Evaluation of immature granulocyte parameters in myeloid neoplasms assayed by Sysmex XN hematology analyzer

Abstract

Immature granulocytes (IGs) have significance for the diagnosis of myeloid neoplasms (MNs). The current study aims to use a hematology analyzer to evaluate the accuracy of IG parameters in MNs. Blood specimens from 388 patients with MN, 524 with non-hematological neoplasms (non-HNs), including 109 patients with inflammation and 68 undergoing G-CSF administration, and 500 healthy control subjects were analyzed. IG parameters was assayed by Sysmex XN-9000 (XN) and compared with manual assessments. A high level of agreement between IG% derived from XN and manual measurements for MN patients (r = 0.828, p < 0.0001) was revealed but only a moderate correlation for acute myeloid leukemia patients (AML; r = 0.597; p < 0.0001). Bland-Altman bias analysis was conducted, and the results showed that differences in IG% from XN and manual analysis for MN patients were considered clinically insignificant. ROC analysis demonstrated a good performance of IG# (AUC = 0.842) and IG% (AUC = 0.885) assessed by XN for MN patients with cut-off values of 0.200 × 10⁹/L and 1.95%, respectively. IG parameters from Sysmex XN analyzer are helpful for screening of MNs even though granulocyte morphological abnormalities may interfere with IG parameter accuracy.

Keywords: Hematology analyzer; Immature granulocytes; Morphological abnormalities; Myeloid neoplasms.

Fig. 1

Comparison of IG#-XN, IG%-XN and IG%-manual values across groups. Columns and bars represent median with interquartile range

Fig. 2

Comparison of XN- and manually-derived IG% values using Bland–Altman plot. The difference between two values (XN IG% – manual IG%) was plotted on the y-axis against manual IG% on the x-axis. Solid lines: mean differences; dashed lines: mean difference ± 1.96 SD