Reference interval for immature platelet fraction on Sysmex XN hematology analyzer: a comparison study with Sysmex XE-2100.

BACKGROUND: Recently introduced hematology analyzer, the Sysmex XN modular system (Sysmex, Kobe, Japan), has newly adopted a florescent channel to detect platelets and immature platelet fraction (IPF). This study aimed to establish new reference intervals for %-IPF and absolute number of IPF (A-IPF) on Sysmex XN. Platelet counts, %-IPF, and A-IPF were also compared between Sysmex XN and XE-2100 systems (Sysmex). METHODS: Except outliers, blood samples from 2104 healthy individuals and 140 umbilical cord blood were analyzed using both Sysmex XN and XE-2100. The results of two systems were compared using Bland-Altman plot. The reference intervals for %-IPF and A-IPF were defined using non-parametric percentile methods according to the Clinical and Laboratory Standard Institute guideline (C28-A3). RESULTS: The platelet counts, %-IPF, and A-IPF showed non-parametric distributions. The mean difference between Sysmex XN and XE-2100 in healthy individuals revealed a positive bias in platelets (+8.0×109/L), %-IPF (+1.2%), and A-IPF (+3.0×109/L). The reference intervals for %-IPF and A-IPF on Sysmex XN were: 1.0%-7.3% and 2.49-15.64×109/L in healthy individuals; and 1.0%-4.4% and 2.94-12.82×109/L in umbilical cord blood. CONCLUSIONS: This large-scale study demonstrates a clear difference of platelet counts and IPF between Sysmex XN and XE-2100. The new reference intervals for IPF on Sysmex XN would provide fundamental data for clinical practice and future research.

Performance evaluation of Sysmex XN hematology analyzer in umbilical cord blood: a comparison study with Sysmex XE-2100.

BACKGROUND: The Sysmex XN (XN) modular system (Sysmex, Kobe, Japan) is a new automated hematology analyzer equipped with different principles from its previous version, Sysmex XE-2100. We compared the performances of Sysmex XN and XE-2100 in umbilical cord blood (CB) specimens. METHODS: In 160 CB specimens, complete blood count (CBC) parameters and white blood cells (WBC) differentials were compared between the two analyzers. Their flagging performances for blasts, abnormal/atypical lymphocytes, immature granulocytes and/or left-shift (IG), and nucleated red blood cells (NRBC) counts were compared with manual counts. For the blast flagging, Q values by Sysmex XN were further compared with manual slide review. RESULTS: Sysmex XN and XE-2100 showed high or very high correlations for most CBC parameters but variable correlations for WBC differentials. Compared with XE-2100, XN showed significantly different flagging performances for blasts, abnormal/atypical lymphocytes, and IG. The flagging efficiency for blasts was significantly better on Sysmex XN than on XE-2100 (85.0% vs. 38.8%): Sysmex XN showed a remarkably increased specificity of blast flag, compromising its sensitivity of blast flag. Among the 24 specimens with blasts (range, 0.5%-1.5%), only one (4.2%) showed a positive Q value. CONCLUSIONS: This study highlighted the remarkable differences of flagging performances between Sysmex XN and XE-2100 in CB specimens. The Sysmex XN modular system seems to be a suitable and practical option for the CB specimens used for hematopoietic stem cell transplantation as well as for the specimens from neonates.

Benefits of VISION Max automated cross-matching in comparison with manual cross-matching: A multidimensional analysis.

BACKGROUND: VISION Max (Ortho-Clinical Diagnostics, Raritan, NJ, USA) is a newly introduced automated blood bank system. Cross-matching (XM) is an important test confirming safety by simulating reaction between packed Red Blood Cells (RBCs) and patient blood in vitro before transfusion. We assessed the benefits of VISION Max automated XM (A-XM) in comparison with those of manual XM (M-XM) by using multidimensional analysis (cost-effectiveness and quality improvement). MATERIALS AND METHODS: In a total of 327 tests (130 patients), results from A-XM and M-XM were compared. We assessed the concordance rate, risk priority number (RPN), turnaround time, hands-on time, and the costs of both methods. We further simulated their annual effects based on 37,937 XM tests in 2018. RESULTS: The concordance rate between A-XM and M-XM was 97.9% (320/327, kappa = 0.83), and the seven discordant results were incompatible for transfusion in A-XM, while compatible for transfusion in M-XM. None of the results was incompatible for transfusion in A-XM, while compatible for transfusion in M-XM, meaning A-XM detect agglutination more sensitively and consequently provides a more safe result than M-XM. A-XM was estimated to have a 6.3-fold lower risk (229 vs. 1,435 RPN), shorter turnaround time (19.1 vs. 23.3 min, P < 0.0001), shorter hands-on time (1.1 vs. 5.3 min, P < 0.0001), and lower costs per single test than M-XM (1.44 vs. 2.70 USD). A-XM permitted annual savings of 46 million RPN, 15.1 months of daytime workers' labor, and 47,042 USD compared with M-XM. CONCLUSION: This is the first attempt to implement A-XM using VISION Max. VISION Max A-XM appears to be a safe, practical, and reliable alternative for pre-transfusion workflow with the potential to improve quality and cost-effectiveness in the blood bank.