Clinical significance of cell population data (CPD) on Sysmex XN-9000 in septic patients with our without liver impairment.

BACKGROUND: This study evaluated the clinical significance of cell population data (CPD) parameters obtained on Sysmex XN-9000 in septic patients admitted to intensive care unit (ICU) and stratified according to liver function. METHODS: The study population consisted in 84 patients, 44 of whom did not develop sepsis (NS), whereas the remaining 40 developed sepsis (SE) (n=24) or septic shock (SS) (n=16). Two hundred ostensibly healthy blood donors [healthy subjects (HS)], undergoing routine blood testing before a regular blood donation, were studied. RESULTS: Except for neutrophils and lymphocytes cell size (NE-FCS and LY-Z), all other CPD values were significantly different in ICU patients compared to HS. Neutrophils and monocytes fluorescence intensity (NE-SFL and MO-X) values were significantly higher in SS compared to sepsis and not develop sepsis patients. The value of many parameters was also different according to liver function. Overall, MO-X and neutrophils fluorescence intensity (NE-SFL) exhibited the best performance for diagnosing sepsis in all patients (AUC, 0.75 and 0.72), as well as in those with (AUC, 0.95 and 0.89) or without (AUC, 0.72 for both) liver impairment. These parameters were also significantly correlated with Sequential Organ Failure Assessment (SOFA) score. CONCLUSIONS: This study suggested that some novel CPD parameters (namely NE-SFL and MO-X) may provide useful information for diagnosis and management of sepsis.

Evaluation of Mindray BC-6800 body fluid mode for automated cerebrospinal fluid cell counting.

BACKGROUND: Cellular analysis in cerebrospinal fluid (CSF) provides important diagnostic information in various medical conditions. The aim of this study was to evaluate the application of Mindray BC-6800 body fluid (BF) mode in cytometric analysis of CSF compared to light microscopy (LM). METHODS: One hundred and twenty-nine consecutive CSF samples were analyzed by BC-6800-BF mode as well as by LM. The study also included limits of blank (LoB), limit of detection (LoD), limit of quantitation (LoQ), carryover and linearity. Results White blood cells LoQ was 4.0×106 cells/L. Linearity was good and carryover was negligible. As for the total and white blood cells, the BC-6800-BF parameters vs. LM showed both bias ranged from -10.28 to 0.06×106 cells/L. Polymorphonuclear and mononuclear cells ranged from 6.64 to 10.90%. For white blood cell the diagnostic agreement was 93% at the cut-off >5.0×106 cells/L, and for polymorphonuclear and mononuclear at the cut-off >50% was 91% and 92%, respectively. CONCLUSIONS: BC-6800-BF offers rapid and accurate counts in clinically relevant concentration ranges, replacing LM for most samples. However, in samples with abnormal cell counts or with abnormal white blood cell differential scattergrams the need to microscopic review for a correct clinical outcome remains.

Reflex Testing Rules for Cell Count and Differentiation of Nucleated Elements in Pleural and Ascitic Fluids on Sysmex XE-5000.

Flow cytometry is widely used in many laboratories for automated nucleated cell counts and their differentiation in body fluids. The implementation of new reflex testing rules on these automated instruments could open new frontiers in laboratory workflow, improving characterization of body fluids and clinical diagnosis and decreasing costs. Ascitic (150) and pleural (33) fluids were collected and assessed by XE-5000 and optical microscopy. Cell counts performed with the methods showed a Pearson's correlation of 0.98 (p < 0.0001), Passing-Bablok regression y = 0.99x + 2.44, and bias of 32.3. In ascitic fluids, the best diagnostic performance was found for polymorphonuclear and neutrophil counts on XE-5000, which exhibited areas under the curve (AUCs) 0.98 (p < 0.0001) and 0.99 (p < 0.0001), respectively. In pleural fluids the best diagnostic performance was found for polymorphonuclear percent parameter, which displayed 0.97 (p < 0.0001). Specific reflex test rules based on these parameters were characterized by 92% diagnostic concordance, 1.00 sensitivity, and 0.84 specificity with optical microscopy. The application of a set of reflex testing rules may improve the diagnostic performance of XE-5000, increasing its reliability for routine automated cell count in body fluids. We acknowledge that further studies should be planned to validate our findings according to clinical data.

Extended leukocyte differential count and C-reactive protein in septic patients with liver impairment: diagnostic approach to evaluate sepsis in intensive care unit.

