Winther-Larsen Anne, Vestergaard Else Marie, Abildgaard Anders
Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.
Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
Clin Chem Lab Med. 2024 Sep 25;63(3):636-644. doi: 10.1515/cclm-2024-0973. Print 2025 Feb 25.
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.
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.
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 × 10/L to 0.297 × 10/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.
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.
虽然血液分析仪进行的标记分类计数中涂片复查的临床价值尚不确定，但通常会进行涂片复查。因此，我们评估了Sysmex XN - 9000与标记样本涂片复查之间分类计数的差异。此外，还研究了所识别的原始细胞的临床价值。
在两个实验室确定了两年期间所有分类计数的数据。对于有原始细胞的患者，查阅了电子健康记录。通过Bland - Altman图评估自动和手动分类计数之间的一致性。根据参考区间对两种方法进行分类的一致性进行评估，并针对随机分析误差导致的无关不一致性进行调整。
总共从4092例患者中识别出5500次标记分类计数。所有细胞类型的自动和手动分类计数之间发现了良好的一致性（-0.480×10/L至0.297×10/L）。除单核细胞外（82%），两种方法在所有细胞类型上的一致性都非常好，在19%的样本中自动估计值高于手动估计值。在241次（1%）涂片复查中识别出原始细胞。13例（5%）患者被诊断为急性白血病，只有1例患者中原始细胞的检测促成了对急性白血病的怀疑。
我们的研究结果表明，对所有标记样本进行常规涂片复查并不会提供额外的重要信息。在进行本地验证并与临床科室进行沟通后，可能可以省略此类复查，以提高成本效益并缩短周转时间。
