Laboratory workflow for optimizing leukocyte count and differential in synovial fluids on Sysmex XN-1000

IF 2.2 4区医学 Q3 HEMATOLOGY International Journal of Laboratory Hematology Pub Date : 2024-03-26 DOI:10.1111/ijlh.14274

Marthe Vanrenterghem, Julie Dom, Nancy Boeckx, Melissa Depypere, Glynis Frans, Georges Vles, Christine Van Laer

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Abstract

Introduction

Falsely elevated synovial white blood cell (WBC) counts using automated hematology analyzers have been reported particularly in the setting of joint arthroplasty. We evaluated the implementation of a laboratory workflow based on Sysmex XN-1000-automated cell counting and scattergram interpretation.

Methods

WBC and differential were measured for 76 synovial fluid samples (29 native joints and 47 with joint arthroplasties) with Sysmex XN-1000 and manual methods. All scattergrams were evaluated for possible incorrect WBC and/or differential according to our implemented workflow. A specific finding was the “banana-shape” scattergram, which indicates possible interferences. The European Bone & Joint Infection Society (EBJIS) criteria were applied to identify possible prosthetic joint infections (PJIs) in patients with joint arthroplasties.

Results

Correlation between automated and manual WBC counts, calculated for samples with WBC count <50 000/μL, was higher for native joints (r = 0.938) compared with patients known with arthroplasty (r = 0.906). Scattergrams classified as OK showed overall a higher correlation compared with scattergrams, which were interpreted as NOT OK. “Banana-shape” scattergrams (n = 19) showed falsely elevated automated WBC count, and the patterns were mainly seen in prosthesis patients (17/19 [89%]). Six of 47 (13%) patients with joint arthroplasties were reclassified from “confirmed” to “unlikely” PJI according to the EBJIS criteria.

Conclusion

Our workflow based on scattergram interpretation resulted in accurate WBC counts in synovial fluid using automated/and or manual methods. It is important to identify the presence of “banana-shape” scattergrams to avoid overestimated automated WBC counts. Overall, automated synovial WBC count can be used, even for patients with arthroplasty, but after visual inspection of the scattergram to exclude possible interferences.

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使用 Sysmex XN-1000 优化滑液中白细胞计数和差值的实验室工作流程。

导言：使用全自动血液分析仪进行滑膜白细胞（WBC）计数时出现错误升高的报道屡见不鲜，尤其是在关节置换术中。我们评估了基于 Sysmex XN-1000 自动细胞计数和散点图解读的实验室工作流程的实施情况：方法：使用 Sysmex XN-1000 和人工方法测量了 76 份滑液样本（29 份原生关节样本和 47 份关节置换样本）的白细胞和差值。根据我们实施的工作流程，对所有散点图进行了评估，以确定白细胞和/或差值是否有误。一个特别的发现是 "香蕉形 "散点图，这表明可能存在干扰。欧洲骨与关节感染学会（EBJIS）的标准被用于识别关节置换术患者中可能存在的人工关节感染（PJI）：结果：自动白细胞计数与人工白细胞计数之间的相关性，对有白细胞计数的样本进行计算：我们基于散点图解读的工作流程可使用自动/和或人工方法准确计算滑膜液中的白细胞数量。重要的是要识别 "香蕉形 "散点图的存在，以避免高估自动白细胞计数。总之，即使是关节置换术患者也可以使用自动滑膜白细胞计数，但必须对散点图进行肉眼检查以排除可能的干扰。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Laboratory Hematology 医学-血液学

CiteScore

4.50

自引率

6.70%

发文量

211

审稿时长

6-12 weeks

期刊介绍： The International Journal of Laboratory Hematology provides a forum for the communication of new developments, research topics and the practice of laboratory haematology. The journal publishes invited reviews, full length original articles, and correspondence. The International Journal of Laboratory Hematology is the official journal of the International Society for Laboratory Hematology, which addresses the following sub-disciplines: cellular analysis, flow cytometry, haemostasis and thrombosis, molecular diagnostics, haematology informatics, haemoglobinopathies, point of care testing, standards and guidelines. The journal was launched in 2006 as the successor to Clinical and Laboratory Hematology, which was first published in 1979. An active and positive editorial policy ensures that work of a high scientific standard is reported, in order to bridge the gap between practical and academic aspects of laboratory haematology.