Publications

Sysmex is one of the world’s leading healthcare companies and our aim is to build and share knowledge. This database is targeted at our customers, clinicians from various medical disciplines and researchers as well as any other interested reader. The literature lists with publications from scientific journals give a comprehensive overview on available evidence for Sysmex products and solutions.

COVID-19

Attention - Please consider the following when assessing the literature regarding COVID-19 (SARS-CoV-2 infection)

Please consider the following when assessing the literature regarding COVID-19 (SARS-CoV-2 infection):
COVID-19 is an emerging, rapidly evolving pandemic.
Available literature is changing quickly and studies summarised here may not represent the latest status of knowledge. Please consider that conclusions of articles of this list may be based on low sample numbers or manuscripts that are not peer-reviewed yet (pre-prints).

Original articles

Kilercik M et al. (2021) PloS ONE; 16(8) e0254073:
A new haematocytometric index: Predicting severity and mortality risk value in COVID-19 patients.
What we see as the essence:
A retrospective analysis of 97 COVID-19 positive patients identified monocyte-to-neutrophil ratio (MNR), MCV, RDW, and PLT as independent risk factors for mortality. A mortality risk score comprised of MNR, neutrophil-to-lymphocyte ratio (NLR), RDW, and PLT achieved an AUC of 0.91 and a specificity of 0.94.
Boulanger M et al. (2021) Am J Med; 134(8): 1029:
Peripheral Plasma Cells Associated with Mortality Benefit in Severe COVID-19: A Marker of Disease Resolution.
What we see as the essence:
This multicentric study investigated the association of plasma cells (HFLC) in peripheral blood of severe COVID-19 patients for morbidity. Retrospective analysis showed that patients exhibiting plasma cells were more likely to develop severe disease but also had a reduced risk of death. In most patients plasma cells appeared after progression to severe disease and, thus, will not serve as an early marker for severe disease.
Martens R et al. (2021) Clin Chem Lab Med; 59(4): 783:
Hemocytometric characteristics of COVID-19 patients with and without cytokine Storm syndrome on the Sysmex XN-10 hematology analyzer.
What we see as the essence:
A study on the haemocytometric characteristics of COVID-19 patients revealed that a cytokine-storm syndrome was associated with higher AS-LYMPH, RE-MONO and monocyte fluorescence.
Dennison D et al. (2021) Int J Infect Dis; 106: 155:
Circulating activated neutrophils in COVID-19: An independent predictor for mechanical ventilation and death.
What we see as the essence:
In multivariable regression analyses NEUT-RI (OR = 1.22) was a statistically significant predictor at admission for a later need of mechanical ventilation and death in COVID-19 positive patients among others. NEUT-RI cut-off value for mechanical ventilation was 52 FI (44% sensitivity, 88% specificity; AUC= 0.67).
Foy B et al. (2020) JAMA Netw Open; 3(9): e2022058:
Association of Red Blood Cell Distribution Width With Mortality Risk in Hospitalized Adults With SARS-CoV-2 Infection.
What we see as the essence:
A retrospective analysis from four US hospitals associated an elevated red cell distribution width (RDW) at admission and an increasing RDW during hospitalisation with increased mortality risk in COVID-19 patients, and identified RDW as an independent mortality risk factor.
Rolla R et al. (2020) Int J Lab Hematol; 43(1): e5:
Reduced activity of B lymphocytes, recognised by Sysmex XN-2000™ haematology analyser, predicts mortality in patients with coronavirus disease 2019.
What we see as the essence:
The antibody-synthesizing lymphocyte count (AS-LYMP#) together with age, C-reactive protein (CRP) and creatinine level was identified as an independent predictor of in-hospital mortality in COVID-19 patients.
Lapic I et al. (2020) Int J Lab Hematol; online ahead of print:
Cell population data: Could a routine hematology analyzer aid in the differential diagnosis of COVID-19.
What we see as the essence:
A letter to the editor that describes the detailed analysis of cell population data (CPD) from an XN-1000 in COVID-19 and non-COVID-19 patients. CBC parameters do not present with significant differences. The CPD parameters present with significant differences, with the most pronounced the elevated LY-WZ.
Urrechaga E et al. (2020) Clin Chem Lab Med; 59(2): e57:
Complete blood counts and cell population data from Sysmex XN analyser in the detection of SARS-CoV-2 infection.
What we see as the essence:
A letter to the editor that describes a categorisation of patients with infection/fever into distinct groups based on statistical analyses of complete blood count and cell population data (CPD) from an XN analyser. 93.5% of COVID-19 patients and 100% of non-COVID-19 patients were correctly classified. The authors suggested a flag for COVID-19 infection, based on the neutrophil-to-lymphocyte ratio (NLR) and CPD values.
Santotoribio J et al. (2020) Clin. Lab; 66(9):
Evaluation of Routine Blood Tests for Diagnosis of Suspected Coronavirus Disease 2019.
What we see as the essence:
A descriptive diagnostic study that evaluated several routine blood tests for the diagnosis of COVID-19 at hospital admission. Lymphocytes, eosinophils, ferritin, LDH, D-dimer and hsCRP were included in the diagnostic criteria that identified suspected COVID-19 patients with a sensitivity of 91% and a specificity of 47%.
Cohen A et al. (2020) J Thromb Thrombolysis; 30: 1:
Immature platelets in patients hospitalized with Covid-19.
What we see as the essence:
Patients with COVID-19 have increased immature platelets parameters (IPF, IPF#) compared to stable patients with cardiovascular risk factors. As the disease progresses IPF and IPF# are increased also compared to acute myocardial infarction patients.
Linssen J et al. (2020) Elife; 9: e63195;:
A novel haemocytometric COVID-19 prognostic score developed and validated in an observational
multicentre European hospital-based study.
What we see as the essence:
The intention of the prognostic score is to support the management of
COVID-19 patients. Score values generated within the first three days of hospital admission can predict clinical severity in COVID-19 patients over the next two weeks. The score performance was shown to be superior to single parameters or parameter ratios.
Osman J et al. (2020) Br J Haematol; epub ahead of print:
Rapid Screening of COVID-19 Patients by White Blood Cells Scattergrams, a Study on 381 Patients.
What we see as the essence:
A specific pattern of WDF scattergram, the “sandglass shape” pattern of lymphocyte population, was investigated in a cohort of 381 patients and exhibited a sensitivity and specificity of 85.9% and 83.5% for identifying COVID-19 infection, respectively.
Yip CYC et al. (2020) Br J Haematol; 190(1): 33:
Temporal changes in immune blood cell parameters in COVID‐19 infection and recovery from severe infection.
What we see as the essence:
The results show that CBC including extended parameters about activated lymphocytes may be a valuable tool to triage patients with COVID-19. AS-LYMP%L (as a percentage of lymphocytes) yielded the best area under the receiver operating characteristic curve for predicting severe disease.
Wang Z et al. (2020) Br J Haematol; Epup ahead of print:
High-fluorescent lymphocytes are increased in patients with COVID-19.
What we see as the essence:
A retrospective analysis of patients from the epicentre of the COVID-19 outbreak in Wuhan, China showed that while lymphocyte (L) counts were progressively decreased as disease severity increased, high-fluorescent lymphocyte (HFL) count and HFL/L ratio were increased in mild and severe cases compared to healthy controls.
Zhang C et al. (2020) Chem Lab Med; 58(7): 1152:
Decreased "WBC*LYM" was observed in SARS-CoV-2-infected patients from a fever clinic in Wuhan.
What we see as the essence:
Retrospective CBC+DIFF data analysis from a fever clinic in Wuhan from February 2020 (mid-Corona-pandemic in China) to evaluate the diagnostic value of haematologic parameters in suspected COVID-19 patients. The combination parameter of WBC and LYM (WBC*LYM) showed the best performance data for the quick evaluation of the patients disease severity and whether the patient is likely to have COVID-19 or not.

