Use of Sysmex XN-10 red blood cell parameters for screening of hereditary red blood cell diseases and iron deficiency anaemia

Abstract

Introduction: In daily practice in haematology laboratories, red blood cell (RBC) abnormalities are frequent and their management is a real challenge. The aim of this study is to establish a "decision tree" using RBC and reticulocyte parameters from the SYSMEX XN-10 analyser to distinguish between patients with a hereditary RBC disease from iron deficiency anaemia and other patients.

Methods: We analysed results of complete RBC counts in a cohort composed of 8217 adults divided into 5 different groups: iron deficiency anaemia (n = 120), heterozygous haemoglobinopathy (n = 92), sickle cell disease syndrome (n = 56), hereditary spherocytosis (n = 18) and other patients (n = 7931). A Classification And Regression Tree (CART) analysis was used to obtain a two-step decision tree in order to predict these previous groups.

Results: Five parameters and the calculated RBC score were selected by the CART method: mean corpuscular haemoglobin concentration, percentage of microcytes, distribution width of the RBC histogram, percentage of nucleated red blood cells, immature reticulocytes fraction and finally RBC Score. When applying the tree and recommended flowchart, 158/166 of the RBC hereditary disease patients and 114/120 iron deficiency anaemia patients are detected. Overall, the correct classification rate reached 99.4%. Sensitivity and specificity for RBC disease detection were 95.2% and 99.9%, respectively. These results were confirmed in an independent validation cohort.

Conclusion: Based on the XN-10 RBC and reticulocyte parameters, we propose a two-step decision tree delivering a good prediction and classification of hereditary RBC diseases. These results can be used to optimize additional reticulocyte analysis and microscopy review.

Keywords: Iron deficiency anaemia; RBC and reticulocyte parameters; RBC disease; Sysmex XN-10; laboratory practice.

Figure 1

Group comparison with Kruskal‐Wallis test between five groups (others patients (grey), iron deficiency anaemia (blue), heterozygous haemoglobinopathy (yellow), sickle cell disease (green), hereditary spherocytosis (red) – (A) for Micro%, RDW‐SD, MCHC and NRBC% for all the cohort [step 1] – (B) for RBC score and IRF% for patients presenting with MCHC > 365 g/L and for patient who need the addition of RET channel in step 1 [step 2]

Figure 2

Global decision tree included CART CBC (step 1) and CART RET (step 2). “OTHERS” in grey, “IDA” in blue, “HGB HTZ” in yellow, "SCD" in green, “HS” in red

Figure 3

Flowchart for unknown patient