sysmex xn2000: experiences and case studies · thank you references: 1. various sysmex xn documents...
TRANSCRIPT
Sysmex XN2000: experiences and case studies
Craig Mabbett
2016
2016
Add pic of XN2000 setup now.
2016
XN-2000
• Automatic reflexing
• Customisable rules
• No sensitivity calibration
• Customisable printout
• Film review rate?
Dislikes?
• Aged sample flag > disabled!
• Suspect sample flag > ? Necessary with
experienced staff and delta checks
• ”Analyser is not ready” alarm > annoying!
• QC -printing to PDF would be nice
-QC comments do not print
-file delivery system
• XbarM > more errors compared to XT (this may be
related to IPU settings)
WDF
• Not much change in function from XT
• improved scatter separation/gating
• Left shift flag = improved specificity
• Blasts/Abn Lympho?
now reflexes to >
• PLT Clumps?
now reflexes to >
WNR
• Automated NRBC
>reduced TAT for some films
• automatic film review >1%
• LIS limitations (would be nice if
TNC-N was a reportable parameter!)
RET
• No Change in function but now have
access to RET-He feature
• Other useful pararmeters RBC-O,
Hb-O, MCHC-O, PLT-O
• RET channel can be used as an
alternative to warming for cold aggs
(reaction chamber incubated at 41°C
for ~21sec)
• Available on all XNL models
RET-He
• In house study 2017 n = 178
• Aim to assess RET-He as a screening
tool for iron deficiency
• Ret-He reported in pg and is a function
of RBC size (FSC)
• Reference range 30.0 - 35.0 pg
• Cut off for iron deficiency <26 pg
• Screening tool only (not diagnostic) but
could be enhanced by using an
algorithm.
Normal
Fe deficient
PLT-F
• Reflexed if PLT IP flag or if
PLT-I <30 x109/L
• PLT Clumps? flag very specific
• PLT Abn Distribution flag
– Giant PLT (MPD/MDS)
– Large PLT (pregnancy, ITP)
– PLT Anisocytosis
– PLT clumps don’t seem to trigger
• PLT Abn Scattergram
– WBC fragments
• IPF
– Measure platelet production
Onboard Rules
• Extremely customisable
• Great feature for smaller labs, or labs that don’t have
access to middleware.
REACTIVE LYMPHS
COLD AGGS RULE
No more 20min warming! R-MFV = MCV RBC-O = RBC
WPC
• White Precursor Cell Channel
Reflexed if: Blasts/Abn Lympho?
WBC>30 or WBC <2
WPC
WPC
• 2016 WPC Qflag study to asses
> Blasts/Abn Lympho? (WDF)
> Blast? (WPC)
> Abn Lympho? (WPC)
• Analysed 2 months of WPC data (279 samples)
• Films reviewed and classified by gold standard
morphologists…
• Film correlated with clinical details (and/or cell
markers and bone marrow report if available)
>Classified as positive (sepcific abnormal cell present)
or negative (specific abnormal cell absent)
WPC
• Data used to predict cut-offs for each IP flag
that would result in the most improved
specificity without sacrificing sensitivity (ie.
false negatives are unacceptable)
RESULTS:
• WDF Blasts/Abn Lympho? = low specificity
> Qflag changed to 110
• WPC
>Blasts? Results suggest Qflag of 140
>Abn Lympho? Results suggest Qflag of 140
Abn Lympho? Final Qflag = 120>Specificity inferior to Blast flag
(Can be triggered by reactive lymphocytes)
Blast? Final Qflag = 120
>Better specificity than Abn Lymph?
P.V. ?transforming to MF
Blast? Qflag = 300
PV patient with occ blast
14/07/2017
Blast? Qflag = 300
17/07/2016
Abn Lympho? Qflag = 300
Hairy Cell Leukaemia
Abn Lymph? Qflag = 250
CLL
Abn Lymph? Qflag = 300
Mantle Cell Lymphoma
Abn Lymph? Qflag = 300
Dengue
Blast? Qflag = 300
Atypical lymph ? Qflag =300
AMML
Blast? Qflag = 160
WPC
• Limitations of study:
Negative films (Qflag <100) were not reviewed
Data set could be larger (but study ongoing)
Did not encompass all possible neoplastic conditions
Morphologist bias
WPC bottom line:
Great as a support tool to assist morphologists
>Specificity vs sensitivity
>?usefulness with Cellavision
>?usefulness to an experienced morphologist
>cost
Case Study
• 24 day old Female (full term gestation)
• Admitted for jaundice investigation
• Bloods indicate severe anaemia…
Case Study
??
Film comment:
Occasional immature cell present;
spherocytes +; polychromasia +;
occasional red cell fragment
Case Study
• MCHC does not correct with warming
• Bilirubin 611µmol/L ?Hb interference
>Hb 67 / Hb-O 60
>MCHC 427 / MCHC-O 380
>MCH 53.6 / RBC-He 30.9
Possibly, but doesn’t explain RBC histogram
• ?Agglutination, ?Haemolysis
• Film reviewed by Charge scientist = ?mild agglutination
Case Study
Red cell indices incorrect ?solution
Use RBC-O, R-MFV, Hb-O
And recalculate others:
Spun HCT = corrected HCT (confirms calculation)
Uncorrected Corrected
Hb 67 60
RBC 1.25 1.83
HCT 0.157 0.176
MCV 125.6 96.0
MCH 53.6 32.6
MCHC 427 341
Case Study
• Futher testing:
>Parvovirus B19 serology: IgM negative
> G6PD studies: negative
>Blood bank: DAT: positive
Group: Coating IgG and C3d. Blood group cannot be
determined
>NZBS reference lab: After DTT treatment, blood group appears to be
A positive. Strong C3d coating on red cells is
causing interference with serological testing.
Repeat at 6 months of age if indicated.
Older Sibling was noted to have a rash at the time this occurred. Tested
negative for Parvovirus serology, but positive for CMV.
>Diagnosis??
Thank youReferences:
1. Various Sysmex XN documents -Roche diagnostics
2. Sysmex Corporation Japan. (2012). Sysmex XN2000 instructions for use.
3. Brugnara C, Schiller B, Moran J. Reticulocyte hemoglobin equivalent (Ret-He) and assessment of
iron-deficient states. Clin Laboratory Haematol, 2006. 28, 303-308.
4. Mast A, Blinder M, Quing L, Flax S, Dietzen D. Clinical utility of the reticulocyte hemoglobin
content in the diagnosis of iron deficiency. Blood, 2002. 99(4), 1489-1491.
It’s not the size of your track that
matters, it’s how you use it!