scholarly journals Evaluation of the Flagging Performance of the Hematology Analyzer Sysmex XN Series on the Basis of “Q Values”

2017 ◽  
Vol 142 (1) ◽  
pp. 83-88 ◽  
Author(s):  
Oh Joo Kweon ◽  
Mi-Kyung Lee ◽  
Hye Ryoun Kim
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Q Value ◽  
Cell Counts ◽  
Related Cell ◽  
Hematology Analyzer ◽  
Abnormal Cells ◽  
Q Values ◽  
Hematology Analyzers

Context.— In the XN series of hematology analyzers (Sysmex, Kobe, Japan), the probability of the presence of abnormal cells is indicated by flags based on Q values. Objective.— To evaluate the Q value performance of the Sysmex XN-20 modular analyzer. Design.— The interinstrumental concordance, intrainstrumental precision, and diagnostic accuracy of Q values, with tested flags of “blasts/abnormal lymphocytes,” “atypical lymphocytes,” and “blasts,” were investigated. Results.— Absolute concordance rates in flagging between 2 analyzers ranged from 69.8% to 80.8%, and κ values ranged from 0.43 to 0.61. In samples with absolute related cell counts lower than 100/μL, the values ranged from 0.31 to 0.52. For intrainstrumental precision, standard deviations ranged from 4.8 to 23.9 for the blasts/abnormal lymphocytes, from 18.7 to 59.1 for the blasts, and from 11.0 to 23.0 for the atypical lymphocytes. Using a default Q value cutoff, diagnostic accuracy values based on the area under the curve, sensitivity, and specificity were, respectively, 0.910, 90.9%, and 72.2% for blasts/abnormal lymphocytes; 0.927, 84.9%, and 89.8% for blasts; and 0.865, 74.4%, and 84.9% for atypical lymphocytes. The diagnostic accuracy of Q values was much lower in samples with absolute related cell counts lower than 100/μL than in those 100/μL or higher. Conclusions.— Q values of the Sysmex XN-20 analyzer were found to be imprecise and irreproducible, especially with samples containing a small number of pathologic cells. Adjustments in the Q value threshold may help in the detection of these cells.

scholarly journals Minimal Hematology Analyzer Plus Blood Smear Digital Imaging/ Analysis Provides Better Clinical Hematology Results Than a Complex Hematology Analyzer Alone

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 4731-4731
Author(s):  
H. Elizabeth Broome ◽  
Han-Inge Bengtsson ◽  
Laura Stephens ◽  
Lisa Palm
Keyword(s):  
Blood Count ◽  
Blood Smear ◽  
Excellent Correlation ◽  
False Negatives ◽  
Employment Equity ◽  
Cell Counts ◽  
Hematology Analyzer ◽  
Abnormal Cells ◽  
Equity Ownership ◽  
Hematology Analyzers

