Use of the reticulocyte channel warmed to 41 °C of the XN-9000 analyzer in samples with the presence of cold agglutinins

ABSTRACT Objectives The purpose of this study was to compare data obtained from the reticulocyte channel (RET channel) heated to 41 °C with those obtained from impedance channel (I-Channel) at room temperature in the samples with the mean corpuscular hemoglobin concentration (MCHC) < 370 g/L and in samples with the MCHC > 370 g/L, in the presence of cold agglutinins. Methods In this study, 60 blood samples (group 1) with the MCHC < 370 g/L (without cold agglutinins) and 78 blood samples (group 2) with the MCHC > 370 g/L (with cold agglutinins) were used to compare the two analytical channels of the XN-9000 analyzer in different preanalytical conditions. The parameters evaluated in both groups were the following: red blood cell (RBC), hemoglobin (HGB), hematocrit (HCT), mean cell volume (MCV), RBC-most frequent volume (R-MFV), mean hemoglobin concentration (MCH) and mean cellular hemoglobin concentration (MCHC). Results The results of this study showed an excellent correlation with both channels of the XN-9000 analyzer in samples with and without cold agglutinins, except for the MCHC. The bias between the values obtained in the I-channel and those obtained in the RET channel of both groups was insignificant and remained within the limits of acceptability, as reported by Ricos et al. for all considered parameters, except for MCHC. Conclusions The presence of cold agglutinins in blood samples can be detected by a spurious lowering of the RBC count and by a spurious increase in the MCHC. The RET channel represents a great opportunity to correct the RBC count in a rapid manner without preheating. However, neither methodology can completely solve the residual presence of cold agglutinins in all samples, despite the MCHC values being < 370 g/L.

Sysmex XN-9000 hematology analyzer in examining peripheral blood nucleated red blood cells: An evaluation of clinical application / 第二军医大学学报

[Abstract] Objective To evaluate the clinical value of Sysmex XN-9000 hematology analyzer for detecting peripheral blood nucleated red blood cells (NRBC). Methods A total of 16 273 peripheral blood samples were collected and examined by Sysmex XN-9000 hematology analyzer and microscopic manual detection. The sensitivity, specificity and positive prediction value and negative predictive value of NRBC were measured by manual measurement under microscope. The 248 specimens positive by both methods were used as subjects, and the correlation between the two methods for detecting NRBC was analyzed. The disease types of 277 patients positive of NRBC were analyzed by microscopic examination. Results The sensitivity of NRBC detected by Sysmex XN-9000 hematology analyzer was 89.5%, specificity was 99.6%, positive predictive value was 80.5%, and negative predictive value was 99.8%. There was a positive correlation between the percentages of NRBC detected by the two methods (rs＝0.813, P0.001). Among the 277 NRBC-positive patients, 173 had hematological diseases and 104 had no hematologic diseases, and there were significant differences in NRBC counts between the two groups (median: 0.38×109/L vs 0.16×109/L, P0.05), and the percentages of NRBC were not significantly different (median: 2.95% vs 3.60%, P＝0.835 1). Among patients with hematological diseases, NRBC was mainly present in patients with acute lymphoblastic leukemia (31 cases), acute myeloid leukemia (55 cases), malignant lymphoma (39 cases) and multiple myeloma (18 cases). Among patients without hematologic diseases, NRBC was mainly present in those with solid cancer (24 cases) and cirrhosis hemorrhage (36 cases). Conclusion The Sysmex XN-9000 hematology analyzer can detect NRBC with high accuracy, and it thus has a promising clinical application value.

Significance of lymphocyte structure parameters of Sysmex XN-9000 hematology analyzer in screening peripheral atypical lymphocytes / 第二军医大学学报

[Abstract] Objective To investigate the significance of lymphocyte structure parameters of Sysmex XN-9000 hematology analyzer in screening peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs. Methods From Dec. 2017 to Dec. 2018, 370 blood samples with positive alarm of atypical lymphocytes, which were detected by XN-9000 hematology analyzer in outpatient and emergency department of Changhai Hospital, Naval Medical University (Second Military Medical University), were collected in this study. Six lymphocyte structure parameters were recorded, including lymphocyte complexity (L-X), lymphocyte fluorescence intensity (L-Y), lymphocyte size (L-Z), dispersion width of lymphocyte complexity (L-WX), dispersion width of lymphocyte fluorescence intensity (L-WY) and dispersion width of lymphocyte size (L-WZ). According to the atypical lymphocyte proportion detected manually under microscope, the 370 samples were divided into 2 groups: atypical lymphocyte positive group (100 samples with an atypical lymphocyte proportion5%) and atypical lymphocyte negative group (270 samples with an atypical lymphocyte proportion≤5%), and the significance of each lymphocyte structure parameter was evaluated by receiver operating characteristic (ROC) curve. Then the parameters with high accuracy for screening atypical lymphocytes were analyzed by logistic regression model to study the significance of their combination. Results The lymphocyte structure parameters L-WY, L-X and L-Z had high accuracies in screening atypical lymphocytes, with the ROC area under curve (AUC) being 0.927, 0.939 and 0.931, respectively. The combined predictor was generated using L-WY, L-X and L-Z by logistic regression analysis model, and the ROC AUC of combined predictor was 0.979. When 0.058 1 was selected as the cut-off value, the sensitivity was 100.0% and the specificity was 77.8%. Conclusion Lymphocyte structure parameters L-WY, L-X and L-Z detected by Sysmex XN-9000 hematology analyzer can effectively screen peripheral blood atypical lymphocytes when positive alarm of atypical lymphocytes occurs.