Review articles

Khartabil TA et al. (2020) Crit Rev Clin Lab Sci; 57(6): 415:
A summary of the diagnostic and prognostic value of hemocytometry markers in COVID-19 patients.
Nokhostin F et al. (2020) J Adv Med Biomed Res; 28(128): 171:
Evaluation of Prognostic/Diagnostic Value of Hematological Markers in the Detection of Inflammation in Coronavirus Disease: A Review Study.

Single case reports

ZHANG B et al. (2020) PLOS ONE. 15(7): e0235458:
Clinical characteristics of 82 cases of death from COVID-19.
Gérard D et al. (2020) Br J Haematol; 189(5): 845:
SARS-CoV-2: A New Aetiology for Atypical Lymphocytes.
Fan BE et al. (2020) Am J Hematol; 95(6): 723:
COVID-19 and mycoplasma pneumoniae coinfection.
Foldes D et al. (2020) Am J Hematol; 95(7): 861:
Plasmacytoid lymphocytes in SARS-CoV-2 infection (Covid-19).
Mitra A et al. (2020) Am J Hematol; 95(8): 999:
Leukoerythroblastic Reaction in a Patient With COVID-19 Infection.
Platelets

Fluorescence platelets (PLT-F)

Tantanate C et al. (2019) Scand J Clin Lab Invest; 79(3):160:
Analytical performance of automated platelet counts and impact on platelet transfusion guidance in patients with acute leukemia.
What we see as the essence:
In this study the performance of impedance platelet counting using PLT-I, LH-750 (PLT-LH), as well as PLT-F was analysed in patients with acute leukaemia. PLT-F demonstrated an excellent performance for the identification of thrombocytopenia and had the lowest rate of under transfusion. Additionally, the authors found that a high blast count is associated with inaccurate PLT-LH and PLT-I counts.
Tantanate C et al. (2017) Arch Pathol Lab Med; 141(6): 830:
Performance Evaluation of Automated Impedance and Optical Fluorescence Platelet Counts Compared With International Reference Method in Patients With Thalassemia.
What we see as the essence:
PLT-I, PLT-O and PLT-F in thalassaemia patients were compared with CD41/CD61 immune flow cytometry. PLT-O and PLT-F had better correlations with flow cytometry than PLT-I. PLT-F had a better specificity for detection of PTL counts below 100,000/µL.
Park SH et al. (2015) Ann Lab Med; 34(6): 471:
The Sysmex XN-2000 Hematology Autoanalyzer Provides a Highly Accurate Platelet Count than the Former Sysmex XE-2100 System Based on Comparison with the CD41/CD61 Immunoplatelet Reference Method of Flow Cytometry.
What we see as the essence:
PLT-F counts from the XN-Series were more accurate than PLT-O counts from the XE series when compared with the CD41/CD61 immunoplatelet reference method.
Wada A et al. (2015) PLoS One; 10(10):
Accuracy of a New Platelet Count System (PLT-F) Depends on the Staining Property of Its Reagents.
What we see as the essence:
The study showed that the PLT-F reagent labels intracellular structures within platelets and confirms previous findings that it strongly marks CD41/CD61-positive platelets.
Tailor H et al. (2014) Hospital Health Care Europe (HHE); 2:181:
Evaluating platelet counting on a new automated analyser.
What we see as the essence:
The PLT-F channel of the XN-Series shows excellent precision and accuracy even in abnormal samples or samples with fragmented red cells, large platelets and low PLT counts when compared to the reference flow cytometric method.
Tanaka Y et al. (2014) J Clin Lab Anal; 28(5): 341:
Performance Evaluation of Platelet Counting by Novel Fluorescent Dye Staining in the XN-Series Automated Hematology Analyzers.
What we see as the essence:
Compared to PLT-I and PLT-O counts, PLT-F had the best correlation with CD61-immunoplatelet counts. PLT-F counts were not affected by WBC fragments in two acute leukaemia patients or by RBC fragments and microcytes in a burn injury patient.
Schoorl M et al. (2013) Am J Clin Pathol;140: 495:
New fluorescent method (PLT-F) on Sysmex XN2000 hematology analyzer achieved higher accuracy
in low platelet counting.
What we see as the essence:
The PLT-F method of the XN-2000 demonstrated excellent reproducibility in samples with low platelet counts. Therefore, it is recommended for making decisions about platelet transfusions.

