The Usefulness of Blast Flags on the Sysmex XE-5000 Is Questionable
Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, PO Box 4 St. Olavs plass, N-0130 Oslo, NorwayAmerican Journal of Clinical Pathology (Impact Factor: 2.51). 05/2013; 139(5):633-40. DOI: 10.1309/AJCPDUZVRN5VY9WZ
Hematology analyzers generate suspect flags that involve microscopic reviews to confirm the presence of pathologic cells. This study investigated the reliability of the blast flag in a side-by-side evaluation of 3 Sysmex XE-5000 instruments (Sysmex, Kobe, Japan). The repeatability of the Q values reported by each instrument for 10 replicates of the same blood samples was low (intraclass correlation coefficient [ICC] values, 0.62-0.74). The reproducibility of the Q values obtained by analyzing 408 samples on all 3 instruments was reasonable (ICC value, 0.85). In addition, a systematic difference was observed among the instruments in the level of reported Q values. With cutoff commonly being 100, the observed reproducibility of the blast flagging among the instruments was evaluated as poor (κ = 0.73). Based on the observed low performances, we question the usefulness of the Q value as a predictor of blasts and whether a blast flag reported by the XE-5000 is sufficient as a criterion for performing a microscopic review.
Article: Sysmex XE-5000 blast Q flag analysisAmerican Journal of Clinical Pathology 12/2013; 140(6):918-9. DOI:10.1309/AJCPCTKEU7IVW6IP · 2.51 Impact Factor
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ABSTRACT: Criteria for peripheral smear review are designed to include those samples with results outside the reference interval and can be more extreme based on what is considered to have clinical utility. However, we are unaware of previous studies that reported the distributions of various complete blood cell count (CBC) parameters in infants. In the following study we reviewed screening CBC results of 692 infants aged 9-15 months in order to determine the proportion of peripheral smear reviews recommended according to consensus criteria and that after adjusting for the observed distributions of the various parameters. According to consensus criteria the recommended reflex peripheral smear review rate was 39.7% (95% CI 36.1-43.4) whereas after adjustment for the observed distributions, the rate fell to 5.6% (95% CI 3.9-7.3) (p < 0.001). The major reasons for the difference in rates were the high proportion of infants with an absolute lymphocyte count > 7 × 10(9)/L (17.5%), the presence of a plus one blast flag (4.3%), and a large unstained cell count of ≥ 5% (26.2%) (equivalent to + 1 atypical flag). We found that international consensus criteria for reflex peripheral smear review results in a very high peripheral smear review rate in well infants, and might be inappropriate.Scandinavian journal of clinical and laboratory investigation 03/2014; 74(4). DOI:10.3109/00365513.2014.893011 · 1.90 Impact Factor
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ABSTRACT: The Sysmex XN (XN) modular system (Sysmex, Kobe, Japan) is a new automated hematology analyzer equipped with different principles from its previous version, Sysmex XE-2100. We compared the performances of Sysmex XN and XE-2100 in umbilical cord blood (CB) specimens. In 160 CB specimens, complete blood count (CBC) parameters and white blood cells (WBC) differentials were compared between the two analyzers. Their flagging performances for blasts, abnormal/atypical lymphocytes, immature granulocytes and/or left-shift (IG), and nucleated red blood cells (NRBC) counts were compared with manual counts. For the blast flagging, Q values by Sysmex XN were further compared with manual slide review. Sysmex XN and XE-2100 showed high or very high correlations for most CBC parameters but variable correlations for WBC differentials. Compared with XE-2100, XN showed significantly different flagging performances for blasts, abnormal/atypical lymphocytes, and IG. The flagging efficiency for blasts was significantly better on Sysmex XN than on XE-2100 (85.0% vs. 38.8%): Sysmex XN showed a remarkably increased specificity of blast flag, compromising its sensitivity of blast flag. Among the 24 specimens with blasts (range, 0.5%–1.5%), only one (4.2%) showed a positive Q value. This study highlighted the remarkable differences of flagging performances between Sysmex XN and XE-2100 in CB specimens. The Sysmex XN modular system seems to be a suitable and practical option for the CB specimens used for hematopoietic stem cell transplantation as well as for the specimens from neonates.Clinical Chemistry and Laboratory Medicine 06/2014; 52(12). DOI:10.1515/cclm-2014-0392 · 2.71 Impact Factor
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