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Before adopting a new hematology analyzer in clinical laboratories, evaluating its platelet counting performance is critical. To assess the analytical performance of impedance (PLT-I), hybrid (PLT-H), and optical (PLT-O) platelet counts on the novel Mindray BC-7800 (BC-7800) and to compare platelet parameters obtained from the BC-7800 and Sysmex XN-3000 (XN-3000), including PLT-I, PLT-O, and PLT-F (optical fluorescent platelet count using oxazine dye), against the international reference method (IRM) in specimens with platelet interferences. Analytical parameters of the BC-7800, including limit of blank, linearity, reproducibility, and carryover, were evaluated. Interference testing included 126 specimens with red blood cell (RBC) microcytosis and 21 specimens from patients with blasts. Diagnostic performance against the IRM was assessed at platelet transfusion thresholds of 10 × 103/µL and 20 × 103/µL. The BC-7800 met acceptable criteria for most basic parameters, except within-run precision for PLT-I and PLT-H in some thrombocytopenic specimens. In RBC microcytosis, all methods showed strong correlations with the IRM, though PLT-I exhibited proportional bias. In leukemia specimens, PLT-O from the BC-7800 and PLT-F from the XN-3000 showed the strongest agreement with the IRM, while PLT-H and PLT-O from the XN-3000 exhibited systematic bias. Specificity and positive predictive value were excellent across all methods. Sensitivity, negative predictive value, and accuracy were highest for PLT-O from the BC-7800 and PLT-F. The BC-7800 demonstrated reliable platelet analysis, particularly with PLT-O in thrombocytopenic and interference-prone specimens. PLT-H and optical fluorescent platelet methods showed strong reliability in specimens with RBC microcytosis, while PLT-O from the BC-7800 and PLT-F offered the highest accuracy for guiding platelet transfusion decisions.

Background Complete blood count (CBC) and erythrocyte sedimentation rate (ESR) are essential tests in clinical practice. The Mindray BC‐6800 Plus integrates CBC and ESR analysis through its Easy‐W ESR module and a hybrid platelet channel (PLT‐H) designed to improve platelet quantification, especially under interference. Methods A prospective analytical study was conducted following CLSI guidelines (EP05‐A3, EP06‐A, EP09c). A total of 460 venous samples were analyzed across multiple modes (Auto, Open‐Vial, Predilute). PLT‐H was compared with PLT‐O and reference values; ESR with the BC‐760CS, which shares the same ESR module validated against Westergren. Interference testing included samples with low MCV (< 75 fL) and high MPV (> 10 fL). Results PLT‐H background was consistently < 5 × 109/L. Precision met predefined limits (CV ≤ 4% whole blood, ≤ 8% predilute; ESR SD ≤ 2 mm/h at ≤ 20 mm/h, CV ≤ 10% at > 20 mm/h). Carryover was ≤ 0.2%. PLT‐H showed excellent linearity to 5000 × 109/L (r = 0.999) and tighter bias distribution than PLT‐O. Agreement was strong for ESR between BC‐6800 Plus and BC‐760CS (r = 0.989) and for PLT‐H versus PLT‐O (r = 0.992). PLT‐H maintained robustness in interference‐prone samples (r = 0.992). Conclusion The BC‐6800 Plus demonstrated excellent analytical performance for ESR and PLT‐H, delivering accurate, reproducible, and interference‐resistant results. It supports efficient, high‐quality testing in modern laboratories. This study evaluated the analytical performance of the Mindray BC‐6800 Plus hematology analyzer, focusing on integrated erythrocyte sedimentation rate (ESR) and hybrid platelet counting (PLT‐H). Results demonstrated excellent background suppression, precision, linearity, and robustness across different modes and analyzers, confirming its reliability for consolidated inflammatory and hematologic testing.

