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Hoon Lee J, Young Yoon H, Lee HJ, Min Kang D, Bak Y, Biazruchka I, Lim S, Kim S, Kyung Kim Y, Kim DH, Lee JS. Fluorescent Phenotyping of Blood Cells Using a Differential Sensing Strategy: Differentiating Physiological Aging Stages and Neuro-Degenerative Disease Drugs. Chemistry 2024; 30:e202302916. [PMID: 37902438 DOI: 10.1002/chem.202302916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 10/30/2023] [Accepted: 10/30/2023] [Indexed: 10/31/2023]
Abstract
Blood continually contributes to the maintenance of homeostasis of the body and contains information regarding the health state of an individual. However, current hematological analyses predominantly rely on a limited number of CD markers and morphological analysis. In this work, differentially sensitive fluorescent compounds based on TCF scaffolds are introduced that are designed for fluorescent phenotyping of blood. Depending on their structures, TCF compounds displayed varied responses to reactive oxygen species, biothiols, redox-related biomolecules, and hemoglobin, which are the primary influential factors within blood. Contrary to conventional CD marker-based analysis, this unbiased fluorescent phenotyping method produces diverse fingerprints of the health state. Precise discrimination of blood samples from 37 mice was demonstrated based on their developmental stages, ranging from 10 to 19 weeks of age. Additionally, this fluorescent phenotyping method enabled the differentiation between drugs with distinct targets, serving as a simple yet potent tool for pharmacological analysis to understand the mode of action of various drugs.
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Affiliation(s)
- Jung Hoon Lee
- Department of Pharmacology, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
| | - Hey Young Yoon
- Department of Pharmacology, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
| | - Hye-Jin Lee
- Department of Pharmacology, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
| | - Dong Min Kang
- Center for Brain Disorders, Brain Science Institute, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Yecheol Bak
- Chemical & Biological Integrative Research Center, Biomedical Division, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Ina Biazruchka
- Chemical & Biological Integrative Research Center, Biomedical Division, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Sungsu Lim
- Center for Brain Disorders, Brain Science Institute, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Sehoon Kim
- Chemical & Biological Integrative Research Center, Biomedical Division, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Yun Kyung Kim
- Center for Brain Disorders, Brain Science Institute, Korea Institute of Science and Technology (KIST), 02792, Seoul, Korea
| | - Dong-Hoon Kim
- Department of Pharmacology, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
| | - Jun-Seok Lee
- Department of Pharmacology, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, 02841, Seoul, Korea
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Kashiwagi H, Kuwana M, Murata M, Shimada N, Takafuta T, Yamanouchi J, Kato H, Hato T, Tomiyama Y. Reference guide for the diagnosis of adult primary immune thrombocytopenia, 2023 edition. Int J Hematol 2024; 119:1-13. [PMID: 37957517 PMCID: PMC10770234 DOI: 10.1007/s12185-023-03672-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 11/15/2023]
Abstract
Primary immune thrombocytopenia (ITP) is an autoimmune disorder characterized by isolated thrombocytopenia due to accelerated platelet destruction and impaired platelet production. Diagnosis of ITP is still challenging because ITP has been diagnosed by exclusion. Exclusion of thrombocytopenia due to bone marrow failure is especially important in Japan because of high prevalence of aplastic anemia compared to Western countries. Hence, we propose a new diagnostic criteria involving the measurement of plasma thrombopoietin (TPO) levels and percentage of immature platelet fraction (RP% or IPF%); 1) isolated thrombocytopenia with no morphological evidence of dysplasia in any blood cell type in a blood smear, 2) normal or slightly increased plasma TPO level (< cutoff), 3) elevated RP% or IPF% (> upper limit of normal), and 4) absence of other conditions that potentially cause thrombocytopenia including secondary ITP. A diagnosis of ITP is made if conditions 1-4 are all met. Cases in which criterion 2 or 3 is not met or unavailable are defined as "possible ITP," and diagnosis of ITP can be made mainly by typical clinical course. These new criteria enable us to clearly differentiate ITP from aplastic anemia and other forms of hypoplastic thrombocytopenia and can be highly useful in clinical practice for avoiding unnecessary bone marrow examination as well as for appropriate selection of treatments.
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Affiliation(s)
- Hirokazu Kashiwagi
- Department of Blood Transfusion, Osaka University Hospital, Suita, Osaka, 565-0871, 2-15, Yamadaoka, Japan.
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Mitsuru Murata
- Center for Clinical Medical Research, International University of Health and Welfare, Ohtawara, Tochigi, Japan
| | - Naoki Shimada
- Center for Basic Medical Research, International University of Health and Welfare, Ohtawara, Tochigi, Japan
| | - Toshiro Takafuta
- Department of Internal Medicine, Hiroshima City Funairi Citizens Hospital, Hiroshima, Hiroshima, Japan
| | - Jun Yamanouchi
- Division of Blood Transfusion and Cell Therapy, Ehime University Hospital, Toon, Ehime, Japan
| | - Hisashi Kato
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takaaki Hato
- Japanese Red Cross Ehime Blood Center, Matsuyama, Ehime, Japan
| | - Yoshiaki Tomiyama
- Department of Hematology and Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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3
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Chen S, Mao Z, Wang S, Deng J, Liao H, Zheng Q. Micro-Red Blood Cell, Fragmented Red Blood Cell, Platelet Distribution Width, Mean Platelet Volume, and Platelet-Large Cell Ratio on Sysmex XN Series Hematology Analyzers Can Be Used for the Reflex Test of Impedance Platelet Count in Clinical Practice. Arch Pathol Lab Med 2024; 148:61-67. [PMID: 37014982 DOI: 10.5858/arpa.2022-0030-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 04/06/2023]
Abstract
CONTEXT.— Platelet (PLT) counting with impedance (PLT-I) is widely used but has low specificity. PLT counting with fluorescence (PLT-F), tested by the Sysmex XN series with high specificity, can be a complementary method to PLT-I. OBJECTIVE.— To identify red blood cell (RBC)- and PLT-related parameters as potential influencing factors for PLT-I and establish PLT reflex test rules with PLT-F. DESIGN.— We prospectively tested both PLT-I and PLT-F in all 3480 samples. In a development data set of 3000 samples, differences between the reflex and nonreflex groups were compared and influencing factors for PLT-I were identified by logistic regression. The area under the receiver operating characteristic (ROC) curve and cutoff values were obtained by ROC curve analysis. Validation was conducted in the remaining 480 samples (validation data set). RESULTS.— PLT-F showed comparable results with immunoplatelet counting. In logistic regression, increased micro-RBC absolute count (micro-RBC#), fragmented RBC absolute count (FRC#), PLT distribution width (PDW), mean PLT volume (MPV), PLT-large cell ratio (P-LCR), and immature PLT fraction absolute count (IPF#) were influencing factors for PLT-I. In ROC curve analysis, the cutoff values of micro-RBC#, FRC#, PDW, MPV, and P-LCR were 0.64 × 106/μL, 0.082 × 106/μL, 15.40 fL, 11.15 fL, and 33.95%, respectively. The areas under the ROC curve of micro-RBC# and FRC# were 0.77 and 0.79, respectively. CONCLUSIONS.— Micro-RBC#, FRC#, PDW, MPV, P-LCR, and IPF# were factors affecting PLT-I. Among them, micro-RBC# and FRC# were the most impactful factors. From our study results, micro-RBC#, FRC#, MPV, PDW, and P-LCR can be used to establish reflex test rules for PLT counting in clinical work.
