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Broz P, Kukralova S, Palatova J, Kolduskova K, Zenkova J, Rajdl D, Racek J. Two cases with discrepancy in the quantitative cytological assessment of cerebrospinal fluid in neonatal samples using light microscopy in comparison with Sysmex XN-1000. Biochem Med (Zagreb) 2024; 34:020802. [PMID: 38665873 PMCID: PMC11042561 DOI: 10.11613/bm.2024.020802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 12/29/2023] [Indexed: 04/28/2024] Open
Abstract
We present two cases from the neonatal department with cerebrospinal fluid examination. We revealed a striking discrepancy in polymorphonuclear (PMN) and mononuclear (MN) cell counts using conventional light microscopy in comparison with automated analyzer Sysmex XN-1000 (PMNs - 13 vs. 173x106/L, MNs - 200 vs. 67x106/L in case 1 and PMNs - 13 vs. 372x106/L, MNs - 411 vs. 179x106/L in case 2). We revealed the dominant presence of hemosiderophages in both cases in cytospin slide. Even though Sysmex XN-1000 offers fast examination with a low sample volume, there is possibility of misdiagnosis, with negative impact on the patient.
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Affiliation(s)
- Pavel Broz
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Simona Kukralova
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jana Palatova
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Klara Kolduskova
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Jana Zenkova
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
| | - Daniel Rajdl
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Jaroslav Racek
- Institute of Clinical Biochemistry and Haematology, University Hospital in Pilsen, Pilsen, Czech Republic
- Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
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Yoon S, Kim HR. Analytical performance of the digital morphology analyzer Sysmex DI-60 for body fluid cell differential counts. PLoS One 2023; 18:e0288551. [PMID: 37498851 PMCID: PMC10374087 DOI: 10.1371/journal.pone.0288551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 06/29/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Sysmex DI-60 (Sysmex, Kobe, Japan) is a digital morphology (DM) analyzer widely used in clinical laboratories and supports body fluid (BF) applications. We evaluated analytical performance of DI-60 compared with XN-350 (Sysmex) and manual counting for BF cell differential counts. METHODS A total of 213 BF samples were collected (47 cerebrospinal fluid [CSF], 80 pleural fluid, and 86 ascites samples). The analytical performance of DI-60 for BF cell differential counts was evaluated based on sensitivity, specificity, accuracy, and agreement. BF cell differential counts obtained by DI-60 were compared with those obtained by XN-350 and manual counting. RESULTS The overall sensitivity was high for neutrophils, lymphocytes, and macrophages (range, 83.1-99.4%). The overall specificity and overall accuracy were high for all cell types (range, 95.3-99.7% and 94.3-99.3%, respectively). The agreement between DI-60 pre-classification and verification was strong (κ = 0.89). The absolute mean differences between DI-60 verification and XN-350 ranged from 0.26 to 11.05, and differences between DI-60 verification and manual counting ranged from 0.01 to 4.76. CONCLUSIONS This is the first study to evaluate the performance of DI-60 compared with XN-350 and manual counting for BF cell differential counts. DI-60 showed reliable performance with CSF, pleural fluid, and ascites samples. For BF cell differential counts, DI-60 may be a better option than XN-350 and could be used for screening purposes in understaffed laboratories. To improve the hematology workflow for BF cell differential counting, the DM analyzer needs to be optimized by taking into account the laboratory situation and unmet needs, and the clinical laboratory needs to establish criteria for verification and manual slide review.
