Utility of immature platelet fraction in the Sysmex XN-1000V for the differential diagnosis of central and peripheral thrombocytopenia in dogs and cats.

BACKGROUND: The immature platelet fraction (IPF), a parameter obtained by the Sysmex XN-1000V analyzer, is used in humans to differentiate between central (CEN) and peripheral (PER) thrombocytopenia (TP) but has not been evaluated in small animals. OBJECTIVES: Compare IPF between healthy, clinical non-TP and TP dogs and cats, study IPF in different causes of TP in dogs and cats and, establish IPF reference intervals (RIs), and study the effect of age and sex on IPF in healthy dogs and cats. ANIMALS: A total of 3281 dogs and 726 cats. METHODS: Retrospective review of medical records. Animals were classified as nonthrombocytopenic (healthy group and group of clinical patients without TP [NTP]) or TP. These latter animals were subclassified as pseudothrombocytopenia (PSE), CEN and PER, based on evaluation of platelet clumps, estimated platelet count in blood smears and final diagnosis. Blood samples were evaluated using a Sysmex XN-1000V with a specific platelet channel (PLT-F). RESULTS: The IPF was significantly different between each subtype of TP in both species. Immature platelet fractions <6.9% in dogs or 13.6% in cats, once PSE has been eliminated by review of blood smears, are indicative of CEN. Reference intervals for IPF were 0.5%-8% in healthy dogs and 1%-40.3% in healthy cats. CONCLUSIONS AND CLINICAL IMPORTANCE: We determined that IPF can differentiate between CEN and PER in dogs and cats, guiding additional testing and avoiding more invasive procedures (bone marrow sampling). A blood smear always should be evaluated to rule out platelet clumping.

In vitro evaluation of a new viscoelastometry-based point-of-care analyzer.

INTRODUCTION: The VCM is a point-of-care analyzer using a new viscoelastometry technique for rapid assessment of hemostasis on fresh whole blood. Its characteristics would make it suitable for use in austere environments. The purpose of this study was to evaluate the VCM in terms of repeatability, reproducibility and interanalyzer correlation, reference values in our population, correlation with standard coagulation assays and platelet count, correlation with the TEG5000 analyzer and resistance to stress conditions mimicking an austere environment. METHODS: Repeatability, reproducibility, and interanalyzer correlation were performed on quality control samples (n = 10). Reference values were determined from blood donor samples (n = 60). Correlations with standard biological assays were assessed from ICU patients (n = 30) and blood donors (n = 60) samples. Correlation with the TEG5000 was assessed from blood donor samples. Evaluation of vibration resistance was performed on blood donor (n = 5) and quality control (n = 5) samples. RESULTS: The CVs for repeatability and reproducibility ranged from 0% to 11%. Interanalyzer correlation found correlation coefficients (r2) ranging from 0.927 to 0.997. Our reference values were consistent with those provided by the manufacturer. No robust correlation was found with conventional coagulation tests. The correlation with the TEG5000 was excellent with r2 ranging from 0.75 to 0.92. Resistance to stress conditions was excellent. CONCLUSION: The VCM analyzer is a reliable, easy-to-use instrument that correlates well with the TEG5000. Despite some logistical constraints, the results suggest that it can be used in austere environments. Further studies are required before its implementation.

Reproducibility and stability of the immature platelet fraction using Sysmex XN-10.

BACKGROUND: The Immature Platelet Fraction (IPF) is an indicator of thrombopoiesis which is a useful parameter in thrombocytopenia. It demonstrates compensatory mechanisms in production of platelets, but currently not implemented in routine clinical practice. The aim of this study was to establish the reproducibility and stability of IPF, for both percentage (%-IPF) and absolute (A-IPF) measurements.Material/methods: A total of 71 samples, of which 45 for reproducibility and 26 for stability analysis, were assayed for full blood count using the Sysmex XN-10 analyser at room temperature (RT:19-25 °C). For reproducibility analysis, IPF measurements were analysed 11 times by different appraisers using the same sample, while for stability analysis, IPF was measured over fourteen hourly-intervals up to 24 h (n = 21) and then separately extended beyond the point of stability to 72 h (n = 5). RESULTS: Reproducibility analysis of %-IPF and A-IPF (n = 45) showed very reliable results, with the range of mean CV% values between 1.25-8.90% and 1.70-9.96%, respectively. On the other hand, overall, stability analysis of %-IPF and A-IPF (n = 21) at RT over 24 h showed reliable results, with pooled mean CV% values of 1.32% and 1.43%, respectively, with no significant difference between %-IPF and A-IPF (p = 0.767 and p = 0.821). All %-IPF and A-IPF values had exceeded the set acceptance criterion of stability (CV% ≥ 10.0%) before 72 h. CONCLUSIONS: Overall, %-IPF and A-IPF reproducibility and storage at RT for 24 h predominantly demonstrates the suitability of their usage for testing on the Sysmex XN-series analysers.

