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

Performance evaluation of a novel platelet count parameter, hybrid platelet count, on the BC-780 automated hematology analyzer

OBJECTIVES

Automated hematology analysis is expected to improve the performance of platelet counting. We evaluated the performance of a new platelet counting, hybrid (PLT-H) and also impedance (PLT-I) and optical (PLT-O) on the BC-780 automated hematology analyzer compared to the international reference method (IRM) in blood samples with thrombocytopenic and platelet interference.

METHODS

The basic platelet count performance of the BC-780 automated hematology analyzer was evaluated according to the requirements of the Clinical Laboratory and Standards Institute (CLSI) Document H26-A2. Additionally, the thrombocytopenic (low PLT count) blood samples and the platelet interference blood samples including fragmented red blood cells (RBCs), microcytes or small RBCs, and giant platelets were determined with the BC-780 hematology analyzer compared to the IRM.

RESULTS

Blank counting and the carry-over contamination rate of platelet count using the BC-780 both met the manufacturers' claim. For both 123 thrombocytopenic and 232 platelet interference blood samples (72 fragmented RBCs, 91 microcytes and 51 giant platelets), all three platelet counting methods exhibited high comparability with the IRM (the lowest correlation (r)=0.916). Interestingly, the comparability of PLT-H (r=0.928-0.986) with the IRM was better than that of PLT-I (r=0.916-0.979).

CONCLUSIONS

The performance of PLT-H in the BC-780 met the manufacturer's specifications. PLT-H exhibits better reproducibility than did PLT-I, correlates well with the PLT-O for thrombocytopenic samples and demonstrates good anti-interference ability. PLT-H counting is therefore recommended as a zero-cost alternative platelet counting method for platelet interference samples in clinical settings.

Performance evaluation the new automated Atellica Hema 580 hematology analyzer

INTRODUCTION

The Atellica Hema (Siemens Healthineers, Tarrytown, NY, USA) is a new generation multi-parameter analyzer for full blood count, 6-part differential and reticulocyte testing by impedance variation and fluorescence flow cytometry. In this study, we verified the whole blood and limited body fluid modes of the Atellica Hema 580.

METHODS

We evaluated precision, linearity, carry-over, throughput and performed a method comparison to assess the performance of the Atellica Hema 580. For comparison of the Atellica Hema 580 with the Sysmex XN-1000 (Sysmex, Kobe, Japan), 140 samples from adult and pediatric patients including both normal and abnormal hematology profiles were analyzed in parallel.

RESULTS

The Atellica Hema 580 demonstrated acceptable imprecision within the manufacturer's specifications for whole blood and body fluid modes, good linearity for high and low ranges and no significant carryover. The full blood count, differential and reticulocyte correlated well with the Sysmex XN-1000, except for mean cell hemoglobin concentration, basophil and large immature cells. The optical platelet count, reflexed in 34 samples with a platelet count <150 × 109 /l, showed a strong correlation with the fluorescent platelet count on the Sysmex XN-1000. The morphology flagging efficiency was 92% for white blood cells, 95% for red blood cells and 87% for platelets.

CONCLUSION

The Atellica Hema 580 showed good analytical performance and workflow efficiency for a wide range of patient samples.

Performance of Platelet Counting in Thrombocytopenic Samples: Comparison between Mindray BC-6800Plus and Sysmex XN-9000

The performance of platelet (PLT) counting in thrombocytopenic samples is crucial for transfusion decisions. We compared PLT counting and its reproducibility between Mindray BC-6800Plus (BC-6800P, Mindray, Shenzhen, China) and Sysmex XN-9000 (XN, Sysmex, Kobe, Japan), especially focused on thrombocytopenic samples. We analyzed the correlation and agreement of PLT-I channels in both analyzers and BC-6800P PLT-O mode and XN PLT-F channel in 516 samples regarding PLT counts. Ten thrombocytopenic samples (≤2.0 × 10⁹/L by XN PLT-F) were measured 10 times to investigate the reproducibility with the desirable precision criterion, 7.6%. The correlation of BC-6800P PLT-I and XN PLT-I was arranged moderate to very high; but the correlation of BC-6800P PLT-O and XN PLT-F was arranged high to very high. Both BC-6800P PLT-I vs. XN PLT-I and BC-6800P PLT-O vs. XN PLT-F showed very good agreement (κ = 0.93 and κ = 0.94). In 41 discordant samples between BC-6800P PLT-O and XN PLT-F at transfusion thresholds, BC-6800P PLT-O showed higher PLT counts than XN-PLT-F, except the one case. BC-6800P PLT-O exceeded the precision criterion in one of 10 samples; but XN PLT-F exceeded it in six of 10 samples. BC-6800P would be a reliable option for PLT counting in thrombocytopenic samples with good reproducibility.

Analytical comparison between two automated biochemical analyzer systems: Roche Cobas 8000 and Mindray BS2000M

Summary Background. The values of biomarkers play a central role in routine clinical decision-making. Whereas, the performances of different automated chemical analyzers remain unclear. To determine the performances of different platforms, we evaluated the capability between Roche Cobas 8000 and Mindray BS2000M.  Methods. A total of 1869 remaining serum samples were collected. CK, LDH-1, RBP, Cys-c, IgA, IgM and IgG were assessed by using paired-t test, Passing-Bablok regression analysis and Bland Altman analysis according to CLSI EP5-A3. Results. There were significant in average bias of all items between two machines (P < 0.001). Due to the 95% confidence interval of intercept A included 0, CK, LDH-1, Cys-c and IgG were not show systemic error in Passing-Bablok regression analysis. Except for IgA, the r values and correlation coefficient of all items were higher than 0.91, which showed that the correlation and consistency is good. The Bland-Altman analysis showed that two instruments had more than 95% of the points apart from CK, LDH-1, and IgA. Conclusions. It can be considered that the two instruments have good correlation and consistency in CK, LDH-1, RBP, Cys-c, IgM and IgG, and the two instruments are interchangeable and can replace each other.

