Construction of platelet count-optical method reflex test rules using Micro-RBC#, Macro-RBC%, “PLT clumps?” flag, and “PLT abnormal histogram” flag on the Mindray BC-6800plus hematology analyzer in clinical practice

Yang Fei; Zhi-gang Xiong; Liang Huang; Chi Zhang

doi:10.1515/cclm-2024-0739

Article

Construction of platelet count-optical method reflex test rules using Micro-RBC#, Macro-RBC%, “PLT clumps?” flag, and “PLT abnormal histogram” flag on the Mindray BC-6800plus hematology analyzer in clinical practice

Yang Fei , Zhi-gang Xiong , Liang Huang and Chi Zhang

Published/Copyright: September 2, 2024

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From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 63 Issue 2

Abstract

Objectives

Utilizing RBC or PLT-related parameters to establish rules for the PLT-O reflex test can assist laboratories in quickly identifying specimens with interfered PLT-I that require PLT-O retesting.

Methods

Prospective PLT-I and PLT-O testing was performed on 6857 EDTA-anticoagulated whole blood samples, split randomly into training and validation cohorts at a 2:3 ratio. Reflex and non-reflex groups were distinguished based on the differences between PLT-I and PLT-O results. By comparing RBC and PLT parameter differences and flags in the training set, we pinpointed factors linked to PLT-O reflex testing. Utilizing Lasso regression, then refining through univariate and multivariate logistic regression, candidate parameters were selected. A predictive nomogram was constructed from these parameters and subsequently validated using the validation set. ROC curves were also plotted.

Results

Significant differences were observed between the reflex and non-reflex groups for 19 parameters including RBC, MCV, MCH, MCHC, RDW-CV, RDW-SD, Micro-RBC#, Micro-RBC%, Macro-RBC#, Macro-RBC%, MPV, PCT, P-LCC, P-LCR, PLR,“PLT clumps?” flag, “PLT abnormal histogram” flag, “IDA Anemia?” flag, and “RBC abnormal histogram” flag. After further analysis, Micro-RBC#, Macro-RBC%,“PLT clumps?”, and “PLT abnormal histogram” flag were identified as candidate parameters to develop a nomogram with an AUC of 0.636 (95 %CI: 0.622–0.650), sensitivity of 42.9 % (95 %CI: 37.8–48.1 %), and specificity of 90.5 % (95 %C1: 89.6–91.3 %).

Conclusions

The established rules may help laboratories improve efficiency and increase accuracy in determining platelet counts as a supplement to ICSH41 guidelines.

Keywords: complete blood count; automated hematology analyzer; platelet count; reflex test

Corresponding author: Liang Huang, Department of Blood transfusion, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan 430030, China, E-mail: qingbeier@aliyun.com; and Chi Zhang, Department of Laboratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave, Wuhan 430030, China, E-mail: zccdfile@163.com

Yang Fei and Zhi-gang Xiong contributed equally to this work.

Acknowledgments

The authors extend their gratitude to Jianping Xiao and Xiaosen Bian from Mindray Medical International Limited (Shenzhen, China), for their invaluable contribution in providing critical data support and statistical assistance. In addition, the authors wish to convey their sincere appreciation to Professor Liming Cheng and the entire team of the Department of Laboratory Medicine at Tongji Hospital for the invaluable assistance provided.

Research ethics: The study has complied with all relevant national regulations and institutional policies, obtained approval from the local Ethics Committee, and been granted a waiver of informed consent.
Informed consent: Not applicable.
Author contributions: Yei Fang and Chi zhang contributed to the intellectual content of this paper and drafted the manuscript. Zhi-gang Xiong and Liang Huang contributed to the collection and analysis of the experimental data, as well as revised the manuscript. All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: The authors state no conflict of interest.
Research funding: None declared.
Data availability: The datasets supporting the findings of this study can be obtained from the corresponding author upon a reasonable request.

References

1. Zandecki, M, Genevieve, F, Gerard, J, Godon, A. Spurious counts and spurious results on haematology analysers: a review. Part I: platelets. Int J Lab Hematol 2007;29:4–20. https://doi.org/10.1111/j.1365-2257.2006.00870.x.Search in Google Scholar PubMed

2. Bassi, C, Richard, C, Béné, MC, Eveillard, M. Interference in platelet count due to microspherocytosis related to extensive burn injury. Int J Lab Hematol 2022;44:57–8. https://doi.org/10.1111/ijlh.13690.Search in Google Scholar PubMed

3. Tantanate, C. Spuriously high platelet counts by various automated hematology analyzers in a patient with disseminated intravascular coagulation. Clin Chem Lab Med 2015;53:e257–9. https://doi.org/10.1515/cclm-2015-0055.Search in Google Scholar PubMed

4. Hatzipantelis, ES, Tsantali, H, Athanassiou-Metaxa, M, Avramidou, K, Zambul, D, Gombakis, N. Hereditary giant platelet disorder presented as pseudothrombocytopenia. Eur J Haematol 2001;67:330–1. https://doi.org/10.1034/j.1600-0609.2001.00604.x.Search in Google Scholar PubMed