In the Sysmex DI-60 digital morphology system, a platelet estimate factor (PEF) is used to calculate the estimated platelet count (PLT). To determine the most accurate PEF by analyzing various specimens, including those with abnormal flag alerts, using both impedance (PLT-I) and optical fluorescent (PLT-F) PLT methods. A validation study was then conducted using random specimens to evaluate the accuracy of the PEF. This study included 120 blood specimens without flag alerts, and 120 blood specimens with flag alerts related to platelet abnormalities to determine the PEF. Each group was equally divided into thrombocytopenia, normal count, and thrombocytosis specimens. The PEF values obtained from the PLT-I and PLT-F methods were analyzed. An additional 120 specimens were used to compare the estimated PLT from PEF with the PLT-F count. Unadjusted PEF disregarded platelet ranges and flag alerts, whereas adjusted PEF incorporated them. The mean PEF values ranged within 9.95 to 12.99 for PLT-I-obtained values (PEF-I) and within 10.32 to 11.69 for PLT-F-obtained values (PEF-F) across different PLT ranges. The mean PEF values were significantly higher in specimens with flags compared with those without flags. The values were 12.43 compared with 10.19 for PEF-I and 11.45 compared with 10.4 for PEF-F. A significant difference was found between PEF-I and PEF-F in flagged specimens, with respective values of 12.43 and 11.45. There was excellent agreement between estimated PLTs using adjusted PEF and PLT-F. However, proportional biases were observed between estimated PLT using unadjusted PEF and PLT-F. Adjustment of PEF values according to specific platelet ranges and flag alert presence was shown to enhance the accuracy of PLT estimation using the Sysmex DI-60 system.

Background This study investigated the accuracy of the “PLT Clumps?” flag triggered by different channels on the Sysmex XN haematology analyser in identifying two sample states and to optimize the platelet review strategy for cancer patients. Methods 570 samples flagged “PLT Clumps?” in CBC + DIFF mode were analysed. After excluding clots, retesting was conducted in CBC + DIFF + PLT‐F mode. The accuracy of the “PLT Clumps?” flag and its correlation with PLT aggregation (PA) or fibrin precipitation (FP) were evaluated. Low‐platelet count samples were collected for a second blood draw to confirm whether pseudothrombocytopenia (PTCP) was present. The incidence and positive predictive value (PPV) of the “PLT Clumps?” flag across different tumours were also analysed. Results Among 85 verified cases (PA = 17, FP = 63), the overall PPV of the “PLT Clumps?” flag was 14.9% (85/570) in CBC + DIFF mode, 3.5% in WNR channel only, 73.9% in WDF channel only, and 94.4% in dual‐channel. In CBC + DIFF + PLT‐F mode, the overall PPV and NPV were 98.5% (65/66) and 97.0% (484/499), respectively. PA and FP accounted for 73.9% (17/23) and 26.1% (6/23) of the PLT‐F‐only flagged samples, respectively, and all WDF‐only and dual‐flagged cases were triggered by FP. The incidence of PTCP in samples flagged for “PLT Clumps?” in CBC + DIFF + PLT‐F mode was 80%. Samples from patients with hepatobiliary tumours showed highest flagging rate (20.4%) but a lower PPV. Conclusion The correlation between “PLT Clumps?” flags originating from different channels and two common preanalytical factors interfering in PLT counting was analysed, and the platelet review strategy for cancer patients was optimized.

Reliable automated blood cell characterization and quantification remain challenging in pathologic samples, whereas slide reviews due to unnecessary flagging should be avoided. We compared 4 modern hematology analyzers—Abbott Sapphire, Siemens Advia 120, Sysmex XE-2100, and Beckman Coulter DxH 800—regarding complete blood cell count (CBC), leukocyte differential count, and flagging efficacy in a total of 202 samples from hematology patients and normal controls. Manual differential count was used as reference. The analyzers exhibited very good correlation for CBC parameters. Neutrophils and eosinophils also showed very good correlations, whereas lymphocytes and monocytes correlated fairly. The Advia 120 displayed notably lower measurements for both parameters, which is attributable to classification of some events as large unstained cells. Basophil counts were unreliable with all analyzers. Flagging for blasts and immature granulocytes showed moderate sensitivity and specificity. Operators must not rely on blast flagging alone to detect leukemic samples with any analyzer.