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Affiliation(s)
- Sumi Yoon
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Hye Ryoun Kim
- Department of Laboratory Medicine, Chung-Ang University College of Medicine, Seoul, Republic of Korea
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3
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Frater JL, Shirai CL, Brestoff JR. Technological features of blast identification in the cerebrospinal fluid: A systematic review of flow cytometry and laboratory haematology methods. Int J Lab Hematol 2022; 44 Suppl 1:45-53. [PMID: 35785436 PMCID: PMC9463081 DOI: 10.1111/ijlh.13869] [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: 03/06/2022] [Accepted: 04/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Involvement of the central nervous system (CNS) by acute leukemias (ALs) has important implications for risk stratification and disease outcome. The clinical laboratory plays an essential role in assessment of cerebrospinal fluid (CSF) specimens from patients with ALs at initial diagnosis, at the end of treatment, and when CNS involvement is clinically suspected. The two challenges for the laboratory are 1) to accurately provide a cell count of the CSF and 2) to successfully distinguish blasts from other cell types. These tasks are classically performed using manual techniques, which suffer from suboptimal turnaround time, imprecision, and inconsistent inter-operator performance. Technological innovations in flow cytometry and hematology analyzer technology have provided useful complements and/or alternatives to conventional manual techniques. AIMS We performed a PRISMA-compliant systematic review to address the medical literature regarding the development and current state of the art of CSF blast identification using flow cytometry and laboratory hematology technologies. MATERIALS AND METHODS We searched the peer reviewed medical literature using MEDLINE (PubMed interface), Web of Science, and Embase using the keywords "CSF or cerebrospinal" AND "blasts(s)". RESULTS 108 articles were suitable for inclusion in our systematic review. These articles covered 1) clinical rationale for CSF blast identification; 2) morphology-based CSF blast identification; 3) the role of flow cytometry; 4) use of hematology analyzers for CSF blast identification; and 5) quality issues. 9 /L, which is much lower than the original machine count and platelet transfusion was warranted. DISCUSSION 1) Clinical laboratory testing plays a central role in risk stratification and clinical management of patients with acute leukemias, most clearly in pediatric ALs; 2) studies focused on other patient populations, including adults and patients with AML are less prevalent in the literature; 3) improvements in instrumentation may provide better performance for the classification of CSF specimens. CONCLUSION Current challenges include: 1) more precisely characterizing the natural history of AL involvement of the CNS, 2) improvements in automated cell count technology of low cellularity specimens, 3) defining the role of flow MRD testing of CSF specimens and 4) improved recognition of specimen quality by clinicians and laboratory personnel.
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Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Cara Lunn Shirai
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jonathan R Brestoff
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
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Seghezzi M, Previtali G, Moioli V, Alessio MG, Guerra G, Buoro S. Performance evaluation of automated cell counts compared with reference methods for body fluid analysis. Diagnosis (Berl) 2021; 9:369-378. [PMID: 34599561 DOI: 10.1515/dx-2021-0088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/10/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Cellular analysis of body fluids (BFs) can assist clinicians for the diagnosis of many medical conditions. The aim of this work is the evaluation of the analytical performance of the UF-5000 body fluid mode (UF-BF) analyzer compared to the gold standard method (optical microscopy, OM) and to XN-1000 (XN-BF), another analyzer produced by the same manufacturer (Sysmex) and with a similar technology for BF analysis. METHODS One hundred BF samples collected in K3EDTA tubes were analyzed by UF-BF, XN-BF and OM. The agreement was evaluated using Passing and Bablok regression and Bland-Altman plot analysis. The receiver operating characteristic (ROC) curves were selected for evaluating the diagnostic agreement between OM classification and UF-BF parameters. RESULTS Comparison between UF-BF and OM, in all BF types, showed Passing and Bablok's slope comprised between 0.99 (polymorphonuclear cells count, PMN-BF) and 1.39 (mononuclear cells count, MN-BF), the intercepts ranged between 26.47 (PMN-BF parameter) and 226.80 (white blood cell count). Bland-Altman bias was comprised between 7.3% (total cell count, TC-BF) and 52.9% (MN-BF). Comparison between UF-BF and XN-BF in all BF showed slopes ranged between 1.07 (TC-BF and PMN-BF) and 1.16 (MN-BF), intercepts ranged between 8.30 (PMN) and 64.78 (WBC-BF). Bland-Altman bias ranged between 5.8 (TC-BF) and 21.1% (MN-BF). The ROC curve analysis showed an area under the curve ranged between 0.9664 and 1.000. CONCLUSIONS UF-BF shows very good performance for the differential counts of cells in ascitic, pleural and synovial fluids and therefore it is useful to screen and count cells in this type of BF.
