Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer

Anne Winther-Larsen; Else Marie Vestergaard; Anders Abildgaard

doi:10.1515/cclm-2024-0973

Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer

Anne Winther-Larsen, Else Marie Vestergaard, Anders Abildgaard

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

Abstract

Objectives: A smear review is typically made in flagged differential counts performed with hematology analyzers although the clinical value of such reviews is uncertain. Therefore, we evaluated the differences in differential counts between Sysmex XN-9000 and a smear review in flagged samples. Furthermore, the clinical value of blasts identified was investigated. Methods: Data on all differential counts performed in a two-year period were identified at two laboratories. In patients with blasts, the electronic health record was reviewed. Agreement between automated and manual differential counts was evaluated by Bland-Altman plots. Concordance between the two methods categorized according to reference intervals was evaluated and adjusted for irrelevant non-concordance caused by random analytical error. Results: In total, 5,500 flagged differential counts were identified from 4,092 patients. A good agreement between the automated and manual differential count was found for all cell types (-0.480 × 10⁹/L to 0.297 × 10⁹/L). The concordance between the two methods was excellent for all cell types, except for monocytes (82%) where the automated estimates were higher than the manual in 19% of samples. Blasts were identified in 241 (1%) of smear reviews. Acute leukemia was diagnosed in 13 (5%) patients, and only in one patient contributed the detection of blasts to the suspicion of acute leukemia. Conclusions: Our findings indicate that routine smear review of all flagged samples do not contribute with additional, significant information. After local validation and dialogue with clinical departments, such reviews may potentially be omitted to increase cost-effectiveness and reduce turn-around-time.

Original language	English
Journal	Clinical Chemistry and Laboratory Medicine
Volume	63
Issue	3
Pages (from-to)	636-644
Number of pages	9
ISSN	1434-6621
DOIs	https://doi.org/10.1515/cclm-2024-0973
Publication status	Published - 1 Feb 2025

Keywords

Sysmex hematology analyzer
blasts
smear review
white blood cell differential count

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10.1515/cclm-2024-0973

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title = "Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer",

abstract = "Objectives: A smear review is typically made in flagged differential counts performed with hematology analyzers although the clinical value of such reviews is uncertain. Therefore, we evaluated the differences in differential counts between Sysmex XN-9000 and a smear review in flagged samples. Furthermore, the clinical value of blasts identified was investigated. Methods: Data on all differential counts performed in a two-year period were identified at two laboratories. In patients with blasts, the electronic health record was reviewed. Agreement between automated and manual differential counts was evaluated by Bland-Altman plots. Concordance between the two methods categorized according to reference intervals was evaluated and adjusted for irrelevant non-concordance caused by random analytical error. Results: In total, 5,500 flagged differential counts were identified from 4,092 patients. A good agreement between the automated and manual differential count was found for all cell types (-0.480 × 109/L to 0.297 × 109/L). The concordance between the two methods was excellent for all cell types, except for monocytes (82%) where the automated estimates were higher than the manual in 19% of samples. Blasts were identified in 241 (1%) of smear reviews. Acute leukemia was diagnosed in 13 (5%) patients, and only in one patient contributed the detection of blasts to the suspicion of acute leukemia. Conclusions: Our findings indicate that routine smear review of all flagged samples do not contribute with additional, significant information. After local validation and dialogue with clinical departments, such reviews may potentially be omitted to increase cost-effectiveness and reduce turn-around-time.",

keywords = "Sysmex hematology analyzer, blasts, smear review, white blood cell differential count",

author = "Anne Winther-Larsen and Vestergaard, {Else Marie} and Anders Abildgaard",

note = "{\textcopyright} 2024 the author(s), published by De Gruyter, Berlin/Boston.",

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doi = "10.1515/cclm-2024-0973",

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Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer. / Winther-Larsen, Anne ; Vestergaard, Else Marie ; Abildgaard, Anders.
In: Clinical Chemistry and Laboratory Medicine, Vol. 63, No. 3, 01.02.2025, p. 636-644.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer

AU - Winther-Larsen, Anne

AU - Vestergaard, Else Marie

AU - Abildgaard, Anders

PY - 2025/2/1

Y1 - 2025/2/1

N2 - Objectives: A smear review is typically made in flagged differential counts performed with hematology analyzers although the clinical value of such reviews is uncertain. Therefore, we evaluated the differences in differential counts between Sysmex XN-9000 and a smear review in flagged samples. Furthermore, the clinical value of blasts identified was investigated. Methods: Data on all differential counts performed in a two-year period were identified at two laboratories. In patients with blasts, the electronic health record was reviewed. Agreement between automated and manual differential counts was evaluated by Bland-Altman plots. Concordance between the two methods categorized according to reference intervals was evaluated and adjusted for irrelevant non-concordance caused by random analytical error. Results: In total, 5,500 flagged differential counts were identified from 4,092 patients. A good agreement between the automated and manual differential count was found for all cell types (-0.480 × 109/L to 0.297 × 109/L). The concordance between the two methods was excellent for all cell types, except for monocytes (82%) where the automated estimates were higher than the manual in 19% of samples. Blasts were identified in 241 (1%) of smear reviews. Acute leukemia was diagnosed in 13 (5%) patients, and only in one patient contributed the detection of blasts to the suspicion of acute leukemia. Conclusions: Our findings indicate that routine smear review of all flagged samples do not contribute with additional, significant information. After local validation and dialogue with clinical departments, such reviews may potentially be omitted to increase cost-effectiveness and reduce turn-around-time.

AB - Objectives: A smear review is typically made in flagged differential counts performed with hematology analyzers although the clinical value of such reviews is uncertain. Therefore, we evaluated the differences in differential counts between Sysmex XN-9000 and a smear review in flagged samples. Furthermore, the clinical value of blasts identified was investigated. Methods: Data on all differential counts performed in a two-year period were identified at two laboratories. In patients with blasts, the electronic health record was reviewed. Agreement between automated and manual differential counts was evaluated by Bland-Altman plots. Concordance between the two methods categorized according to reference intervals was evaluated and adjusted for irrelevant non-concordance caused by random analytical error. Results: In total, 5,500 flagged differential counts were identified from 4,092 patients. A good agreement between the automated and manual differential count was found for all cell types (-0.480 × 109/L to 0.297 × 109/L). The concordance between the two methods was excellent for all cell types, except for monocytes (82%) where the automated estimates were higher than the manual in 19% of samples. Blasts were identified in 241 (1%) of smear reviews. Acute leukemia was diagnosed in 13 (5%) patients, and only in one patient contributed the detection of blasts to the suspicion of acute leukemia. Conclusions: Our findings indicate that routine smear review of all flagged samples do not contribute with additional, significant information. After local validation and dialogue with clinical departments, such reviews may potentially be omitted to increase cost-effectiveness and reduce turn-around-time.

KW - Sysmex hematology analyzer

KW - blasts

KW - smear review

KW - white blood cell differential count

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U2 - 10.1515/cclm-2024-0973

DO - 10.1515/cclm-2024-0973

M3 - Journal article

C2 - 39321044

SN - 1434-6621

VL - 63

SP - 636

EP - 644

JO - Clinical Chemistry and Laboratory Medicine

JF - Clinical Chemistry and Laboratory Medicine

IS - 3

ER -

Clinical value of smear review of flagged samples analyzed with the Sysmex XN hematology analyzer

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Keywords

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