Abstract Introduction: Devices such as the CellaVision® DM96 (CellaVision AB, Lund, Sweden) locate and image nucleated cells on blood smears. Using image recognition software, the DM96 also pre-classifies those cells into differential categories similar to the most complex hematology analyzers. We compared the cell counts, differential counts and flagging information gained from a complex hematology analyzer, the XE5000 (Sysmex, Kobe, Japan), with information from a minimal hematology analyzer (Sysmex PocHi) plus the DM96. We found that the cell counts, differential and flagging capabilities are similar, but the PocHi plus DM96 advantages include allowing remote review of the blood smear. Methods: 210 blood samples, selected for various abnormalities, had complete blood counts with automated differentials produced by a Sysmex XE5000 hematology analyzer. These results were compared with cell counts from the Sysmex PocHi hematology analyzer, their 100-cell DM96 post reclassification differentials, and with DM96 pre-classification differentials using standard regression analyses and Rumke 95% confidence intervals (CI) as calculated using the Clopper-Pearson method. Flagging by the XE5000 for immature granulocytes (IG's) and for blasts/abnormal cells was compared to the DM96 pre-classification using truth tables with the DM96 post reclassification as the gold standard. The following translations were used to compare flagging: IG's > 2 for either post reclassification DM96 differential, XE5000 or the DM96 pre-classification differential; Any blast cells on the manual differential were compared to XE5000 flags WBC Abn Scg; NRBC Abn Scg; Blasts?; Atyp LY?; Abn Ly/ L_Bl? and to DM96 pre-classification % Blasts > 0%; unidentified cells >3%. . Results: Non-differential blood count parameters including white blood count, red blood count, hemoglobin, mean corpuscular volume (MCV), and platelet count showed excellent correlation between the PocHi and the XE5000 with R2>0.95. Differential-dependent blood count parameters including neutrophils, lymphocytes, monocytes, eosinophils, basophils and immature granulocytes showed excellent correlation between the XE5000 and pre-classification DM96 with R2>0.95. Nucleated red cells also showed excellent correlation between the XE5000 and the DM96 with R2>0.85. For blasts/abnormal cells, the DM96 showed 100% sensitivity and 40% specificity with 0% false negatives. The XE5000 showed 93% sensitivity and 19% specificity with 3% false negative. Two of the false negatives were shared by both instruments and were 1% blasts. Of the three false negatives with the XE5000 that were true positives with the DM96, two had 1% blasts while one had 2% blasts. For immature granulocytes (IG's), the XE5000 showed 94% sensitivity and 79% specificity with 2% false negatives. The DM96 showed 85% sensitivity and 95% specificity with 4% false negatives. All of the false negatives were for IG's < 5% Conclusions: Pairing the DM96 or a similar imaging instrument with a relatively inexpensive hematology analyzer, such as those commonly used in physician office laboratories, would provide all of the information available from expensive, complex hematology analyzers in high throughput laboratories AND allow remote review of the blood smear findings by experts. Disclosures Broome: CellaVision: Consultancy, Research Funding. Bengtsson:CellaVision AB: Employment, Equity Ownership. Palm:CellaVision: Employment, Equity Ownership.

scholarly journals Comparison of the diagnostic accuracy of cone beam computed tomography and three intraoral radiographic systems in the diagnosis of carious lesions in vitro.

2020 ◽  
Vol 9 (6) ◽  
pp. 466-473
Author(s):  
Jorge A. Beltrán ◽  
◽  
Roberto A. León-Manco ◽  
Maria Eugenia Guerrero ◽  
◽  
...  
Keyword(s):  
Computed Tomography ◽  
Dental Caries ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Cone Beam Computed Tomography ◽  
Area Under The Curve ◽  
Cone Beam ◽  
Occlusal Surfaces ◽  
Caries Lesions

Objective: The objective of the study was to compare the diagnostic accuracy of cone beam computed tomography and three intraoral radiographic systems in the detection of in vitro caries lesions. Material and Methods: One hundred teeth (46 molars and 54 premolars) were evaluated, including 176 proximal surfaces and 90 occlusal surfaces, with or without dental caries lesions. Digital images of all teeth were obtained using specific intraoral radiographs, VistaScan DürrDental®phosphor-plate radiography, XIOS XG Sirona® digital sensor radiography, and CBCT I-CATTM. Observers evaluated the images for the detection of caries lesions. The teeth were clinically sectioned and stereomicroscopy served as a validation tool. The relationship of sensitivity and specificity between all systems was determined through the ROC curve using Az values. Results: The values of the area under the curve (Az) selected for the CBCT I-CATTM system were 0.89 (0.84-0.93), for conventional radiography 0.71 (0.66-0.76), digital sensor radiography 0.74 (0.70-0.78) and digital radiography with phosphor-plates 0.73 (0.69-0.77). Statistically significant differences were found between the CBCT I-CATTM system and intraoral radiographic systems (p<0.01). The sensitivity and specificity values for the CBCT I-CATTM were 0.84 and 0.93 respectively. Conclusion: CBCT has a high sensitivity and specificity compared to intraoral radiographic systems for the diagnosis of dental caries lesions in vitro.

scholarly journals Validation of ICMR Neurocognitive Toolbox for Dementia in the Linguistically Diverse Context of India

2021 ◽  
Vol 12 ◽  
Author(s):  
Mansi Verma ◽  
Manjari Tripathi ◽  
Ashima Nehra ◽  
Avanthi Paplikar ◽  
Feba Varghese ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Linguistic Diversity ◽  
Neuropsychological Test ◽  
Area Under The Curve ◽  
Cognitive Screening ◽  
Indian Languages ◽  
Middle Income ◽  
Significant Difference ◽  
Diagnosis Of Dementia

