List of clinical publications for reference for Sysmex hematology spin chart

Immature Granulocytes (IG)
  • Hampson P et al. (2016): Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients: A Prospective Observational Cohort Study. Ann Surg.; early online
    What we see as the essence: Neutrophil and IG counts correlated with sepsis risk in burn patients. They could be used as predictive markers of sepsis in burn patients together with other markers such as the phagocytic index and cell free DNA.
  • Ha SO et al. (2015): Fraction of immature granulocytes reflects severity but not mortality in sepsis. Scand J Clin Lab Invest.; 75(1):36
    What we see as the essence: Sepsis patients with an IG count on the XE-2100 of more than 0.5% were more likely to suffer from severe sepsis or septic shock, while WBC, CRP and PCT were not predictive of sepsis severity. None of the tested markers could predict 28-day mortality.
  • Nierhaus A et al. (2013): Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis – a prospective, observational study. BMC Immunology 14: 8
    Quote: Our findings demonstrate that sepsis is associated with an increased immature granulocyte count. The IG count can differentiate between patients with an infection and those who are not infected, particularly within the first critical hours after an initial SIRS alert. Using ROC analysis we found the IG count a superior biomarker for sepsis compared to C-reactive protein, lipopolysaccharide binding protein and interleukin-6.
  • Ansari-Lari A et al. (2003): Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol 120: 795–799.
    What we see as the essence: The automated IG count matches the manual IG count very well. At significantly elevated levels, it is a very specific predictor of sepsis. Multiparameter algorithms might be more successful at lower concentrations.
Nucleated Red Blood Cells (NRBCs)
  • Monteiro Juior JG et al. (2015): Nucleated Red Blood Cells as Predictors of All-Cause Mortality in Cardiac Intensive Care Unit Patients: A Prospective Cohort Study. PLoS One. 29;10(12):e0144259
    What we see as the essence: The presence of NRBC (XE-2100) was associated with a higher ICU mortality (49.4% vs 21.7%, P<0.001) as well as in-hospital mortality (61.4% vs 33.3%, p = 0.001).
  • C et al. (2014): Performance evaluation of the automated nucleated red blood cell enumeration on Sysmex XN analyser. Int J Lab Hematol. 2015;37(3):341.
    What we see as the essence: NRBC counts from the XN-Series could replace manual counts: the precision of the XN-Series was superior and a small bias (manual counts slightly higher than NRBC counts from the XN-Series) was only observed for NRBC counts above 200/100 WBC.
  • Danise P et al. (2011): Evaluation of nucleated red blood cells in the peripheral blood of hematological diseases. Clin Chem Lab Med 50: 357–360.
    What we see as the essence: NRBC are found in nearly all onco-haematological diseases at diagnosis and frequently during therapy. They are absent at remission.
  • Danise P et al. (2009): Nucleated red blood cells and soluble transferrin receptor in thalassemia syndromes: relationship with global and ineffective erythropoiesis. Clin Chem Lab Med 47: 1539–1542.
    What we see as the essence: The NRBC count helps defining ineffective erythropoiesis in thalassaemia patients and supporting transfusion management.
Immature Platelet Fraction (IPF)
  • Greene LA et al. (2015): Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia. Br J Haematol; 166(4):592
    What we see as the essence: The IPF# demonstrated stronger correlation with acute bleeding score than platelet counts. The strongest correlation was seen for paediatric patients with platelet counts <30 x 109/L. High IPF# was associated with low bleeding score.
  • Sakuragi M et al. (2015): Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders. Int J Hematol 101(4): 369.
    What we see as the essence: IPF% from the XN-1000 and RP% obtained by immuno flow cytometry had a comparable diagnostic value for the distinction between controls, immune thrombocytopenia (due to platelet destruction) and aplastic thrombocytopenia.
  • Dadu T et al. (2014): Evaluation of the IPF as an indicator of PLT recovery in dengue patients. Int J Lab Hematol 36(5): 499.
    What we see as the essence: IPF can be used to monitor the thrombocytopenia in patients with dengue fever. Furthermore, it can predict the recovery of PLT and so avoid unnecessary blood transfusions.
  • Van der Linden N et al. (2014): Immature platelet fraction (IPF) measured on the Sysmex XN haemocytometer predicts thrombopoietic recovery after autologous stem cell transplantation. Eur J Haematol 93(2): 150
    Quotes: “IPF is a promising predictor of platelet recovery in patients after autologous SCT.” “The proposed cut-off value of 5,3% can theoretically be used to decide whether or not to give a platelet transfusion.”
  • Strauss G et al. (2010): Immature Platelet Count: A Simple Parameter for Distinguishing Thrombocytopenia in pediatric acute lymphocytic leukemia from immune thrombocytopenia. Pediatr Blood Cancer 57(4): 641-7
    What we see as the essence: “Both IPF% and IPF# parameters should become a standard for evaluating the respective pathophysiologies underlying both congenital and acquired thrombocytopenias.”
  • Yamaoka G et al. (2010): The immature platelet fraction is a useful marker for predicting the timing of platelet recovery in patients with cancer after chemotherapy and hematopoietic stem cell transplantation. Int J Lab Hematol 32: e208–e216.
    What we see as the essence: An IPF% of above 10% is a useful marker for predicting the timing of platelet recovery after chemotherapy and haematopoietic stem cell transplantation and has the potential to facilitate optimal platelet transfusion.
Human Progenitor Cells (HPC)
  • Park SH et al. (2015): The New Sysmex XN-2000 Automated Blood Cell Analyzer More Accurately Measures the Absolute Number and the Proportion of Hematopoietic Stem and Progenitor Cells Than XE-2100 When Compared to Flow Cytometric Enumeration of CD34(+) Cells. Ann Lab Med.;35(1):146
    What we see as the essence: Stem cell counts from the XN-Series were more accurate than stem cell counts from the XE-Series when compared to CD34 flow cytometry.
  • Peerschke El et al. (2015): Evaluation of new automated hematopoietic progenitor cell analysis in the clinical management of peripheral blood stem cell collections. Transfusion.55(8):2001
    What we see as the essence: XN-Stem Cells is a functional equivalent of CD34 analysis and may be a surrogate for CD34 analysis to predict optimal timing of stem cell collections from mobilized peripheral blood.

