Neutrophil Reactivity Intensity and misclassification of immature granulocytes
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Neutrophil Reactivity Intensity and misclassification of immature granulocytes. / Wiwe, Elias Frost; Kofoed, Isabella Katarina; Dufréchou, Muriel Julie Falk; Philipsen, Jens Peter; Lemvig, Birthe; Rasmussen, Katrine Laura; Smith, Julie; Hillig, Thore.
In: International Journal of Laboratory Hematology, Vol. 46, No. 2, 2024, p. 312-321.Research output: Contribution to journal › Journal article › Research › peer-review
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TY - JOUR
T1 - Neutrophil Reactivity Intensity and misclassification of immature granulocytes
AU - Wiwe, Elias Frost
AU - Kofoed, Isabella Katarina
AU - Dufréchou, Muriel Julie Falk
AU - Philipsen, Jens Peter
AU - Lemvig, Birthe
AU - Rasmussen, Katrine Laura
AU - Smith, Julie
AU - Hillig, Thore
N1 - Publisher Copyright: © 2023 John Wiley & Sons Ltd.
PY - 2024
Y1 - 2024
N2 - Introduction: Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN-series hehmatology analyzer compared with manual differential. These cases were associated with high values of “Neutrophil Reactivity Intensity” (NEUT-RI), which should reflect the metabolic activity of the neutrophils. Methods: We conducted a three-stage study to evaluate whether NEUT-RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential. First, 124 patient samples were selected for 800-cell manual smear analysis based on their NEUT-RI values and compared with the automatic Sysmex IG% results. Next, 11 098 routine 110-cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19-day period 160 additional patient samples underwent smear based on NEUT-RI values ≥56 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice. Results: NEUT-RI ≥56 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag “Abnormal WBC Scattergram” was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT-RI ≥56 FI had a positive predictive value below 1%. Conclusion: Both NEUT-RI and the internal Sysmex flag “Abnormal WBC Scattergram” work well to identify cases of IG% misclassification. However, in our setting NEUT-RI ≥56 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules.
AB - Introduction: Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN-series hehmatology analyzer compared with manual differential. These cases were associated with high values of “Neutrophil Reactivity Intensity” (NEUT-RI), which should reflect the metabolic activity of the neutrophils. Methods: We conducted a three-stage study to evaluate whether NEUT-RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential. First, 124 patient samples were selected for 800-cell manual smear analysis based on their NEUT-RI values and compared with the automatic Sysmex IG% results. Next, 11 098 routine 110-cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19-day period 160 additional patient samples underwent smear based on NEUT-RI values ≥56 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice. Results: NEUT-RI ≥56 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag “Abnormal WBC Scattergram” was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT-RI ≥56 FI had a positive predictive value below 1%. Conclusion: Both NEUT-RI and the internal Sysmex flag “Abnormal WBC Scattergram” work well to identify cases of IG% misclassification. However, in our setting NEUT-RI ≥56 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules.
KW - differential leukocyte count
KW - hematologic tests
KW - neutrophils
KW - patient safety
KW - quality assurance
U2 - 10.1111/ijlh.14204
DO - 10.1111/ijlh.14204
M3 - Journal article
C2 - 37985128
AN - SCOPUS:85177446017
VL - 46
SP - 312
EP - 321
JO - Clinical and Laboratory Haematology
JF - Clinical and Laboratory Haematology
SN - 1751-5521
IS - 2
ER -
ID: 387254891