Lab Med Online.  2022 Jan;12(1):33-39. 10.47429/lmo.2022.12.1.33.

Validation of Hematology Rapid Reporting System for Complete Blood Cell Count with Differential

• Lee J
• Yoon SY
• Park JY
• Kim J

• KMID: 2538581
• DOI: http://doi.org/10.47429/lmo.2022.12.1.33

Abstract

Background
Complete blood cell count (CBC) test, peripheral blood smears (PBS), and automatic hematology analyzers are used to screen patients with high-risk hematology malignancies. In this study, the workflow of urgent and routine samples and methods to improve the detection rate of blasts were evaluated. The purpose of this study was to validate the hematology rapid reporting system (HRS) for CBC and establish a strategy for the effective use of an automated hematology analyzer in clinical laboratories.
Methods
The flag performances of UniCel DxH 800 (Beckman Coulter, USA) and XE-2100 (Sysmex, Japan) systems used for blood tests were analyzed for urgent and routine samples. The results were compared with PBS results. Each test method’s sensitivity and specificity were determined to identify the most efficient blast detection method. In addition, receiver operating characteristic (ROC) curves of various parameters such as CBC and age were analyzed.
Results
The sensitivity and specificity of HRS were 66.80% and 99.85%, respectively, with urgent flags (four flags) and 92.95% and 98.49%, respectively, with routine flags (15 flags). The sensitivity of HRS for routine samples was significantly different from that for urgent samples (66.80% vs. 92.95%; P<0.0001), but no significant difference was observed in the specificity for HRS between routine and urgent samples (99.85% vs. 98.49%; P=1.00).
Conclusions
HRS using flags and blast history can be effectively used in clinical laboratories. HRS can be used as an effective reporting workflow for differential CBC in clinical laboratories.

Keyword

Automated hematology analyzer; Peripheral blood smear; Complete blood cell count

Figure

• 

  Fig. 1 Current workflow of hematology rapid reporting system (HRS). *4 Flag means flags of BL, NE, LY, MO from automatic hematology analyzer. †15 Flag means flags of LS, VL, OV, IG, Bl, I2, Aty.L, IG, NE, E, Abn.L, MO, L, LY, and LS from automatic hematology analyzer. ‡Interim report after commenting on possibility of correction. Abbreviations: LS, left-shift; VL, variant lymphocyte; OV, monocyte-neutrophil overlap, neutrophil-eosinophil overlap, nRBC-lymphocyte overlap; IG, immature granulocyte; Bl, blast suspected; I2, immature granulocyte; Aty.L, atypical lymphocyte; IG, immature granulocyte; NE, neutrophil blast; E, eosinophil >20%; Abn.L, abnormal lymphocyte; MO, Monoblast; L, lymphocytosis >80%; LY, lymphoblast; LS, left-shift.

• 

  Fig. 2 ROC curve of CBC parameters for prediction of blasts: (A) Platelet (PLT) count and (B) Hemoglobin (Hb). Abbreviations: ROC, receiver operating characteristic; CBC, complete blood cell count.

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  Fig. 3 Corrected workflow of hematology rapid reporting system (HRS). *15 Flag means flags of LS, VL, OV, IG, Bl, I2, Aty.L, IG NE, E, Abn.L, MO, L, LY, and LS from automatic hematology analyzer. †Interim report after commenting on the possibility of correction. Abbreviations: LS, left-shift; VL, variant lymphocyte; OV, monocyte-neutrophil overlap, neutrophil-eosinophil overlap, nRBC-lymphocyte overlap; IG, immature granulocyte; Bl, blast suspected; I2, immature granulocyte; Aty.L, atypical lymphocyte; IG, immature granulocyte; NE, neutrophil blast; E, eosinophil >20%; Abn.L, abnormal lymphocyte; MO, monoblast; L, lymphocytosis >80%; LY, lymphoblast; LS, left-shift.

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