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Affiliation(s)
- Si Chen
- From the Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China (Chen, Mao, Wang, Liao, Zheng)
| | - Zhigang Mao
- From the Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China (Chen, Mao, Wang, Liao, Zheng)
| | - Shuang Wang
- From the Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China (Chen, Mao, Wang, Liao, Zheng)
| | - Jiamin Deng
- West China School of Medicine, Sichuan University, Chengdu, China (Deng)
| | - Hongyan Liao
- From the Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China (Chen, Mao, Wang, Liao, Zheng)
| | - Qin Zheng
- From the Department of Laboratory Medicine, West China Hospital of Sichuan University, Chengdu, China (Chen, Mao, Wang, Liao, Zheng)
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Allan HE, Vadgama A, Armstrong PC, Warner TD. Platelet ageing: A review. Thromb Res 2023; 231:214-222. [PMID: 36587993 DOI: 10.1016/j.thromres.2022.12.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/02/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
Platelet ageing is an area of research which has gained much interest in recent years. Newly formed platelets, often referred to as reticulated platelets, young platelets or immature platelets, are defined as RNA-enriched and have long been thought to be hyper-reactive. This latter view is largely rooted in associations and observations in patient groups with shortened platelet half-lives who often present with increased proportions of newly formed platelets. Evidence from such groups suggests that an increased proportion of newly formed platelets is associated with an increased risk of thrombotic events and a reduced effectiveness of standard anti-platelet therapies. Whilst research has highlighted the existence of platelet subpopulations based on function, size and age within patient groups, the common intrinsic changes which occur as platelets age within the circulation are only just being explored. By understanding the changes that occur during the natural ageing processes of platelets, we may be able to identify the triggers for alterations in platelet life span and platelet reactivity. Here we review research on platelet ageing in the context of health and disease, paying particular attention to the experimental approaches taken and the robustness of conclusions that can be drawn.
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Affiliation(s)
- Harriet E Allan
- Centre for Immunobiology, Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom.
| | - Ami Vadgama
- Centre for Immunobiology, Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Paul C Armstrong
- Centre for Immunobiology, Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
| | - Timothy D Warner
- Centre for Immunobiology, Blizard Institute, Barts & the London School of Medicine and Dentistry, Queen Mary University of London, United Kingdom
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5
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Noel MM, Feugray G, Kasonga F, Buchonnet G, Daliphard S, Barbay V, Bera E, Le Cam Duchez V, Billoir P. Stability over time of immature platelet fraction and comparison between EDTA and citrated whole blood samples. J Clin Lab Anal 2023; 37:e24946. [PMID: 37475131 PMCID: PMC10492457 DOI: 10.1002/jcla.24946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/22/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND Immature platelets (IP) are the youngest circulating platelets, released from megakaryocytes, and demonstrating increased dimensions, significant RNA content, and enhanced activity. Immature platelet research focuses on a differential diagnostic help in patients with thrombocytopenia. The objectives of this study were to compare the variability of IP in citrate and EDTA samples, and to determine stability over time. METHODS Fifty-six patients were included for comparison between EDTA and citrate whole blood sample collection. Among the patients, 28 had thrombocytopenia (platelet count < 150G/L). Platelet measurement impedancemetry and fluorimetry were performed with Sysmex XN-9000. The immature platelet fraction (IPF) and absolute immature platelet count (A-IPC) were determined with a fluorescent method. RESULTS The mean value of platelet count with fluorescence was, in EDTA sample, 215 ± 171 and, in citrate sample, 153 ± 118 G/L. No significant difference was observed between IPF between EDTA and citrate (7.74 ± 6.68% vs. 8.45 ± 7.37%, p = 0.69), respectively. With the Bland-Altman analysis, the mean difference in the EDTA sample, between 1 and 24 h, was 8.06 ± 6.96% and 8.73 ± 7.12% for IPF, whereas in the citrate sample, between 1 and 6 h, it was 8.60 ± 7.29% and 7.54 ± 6.97%, for IPF. Comparing 1 h EDTA sample with 6 h citrate sample, the variance ratio was 0.974 (95% CI: 0.864-1.084) in IPF. CONCLUSIONS We confirmed the potential to conduct IP measurements up to 24 h in the EDTA sample and IPF measurements in the citrate sample for up to 6 h. These results may be useful for the use of IPF, which is a promising parameter whose interest in clinical practice and standardization is not yet well defined.
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Affiliation(s)
| | - Guillaume Feugray
- Univ ROUENINSERM U1096RouenFrance
- General Biochemistry, CHU RouenRouenFrance
| | | | | | | | | | - Elsa Bera
- Rouen, France Hematology laboratoryCHU RouenRouenFrance
| | | | - Paul Billoir
- CHU RouenVascular Hemostasis UnitRouenFrance
- Univ ROUENINSERM U1096RouenFrance
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Soulard M, Croix P, Cohen P. Comparison of platelet count results on the Sysmex XN between citrate or MgSO 4 and K2 EDTA anticoagulants. Int J Lab Hematol 2023; 45:20-28. [PMID: 36093831 PMCID: PMC10087425 DOI: 10.1111/ijlh.13966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/13/2022] [Indexed: 01/18/2023]
Abstract
INTRODUCTION The aim of this study performed on Sysmex XN is to compare platelet values on citrate and MgSO4 (TBX) in patients with K2EDTA-induced platelet clusters and to identify platelet biases of these matrices compared to K2EDTA. METHODS Sixty patients with K2EDTA-induced platelet clusters were re-sampled with K2EDTA, citrate and TBX. Platelet results were then compared, and smears were analysed for clumping. Platelet results from 120 patients without K2EDTA-induced platelet clusters were compared between K2 EDTA, citrate, and MgSO4 with impedance and fluorescence modes. Biases from regressions were analysed. RESULTS Out of the 60 patients with K2EDTA-induced platelet clusters, none showed platelet clusters with MgSO4 whereas 50% still showed clusters with citrate. Among those without platelet clusters on citrate, the mean relative difference between (citrate- MgSO4 )/MgSO4 was -12.7% in impedance and -9.8% in fluorescence. Among the 120 patients without K2EDTA-induced platelet clusters, in fluorescence the mean relative bias with respect to K2EDTA was -2.06% for MgSO4 and -10.3% for Citrate. For the MgSO4 versus K2 EDTA regressions, the maximum absolute values of the 95% CI of the relative biases at 150 × 109 /L (5.45%) and 450 × 109 /L (3.56%) were below the desirable analytical objectives of the EFLM. CONCLUSION In patients with K2EDTA-induced platelet clusters, MgSO4 is preferable to citrate. MgSO4 provides a bias with XN in fluorescence when compared to EDTA which is within analytical tolerance.
