The flagging features of the Sysmex XN-10 analyser for detecting platelet clumps and the impacts of platelet clumps on complete blood count parameters

Peng Xu; Kui Fang; Xiling Chen; Yangruiqi Liu; Zheqing Dong; Ji Zhu; Keda Lu

doi:10.1515/cclm-2021-1226

Article

The flagging features of the Sysmex XN-10 analyser for detecting platelet clumps and the impacts of platelet clumps on complete blood count parameters

Peng Xu , Kui Fang , Xiling Chen , Yangruiqi Liu , Zheqing Dong , Ji Zhu and Keda Lu

Published/Copyright: February 23, 2022

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 60 Issue 5

Abstract

Objectives

Platelet clumps present in anticoagulant specimens may generate a falsely decreased platelet count and lead to an incorrect diagnosis. A clear understanding of the ability of a haematology analyser (HA) to detect platelet clumps is important for routine work in the clinical laboratory.

Methods

Citrate-anticoagulated whole-blood samples were collected from various patients as a negative group. Adenosine diphosphate (ADP)-induced platelet aggregation was performed on those negative samples to mimic platelet-clump-containing (positive) samples. The ‘platelet clumps’ and ‘platelet abnormal’ flags generated by the Sysmex XN-10 instrument were used to assess the flagging performance of this HA and demonstrate its flagging features. The complete blood count (CBC) results of paired negative and positive samples were compared to evaluate the impact of platelet clumps on the CBC parameters.

Results

A total of 187 samples were eligible for this study. The total accuracy, sensitivity, and specificity of the platelet clumps flag were 0.786, 0.626, and 0.947, respectively. The total accuracy, sensitivity, and specificity of the platelet abnormal flag were 0.631, 0.348, and 0.914, respectively. A separate assessment focusing on the positive samples with low platelet counts showed that the total sensitivities of the platelet clumps and platelet abnormal flags were 0.801 and 1.000, respectively. Platelet clumps may interfere with the leukocyte count and with platelet and erythrocyte indices.

Conclusions

Platelet clumps can influence not only platelet indices but also leukocyte and erythrocyte counts. The Sysmex XN-10 instrument is sensitive to positive samples with low platelet counts but insensitive to those with high platelet counts.

Keywords: complete blood count; flagging quality; haematology analyser; platelet aggregates

Corresponding author: Keda Lu, Zhejiang Chinese Medical University Affiliated Third Hospital, Hangzhou 310000, P.R. China, E-mail: lukedazsyy@outlook.com

Peng Xu and Kui Fang contributed equally as co-first authors.

Funding source: Medical and Health Research Project of Zhejiang Province http://dx.doi.org/10.13039/501100017531

Award Identifier / Grant number: 2022KY931

Research funding: This work was supported by the Science Fund of the Medical and Health Research Project of Zhejiang Province. Project ID: 2022KY931.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors stated that there are no conflicts of interest regarding the publication of this article.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical approval: The study was approved by the Institutional Research Ethics Committee of The Third Affiliated Hospital of Zhejiang Chinese Medical University.

References

1. Bizzaro, N. EDTA-dependent pseudothrombocytopenia: a clinical and epidemiological study of 112 cases, with 10-year follow-up. Am J Hematol 1995;50:103–9. https://doi.org/10.1002/ajh.2830500206.Search in Google Scholar PubMed

2. Baccini, V, Geneviève, F, Jacqmin, H, Chatelain, B, Girard, S, Wuilleme, S, et al.. Platelet counting: ugly traps and good advice. Proposals from the French-Speaking Cellular Hematology Group (GFHC). J Clin Med 2020;9:808. https://doi.org/10.3390/jcm9030808.Search in Google Scholar PubMed PubMed Central

3. Deng, J, Chen, Y, Zhang, S, Li, L, Shi, Q, Liu, M, et al.. Mindray SF-Cube technology: an effective way for correcting platelet count in individuals with EDTA dependent pseudo thrombocytopenia. Clin Chim Acta 2020;502:99–101. https://doi.org/10.1016/j.cca.2019.12.012.Search in Google Scholar PubMed

