Automated<i>Plasmodium</i>detection by the Sysmex XN hematology analyzer

Dumas, Cécile; Bienvenu, Anne‐Lise; Girard, Sandrine; Picot, Stéphane; Debize, G; Durand, Brigitte

doi:10.1136/jclinpath-2017-204878

Cited by 17 publications

(15 citation statements)

References 14 publications

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“…We showed evidence that the pRBC flag from Sysmex XN-10 revealed a poor sensitivity of 7.8% for malaria parasites, notably for Pf samples (0/59). However, as previously demonstrated on the XN-10 analyser,2 3 the sensitivity was increased to nearly 50% if samples are positive for mature forms of Plasmodium that are mostly recovered during non-Pf infections. The sensitivity was also improved using a lower defined threshold of 10.…”

Section: Discussionmentioning

confidence: 53%

“…Automated complete blood count (CBC) is usually indicated for patients admitted with fever. Sysmex XN-10 was indeed reported to detect mature stages of Plasmodium through the flow cytometry White blood cells Differential Fluorescence (WDF) scattergram 2 3. Automated CBCs performed on Sysmex XN-10 haematology analyser (Sysmex Corporation, Kobe, Japan) may therefore represent a tool to suspect malaria diagnosis.…”

Section: Introductionmentioning

confidence: 99%

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Flagging performance of Sysmex XN-10 haematology analyser for malaria detection

et al. 2020

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AimThe aim was to assess the flagging performance of Sysmex XN-10 haematology analyser for malaria detection through the parasitic red blood cell (‘pRBC’) alarm.MethodsWe retrospectively studied 584 blood samples performed on the Sysmex XN-10 analyser that were tested for malaria. Sensitivity, specificity, positive and negative predictive values, and prevalence were established for the pRBC alarm.ResultsSensitivity, specificity, and positive and negative predictive values for the pRBC flag were 7.8%, 100%, 100% and 87.7%, respectively. The prevalence of pRBC flag of 0.026% in the overall population was significantly different from the prevalence of 1.027% in the population tested for malaria.ConclusionsConsidering the excellent specificity and the low prevalence of the flag in the overall population, we suggest, in case of the presence of pRBC flag, the implementation of a rapid review of the blood smear looking for Plasmodium, mostly if the patient had fever and had not been tested for malaria.

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Section: Discussionmentioning

confidence: 53%

Section: Introductionmentioning

confidence: 99%

Flagging performance of Sysmex XN-10 haematology analyser for malaria detection

et al. 2020

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“…Automated hematology analyzers to diagnose malaria have been studied in the last two decades, applying different techniques such as abnormal depolarization in the granularity of phagocytes, abnormalities in the size of blood cells, or blood cell differentiation patterns [22–27]. However, these methods often carry limitations such as low- and variable sensitivities and specificities due to technical limitations and confounding host- and pathology-specific differences [27, 28]. Direct staining of malaria nucleic acid in parasites and subsequent analysis by a flow cytometry-like technique may prevent drawbacks from indirect tests [29–31].…”

Section: Discussionmentioning

confidence: 99%

The XN-30 hematology analyzer for rapid sensitive detection of malaria: a diagnostic accuracy study