General

Ortiz A et al. (2020) Sysmex J Int; 30(1): 9:
Performance Comparison of Sysmex Hematology Analyzers XN-550 and XN-10.
What we see as the essence:
The XN-550 is highly reliable with functionality comparable to the XN-10. It has shown high correlation coefficients and excellent comparative performance in all CBC, DIFF and RET parameters (except BASO%). The overall flagging comparison was excellent among the XN-10, the XN-550 and the manual differential.
Cao J et al. (2017) Lab Med; 48(2): 188:
Establishing a Stand-Alone Laboratory Dedicated to the Care of Patients With Ebola Virus Disease.
What we see as the essence:
The pocH-100i was used in a laboratory dedicated to detection of Ebola virus disease. Its accuracy was verified by comparison with the XE-2100 in the main laboratory, and its precision and reportable range were also consistent with Sysmex's claims.
Cornet E et al. (2016) Scand J Clin Lab Invest; 76(6): 465:
Evaluation and optimization of the extended information process unit (E-IPU) validation module integrating the sysmex flag systems and the recommendations of the French-speaking cellular hematology group (GFHC).
What we see as the essence:
Using the biomedical validation criteria, 21.3 % of samples triggered
a smear review. Modification of four criteria reduced the number of smears from 21.3 % to 15.0 % without loss of clinical value.
Van Dievoet MA et al. (2016) Int J Lab Hematol; 38(5): 490:
Performance evaluation of the Sysmex® XP-300 in an oncology setting: evaluation and comparison of hematological parameters with the Sysmex® XN-3000.
What we see as the essence:
The XP-300 showed very good precision and linearity results, comparable with the XN-3000 analyser.
SEO JY et al. (2015) Int J Lab Hematol; 37(2): 155:
Performance evaluation of the new hematology analyzer Sysmex XN-series.
What we see as the essence:
A good correlation was found between the XN-Series and XE-series for all parameters. The XN-Series dramatically reduced the smear rate (by 58%). Even at counts below 500/µL the XN provided an accurate WBC count using the Low WBC mode.
Arneth B et al. (2015) J Clin Lab Anal; 29(3): 175:
Technology and New Fluorescence Flow Cytometry Parameters in Hematological Analyzers.
What we see as the essence:
This paper gives a good overview of the technology behind the XE-series and the benefits of flow cytometry and automatic cell counting. It shows that the XE-5000 delivers faster accurate results than older analysers.
Genevieve F et al. (2014) feuillets de Biologie; VOL LVI N° 317:
Smear microscopy revision: propositions by the GFHC.
What we see as the essence:
The GFHC reviewed in detail the criteria used within the CBC to generate blood smears and has decided on a number of minimum recommendations, defining threshold values and various situations in which the blood smear review is desirable.
Briggs C et al. (2012) J Clin Pathol; 65:1024:
Performance evaluation of the Sysmex haematology XN modular system.
What we see as the essence:
The XN showed reduced sample turnaround time and reduced number of blood film reviews compared to the XE-2100 without loss of sensitivity and with more precise and accurate results for both platelets and low WBC counts.

Immature platelet fraction (IPF)