Alinity hq platelet results are equivalent with the international reference method in thrombocytopenic samples

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.

Performance evaluation of optical platelet counting of BC-6000Plus automated hematology analyzer

Background

The BC-6000Plus (Mindray, Shenzhen, China) is a recently developed hematology analyzer that utilizes fluorescent technology. Based on fluorescent nucleic acid stain and optical detection, the optical platelet counting (PLT-O) on the BC-6000Plus has strong anti-interference potential in platelet (PLT) detection. Its Auto 8×PLT-O Counting Tech can be automatically triggered in low-PLT samples, which enables the PLT-O on the BC-6000Plus to count low PLT more efficiently. Here, we evaluated the performance of the BC-6000Plus automated hematology analyzer in optical PLT counting.

Methods

The basic features (including blank counting, carryover, trueness, and accuracy) of the BC-6000Plus for PLT counting were evaluated according to the Analytical Quality Specifications for Routine Tests in Clinical Hematology (WST 406-2012). Low-PLT samples with a PLT count of below 100×10⁹/L were selected for repeatability tests. Meanwhile, the potential correlations of BC-6000Plus with the XN-L 350 and manual microscopy within different PLT ranges or under interferences of small red blood cells (RBCs) or PLT aggregation were analyzed.

Results

The PLT-O on BC-6000Plus met the technical requirements of PLT counting in terms of blank count, carryover, trueness, and accuracy. The repeatability of the enhanced mode (PLT-O 8×) on the BC-6000Plus was better than that of the XN-L 350 in three low PLT count ranges, including 10–20, 20–60, and 60–100 (×10⁹/L). Under the interference-free conditions, the BC-6000Plus correlated well with the XN-L 350 in different PLT counting ranges. Under the interferences of small RBCs and PLT aggregation, the PLT-O on BC-6000Plus correlated better with microscopy than with the platelet impedance count (PLT-I).

Conclusions

The PLT-O on BC-6000Plus can meet the technical requirements of PLT counting in terms of blank counting, carryover rate, trueness, and accuracy. The PLT-O 8× has good repeatability, correlates well with the XN-L 350, and demonstrates good anti-interference ability. It can thus meet the needs of blood cell analysis in clinical settings.

Pseudothrombocytopenia-A Review on Causes, Occurrence and Clinical Implications

Pseudothrombocytopenia (PTCP), a relative common finding in clinical laboratories, can lead to diagnostic errors, overtreatment, and further (even invasive) unnecessary testing. Clinical consequences with potential life-threatening events (e.g., unnecessary platelet transfusion, inappropriate treatment including splenectomy or corticosteroids) are still observed when PTCP is not readily detected. The phenomenon is even more complex when occurring with different anticoagulants. In this review we present a case of multi-anticoagulant PTCP, where we studied different parameters including temperature, amikacin supplementation, measurement methods, and type of anticoagulant. Prevalence, clinical risk factors, pre-analytical and analytical factors, along with clinical implications, will be discussed. The detection of an anticoagulant-dependent PTCP does not necessarily imply the presence of specific disorders. Conversely, the incidence of PTCP seems higher in patients receiving low molecular weight heparin, during hospitalization, or in men aged 50 years or older. New analytical technologies, such as fluorescence or optical platelet counting, will be soon overturning traditional algorithms and represent valuable diagnostic aids. A practical laboratory approach, based on current knowledge of PTCP, is finally proposed for overcoming spuriously low platelet counts.

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

INTRODUCTION

Accurate platelet counting is essential for risk assessment of bleeding and thrombosis. Abbott Alinity hq hematology analyzer was recently introduced, and its performance in platelet counting has yet to be evaluated comprehensively. In this study, we evaluated the performance of the optical platelet counting of Abbott Alinity hq (Alinity-PLT) and the impedance and fluorescent platelet counting of Sysmex XN-9000 (XN-PLT-I and XN-PLT-F) compared with the international reference method.

METHODS

Blood samples were analyzed via Alinity hq and XN-9000 with PLT-F channel. Immuno-platelet (ImmnoPLT) reference method was performed with CD41/CD61 antibodies using FACSLyric^TM flow cytometer (BD). Precision was determined using 10 replicates in a single run, and the platelet counts of Alinity-PLT, XN-PLT-I, XN-PLT-F, and ImmnoPLT were compared.

RESULTS

At a platelet count of 13 × 10⁹ /L, the CVs of Alinity-PLT, XN-PLT-I, and XN-PLT-F were 4.2%, 6.7%, and 4.3%, respectively, and at a platelet count of 44 × 10⁹ /L, all showed a CV of less than 3%. For the total 210 samples, all three methods showed a very strong correlation with ImmunoPLT (r > 0.99). For platelet levels below 20 × 10⁹ /L, XN-PLT-F showed the strongest correlation with ImmunoPLT (r = 0.975), and for platelet levels of 20-100 × 10⁹ /L, Alinity-PLT and XN-PLT-I were comparable to ImmunoPLT. For platelet levels of 100-450 × 10⁹ /L, XN-PLT-I was the most comparable to ImmunoPLT, and for platelet levels above 450 × 10⁹ /L, Alinity-PLT was comparable to ImmunoPLT.

CONCLUSIONS

All three methods were highly correlated with ImmunoPLT, and each method had different performance advantages according to the platelet levels.