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Affiliation(s)
- Michel Soulard
- Biogroup Hematology LaboratoryLa ChocolaterieLevallois PerretFrance
| | - Pascale Croix
- Biogroup Hematology LaboratoryLa ChocolaterieLevallois PerretFrance
| | - Patrick Cohen
- Division of Laboratory Medicine, Diagnostic DepartmentGeneva University Hospitals and Faculty of MedicineGenevaSwitzerland
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7
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Deng J, Xie S, Chen Y, Ma Q, He Y, Liu M, Wang D, Yu X. Application of the Fluorescence Method on Sysmex XN9000 Hematology Analyzer for Correcting Platelet Count in Individuals with Microcytosis. Lab Med 2023; 54:e10-e13. [PMID: 35713611 DOI: 10.1093/labmed/lmac063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Although small red blood cells are a well-known analytical pitfall that could cause artifactual increase of the platelet count, limited information is available on the accuracy of impedance platelet counting in cases with microcytosis. The aim of this study is to assess the accuracy of impedance platelet counting in the presence of small red blood cells, and to establish the optimal mean corpuscular volume (MCV) cutoff to endorse fluorescence platelet counting. METHODS In this study, platelet counts estimated by the impedance method on the Sysmex XN9000 analyzer (Sysmex, Kobe, Japan) were compared with those provided by the fluorescence method. The accuracy of impedance platelet counting was assessed. Receiver operating characteristic curve was used to evaluate the performance of MCV in predicting falsely increased platelet counts. RESULTS There was a tendency for the impedance method to overestimate the platelet count in samples with 70 fL < MCV ≤ 80 fL, 60 fL < MCV ≤ 70 fL, MCV ≤ 60 fL. Receiver operating characteristic curve analysis showed that a 73.5fL cutoff of MCV was highly sensitive in predicting falsely increased platelet counts. CONCLUSION In cases with MCV < 73.5 fL, we strongly suggest that the platelet counts obtained by the impedance method on the Sysmex XN9000 analyzer should be checked and corrected by fluorescence counting.
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Affiliation(s)
- Jiankai Deng
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuhua Xie
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yaoming Chen
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qinghua Ma
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yuting He
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Min Liu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dong Wang
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xuegao Yu
- Department of Laboratory Medicine, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lakos G, Mukhtar Z, Masi L, Valente S, Papa F. Alinity hq platelet count is not impacted by severe microcytosis. J Clin Lab Anal 2022; 36:e24218. [PMID: 35274768 PMCID: PMC8993633 DOI: 10.1002/jcla.24218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/24/2021] [Accepted: 12/19/2021] [Indexed: 11/16/2022] Open
Abstract
Background Impedance technology has been shown to overestimate platelet (PLT) count in samples with microcytes, while the optical‐fluorescence PLT count (PLT‐F) by Sysmex has been suggested to be unaffected by microcytosis. The Abbott Alinity hq analyzer employs multi‐dimensional optical PLT counting. Our goal was to assess the accuracy of this technology in microcytic samples. Methods Platelet measurements were performed by Alinity hq and the impedance (PLT‐I) and PLT‐F methods on a Sysmex XN‐3000 analyzer on 464 samples. PLT concentration range was 6.56–947 × 109/L and mean cell volume (MCV) 40.9–123.0 fL. Samples were categorized into normocytic (MCV > 80 fL), microcytic (MCV 65–80 fL), and severely microcytic (MCV < 65 fL) groups. Results Alinity hq PLT count showed excellent agreement with PLT‐F (r = 1.00). Sysmex PLT‐I data showed somewhat weaker correlation with both PLT‐F and Alinity hq (r = 0.98). Increasing bias between Sysmex PLT‐I and PLT‐F was seen with decreasing MCV values, with mean bias of 35.2 × 109/L in severe microcytosis. An inverse relationship was demonstrated between the PLT‐I versus PLT‐F bias and MCV (p < 0.0001). Consistent mean bias was observed between Alinity hq and PLT‐F across all MCV ranges. Mean platelet volume was suppressed or flagged by Sysmex XN in 50% of the samples in the severely microcytic group, and markedly higher red cell distribution width (RDW) was reported compared to Alinity hq (18.1% vs 13.7%, p < 0.0001). Conclusion The Sysmex PLT‐I method overestimated the PLT count in samples with severe microcytosis. Alinity hq provided PLT counts and PLT and RBC indices that were not impacted by microcytosis.
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Affiliation(s)
| | | | - Loredana Masi
- Clinical Pathology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Sabatino Valente
- Clinical Pathology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
| | - Fabrizio Papa
- Clinical Pathology Department, San Giovanni Calibita Fatebenefratelli Hospital, Rome, Italy
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Collins J, Astle WJ, Megy K, Mumford AD, Vuckovic D. Advances in understanding the pathogenesis of hereditary macrothrombocytopenia. Br J Haematol 2021; 195:25-45. [PMID: 33783834 DOI: 10.1111/bjh.17409] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/19/2021] [Indexed: 12/14/2022]
Abstract
Low platelet count, or thrombocytopenia, is a common haematological abnormality, with a wide differential diagnosis, which may represent a clinically significant underlying pathology. Macrothrombocytopenia, the presence of large platelets in combination with thrombocytopenia, can be acquired or hereditary and indicative of a complex disorder. In this review, we discuss the interpretation of platelet count and volume measured by automated haematology analysers and highlight some important technical considerations relevant to the analysis of blood samples with macrothrombocytopenia. We review how large cohorts, such as the UK Biobank and INTERVAL studies, have enabled an accurate description of the distribution and co-variation of platelet parameters in adult populations. We discuss how genome-wide association studies have identified hundreds of genetic associations with platelet count and mean platelet volume, which in aggregate can explain large fractions of phenotypic variance, consistent with a complex genetic architecture and polygenic inheritance. Finally, we describe the large genetic diagnostic and discovery programmes, which, simultaneously to genome-wide association studies, have expanded the repertoire of genes and variants associated with extreme platelet phenotypes. These have advanced our understanding of the pathogenesis of hereditary macrothrombocytopenia and support a future clinical diagnostic strategy that utilises genotype alongside clinical and laboratory phenotype data.