Jones N et al. (2021) Platelets; 7: 32(7): 941:
Immature platelet indices alongside procalcitonin for sensitive and specific identification of bacteremia in the intensive care unit.
What we see as the essence:
The study results demonstrate the predictive power of IPF and IPF# for identification of bacteremia in ICU patients as individual parameters and even more by calculating the change in these parameters between day 1 and 2 of ICU stay (ΔIPF, ΔIPF#). The use of a combination of ΔIPF (cut-off > 1.95%) and day 2 PCT (cut-off > 0.57 ng/ml) has a PPV of 100% and a NPV of 96.1% and thereby accurately ruling out patients from a diagnosis of bacteremia.
Jeon MJ et al. (2020) Korean J Intern Med; 35(4): 970:
Immature platelet fraction based diagnostic predictive scoring model for immune thrombocytopenia
What we see as the essence:
The authors concluded that immature platelet fraction (IPF) could be a useful parameter to distinguish immune thrombocytopenia (ITP) from other causes of thrombocytopenia. They developed the predictive scoring model that could predict ITP with high probability.
Jeon K et al. (2020) Medicine (Baltimore); 99(7): e19096:
Immature platelet fraction: A useful marker for identifying the cause of thrombocytopenia and predicting platelet recovery
What we see as the essence:
The authors demonstrated that the IPF is an excellent marker for distinguishing hyperdestructive/consumptive from hypoproductive thrombocytopenia. Moreover IPF is a robust and reliable predictor of platelet recovery in patients with immune thrombocytopenia (ITP) and with malignancies undergoing chemotherapy.
El-Gamal RA et al. (2020) Indian J Hematol Blood Transfus; 36(2): 316:
Combined Immature Platelet Fraction and Schistocyte Count to Differentiate Pregnancy-Associated Thrombotic Thrombocytopenic Purpura from Severe Preeclampsia/Haemolysis, Elevated Liver Enzymes, and Low Platelet Syndrome (SPE/HELLP)
What we see as the essence:
IPF and manual schistocyte counts were able to discriminate pregnancy-associated severe preeclampsia/haemolysis, elevated liver enzymes, and low platelet syndrome (SPE/HELLP) versus thrombotic thrombocytopenic purpura (TTP) patients. The model based on combination of parameters had a good predictive value to discriminate TTP from SPE/HELLP - sensitivity of 92.3%, specificity of 62.5% and AUC 0.827.
Zhao Y et al. (2020) Front Cardiovasc Med; 7: 578041:
The Prognostic Value of Reticulated Platelets in Patients With Coronary Artery Disease: A Systematic Review and Meta-Analysis.
What we see as the essence:
This comprehensive metanalysis revealed that the level of immature platelets might be a useful prognostic biomarker for adverse cardiovascular events in patients with coronary artery disease even after adjustment for other prognostic factors.
Buttarello M et al. (2020) Int J Lab Hematol; 42(4): 363 (IPF):
Reticulated platelets and immature platelet fraction: Clinical applications and method limitations
What we see as the essence:
Thorough review about reticulated platelets and immature platelet fraction including overview of preanalytical and analytical limitations of methods and clinical applications.
van De Wyngaert Z et al. (2019) Curr Res Transl Med; 68(1):37:
Immature platelet fraction (IPF): A reliable tool to predict peripheral thrombocytopenia.
What we see as the essence:
This retrospective study found that IPF higher than 13 % is predictive of peripheral thrombocytopenia. In isolated thrombocytopenia bone marrow aspiration could have been avoided in 66 % of patients in this study cohort.
Johnson S et al. (2019) Int J Lab Hematol; 41(2): 271:
A CBC algorithm combined with immature platelet fraction is able to identify JAK2 V617F mutation-positive polycythaemia vera patients.
What we see as the essence:
The study proposes an algorithm based on CBC and IPF# parameters that allows to identify a cohort of high-likelihood polycythaemia vera (PV) patients and refer them for haematological review. IPF# > 20 ×109/L in combination with positive CBC criteria can identify JAK2 V617F mutation-positive PV patients.
Bernstein U et al. (2019) Arch Gynecol Obstet; 299(6): 1537:
The immature platelet fraction in hypertensive disease during pregnancy
What we see as the essence:
This study shows that IPF% can be used to identify hypertensive diseases in pregnancy. Moreover, the absolute number of IPF and platelets could help to differentiate preeclampsia and HELLP syndrome.
Perl L et al. (2019) Platelets; 17:1:
Prognostic significance of reticulated platelet levels in diabetic patients with stable coronary artery disease.
What we see as the essence:
In stable coronary artery disease patients with diabetes the increased levels of immature platelets (IPF) are associated with a higher risk of major adverse cardiovascular events and inversely correlated with the risk of bleeding.
Thorup C et al. (2019) Semin Thromb Hemost; 46(3): 320:
Immature Platelets As a Predictor of Disease Severity and Mortality in Sepsis and Septic Shock - A Systematic Review.
What we see as the essence:
Based on nine studies the review highlighted that an increased number of immature platelets is associated with increase disease severity and mortality in patients with sepsis and septic shock.
Hannawi B et al. (2018) Thromb Haemost; 118(9): 1517:
Reticulated Platelets - Changing Focus from Basics to Outcomes.
What we see as the essence:
The authors discussed the role of reticulated platelets in coronary artery disease and in hypo responsiveness to the commonly used anti-platelet drugs. Reticulated platelets may be a useful marker for predicting worse cardiovascular outcome.
Buoro S et al. (2018) J Clin Pathol.; 71(4): 330:
Innovative haematological parameters for early diagnosis of sepsis in adult patients admitted in intensive care unit.
What we see as the essence:
The combination of an increased value of IPF# and a decreased value of RET% 24 hours before the onset of sepsis in ICU patients may be considered an early, rapid, inexpensive and widely available measure of sepsis prediction.
Sakuragi M et al. (2018) Int J Hematol; 107(3): 320:
Immature platelet fraction (IPF) as a predictive value for thrombopoietic recovery after allogeneic stem cell transplantation.
What we see as the essence:
IPF was able to predict platelet recovery in patients after allogeneic haematopoietic stem cell transplantation in 5 out of 11 patients, while IPF# was able to predict recovery in 7 out of 11 patients. Cut-offs of 5.8 % and 200/µL were used, respectively.
Pedersen OH et al. (2017) Am J Case Rep; 18: 945:
Recurrent Cardiovascular Events Despite Antiplatelet Therapy in a Patient with Polycythemia Vera and Accelerated Platelet Turnover.
What we see as the essence:
The case report illustrates that insufficient platelet inhibition with clopidogrel monotherapy in a patient with thrombocytosis may be associated with recurrent arterial thrombosis. A plausible explanation may be an accelerated platelet turnover reflected by an increased number of immature platelets.
Anetsberger A et al. (2017) Thromb Haemost; 117(10): 1887:
Immature platelets as a novel biomarker for adverse cardiovascular events in patients after non-cardiac surgery.
What we see as the essence:
IPF with optimal cut-off of > 5.4 % is an independent predictor of major adverse cardiovascular events, deep vein thrombosis or pulmonary embolism (modMACE) after non-cardiac surgery and improve risk stratification of surgical patients.
