New parameters available on Sysmex <scp>XE</scp>‐5000 hematology analyzers contribute to differentiating dengue from leptospirosis and enteric fever

Oehadian, Amaylia; Michels, Meta; Mast, Quirijn de; Prihatni, Delita; Puspita, Mita; Hartantri, Yovita; Sinarta, Sylvia; Ven, A.J.A.M. van der; Alisjahbana, Bachti

doi:10.1111/ijlh.12422

Cited by 20 publications

(21 citation statements)

References 34 publications

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“…A study in Indonesia identified the possible use of new parameters to enable the differentiation of dengue from leptospirosis and enteric fever using flow cytometry to quantitate the atypical lymphocyte area, high-fluorescent lymphocyte counts, immature granulocytes and IPF [21]. These investigations may give high accuracy for diagnosis but are inaccessible in all hospitals.…”

Section: Discussionmentioning

confidence: 99%

Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study

et al. 2018

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BackgroundDengue infection patients are presented with acute febrile illness. Clinical presentations may mimic other infections. The serology for definite diagnosis is costly and inaccessible in many hospitals. We sought to identify the clinical features and hematologic parameters from a complete blood count (CBC) which distinguish dengue infection from other causes.MethodsThis was a retrospective single center study from Chiang Mai University Hospital. All patients who presented with acute fever between September 2013 and July 2015 were included. The diagnosis of dengue infection must be confirmed by serology. The control groups were patients who presented with acute febrile illness without localizing signs. Clinical data and CBC results were reviewed and compared. The Chi-square test was used to compare categorical variables. The CBC parameters were analyzed using the linear mixed model.ResultsOne hundred and fifty-four dengue and 146 control patients were included. Headache, nausea, loss of appetite and bleeding diathesis were significantly symptoms in dengue patients (p < 0.05). There was some diversity in the the CBC in the dengue patients compared to the control group. Moreover, this study also identified the day of fever which these parameters were statistically significant. The dengue group had higher hemoglobin and hematocrit from day 3 to day 10 (p < 0.001), lower white blood cell count from day 1 to day 10 (p < 0.001), lower platelet count from day 3 to day 10 (p < 0.001), higher monocyte on day 1–4 (p < 0.001), higher atypical lymphocyte percentage on day 5–9 (p < 0.001) and higher eosinophil percentage on day 9–10 (p = 0.001). Furthermore, the neutrophil to lymphocyte percentage ratio of dengue group was > 1 on the first 5 days then reversed on day 6 to Day 9 but in non-dengue group, the ratio was always > 1.ConclusionWe identified important clinical features and CBC parameters to differentiate dengue patients from other patients who had acute febrile illness from other causes. This identification could be done in local hospitals to give an accurate diagnosis, enabling further investigation to be tailored and treatment commenced earlier.

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Section: Discussionmentioning

confidence: 99%

Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study

et al. 2018

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“…HFLC, immature granulocytes, and immature platelets by Sysmex XE-5000 hematology analyzers can help to differentiate between common causes of febrile illnesses with thrombocytopenia in dengue-endemic areas. 20 In our study, most of the AL TP cases had dengue viral infections in the Emergency Department, which is prevalent in Guangzhou. 21 There were fewer AL TP samples detected in Hematology and Oncology.…”

Section: Discussionmentioning

confidence: 56%

“…Patients with infections had the highest HFLC counts, and most of these individuals had dengue infection . The detection of AL, HFLC, immature granulocytes, and immature platelets by Sysmex XE‐5000 hematology analyzers can help to differentiate between common causes of febrile illnesses with thrombocytopenia in dengue‐endemic areas . In our study, most of the AL TP cases had dengue viral infections in the emergency department, which is prevalent in Guangzhou .…”

Section: Discussionmentioning

confidence: 59%

Combined hematologic parameters to optimize review criteria on XE‐5000

Guo

et al. 2019

Int J Lab Hematology

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Introduction Forty‐one consensus review rules are presented to a large number of hematology laboratories worldwide, as suggested by the International Consensus Group for Hematology Review. Research on the review criteria has mainly focused on adjusting the threshold of each parameter to establish optimized criteria with better efficiency based on the consensus group criteria. This study aimed to optimize the review criteria by combining hematologic parameters on a Sysmex XE‐5000 hematology analyzer (XE‐5000). Material and methods A total of 662 nucleated red blood cell (NRBC) and 406 atypical lymphocyte cell (AL) flagged samples were used to establish hematologic parameters associated with NRBC and AL, respectively. Another set of 1423 optimization samples were used to validate the optimized criteria of NRBC and AL by combining associative hematologic parameters. The efficiency of each set of criteria was compared and optimized to obtain better efficiency, an acceptable slide review rate, and a low false‐negative rate. Results In the optimization NRBC set combining triple parameters, compared with the default setting (P < .001), the slide review rate declined from 30.26% to 14.42%, and the efficiency increased from 75.65% to 91.02%. In the optimization AL set combining triple parameters, compared with the default setting (P < .001), the slide review rate declined from 40.60% to 11.80%, and the efficiency increased from 64.02% to 93.00%. Conclusions Based on the adjustment of Q‐flag values combining associative hematologic parameters, the optimal criteria with a low false‐negative rate not only might have a higher efficiency but also may significantly reduce the slide review rate.

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“…[13,14] Oehadian et al observed that flags such as increased atypical lymphocytes, high-fluorescent lymphocyte counts, and immature platelets were more commonly generated by Sysmex XE-5000 5-part hematology analyzer in dengue patients. [15] We observed abnormal WBC flags generated by ABX Micros-60 three-part hematology analyzer in 28 serologically confirmed dengue patients, including two patients in whom all other hematological parameters were within normal range. The CBC data in all except two patients had M2G1G2 flag, while samples of remaining two patients had M2G1 and L1M2G1G2 flags, respectively, which are generally thought to hint at leukemic blasts.…”

Section: Methodsmentioning

confidence: 76%

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2019

J Lab Physicians

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BACKGROUND: Automated hematology analyzers often generate many flags which can provide important clues to the underlying hematological abnormality. Although pathologists are generally well versed in recognizing the importance of flags indicating potential leukemic blasts, their utility in hinting toward infectious etiology, especially during epidemics, is less well known. We analyzed any abnormal flags generated by a three-part automated hematology analyzer in serologically confirmed cases of dengue. MATERIALS AND METHODS: The study included 28 patients diagnosed with serologically confirmed dengue infection. The venous samples were run on ABX Miros-60 three-part hematology analyzer. The complete blood count data and any abnormal flags were noted and correlated with peripheral blood film findings in all patients. RESULTS: An abnormal white blood cell (WBC) flag was noted in all 28 patients, including two in whom all other hematological parameters were within normal limits. In 26 (93%) patients, M2G1G2 WBC flag was noted while the samples of the remaining two patients generated M2G1 and L1M2G1G2 WBC flags, respectively. CONCLUSION: An abnormal WBC flag, when correlated in appropriate clinical context, especially during a dengue outbreak, can aid in targeting the cohort of patients who will require immediate referral for serological confirmation.

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New parameters available on Sysmex XE‐5000 hematology analyzers contribute to differentiating dengue from leptospirosis and enteric fever

Cited by 20 publications

References 34 publications

Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study

Useful clinical features and hematological parameters for the diagnosis of dengue infection in patients with acute febrile illness: a retrospective study

Combined hematologic parameters to optimize review criteria on XE‐5000

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