Decreased body-fat accumulation and increased vasorelaxation to glyceryl trinitrate in middle-aged male rats following six-weeks consumption of coconut milk protein

Abstract We investigated whether coconut milk protein (CMP) contributes to the beneficial effects of coconut milk consumption on cardiovascular health markers previously found in middle-aged rats. CMP was isolated and precipitated from dried fresh coconut milk, then gavaged (1 g/kg) to middle-aged male rats for six weeks; control rats received distilled water. Compared to controls, CMP caused decreased body fat and lipid accumulation in liver cells and the platelet count. CMP did not affect basal blood pressure or heart rate in anesthetized rats. Vascular responsiveness to phenylephrine, DL-propargylglycine (PAG), acetylcholine or sodium nitroprusside was unaffected, but vasorelaxation to glyceryl trinitrate (GTN) increased. Effects of ODQ on vasorelaxation to GTN were similar in both groups. Expression of blood vessel eNOS, CSE and sGC was normal. The cyclic guanosine monophosphate (cGMP) level of CMP-treated rats was normal but addition of GTN increased cGMP and NO concentration more in CMP-treated rats than in controls, an effect unaltered by addition of diadzin. Taken together, CMP appears partially responsible for the improvement in cardiovascular health markers caused by coconut milk in middle-aged male rats

Performance evaluation of platelet counting of Abbott Alinity hq and Sysmex XN-9000 automated hematology analyzer compared with international reference method.

INTRODUCTION: Accurate platelet counting is essential for risk assessment of bleeding and thrombosis. Abbott Alinity hq hematology analyzer was recently introduced, and its performance in platelet counting has yet to be evaluated comprehensively. In this study, we evaluated the performance of the optical platelet counting of Abbott Alinity hq (Alinity-PLT) and the impedance and fluorescent platelet counting of Sysmex XN-9000 (XN-PLT-I and XN-PLT-F) compared with the international reference method. METHODS: Blood samples were analyzed via Alinity hq and XN-9000 with PLT-F channel. Immuno-platelet (ImmnoPLT) reference method was performed with CD41/CD61 antibodies using FACSLyricTM flow cytometer (BD). Precision was determined using 10 replicates in a single run, and the platelet counts of Alinity-PLT, XN-PLT-I, XN-PLT-F, and ImmnoPLT were compared. RESULTS: At a platelet count of 13 × 109 /L, the CVs of Alinity-PLT, XN-PLT-I, and XN-PLT-F were 4.2%, 6.7%, and 4.3%, respectively, and at a platelet count of 44 × 109 /L, all showed a CV of less than 3%. For the total 210 samples, all three methods showed a very strong correlation with ImmunoPLT (r > 0.99). For platelet levels below 20 × 109 /L, XN-PLT-F showed the strongest correlation with ImmunoPLT (r = 0.975), and for platelet levels of 20-100 × 109 /L, Alinity-PLT and XN-PLT-I were comparable to ImmunoPLT. For platelet levels of 100-450 × 109 /L, XN-PLT-I was the most comparable to ImmunoPLT, and for platelet levels above 450 × 109 /L, Alinity-PLT was comparable to ImmunoPLT. CONCLUSIONS: All three methods were highly correlated with ImmunoPLT, and each method had different performance advantages according to the platelet levels.

First-Trimester Platelet Count as a Predictive Biomarker for Neonatal Birth Weight Among Pregnant Women at Advanced Maternal Age.

The aim of this study was to investigate the association between first-trimester platelet count and neonatal birth weight in pregnant woman at advanced maternal age. Our study included 148 pregnancy women of advanced maternal age, the clinical and laboratory materials were retrospective obtained from medical record system. The neonatal birth weight was positively correlated with maternal body mass index and fetus gestational age (r = 0.332, P < .001; r = 0.469, P < .001), even more interestingly, the neonatal birth weight was positively correlated with first-trimester platelet count in pregnant women of advanced maternal age (r = 0.203, P = .013). Multiple linear regression analysis revealed that neonatal birth weight had an independently association with first-trimester platelet count in pregnant women of advanced maternal age (multiple-adjusted r values 0.167, P = .013). First-trimester platelet count is positively associated with neonatal birth weight, suggesting that first-trimester platelet count may be a predictive biomarker for neonatal birth weight in pregnant women of advanced maternal age.

Estimation of white blood cell and platelet counts in ovine blood smears, and a comparison with the ADVIA 120 hematology analyzer.

BACKGROUND: Manual evaluation of blood cell counts on stained blood films is a common procedure in resource-limited laboratories of farm animal clinics. Moreover, settings for sheep blood cell counts are not provided on most veterinary hematology analyzers. OBJECTIVES: We aimed to (a) compare the results of white blood cell (WBC) counts evaluated microscopically on ovine blood smears with those obtained by the ADVIA 120 hematology analyzer and validate appropriate correction factors for the manual technique; and (b) assess the two suggested factors to calculate platelet counts on blood smears in sheep. METHODS: The blood samples of 57 sheep were used to generate a regression equation between the average WBC count per field and the WBC count determined using the ADVIA 120 analyzer. Thirty-one new ovine samples were used to assess the agreement between the calculated WBC counts based on a generated equation and those obtained by the analyzer using the Passing-Bablok test and Bland-Altman plots. Similarly, agreements between platelet counts using two different factors for platelet calculation were assessed using the Bland-Altman plot. RESULTS: The average bias of calculated WBC counts was 0.4%, with precision and accuracy being over 95%. Regarding calculated platelet counts, Bland-Altman plots revealed a bias of 26.4% and 1.4% when the average number of platelets per field was multiplied by 15 000 and 20 000, respectively. CONCLUSIONS: Microscopic WBC counting in ovine blood is a reliable alternative to automated analyses using the generated equation. A better agreement between the two methods was observed when a factor of 20 000 was used to calculate platelet counts in ovine blood smears.

Multicenter evaluation of analytical performances of platelet counts and platelet parameters: Carryover, precision, and stability.

INTRODUCTION: The correctness of the results of automated platelet analysis is still highly debated. The aim of this multicenter study, conducted according to international guidelines, was to verify the analytical performance of nine different types of hematology analyzers (HAs) in the automated platelet analysis. METHODS: Four hundred eighty-six peripheral blood samples (PB), collected in K3 EDTA tubes, were analyzed by ABX Pentra, ADVIA2120i, BC-6800, BC-6800 Plus, Cell-DYN Sapphire, DxH800, XE-2100, XE-5000, XN-20 with PLT-F App. Within-run imprecision and between-run imprecision were carried out using PB and material control, respectively. The carryover, low limit of quantification (LoQ), and the PB stability were evaluated. RESULTS: The carryover was absent for all HAs. The LoQ of PLT ranged between 2.0 (Cell-Dyn Sapphire) and 25.0 × 109 /L (ADVIA 2120i), while immature platelet fraction (IPF) ranged between 1.0 (XN-20) and 12.0 × 109 /L (XE-5000). The imprecision (%CV) increases as the platelet count decreases. No HAs showed desirable CVAPS for PLT counts less than 50.0 × 109 /L, with the exception of Cell-DYN Sapphire (CV 3.0% with PLT-O mean value of 26.7 × 109 /L), XN-20 (CV 2.4% with PLT-F mean value of 21.5 × 109 /L), and BC-6800 Plus (CV 1.9% with PLT-O mean value of 26.5 × 109 /L). The sample stability ranged between under two hours for MPV by ADVIA2120i and 8 hours for other PLT parameters and HAs. CONCLUSION: The findings of this study may provide useful information regarding carryover, precision, and stability of platelet counts and parameters, especially in thrombocytopenic samples. Moreover, the stability of sample for platelet analysis is conditioned by the HA and by temperature and storage time.