Ferreira FLB et al. (2017) Sci Rep; 7(1): 3355:
Evaluation of the immature platelet fraction contribute to the differential diagnosis of hereditary, immune and other acquired thrombocytopenias.
What we see as the essence:
The authors evaluated the use of IPF in the differential diagnosis between ITP and hereditary macrothrombocytopenia (HM). The IPF values were higher in HM than in ITP as already demonstrated by other studies.
Freynhofer MK et al. (2017) Thromb Haemost; 117(5): 923:
Platelet turnover predicts outcome after coronary intervention.
What we see as the essence:
An elevated platelet turnover independently predicts major adverse cardiovascular events after percutaneous coronary intervention. The optimal cut-off value was at IPF = 3.35 %.
Buoro S et al. (2017) Scand J Clin Lab Invest; 77(1): 73:
Abnormal leukocyte scattergrams and immature platelet fraction on Sysmex XN-9000 analyzer: a new diagnostic tool for altered megakaryopoiesis?
What we see as the essence:
This case report shows how a high IPF, combined with abnormal WNR, WDF and WPC scattergrams could be used as a marker of dysmegakaryopoiesis, and led to the diagnosis of MDS type 2-refractory anaemia with excess blasts (REAB-2) in a nine year-old girl.
Jaing TH et al. (2016) Cell Transplant; 25: 1259:
Assessment of platelet activation and immature platelet fraction as predictors of platelet engraftment after hematopoietic stem cell transplantation.
What we see as the essence:
The study showed that IPF (XE-2100) can be used to assess thrombopoietic recovery after stem cell transplantation. Patients in the cord blood group had a higher IPF than the peripheral blood group on day 56 and day 97 post-transplantation.
Cremer M et al. (2016) Seminars in Fetal & Neonatal Medicine; 21(1): 10:
Thrombocytopenia and platelet transfusion in the neonate.
What we see as the essence:
The review summarises the pathophysiology and current management (including platelet transfusion thresholds) of neonatal thrombocytopenia. Novel index score for bleeding risk in thrombocytopenic neonates is proposed (including IPF#).
Moraes D et al. (2016) Platelets; 27(4): 333:
Immature platelet fraction in hypertensive pregnancy.
What we see as the essence:
IPF% measured on the XE-5000 in pregnant women suffering hypertensive disorders was higher than in control group (3.8, 2.4–5.1 %; 8.6, 5.8–10.6 %; 7.3, 4.2–10.2 %; p < 0.001 for control group, preeclampsia syndrome and non-proteinuric hypertension, resp.).
Hong H et al. (2015) Transfusion; 55(4): 756:
Absolute immature platelet count dynamics in diagnosing and monitoring the clinical course of thrombotic thrombocytopenic purpura.
What we see as the essence:
The absolute IPF (from XE-5000) is useful to diagnose and to monitor the clinical course of therapeutic plasma exchange in TTP patients. Routine analysis of the absolute IPF is recommended for diagnosis and to better assess the need for adjustment of treatment.
Sakuragi M et al. (2015) Int J Hematol; 101(4): 369:
Clinical significance of IPF% or RP% measurement in distinguishing primary immune thrombocytopenia from aplastic thrombocytopenic disorders.
What we see as the essence:
IPF% from the XN-1000 and RP% obtained by immuno flow cytometry had a comparable diagnostic value for the distinction between controls, immune thrombocytopenia (due to platelet destruction) and aplastic thrombocytopenia.
Mao W et al. (2015) Clin Res Hepatol Gastroenterol; 39(4): 469:
Immature platelet fraction values predict recovery of platelet counts following liver transplantation.
What we see as the essence:
IPF% value predict recovery of PLT counts after liver transplantation. PLT counts reached the pre-transplant levels at 3-4 days after the IPF% peak value.
Miyazaki K et al. (2015) Hematology; 20(10): 587:
Immature platelet fraction measurement is influenced by platelet size and is a useful parameter for discrimination of macrothrombocytopenia.
What we see as the essence:
The IPF% values were about five times higher in May-Hegglin disorders (IPF 48.6 ± 1.9 %) and about twice as high in other macrothrombocytopenias (IPF 18.4 ± 2.1 %) than in ITP patients with similar platelet counts (IPF 9.2 ± 0.3 %).
Adly AA et al. (2015) Platelets; 26(7): 645:
Evaluation of the immature platelet fraction in the diagnosis and prognosis of childhood immune thrombocytopenia.
What we see as the essence:
IPF% obtained from the XE-2100 was increased in immune thrombo-cytopenia patients but not in patients with haematological malignancies. Therefore, IPF% may be used to evaluate the thrombopoietic state of the bone marrow.
Morkis IVC et al. (2015) Int J Lab Hematol; 37(2): 259:
Assessment of immature platelet fraction and immature reticulocyte fraction as predictors of engraftment after hematopoietic stem cell transplantation.
What we see as the essence:
Both IRF% and IPF% can be used to predict neutrophil and platelet recovery, respectively. Work was done on XE-5000.
Greene LA et al. (2015) Br J Haematol; 166(4): 592:
Beyond the platelet count: immature platelet fraction and thromboelastometry correlate with bleeding in patients with immune thrombocytopenia.
What we see as the essence:
The IPF# demonstrated stronger correlation with acute bleeding score than platelet counts. The strongest correlation was seen for paediatric patients with platelet counts <30 x109/L. High IPF# was associated with low bleeding score.
Ibrahim H et al. (2014) J Am Coll Cardiol; 64: 2122:
Association of Immature Platelets With Adverse Cardiovascular Outcomes.
What we see as the essence:
IPF# (XE-2100) allows for stratification of patients with coronary artery disease in terms of risk for future adverse events. Patients with an IPF# level ≥ 7,632 /µL were more likely to experience an adverse event (hazard odds ratio: 4.65; p < 0.002).
Dadu T et al. (2014) Int J Lab Hematol; 36(5): 499:
Evaluation of the IPF as an indicator of PLT recovery in dengue patients.
What we see as the essence:
IPF can be used to monitor the thrombocytopenia in patients with dengue fever. Furthermore, it can predict the recovery of PLT and so avoid unnecessary blood transfusions.
Everett TR et al. (2014) Thromb Haemost; 111(6): 1177:
Immature platelet fraction analysis demonstrates a difference in thrombopoiesis between normotensive and preeclamptic pregnancies.
What we see as the essence:
The study illustrates the potential utility of IPF as a parameter to distinguish between normotensive and preeclamptic pregnant women. The authors suggest that IPF is a far better parameter than MPV, which has previously been suggested for this purpose, and can distinguish between the two groups even at normal platelet counts.
Van der Linden N et al. (2014) Eur J Haematol; 93(2): 150:
Immature platelet fraction (IPF) measured on the Sysmex XN haemocytometer predicts thrombopoietic recovery after autologous stem cell transplantation.
What we see as the essence:
"IPF is a promising predictor of platelet recovery in patients after autologous SCT." "The proposed cut-off value of 5.3% can theoretically be used to decide whether or not to give a platelet transfusion."
Bat T et al. (2013) Transfusion; 53(6): 1201:
Measurement of the absolute immature platelet number reflects marrow production and is not impacted by platelet transfusion.