The aim of this study is to evaluate the performance of different platelet counting methods (optical, impedance, fluorescence and hand counting) applied in different analysers by comparing with the international flow cytometric reference method (IRM). A total of 333 blood samples from different subgroups (168 cases with thrombocytopenia, 136 cases with normal platelet counts and 29 cases with thrombocytosis) were tested. Regarding IRM as the gold standard, we compared the accuracy and precision of different platelet count methods; i.e. LH780 (impedance), BC-6000 Plus (optical (O) and impedance (I)), Sysmex XN-9000 (optical (O), impedance (I), fluorescence (F)), and hand counting. Sysmex XN-9000-F (r = 0.988) had the best correlation with IRM for thrombocytopenic samples; BC-6000 Plus-I (r = 0.966) was more relevant to IRM than any other method for samples with normal platelet counts. Correlation between Sysmex XN-9000-I (r = 0.960) and IRM was the highest among these methods for samples with thrombocytosis. For bias evaluation, the average bias of Sysmex XN-9000-F was -1.5 × 109/L (95% LA = -9.4 to +6.4) for samples with thrombocytopenia, compared with IRM. BC-6000 Plus-I had a small mean difference with IRM for samples with normal platelet counts or thrombocytosis. Moreover, all evaluated methods had acceptable sensitivity, specificity, and concordance rates as compared with IRM in the diagnosis of thrombocytopenia and thrombocytosis. Platelet counting by Sysmex XN-9000-F is more accurate than other methods for thrombocytopenic samples. BC-6000 Plus-I has superior association and consistency for normal platelet counts. As for thrombocytosis patients, Sysmex XN-9000-I has the highest correlation with IRM while Sysmex XN-9000-O has the highest diagnosis efficacy.

In thrombocytopenia, high accuracy and precision of low platelet count is essential for appropriate decisions. The recently introduced Sysmex XN2000 analyzer (Sysmex, Kobe, Japan) offers 3 methods for platelet counting: impedance (PLT-I), optical (PLT-O), and a new fluorescence method (PLT-F). The precision of the PLT-F method in blood samples with platelet counts less than 50 × 10(3)/μL (50 × 10(9)/L) was investigated and compared with the ICSH CD61-ImmunoPLT reference method. For comparison, PLT-I and PLT-O were determined on the Sysmex XN2000 and Sysmex XE2100 analyzer. Blood samples with platelet counts less than 50 × 10(3)/μL (50 × 10(9)/L) (n = 37) were analyzed on the Sysmex XN2000 and XE2100 analyzers. The CD61-ImmunoPLT method was performed on a Beckman Coulter FC-500 flow cytometer (Miami, FL). At a platelet count of 20 × 10(3)/μL (20 × 10(9)/L), reproducibility for PLT-I, PLT-O, and PLT-F on the XN2000 demonstrated coefficients of variation of 9.3%, 8.5%, and 3.0%, respectively. Correlation between PLT-O on the XN2000 and XE2100 yielded an r value of more than 0.977. Linear regression analysis between the PLT-F and CD61-ImmunoPLT methods resulted in a PLT-F of 0.71*CD61 - 0.8 (r = 0.988). Linear regression between PLT-F and PLT-O on the XN2000 resulted in a PLT-F of 1.05*PLT-O - 2 (r = 0.975), and using the transfusion threshold of 20 × 10(9)/L platelets resulted in a PLT-F of 0.90*PLT-O - 0.4 (r = 0.956). The new PLT-F method demonstrated excellent results for reproducibility in samples with platelet counts less than 50 × 10(9)/L. PLT-F could be helpful in making better decisions for platelet transfusions.