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Affiliation(s)
- Michela Seghezzi
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Giovanni Guerra
- Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Sabrina Buoro
- Regional Reference Center for the Quality of Laboratory Medicine Services, Milan, Italy
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Lu Q, Chu K, Dou H, Smith ZJ. A sample-preparation-free, automated, sample-to-answer system for cell counting in human body fluids. Anal Bioanal Chem 2021; 413:5025-5035. [PMID: 34170346 DOI: 10.1007/s00216-021-03466-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/03/2021] [Accepted: 06/08/2021] [Indexed: 10/21/2022]
Abstract
While many clinical laboratory tests are now highly automated, body fluid cell counting, particularly in low-cellularity samples such as cerebral spinal fluid (CSF), is often performed manually. Here, we report a simple, cost-effective method to obtain white and red blood cell counts from human body fluids such as CSF. The method consists of a compact, automated, and low-cost fluorescence microscope system, coupled to a sample chamber containing all of the necessary reagents in dry form to stain and prepare the sample. Sample focus and scanning are handled automatically, and the acquired multimodal images are automatically analyzed to extract cell counts. Comparison with manual counting on over 200 clinical samples shows excellent agreement. As the system counts a substantially larger image region than a standard manual cell count, we find our sensitivity to extremely low cellularity samples to potentially be higher than the manual gold standard, evidenced by our system recording images of cells in samples whose cell count was registered as "0" by a trained user. Thus, our system holds promise for routine, automated, and sensitive analysis of body fluids whose cellularity extends across a wide dynamic range.
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Affiliation(s)
- Qiang Lu
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230027, Anhui, China
| | - Kaiqin Chu
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230027, Anhui, China.,Hefei National Laboratory for Physical Sciences at the Microscale, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230027, Anhui, China
| | - Hu Dou
- Department of Clinical Laboratory, Ministry of Education Key Laboratory of Child Development and Disorders, Key Laboratory of Pediatrics in Chongqing, Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan 2nd Road, Chongqing, 400014, China.
| | - Zachary J Smith
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, 96 Jinzhai Road, Hefei, 230027, Anhui, China.
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Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices-A Critical Appraisal. Cells 2021; 10:cells10051232. [PMID: 34069775 PMCID: PMC8157290 DOI: 10.3390/cells10051232] [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: 03/27/2021] [Revised: 05/09/2021] [Accepted: 05/10/2021] [Indexed: 11/16/2022] Open
Abstract
The analysis of cells in the cerebrospinal fluid (CSF) is a routine procedure that is usually performed manually using the Fuchs–Rosenthal chamber and cell microscopy for cell counting and differentiation. In order to reduce the requirement for manual assessment, automated analyses by devices mainly used for blood cell analysis have been also used for CSF samples. Here, we summarize the current state of investigations using these automated devices and critically review their limitations. Despite technical improvements, the lower limit for reliable leukocyte counts in the CSF is still at approximately 20 cells/µL, to be validated depending on the device. Since the critical range for clinical decisions is in the range of 5–30 cells/µL this implies that cell numbers < 30/µL require a manual confirmation. Moreover, the lower limit of reliable erythrocyte detection by automated devices is at approximately 1000/µL. However, even low erythrocyte numbers may be of clinical importance. In contrast, heavily hemorrhagic samples from neurosurgery may be counted automatically at an acceptable precision more quickly. Finally, cell differentiation by automated devices provides only a rough orientation for lymphocytes, granulocytes and monocytes. Other diagnostically important cell types such as tumor cells, siderophages, blasts and others are not reliably detected. Thus, although the automation may give a gross estimate sufficient for the emergency room situation, each CSF requires a manual microscopy for cytological evaluation for the final report. In conclusion, although automated analysis of CSF cells may provide a first orientation of the cell profile in an individual sample, an additional manual cell count and a microscopic cytology are still required and represent the gold standard.
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Alcaide Martín MJ, Altimira Queral L, Sahuquillo Frías L, Valiña Amado L, Merino A, García de Guadiana-Romualdo L. Automated cell count in body fluids: a review. ADVANCES IN LABORATORY MEDICINE 2021; 2:149-177. [PMID: 37363326 PMCID: PMC10197423 DOI: 10.1515/almed-2021-0011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/21/2020] [Indexed: 06/28/2023]
Abstract
Body fluid cell counting provides valuable information for the diagnosis and treatment of a variety of conditions. Chamber cell count and cellularity analysis by optical microscopy are considered the gold-standard method for cell counting. However, this method has a long turnaround time and limited reproducibility, and requires highly-trained personnel. In the recent decades, specific modes have been developed for the analysis of body fluids. These modes, which perform automated cell counting, are incorporated into hemocytometers and urine analyzers. These innovations have been rapidly incorporated into routine laboratory practice. At present, a variety of analyzers are available that enable automated cell counting for body fluids. Nevertheless, these analyzers have some limitations and can only be operated by highly-qualified laboratory professionals. In this review, we provide an overview of the most relevant automated cell counters currently available for body fluids, the interpretation of the parameters measured by these analyzers, their main analytical features, and the role of optical microscopy as automated cell counters gain ground.
