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Lee, Song, Oh, Shin, Kim, Jun, and Lee: Evaluation of the Automated Hematology Analyzer Sysmex XN-2000 and the Accuracy of Differential Leukocyte Counts Using the Low WBC Mode
Original Article

Lab Med Online 2015;5(4):188-195.

Published online: 20 October 2015

DOI: https://doi.org/10.3343/lmo.2015.5.4.188

Evaluation of the Automated Hematology Analyzer Sysmex XN-2000 and the Accuracy of Differential Leukocyte Counts Using the Low WBC Mode

Ja Young Lee, M.D.1, Sae Am Song, M.D.2, Seung Hwan Oh, M.D.1, Jeong Hwan Shin, M.D.1, , Hye Ran Kim, M.D.1, Kyung Ran Jun, M.D.2, Jeong Nyeo Lee, M.D.2

1Department of Laboratory Medicine, Busan Paik Hospital, Haeundae Paik Hospital, Busan, Korea

2Inje University College of Medicine, Busan, Korea

Corresponding author: Jeong Nyeo Lee Department of Laboratory Medicine, Haeundae Paik Hospital, Inje University College of Medicine, 875 Haeundaero, Haeundae-gu, Busan 48108, Korea Tel: +82-51-797-3190, Fax: +82-51-797-3194, E-mail: jeong418@medimail.co.kr

Received 1 December 2014       Revised 21 January 2015       Accepted 14 May 2015

Copyright © 2015 The Korean Society for Laboratory Medicine

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The XN-series (Sysmex, Japan) is the new hematology analyzer from Sysmex, with new channels to improve the accuracy of differential leukocyte count and platelet count in the low cell count range. We evaluated the analytical performance and low white blood cell (WBC) mode of the XN-2000.

Methods

Precision, linearity, and carryover were evaluated for the analyzer. We analyzed the accordance of complete blood count (CBC), reticulocyte count, and differential leukocyte count between the XN-2000 and XE-2100 (Sysmex), using 200 samples from normal controls and patients. For 80 samples with a WBC count <1.5×109 cells/L, the low WBC mode was evaluated by comparing the automated count with a manual differential count as the reference.

Results

The coefficients of variation of precision were <5% for most CBC parameters and <10% for differential leukocyte count. All results obtained with the XN-2000 showed good correlation with those obtained with the XE-2100. The correlation coefficients (r) were >0.9800 for all CBC parameters except mean corpuscular hemoglobin concentration, mean platelet volume, and platelet distribution width, and >0.9900 for differential leukocyte count except monocytes and basophils. The low WBC mode provided accurate counts for neutrophils and lymphocytes, with r >0.9300 for samples with a WBC count of 0.1–1.5×109 cells/L.

Conclusions

The XN-2000 showed good analytical performance and correlation with the existing model, the XE-2100. The XN-2000 provided accurate results for differential leukocyte count in samples with a WBC count of 0.1–1.5×109 cells/L, and reduced manual slide reviews.

Keywords: Hematology analyzer, XN-2000, Differential leukocyte count, Low cell count