EDTA-dependent pseudothrombocytopenia (EDTA-PTCP) is an phenomenon that may lead to expensive, time-consuming, and invasive diagnostic procedures as well as unnecessary patient treatment. The purpose of this study was to explore the effects of time, anticoagulant and detection channel on the platelet (PLT) count of EDTA-PTCP samples, and to suggest a better method for correcting spurious low PLT counts. In this study, 43 identified EDTA-PTCP samples were collected. The Sysmex XN-9100, Mindray BC-6900 and Mindray BC-5390 haematology analysers were used to test these EDTA-PTCP samples on the following detection channels at different time points: PLT count by impedance method (PLT-I), PLT count by optical method (PLT-O) and PLT count by fluorescent staining (PLT-F). EDTA-PTCP was time-dependent and small PLT agglutination occurred in most of the corresponding citrate-treated samples. Our results further demonstrated that the detection channel significantly affected the PLT count of the EDTA-PTCP samples. The XN-9100 PLT-F channel exhibited a greater dissociative effect than the XN-9100 PLT-I and PLT-O channels. Moreover, blood samples processed in the PLT-O channel of the Mindray hematology analyzer showed the highest PLT count in EDTA-K2 tubes compared to the other detection channels. Our data showed that time, anticoagulant and detection channel significantly affected the PLT count in the EDTA-PTCP samples. For the EDTA-PTCP samples, the simplest retest method was to use the PLT-O channel of the Mindray automatic blood analyser within 30 min. In addition, changing the sodium citrate anticoagulant and using the XN-9100 PLT-F channel within 15 min were also suitable for correcting the spurious low PLT of the EDTA-PTCP samples.

Objective: The immature platelet fraction (IPF) is a laboratory measurement analogous to the reticulocyte count, but reflecting the thrombopoietic state. Similar to a reticulocyte count, it can be expressed as a percent (IPF%=percent of platelets that are immature) or as an absolute number per μl blood; the immature platelet count (IPC=IPF% × platelets per μl of blood). Study design: Using a retrospective analysis of de-identified data from non-thrombocytopenic neonates, we created reference intervals for IPF% and IPC. We then tested the value of these measurements for categorizing thrombocytopenic neonates. Results: New charts display reference intervals for IPF% and IPC on the day of birth according to gestational age, and during the first 90 days after birth. Neonates with hyporegenerative varieties of thrombocytopenias (syndromes, small for gestational age, birth asphyxia) had lower IPF% and IPC than did neonates with consumptive thrombocytopenias (immune-mediated, infection, disseminated intravascular coagulation, necrotizing enterocolitis; both P <0.0001). Conclusion: The new reference interval charts can be used to recognize abnormal IPFs. The IPF parameters can help clarify the kinetic mechanism responsible for thrombocytopenias in neonates.

Background: The aim of this study was to evaluate the changes in platelet indices (PLT) provided by the ADVIA 2120 hematology analyzer (Siemens Hematology System) in the early stages of onset of infections and acute coronary syndromes (ACSs). Methods: Samples were selected from 40 patients admitted to the intensive care unit with suspected uncomplicated sepsis at presentation, from 40 patients with a biochemical diagnosis of ACS at presentation and from 40 apparently healthy subjects. These samples were tested for PLT and PLT indices [mean platelet volume (MPV); mean platelet mass (MPM); mean platelet component (MPC); immature platelets (RtcPlts)] obtained by automation with the ADVIA 2120 and specific biomarkers for sepsis [white blood cells (WBCs); neutrophil granulocytes (NGs); presepsin (PSP); procalcitonin (Pct); C-reactive protein (CRP)] and for SCA (hs cTnI). Results: Platelet indices (RtcPlts, MPV, MPM) were significantly altered (p > 0.005) in patients with suspected sepsis and patients with ACS compared to control subjects; however, no statistically significant difference was observed between the two groups of patients with disease. Cutoff values (ROC curves) were obtained for platelet indices that best discriminated healthy subjects from subjects with severe infection or ACS. Conclusions: Our data show that, in subjects with suspected sepsis and ACS at disease onset, a state of early platelet activation exists that is not disease-specific. Immature platelets (RtcPlts) and the platelet indices MPM and MPV, provided by the ADVIA 2120 hematology analyzer, showed high sensitivity in subjects with suspected sepsis or ACS at disease onset.