Evaluation of the ability of the differential count on two hematology analyzers to detect leukemias, verified by bone marrow and peripheral blood smears

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Mansyur Arif1, Asvin Nurulita1, Agus Alim Abdullah1, Fili Oei1, Arifin Seweng2
1 Department of Clinical Pathology and Laboratory Medicine, Medical University of Hasanuddin, Makassar, 2Medical University of Hasanuddin

Background

The hematology analyzer allows the measurement of several hematological parameters useful in diagnostic and clinical patients. In leukemia, hematological parameters especially in the case of leukocyte differential count helps early diagnosis of leukemia.

 

Methods

A cross sectional study in 57 subjects. Measurement of differential count using two hematology analyzers Yumizen H1500/2500 and Sysmex XN-1000. The statistical tests were Mann-Whitney and Spearman’s test. The test results are significant if the p-value < 0.001.

 

Results

57 patients consisted of 15 AML, 12 ALL, 14 CML, 9 MDS, and 7 other diagnosis. There was significant relationship between the leukocyte differential count parameter with the morphology of peripheral blood smear and bone marrow aspiration (p<0,001). The correlation between leukocyte differential counts parameters of two hematology analyzers using Spearman’s correlation has a significant positive correlation with moderate to very strong (p<0,001). The parameters of leukocytes, lymphocytes, and eosinophils were very strong correlation (r = 0,990, 0,892 and 0,717), monocytes and neutrophils were a strong correlation (r = 0,706 and 0,782) and basophils were moderate correlation (r = 0,376).

 

Chart

Results

WBCInstrument       Yumizen H2500
WBC305.90D10^3/mm33.50-10.00
TNC307.12 10^3/mm33.50-10.00
ERYInstrument       Yumizen H2500
RBC2.75 10^6/mm34.20-6.0
HGB8.6 g/dL13.0-17.0
HCT24.4 %40.0-54.0
MCV88.8 fL80.0-100.0
MCH31.4 pg27.0-34.0
MCHC35.4 g/dL32.0-35.0
RDW-CV17.0 %12.0-18.0
RDW-SD51.0 fL37.0-56.0
MIC%6.8 %0.0-20.0
MAC%3.3 %2.0-10.0
PLTInstrument       Yumizen H2500
PLT182 10^3/mm3150-400
PLTO190 10^3/mm3150-400
MPV10.0 fL7.4-12.0
PCT0.182 %0.150-0.400
PDW18.3 fL11.0-20.0
DIFInstrument       Yumizen H2500
NEU%22.7 %40.0-75.0
LYM%1.4 %15.0-45.0
MON%6.4 %4.0-13.0
EOS%4.5 %0.5-7.0
BAS%8.3 %0.0-2.0
ALY%0.2 %0.0-2.5
LIC%56.7 %0.0-3.0
IML%4.6 %0.0-0.2
IMM%23.0 %0.0-0.5
IMG%29.1 %0.0-2.0
NRBC%0.4 %0.0-2.0
NEU#69.49 10^3/mm31.50-7.00
LYM#4.39 10^3/mm31.00-4.00
MON#19.54 10^3/mm30.20-0.80
EOS#13.89 10^3/mm30.00-0.50
BAS#25.25 10^3/mm30.0-0.20
ALY#0.69 10^3/mm30.0-0.20
LIC#173.34 10^3/mm30.0-0.20
IML#14.18 10^3/mm30.0-0.05
IMM#70.23 10^3/mm30.0-0.10
IMG#88.93 10^3/mm30.0-999.90
NRBC#1.22 10^3/mm30.0-0.15

Histograms & Matrix

Histograms and matrix

Comments:
Sep. Neutro/Eosino
Sep. Mono/Neutro
Left Neutro
Right Neutro
Right Mono
WBC instability (DIFF)
WBC out of linearity
WBC noise (DIFF)
WBC abnormal DIFF

Table 1. Correlation between leukocytes and differential count of Yumizen H1500/2500 and Sysmex XN-1000 tools

Parameters (n=57)Correlation coefficient (R)*p-value
WBC0.9900.000
Lymph0.8920.000
Mono0.7170.000
Neut0.7060.000
Eos0.7820.000
Baso0.3760.000
*Spearman's Correlation Test

 

Table 2. Comparison between leukocytes and differential count of Yumizen H1500/2500 with peripheral blood smear and bone marrow

ParametersYumizen H1500/2500 (n=57) 
AcuteChronicp-value
MeanSDMeanSD
WBC64.0996.33223.59118.28<0.001
Neut42.0022.2411.5819.79<0.001
Lymph21.9321.496.836.330.001
Mono19.2312.866.836.330.001
Eos0.971.762.781.52<0.001
Baso2.964.8010.758.600.013
*Mann-Whitney Test

 

Table 3. Comparison between leukocytes and differential count of Sysmex XN-1000 with peripheral blood smear and bone marrow

ParametersSysmex XN-1000 (n=57) 
AcuteChronicp-value
MeanSDMeanSD
WBC72.39116.08248.31163.98<0.001
Neut27.2423.9172.1824.28<0.001
Lymph41.6322.9210.3020.43<0.001
Mono29.6920.709.359.920.001
Eos1.262.692.822.810.009
Baso0.551.015.025.05<0.001
*Mann-Whitney Test
Microscopic_views

b. Blood smear patient with CML c. Bone marrow smear patient with CML

Discussion

The results of the leukocyte differential count showed the same cell types found in the morphology of the peripheral blood smear and bone marrow aspiration. The correlation between the two hematology analyzers showed that the results of the differential count were either increasing or decreasing even though the methods of the two hematology analyzers were different.

Conclusion

There was no difference in the leukocyte differential count parameters between both hematology analyzers and had a significant positive correlation with the morphology of the peripheral blood smear and bone marrow aspiration.

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