Performance evaluation of new Abbott Alinity hq hematology analyzer.

INTRODUCTION: Abbott Alinity hq is a next-generation automated hematology analyzer providing complete blood count (CBC) with 6-part white blood cells (WBC) differential counts. The purpose of this study was to evaluate the performance of the analyzer to verify the diagnostic and clinical utility of the Abbott Alinity hq automated system. METHODS: We evaluated specimen stability, precision, linearity, carry-over, and method comparison to assess the performance of Alinity hq. For comparison of the Alinity hq with Sysmex XN-9000, totally 314 samples from adult and pediatric patients including both normal and abnormal hematology profiles were analyzed in parallel. The Alinity hq was also compared with the manual differential counts for the same 314 samples. RESULTS: At 4°C, the Alinity hq analyzer showed no significant changes in CBC and WBC differential count up to 48 hours. When stored at room temperature (18-25°C), all parameters except the mean platelet volume (MPV) were stable up to 36 hours. The Abbott Alinity hq analyzer demonstrated excellent reproducibility and between-batch precision for all CBC and WBC differential parameters. WBC, red blood cells (RBC), hemoglobin (HGB), and platelets showed good linearity and acceptable carry-over. Comparison with a Sysmex XN-9000 analyzer and manual 400-cell differential showed excellent correlation for CBC and WBC differential count parameters (correlation coefficient = 0.815-0.999) except for mean corpuscular hemoglobin concentration (MCHC) and basophils. CONCLUSION: We performed initial validation studies and confirmed performance specifications on specimen stability, precision, linearity, carry-over, and method comparison. The Abbott Alinity hq analyzer showed good analytical performance for all standard CBC parameters.

Compare the accuracy and precision of Coulter LH780, Mindray BC-6000 Plus, and Sysmex XN-9000 with the international reference flow cytometric method in platelet counting.

OBJECTIVE: The aim of this study is to evaluate the performance of different platelet counting methods (optical, impedance, fluorescence and hand counting) applied in different analysers by comparing with the international flow cytometric reference method (IRM). METHODS: A total of 333 blood samples from different subgroups (168 cases with thrombocytopenia, 136 cases with normal platelet counts and 29 cases with thrombocytosis) were tested. Regarding IRM as the gold standard, we compared the accuracy and precision of different platelet count methods; i.e. LH780 (impedance), BC-6000 Plus (optical (O) and impedance (I)), Sysmex XN-9000 (optical (O), impedance (I), fluorescence (F)), and hand counting. RESULTS: Sysmex XN-9000-F (r = 0.988) had the best correlation with IRM for thrombocytopenic samples; BC-6000 Plus-I (r = 0.966) was more relevant to IRM than any other method for samples with normal platelet counts. Correlation between Sysmex XN-9000-I (r = 0.960) and IRM was the highest among these methods for samples with thrombocytosis. For bias evaluation, the average bias of Sysmex XN-9000-F was -1.5 × 109/L (95% LA = -9.4 to +6.4) for samples with thrombocytopenia, compared with IRM. BC-6000 Plus-I had a small mean difference with IRM for samples with normal platelet counts or thrombocytosis. Moreover, all evaluated methods had acceptable sensitivity, specificity, and concordance rates as compared with IRM in the diagnosis of thrombocytopenia and thrombocytosis. CONCLUSIONS: Platelet counting by Sysmex XN-9000-F is more accurate than other methods for thrombocytopenic samples. BC-6000 Plus-I has superior association and consistency for normal platelet counts. As for thrombocytosis patients, Sysmex XN-9000-I has the highest correlation with IRM while Sysmex XN-9000-O has the highest diagnosis efficacy.

Comparative evaluation of platelet counts in two hematology analyzers and potential effects on prophylactic platelet transfusion decisions.

