Improving the efficiency of the autoverification workflow for nucleated red blood cell reporting in the hematology laboratory

Abstract

Objective Although the microscopic manual count is considered the standard method for NRBC enumeration, modern hematology analyzers can perform this task automatically with reliable accuracy and efficiency. This study aims to evaluate the diagnostic performance of the Sysmex XN hematology analyzer and to construct the optimal workflow for accurate and efficient NRBC reporting. Methods Specimens containing different levels of NRBC were included. Analytical performance was evaluated via method comparison with flow cytometry (FCM) and manual count (MC). Clinical sensitivity was analyzed by ROC analysis using manual count as the standard method. Results Correlation study of %NRBC with FCM and MC demonstrated an r value of 0.925 (95% CI 0.905 to 0.942) and 0.990 (95% CI 0.987 to 0.992) with a mean difference of −0.8 (95%CI: −6.7 to +5.0) and +0.50 (95% CI: −6.7 to +7.7), respectively. When the automated NRBC count was equal to zero and >0.07 × 109/L, the false‐negative rate and false‐positive rate were 100%, respectively; hence, manual slide review could be omitted. A false‐positive rate of 72.7% was noted in specimens containing NRBC count less than 0.07 × 109/L. Conclusion The Sysmex XN can help improve the efficiency of NRBC enumeration owing to its accuracy, rapidity, and automation. However, further studies are required to improve the accuracy of detection in specimens containing a very low level of NRBC.

Correlation of nucleated red blood cell counts by Sysmex XN-1000 with conventional microscopy

“…They are preferable to manual count by being cost effective and convenient. Previous studies in other countries have been conducted to determine the precision and diagnostic accuracy of Sysmex XN series and they have been very encouraging [2,12]. Our study also shows that Sysmex XN-1000 analyzer with its WNR channel is highly sensitive (90.56%) and specific (88.30%) in enumerating nRBCs.…”

“…In the positive samples, those with nRBCs identified on manual microscopy, Sysmex XN 1000 showed positive predictive value of 88.26%. It was slightly lower than other studies due to some false negative values [2]. And in negative samples it showed negative predictive value of 90.6%.…”

“…Peripheral blood examination in conjunction with a patient's clinical history and symptoms play a key role in diagnosing and treating a wide spectrum of hematological illnesses [1]. Nucleated red blood cells (nRBCs) are immature cells of erythropoietic lineage, normally present in bone marrow and peripheral blood of only newborns (until the 5 th day of life) [2,3]. Their presence in the peripheral blood of older children and adults indicates a pathology.…”

Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time

“…Automated analyzers have been introduced in hematology laboratories and blood bank laboratories; however, few studies have focused on laboratory efficiency in these laboratories with high manual workload [ 24 - 26 ]. These studies demonstrated the usefulness and applicability of FMEA in clinical laboratories and showed that automated methods are associated with lower RPNs than manual methods, which is in line with the present results.…”

Diagnostic Value and Prognostic Significance of Nucleated Red Blood Cells (NRBCs) in Selected Medical Conditions

“…Nucleated red blood cells (NRBCs) are premature erythrocyte precursors rarely present in the circulatory systems of healthy adults [1,2]. They normally reside in the bone marrow of humans of all ages (Figure 1), where the common myeloid progenitor cell differentiates into more developed cells to finally become an erythroblast [3][4][5].…”