant differences were noticed between groups in the NEUT-GI granularity parameter. Neutrophil size assessed by NE-FSC parameter was reduced in all groups compared to HCs. The values of complexity (NE-WX), fluorescence (NE-WY), and size (NE-WZ) were the lowest in the HCs, whereas the highest median proportions of NE-WX, NE-WY, and NE-WZ were in LC patients. Patients from the SA group differed significantly from the HC group only for the NE-WZ parameter. We showed the usefulness of neutrophil parameters and their reactivity, morphology, and exhaustion. A more detailed analysis of blood counts may reveal trends that indicate a disease-specific immune response. Full article

Cerebrospinal fluid analysis is an important diagnostic test when assessing a neurological canine patient. For this analysis, the total nucleated cell count and differential cell counts are routinely taken, but both involve time-consuming manual methods. To investigate faster automated methods, in this study, the Sysmex XN-V body fluid mode and the deep-learning-based algorithm generated by the Olympus VS200 slide scanner were compared with the manual methods in 161 canine cerebrospinal fluid samples for the total nucleated cell count and in 65 samples with pleocytosis for the differential counts. Following incorrect gating by the Sysmex body fluid mode, all samples were reanalyzed with manually set gates. The Sysmex body fluid mode then showed a mean bias of 15.19 cells/μL for the total nucleated cell count and mean biases of 4.95% and −4.95% for the two-part differential cell count, while the deep-learning-based algorithm showed mean biases of −7.25%, −0.03% and 7.27% for the lymphocytes, neutrophils and monocytoid cells, respectively. Based on our findings, we propose that the automated Sysmex body fluid mode be used to measure the total nucleated cell count in canine cerebrospinal fluid samples after making adjustments to the predefined settings from the manufacturer. However, the two-part differential count of the Sysmex body fluid mode and the deep-learning-based algorithm require some optimization. Full article

The enumeration of nRBCs (nucleated red blood cells) by manual counting is time-consuming and imprecise. As the first veterinary hematology analyzer, Sysmex XN-V provides automated nRBC counts. This study aimed to evaluate the performance of Sysmex XN-V in the enumeration of nRBCs for cats and dogs by comparing automated nRBC counts to manual counts from a total of 3810 canine and 2844 feline specimens. Repeatability, reproducibility, stability, carry-over, and linearity were assessed. The repeatability and reproducibility of Sysmex XN-V were good, with mean coefficients of variation (CV) of 4.5% and 5.4%, respectively. Bland–Altman difference analysis revealed mean biases shown as nRBCs/100 WBCs of 0.01 in dogs and 0.11 in cats with low nRBCs (<5/100 WBCs), mean biases of −1.27 in dogs and −0.24 in cats with moderate nRBC counts (5–20 nRBCs/100 WBCs), and mean biases of −7.76 in dogs and −1.31 in cats with high nRBC counts (>20 nRBCs/100 WBCs). The total observable error was below 9% in both species and at all ranges. Overall concordance between methods was high (91% in canine and 93% in feline samples). The automated nRBC count by Sysmex XN-V was found to be accurate and precise and can replace manual counts for cat and dog samples. Non-statistical quality assurance by scattergram evaluation, re-gating, and confirmation by blood smear evaluation is, however, recommended, especially in cases with severe normoblastosis. This advancement will save time, reduce errors, and add prognostic value to hematological results for animal patients. Full article

The Sysmex XN-1000V analyzer can identify those reticulocytes with high RNA content and fluorescence, providing the immature reticulocyte fraction (IRF). While this parameter has been used in human medicine to identify the cause of anemia, few studies have focused on its use in veterinary medicine. In this study, we determined the IRF and related reticulocyte parameters in a large population of non-anemic and anemic dogs and cats (subclassified depending on the origin of their anemia). The IRF was significantly higher in hemolytic anemias compared to hemorrhagic ones in both species. Moreover, the IRF was significantly lower in dogs and cats with bone marrow failure than in other non-regenerative anemias and in both groups compared to pre-regenerative anemias. The accurate cut-off values for the differential in regenerative anemias and reference ranges for both species using the Sysmex XN-1000V are also reported. The measurement of the IRF in this analyzer can help clinicians to further classify the type of anemia in both species. Full article

In India, where malaria is endemic, the prompt and accurate detection of infections is crucial for disease management and vector control. Our study aimed to evaluate the “iRBC” flag, a novel parameter developed for routine hematology analyzers, for its sensitivity and specificity in detecting Plasmodium vivax (P. vivax) infections. We used residual blood samples from patients with suspected malaria and compared the iRBC flag results with microscopy, which serves as the gold standard. Additionally, we compared the results with rapid immuno-chromatographic tests (RDTs) commonly used in the field. Our study included 575 samples, of which 187 were positive for P. vivax. The iRBC flag demonstrated a high sensitivity of 88.7% and 86.1% on the XN and XN-L hematology analyzers, respectively, and a clinical specificity of 100% on both analyzers. Furthermore, the scattergram derived from each positive dataset exhibited distinct patterns, which facilitated rapid confirmation by laboratory specialists. Notably, the iRBC flag remained effective even in the presence of interfering conditions. Overall, our results indicate that the iRBC flag is a reliable and rapid screening tool for identifying P. vivax in routine blood testing. Our findings have significant implications for malaria detection and control in endemic regions like India. Full article