Performances evaluation of Sysmex XN-9000 hematology analyzer under body fluid mode for detecting peritoneal and pleural fluids / 医疗卫生装备

Object To verify and evaluate the performances of Sysmex XN-9000 hematology analyzer under body fluid mode when used for peritoneal and pleural fluids detection.Methods According to the guidance of ICSH, Sysmex XN-9000 hematology analyzer under body fluid mode had its performances verified on background counting, carryover, precision, linear range and etc of RBC-BF and TC-BF, and then was compared with microscopy on RBC-BF, TC-BF, PMN％, MN％, N％, L％, M％and E％.Results The RBC-BF and TC-BF had the background counting being 0.00, carryover being 0.00％and 0.07％ respectively, coefficients of variation (CV) of within-run precision being from 0.96％to 17.89％as well as from 2.19％to 10.33％respectively, CV of between-run precision being from 3.34％to 4.73％as well as from 8.33％to 10.75％resptctively, and the linear ranges being (0～5) ×1012/L and (0～20) ×109/L respectively. There was a high correlation between Sysmex XN-9000 hematology analyzer and microscopy when detecting RBC-BF, TC-BF, PMN％, MN％, N％, L％, M％and E％. The Spearman rank correlation coefficients (rs) were 0.977, 0.995, 0.863, 0.929, 0.926, 0.949, 0.965 and 0.816 (P<0.05), and there were statistical significances between the correlations. Bland-Altman bias analysis on the analyzer and microscopy showed that RBC-BF had the bias (4.6％) lower than that (5.6％) of TC-BF;MN％had the bias (-2.0％) lower than that (4.2％) of PMN％;L％, N％, M％and E％had the bias being-0.5％, 4.4％,-5.9％and-1.6％respectively, which were all met the requirements of the manufacturer.Conclusion Sysmex XN-9000 hematology analyzer under body fluid mode proves its performances for routine detection of peritoneal and pleural fluids.

Assessment of blood sample stability for complete blood count using the Sysmex XN-9000 and Mindray BC-6800 analyzers

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 Steel­Dwass­Critchlow­Fligner test and by Bland­Altman 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 signifi- cant 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

Performance evaluation of Sysmex XN-9000 automated hematology analyzer / 国际检验医学杂志

Objective To evaluate the performance of Sysmex XN‐9000 automated hematology analyzer .Methods According to international and domestic standards ,performance of analyzer was evaluated .Results The within‐batch and between‐batch preci‐sion ,carryover pollution rate ,linearity range and the accuracy of Sysmex XN‐9000 analyzer were all conform to related require‐ments .Leukocyte classification results compared with manual classification ,the correlation of neutrophil ,lymphocyte ,monocyte and eosinophil were fine ,but correlation of basophil was not very ideal .Conclusion The performance of Sysmex XN‐9000 analyzer could be satisfying ,could meet the needs of clinical inspection and diagnosis and treatment .

Blood analyzer Sysmex XN-9000 testing in low whole blood platelet performance evaluation / 中国医学装备

Objective:To evaluate the performance of Sysmex XN-9000 automatic blood analyzer (hereinafter referred to as XN-9000) in whole blood with the low platelet (PLT). Methods:A total of 48 whole blood samples with platelet count less than 70×109/L were randomly collected from XN-9000 correlation analysis to evaluate XN-9000 the accuracy and precision of detection in low whole blood PLT and carry pollution rate, use XN-9000 and microscope count, respectively.Results: XN-9000 detection in low whole blood PLT between batch and batch of CV% 1.13% and 1.29%, respectively; XN-9000 with microscope PLT count results have high correlation, The regression equation forY=0.917X+3.217,correlation coefficientr=0.964; XN-9000 detection in low whole blood PLT carry pollution at a rate of 0.12%. Detection accuracy of PLT Bias, %(-1.25%~1.8%); Linear range(0~1206)×109/L; Clinical reportable range (0~6030)×109/L.Conclusion: The detection of XN-9000 blood analyzer is in low whole blood PLT has high precision and accuracy, carry pollution rate is extremely low, the result has the reliability, can be directly applied to clinical.