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Affiliation(s)
- Janine Collins
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- Department of Haematology, Barts Health NHS Trust, London, UK
| | - William J Astle
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge Institute of Public Health, Forvie Site, Robinson Way, Cambridge, UK
| | - Karyn Megy
- Department of Haematology, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK
- National Health Service Blood and Transplant, Cambridge Biomedical Campus, Cambridge, UK
- NIHR BioResource, Cambridge University Hospitals NHS Foundation, Cambridge Biomedical Campus, Cambridge, UK
| | - Andrew D Mumford
- School of Cellular and Molecular Medicine, University of Bristol, Bristol, UK
| | - Dragana Vuckovic
- Department of Biostatistics and Epidemiology, Faculty of Medicine, Imperial College London, London, UK
- Human Genetics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
- National Institute for Health Research Blood and Transplant Research Unit (NIHR BTRU) in Donor Health and Genomics, University of Cambridge, Cambridge, UK
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10
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Velizarova M, Yacheva T, Genova M, Svinarov D. Evaluation of automated hematology analyzer DYMIND DH76 compared to SYSMEX XN 1000 system. J Med Biochem 2021; 40:367-377. [PMID: 34616226 PMCID: PMC8451233 DOI: 10.5937/jomb0-28836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 02/03/2021] [Indexed: 12/02/2022] Open
Abstract
Background DYMIND DH76 (DYMIND BIOTECH, China) is a new automated hematology system designed to provide CBC count, including a 5-part WBC differential count, and its analytical performance should be assessed before adoption for clinical use. Methods The analyzer was evaluated according to the International Council for Standardization in Haematology guideline. The purposes of this study were to assess its analytical performance in comparison to SYSMEX XN 1000 hematology analyzer currently used in our laboratory, as well as to compare the automated and manual WBC differential. Results Within-run precision in all concentration ranges was very good with coefficients of variation (CVs) between 0.02% and 2.5% except for platelets over 500×109/L (CV 9.5%). Within-batch imprecision showed CVs lower the declared deviation ranges. Accuracy (defined as trueness) was excellent for all CBC and white cell differential parameters, compared with the state of the art%. Linearity was confirmed with excellent regression coefficients (0.999-1.000), even in the lowest values, and carryover was ≤ 1%. Comparison between DYMIND DH76 and SYSMEX XN 1000 was also very good with correlation coefficients (R2) for WBC (1.000), RBC (0.999), hemoglobin (0.999) and PLT over 50×109/L (0.994) and R2 was lower but still acceptable (0.910) for PLT<50×109/L. R2 for neutrophils, lymphocytes, eosinophils, basophils, and monocytes were 0.974, 0.982, 0.957, 0.625, and 0.836, respectively, in the comparison between the manual and DYMIND DH76 automated differential WBC counts. Conclusions With excellent analytical performance and acceptable comparative analysis, DYMIND DH76 hematology analyser covered the predefined international standards and requirements and is fully appropriate for clinical application.
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Affiliation(s)
- Milena Velizarova
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Teodora Yacheva
- UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Mariana Genova
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
| | - Dobrin Svinarov
- Medical University of Sofia, Faculty of Medicine, Department of Clinical Laboratory, Sofia, Bulgaria.,UMBAL Alexandrovska, Clinical Laboratory & Clinical Pharmacology, Sofia, Bulgaria
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11
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Lifson MA, Wakui M, Arai T, Mitsuhashi T, Lakos G, Murata M. Alinity hq platelet results are equivalent with the international reference method in thrombocytopenic samples. Int J Lab Hematol 2021; 43:1357-1362. [PMID: 34224209 DOI: 10.1111/ijlh.13604] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/15/2021] [Accepted: 05/01/2021] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Accurate and precise platelet (PLT) count is critical for the appropriate management of patients with thrombocytopenia. This study evaluated the performance of PLT counting with the Abbott Alinity hq hematology analyzer, which utilizes multi-dimensional optical technology. METHODS Imprecision, linearity, and accuracy were assessed per CLSI guidelines. Alinity hq PLT results were compared to the international flow cytometry reference method (IRM) in the concentration range of 6.3 to 103.0 × 109 /L. Additional comparisons were made with Sysmex XN-3000 PLT counts: impedance (PLT-I), optical (PLT-O), and optical fluorescent (PLT-F) methods. RESULTS The average within-run %CV was 4.7% on patient samples with PLT concentrations ranging from 13.1 to 41.7 × 109 /L, and the within-laboratory %CV was 3.6% at the level of 68.2 × 109 /L. Linearity evaluation indicated a maximum deviation of 3.1% from the linear fit in the range of 0.1 to 316.8 × 109 /L. Comparison between Alinity hq and the IRM PLT counts yielded a correlation coefficient of 0.99 and predicted bias of 0.0 and -0.5 × 109 /L at 10.0 and 20.0 × 109 /L transfusion thresholds, respectively. Alinity hq PLT counts also correlated well with Sysmex PLT counts, with strongest correlation obtained with PLT-F and PLT-O (r = .99) methods. CONCLUSION This study demonstrated excellent analytical performance of Alinity hq PLT counting in thrombocytopenic samples, equivalency with the IRM and strong agreement with Sysmex PLT-F and PLT-O methods. The Alinity hq multi-dimensional optical PLT count is available with every CBC without additional reagents and may help promote efficiency in clinical laboratories.
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Affiliation(s)
| | - Masatoshi Wakui
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tomoko Arai
- Clinical Laboratory, Keio University Hospital, Tokyo, Japan
| | - Takayuki Mitsuhashi
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | | | - Mitsuru Murata
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
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Farah RS, Hussain N, Shaik JA, Sadick N, Gregorich G, Asiala J, Freese R, Hordinsky M. Reply to: Response to "Inconsistent platelet-rich plasma product from Food and Drug Administration cleared devices: A retrospective review of clinic data". J Am Acad Dermatol 2021; 85:e179-e180. [PMID: 33872712 DOI: 10.1016/j.jaad.2021.03.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Ronda S Farah
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota.
| | - Noora Hussain
- College of Continuing and Professional Studies, University of Minnesota, Minneapolis, Minnesota
| | - Javed A Shaik
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
| | - Neil Sadick
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota; Sadick Dermatology, New York, New York; Weill Cornell Medical College, New York, New York
| | - Graham Gregorich
- Blood Bank Quality Center, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Jessica Asiala
- Blood Bank Quality Center, University of Minnesota Medical Center, Minneapolis, Minnesota
| | - Rebecca Freese
- Biostatistical Design and Analysis Center, Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota
| | - Maria Hordinsky
- Department of Dermatology, University of Minnesota, Minneapolis, Minnesota
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Starks RD, Merrill AE, Davis SR, Voss DR, Goldsmith PJ, Brown BS, Kulhavy J, Krasowski MD. Use of Middleware Data to Dissect and Optimize Hematology Autoverification. J Pathol Inform 2021; 12:19. [PMID: 34221635 PMCID: PMC8240550 DOI: 10.4103/jpi.jpi_89_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/01/2020] [Accepted: 11/20/2020] [Indexed: 11/13/2022] Open
Abstract
Background: Hematology analysis comprises some of the highest volume tests run in clinical laboratories. Autoverification of hematology results using computer-based rules reduces turnaround time for many specimens, while strategically targeting specimen review by technologist or pathologist. Methods: Autoverification rules had been developed over a decade at an 800-bed tertiary/quarternary care academic medical central laboratory serving both adult and pediatric populations. In the process of migrating to newer hematology instruments, we analyzed the rates of the autoverification rules/flags most commonly associated with triggering manual review. We were particularly interested in rules that on their own often led to manual review in the absence of other flags. Prior to the study, autoverification rates were 87.8% (out of 16,073 orders) for complete blood count (CBC) if ordered as a panel and 85.8% (out of 1,940 orders) for CBC components ordered individually (not as the panel). Results: Detailed analysis of rules/flags that frequently triggered indicated that the immature granulocyte (IG) flag (an instrument parameter) and rules that reflexed platelet by impedance method (PLT-I) to platelet by fluorescent method (PLT-F) represented the two biggest opportunities to increase autoverification. The IG flag threshold had previously been validated at 2%, a setting that resulted in this flag alone preventing autoverification in 6.0% of all samples. The IG flag threshold was raised to 5% after detailed chart review; this was also the instrument vendor's default recommendation for the newer hematology analyzers. Analysis also supported switching to PLT-F for all platelet analysis. Autoverification rates increased to 93.5% (out of 91,692 orders) for CBC as a panel and 89.8% (out of 11,982 orders) for individual components after changes in rules and laboratory practice. Conclusions: Detailed analysis of autoverification of hematology testing at an academic medical center clinical laboratory that had been using a set of autoverification rules for over a decade revealed opportunities to optimize the parameters. The data analysis was challenging and time-consuming, highlighting opportunities for improvement in software tools that allow for more rapid and routine evaluation of autoverification parameters.
