Immature granulocyte count on the new Sysmex XN-9000: performance and diagnosis of sepsis in the intensive care unit

Introduction. The amount of immature leukocytes reflects marrow response to bacterial infection, and this may be quantified as the band or immature granulocyte (IG) count. The aim of this study was to analyze the IG count performance of the Sysmex XN-9000 hematology analyzer in intensive care unit (ICU) patients. Methods. 480 peripheral blood samples from adult patients admitted to the ICU (301 control, 119 sepsis and 60 septic shock) were analyzed with Sysmex XN-9000. Serum C reactive protein (CRP) was measured on Siemens ADVIA 2400. IG count in peripheral blood was determined either by XN-9000 or optical microscopy (OM). Agreement between the two methods was assessed with Pearson’s correlation, Passing-Bablok regression and Bland Altman bias. Diagnostic accuracy was estimated through ROC curves analysis. Sysmex XN-9000 imprecision and within-run precision were also evaluated. Results. Pearson’s correlation (r) relative to IG count, as absolute and percentage values, was 0.89 (p <0.0001) and 0.74 (p <0.0001), respectively, with a Bias of 0.22 and 1.69 respectively. The Area Under the curve (AUC) for the IG count for diagnosing sepsis was greater on XN-9000 than OM and equal to the serum CRP. The diagnostic accuracy of IG counts improves when taking into account the conventional criteria for diagnosing sepsis. Conclusion. IG count appears suitable and reliable when performed using XN-9000. Even if a modest overestimation was found, the diagnostic accuracy showed by IG analysis on XN-9000 may represent a valid alternative to OM count for diagnosing sepsis in ICU patients

A Preliminary Proposal for Quality Control Assessment and Harmonization of Leukocytes Morphology-Structural Parameters (Cell Population Data Parameters)

Background: The cell population data (CPD) measured by Sysmex XN-9000 can be used for screening many hematological and non-hematological disorders. Since little information is available on harmonization of CPD among different instrumentation and clinical laboratories, this study aimed at assessing the current degree of CPD harmonization between separate Sysmex XN modules allocated to the same laboratory.Methods: A total number of 78291 data were used for verification of within-run imprecision, analyzers harmonization, reference ranges and assessment of blood sample stability of CPD parameters, including results of daily quality control testing and those generated in samples collected from blood donors and healthy volunteers.Results: Within-run imprecision of CPD parameters ranged between 0.4 and 14.1%. Good agreement was found among five different XN-modules, especially when values were adjusted after calculation of instrument-specific alignment factors. The bias of all parameters remained always lower than the reference change values in samples stored for up to 8 hours, regardless of storage temperature.Conclusions: The imprecision of CPD parameters was acceptable, except for those reflecting the dispersion of cellular clusters. Due to the lack of reference control materials, we showed that the use of data generated on a large number of normal routine samples (i.e., a Moving Average population) may be a reliable approach for testing analyzers harmonization. Nevertheless, availability of both calibration and quality control materials for these parameters is highly advisable in the future. We finally showed that whole blood samples may be stable for up to 2-4 hours for most CPD parameters

Infection fatality ratio of SARS-CoV-2 in Italy

We analyzed 5,484 close contacts of COVID-19 cases from Italy, all of them tested for SARS-CoV-2 infection. We found an infection fatality ratio of 2.2% (95%CI 1.69-2.81%) and identified male sex, age >70 years, cardiovascular comorbidities, and infection early in the epidemics as risk factors for death

Clinical usefulness of automated cellular analysis of synovial fluids: a paradigmatic case report for diagnosing peri-prosthetic infections

We describe here the case of an 18 years old male patient who underwent osteosynthesis surgery with a plate and screws for multi-fragment fracture of his right femur, in December 2000. The patient developed a series of complications up to May 2017, when he was readmitted with severe functional impairment and inability to walk without crutches. Physical examination revealed erythema, swelling at surgical site and leakage of pus from sinus-tract. An arthrocentesis was hence performed, followed by white blood cell count and differential in synovial fluid with Sysmex XN 2000 body fluid mode. The final leukocyte count was 38 7109/L, with 95% polymorphonuclear leukocytes (PMN), thus compatible with peri-prosthetic infection. The patient underwent additional surgery to remove the knee replacement, accurate debridement and antibiotic impregnated static cement spacer implantation. Three months after surgery, the patient was readmitted for removing the spacer, replaced by a new static device. In May 2018, surgical debridement and removal of the spacer was scheduled with resection arthroplasty. In November 2018 the patient presented again a sinus tract, and underwent another arthrocentesis for physical and microbiological examination of synovial fluid. The leukocyte count in the synovial fluid was again performed with Sysmex XN 2000 body fluid mode, and revealed the presence of 44.5 7109/L cells, with 90% PMN. The synovial fluid was positive for Van-A Enterococcus faecalis, so that right hip disarticulation was urgently planned. In conclusions, this case provides clear evidence that automated leukocyte count and differential in synovial fluid shall now be considered an unavoidable part of the diagnostic approach to patients with suspected peri-prosthetic infections

Harmonization of laboratory hematology: a long and winding journey

Harmonization of laboratory hematology: a long and winding journe

Platelet Transfusion Thresholds: How Low Can We Go in Respect to Platelet Counting?