  • Tanosaki R et al. (2014): Novel and rapid enumeration method of peripheral blood stem cells using automated hematology analyzer. Int J Lab Hematol;36(5):521.
    What we see as the essence: This study found that CD34-positive cells fall in the XN stem cell gate in the WPC scattergram. The final yield of collected CD34-positive cells could be predicted from the XN-HPC value in pre-apheresis blood and apheresis products.
Body Fluids
  • Cho YU et al. (2015): Body fluid cellular analysis using the Sysmex XN-2000 automatic hematology analyzer: focusing on malignant samples. Int J Lab Hematol. 37(3): 346
    What we see as the essence: It was found that cell counts obtained from the XN-2000 body fluid mode was comparable to counts obtained from microscopy. The authors recommend that samples with highly fluorescent cells (HF-BF) should be further analysed.
  • Fleming C et al. (2015): Clinical relevance and contemporary methods for counting blood cells in body fluids suspected of inflammatory disease. Clin Chem Lab Med 53(11):1689
    What we see as the essence: Excellent review on body fluid analysis. Several different analysers were compared, including the XE-5000, XN-Series and UF-Series.
  • Fleming C et al. (2012): Validation of the body fluid module on the new Sysmex XN-1000 for counting blood cells in cerebrospinal fluid and other body fluids. Clin Chem Med Lab 50: 1791-1798.
    Quote: “The BF module on the XN-1000 is a suitable tool for fast and accurate quantification of WBC (differential) and RBC counts in CSF and other BFs in a diagnostic setting.”
  • Seghezzi M et al. (2016): Optimization of Cellular analysis of Synovial Fluids by optical microscopy and automated count using the Sysmex XN Body Fluid Mode. Clin Chem Acta 462:41
    What we see as the essence: The study found that the XN-Series body fluid mode has an excellent performance, which makes it a reliable and practical alternative to optical microscopy for synovial fluids in clinical laboratories.
  • Buoro S et al. (2016): Cell population data and reflex testing rules of cell analysis in pleural and ascitic fluids using body fluid mode on Sysmex XN-9000. Clin Chem Acta; 452:92
    What we see as the essence: Results of the study confirm that the XN-BF module on Sysmex XN-9000 is a suitable alternative to optical microscopy for screening body fluid samples. Peritoneal and pleural fluids were analysed in the study. Authors implemented own validation rules that increased the productivity.
Reticulocyte Hemoglobin Equivalent (RET-He)
  • Weimann A et al. (2016): Delta-He, Ret-He and a New Diagnostic Plot for Differential Diagnosis and Therapy Monitoring of Patients Suffering from Various Disease-Specific Types of Anemia. Clin Lab;62(4):667
    What we see as the essence: A diagnostic plot using RET-He and Delta-He was developed based on differences between different patient groups suffering from anaemia. Several case examples show the clinical utility of this plot for therapy monitoring.
  • Mehta S et al. (2016): Reticulocyte Hemoglobin vis-a-vis Serum Ferritin as a Marker of Bone Marrow Iron Store in Iron Deficiency Anemia. J Assoc Physicians India 64(11):38.
    What we see as the essence: This study showed that RET-He is a better predictor of bone marrow iron stores in patients with severe anaemia than serum ferritin.
  • Urrechaga E et al. (2013): Erythrocyte and reticulocyte indices in the assessment of erythropoiesis activity and iron availability. Int J Lab Hematol 35: 144–149.
    What we see as the essence: RET-He and %HYPO-He are helpful in assessing erythropoiesis and iron status.
  • Mast A et al. (2008): Reticulocyte hemoglobin content. Am J Hematol 83: 307–310.
    What we see as the essence: Reticulocyte haemoglobin can be used to differentiate iron deficiency from other causes of anaemia and as an early marker to monitor the therapy.

  • Brugnara C et al. (2006): Reticulocyte hemoglobin equivalent (Ret He) and assessment of iron-deficient states. Clin Lab Haematol 28: 303–308.
    What we see as the essence: RET-He is a reliable marker of cellular haemoglobin content and can be used to identify iron-deficient states, particularly in dialysis patients. RET-He and CHr are in good agreement.

The uses or clinical applications described in these publications have not been approved or cleared by any regulatory authority.
It is the clinician’s responsibility to validate any off-label applications for use in routine clinical practice.

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