BACKGROUND: Sepsis is still a major cause of death in intensive care units (ICUs) worldwide. Patients with liver impairment express an imbalanced cytokine response which alters common sepsis biphasic nature. Cytokines measurement is expensive, often unavailable, whereas leukocytes (WBC) evaluation performed through hematology analyzers can provide a practical strategy for monitoring inflammatory response. METHODS: A total of 200 healthy subjects (HS) and 84 patients (18 with, 66 without liver impairment) admitted to ICU, were assessed for International Sepsis Definitions, Sequential Organ Failure Assessment (SOFA) and Model for End-Stage Liver Disease (MELD) scores. We tested 1,022 peripheral blood samples using Sysmex XN-9000, estimating diagnostic accuracy of leukocyte differential count and nontraditional parameters through receiver operating characteristics (ROC) curves analysis compared to clinical classification. RESULTS: Median value of all-leukocyte parameters was different in ICU patients compared to HS. Leukocytes, neutrophils (NE) and immature granulocytes (IGs) in sepsis and septic shock (SS) were higher than no sepsis (NS), with an area under the curve: 0.81, 0.82 and 0.78 respectively. Lymphocytes (LY) and monocytes (MO) were significantly associated with liver impairment. CONCLUSIONS: Diagnostic accuracy of all-leukocyte parameters may provide valuable information for diagnosis and follow-up of sepsis in ICU patients, especially those with liver impairment.

Evaluation of nucleated red blood cell count by Sysmex XE-2100 in patients with thalassaemia or sickle cell anaemia and in neonates.

BACKGROUND: Current haematology analysers have variable sensitivity and accuracy for counting nucleated red blood cells in samples with low values and in all those conditions characterised by altered sensitivity of red blood cells to the lysing process, such as in beta-thalassaemia or sickle-cell diseases and in neonates. The aim of our study was to evaluate the performance of the automated analyser XE-2100 at counting nucleated red blood cells in the above-mentioned three categories of subjects with potentially altered red blood cell lysis sensitivity and yet a need for accurate nucleated red blood cell counts. MATERIALS AND METHODS: We measured nucleated red blood cell count by XE-2100 in peripheral blood samples of 187 subjects comprising 55 patients with beta-thalassaemia (40 major and 15 traits), 26 sickle-cell patients, 56 neonates and 50 normal subject. Results were compared with those obtained by optical microscopy. Agreement between average values of the two methods was estimated by means of Pearson's correlation and bias analysis, whereas diagnostic accuracy was estimated by analysis of receiver operating characteristic curves. RESULTS: The comparison between the two methods showed a Pearson's correlation of 0.99 (95% CI; 0.98-0.99; p<0.001) and bias of -0.61 (95% CI, -1.5-0.3). The area under the curve of the nucleated red blood cell count in all samples was 0.98 (95% CI, 0.96-1.00; p<0.001). Sub-analysis revealed an area under curve of 0.99 (95% CI, 0.98-1.00; p<0.001) for patients with thalassaemia, 0.94 (95% CI, 0.85-1.00; p<0.001) for patients with sickle cell anaemia, and 1.00 (95% CI, 1.0-1.0) for neonates. DISCUSSION: XE-2100 has excellent performance for nucleated red blood cell counting, especially in critical populations such as patients with haemoglobinopathies and neonates.

Detection of glaucomatous visual field changes using the Moorfields regression analysis of the Heidelberg retina tomograph.

PURPOSE: To evaluate the sensitivity and specificity of optic disk examinations performed using the Moorfields regression analysis (MRA) of the Heidelberg Retina Tomograph (HRT) in differentiating normal from glaucomatous eyes. DESIGN: Retrospective cross-sectional study. METHODS: Five hundred and nineteen patients were included in the study for a total of 193 normal eyes, 213 with suspected glaucoma (primary open-angle glaucoma [POAG]), and 113 with POAG. The intervention consisted of optic disk imaging by means of HRT I. A mean of three repeated images was analyzed using version 2.01 software. The optic disk was classified as "normal/outside normal limits" on the basis of the MRA. The visual field was examined using the DS 24 II program (Humphrey perimeter), with a glaucomatous visual field being defined on the basis of an abnormal Glaucoma Hemifield Test and a statistically significant corrected pattern standard deviation greater than 2 dB. The results obtained with MRA were compared with those obtained using the multivariate discriminant analysis (MDA) provided in the HRT I. The main outcome measures were sensitivity, specificity, and positive and negative predictive values of HRT examination. RESULTS: The sensitivity and specificity of the HRT-MRA examination were, respectively, 74% and 94% (83% and 75% with MDA) when the patients with suspected POAG were excluded from the analysis; the figures were 74% and 85%, and 41% and 94% (83% and 64%, and 60% and 75% with MDA) when the same patients were included as being normal or having POAG. CONCLUSIONS: In a broad clinical setting including normal subjects, patients with suspected POAG, and POAG patients, the HRT-MRA showed a high degree of diagnostic accuracy. The MRA was less sensitive but more specific than MDA. Greater diagnostic ability may be added by HRT-MRA examinations than by HRT-MDA to standard POAG diagnostic studies.