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. 2022 Jul 1;42(4):398-405.
doi: 10.3343/alm.2022.42.4.398.

Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time

Minjeong Nam  1 , Sumi Yoon  2 , Mina Hur  3 , Gun Hyuk Lee  3 , Hanah Kim  3 , Mikyoung Park  4 , Hyeong Nyeon Kim  5
Affiliations

Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time

Minjeong Nam et al. Ann Lab Med. .

Abstract

Background: Digital morphology (DM) analyzers are increasingly being used for white blood cell (WBC) differentials. We assessed the laboratory efficiency of the Sysmex DI-60 system (DI-60; Sysmex, Kobe, Japan) in comparison with manual counting in leukopenic samples.

Methods: In total, 40 peripheral blood smear samples were divided into normal, mild leukopenia, moderate leukopenia, and severe leukopenia groups based on WBC count. In each group, the risk and turnaround time (TAT) were compared between DI-60 and manual counting. Risk was determined by failure mode and effect analysis using the risk priority number (RPN) score, and TAT was recorded for the analytical phase.

Results: Overall, DI-60 showed a five-fold lower risk (70 vs. 350 RPN) and longer TAT than manual counting. In severe leukopenic samples, DI-60 showed a shorter TAT/slide and a remarkably lower cell count/slide than manual counting. In all samples, the TAT/cell for DI-60 was substantially longer than that for manual counting (DI-60 vs. manual: total, 1.8 vs. 1.0 sec; normal, 1.5 vs. 0.7 sec; mild leukopenia, 1.9 vs. 0.9 sec; moderate leukopenia, 1.8 vs. 1.0 sec; severe leukopenia, 28.8 vs. 19.0 sec).

Conclusions: This is the first comparative assessment of risk and TAT between DI-60 and manual counting in leukopenic samples. DI-60 decreases the laboratory risk and improves patient safety, but requires more time to count fewer cells, especially in severe leukopenic samples. DM analyzers should be applied selectively depending on the WBC count to optimize laboratory efficiency.

Keywords: DI-60; Laboratory efficiency; Leukopenia; Risk; Turnaround time; WBC differential.

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Conflict of interest statement

CONFLICTS OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Fig. 1
Fig. 1
Comparison of TAT/slide (A) and cell count/slide (B) between DI-60 analysis and manual counting for the four WBC count groups. Triangles and quadrangles indicate median values of DI-60 and manual counting, respectively, and lines indicate interquartile ranges. Total cells counted were summated by each TAT/slide or cell count/slide in each group. Abbreviations: TAT, turnaround time; WBC, white blood cell.
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References

    1. Stouten K, Riedl JA, Levin MD, van Gelder W. Examination of peripheral blood smears: performance evaluation of a digital microscope system using a large-scale leukocyte database. Int J Lab Hematol. 2015;37:e137–40. doi: 10.1111/ijlh.12391. - DOI - PubMed
    1. CLSI, author. CLSI Document H20-A2. 2nd ed. Clinical Laboratory Standards Institute; Wayne, PA: 2007. Reference leukocytes (WBC) differential count (proportional) and evaluation of instrumental methods; approval guideline.
    1. Kratz A, Lee SH, Zini G, Riedl JA, Hur M, Machin S International Council for Standardization in Haematology, author. Digital morphology analyzers in hematology: ICSH review and recommendations. Int J Lab Hematol. 2019;41:437–47. doi: 10.1111/ijlh.13042. - DOI - PubMed
    1. Novis DA, Walsh M, Wilkinson D, St Louis M, Ben-Ezra J. Laboratory productivity and the rate of manual peripheral blood smear review: a College of American Pathologists Q-Probes study of 95,141 complete blood count determinations performed in 263 institutions. Arch Pathol Lab Med. 2006;130:596–601. doi: 10.5858/2006-130-596-LPATRO. - DOI - PubMed
    1. Kratz A, Lee SH, Zini G, Hur M, Machin S. Rebuttal of a paper submitted by Hans-Inge Bengtsson Comment. Int J Lab Hematol. 2020;42:e216–7. doi: 10.1111/ijlh.13279. - DOI - PubMed

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