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Affiliation(s)
- Rachel D Starks
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Anna E Merrill
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Scott R Davis
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Dena R Voss
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Pamela J Goldsmith
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Bonnie S Brown
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Jeff Kulhavy
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Matthew D Krasowski
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
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Ianni B, McDaniel H, Savilo E, Wade C, Micetic B, Johnson S, Gerkin R. Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life. Arch Pathol Lab Med 2021; 145:66-74. [PMID: 33367662 DOI: 10.5858/arpa.2019-0444-oa] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Automated analyzers have advanced the field of clinical hematology, mandating updated complete blood count (CBC) reference intervals (RIs) to be clinically useful. Contemporary newborn CBC RI publications are mostly retrospective, which some authors have cited as one of their cardinal limitations and recommended future prospective studies. OBJECTIVE.— To prospectively establish accurate hematologic RIs for normal healthy term newborns at 24 hours of life given the limitations of the current medical literature. DESIGN.— This prospective study was conducted at an academic tertiary care center, and hematology samples were collected from 120 participants deemed to be normal healthy term newborns. Distributions were assessed for normality and tested for outliers. Reference intervals were values between the 2.5th percentile and 97.5th percentile. RESULTS.— The novel RIs obtained for this study population are as follows: absolute immature granulocyte count, 80/μL to 1700/μL; immature granulocyte percentage, 0.6% to 6.1%; reticulocyte hemoglobin equivalent, 31.7 to 38.4 pg; immature reticulocyte fraction, 35.9% to 52.8%; immature platelet count, 4.73 × 103/μL to 19.72 × 103/μL; and immature platelet fraction, 1.7% to 9.8%. CONCLUSIONS.— This prospective study has defined hematologic RIs for this newborn population, including new advanced clinical parameters from the Sysmex XN-1000 Automated Hematology Analyzer. These RIs are proposed as the new standard and can serve as a strong foundation for continued research to further explore their value in diagnosing and managing morbidities such as sepsis, anemia, and thrombocytopenia.
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Affiliation(s)
- Barbara Ianni
- From the Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona.,University of Arizona College of Medicine - Phoenix.,Neonatal Intensive Care Unit, Banner - University Medical Center Phoenix, Phoenix, Arizona (Ianni)
| | - Holly McDaniel
- Laboratory, Banner Desert and Cardons Children's Medical Centers, Laboratory Sciences of Arizona, Mesa (McDaniel)
| | - Elena Savilo
- Laboratory, Banner - University Medical Center Phoenix, Laboratory Sciences of Arizona, Phoenix (Savilo)
| | - Christine Wade
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Becky Micetic
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Scott Johnson
- Clinical Research, Division of Neonatal Medicine, MEDNAX Services, Inc, Phoenix Perinatal Associates, Phoenix, Arizona (Wade, Micetic, Johnson)
| | - Richard Gerkin
- Department of Internal Medicine, Banner - University Medical Center Phoenix, Phoenix, Arizona and University of Arizona College of Medicine - Phoenix (Gerkin)
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15
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Mannuß S. Influence of different methods and anticoagulants on platelet parameter measurement. J LAB MED 2020. [DOI: 10.1515/labmed-2020-0037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Abstract
Platelets are the smallest and perhaps the most versatile components of human blood. Besides their role in coagulation and the maintenance of vascular integrity, they are involved in many physiological processes, ranging from immune response and leukocyte recruitment to the production of antimicrobial peptides and immune-suppressive factors like TGF-β. These versatile abilities make platelets interesting for researchers from different disciplines. However, beside profound investigation into platelets’ physiological role, there is a need for correct, standardized and thus reproducible quantification of platelet parameters. Mean platelet volume (MPV) is a widespread prognostic marker for several conditions, such as, acute coronary syndrome, chronic kidney disease and liver cirrhosis. Platelet activation is regarded as a marker for inflammatory processes, for example in autoimmune diseases such as type-1 diabetes, systemic lupus erythematosus and rheumatoid arthritis. The monitoring of platelet function is relevant for patients receiving antiplatelet medication. Platelet parameter measurement is affected by the choice of in vitro anticoagulant, the measurement technology and the time delay after sampling. This review focuses on the pre-analytical variability that arises as a result of the use of different in vitro anticoagulants and analyzer technologies when determining platelet parameters, since, even approximately 180 years after the discovery of platelets, there is still no standardized procedure.
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Affiliation(s)
- Steffen Mannuß
- Klinikum der Stadt Ludwigshafen , Institut für Labordiagnostik, Hygiene und Transfusionsmedizin , Ludwigshafen , Germany
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16
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Effects of Time-Interval since Blood Draw and of Anticoagulation on Platelet Testing (Count, Indices and Impedance Aggregometry): A Systematic Study with Blood from Healthy Volunteers. J Clin Med 2020; 9:jcm9082515. [PMID: 32759828 PMCID: PMC7465339 DOI: 10.3390/jcm9082515] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 11/17/2022] Open
Abstract
Platelet count, indices (mean volume, young-immature platelet fraction) and aggregation are widely used laboratory parameters to investigate primary hemostasis. We performed a systematic, thorough evaluation of the influence of the time-interval since blood draw from 20 healthy individuals and of the anticoagulation of collected blood on such parameters. Blood was anticoagulated with citrate, K2-ethylenediaminetetraacetic acid (EDTA) and hirudin and analyzed 5, 30, 60, 120 and 180 min after blood draw. Multiple electrode aggregometry (MEA) was performed with either hirudin (half-diluted with NaCl) or citrate samples (half-diluted with NaCl or CaCl2 3 mM). Platelet count and indices (Sysmex XN-20) were rather stable over time with EDTA blood. MEA results were lower with citrate blood than with hirudin blood; supplementation with calcium was partially compensatory. MEA results were also lower when performed less than 30 or more than 120 min after blood draw. Platelet clumping, quantitatively estimated with microscope examination of blood smears, was more important in hirudin blood than citrate or EDTA blood and could explain some of the differences observed between preanalytical variables. The results stress once more the importance of preanalytical variables in hemostasis laboratory testing. Decision thresholds based on those tests are only applicable within specific preanalytical conditions.