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Affiliation(s)
- María José Alcaide Martín
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
- Hematologic Biology Committee, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Altimira Queral
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Sahuquillo Frías
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Laura Valiña Amado
- Committee of Laboratory Tests, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
| | - Anna Merino
- Hematologic Biology Committee, Spanish Society of Laboratory Medicine (SEQC-ML), Barcelona, Spain
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Lee J, Cho Y, Kim HS, Kang HJ, Kim M, Lee YK. A comparison of the analysis of 3 types of body fluids using the XN-350 hematology analyzer versus light microscopy assessment. Medicine (Baltimore) 2021; 100:e24852. [PMID: 33725957 PMCID: PMC7982217 DOI: 10.1097/md.0000000000024852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 01/26/2021] [Indexed: 01/05/2023] Open
Abstract
We evaluated the capacity of the XN-350 instrument to analyze 3 different types of body fluid samples under "body fluid mode."The performance of XN-350 was evaluated in terms of precision, carryover, limit of blank, limit of detection, limit of quantification, and linearity. Cell enumeration and differential data produced by the XN-350 were compared to manual chamber counting results in 63 cerebrospinal fluid (CSF), 51 ascitic fluid, and 51 pleural fluid (PF) samples. Comparisons between XN-350 versus Cytospin data were also performed in PF samples.The precision, carry-over, limit of blank, and linearity of the XN-350 were acceptable. The limits of detection for white blood cells (WBCs) and red blood cells were 1.0/μL, and 1,000.0/μL, respectively; the corresponding limits of quantitation (LOQs) were 5.0/μL and 2,000.0/μL, respectively. The XN-350's cell enumeration and differential counting correlated well with those of manual chamber counting for all 3 sample types (except for differential counting in CSF samples), particularly parameters involving monocytes (r = 0.33) and mononuclear cells (MO- body fluid [BF]; r = 0.26), as well as total cell (TC-BF) enumeration (r = 0.50) and WBC-BF (r = 0.50) in PF samples. The MO-BF in CSF samples differed significantly from manual chamber counting results, but neither TC-BF nor WBC-BF in PF samples did. The XN-350 also showed good correlations with Cytospin analyses for differential counting of neutrophils, lymphocytes, and monocytes in PF samples. The differential counting of eosinophils via the XN-350 and Cytospin were not significantly correlated, but the difference between them was not significant.The XN-350 is an acceptable alternative to manual fluid analysis. Samples with low cellularity around the LOQ should be checked manually. Moreover, manual differential counting should be performed on CSF samples, particularity those with low cell numbers.
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Chun S, Phan MTT, Hong S, Yang J, Yoon Y, Han S, Kang J, Yazer MH, Kim J, Cho D. Double-filtered leukoreduction as a method for risk reduction of transfusion-associated graft-versus-host disease. PLoS One 2020; 15:e0229724. [PMID: 32214402 PMCID: PMC7098637 DOI: 10.1371/journal.pone.0229724] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 02/13/2020] [Indexed: 11/20/2022] Open
Abstract
Background Transfusion-associated graft-versus-host disease (TA-GvHD) is caused by leukocytes, specifically T cells within a transfused blood product. Currently, the prevention of transfusion-associated graft-versus-host disease is performed by irradiation of blood products. With a sufficient reduction of leukocytes, the risk for TA-GvHD can be decreased. With consistent advances in current state-of-the-art blood filters, we herein propose that double filtration can sufficiently reduce leukocytes to reduce the risk for TA-GvHD. Materials Thirty RBC concentrates were filtered with leukocyte filters, followed by storage at 1–6 oC for 72 hours, and then a second filtration was performed. Residual leukocytes in the double-filtered RBC units (n = 30) were assessed with flow cytometric methods, and an additional assay with isolated peripheral blood mononuclear cells (PBMCs) (n = 6) was done by both flow cytometric methods and an automated hematology analyzer. Quality of the RBCs after filtration was evaluated by hematological and biochemical tests. In vitro T cell expansion was performed using anti-CD3/CD28-coated Dynabeads or anti-CD3 (OKT3). In vivo experiment for GvHD was performed by using NOD.Cg-Prkdcscid Il2rgtm1Wjl/SzJ (NSG) mice. Results Double-filtered blood products showed residual leukocyte levels below detection limits, which calculated to be below 1200–2500 cells per blood unit. In vitro expansion rate of T cells showed that 6x103 and 1x103 cell-seeded specimens showed 60.8±10.6 fold and 10.2±9.7-fold expansion, respectively. Cell expansion was not sufficiently observed in wells planted with 1x102 or 10 cells. In vivo experiments showed that mice injected with 1x105 or more cells cause fatal GvHD. GvHD induced inflammation was observed in mice injected with 1x104 or more cells. No evidence of GvHD was found in mice injected with 103 cells. Conclusions Our study suggests that additional removal of contaminating lymphocytes by a second leukodepletion step may further reduce the risk for TA-GvHD.