Post

Kaboré

Reuling

et al. 2019

BMC Med

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Background Accurate and timely diagnosis of malaria is essential for disease management and surveillance. Thin and thick blood smear microscopy and malaria rapid diagnostic tests (RDTs) are standard malaria diagnostics, but both methods have limitations. The novel automated hematology analyzer XN-30 provides standard complete blood counts (CBC) as well as quantification of malaria parasitemia at the price of a CBC. This study assessed the accuracy of XN-30 for malaria detection in a controlled human malaria infection (CHMI) study and a phase 3 diagnostic accuracy study in Burkina Faso. Methods Sixteen healthy, malaria-naive CHMI participants were challenged with five Plasmodium falciparum- infected mosquitoes. Blood was sampled daily for XN-30, blood smear microscopy, and malaria qPCR. The accuracy study included patients aged > 3 months presenting with acute febrile illness. XN-30, microscopy, and rapid diagnostic tests (HRP-2/pLDH) were performed on site; qPCR was done in retrospect. The malaria reference standard was microscopy, and results were corrected for sub-microscopic cases. Results All CHMI participants became parasitemic by qPCR and XN-30 with a strong correlation for parasite density ( R 2 = 0.91; p < .0001). The XN-30 accurately monitored treatment and allowed detection of recrudescence. Out of 908 patients in the accuracy study, 241 had microscopic malaria (density 24–491,802 parasites/μL). The sensitivity and specificity of XN-30 compared to microscopy were 98.7% and 99.4% (PPV = 98.7%, NPV = 99.4%). Results were corrected for qPCR-confirmed sub-microscopic cases. Three microscopy-confirmed cases were not detected by XN-30. However, XN-30 detected 19/134 (14.2%) qPCR-confirmed cases missed by microscopy. Among qPCR-confirmed cases, XN-30 had a higher sensitivity (70.9% versus 66.4%; p = .0009) and similar specificity (99.6% versus 100%; p = .5) as microscopy. The accuracy of XN-30 for microscopic malaria was equal to or higher than HRP-2 and pLDH RDTs, respectively. Conclusions The XN-30 is a novel, automated hematology analyzer that combines standard hemocytometry with rapid, objective, and robust malaria detection and quantification, ensuring prompt treatment of malaria and malaria anemia and follow-up of treatment response. Trial registration Both trials were registered on clinicaltrials.gov with respective identifiers NCT02836002 (CHMI trial) and NCT02669823 (diagnostic accuracy study). Electronic supplementary material The online version of this article (10.1186/s12916-019-1334-5) contains supplementary material, which is available to authorized users.

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“…The mature an parasite and hemozoine crystal are more likely to be found in a blood sample infected by P.vivax and P.ovale compared to P.falciparum, leading to frequent WDF scattergram abnormalities caused by these two species. Blood samples containing gametocytes and/or schizonts can cause blue "ghost" cluster abnormalities of the WNR channel; therefore, use of the WNR scattergram is more 9,10 accurate. This research was consistent with study Dumas et al and…”

Section: Wdf and Wnr Scattergrammentioning

confidence: 99%

Correlation between WDF, WNR, and RET Abnormal Scattergram Detected by Sysmex XN-1000 and Parasitemia of Malaria Patients in Merauke Hospital

Ranoko¹,

Aryati²,

Hajat³

2019

Indonesian J. Clin. Pathol. Med. Lab.

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Malaria remains a health problem in Indonesia. Microscopic examination with Giemsa staining is the gold standard for diagnosing malaria. The density of parasites correlates with the degree of severity and response to therapy of malaria. Malaria-causing plasmodium can be detected by Sysmex XN-1000 which is marked by abnormalities in the WDF, WNR and RET scattergram. This research aimed to determine the correlation of WDF, WNR and RET abnormal scattergram detected by Sysmex XN-1000 and the parasitemia index of malaria at the Merauke General Hospital. This was a cross-sectional study with observational approach conducted between November 2017 – February 2018 at the Merauke General Hospital. Positive malaria samples were stained with Giemsa, their parasitemia index was calculated, routine complete blood count using Sysmex XN-1000 was performed, and the scattergram abnormalities were then analyzed. There were 65 positive malaria samples as follows: P.falciparum (35%), P.vivax (60%), P.ovale (3.1%), and P.malariae (1.5%), but the species did not correlate with parasitemic index (p=0.691). Abnormalities of WDF and WNR scattergram were predominantly found than RET scattergram (80% vs. 27.7%). P.vivax predominantly caused abnormalities of the WDF and WNR scattergram in 36 of 39 samples (92.3%), whereas P.falciparum predominantly caused abnomalities of the RET scattergram in 14 of 23 samples (60.9%). There was 95% positivity of an abnormality in WDF/WNR/RET scattergram with a cut-off of > 5,0165.5/µL. There was correlation between WDF, WNR, RET scattergram detected by Sysmex XN-1000 and the parasitemia index.

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AutomatedPlasmodiumdetection by the Sysmex XN hematology analyzer

Abstract: Associated to thrombocytopaenia, a Sysmex XN pattern may represent a useful warning for detection in unsuspected patients, particularly when mature parasite stages are present.

Cited by 17 publications

References 14 publications

Flagging performance of Sysmex XN-10 haematology analyser for malaria detection

Flagging performance of Sysmex XN-10 haematology analyser for malaria detection

The XN-30 hematology analyzer for rapid sensitive detection of malaria: a diagnostic accuracy study

Correlation between WDF, WNR, and RET Abnormal Scattergram Detected by Sysmex XN-1000 and Parasitemia of Malaria Patients in Merauke Hospital

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