References

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Fig. 1.
Linearities of white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb), hematocrit (HCT), and platelet (PLT) count determined by the XN-2000 (A, XN-10 B3; B, XN-10 B4).
lmo-5-188f1.tif
Fig. 2.
Comparison of complete blood count parameters including mean platelet volume (MPV) and platelet distribution width (PDW) between the XN-2000 and XE-2100 using Bland-Altman plots (A, XN-10 B3; B, XN-10 B4).
lmo-5-188f2.tif
Table 1.
Within-run precision of complete blood count parameters, white blood cell differentials, and reticulocyte counts obtained with the XN-2000
Parameter Low Normal High Specificity
XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4
Mean CV (%) Mean CV (%) Mean CV (%) Mean CV (%) Mean CV (%) Mean CV (%)
WBC (×109/L) 2.9 1.7 2.9 2.3 7.0 1.3 7.0 1.0 16.5 0.8 16.5 0.8 ≤3.0%
RBC (×1012/L) 2.3 0.6 2.3 1.0 4.2 0.5 4.2 0.5 5.3 0.6 5.3 0.5 ≤1.5%
Hb (g/dL) 5.9 0.7 5.9 0.5 12.5 0.4 12.5 0.8 16.1 0.4 16.1 0.5 ≤1.0%
HCT (%) 16.9 0.8 16.6 1.1 35.3 0.5 34.8 0.5 45.9 0.7 45.4 0.4 ≤1.5%
MCV (fL) 72.7 0.4 72.1 0.2 83.5 0.1 82.7 0.3 86.4 0.5 85.5 0.4 ≤1.0%
MCH (pg) 25.3 1.1 25.6 0.9 29.6 0.8 29.6 0.8 30.3 0.6 30.3 0.4 ≤2.0%
MCHC (g/dL) 34.8 1.3 35.5 0.9 35.4 0.8 35.8 0.6 35.0 0.7 35.5 0.6 ≤2.0%
PLT (×109/L) 62.0 3.8 66.0 2.5 241.0 1.7 249.0 1.5 549.0 1.4 547.0 1.6 ≤4.0%
RDW (%) 16.9 0.5 17.2 0.8 14.3 0.6 14.6 0.3 14.4 0.6 14.5 0.5 ≤2.0%
MPV (fL) 9.3 3.9 9.3 3.8 10.3 1.4 10.2 2.2 10.1 0.8 9.9 0.8 ≤4.0%
PDW (%) 7.0 5.4 7.2 5.7 9.7 1.4 9.6 3.4 10.0 1.4 9.8 1.3 ≤10.0%
Neutrophils (%) 38.5 2.8 37.9 3.0 41.2 2.4 40.2 1.6 45.9 2.8 45.9 2.1 ≤8.0%
Lymphocytes (%) 32.2 3.0 32.7 4.0 30.3 3.2 31.8 3.8 25.2 3.2 26.1 2.9 ≤8.0%
Monocytes (%) 15.1 5.2 14.8 9.3 13.9 5.4 13.0 9.3 13.1 3.3 12.4 8.2 ≤20.0%
Eosinophils (%) 9.4 7.8 9.7 6.5 9.8 10.7 10.2 4.6 11.1 5.7 10.8 6.8 ≤25.0%
Basophils (%) 4.8 3.8 4.8 2.6 4.8 2.4 4.9 3.2 4.8 3.2 4.8 2.7 ≤40.0%
Reticulocytes (%) 4.9 1.6 – – 2.1 3.0 – – 0.9 4.0 – – ≤15.0%

Abbreviations: CV, coefficient of variation; WBC, white blood cells; RBC, red blood cells; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, mean corpuscular hemoglobin concentration; PLT, platelets; RDW, red blood cell distribution width; MPV, mean platelet volume; PDW, platelet distribution width.

