Blast flagging of the Sysmex XN‐10 hematology analyzer with supervised cell image analysis: Impact on quality parameters

Abstract

Introduction The Sysmex XN‐10 automated hematology analyzer (Sysmex Corporation) is routinely used in hematology laboratories to perform complete blood cell count with differential (CBC w/ diff). The sensitivity of this system for blast detection is unclear, since many prior studies evaluating the blast flagging capabilities of Sysmex XN series used the white precursor cell (WPC) channel, which is not cleared for use in the United States. Methods We assessed the blast flagging capabilities of the Sysmex XN‐10 compared with CellaVision (a cell image analyzer)‐assisted visual hematology results. We evaluated the following flags: “blasts?/abnormal lymph?” and “immature granulocytes present” and compared differences in turnaround time between methods. Results We collected data on 2239 CBC w/ diff Sysmex automated analyzer differential and CellaVision‐assisted visual differential from the inpatient hematology‐oncology population of a tertiary care medical center. Solely analyzing the first CBC/diff from each unique patient, both flags had a combined sensitivity of 100%, specificity of 50.2%, PPV of 21.7%, and NPV of 100%. The mean turnaround time for the automated differential was 19.5 minutes (SD 35.9 minutes) compared with 66.4 minutes for the CellaVision‐assisted visual differential (SD 68.5 minutes; P < 0.001; Figure 1). Conclusion The Sysmex XN‐10 abnormal lymphocyte/blast and immature granulocytes flags had excellent sensitivity and acceptable specificity in detecting circulating blasts with shorter turnaround time than the CellaVision‐assisted visual differential. Our study suggests that automated differentials performed on Sysmex XN‐10 can replace visual differentials as a first‐line screening method for blast detection with improved turnaround time in hematology‐oncology populations.

Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa

“…Congruent with reports in the literature, the accuracy of the ‘blast’, ‘abnormal lymphocytes’, ‘left shift’ and ‘monocytosis’ automated WBC flags were impacted by clinical parameters such as current infection, low WCC (≤ 1.5 × 10 9 /L), malignancy, and current treatment with chemotherapy. 11 Failure to identify malignant conditions portends significant clinical implications and is one of the greatest concerns for laboratories. Therefore, in these instances, laboratories should rely on the confirmatory result of a detailed microscopic assessment, which is the gold standard.…”

The integration of Sysmex XN‐9100’ WPC channel reflex testing in the detection of reactive versus malignant blood samples

“…In the XN series, detection of WBC abnormalities is based on a complex flagging algorithm guided by the information processing unit (IPU) software of the analyzer. The instrument can detect particular cell populations with an abnormal size, shape or position in the scattergrams 1,5,7,8,11,12 . Based on these findings, a Q ‐value is calculated.…”

Flagging performance of two automated hematology analyzers in blast cell screening

“…With the rapid development of automated hematology analyzers, hematology analyzers have gradually become routinely adopted in hematology laboratories, with improved efficiency and accuracy. To enable the laboratory to review specific blood specimens selectively and to significantly improve the efficiency and quality of clinical laboratories, the capability of hematology analyzers to identify and flag abnormal cells has become one of the most critical links (1). Whether there are blast cells in peripheral blood (PB) is of great value for clinical screening and monitoring of the occurrence and progression of hematological malignancies (2,3).…”