What we see as the essence:
Absolute IPF is a good parameter to assess the megakaryocytic activity of the bone marrow in transfusion-dependent thrombocytopenic patients.
Cremer M et al. (2013) J Perinatol; 33(8): 622:
Low immature platelet fraction suggests decreased megakaryopoiesis in neonates with sepsis or necrotizing enterocolitis.
What we see as the essence:
Low absolute IPF values during the course of neonatal sepsis/necrotising enterocolitis suggest suppression of megakaryopoietic activity.
Cesari F et al. (2013) Thrombosis and Haemostasis; 109: 846:
Reticulated platelets predict cardiovascular death in acute coronary syndrome patients. Insights from the AMI-Florence 2 Study.
What we see as the essence:
Reticulated (immature) platelets may be independent predictors of cardiovascular death and may potentially be useful in improving risk stratification for acute coronary syndrome patients.
Sinclair L (2012) Aust J Med Sci; 33(1): 10:
The immature platelet fraction: where is it now?
What we see as the essence:
A clear and concise review of 53 original publications concerning the clinical value of IPF. The diagnostic and prognostic potential of IPF in various conditions, and also advantages and limitations of IPF are described.
Sinclair L (2012) Aust J Med Sci; 33(2): 48:
The immature platelet fraction: an assessment of its application to a routine clinical laboratory.
What we see as the essence:
The purpose of the review is to assess the suitability of the IPF%
as a routine test. Productivity rather than clinical value is discussed. Reference ranges are given.
Psaila B et al. (2012) Blood; 119: 4066:
In vivo effects of eltrombopag on platelet function in immune thrombocytopenia: no evidence of platelet activation.
What we see as the essence:
IPF% was higher in patients with ITP than the controls, reflecting the increased platelet production. Treatment with eltrombopag led to increased platelet counts, platelet size, and absolute IPF, but no significant change in IPF%.
Parco S et al. (2012) OncoTargets and Therapy; 5: 1:
Application of reticulated platelets to transfusion management during autologous stem cell transplantation.
What we see as the essence:
Using IPF-rich platelet transfusions reduces the number of transfusions and bleedings after stem cell transplantation in paediatric patients.
Zucker ML et al. (2012) Int J Lab Hematol; 34: 525:
Mechanism of thrombocytopenia in chronic hepatitis C as evaluated by the immature platelet fraction.
What we see as the essence:
IPF% can support the differentiation between platelet destruction and bone marrow failure in hepatitis C patients.
Goncalo A et al. (2011) Transplant Proc; 43: 241:
Predictive value of immature reticulocyte and platelet fractions in hematopoietic recovery of allograft patients.
What we see as the essence:
The immaturity fractions IPF and IRF offer an easy and early evaluation method of post-transplantational recovery of the bone marrow
Barsam SJ et al. (2011) Blood 117; 5723:
Platelet production and platelet destruction: assessing mechanisms of treatment effect in immune thrombocytopenia.
What we see as the essence:
The absolute immature platelet count (IPF#) can be used to assess the effect of different treatments of immune thrombocytopenia and could in such cases be more useful than IPF%.
Strauss G et al. (2010) Pediatr Blood Cancer; 57(4): 641:
Immature Platelet Count: A Simple Parameter for Distinguishing Thrombocytopenia in pediatric acute lymphocytic leukemia from immune thrombocytopenia.
What we see as the essence:
"Both IPF% and IPF# parameters should become a standard for evaluating the respective pathophysiology’s underlying both congenital and acquired thrombocytopenias."
Cesari F et al. (2010) Thrombosis and Haemostasis; 104: 804:
High platelet turnover and reactivity in renal transplant recipients patients.
What we see as the essence:
Renal transplant recipients showed significantly higher values of reticulated platelets (IPF) than healthy control subjects, especially in those not on aspirin treatment.
An elevated IPF% could be an additional hint for a mechanism involved in the increased cardiovascular risk profile of those patients.
Yamaoka G et al. (2010) Int J Lab Hematol; 32: e208:
The immature platelet fraction is a useful marker for predicting the timing of platelet recovery in patients with cancer after chemotherapy and hematopoietic stem cell transplantation.
What we see as the essence:
An IPF% of above 10% is a useful marker for predicting the timing of platelet recovery after chemotherapy and haematopoietic stem cell transplantation and has the potential to facilitate optimal platelet transfusion.
Cremer M et al. (2009) Br J Haematol 144: 619–621.:
Immature platelet fraction as novel laboratory parameter predicting the course of neonatal thrombocytopenia.
What we see as the essence:
"If the IPF is high, thrombocytopenic neonates are likely to recover on their own."
Hong KH et al. (2009) Blood Coag and Fibrinolysis; 20(6): 409:
Prognostic value of immature platelet fraction and plasma thrombopoietin in disseminated intravascular coagulation
What we see as the essence:
The authors demonstrated that the IPF is an excellent marker for distinguishing hyperdestructive/consumptive from hypoproductive thrombocytopenia. Moreover IPF is a robust and reliable predictor of platelet recovery in patients with immune thrombocytopenia (ITP) and with malignancies undergoing chemotherapy.
Takami A et al. (2007) Bone Marrow Transplant; 39: 501:
Immature platelet fraction for prediction of platelet engraftment after allogeneic stem cell transplantation.
What we see as the essence:
IPF counting can provide an accessible marker of engraftment after transplantation, especially of thrombopoietic activity.
Abe Y et al. (2006) Thromb Res; 118: 463:
A simple technique to determine thrombopoiesis level using immature platelet fraction (IPF).
What we see as the essence:
The results show that the IPF reflects the pathology of thrombo¬cytopenic disorders (i.e. consumptive versus productive). Measurement of the IPF is useful for the differential diagnosis and analysis of platelet kinetics and significantly more so than the mean platelet volume (MPV).
Briggs C et al. (2006) Transfus Med; 16: 101:
Immature platelet fraction measurement: a future guide to platelet transfusion requirement after haematopoietic stem cell transplantation.
What we see as the essence:
The automated IPF is a useful parameter in the clinical evaluation of the thrombocytopenic patient and has the potential to allow optimal transfusion of platelet concentrates.
Kickler T et al. (2006) Am J Clin Pathol; 125: 282:
A clinical evaluation of high fluorescent platelet fraction percentage in thrombocytopenia.
What we see as the essence:
The IPF (here named HFPF for ‘high fluorescence platelet fraction’) was predictive in the evaluation of thrombocytopenia. An elevated IPF is found with increased platelet production, particularly associated with platelet destruction, and in disorders associated with decreased platelet production the IPF is normal.
Briggs C et al. (2004) Br J Haematol; 126: 93:
Assessment of an immature platelet fraction (IPF) in peripheral thrombocytopenia.
What we see as the essence:
Automated IPF% measurement should become a standard parameter in evaluating the thrombocytopenic patient.