Platelet transfusion is conventionally used to prevent or treat bleeding in patients with low platelet counts or impaired platelet function. The identification of accurate thresholds of platelet count for guiding platelet transfusion practices is a crucial aspect in health care to prevent adverse events, side effects, unwarranted costs for the health care service, and deprivation of supplies. This article is therefore aimed at providing a narrative overview on current guidelines and recommendations for platelet transfusion across many clinical settings, including platelet function disorders, and critically analyzing the available platelet transfusion thresholds according to the current analytical performance of platelet counting with automated hematological analyzers. Overall, universal agreement on the definition of platelet transfusion thresholds has not been reached. The degree of accuracy and imprecision of many fully automated hematological analyzers appears also unsatisfactory, especially at the lower thrombocytopenic range, and this may thus jeopardize the managed care of patients who are candidates for platelet transfusions. Potential solutions to overcome the current shortcomings of automated platelet counting are also discussed, encompassing the use of alternative tests for guiding platelet transfusion (e.g., thrombin generation assays or thromboelastography) along with innovative approaches for platelet enumeration (e.g., fluorescent labeling and flow cytometry)

Harmonization of interpretative comments in laboratory hematology reporting: the recommendations of Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC)

The goal of harmonizing laboratory testing is contributing to improving the quality of patient care and ultimately ameliorating patient outcome. The complete blood and leukocyte differential counts are among the most frequently requested clinical laboratory tests. The morphological assessment of peripheral blood cells (PB) through microscopic examination of properly stained blood smears is still considered a hallmark of laboratory hematology. Nevertheless, a variable inter-observer experience and the different terminology used for characterizing cellular abnormalities both contribute to the current lack of harmonization in blood smear revision. In 2014, the Working Group on Diagnostic Hematology of the Italian Society of Clinical Chemistry and Clinical Molecular Biology (WGDH-SIBioC) conducted a national survey, collecting responses from 78 different Italian laboratories. The results of this survey highlighted a lack of harmonization of interpretative comments in hematology, which prompted the WGDH-SIBioC to develop a project on "Harmonization of interpretative comments in the laboratory hematology report", aimed at identifying appropriate comments and proposing a standardized reporting system. The comments were then revised and updated according to the 2016 revision of the World Health Organization classification of hematologic malignancies. In summary, the purpose of revaluating comments was aimed at: (a) reducing their overall number, (b) standardizing the language

Automated cerebrospinal fluid cell counts using the new body fluid mode of Sysmex UF-1000i

Background: We evaluated the new body fluid module on Sysmex UF1000i (UF1000i-BF) for analysis of white blood cell (WBC) and red blood cell (RBC) in cerebrospinal fluid (CSF). Methods: WBC and RBC counting were compared between UF1000i-BF and Fuchs-Rosenthal counting chamber in 67 CSF samples. This study also included the evaluation of between-day precision, limit of blank (LoB), limit of detection (LoD), functional sensitivity (limit of quantitation, LoQ), carryover and linearity. Diagnostic agreement for differentiation between normal and increased WBC counts (>= 5.0 x 10(6)/L) was also assessed. Results: The agreement between UF1000i-BF and manual WBC counts was otpiaml in all CSF samples (r = 0.99; y = 1.05x + 0.09). A modest overestimation was noticed in samples with WBC = 18 x 10(6)/L (r = 0.98; y = 1.01x + 8.90). Between-day precision was good, with coefficient of variations (CVs) lower than 7.2% for both WBC and RBC. The LoBs were 0.1 x 10(6) WBC/L and 1.2 x 10(6) RBC/L, the LoDs were 0.7 x 10(6) WBC/L and 5.5 x 10(6) RBC/L, the LoQswere 2.4x10(6) WBC/L and 18.0 x 10(6) RBC/L, respectively. Linearity was excellent (r = 1.00 for bothWBC and RBC). Carryover was negligible. Excellent diagnostic agreement was obtained at 4.5 x 10(6) WBC/L cut-off (sensitivity, 100%; specificity, 97.4%). Conclusion: The UF1000i-BF provides rapid and accurate WBC and RBC counts in clinically relevant values of CSF cells. The use of UF1000i-BF may hence allow to replace routine optical counting, except for samples displaying abnormal WBC counts or abnormal scattergram distribution, for which differential cell counts may still be required. (C) 2015 Wiley Periodicals, Inc