Interchangeability of multiple Sysmex XN10 and XN20 modules for six types of leukocytes

Abstract

Introduction: Differential counts of leukocytes are frequent, and often several automated blood cell counters are needed in contemporary laboratories. However, these modules are often individually quality assured. Our aim was therefore to validate the interchangeability of five hematology modules in a large modern laboratory and to compare them with our gold standard (GS) manual white blood cell differential count.Methods: At Copenhagen University Hospital, we compared five Sysmex XNmodules for neutrophils, lymphocytes, monocytes, eosinophils, basophils, and immature granulocytes (IG). We analyzed control samples in three levels to evaluate intra-and intermodular precision. Bias between modules was evaluated by analyzing 93 random patient samples within reference intervals. XN-modules' mean counts were compared with GS. Results:We found acceptable intramodular CV% (0.92%-8.76%), only neutrophils and eosinophils exceeded state-of-the-art imprecision or desirable specifications for medium control levels. Intermodular CV% showed significance difference for only monocytes (ANOVA, P < .0001). For patient samples, there were significant differences between XN-modules regarding four WBC types (ANOVA); however, proportional bias ranged from 1.7% to 3.8%, being within desirable specifications except basophils and IG (bias = 13.3% and 24.9%, respectively). Comparisons with GS, XNmodules exceeded desirable bias for basophils (lower than GS); monocytes and IG (higher than GS). Conclusion:This multimodule comparison shows acceptable intermodular imprecision and bias for clinical purposes, which is important for patient safety. Similar multimodule study should be performed with samples out of reference range in large-scale laboratories to confirm the interchangeability.

Automated analysers underestimate atypical basophil count in myeloid neoplasms

“…We also found that there were no significant differences in the counts of non‐basophil leukocytes between the automated analyser and manual differential, which further supports the comparatively greater discrepancy in basophil counts. The Sysmex XN platform is one of the most widely used analysers and has been previously reported to undercount basophils when compared to other automated analysers and manual differential 18 . Furthermore, for the Sysmex XN, discrepancies in counts have been observed only for basophils and not for other leukocytes 18,19 .…”

“…The Sysmex XN platform is one of the most widely used analysers and has been previously reported to undercount basophils when compared to other automated analysers and manual differential. 18 Furthermore, for the Sysmex XN, discrepancies in counts have been observed only for basophils and for other leukocytes. 18,19 Our results show this trend is consistent in patients with myeloid neoplasms.…”

“…18 Furthermore, for the Sysmex XN, discrepancies in counts have been observed only for basophils and for other leukocytes. 18,19 Our results show this trend is consistent in patients with myeloid neoplasms.…”