BACKGROUND: Decisions on prophylactic platelet (PLT) transfusions are generally based on the recipient's PLT count, but few clinicians are aware of precision and accuracy of the PLT counting methods used by the clinical laboratory. Each PLT counting technology has its specific inaccuracy, especially in thrombocytopenic samples and therefore may impact decisions on PLT transfusions. STUDY DESIGN AND METHODS: Five routine PLT counting methods available in two hematology analyzers (Sysmex XN-2000 and Abbott CELL-DYN Sapphire) were investigated (impedance and optical on both analyzers and fluorescent on XN-2000), using the CD61 immunologic PLT method as a reference. The impact of counting inaccuracy on imaginary transfusion decisions was examined at various common PLT thresholds. RESULTS: In total 341 samples were analyzed, 178 of which had PLT counts of less than 35 × 109 /L. Despite excellent overall correlation with the reference method (r > 0.99), thrombocytopenic samples showed only modest correlation for impedance and XN-2000 optical methods. Sapphire optical and XN-2000 fluorescent methods correlated very well with the reference, albeit with bias in the very low range. We noticed potential risk of undertransfusion (ranging from 2% to 90%), depending on the threshold used. The risk of overtransfusion was small (<10%). CONCLUSIONS: The XN-2000 fluorescent PLT counting method showed excellent correlation with the CD61 reference count, closely followed by the CELL-DYN Sapphire optical method. XN-2000 impedance and optical and Sapphire impedance methods are not accurate enough for basing transfusion decisions on. Only XN-2000 fluorescent, Sapphire optical, and CD61 methods are sufficiently accurate for making appropriate clinical decisions in patients with severe thrombocytopenia.

Effects of Analyzer Detection Method, Ethnicity, and Reference Individuals on Reference Interval of Immature Platelet Fraction.

BACKGROUND: Immature platelet fraction (IPF) is a new biomarker for thrombopoiesis and inflammation. However, the reference interval (RI) is wildly discrepant among published reports. This study aimed to establish the RI of IPF for a population in Taiwan and evaluate the effects the detection method of the analyzer, ethnicity, and reference individuals have on the RI of IPF. METHODS: The RI of absolute IPF (A-IPF) and IPF% were established with healthy subjects from the outpatient services of the Health Management Department of Taichung Veterans General Hospital between January 1, 2015 and March 1, 2016. These values were used along with published reports for meta-analysis. RESULTS: A-IPF (109/L) and IPF% of Taiwanese were 6.9 - 7.6 and 3.1 - 3.4, respectively. Significant differences were found when performing paired comparisons of the RI of A-IPF and IPF% published in reports. For A-IPF, there was only one paired comparison with a significant difference (Z > 1.96) across 6 reports. Thus, the contribution of the factors examined on the RI of IPF cannot be determined. For IPF%, there were 8 paired comparisons with significant differences across 10 reports. The discrepancy rates of RI for IPF% were 41.2%, 50.0%, and 25.0% with the difference of reference individuals, the analyzer method, and ethnicity, respectively. CONCLUSIONS: The RIs of Taiwanese for A-IPF and IPF% were established. Furthermore, the analyzer detection method and the reference individuals contribute to the discrepancy of the RI for IPF% and should be considered cautiously when the value of IPF is interpreted.

The combined effects of the microcirculatory status and cardiopulmonary bypass on platelet count and function during cardiac surgery.

BACKGROUND: Cardiac surgery with cardiopulmonary bypass is associated with important changes in the microcirculation, usually attributed to endothelial dysfunction. Another common finding of cardiac surgery is postoperative thrombocytopenia and platelet loss of function. OBJECTIVE: To investigate the association between microvascular flow pattern and postoperative changes in platelet count and function in cardiac surgery patients. METHODS: Twelve adult cardiac surgery patients received microvascular circulation (sidestream darkfield sublingual mucosa analysis) and platelet count and function (multiple electrode aggregometry ADPtest and TRAPtest) assessment before and after cardiopulmonary bypass. RESULTS: After cardiopulmonary bypass, sublingual microcirculation showed a significantly (P = 0.001) decreased microvascular flow index and increased heterogeneity index (P = 0.006). Platelet function significantly decrease after cardiopulmonary bypass both at ADPtest (P = 0.011) and TRAPtest (P = 0.002). Preoperative patterns of poor microvascular perfusion (low perfused vessels density and total vessels density) were significantly associated with lower values of post-cardiopulmonary bypass platelet function (ADPtest, P = 0.009, TRAPtest, P = 0.031) and count (P = 0.048). CONCLUSIONS: A preoperative disturbance of the microcirculation is associated with a greater postoperative platelet dysfunction. Endothelial damage, chemical and mechanical stimuli are the possible link between the two patterns.