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17
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Hummel K, van Dun LPJM, Sachse M, Beeger C, Hoffmann JJML. Leukocyte fragments may interfere in the fluorescent platelet count of Sysmex XN hematology analyzers. Int J Lab Hematol 2020; 42:e167-e169. [PMID: 32348029 DOI: 10.1111/ijlh.13219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/23/2020] [Accepted: 04/03/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Kornelia Hummel
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics Altona, Hamburg, Germany
| | - Ludi P J M van Dun
- Hematology Support Group, Abbott Hematology, Wiesbaden-Delkenheim, Germany
| | - Michaela Sachse
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics Altona, Hamburg, Germany
| | - Cord Beeger
- Department of Hematology, Asklepios Clinics Altona, Hamburg, Germany
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Abstract
Abstract
Reticulated platelets are immature platelets freshly released from the bone marrow into the circulation and contain vestigial amounts of ribonucleic acid. Thus, they can serve as an indicator for the activity of thrombopoiesis. Despite the current lack of a standardized reference method, two types of hematology analyzers have incorporated a fully automated measurement of reticulated platelets. The “immature platelet fraction” (IPF; Sysmex XE-/XN-series) has some clinical utility in the differential diagnosis of thrombocytopenia. This is less clear for “reticulated platelets” (retPLT; Abbott CELL-DYN Sapphire/Alinity HQ). The usefulness of these parameters in the prediction of platelet recovery after chemotherapy or stem cell transplantation and as a decision aid for platelet transfusions has not been unequivocally confirmed. Recent findings have shown an association of reticulated platelets with an adverse risk in patients with coronary artery disease and stroke as well as resistance to anti-platelet therapy. Furthermore, a role of reticulated platelets for the prediction of sepsis was indicated. However, validation in larger prospective trials is necessary to establish the clinical benefit of reticulated platelets in these conditions. This review gives an overview of the available analytical methods and summarizes the current knowledge regarding the clinical application of reticulated platelets.
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Affiliation(s)
- Lisa Meintker
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
| | - Stefan W. Krause
- Department of Medicine 5 for Hematology and Oncology , University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg , Erlangen , Germany
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Affiliation(s)
- Fiona Swain
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Robert Bird
- Division of Cancer Services, Princess Alexandra Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Tantanate C, Khowawisetsut L, Sukapirom K, Pattanapanyasat K. Analytical performance of automated platelet counts and impact on platelet transfusion guidance in patients with acute leukemia. Scandinavian Journal of Clinical and Laboratory Investigation 2019; 79:160-166. [PMID: 30761915 DOI: 10.1080/00365513.2019.1576100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The aim of this study was to evaluate the performance of automated impedance platelet counts by Beckman Coulter LH780 (PLT-LH), Sysmex XN-3000 (PLT-XNi) and fluorescence method by Sysmex XN-3000 (PLT-F) in patients with acute leukemia. Blood specimens were subjected to platelet measurements by evaluated methods and then compared against the international reference method (IRM). Eighty-two blood specimens were included. Bland-Altman plots of the differences between the evaluated methods and IRM demonstrated mean biases of PLT-LH, PLT-XNi and PLT-F of 9 × 109/L, 11 × 109/L and 2 × 109/L, respectively. For platelet transfusion guidance, all evaluated methods had acceptable accuracy. For platelet transfusion guidance, the sensitivities of PLT-LH, PLT-XNi and PLT-F were 33.3, 25.0 and 83.3%, respectively, at a transfusion threshold of 10 × 109/L, and 73.1, 61.5 and 84.6%, respectively, at transfusion threshold of 20 × 109/L. High blast count was associated with inaccurate PLT-LH and PLT-XNi. In conclusion, the PLT-F demonstrated excellent performance for diagnosis of thrombocytopenia and for platelet transfusion guidance in the evaluated specimens from acute leukemia patients. With respect to clinical relevance, careful blood smear review is necessary in case of high blast counts.
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Affiliation(s)
- Chaicharoen Tantanate
- a Department of Clinical Pathology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Ladawan Khowawisetsut
- b Department of Parasitology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Kasama Sukapirom
- c Department of Research and Development , Siriraj Center of Research Excellence for Microparticle and Exosome in Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
| | - Kovit Pattanapanyasat
- c Department of Research and Development , Siriraj Center of Research Excellence for Microparticle and Exosome in Diseases, Faculty of Medicine Siriraj Hospital, Mahidol University , Bangkok , Thailand
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21
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Shim MJ, Lee HA. Maintenance of Platelet Counts with Low Level QC Materials and the Change in P-LCR according to Hemolysis with XN-9000. KOREAN JOURNAL OF CLINICAL LABORATORY SCIENCE 2018. [DOI: 10.15324/kjcls.2018.50.4.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Moon-Jung Shim
- Department of Clinical Laboratory Science, Ansan University, Ansan, Korea
| | - Hyun-A Lee
- Department of Laboratory Medicine, Korea University Medical Center, Ansan Hospital, Ansan, Korea
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22
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Hummel K, Sachse M, Hoffmann JJML, van Dun LPJM. Comparative evaluation of platelet counts in two hematology analyzers and potential effects on prophylactic platelet transfusion decisions. Transfusion 2018; 58:2301-2308. [PMID: 30222860 DOI: 10.1111/trf.14886] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/01/2018] [Accepted: 06/06/2018] [Indexed: 12/01/2022]
Abstract
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.
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Affiliation(s)
- Kornelia Hummel
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics, Hamburg, Germany
| | - Michaela Sachse
- MEDILYS Laboratories LmbH, Central Laboratory of the Asklepios Clinics, Hamburg, Germany
| | | | - Ludi P J M van Dun
- Hematology Support Group, Abbott Hematology, Wiesbaden-Delkenheim, Germany
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Changes in novel haematological parameters following thermal injury: A prospective observational cohort study. Sci Rep 2017; 7:3211. [PMID: 28607467 PMCID: PMC5468303 DOI: 10.1038/s41598-017-03222-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/24/2017] [Indexed: 12/15/2022] Open
Abstract
The mortality caused by sepsis is high following thermal injury. Diagnosis is difficult due to the ongoing systemic inflammatory response. Previous studies suggest that cellular parameters may show promise as diagnostic markers of sepsis. The aim of this study was to evaluate the effect of thermal injury on novel haematological parameters and to study their association with clinical outcomes. Haematological analysis was performed using a Sysmex XN-1000 analyser on blood samples acquired on the day of the thermal injury to 12 months post-injury in 39 patients (15–95% TBSA). Platelet counts had a nadir at day 3 followed by a rebound thrombocytosis at day 21, with nadir values significantly lower in septic patients. Measurements of extended neutrophil parameters (NEUT-Y and NEUT-RI) demonstrated that septic patients had significantly higher levels of neutrophil nucleic acid content. A combination of platelet impedance count (PLT-I) and NEUT-Y at day 3 post-injury exhibited good discriminatory power for the identifying septic patients (AUROC = 0.915, 95% CI [0.827, 1.000]). Importantly, the model had improved performance when adjusted for mortality with an AUROC of 0.974 (0.931, 1.000). A combination of PLT-I and NEUT-Y show potential for the early diagnosis of sepsis post-burn injury. Importantly, these tests can be performed rapidly and require a small volume of whole blood highlighting their potential utility in clinical practice.