Objectives: The growing prevalence of dementia, especially in low- and middle-income countries (LMICs), has raised the need for a unified cognitive screening tool that can aid its early detection. The linguistically and educationally diverse population in India contributes to challenges in diagnosis. The present study aimed to assess the validity and diagnostic accuracy of the Indian Council of Medical Research-Neurocognitive Toolbox (ICMR-NCTB), a comprehensive neuropsychological test battery adapted in five languages, for the diagnosis of dementia.Methods: A multidisciplinary group of experts developed the ICMR-NCTB based on reviewing the existing tools and incorporation of culturally appropriate modifications. The finalized tests of the major cognitive domains of attention, executive functions, memory, language, and visuospatial skills were then adapted and translated into five Indian languages: Hindi, Bengali, Telugu, Kannada, and Malayalam. Three hundred fifty-four participants were recruited, including 222 controls and 132 dementia patients. The sensitivity and specificity of the adapted tests were established for the diagnosis of dementia.Results: A significant difference in the mean (median) performance scores between healthy controls and patients with dementia was observed on all tests of ICMR-NCTB. The area under the curve for majority of the tests included in the ICMR-NCTB ranged from 0.73 to 1.00, and the sensitivity and specificity of the ICMR-NCTB tests ranged from 70 to 100% and 70.7 to 100%, respectively, to identify dementia across all five languages.Conclusions: The ICMR-NCTB is a valid instrument to diagnose dementia across five Indian languages, with good diagnostic accuracy. The toolbox was effective in overcoming the challenge of linguistic diversity. The study has wide implications to address the problem of a high disease burden and low diagnostic rate of dementia in LMICs like India.

scholarly journals Alpha-Defensin versus Leukocyte Esterase in Periprosthetic Joint Infection: An Updated Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Zhizhuo Li ◽  
Qingyu Zhang ◽  
Lijun Shi ◽  
Fuqiang Gao ◽  
Wei Sun ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Periprosthetic Joint Infection ◽  
Data Extraction ◽  
Meta Analysis ◽  
Joint Infection ◽  
Area Under The Curve ◽  
Cochrane Library ◽  
Systematic Research ◽  
High Diagnostic Accuracy

Periprosthetic joint infection (PJI) is a devastating complication after arthroplasty. Prompt establishment of an infection diagnosis is critical but can be very challenging at present. In order to evaluate the diagnostic accuracy of alpha-defensin or leukocyte esterase for PJI, we performed systematic research in PubMed, Embase, and Cochrane Library to retrieve relevant studies. Data extraction and quality assessment were performed by two reviewers independently. A total of thirty-one eligible studies were finally included in the quantitative analysis. The pooled sensitivity and specificity of alpha-defensin (21 studies) for the diagnosis of PJI were 0.89 (95% confidence interval (CI), 0.83 to 0.93) and 0.96 (95% CI, 0.95 to 0.97), respectively. The value of the pooled diagnostic odds ratios (DOR) of alpha-defensin for PJI was 209.14 (95% CI, 97.31 to 449.50), and the area under the curve (AUC) was 0.98 (95% CI, 0.96 to 0.99). The pooled sensitivity and specificity of leukocyte esterase (17 studies) for the diagnosis of PJI were 0.90 (95% CI, 0.84 to 0.95) and 0.96 (95% CI, 0.93 to 0.97), respectively. The value of the DOR of leukocyte esterase for PJI was 203.23 (95% CI, 96.14 to 429.61), and the AUC was 0.98 (95% CI, 0.96 to 0.99). Based on the results of our meta-analysis, we can conclude that alpha-defensin and leukocyte esterase are valuable synovial fluid markers for identifying PJI with comparable high diagnostic accuracy.

scholarly journals Pleural Fluid Soluble Triggering Receptor Expressed on Myeloid Cells-1 in Complicated and Uncomplicated Parapneumonic Pleural Effusions

2011 ◽  
Vol 2011 ◽  
pp. 1-6
Author(s):  
Adel Salah Bediwy ◽  
Mohamed Gamal A. Elkholy ◽  
Mohamed Mohamed Elbedewy ◽  
Mohamed A. Hasanein
Keyword(s):  
Pleural Effusion ◽  
Diagnostic Accuracy ◽  
Pleural Fluid ◽  
Sensitivity And Specificity ◽  
Myeloid Cells ◽  
Area Under The Curve ◽  
Pleural Effusions ◽  
Cutoff Value ◽  
High Concentrations ◽  
Early Diagnose