5. Bao, Y, Wang, J, Wang, A, Bian, J, Jin, Y. Correction of spurious low platelet counts by optical fluorescence platelet counting of BC-6800 hematology analyzer in EDTA-dependent pseudo thrombocytopenia patients. Transl Cancer Res 2020;9:166–72. https://doi.org/10.21037/tcr.2019.12.58.Search in Google Scholar PubMed PubMed Central

6. Chen, S, Mao, Z, Wang, S, Deng, J, Liao, H, Zheng, Q. Micro-red blood cell, fragmented red blood cell, platelet distribution width, mean platelet volume, and platelet-large cell ratio on sysmex XN series hematology analyzers can Be used for the reflex test of impedance platelet count in clinical practice. Arch Pathol Lab Med 2024;148:61–7. https://doi.org/10.5858/arpa.2022-0030-oa.Search in Google Scholar

7. Westgard Quality Control. CLIA proposed acceptance limits for proficiency testing; 2024. https://westgard.com/clia-a-quality/quality-requirements/1002-2024-clia-requirements.html [Accessed 23 July 2024].Search in Google Scholar

8. Barnes, PW, McFadden, SL, Machin, SJ, Simson, E, International consensus group for hematology. The international consensus group for hematology review: suggested criteria for action following automated CBC and WBC differential analysis. Lab Hematol 2005;11:83–90. https://doi.org/10.1532/lh96.05019.Search in Google Scholar

9. Luo, X, Zhang, H, Luo, X, Geng, L, Liu, K. Pseudothrombocytosis due to small misshapen RBC and fragmented RBC in coexistence of beta thalassemia minor and secondary elliptocytosis. Int J Lab Hematol 2022;44:e29–31. https://doi.org/10.1111/ijlh.13678.Search in Google Scholar PubMed

10. Gulati, G, Uppal, G, Gong, J. Unreliable automated complete blood count results: causes, recognition, and resolution. Ann Lab Med 2022;4:515–30. https://doi.org/10.3343/alm.2022.42.5.515.Search in Google Scholar PubMed PubMed Central

11. Wang, L, Wang, H, Liang, H, Ren, Z, Gao, L. Giant platelets induce double interference in complete blood count. Ann Clin Lab Sci 2019;49:554–6.Search in Google Scholar

12. Guo, P, Cai, Q, Mao, M, Lin, H, Chen, L, Wu, F, et al.. Performance evaluation of the new platelet measurement channel on the BC-6800 Plus automated hematology analyzer. Int J Lab Hematol 2022;4:281–7. https://doi.org/10.1111/ijlh.13753.Search in Google Scholar PubMed

13. Sun, Y, Hu, Z, Huang, Z, Chen, H, Qin, S, Jianing, Z, et al.. Compare the accuracy and precision of Coulter LH780, Mindray BC-6000 Plus, and Sysmex XN-9000 with the international reference flow cytometric method in platelet counting. PLoS One 2019;14:e0217298. https://doi.org/10.1371/journal.pone.0217298.Search in Google Scholar PubMed PubMed Central

14. Shen, Y, Liu, D, Wang, Y, Cao, J, Zhang, S, Wen, H, et al.. Evaluation on clinical performance of the new low-value platelet measurement mode (PLT-8X) of BC-6800Plus. Ann Transl Med 2022;10:692. https://doi.org/10.21037/atm-22-1501.Search in Google Scholar PubMed PubMed Central

15. Hu, X, Tang, Y, Li, M, Fu, C, Deng, Z, Tang, W, et al.. Performance evaluation of optical platelet counting of BC-6000Plus automated hematology analyzer. Ann Transl Med 2021;9:508. https://doi.org/10.21037/atm-21-691.Search in Google Scholar PubMed PubMed Central

16. Kim, H, Hur, M, Lee, GH, Kim, SW, Moon, HW, Yun, YM. Performance of platelet counting in thrombocytopenic samples: comparison between Mindray BC-6800Plus and Sysmex XN-9000. Diagnostics (Basel) 2021;12:68. https://doi.org/10.3390/diagnostics12010068.Search in Google Scholar PubMed PubMed Central

17. Fei, Y, Zhang, C, He, X. The mismatch between Sysmex XN-20 automated hematology analyzers and the visual examination of blood smears-Misclassification of hypogranular eosinophils and platelets. Int J Lab Hematol 2024;46:400–4. https://doi.org/10.1111/ijlh.14221.Search in Google Scholar PubMed

18. Lam, WK, Law, YFW, Yip, SF. Resolution of platelet count interference due to cytoplasmic fragments of leukaemic cells by flow cytometry in acute myeloid leukaemia. Int J Lab Hematol 2022;44:983–5. https://doi.org/10.1111/ijlh.13859.Search in Google Scholar PubMed

19. Fohlen-Walter, A, Jacob, C, Lecompte, T, Lesesve, JF. Laboratory identification of cryoglobulinemia from automated blood cell counts, fresh blood samples, and blood films. Am J Clin Pathol 2002;117:606–14. https://doi.org/10.1309/qxpp-dc4x-n3q8-kw62.Search in Google Scholar PubMed

Received: 2024-06-24

Accepted: 2024-08-19

Published Online: 2024-09-02

Published in Print: 2025-01-29

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Articles in the same Issue

https://doi.org/10.1515/cclm-2024-0739

Keywords for this article

complete blood count; automated hematology analyzer; platelet count; reflex test