Hypogranular eosinophils in eosinophilic gastrointestinal disease

The mismatch between Sysmex XN‐20 automated hematology analyzers and the visual examination of blood smears—Misclassification of hypogranular eosinophils and platelets

“…This phenomenon has also been reported in other series of AHA, in which the eosinophils were 14.0% of the total according to the analyzer whereas was 22.0% upon visual examination of blood smears. 5 The AHA identify cells based on volume and light scatter, but the hypogranular eosinophils overlapped with neutrophils on the WDF plot (Figure 1F, red circle), unlike normal eosinophils (Figure 1I, red circle). This explains their under-recognition.…”

“…4 Similarly, hypogranularity can also lead to white blood cell misclassification on the CBC examination. 5 Recently, we identified two cases of blood cell misclassifications by the XN-20 automated hematology analyzers (Sysmex Corporation, Kobe, Japan) in our daily practice. As reported below.…”