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Affiliation(s)
- Sejong Chun
- Department of Laboratory Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea
| | - Minh-Trang Thi Phan
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Saetbyul Hong
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Jehoon Yang
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
| | - Yeup Yoon
- Animal Research and Molecular Imaging Center, Samsung Medical Center, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
| | - Sangbin Han
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jungwon Kang
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Jaehyun Kim
- Blood Transfusion Research Institute, Korean Red Cross, Wonju, Korea
- * E-mail: (DC); (JK)
| | - Duck Cho
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunwan University School of Medicine, Seoul, Korea
- Samsung Advanced Institute for Health Sciences & Technology, Sungkyunwan University School of Medicine, Seoul, Korea
- * E-mail: (DC); (JK)
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Favresse J, Boland L, Schellen M, Fervaille C, Wuestenberghs F, Camboni A, Chatelain B, Mullier F, Defour JP, Jacqmin H. Two-site evaluation of a new workflow for the detection of malignant cells on the Sysmex XN-1000 body fluid analyzer. Int J Lab Hematol 2020; 42:544-551. [PMID: 32163671 DOI: 10.1111/ijlh.13187] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 02/12/2020] [Accepted: 02/23/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION The presence of high fluorescent cells (HF-BF) on the Sysmex XN-1000 hematology analyzers has gained interest regarding the prediction of malignant cells in body fluids, but lacks sensitivity. We aimed to increase this sensitivity by combining HF-BF value, automated results, and clinical information. METHODS We evaluated a new workflow for the management of body fluids in the hematology laboratory, including the HF-BF criterion and clinical information. In two laboratories, 1623 serous fluids were retrospectively analyzed on the XN-1000 BF mode. All samples were morphologically screened for malignant cells. Optimal HF-BF cutoffs were determined to predict their presence. Thereafter, the added value of clinical information was evaluated. Other reflex testing rules (eosinophilic count >5% and presence of the WBC Abnormal Scattergram flag) were also used to refine our workflow. RESULTS Optimal HF-BF cutoffs in the two hematology centers were 108 and 45 cells/µL, yielding a sensitivity/specificity of 66.7/93.6% and 86.8/66.6% for malignant cell detection. When adding clinical information, sensitivity/specificity evolved to 100.0/68.9% and 100.0%/not determined. Of 104 samples containing malignant cells, 97 had positive clinical information; the remainder had a HF-BF > cutoff. CONCLUSION Combining clinical information and HF-BF reached 100% sensitivity for malignant cell detection in body fluid analysis. Lack of robustness of the optimal HF-BF cutoff deserves the use of local cutoffs. Rapid automated results reporting from the XN-1000 BF mode are also feasible in clinical practice. Prospective evaluation of the workflow is needed before its implementation in clinical practice.
