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Performance and Abnormal Cell Flagging Comparisons of Three Automated Blood Cell Counters
Cell-Dyn Sapphire, DxH-800, and XN-2000

Julie Hotton PharmD, Jan Broothaers, Caroline Swaelens, Brigitte Cantinieaux MD
DOI: http://dx.doi.org/10.1309/AJCPE5R4SOQBUULZ 845-852 First published online: 1 December 2013


Objectives To compare two hematological analyzers—the DxH-800 (DxH; Beckman-Coulter, Miami, FL) and XN-2000 (XN; Sysmex, Kobe, Japan)—with the Cell-Dyn Sapphire (SAPH; Abbott, Santa Clara, CA).

Methods We analyzed 4,375 samples. Slide reviews were made in the presence of blast, abnormal lymphocyte, and immature granulocyte (IG) flags or nucleated RBC (NRBC) count.

Results The analyzers exhibited excellent correlations for CBC and neutrophils but displayed a limit correlation for lymphocytes. The XN did not miss circulating blasts (0.5%–95% in microscopy). For NRBCs, the XN demonstrated a sensitivity of 90%; DxH, 74%; and SAPH, 29%. Only the XN demonstrated a correlation with microscopy, permitting a WBC six-part differential until 15% of NRBCs. The XN and DxH gave useful IG counts with a cutoff less than 5% and a WBC level more than 2,500/mm3. For abnormal lymphocytes detection, only XN demonstrated sensitivity of more than 95%, but its specificity of 54% requires adaptation.

Conclusion The XN increases the sensitivity of abnormal cell detection compared with the other counters, permitting a seven-part differential between predefined levels, decreasing the slide review from 20% to 9%.

Key Words:
  • Cell-Dyn Sapphire
  • DxH-800
  • XN-2000
  • HemaCAM
  • Flag
  • Blast
  • Abnormal lymphocytes
  • IG
  • NRBC
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