4. Palmer, L, Briggs, C, Mcfadden, S, Zini, G, Burthem, J, Rozenberg, G, et al.. ICSH recommendations for the standardization of nomenclature and grading of peripheral blood cell morphological features. Int J Lab Hematol 2015;37:287–303. https://doi.org/10.1111/ijlh.12327.Search in Google Scholar PubMed

5. Bruegel, M, Nagel, D, Funk, M, Fuhrmann, P, Zander, J, Teupser, D. Comparison of five automated hematology analyzers in a university hospital setting: Abbott cell-dyn sapphire, Beckman coulter DxH 800, Siemens advia 2120i, Sysmex XE-5000, and Sysmex XN-2000. Clin Chem Lab Med 2015;53:1057–71. https://doi.org/10.1515/cclm-2014-0945.Search in Google Scholar PubMed

6. Fuster, Ó, Andino, B, Laiz, B. Performance evaluation of low platelet count and platelet clumps detection on Mindray BC-6800 hematology analyzer. Clin Chem Lab Med 2016;54:e49–51. https://doi.org/10.1515/cclm-2015-0409.Search in Google Scholar PubMed

7. Hawkins, J, Gulati, G, Uppal, G, Gong, J. Assessment of the reliability of the Sysmex XE-5000 analyzer to detect platelet clumps. Lab Med 2016;47:189–94. https://doi.org/10.1093/labmed/lmw016.Search in Google Scholar PubMed PubMed Central

8. Sandhaus, LM, Osei, ES, Agrawal, NN, Dillman, CA, Meyerson, HJ. Platelet counting by the Coulter LH 750, Sysmex XE 2100, and Advia 120: a comparative analysis using the RBC/platelet ratio reference method. Am J Clin Pathol 2002;118:235–41. https://doi.org/10.1309/mk3g-mc3v-p06r-pnv2.Search in Google Scholar

9. Chapman, K, Favaloro, EJ. Time dependent reduction in platelet aggregation using the multiplate analyser and hirudin blood due to platelet clumping. Platelets 2018;29:305–8. https://doi.org/10.1080/09537104.2017.1384540.Search in Google Scholar PubMed

10. D’Souza, C, Briggs, C, Machin, SJ. Platelets. The few, the young, and the active. Clin Lab Med 2015;35:123–31. https://doi.org/10.1016/j.cll.2014.11.002.Search in Google Scholar PubMed

11. Briggs, C, Harrison, P, Machin, SJ. Continuing developments with the automated platelet count. Int J Lab Hematol 2007;29:77–91. https://doi.org/10.1111/j.1751-553x.2007.00909.x.Search in Google Scholar PubMed

12. Briggs, CJ, Linssen, J, Longair, I, Machin, SJ. Improved flagging rates on the sysmex XE-5000 compared with the XE-2100 reduce the number of manual film reviews and increase laboratory productivity. Am J Clin Pathol 2011;136:309–16. https://doi.org/10.1309/ajcpdlr4kgkafw4w.Search in Google Scholar PubMed

13. Briggs, C, Longair, I, Kumar, P, Singh, D, Machin, SJ. Performance evaluation of the Sysmex haematology XN modular system. J Clin Pathol 2012;65:1024–30. https://doi.org/10.1136/jclinpath-2012-200930.Search in Google Scholar PubMed

14. Dai, Q, Zhang, G, Lai, C, Du, Z, Chen, L, Chen, Q, et al.. Two cases of false platelet clumps flagged by the automated hematology analyzer Sysmex XE-2100. Clin Chim Acta 2014;429:152–6. https://doi.org/10.1016/j.cca.2013.12.013.Search in Google Scholar PubMed

15. Zandecki, M, Genevieve, F, Gerard, J, Godon, A. Spurious counts and spurious results on haematology analysers: a review. Part II: white blood cells, red blood cells, haemoglobin, red cell indices and reticulocytes. Int J Lab Hematol 2007;29:21–41. https://doi.org/10.1111/j.1365-2257.2006.00871.x.Search in Google Scholar PubMed

16. Xiao, Y, Xu, Y. Concomitant spuriously elevated white blood cell count, a previously underestimated phenomenon in EDTA-dependent pseudothrombocytopenia. Platelets 2015;26:627–31. https://doi.org/10.3109/09537104.2014.963543.Search in Google Scholar PubMed

