Spurious low WBC count in the WNR channel of Sysmex XN-9000 hematology analyzer in a case with leukocyte aggregation

Dai, Qinsheng; Peng, Lincai; Shi, Rui

doi:10.1515/cclm-2022-1308

Cited by 1 publication

(1 citation statement)

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“…FSCW is usually a signal of leukocyte size, and the widening of the plot may be due to (1) the presence of leukocyte aggregation or (2) the detection of abnormal particles because of reactions between acid hemolytic agents in the reagents. The appearance of such interfering substances in the WNR can affect the measurement as a discrepancy in the WBC count between channels [12], [13].…”

Section: Discussionmentioning

confidence: 99%

Deviation in White Blood Cell Count Measurement between WNR and WDF Channels on an Automated Hematology Analyzer XN-3000: A Case Report

Doi,

Matsuura,

Akiyama

et al. 2023

SEE J Immunol

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BACKGROUND: At present, complete blood count (CBC) testing is one of the most common clinical tests. The XN-3000 used in our hospital utilizes the principles of impedance and semiconductor laser flow cytometry, which contains two types of leukocyte fractionation methods: White cell nucleated (WNR) and white cell differential (WDF) channels. CASE PRESENTATION: Herein, we present the case of a 63-year-old male patient who was admitted to our hospital for the treatment of non-small cell lung cancer (T4N3M1 [LYM, HEP, and OSS]). Biochemical data showed abnormal liver function and anemia. WNR results showed poor leukocyte and debris fractions compared with WDF results, and leukocyte counts were different between the two channels. However, the poor fractionation of the leukocyte and debris fractions in the WNR was resolved at the twofold dilution stage. To investigate the cause of the problem, precipitates affecting the WNR measurement were visually checked. Consequently, insoluble precipitates were observed in the WNR mixture of the specimen of the patient. In our hospital, we measure 1200 CBCs/day and very rarely encounter abnormal specimens such as in the presented case. Normally, leukocyte counts are reported in priority to those measured by the WNR channel; however, in this case, the switching function was effective in giving priority to WDF count results because of the appearance of abnormal WNR plots. However, a system that can promptly confirm events when results are reported is necessary. CONCLUSION: We very rarely encounter abnormal specimens such as in the presented case. Normally, leukocyte counts are reported in priority to those measured by the WNR channel; however, in this case, the switching function was effective in giving priority to WDF count results because of the appearance of abnormal WNR plots. However, a system that can promptly confirm events when results are reported is necessary. When no clinical request for WDF measurement was made, the WNR scattergram must be confirmed, dilution measurement, if necessary, must be performed, or the WDF must be measured and reported to the clinician as useful criteria for diagnosis.

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Section: Discussionmentioning

confidence: 99%