Convenience of Hgb-O detected by optical method in XN-series hematology analyzers in evaluating hemoglobin concentration in samples with chylous turbidity

Abstract

The chylous turbidity of blood samples is one of the causes of false-high hemoglobin (Hgb) concentration measurements by the colorimetric method, which has been widely applied in hematology analyzers. In such cases, additional manual procedures are required to correct Hgb concentrations. We therefore examined the effectiveness of an optical method for measuring Hgb concentrations in samples with chylous turbidity using Hgb-O in the reticulocyte channel equipped in XN-series analyzers (Sysmex, Kobe, Japan). Hgb-O showed excellent basic performance, including linear correlation and invariability with sodium lauryl sulfate (SLS)-Hgb detected by the colorimetric method. In the analysis of samples from healthy volunteers supplemented with fat emulsion, chylous turbidity did not affect Hgb-O but SLS-Hgb, which was falsely increased according to the dose of fat emulsion. Actually, SLS-Hgb was falsely elevated in 34 of 40 chylous turbidity 3+ samples. The remaining 6 samples were measured in hematology analyzers where Hgb-O was inconsistent with SLS-Hgb in the internal quality control records. For these samples, the correction factors calculated from the internal quality control records could contribute to providing the corrected Hgb-O value. These findings suggested that the optical method was effective and convenient for accurately evaluating Hgb concentrations in samples with extremely chylous turbidity.

Optimizing the management of analytical interferences affecting red blood cells on XN‐10 (Sysmex®)

“…Our study aimed at optimizing the management of analytical interferences on RBCs parameters using the alternative parameters given by SYSMEX XN‐10. These parameters, obtained by optical method on RET channel, have been reported as potentially useful in the case of interferences, such as increased MCHC, very high leukocytosis, cold agglutinins, or chylous turbidity 1–4,11,12 . Twelve categories of interferences were initially included in our evaluation: leukocytosis >90 × 10 9 /L, cold agglutinins' suspicion, presence of lipids on scattergrams, hereditary spherocytosis, sickle cell disease, cryoglobulin, high immunoglobulins titer, hyperglycemia, bilirubinemia, lipemic sample, icteric sample, hemolysis.…”

“…Many interferences are described in the literature [1][2][3][4][5][6][7][8][9][10] ; however, some of them were not included in our study, for the following reasons:…”

“…Several sources of interferences are well-recognized: plasma changes (due to hemolysis, lipemia, icteric plasma, or immunoglobulins), haemoglobin or red blood cells disorders, leukocytosis. [1][2][3][4][5][6][7] With the development of new generation analyzers, novel technologies and parameters have been introduced to improve both analytical performances and detection of presumed interferences.…”

“…Regarding interferences with XN-10, the circumstances associated with spurious increased mean corpuscular haemoglobin concentration (MCHC), which stands as one of the best identified and described interference-related situation, have been studied by Berda-Haddad et al who proposed a decision-tree to ensure accurate results 1 and by Roccaforte et al as well who studied cold agglutinins and RET channel especially 3 ; in addition, Aruga et al have recently assessed haemoglobin concentration in case of chylous turbidity. 2 Furthermore, the impact of leukocytosis on RBCs parameters and the subsequent management has been recently evaluated by Schillinger. 4 Nevertheless, while all of the alternative parameters are expected to improve the management of analytical errors, the concrete impact of each relevant type of interferences on the different measurement channels remains to be determined.…”

“…While many situations may impair measurements and accurate cell counts, interferences affecting red blood cells (RBCs) and the associated parameters are among the most common. Several sources of interferences are well‐recognized: plasma changes (due to hemolysis, lipemia, icteric plasma, or immunoglobulins), haemoglobin or red blood cells disorders, leukocytosis 1–7 …”