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Affiliation(s)
- Julien Favresse
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - Lidvine Boland
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Marie Schellen
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Caroline Fervaille
- Pathology Department, CHU UCL Namur, Université catholique de Louvain, Yvoir, Belgium
| | - Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Godinne University Hospital, UCLouvain, Yvoir, Belgium
| | - Alessandra Camboni
- Pathology Department, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium
| | - Bernard Chatelain
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - François Mullier
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
| | - Jean-Philippe Defour
- Hematology Laboratory, Department of Laboratory Medicine, St-Luc University Hospital and catholic University of Louvain, Brussels, Belgium.,Ludwig Cancer Research and de Duve Institute, Université catholique de Louvain, Brussels, Belgium
| | - Hugues Jacqmin
- CHU UCL Namur, Namur Thrombosis and Hemostasis Center, Hematology Laboratory, Université catholique de Louvain, Yvoir, Belgium
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Favresse J, Fervaille C, Wuestenberghs F, Chatelain B, Mullier F, Jacqmin H. Utility of the XN‐1000 research mode for leukocytes counting in ascitic and pleural fluids. Int J Lab Hematol 2019; 42:e92-e95. [DOI: 10.1111/ijlh.13128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/29/2019] [Accepted: 11/04/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Julien Favresse
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Caroline Fervaille
- Pathology Department Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Bernard Chatelain
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - François Mullier
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
| | - Hugues Jacqmin
- Hematology Laboratory Namur Thrombosis and Hemostasis Center Université catholique de Louvain CHU UCL Namur Yvoir Belgium
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12
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Petersson A, Ekblom K. Evaluation of a routine hematology analyzer for quality control of leukoreduced plasma. Transfusion 2019; 59:3214-3218. [PMID: 31400008 DOI: 10.1111/trf.15481] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 06/13/2019] [Accepted: 07/10/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Quality control of residual white blood cells (WBCs) and red blood cells (RBCs) in leukoreduced plasma is mandatory. Although technological advances have been made, analysis of quality controls using routine hematology analyzers has not generally been introduced. The aim of this study was to evaluate if the routine hematology analyzer Sysmex XN-10, (Sysmex Nordic ApS) could be used for quality control of residual WBCs and RBCs in leukoreduced plasma. STUDY DESIGN AND METHODS Linearity, accuracy, and precision were established for two Sysmex XN-10 analyzers using spiked donor plasma. ADAM rWBC (NanoEnTek) and manual counting in the Bürker chamber (NanoEnTek) were reference methods for WBCs and RBCs, respectively. Twenty-five consecutive leukoreduced donor plasma samples were also tested. RESULTS For WBCs, the linearity criteria were met for the ADAM rWBC, but not for the Sysmex XN-10 instruments. Precision on both Sysmex XN-10 instruments was accurate only at 6 cells/μL, and accuracy was consistently acceptable only at 5 to 6 cells/μL. The precision and accuracy of the ADAM rWBC were acceptable at 2 to 6 cells/μL. For RBCs, both Sysmex XN-10 instruments and manual counting in the Bürker chamber were linear and fulfilled the precision criteria. Accuracy was acceptable for both Sysmex instruments at 6 to 12 × 109 WBCs/L but fluctuated within the study's measuring range for the Bürker chamber. No false-positive results were seen in the 25 consecutive donor plasma samples tested. CONCLUSION For quality control purposes of leukoreduced plasma, the Sysmex XN-10 analyzer is suitable for the enumeration of residual RBCs but not of residual WBCs.
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Affiliation(s)
- Annika Petersson
- Clinical Chemistry and Transfusion Medicine, Växjö Central Hospital, Växjö, Sweden
| | - Kim Ekblom
- Department of Research and Development, Region Kronoberg, Växjö, Sweden.,Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Shen Y, Cao J, Zhou Z, Wang Y, Shen Y, He J. Clinical performance evaluation of the new hematology analyzer Mindray BC‐6000. Int J Lab Hematol 2019; 41:622-634. [PMID: 31286670 DOI: 10.1111/ijlh.13075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 05/23/2019] [Accepted: 05/28/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Yimin Shen
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
| | - Jun Cao
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
| | - Zhiying Zhou
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
| | - Yong Wang
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
| | - Yili Shen
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
| | - Jun He
- Department of Laboratory Medicine The First Affiliated Hospital of Soochow University Suzhou China
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14
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Buoro S, Seghezzi M, Baigorria Vaca MDC, Manenti B, Moioli V, Previtali G, Simon C, Cugola D, Brucato A, Ottomano C, Lippi G. Comparison between optical microscopy and automation for cytometric analysis of pericardial fluids in a cohort of adult subjects undergoing cardiac surgery. J Clin Pathol 2019; 72:493-500. [DOI: 10.1136/jclinpath-2019-205788] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 03/28/2019] [Accepted: 03/28/2019] [Indexed: 01/04/2023]
Abstract
AimsLimited information is available on number and type of cells present in the pericardial fluid (PF). Current evidence and has been garnered with inaccurate application of guidelines for analysis of body fluids. This study was aimed at investigating the performance of automate cytometric analysis of PF in adult subjects.MethodsSeventy-four consecutive PF samples were analysed with Sysmex XN with a module for body fluid analysis (XN-BF) and optical microscopy (OM). The study also encompassed the assessment of limit of blank, limit of detection and limit of quantitation (LoQ), imprecision, carryover and linearity of XN-BF module.ResultsXN-BF parameters were compared with OM for the following cell classes: total cells (TC), leucocytes (white blood cell [WBC]), polymorphonuclear (PMN) and mononuclear (MN) cells. The relative bias were −4.5%, 71.2%, 108.2% and −47.7%, respectively. Passing and Bablok regression yielded slope comprised between 0.06 for MN and 5.8 for PMN, and intercept between 0.7 for PMN and 220.3 for MN. LoQ was comprised between 3.8×106 and 6.0×106 cells/L for WBC and PMN. Linearity was acceptable and carryover negligible.ConclusionsPF has a specific cellular composition. Overall, automated cell counting can only be suggested for total number of cells, whereas OM seems still the most reliable option for cell differentiation.
