Comparison of platelet counts by sysmex XE 2100 and LH-750 with the international flow reference method in thrombocytopenic patients

Background: There are several methods for counting platelets, of which the international flow reference method (IRM) is considered to be the gold standard. We compared the platelet count given by this method to the count given by automated analyzers using other methods, such as optical fluorescence and impedance. Aims: The aim of this study is to compare the platelet counts obtained by Sysmex XE 2100 by Impedance (Sysmex-I), optical florescence (Sysmex-O) and reported (Sysmex-R) based on the switching algorithm and LH-750 by Impedance (LH-750) with the IRM in thrombocytopenic blood samples. To calculate the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of various technologies at the clinically relevant transfusion thresholds of 10 × 10 9 /l and 20 × 10 9 /l. Materials and Methods: A total of 118 blood samples with platelet count of <50 × 10 9 /l were selected for the study. Platelet counts of all samples were analyzed by all methods using the Sysmex analyzer, LH-750 and IRM in parallel within 6 h of collection. Statistical Analysis Used: Pearson correlation, bland Altman analysis, sensitivity and specificity, PPV and NPV. Results and Conclusions: Sysmex-R had the least Bias and 95% limits of agreement (95%LA) range and thus correlated best with IRM values. LH-750 had a higher Bias compared to Sysmex-O and Sysmex-R, but a strikingly similar 95% LA ensures similar results in all three methods. In fact, in the oncology subset, it had the narrowest 95% LA, which made it the best performer in this subgroup. Of the three Sysmex results, Sysmex-I had the highest bias, widest 95% LA and highest potential risk of over transfusion. Hence, Sysmex-R and LH-750 were found to be reliable tools for estimation of platelet count in thrombocytopenic patients

Reference range evaluation of complete blood count parameters with emphasis on newer research parameters on the complete blood count analyzer Sysmex XE-2100

Since the advent of automation in the field of hematological cell counters there has been a constant refinement of the technology and increase in the number of newer parameters available on CBC analysers. Many novel parameters are being put into routine clinical use and both clinical evaluation and monitoring critically depend on knowledge of laboratory reference ranges. Here, we present reference interval for the Sysmex XE-2100, with emphasis on the novel or newer research parameters. Blood samples from a total of 122 clinically asymptomatic and apparently healthy subjects were evaluated and a final of 100 subjects (54-M, 46-F) were included in the study. A broad spectrum of parameters available with the analyser was assessed and reference ranges for the same evaluated

Sehgal index: A new index and its comparison with other complete blood count-based indices for screening of beta thalassemia trait in a tertiary care hospital

Introduction: Beta thalassemia trait (BTT) must be differentiated from iron deficiency anemia to avoid unnecessary iron therapy and for the prevention of thalassemia major by genetic counseling. In a tertiary care hospital, it is vital that the screening tool is not only sensitive but also specific so as to be cost effective and save time. Aim: The aim of this study was to evaluate the new Sehgal index and compare it to existing complete blood count-based indices for the best combination of sensitivity and specificity to predict BTT. Materials and Methods: Study was done in 2 phases - Phase 1: A retrospective analysis of 1022 consecutive high-performance liquid chromatography (HPLC) cases from July 2008 to June 2011. Phase 2: A prospective analysis of 973 consecutive HPLC cases from July 1, 2011 to June 10, 2013 was done to confirm the results of Phase 1 and the applicability of the new Sehgal index. Results: Prevalence of BTT was 28.8% (294/1022) and 25.39% (247/973) in Phase 1 and Phase 2, respectively. Receiver operating characteristic-area under the curve and Youden index was highest for new Sehgal index, followed by Mentzers index <14. The prospective study shows results similar to those in Phase 1 confirming the superiority of the above two indices. Conclusion: Sehgal index and Mentzers index <14 showed the best combination of sensitivity and specificity in predicting BTT. The best indices or combination can be used as a "validated flag rule" in the analyzer middleware program in a hospital for identifying suspected cases of BTT

Treatment of newly diagnosed paediatric acute lymphoblastic leukaemia on BFM-based chemotherapy protocol: Feasibility and outcome from a tertiary care center in India

Background: Data on outcomes in children with acute lymphoblastic leukaemia (ALL) who are on Berlin-Frankfurt-Munster (BFM)-based chemotherapy protocol is scarce from India. We share experience on the survival of children with ALL treated on the modified IC BFM 2002 protocol. Methods: Children (1–18 years) diagnosed with ALL between January 1, 2011 and January 1, 2021 at BLK-MAX Super Specialty Hospital were analyzed retrospectively. Patients were treated with modified IC BFM 2002 protocol. Data on the type of leukaemia, risk status, minimal residual disease (MRD), cytogenetic, and molecular genetics were collected. Disease free survival (DFS) and overall survival (OS) were calculated. Results: Hundred (88 B-cell, 12 T-cell) patients with ALL were evaluated. The median age at presentation was 6.5 years. According to the BFM risk stratification, 35 children were standard-risk, 45 were intermediate and 20 were high-risk. Bone marrow aspiration for MRD by flow cytometry on day 33 of induction chemotherapy was performed in 61 patients. One patient died on day 50 of induction. Day 78 MRD was performed in 60 patients. Day 78 MRD positivity was used for treatment escalation. There were 18 deaths. DFS as on 1st July 2023 for standard, intermediate and high-risk patients was 89%, 85% and 55% respectively. Overall survival in all risk groups was 82%. Conclusion: Treating childhood ALL with BFM-based chemotherapy protocol is feasible in developing countries without major modifications and with results comparable to those reported in Western literature

Comparison of “Amicus and COBE Spectra” for autologous peripheral blood stem cell harvest: An Indian experience

Background: Adequate collection of peripheral stem cells from the patients depends on the disease condition, efficient mobilization and the equipment used for PBSC harvest. COBE Spectra has been the major platform for collecting these PBSC for more than 2 decades. Now with introduction of PBSC harvest option with Amicus cell separators (which was used primarily for plateletpheresis) in India, it is worth while comparing both the platforms for stem cells collections. Materials and Methods: Our study is a retrospective analysis of autologous PBSC harvest procedures done at our centre. The study included the data of autologous PBSC collections from January 2015 to June 2016. Total 61 patients underwent 85 autologous PBSC harvests for both haematological and non haematological indications. Results: Out 61 patients, 40 patients collected their target number of cell in a single harvest, 18 patient required dual harvests and 3 patients required three consecutive days of harvest. Pre-Apheresis WBC, platelets and CD45/CD34 cell counts were comparable. COBE Spectra collects significantly higher product volume and higher number of platelets in the apheresis product. Whereas WBC counts of the product, total CD45/CD34 cell dose and collection efficiency (CE2) and collection ratio (CR) were comparable on both the platforms. Conclusions: Amicus took more time to harvest the anticipated number of cells in the graft as well as COBE Spectra resulted in higher platelets loss during the process of cell collection. Our analysis is first of its kind from Indian subcontinent and indicates that with gradual phasing out of COBE spectra from the market Amicus offers a comparative platform for PBSC harvest