Measurement uncertainty of platelet concentration using the Sysmex XN automated hematology analyzer.

We estimated the measurement uncertainty (MU) of platelet concentration measured using the Sysmex XN system with two reference platelet counting methods described by DIN 58932-5 (PTB method) and the International Council for Standardization in Haematology (ICSH method). Ten blood samples were used to estimate and compare the MU of the XN system, and 30 samples were used to compare the methods. The standard uncertainty of the reference method was significantly higher for the ICSH method; the PTB method showed higher platelet concentrations than the ICSH method. When applying different methods with the XN system, optic counting showed higher MU compared to the other methods. There was good correlation among the two reference methods and three automated platelet-counting methods. We evaluated the MU in platelet concentrations measured using an automated hematology analyzer. Our results suggest that using the PTB method for calculating MU of the automated hematology analyzer is superior to the ICSH method because of its lower standard uncertainty.

Linearidade e carryover do contador hematológico Horiba ® Abx Micros ESV 60 / Linearity and carryover of automated hematology counter Horiba ® Abx Micros ESV 60

O contador automático hematológico ABX Micros ESX 60 (Horiba Medical 2012) é analisador hematológico veterinário multi-espécie que realiza 50 contagens por hora, libera 18 parâmetros sanguíneos, além de fazer representações gráficas (histogramas) para leucócitos, hemácias e plaquetas. O objetivo deste trabalho é avaliar o desempenho do referido aparelho em relação à linearidade e carryover, através de controle comercial e de amostras de sangue provenientes da rotina do Laboratório de Patologia Clínica Veterinária. De acordo com resultados é possível afirmar que o presente aparelho possui um excelente coeficiente de linearidade (r2=0,99) nos parâmetros de leucócitos, eritrócitos e plaquetas em relação às diluições estudadas. Em relação aos carryover houve excelente desempenho do aparelho, contudo, houve valores não conformes nos parâmetros de CHCM e VPM em uma das metodologias realizadas que pode ser justificada pela limitação da fórmula que não considera a características do equipamento.(AU)

The automated hematology counter ABX Micros 60 ESX (Horiba Medical 2012) is veterinary hematology analyzer multi-species that carries 50 counts per hour releases 18 blood parameters, in addition to graphical representations (histograms) for leukocytes, erythrocytes and platelets. The objective of this study is to evaluate the performance of the apparatus with respect to linearity and carryover through commercial control and blood samples from the routine of Veterinary Clinical Pathology Laboratory. According to results we can say that this device has excellent linearity coefficient (r2=0.99) in leukocyte parameters, erythrocytes and platelets during that time dilutions. Regarding the carryover was excellent device performance, however, was not in conformity values ​​in the parameters of MCHC and VPM in one of the methodologies made that can be justified by the limited formula that does not consider the equipment characteristics.(AU)

Reference intervals for absolute and percentage immature platelet fraction using the Sysmex XN-10 automated haematology analyser in a UK population.