Optical platelets (PLT-O)

Briggs C et al. (2004) Clin Lab Haematol; 26:157:
The most accurate platelet count on the Sysmex XE-2100. Optical or impedance?
What we see as the essence:
The accuracy of the XE-2100 platelet counting on chemotherapy samples with low counts is excellent when the switching algorithm is used. The optical count is not always the most accurate and the overriding of the algorithm is not good practice.

Reference intervals

Wilson S et al. (2021) Int J Lab Hematol; Online ahead of print:
Continuous reference curves for common hematology markers in the CALIPER cohort of healthy children and adolescents on the Sysmex XN-3000 system
What we see as the essence:
First study that generated continuous reference intervals (curves) of healthy children and adolescents for 19 haematological XN parameters. Seven parameters required sex-specific reference curves. Continuous reference intervals were found to be accurate estimate of haematological reference ranges over the paediatric age range.
Angelo A et al. (2021) BMC Pediatrics; 21: 275:
Umbilical cord blood hematological parameters reference interval for newborns from Addis Ababa, Ethiopia.
What we see as the essence:
This pilot study enrolled 139 umbilical cord blood samples from healthy newborns to establish reference values for the KX-21N. For WBC, RBC, and NEUT significant differences were found between caesarean and natural birth.
Florin L et al. (2020) Int J Lab Hematol; 42(3): e110:
Establishment of common reference intervals for hematology parameters in adults, measured in a multicenter study on the Sysmex XN-series analyzer.
What we see as the essence:
The study provides reference intervals (CBC+DIFF+RET) that could serve as reference values for haematology parameters in adults for laboratories that use the XN-Series analysers.
Bohn MK et al. (2020) Int J Lab Hematol; 42(6): 750:
Complex biological patterns of hematology parameters in childhood necessitating age- and sex-specific reference intervals for evidence-based clinical interpretation.
What we see as the essence:
The study establishes a comprehensive paediatric (birth to 21 years) reference intervals for haematology parameters using the XN analyser. The data highlight the dynamic haematological profiles observed in healthy children and adolescents and the need for reference interval stratification by age and sex.
Ianni B et al. (2020) Arch Pathol Lab Med; 145(1):66:
Defining Normal Healthy Term Newborn Automated Hematologic Reference Intervals at 24 Hours of Life Arch Pathol Lab Med; Online ahead of print.
What we see as the essence:
Reference intervals on Sysmex XN-Series for normal healthy term new-borns at 23-25 hours of life were prospectively established for CBC, IG%, IG#, IRF, RET-He, IPF and IPF#.
Arbiol-Roca A et al. (2018) EJIFCC; 29(1): 48:
Reference intervals for a complete blood count on an automated haematology analyser Sysmex XN in healthy adults from the southern metropolitan area of Barcelona.
What we see as the essence:
The aim of the study was to establish reference intervals for CBC, DIFF and reticulocytes for a Spanish population. Significant gender differences were found for RBC, PLT, HCT and HGB.
MacQueen BC et al. (2017) J Perinatol; 37(7): 834:
The immature platelet fraction: creating neonatal reference intervals and using these to categorize neonatal thrombocytopenias.
What we see as the essence:
Neonatal reference intervals for IPF and IPF# were reported according to gestational age, and during the first 90 days after birth. Moreover, neonates with hyporegenerative thrombocytopenias had lower IPF and IPF# than neonates with consumptive ones.
Ozarda Y et al. (2017) (2017) Biochem Med (Zagreb); 27(2): 350:
A nationwide multicentre study in Turkey for establishing reference intervals of haematological parameters with novel use of a panel of whole blood.
What we see as the essence:
Using the Cell Dyn and Ruby (Abbott), LH780 (Beckman Coulter) and XT-2000i (Sysmex) analysers, Turkish reference intervals were obtained for CBC-DIFF parameters. Analyser-specific reference intervals were reported for BASO%, BASO#, MCHC, RDW and MPV.
Ko Y et al. (2015) Clin Chem Lab Med; 53(7): 1091:
Reference interval for immature platelet fraction on Sysmex XN hematology analyzer: a comparison study with Sysmex XE-2100.
What we see as the essence:
Reference intervals for PLT, IPF% and IPF# were established on the XE- and XN-Series. It was found that the values measured on the XN were higher than on the XE-2100.
Ko Y et al. (2013) Int J Lab Hematol; 35(5): 528:
Establishment of reference interval for immature platelet fraction.
What we see as the essence:
The study provides reference intervals for PLT, IPF% and absolute IPF from more than 2,000 healthy individuals and from umbilical cord blood, according to the CLSI guideline. These results could be used as fundamental data for clinical use as well as future researches.
Urinalysis