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Buoro S, Seghezzi M, Dominoni P, Moioli V, Manenti B, Previtali G, Ottomano C, Lippi G. Lack of harmonization in high fluorescent cell automated counts with body fluids mode in ascitic, pleural, synovial, and cerebrospinal fluids. Int J Lab Hematol 2019; 41:277-286. [PMID: 30758900 DOI: 10.1111/ijlh.12968] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 11/28/2018] [Accepted: 12/12/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Cellular analysis in body fluids (BFs) provides important diagnostic information in various pathological settings. This study was hence aimed at comparing automated cell count obtained with Mindray BC-6800 (BC-BF) vs Sysmex XN-series (XN-BF) and evaluating other quantitative and qualitative information provided by these analyzers in ascitic (AF), pleural (PF), synovial (SF), and cerebrospinal (CSF) fluids. METHODS Three hundred and fifty-one samples (99 AFs, 45 PFs, 75 SFs, and 132 CSFs) were analyzed in parallel with BC-BF, XN-BF, and optical microscopy (OM). The study also included the assessment of diagnostic agreement among BC-BF, XN-BF, and OM. RESULTS The comparison of BC-BF vs XN-BF yielded slopes of Passing and Bablok regression always comprised between 0.9 and 1.0 except for EO-BF and HF-BF, whilst the intercepts ranged from -0.4 for MN-BF and 12.0 for PMN-BF. The bias was comprised between -103.3% and 67.1% for HF-BF and EO-BF, respectively. A significant bias was found for TC-BF, WBC-BF, HF-BF (negative bias) and for PMN-BF and EO-BF (positive bias). The agreement (Cohen's kappa) between XN-BF and BC-BF was always ≥0.7, ranging between 0.87 in CSFs and 0.94 in AFs, and that with OM was similar (ie, 0.85 and 0.96). CONCLUSION The cytometric analysis of BF samples using BC-BF and XN-BF is clinically favorable when appropriately combined with OM. Quantitative and qualitative parameters displayed optimal agreement, whilst instrument-specific cut-offs should be defined and implemented for HF-BF and EO-BF. Further efforts should be made for achieving better harmonization in cytometric analysis of BF samples.
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Affiliation(s)
- Sabrina Buoro
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Michela Seghezzi
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Paola Dominoni
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Valentina Moioli
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Barbara Manenti
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Giulia Previtali
- Clinical Chemistry Laboratory, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
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Favresse J, van Dievoet MA, De Wolf H, Rodriguez-Villalobos H, Defour JP. Characterization of Candida
spp. interference on the Sysmex XN-1000 body fluid mode. Int J Lab Hematol 2018; 40:e28-e32. [DOI: 10.1111/ijlh.12780] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/10/2018] [Indexed: 11/29/2022]
Affiliation(s)
- J. Favresse
- Department of Laboratory Hematology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - M.-A. van Dievoet
- Department of Laboratory Hematology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - H. De Wolf
- Department of Laboratory Hematology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - H. Rodriguez-Villalobos
- Department of Laboratory Hematology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
- Department of Microbiology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
| | - J.-P. Defour
- Department of Laboratory Hematology; Cliniques Universitaires Saint-Luc; Université catholique de Louvain; Brussels Belgium
- Ludwig Cancer Research and de Duve Institute; Université catholique de Louvain; Brussels Belgium
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