Lab Med Online.  2013 Jan;3(1):1-5. 10.3343/lmo.2013.3.1.1.

Utilization of Mean Peroxidase Index for Discrimination of Pseudoneutropenia

Affiliations
  • 1Department of Laboratory Medicine, Korea Cancer Center Hospital, Korea Institute of Radiological & Medical Sciences, Seoul, Korea. cyhlabo@kcch.re.kr
  • 2University of Science & Technology, Daejeon, Korea.

Abstract

BACKGROUND
Autoanalyzer ADVIA2120 uses intracellular peroxidase concentration to perform white blood cell (WBC) differential. Therefore, in specimens containing neutrophils with low peroxidase concentration, neutrophils can be miscounted as monocytes or large unstained cells resulting in pseudoneutropenia. Myeloperoxidase deficiency can be detected by the mean peroxidase index (MPXI). The aims of this study are to establish the reference interval of MPXI and define a cut off value for manual slide review to discriminate pseudoneutropenia.
METHODS
We calculated reference intervals as mean+/-2SD according to the indirect method of CLSI C28-A3 guideline from MPXI data of 5,802 individuals who took routine health checkup from April 2010 to June 2012. We performed manual slide review on specimens with low MPXI and compared neutrophil differential count of manual method with that of autoanalyzer. When neutrophil differential in manual slide review was >20%P higher than autoanalyzer result, it was regarded as a pseudoneutropenia. We performed ROC analysis using the MPXI results of samples with and without pseudoneutropenia to define a cutoff to discriminate pseudoneutropenia.
RESULTS
The reference intervals of MPXI in total population, male, and female were -4.9 to 7.5, -5.5 to 7.3, and -4.5 to 7.5, respectively. The mean value of MPXI was significantly higher in female than in male and there was no difference by age. Twenty-two pseudoneutropenia samples from 7 patients were identified. ROC analysis yielded cutoff value of -20.7 with 94.9% of sensitivity and 77.3% of specificity.
CONCLUSIONS
MPXI may be used in the manual slide review guideline for detecting pseudoneutropenia.

Keyword

Mean peroxidase index; Reference interval; Pseudoneutropenia; Manual slide review

MeSH Terms

Discrimination (Psychology)
Female
Humans
Leukocytes
Male
Metabolism, Inborn Errors
Monocytes
Neutrophils
Peroxidase
ROC Curve
Metabolism, Inborn Errors
Peroxidase

Figure

  • Fig. 1 ROC curve evaluating cases with MPO deficiency and low MPXI. The area under the curve (0.894) is shown with its 95% confidence intervals. Abbreviations: MPO, myeloperoxidase; MPXI, mean peroxidase index.


Reference

1. Dominguez-Rodriguez A. Current role of myeloperoxidase in routine clinical practice. Expert Rev Cardiovasc Ther. 2011. 9:223–230.
Article
2. Kutter D. Prevalence of myeloperoxidase deficiency: population studies using Bayer-Technicon automated hematology. J Mol Med (Berl). 1998. 76:669–675.
Article
3. Park G, Park YJ, Jang SJ, Moon DS. A case of myeloperoxidase deficiency: its detection on the automated hematology analyzer Technicon H*2. Korean J Clin Pathol. 2002. 22:80–83.
4. Bononi A, Lanza F, Dabusti M, Gusella M, Gilli G, Menon D, et al. Increased myeloperoxidase index and large unstained cell values can predict the neutropenia phase of cancer patients treated with standard dose chemotherapy. Cytometry. 2001. 46:92–97.
Article
5. Yonezawa K, Horie O, Yoshioka A, Matsuki S, Tenjin T, Tsukamura Y, et al. Association between the neutrophil myeloperoxidase index and subsets of bacterial infections. Int J Lab Hematol. 2010. 32:598–605.
Article
6. D Zelmanovic V Jones . Single channel, single dilution detection method for the identification and quantification of blood cells and platelets in a whole blood sample using an automated hematology analyzer. US Patent. 6,524,858 B1. 2003.
7. Lee KN, Yoon JH, Cho HI, Na EH, Moon SY, Park JY, et al. A study on reference values from health checkup data of Korea association of health promotion by indirect method: a study on standardization of reference values among laboratories of Korea association of health promotion II. J Lab Med Qual Assur. 2009. 31:309–315.
8. Clinical and Laboratory Standards Institute. CLSI document C28-A3. Defining, establishing, and verifying reference intervals in the clinical laboratory; Approved guideline. 2010. 3rd ed. Wayne, PA: Clinical and Laboratory Standards Institute.
9. Esposito D, Corruble E, Hardy P, Chouinard G. Risperidone-induced morning pseudoneutropenia. Am J Psychiatry. 2005. 162:397.
Article
10. Singh G, Kodela S. Morning pseudoneutropenia during risperidone treatment. BMJ Case Rep. 2009. In press.
Article
11. Tfayli A, Gadde L, Shamseddin A. Pseudoneutropenia from EDTA leukoagglutination. Middle East J Cancer. 2010. 1:189–190.
12. Rudolph TK, Wipper S, Reiter B, Rudolph V, Coym A, Detter C, et al. Myeloperoxidase deficiency preserves vasomotor function in humans. Eur Heart J. 2012. 33:1625–1634.
Article
13. Chang CY, Song MJ, Jeon SB, Yoon HJ, Lee DK, Kim IH, et al. Dual functionality of myeloperoxidase in rotenone-exposed brain-resident immune cells. Am J Pathol. 2011. 179:964–979.
Article
14. Ziaei JE, Dastgirl S. Role of myeloperoxidase index in differentiation of megaloblastic and aplastic anemia. Indian J Med Sci. 2004. 58:345–348.
15. Park G, Park YJ, Lee SH, Jang SJ, Moon DS. Analysis of the mean peroxidase index for iron deficiency anemia patients using the hematology autoanalyzer Technicon H*2. Korean J Lab Med. 2002. 22:289–294.
16. Charuruks N, Voravud N, Sriuranpong V. MPXI and early neutrophilia: New potential therapeutic biomarkers for recombinant human granulocyte colony-stimulating factor. J Clin Lab Anal. 1998. 12:41–46.
Article
Full Text Links
  • LMO
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr