Ambayya, A.

Meng, C.K.

Sasmita, A.O.

Sathar, J.

Ting, A.S

Yegappan, S.

Zhang, Q.-Y.

Unimas Institutional Repository

534 Med J Malaysia Vol 74 No 6 December 2019SUMMARYHaematological cellular structures may be elucidated usingautomated full blood count (FBC) analysers such as UnicelDxH 800 via cell population data (CPD) analysis. The CPDvalues are generated by calculating volume, conductivity,and five types of scatter angles of individual cells whichwould form clusters or populations. This study considered126 CPD parameter values of 1077 healthy Malaysian adultsto develop reference intervals for each CPD parameter. Theutility of the CPD reference interval established may rangefrom understanding the normal haematological cellularstructures to analysis of distinct cellular features related tothe development of haematological disorders andmalignancies.KEY WORDS:Cell population data; CPD; full blood count; reference interval;Unicel DxH 800INTRODUCTIONCell Population Data (CPD) generated in recent generationsof automated full blood count (FBC) analysers measure thecharacteristics of cells based on multiple light scatter anglesderived from flow cytometric digital morphology (FCDM)technology. The CPD generated by Unicel DxH 800 providesinformation on the volume (V), conductivity (C), and fivelight scatter angles as follow: Axial Light Loss A° (AL2), LowAngle Light Scatter 5.1° (LALS), Lower Median Angle LightScatter 10°-20° (LMALS), Upper Median Angle Light Scatter20o-42o (UMALS), and a fifth scatter channel called MALS,being the sum of Upper Median Angle Light Scatter 20°-42°and Lower Median Angle Light Scatter 10°-20° regions asdepicted in Figure 1.1Based on these CPD parameters, structural information andinternal complexity of the cells are identified includingindividual cell’s granularity as FCDM principles are beingadapted in the analysis. Given the integration of such featurein widely available laboratory equipment, laboratorypersonnel may utilise this exact feature to better comprehendhaematological cellular structures and how CPD might beaffected in varying aetiologies. In this study, we haveestablished the largest and most comprehensive referenceintervals of CPD on Unicel DxH 800 in a multi-ethnicpopulation of Malaysian adults.This is an extension study of our previously published workwhereby 2,725 apparently healthy adults comprising bothgenders and three principal races in Malaysia were recruitedthrough voluntary participations.2 We selected 1,077 healthyMalaysian adults aged 19 and above, both genders (403 maleand 675 female), and three principal racial groups (Malay,Chinese, and Indian) who had complete data for all CPDparameters in this study. All clinical aspects of this study hasbeen approved by the Medical Research Ethics Committee ofthe Ministry of Health of Malaysia (Research ID 10-277-5480). FBC analysis was performed on the Unicel DxH 800FBC analyser and CPD was retrieved for further analysis.Morphological H inclusion review, haemoglobin analysis,serum ferritin and serum soluble transferrin receptor assayswere performed on all cases. All CPD parameters in this studywere tested for normality using the Shapiro-Wilk test in totaland according to the predefined subgroups followed bydetermination of reference intervals, measures of centraltendency, and dispersion along the point estimates for eachsubgroup. One-way analysis of variance (ANOVA) was usedto compare mean values between gender, age and ethnicity.As we did not find any clinically significant differencesbetween the age group, gender, and racial groups for anyCPD parameter upon conducting ANOVA, the data wascombined. Reference intervals for 126 CPD parameters basedon the volume, conductivity, and five light scatter angles ofthe laser (MALS, UMALS, LMALS, LALS, AL2) whichencompass neutrophils, lymphocytes, monocytes,eosinophils, nucleated red blood cells, reticulocytes and earlygranulocyte cells were generated and each of their respectivereference intervals are elaborated in Table I.Based on reports, the utility of CPD extends from the properdiagnosis of aetiologies, including sepsis,3 dengue fever,4 andeven lymphoproliferative disorders.5 Due to the nature of thedisorders that affect the morphologies of blood cells, CPDanalysis  generate values which are distinguishable fromnormal subjects, and thus, it is worth noting that there is aninterest in establishing reference intervals of CPD in differentpopulations as genetic or geographical factors mayReference interval establishment of full blood countextended research parameters in the multi-ethnicpopulation of MalaysiaAngeli Ambayya, MSc1, Andrew Octavian Sasmita, BSc1, Qian-Yun Zhang, PhD3, Anselm Su Ting, PhD2, ChangKian Meng, MRCP1, Jameela Sathar, MRCP1, Subramanian Yegappan, MBBS11Clinical Haematology Referral Laboratory, Haematology Department, Hospital Ampang, Ampang, Selangor, Malaysia,2Department of Medicine and Health Science, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, Malaysia, 3Departmentof Pathology, University of New Mexico, Albuquerque, United States of AmericaSHORT COMMUNICATIONThis article was accepted: 9 August 2019Corresponding Author: Subramanian YegappanEmail: 13-Reference00177R4_3-PRIMARY.qxd  12/12/19  11:05 PM  Page 534

Reference interval establishment of full blood count extended research parameters in the multi-ethnic population of Malaysia

http://ir.unimas.my/id/eprint/28913/1/Reference%20interval%20establishment%20of%20full%20blood%20count%20extended%20research%20parameters%20in%20the%20multi-ethnic%20population%20of%20Malaysia_1-1_Abstract.pdf

Reference interval establishment of full blood count extended research parameters in the multi-ethnic population of Malaysia

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