Table 2.
Correlations of complete blood count parameters, white blood cell differentials (N=150), and reticulocyte counts (N=50) obtained with the XN-2000 vs. the XE-2100
Parameter Range XN-10 B3 vs. XE-2100 XN-10 B4 vs. XE-2100
Mean difference Intercept Slope r Mean difference Intercept Slope r
WBC (×109/L) 1.18–25.45 0.4 –0.0642 1.0136 0.9988 0.1 –0.0379 1.0068 0.9988
RBC (×1012/L) 1.62–5.72 –0.7 –0.2656 1.0580 0.9971 –0.6 –0.2839 1.0633 0.9978
Hb (g/dL) 5.4–18.1 –0.3 –0.6569 1.0497 0.9980 –0.1 –0.6184 1.0481 0.9979
HCT (%) 17.0–51.1 –0.4 –1.7692 1.0429 0.9956 –0.6 –1.9316 1.0457 0.9966
MCV (fL) 67.3–114.4 0.4 0.6379 0.9967 0.9955 0.1 0.1299 0.9999 0.9951
MCH (pg) 20.0–38.1 0.5 –1.1987 1.0440 0.9807 0.6 –0.8476 1.0333 0.9832
MCHC (g/dL) 29.1–36.7 0.1 0.8953 0.9743 0.9173 0.4 2.1830 0.9388 0.9281
PLT (×109/L) 39–575 –0.2 1.3760 0.9924 0.9888 0.1 1.7032 0.9943 0.9892
RDW (%) 11.5–22.1 –2.4 –1.1611 1.0591 0.9950 –1.0 –1.0107 1.0627 0.9946
MPV (fL) 8.6–12.6 3.8 0.6604 0.9723 0.9420 2.4 0.7443 0.9485 0.9508
PDW (%) 8.4–17.3 5.6 –0.5532 1.1106 0.9290 2.7 –0.6146 1.0861 0.9469
Neutrophils (%) 33.1–96.3 0.4 0.6710 0.9953 0.9960 0.3 0.7167 0.9935 0.9955
Lymphocytes (%) 2.7–57.7 –0.9 –0.2779 0.9802 0.9937 –0.6 –0.2814 0.9899 0.9953
Monocytes (%) 0.5–22.1 0.3 0.5254 0.9752 0.9494 0.1 0.5877 0.9354 0.9539
Eosinophils (%) 0.0–21.6 0.0 0.0111 0.9806 0.9909 0.0 0.0373 0.9779 0.9913
Basophils (%) 0.1–4.2 0.2 0.2315 0.9345 0.8722 0.2 0.3682 0.6754 0.7260
Reticulocytes (%) 0.17–7.38 0.3 0.3085 1.0202 0.9821 – – – –

Abbreviations: See Table 1.

Table 3.
Comparison of automated white blood cell (WBC) differentials, obtained with the XN-2000 using the low WBC mode and the XE-2100, and manual differential counts
  Neutrophils (%) Lymphocytes (%) Monocytes (%) Eosinophils (%) Basophils (%)
XN-10 B3 (N=80)
Intercept 12.0254 6.1391 3.5972 0.8592 0.3561
Slope 0.8107 0.7829 0.7240 0.1036 0.3443
r 0.8588 0.8722 0.6983 0.2737 0.4376
XN-10 B4 (N=80)
Intercept 11.2514 7.3356 2.9366 0.9330 0.6112
Slope 0.8125 0.7933 0.6354 0.1080 0.4085
r 0.8569 0.8693 0.6945 0.2706 0.4171
XE-2100 (N=62)∗
Intercept 5.7094 8.5618 4.0084 0.2666 0.2244
Slope 0.8257 0.8198 0.7259 0.7252 0.2414
r 0.9528 0.9188 0.5279 0.8186 0.3824

∗ The Sysmex XE-2100 did not report WBC differentials in 18/80 (22.5%) samples.

Table 4.
Comparison of automated white blood cell (WBC) differentials, obtained with the XN-2000 using the low WBC mode, and manual differential counts for different WBC count ranges
  Neutrophils (%) Lymphocytes (%) Monocytes (%) Eosinophils (%) Basophils (%)
XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4 XN-10 B3 XN-10 B4
WBC count 0.1–1.5 ×109/L, N=68
Intercept 6.6453 5.7461 5.9056 5.8546 2.8081 2.3103 0.0875 0.1469 0.4480 0.7593
Slope 0.8751 0.8768 0.8163 0.8444 0.8913 0.8180 0.7527 0.7621 0.3396 0.3957
r 0.9752 0.9734 0.9336 0.9490 0.7457 0.7599 0.8676 0.8745 0.4354 0.4144
WBC count < 0.1 ×109/L, N=12
Intercept 31.2334 30.7946 4.1963 12.6028 2.3242 –0.2378 0.9367 1.0716 NA NA
Slope 0.7139 0.7359 0.6637 0.5803 0.6080 0.5401 0.0138 0.0157 NA NA
r 0.4981 0.5121 0.6697 0.5714 0.6706 0.7028 0.0540 0.0540 NA NA

Abbreviations: NA, not applicable.

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