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Tantanate C, Khowawisetsut L, Pattanapanyasat K. Performance Evaluation of Automated Impedance and Optical Fluorescence Platelet Counts Compared With International Reference Method in Patients With Thalassemia. Arch Pathol Lab Med 2017; 141:830-836. [PMID: 28402168 DOI: 10.5858/arpa.2016-0222-oa] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT - Spurious platelet counts from automated methods have been reported in patients with abnormal red blood cells. However, there is no specific study regarding performance of platelet counts by automated methods in patients with thalassemia. OBJECTIVE - To investigate the performance of automated platelet counts, including impedance (PLT-I) and optical fluorescent (PLT-O and PLT-F) methods, and compare them with the international reference method (IRM) for platelet counting in patients with thalassemia. DESIGN - Two hundred forty-nine thalassemia specimens from various subtypes were examined. PLT-I, PLT-O, and PLT-F from a Sysmex XN analyzer were evaluated and compared against the IRM. Demographic data, platelet counts, and red blood cell parameters are shown. Comparability between evaluated methods and IRM, as well as test characteristics, is presented. Factors involving inaccurate PLT-I were analyzed. RESULTS - Specimens with platelet counts ranging from 31 × 103/μL to 932 × 103/μL were included. Most patients were patients with thalassemia major. Correlation between PLT-I and IRM was lower than that of the other methods in overall patients. PLT-O and PLT-F were correlated to IRM when classifying patients according to clinically significant platelet ranges. All automated methods had acceptable sensitivities; however, specificity of PLT-I was low for diagnosis of thrombocytopenia. High RDW-CV (red blood cell distribution width-coefficient of variation) was an independent factor of inaccurate PLT-I measurement. CONCLUSIONS - Among the evaluated methods, PLT-I was the method least correlated to IRM, with PLT-O and PLT-F comparable to IRM in patients with thalassemia. Optical platelet counts and careful blood smear examination are recommended alternative platelet counting methods, depending on the clinical setting.
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Affiliation(s)
| | | | - Kovit Pattanapanyasat
- From the Departments of Clinical Pathology (Dr Tantanate) and Parasitology (Dr Khowawisetsut), and Center of Excellence for Flow Cytometry, Department of Research and Development (Dr Pattanapanyasat), Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Cornet E, Mullier F, Despas N, Jacqmin H, Geara C, Boubaya M, Chatelain B, Troussard X. Evaluation and optimization of the extended information process unit (E-IPU) validation module integrating the sysmex flag systems and the recommendations of the French-speaking cellular hematology group (GFHC). Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:465-71. [PMID: 27347841 DOI: 10.1080/00365513.2016.1199049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The French-Speaking Cellular Haematology Group (GFHC) recently published criteria for microscopic analysis of a blood smears when a hemogram is requested. In order to evaluate and improve these recommendations using an XN (Sysmex) analyzer, we assessed 31,836 samples categorized into two sub-groups of patients either receiving or not receiving care in the clinical hematology/oncology departments of two university hospitals. By combining the manufacturer's recommendations and the GFHC recommendations, 21.3% of samples had a positive review flag in phase 1 of our study (17,991 samples). In phase 2 (13,845 samples), increasing the immature granulocytes (IG) percentage from 5-10% as a review trigger threshold, and ignoring slides with isolated flags 'PLT HIGH' (thrombocytosis) or 'MCV LOW' (microcytosis) or 'Blast/Abn Lymph and Atypical Lymph' (blast cells/abnormal lymphocytes and atypical lymphocytes) (in the absence of abnormal cells on a previous blood smear within 72 h), enabled us to significantly reduce the number of slides reviewed from 21.3-15.0% (p < 0.0001), without loss of clinical value. This decrease occurred in both sub-groups (hematology 48.7-38.0%, non-hematology 18.3-11.7%, p < 0.0001). In conclusion, the application of the GFHC criteria adapted to XN analyzers has enabled us to optimize the hematology laboratory processes, and thus reduce the production costs and the turnaround time of hemogram results.
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Affiliation(s)
| | - François Mullier
- b Haematology Laboratory , Namur Thrombosis and Haemostasis Center (NTHC) , Namur Research Institute for Life Sciences (NARILIS), CHU UCL Namur, Université Catholique de Louvain , Belgium
| | - Noemie Despas
- b Haematology Laboratory , Namur Thrombosis and Haemostasis Center (NTHC) , Namur Research Institute for Life Sciences (NARILIS), CHU UCL Namur, Université Catholique de Louvain , Belgium
| | - Hugues Jacqmin
- b Haematology Laboratory , Namur Thrombosis and Haemostasis Center (NTHC) , Namur Research Institute for Life Sciences (NARILIS), CHU UCL Namur, Université Catholique de Louvain , Belgium
| | - Carole Geara
- a CHU CAEN - Laboratory of Haematology , Caen , France
| | | | - Bernard Chatelain
- b Haematology Laboratory , Namur Thrombosis and Haemostasis Center (NTHC) , Namur Research Institute for Life Sciences (NARILIS), CHU UCL Namur, Université Catholique de Louvain , Belgium
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Assessment of blood sample stability for complete blood count using the Sysmex XN-9000 and Mindray BC-6800 analyzers. Rev Bras Hematol Hemoter 2016; 38:225-39. [PMID: 27521861 PMCID: PMC4997904 DOI: 10.1016/j.bjhh.2016.05.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 05/16/2016] [Accepted: 05/30/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Different hematological analyzers have different analytical performances that are often reflected in the criteria for sample stability of the complete blood count. This study aimed to assess the stability of several hematological parameters using the XN-9000 Sysmex and BC-6800 Mindray analyzers. METHODS The impact of storage at room temperature and 4°C was evaluated after 2, 4, 6, 8, 24, 36 and 48h using ten normal and 40 abnormal blood samples. The variation from the baseline measurement was evaluated by the Steel-Dwass-Critchlow-Fligner test and by Bland-Altman plots, using quality specifications and critical difference as the total allowable variation. RESULTS Red blood cells and reticulocyte parameters (i.e. hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration, red blood cell distribution width, immature reticulocyte fractions, low-fluorescence reticulocytes, middle-fluorescence reticulocytes, high fluorescence mononuclear cells) showed less stability compared to leukocyte and platelet parameters (except for monocyte count and mean platelet volume). The bias for hematocrit, mean corpuscular volume, mean corpuscular hemoglobin concentration and red blood cell distribution width coefficient of variation was higher than the critical difference after 8h using both analyzers. CONCLUSION Blood samples measured with both analyzers do not show analytically significant changes in up to 2h of storage at room temperature and 4°C. However, the maximum time for analysis can be extended for up to 8h when the bias is compared to the critical difference.
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van Dievoet MA, Louagie H, Ghys T. Performance evaluation of the Sysmex(®) XP-300 in an oncology setting: evaluation and comparison of hematological parameters with the Sysmex(®) XN-3000. Int J Lab Hematol 2016; 38:490-6. [PMID: 27321240 DOI: 10.1111/ijlh.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The Sysmex XP-300(®) (XP-300) is a new, fully automated hematology analyzer, designed to generate complete blood counts (CBC) with 3-part differential. In our study, the XP-300 was evaluated as a point-of-care (POC) analyzer in an oncology setting. In which blood samples from patients with different pathologies and treatments, affecting hematopoiesis, were analyzed. METHODS Performance was evaluated according to the International Council for Standardization in Haematology (ICSH) guidelines and CLSI protocol H20-A2 . Beside precision, linearity and carry-over, a comparison study with the Sysmex(®) XN-3000 (XN-3000) and a manual reference leukocyte differential was performed. Flagging performance was also evaluated. RESULTS XP-300 showed excellent precision and linearity results. For within- and between-run precision, the criteria, according to Ricos et al. , were met for all parameters tested, except for platelets in the low level. Less than or equal to 0.5% carry-over was seen for all parameters tested. Comparison studies showed an acceptable correlation with both XN-3000 and the manual reference leukocyte count. A suboptimal flagging performance was demonstrated. CONCLUSION In the context of diagnosing cytopenia due to myelosuppressing agents or leukocytosis due to infection, the XP-300 showed good analytical performance. However, in the thrombocytopenic range, precision was suboptimal. In follow-up of hematological malignancies with the occurrence of abnormal cells, we advise verification with a more advanced analyzer or with microscopic review, although further studies with a higher prevalence of abnormal cells are needed.