BACKGROUND: Immature platelet fraction (IPF) estimation is a non-invasive and sensitive test that is available on recently introduced Sysmex XN-series of automated haematology analysers. It is a direct cellular indicator of thrombopoiesis. The aim of this study was to establish reference intervals for IPF, for both absolute (A-IPF) and percentage (%-IPF) measurements. MATERIAL AND METHODS: A total of 2366 samples that met the inclusion criteria were assayed for full blood count on the Sysmex XN-10 and a non-parametric percentile method was used for calculating the reference intervals. RESULTS: After the outliers were excluded, the reference interval for %-IPF and A-IPF on Sysmex XN-10 were 1.6-10.1% and 4.37-23.21 × 109/L in total individuals, respectively. There was a statistical significance noted between the sexes (p = .004) for %-IPF, therefore a sex-specific reference interval was established, which was 1.8-10.0% for the males and 1.5-10.1% for females. No significant difference in sex status for A-IPF and age status for both %-IPF and A-IPF was observed. A very poor correlation was estimated between age versus %-IPF, ρ = 0.0156, and age versus A-IPF, ρ = -0.0023, indicating that there is no overall biological relationship between age and these parameters. As expected, a strong correlation between %-IPF and A-IPF was noted which could be attributed to their inter-relatedness. CONCLUSIONS: This large-scale study showed comparable reference intervals with the previous studies for %-IPF and A-IPF in a UK population. It found the need to establish sex-specific reference intervals for %-IPF, but not for A-IPF, whereas reference intervals were found to be stable across the age range.

New Alert Message Settings for the XN-series Automated Hematology Analyzer Are Useful for Avoiding Falsely High WBC Counts and to Detect Specimens with Giant Platelets.

We encountered blood specimens from a patient with MYH9 related diseases, which gave falsely high white blood cell (WBC) counts during laboratory analysis using Sysmex XN-series automated hematology analyzers. This overcount was revealed to be caused by the overlapping of platelet (PLT) distribution with the WBC area in the WNR channel, which was used for routine WBC count with the XN-series. On the other hand, the WBC count obtained through the WDF channel of the XN-series seemed more accurate in such a case. We then created and introduced alert message settings for such rare but critical specimens, which gives a warning when the discrepancy in WBC counts between the WNR and WDF channels is higher than 1.0×109/L. By using the alert message setting, we were able to detect some specimens which gave falsely high WBC counts with the routine WNR channel from three other cases of giant PLTs. In conclusion, our alert message setting seems useful in avoiding false reporting of WBC count due to abnormal cells, including giant PLTs.

Evaluation of mouse red blood cell and platelet counting with an automated hematology analyzer.

An evaluation of mouse red blood cell (RBC) and platelet (PLT) counting with an automated hematology analyzer was performed with three strains of mice, C57BL/6 (B6), BALB/c (BALB) and DBA/2 (D2). There were no significant differences in RBC and PLT counts between manual and automated optical methods in any of the samples, except for D2 mice. For D2, RBC counts obtained using the manual method were significantly lower than those obtained using the automated optical method (P<0.05), and PLT counts obtained using the manual method were higher than those obtained using the automated optical method (P<0.05). An automated hematology analyzer can be used for RBC and PLT counting; however, an appropriate method should be selected when D2 mice samples are used.

High platelet count at diagnosis is a protective factor for thrombosis in patients with essential thrombocythemia.

To assess the role of platelet (PLT) count for thrombotic complications in Essential Thrombocythemia (ET), 1201 patients followed in 11 Hematological centers in the Latium region were retrospectively evaluated. At multivariate analysis, the following factors at diagnosis were predictive for a worse Thrombosis-free Survival (TFS): the occurrence of previous thrombotic events (p=0.0004), age>60years (p=0.0044), spleen enlargement (p=0.042) and a lower PLT count (p=0.03). Receiver Operating Characteristic (ROC) analyses based on thrombotic events during follow-up identified a baseline platelet count of 944×109/l as the best predictive threshold: thrombotic events were 40/384 (10.4%) in patients with PLT count >944×109/l and 109/817 (13.3%) in patients with PLT count <944×109/l, respectively (p=0.04). Patients with PLT count <944×109/l were older (median age 60.4years. vs 57.1years., p=0.016), had a lower median WBC count (8.8×109/l vs 10.6×109/l, p<0.0001), a higher median Hb level (14.1g/dl vs 13.6g/dl, p<0.0001) and a higher rate of JAK-2-V617F positivity (67.2% vs 41.6%, p<0.0001); no difference was observed as to thrombotic events before diagnosis, spleen enlargement and concomitant Cardiovascular Risk Factors. In conclusion, our results confirm the protective role for thrombosis of an high PLT count at diagnosis. The older age and the higher rate of JAK-2 V617F positivity in the group of patients with a baseline lower PLT count could in part be responsible of this counterintuitive finding.