Background. Soluble triggering receptor expressed on myeoid cells-1 (sTREM-1) has recently been found to be high in infected pleural fluid (PF). Objectives. Diagnostic accuracy of PF sTREM-1 for differentiating uncomplicated parapneumonic effusions (UPPEs) from complicated parapneumonic effusions (CPPEs) was evaluated prospectively. Methods. Serum and PF sTREM-1 were measured for 68 patients with parapneumonic and transudative pleural effusion. Results. PF (but not serum) sTREM-1 concentrations were significantly higher in CPPE than in UPPE. Serum and PF sTREM-1 levels were higher in parapneumonic than in transudative groups. PF sTREM-1 had a sensitivity of 85.19% and a specificity of 83.33% at cutoff value of 250.5 pg/mL for differentiating CPPE and UPPE with area under the curve (AUC) of 0.9336. After excluding purulent CPPE cases, sensitivity and specificity became 90.48% and 83.33%, respectively (at the same cutoff value) with AUC of 0.9444. Conclusion. High concentrations of PF sTREM-1 (above 250.5 pg/mL) help to early diagnose and differentiate CPPE from UPPE.

scholarly journals King-Devick Sensitivity and Specificity to Concussion in Collegiate Athletes

2021 ◽  
Author(s):  
Rachel K. Le ◽  
Justus D. Ortega ◽  
Sara P. D. Chrisman ◽  
Anthony P. Kontos ◽  
Thomas A. Buckley ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Collegiate Athletes ◽  
Return To Play ◽  
Cutoff Score ◽  
Confounding Factors ◽  
Post Injury ◽  
Cross Sectional ◽  
Cutoff Scores

Context: The King-Devick (K-D) is used to identify oculomotor impairment following concussion. However, the diagnostic accuracy of the K-D over time has not been evaluated. Objective: (a) Examine the sensitivity and specificity of the K-D test at 0–6 hours of injury, 24–48 hours, asymptomatic, return-to-play, and 6-months following concussion and (b) compare outcomes for differentiating athletes with a concussion from non-concussed across confounding factors (sex, age, contact level, school year, learning disorder, ADHD, concussion history, migraine history, administration mode). Design: Retrospective, cross-sectional design. Setting: Multisite institutions within the Concussion Assessment, Research, and Education (CARE) Consortium. Patients or Other Participants: 1239 total collegiate athletes without a concussion (age=20.31±1.18, male=52.2%) were compared to 320 athletes with a concussion (age=19.80±1.41, male=51.3%). Main Outcome Measure(s): We calculated K-D time difference (sec) by subtracting baseline from the most recent time. Receiver operator characteristics (ROC) and area under the curve (AUC) analyses were used to determine the diagnostic accuracy across timepoints. We identified cutoff scores and corresponding specificity at 80% and 70% sensitivity levels. We repeated ROC with AUC outcomes by confounding factors. Results: King-Devick predicted positive results at 0-6 hours (AUC=0.724, p&lt;0.001), 24-48 hours (AUC=0.701, p&lt;0.001), return-to-play (AUC=0.640, P&lt;0.001), and 6-months (AUC=0.615, P&lt;0.001), but not at asymptomatic (AUC=0.513, P=0.497). The 0–6 and 24–48-hour timepoints yielded an 80% sensitivity cutoff score of −2.6 and −3.2 seconds (faster) respectively, but 46% and 41% specificity. The K-D test had significantly better AUC when administered on an iPad (AUC=0.800, 95%CI:0.747,0.854) compared to the spiral card system (AUC=0.646, 95%CI:0.600,0.692; p&lt;0.001). Conclusions: The K-D test has the greatest diagnostic accuracy at 0–6 and 24–48 hours of concussion, but declines across subsequent post-injury timepoints. AUCs did not significantly differentiate between groups for confounding factors. Our negative cutoff scores indicate that practice effects contribute to improved performance, requiring athletes to outperform their baseline.

scholarly journals Comparison of diagnostic performance of Two-Question Screen and 15 depression screening instruments for older adults: Systematic review and meta-analysis

2017 ◽  
Vol 210 (4) ◽  
pp. 255-260 ◽  
Author(s):  
Kelvin K. F. Tsoi ◽  
Joyce Y. C. Chan ◽  
Hoyee W. Hirai ◽  
Samuel Y. S. Wong
Keyword(s):  
Older Adults ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Diagnostic Performance ◽  
Meta Analysis ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Area Under The Curve ◽  
Depression Screening ◽  
Screening Instruments