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Affiliation(s)
| | - H Louagie
- Clinical laboratory AZ Sint-Lucas, Ghent, Belgium
| | - T Ghys
- Clinical laboratory AZ Sint-Lucas, Ghent, Belgium
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Serrando M, Marull A, Ruiz M, Perez del Campo D, Puig-Pey I, Muñoz JM, Tejerina P, Morales-Indiano C. Clinical significance of IPF% measurement in diagnosing thrombocytopenic disorders: distinguishing primary immune thrombocytopenia from other disorders. Int J Lab Hematol 2016; 38:e65-8. [DOI: 10.1111/ijlh.12485] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- M. Serrando
- Clinical Laboratory; University Hospital Dr Josep Trueta; Girona Spain
| | - A. Marull
- Clinical Laboratory; University Hospital Dr Josep Trueta; Girona Spain
| | - M. Ruiz
- Clinical Laboratory; University Hospital Dr Josep Trueta; Girona Spain
| | | | - I. Puig-Pey
- Clinical Laboratory; University Hospital Dr Josep Trueta; Girona Spain
| | | | - P. Tejerina
- Clinical Laboratory; University Hospital Dr Josep Trueta; Girona Spain
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Pérez I, Redín ME, Vives A, Garrido A, Urrechaga E, Lacasta M. Local verification between the hematological analyzers Sysmex XN-series and XE-5000. Int J Lab Hematol 2016; 38:256-64. [PMID: 26992454 DOI: 10.1111/ijlh.12478] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 01/12/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION The aim of this study was to perform a verification of the hematology analyzer Sysmex XN-2000 by comparing with the previous XE-5000. This study assessed the precision and carryover on the XN-2000 and the systematic error between the both counters according to desirable biological variability criterion and a flag comparison study. METHODS Within-run precision and between-batch precision were measured according to the ICSH guidelines. A comparative study was performed analyzing two hundred and six samples of peripheral blood from patients. The statistical study was conducted using the Passing-Bablok and Bland-Altman analyses. The leucocyte flag comparison was made by measuring the efficiency rate. RESULTS Between-batch precision was lower than that recommended by the biological variability criterion and manufacturer specifications. The comparison gave nonagreement results for neutrophil and basophil counts according to the criterion of biological variability. Erythroblasts and immature granulocytes showed nonagreement, but there is no available biological variation database for these parameters to compare with. Nevertheless, excellent absolute agreement was found for red blood cell parameters, and for platelet, lymphocyte, monocyte, and eosinophil counts. CONCLUSIONS The global results obtained for the precision, comparability, and efficiency provide a satisfactory integration of the XN-2000 in the core laboratory routine and accomplish an optimal reliability.
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Affiliation(s)
- I Pérez
- Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
| | - M E Redín
- Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
| | - A Vives
- Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
| | - A Garrido
- Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
| | - E Urrechaga
- Laboratory Hospital Galdakao Usansolo, Galdakao, Vizcaya, Spain
| | - M Lacasta
- Laboratory Medicine, Core Laboratory, University Hospital Donostia, Guipuzcoa, Spain
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Accuracy of a New Platelet Count System (PLT-F) Depends on the Staining Property of Its Reagents. PLoS One 2015; 10:e0141311. [PMID: 26496387 PMCID: PMC4619826 DOI: 10.1371/journal.pone.0141311] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 10/07/2015] [Indexed: 12/05/2022] Open
Abstract
Background Platelet count is essential for the diagnosis and management of hemostasis abnormalities. Although existing platelet count methods installed in common hematology analyzers can correctly count platelets in normal blood samples, they tend to miscount platelets in some abnormal samples. The newly developed PLT-F channel in the XN-Series hematology analyzer (Sysmex) has been reported to be a reliable platelet count system, even in abnormal samples. However, how the PLT-F platelet counting system achieves such accuracy has not been described in scientific articles. Methods Isolated platelets, erythrocytes, and fragmented erythrocytes were examined using an automated hematology analyzer. The samples were labeled by combining PLT-F reagents and anti-CD62p, CD63, Grp75, Calreticulin, CD41, or CD61 antibody, and analyzed using confocal laser scanning microscopy or flow cytometry. Results The PLT-F system correctly discriminated platelets in erythrocytes. Its reagents strongly stained some intraplatelet organelles labeled with anti-Grp75, but only faintly stained the plasma membrane of both platelets and erythrocytes. Microscopic observation and flow cytometric examination revealed that all of these strongly stained cells were also labeled with platelet-specific anti-CD41 and anti-CD61 antibodies. Conclusions This study revealed that the staining property of the PLT-F reagents, by which platelets and fragmented erythrocytes are clearly distinguished, contributes to the platelet-counting accuracy of the PLT-F system.
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Sample stability for complete blood cell count using the Sysmex XN haematological analyser. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:576-82. [PMID: 26057491 DOI: 10.2450/2015.0007-15] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 02/12/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Sample stability is a crucial aspect for the quality of results of a haematology laboratory. This study was conducted to investigate the reliability of haematological testing using Sysmex XN in samples stored for up to 24 h at different temperatures. MATERIALS AND METHODS Haematological tests were performed on whole blood samples collected from 16 ostensibly healthy outpatients immediately after collection and 3 h, 6 h or 24 h afterwards, with triple aliquots kept at room temperature, 4 °C or 37 °C. RESULTS No meaningful bias was observed after 3 h under different storage conditions, except for red blood cell distribution width (RDW) and platelet count (impedance technique, PLT-I) at 37 °C. After 6 h, meaningful bias was observed for mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) at room temperature, red blood cell (RBC) count, mean corpuscular haemoglobin concentration (MCHC), MCH, MCV and PLT-I at 4 °C, and RBC, RDW, MCHC, MCH and PLT-I at 37 °C. After 24 h, a meaningful bias was observed for MCHC, MCV, platelet count (fluorescent technique, PLT-F) and mean platelet volume (MPV) at room temperature, MCHC, MCV, PLT-I and MPV at 4 °C, and all parameters except RBC count and MPV at 37 °C. DISCUSSION Great caution should be observed when analysing results of haematological tests conducted more than 3 h after sample collection.
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Sakuragi M, Hayashi S, Maruyama M, Kabutomori O, Kiyokawa T, Nagamine K, Kato H, Kashiwagi H, Kanakura Y, Tomiyama Y. Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders. Int J Hematol 2015; 101:369-75. [DOI: 10.1007/s12185-015-1741-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2014] [Revised: 01/06/2015] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
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