The Usefulness of Blast Flags on the Sysmex XE-5000 Is Questionable

Abstract

Hematology analyzers generate suspect flags that involve microscopic reviews to confirm the presence of pathologic cells. This study investigated the reliability of the blast flag in a side-by-side evaluation of 3 Sysmex XE-5000 instruments (Sysmex, Kobe, Japan). The repeatability of the Q values reported by each instrument for 10 replicates of the same blood samples was low (intraclass correlation coefficient [ICC] values, 0.62-0.74). The reproducibility of the Q values obtained by analyzing 408 samples on all 3 instruments was reasonable (ICC value, 0.85). In addition, a systematic difference was observed among the instruments in the level of reported Q values. With cutoff commonly being 100, the observed reproducibility of the blast flagging among the instruments was evaluated as poor (κ = 0.73). Based on the observed low performances, we question the usefulness of the Q value as a predictor of blasts and whether a blast flag reported by the XE-5000 is sufficient as a criterion for performing a microscopic review.

Comparison of abnormal cell flagging of the hematology analyzers Sysmex XN and Sysmex XE‐5000 in oncohematologic patients

“…Compared to the sensitivity results published in some papers for Sysmex XN, XE‐5000, and XE‐2100 analyzers , we obtained a relatively lower result. For Sysmex XE‐5000 analyzer, our results were closer to the ones found in other papers . The sensitivity results in our group of patients were similar to some published results with other analyzers as Abbott Cell‐Dyn Sapphire, ADVIA 2120, and Beckman Coulter DxH 800 and LH 750 .…”

Auto-validation of complete blood counts in an outpatient’s regional laboratory

“…The LUC in contrast to flags has controls, and increases the detection rate for acute leukemia in adults. Others have questioned the usefulness of the blast flags on the Sysmex XE-5000 because of the low repeatability in repeated measurements from the same sample in the same instrument, lack of agreement among harmonized instruments, and the inability to predict the presence and absence of blasts on peripheral smear review [18].…”

Evaluation of the detection of blasts by Sysmex hematology instruments, CellaVision DM96, and manual microscopy using flow cytometry as the confirmatory method

“…Despite the continuous improvement of the hematology analyzers, the flags are subject to ambiguities that require further examination. Several previous studies have evaluated the flagging performance of modern hematology instruments by comparing the data with the manual blood smear examination . Microscopic counting and characterization of blood cells have been considered as the reference method despite the fact that the method is cumbersome, time‐consuming, and also affected by inter‐observer differences.…”