Performance of the Sysmex White Precursor Channel to discover circulating leukemic blast cells

Sejrup, Jesper; Pedersen, David M.; Phillipsen, Jens P.; Nielsen, Jesper Østrup; Koch, Sheila Perez Rovsing; Smith, Julie

doi:10.1111/ijlh.13274

Cited by 2 publications

(6 citation statements)

References 19 publications

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“… 2 In the case of leucopenia, blasts may be further missed due to infrequency. 4 Our study demonstrated that microscopy remains the gold standard in the detection of blasts in patients with a low WCC, patients with a malignancy, and patients receiving chemotherapy.…”

Section: Discussionmentioning

confidence: 69%

“… 13 Although the WPC, employed by the XN-series, has improved the detection of blasts, the literature demonstrates a low specificity and variable sensitivity (60% – 100%). 4 A study conducted in Denmark in 2020 revealed that the WPC produced a high number of FP (14.5%) and FN (12.8%) results when detecting blasts, possibly due to leucopenia and a low number of circulating blast cells. 4 Our study demonstrated a sensitivity of 96.3% and a specificity of 84.9% for the blast flag, and the blast count ranged from 0% to 78%.…”

Section: Discussionmentioning

confidence: 99%

“… 4 A study conducted in Denmark in 2020 revealed that the WPC produced a high number of FP (14.5%) and FN (12.8%) results when detecting blasts, possibly due to leucopenia and a low number of circulating blast cells. 4 Our study demonstrated a sensitivity of 96.3% and a specificity of 84.9% for the blast flag, and the blast count ranged from 0% to 78%. The sensitivity and specificity of the blast WBC flag were determined to be influenced by leucopenia (WCC of ≤ 1.5 × 10 9 /L).…”

Section: Discussionmentioning

confidence: 99%

“…However, there are limitations in the specificity and sensitivity of these flags. 4 The Sysmex XN-3000 automated FBC analyser (Sysmex Corporation, Kobe, Japan) has white cell differential, white cell nucleated, and white cell precursor (WPC) channels, with the WPC channel demonstrated to possess an improved sensitivity for detecting blasts. 5 …”

Section: Introductionmentioning

confidence: 99%

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Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa

Ramiah,

Pillay,

Rapiti

2023

African Journal of Laboratory Medicine

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Background: Automated haematology analysers such as the Sysmex XN-3000 (Sysmex Corporation, Kobe, Japan) utilise white blood cell (WBC) flags to identify quantitative and qualitative abnormalities. Owing to clinical and biological factors, the sensitivity and specificity of the flags vary when compared to microscopy, the gold-standard method for assessing peripheral blood smear (PBS) morphology.Objective: This study assessed the performance of the Sysmex XN-3000 haematology analyser in comparison to PBS microscopy for the detection of WBC abnormalities.Methods: We collected 250 random full blood count samples from the haematology laboratory at Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa, from March 2022 to April 2022. The performance of the automated WBC flags of the Sysmex XN-3000 was assessed in comparison to PBS microscopy, and the impact of established clinical variables on the performance of the flags was determined.Results: The sensitivity of the ‘blast’ flag was 96.3%, and the specificity was 84.9%. The efficiency of the flag was adversely impacted by low white cell counts ( 1.5 × 109/L; p 0.001), chemotherapy (p = 0.002), malignancy (p = 0.02), and infection (p = 0.02). The ‘abnormal lymphocyte’ flag demonstrated a sensitivity of 90% and a specificity of 96.2%, and its performance was adversely impacted by chemotherapy exposure (p = 0.03). Three cases (1.2%) erroneously flagged as ‘monocytosis’ demonstrated blasts on microscopy.Conclusion: In our setting, PBS microscopy remains necessary to confirm blasts, abnormal lymphocytes, and monocytosis in patients with malignancy, current chemotherapy exposure, low white cell counts, and infection.What this study adds: This study adds evidence that PBS morphology remains the gold standard for confirming WBC abnormalities in patients with a history of malignancy, chemotherapy, and leucopenia.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa

Ramiah,

Pillay,

Rapiti

2023

African Journal of Laboratory Medicine

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“…The only difference between XN10 and XN20 modules is the integration of the White Precursor Channel (WPC channel) for XN20. 2 Our control samples and patient samples in this study were placed in a specific rack informing the XN9000 system that the sample must be analyzed on all five modules. They were done so in the same consecutive order-module one to five.…”

Section: Materials S and Me Thodsmentioning

confidence: 99%

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

Koch

Thomasen

Nielsen

et al. 2021

Int J Lab Hematology

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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.

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Performance of the Sysmex White Precursor Channel to discover circulating leukemic blast cells

Cited by 2 publications

References 19 publications

Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa

Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa

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

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