BackgroundScreening for depression in older adults is recommended.AimsTo evaluate the diagnostic accuracy of the Two-Question Screen for older adults and compare it with other screening instruments for depression.MethodWe undertook a literature search for studies assessing the diagnostic performance of depression screening instruments in older adults. Combined diagnostic accuracy including sensitivity and specificity were the primary outcomes. Potential risks of bias and the quality of studies were also assessed.ResultsA total of 46506 participants from 132 studies were identified evaluating 16 screening instruments. The majority of studies (63/132) used various versions of the Geriatric Depression Scale (GDS) and 6 used the Two-Question Screen. The combined sensitivity and specificity for the Two-Question Screen were 91.8% (95% CI 85.2–95.6) and 67.7% (95% CI 58.1–76.0), respectively; the diagnostic performance area under the curve (AUC) was 90%. The Two-Question Screen showed comparable performance with other instruments, including clinician-rated scales. The One-Question Screen showed the lowest diagnostic performance with an AUC of 78%. In subgroup analysis, the Two-Question Screen also had good diagnostic performance in screening for major depressive disorder.ConclusionsThe Two-Question Screen is a simple and short instrument for depression screening. Its diagnostic performance is comparable with other instruments and, therefore, it would be favourable to use it for older adult screening programmes.

scholarly journals Accuracy, Sensitivity, and Specificity of Different Tests to Detect Impaired Hand Function in Parkinson’s disease

2020 ◽  
Author(s):  
Cintia C. G. Alonso ◽  
Paulo Barbosa de Freitas ◽  
Raquel Pires ◽  
Dalton Lustosa de Oliveira ◽  
Sandra M. S. Ferreira de Freitas
Keyword(s):  
Parkinson’S Disease ◽  
Parkinson's Disease ◽  
Diagnostic Accuracy ◽  
Sensitivity And Specificity ◽  
Roc Analysis ◽  
Hand Function ◽  
Area Under The Curve ◽  
Maximum Power ◽  
Pinch Grip ◽  
Nine Hole Peg Test

AbstractIntroductionParkinson’s Disease (PD) can affect hand function. To examine the diagnostic accuracy, sensitivity, and specificity of four traditionally used hand function tests in individuals with PD by using the receiver operator characteristic (ROC) analysis.MethodsEighty individuals (24 with PD and 56 healthy controls) performed the Jebsen-Taylor Hand Function Test (JTHF, with seven subtests), Nine-Hole Peg Test, and maximum power and pinch grip strength tests. The outcomes of the tests were compared between groups. The values of the area under the curve from the ROC analysis assessed the diagnostic accuracy, sensitivity, and specificity of the tests.ResultsIndividuals with PD presented worst performance than controls in all tests, except the writing subtest of the JTHF and maximum power strength. Two subtests of the JTHF, the turning cards and moving large, heavy objects, showed the highest area under the curve in the ROC analysis. The Nine-Hole Peg Test was able to distinguish the PD stage and progression, while the simulated feeding of the JTHFT subtest showed a high area under the curve only for PD stage analysis.ConclusionTwo dexterity tasks (turning cards and moving large, heavy objects) were highly discriminative of the hand function impairments in individuals with PD. The Nine-Hole Peg Test provides the most accurate identification of the PD stage and progression based on hand function impairment. Different dexterity tasks should be used depending on the aims of the evaluation, whether for diagnosis, monitoring, or classification of the PD.

scholarly journals Evaluation of Xpert GBS assay and Xpert GBS LB assay for detection of Streptococcus agalactiae

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Meng-Yi Han ◽  
Chen Xie ◽  
Qing-Qing Huang ◽  
Qiao-Hua Wu ◽  
Qing-Yun Deng ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Publication Bias ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Neonatal Morbidity ◽  
High Sensitivity ◽  
Alternative Methods ◽  
Cochrane Library ◽  
Diagnostic Standards ◽  
Group B