17. Schrezenmeier, H, Muller, H, Gunsilius, E, Heimpel, H, Seifried, E. Anticoagulant-induced pseudothrombocytopenia and pseudoleucocytosis. Thromb Haemostasis 1995;73:506–13. https://doi.org/10.1055/s-0038-1653805.Search in Google Scholar

18. Lombarts, AJPF, De Kieviet, W. Recognition and prevention of pseudothrombocytopenia and concomitant pseudoleukocytosis. Am J Clin Pathol 1988;89:634–9. https://doi.org/10.1093/ajcp/89.5.634.Search in Google Scholar PubMed

19. Igout, J, Fretigny, M, Vasse, M, Callat, MP, Silva, M, Willemont, L, et al.. Evaluation of the coulter LH 750 haematology analyzer compared with flow cytometry as the reference method for WBC, platelet and nucleated RBC count. Clin Lab Haematol 2004;26:1–7. https://doi.org/10.1111/j.0141-9854.2003.00577.x.Search in Google Scholar PubMed

20. Offermanns, S. Activation of platelet function through G protein-coupled receptors. Circ Res 2006;99:1293–304. https://doi.org/10.1161/01.res.0000251742.71301.16.Search in Google Scholar

21. Getz, TM, Dangelmaier, CA, Jin, J, Daniel, JL, Kunapuli, SP. Differential phosphorylation of myosin light chain (Thr)18 and (Ser)19 and functional implications in platelets. J Thromb Haemostasis 2010;8:2283–93. https://doi.org/10.1111/j.1538-7836.2010.04000.x.Search in Google Scholar PubMed PubMed Central

22. de Jonge, G, dos Santos, TL, Cruz, BR, Simionatto, M, Bittencourt, JIM, Krum, EA, et al.. Interference of in vitro hemolysis complete blood count. J Clin Lab Anal 2018;32:1–8. https://doi.org/10.1002/jcla.22396.Search in Google Scholar PubMed PubMed Central

23. Koplitz, SL, Scott, MA, Cohn, LA. Effects of platelet clumping on platelet concentrations measured by use of impedance or buffy coat analysis in dogs. J Am Vet Med Assoc 2001;219:1552–6. https://doi.org/10.2460/javma.2001.219.1552.Search in Google Scholar PubMed

24. Li, K, Peng, YG, Yan, RH, Song, WQ, Peng, XX, Ni, X. Age-dependent changes of total and differential white blood cell counts in children. Chin Med J (Engl) 2020;133:1900–7. https://doi.org/10.1097/cm9.0000000000000854.Search in Google Scholar

25. Korniluk, A, Koper-Lenkiewicz, OM, Kamińska, J, Kemona, H, Dymicka-Piekarska, V. Mean platelet volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediat Inflamm 2019;2019:1–14. https://doi.org/10.1155/2019/9213074.Search in Google Scholar PubMed PubMed Central

26. Iyer, KS, Dayal, S. Modulators of platelet function in aging. Platelets 2020;31:474–82. https://doi.org/10.1080/09537104.2019.1665641.Search in Google Scholar PubMed PubMed Central

27. Hardy, M, Lessire, S, Kasikci, S, Baudar, J, Guldenpfennig, M, Collard, A, et al.. Effects of time-interval since blood draw and of anticoagulation on platelet testing (count, indices and impedance aggregometry): a systematic study with blood from healthy volunteers. J Clin Med 2020;9:1–17. https://doi.org/10.3390/jcm9082515.Search in Google Scholar PubMed PubMed Central

28. Olsen, AK, Bladbjerg, EM, Jensen, AL, Hansen, AK. Effect of pre-analytical handling on haematological variables in minipigs. Lab Anim 2001;35:147–52. https://doi.org/10.1258/0023677011911516.Search in Google Scholar PubMed

Received: 2021-11-24

Accepted: 2022-02-11

Published Online: 2022-02-23

Published in Print: 2022-04-26

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Articles in the same Issue

https://doi.org/10.1515/cclm-2021-1226

Keywords for this article

complete blood count; flagging quality; haematology analyser; platelet aggregates