Abstract Background Group B Streptococcal (GBS) infection is the primary agent of neonatal morbidity and mortality. Rapid and simple methods to detect GBS are Xpert GBS and GBS LB assays based on real-time polymerase chain reaction (PCR). However, since the diagnostic accuracy of the two techniques in diagnosing GBS remains unclear, we designed this study to appraise the diagnostic accuracy of the aforementioned. Methods A systematic search of all literature published before July 16, 2020 was conducted using Embase, PubMed, Web of Science, and Cochrane Library. The study quality was evaluated through Review Manager 5.3. Accordingly, data extracted in the included studies were analyzed using Meta-DiSc 1.4 and Stata 12.0 software. The diagnosis odds ratio (DOR) and bivariate boxplot were utilized to evaluate the heterogeneity. Publication bias was appraised by using Deeks’ funnel plot. Results A total of 13 studies were adopted and only 19 sets of data met the criteria. The sensitivity and specificity of Xpert GBS were 0.91 (95% CI 0.89–0.92) and 0.93 (95% CI 0.92–0.94). The area under the curve (AUC) was 0.9806. The sensitivity and specificity results of Xpert GBS LB were 0.96 (95% CI 0.95–0.98) and 0.94 (95% CI 0.92–0.95), respectively. The AUC was 0.9950. No publication bias was found. Conclusions The Xpert GBS and GBS LB assays are valuable alternative methods with high sensitivity and specificity. However, determining whether they can be used as clinical diagnostic standards for GBS is essential for the future.

WBC Differential by Flow Cytometry: The First Routine Application in a Large University Hospital Clinical Laboratory.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3845-3845
Author(s):  
Mikael Roussel ◽  
Cyrille Benard ◽  
Béatrice Ly Sunnaram ◽  
Danielle Gerard ◽  
Jean Feuillard ◽  
...  
Keyword(s):  
Flow Cytometry ◽  
White Blood Cells ◽  
Flow Cytometer ◽  
University Hospital ◽  
Inflammatory Monocytes ◽  
Cell Counts ◽  
Hematology Analyzer ◽  
Normal Procedure ◽  
Data Manager ◽  
Hematology Analyzers

Abstract Hematology analyzers deliver high precision blood cell counts and a good leukocyte differential (WBCD) on normal samples. But their ability to identify and quantify abnormal cells is less good and generates a significant amount of false positive results. Routinely, about 10% to 30% of results must have manual blood film reviews, which requires considerable time and are prone to a high degree of inaccuracy, especially for the less frequent cell types (Rümke et al. 1975). In contrast, flow cytometry offers superior detection and quantification of these rare events. A Cyto Diff tube combining six antibodies (CD45, 16, 2, 36, 19 & CRTH2) analysed on a modern multicolor flow cytometer make very accurate automated WBCD feasible for abnormal samples (Feuillard J et al. ISLH 2007). The objective of the study was to evaluate the efficiency of the Cyto Diff process compared to the normal laboratory process as: The time for both methods, the labor and time savings, the relative costs of both methods including med tech time, consumables, number of residual manual review. Two Coulter LH750® hematology analysers were used for the analysis of CBC, WBCD and Reticulocyte counting. An immuno-phenotyping system, with an automatic preparator Coulter FP 1000 and an Coulter FC 500® flow cytometer were connected with a Hematology analyzer to the REMISOL data manager that requests a reflex CytoDiff tube on every sample flagged by the hematology analyzer according to the laboratory’s validation rules. The remaining samples are displayed for manual validation by an operator. The complete line is called HematoFlow. Among the 4896 non-selected CBC tests evaluated during the 10 working days of our study, 877 cases were flagged by the analyzers, reviewed manually following the normal procedure as well as analyzed on HematoFlow. Interestingly, this latter allowed: 68.8% of auto-validation by the REMISOL Data Manager, 12.8% validation directly by the operator after checking the auto-gating, 8.4% required a region readjustment before validation and finally, only 10.3% (91 of the 877-flagged samples) required further exploration because the presence of large amount of ImmGrans, Plt clumps, NRBCs, etc. In conclusion, the CytoDiff tube performs well in regular clinical lab workflow saving almost 90% of the samples flagged by the hematology analyzers for WBC abnormalities that need further exploration following current routine procedure. Our study confirmed our previous results and the fact that the standard auto-gating is set correctly needing only 8.4% of region readjustment by an operator who can be trained easily in few days. Basically, we are expecting that one operator well-trained for smear review and working on the HematoFlow line can handle the same workload as at least 3 operators at microscope stations following a current normal procedure. Furthermore, the CytoDiff approach provides additional information concerning the white blood cells in pathological context never obtained previously by cytomorphology including the detection of likely pro-inflammatory monocytes, several blast subsets, and multiple lymphocyte sub populations as well.

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