Biochemistry

Nah et al. (2021) Annals of Public Health Reports 5(1):152-159:
Screening of Chronic Kidney Disease in Primary Health: Comparison of the Urine Dipstick Albumin-to-Creatinine Ratio and Dipstick Proteinuria.
What we see as the essence:
The aim of this study was to compare test strip ACR with proteinuria for CKD screening in a primary healthcare setting. This cross-sectional study included 88,479 specimens with ACR and proteinuria was measured on the UC-3500 automated urine test strip analyser. In conclusion, the CKD risk category using test strip proteinuria was underestimated compared to the ACR-based CKD risk category, suggesting a recommendation of the use of test strip ACR for CKD screening in primary healthcare settings.
Currin et al. (2021) BMC Nephrology 22:103:
Diagnostic accuracy of semiquantitative point of care urine albumin to creatinine ratio and urine dipstick analysis in a primary care resource limited setting in South Africa.
What we see as the essence:
This study evaluated the diagnostic accuracy of the semi-quantitative albumin-creatinine ratio (ACR) measurement on the UC-1000 at the point of care by determining the sensitivity, specificity, positive predictive value, and negative predictive value of the ACR. The prevalence of albuminuria in the study cohort was 11.6% and accompanied by underlying diseases such as diabetes and hypertension. The performance showed of the ACR measurement showed a sensitivity of 0.79, a specificity of 0.84, a positive predictive value of 0.39 and a negative predictive value 0.97. The sensitivity improved, if including additional information, such as underlying diseases and age. In summary, the study demonstrated a good NPV for ACR at the point of care, offering the potential for frequent screening of risk group patients and reliable rule-out of albuminuria, if screening for CKD.
Oyaert M and Delanghe JR (2019) J Clin Lab Anal 33(5):e22870:
Semiquantitative, fully automated urine test strip analysis.
What we see as the essence:
This study evaluated the analytical and diagnostic performance of the UC-3500 for the presence of glucose, protein, albumin, leukocyte esterase, and hemoglobin peroxidase activity and ordinal scale results in comparison to the analysis of urine sediments using the UF-5000 as well as in comparison to wet clinical chemistry using the Roche cobas® 8000. Especially for detection of glycosuria, proteinuria and albuminuria, a perfect agreement between the reflectance data of the UC-3500 and immunochemistry results has been obtained. This allows the UC-3500 to provide a high‐throughput first‐level screening method for urinalysis which acts as a reliable sieving system to reduce the workload for further validation methods. Especially the albumin measurement fulfills optimum criteria for trueness allowing a reliable, semiquantitative detection of albumin.
Salinas et al. (2019) Clin Chem Lab Med 57(2):204-209:
Urinary albumin strip assay as a screening test to replace quantitative technology in certain conditions.
What we see as the essence:
This study aims to evaluate the diagnostic performances of a test strip for measuring ACR for differentiating patients who are candidates for subsequent albumin quantification, and to evaluate the economic effects of its implementation. In conclusion, the detection of albumin and the albumin:creatinine ratio (ACR) is a suitable screening strip test to identify pathological albuminuria for further confirmation through quantitative methods. The performance of the test strip and its workflow benefits do not only foster economic savings, but also elucidates the potential for frequently screening of risk group patients.
Oyaert M et al. (2018) Clin Chem Lab Med 56(7):1126-1132:
Quantitative urine test strip reading for leukocyte esterase and hemoglobin peroxidase.
What we see as the essence:
This study investigates diagnostic accuracy of the Sysmex UC-3500 automated urine chemistry analyzer based that uses CMOS sensor technology for leukocyte esterase and hemoglobin peroxidase results. In addition, the influence of urinary dilution, haptoglobin, urinary pH and ascorbic acid on the test results has been assessed. In conclusion, CMOS technology allows to obtain high quality test strip results for assessing WBC and RBC in urine. Quantitative peroxidase and leukocyte esterase are complementary with flow cytometry and have an added value in urinalysis, which may form a basis for expert system development.
Delanghe JR et al. (2017) Clin Chim Acta 471:107-112:
Sensitive albuminuria analysis using dye-binding based test strips.
What we see as the essence:
Delanghe and colleagues investigated the potential of the CMOS sensor technology of the UC-3500 for obtaining quantitative albuminuria results in comparison to clinical wet chemistry using the cobas® 8000 immunochemistry analyser. For albumin, this study revealed a limit of detection of 5.5 mg/l, respecting limits for screening for albuminuria in patients at risk of CKD. A strong or good correlation between strip reflectance data and albuminuria creatinine, respectively, potentially allows quantification of albuminuria and ACR by dye-binding test strip.

Bladder Cancer

Aydin O (2021) Turk J Biochem; Diagnostic Pathology 16:9:
Atypical cells parameter in Sysmex UN automated urine analyzer: feedback from the field.
What we see as the essence:
This study investigates the research parameter “Atypical cells” parameter in context of automated urinalysis to detect cellular atypia as a potential indicator of bladder cancer. In total, 50, mainly female samples with higher than 1 atypical cell/μL result were included in the study with one case of a high-grade urothelial carcinoma. The positive case provided evidence for the capability of the UF-Series to detect atypical cells in urine. The negative cases presented clues that probable vulvovaginal contamination and crowded specimens could be deceptive for this parameter.
Ren C et al. (2020) Diagn Pathol 15(1):77:
Investigation of Atyp.C using UF-5000 flow cytometer in patients with a suspected diagnosis of urothelial carcinoma: a single-center study.
What we see as the essence:
This study evaluated the predictive power of the UF-5000 research parameter ‘Atypical Cells’ for patients with a suspected diagnosis of urothelial carcinoma. In total, urinary specimens of 128 patients that were enrolled for urinary cytology analysis were included in this investigation and analysed on the UF-5000, aiming to evaluate its performance in identifying atypical or malignant urothelial cells. The UF-5000 findings were in agreement with cytopathology in 73 % of the investigated cases. Using follow-up histologic diagnosis of urothelial carcinoma with or without urinary tract cytology (UTCy) as a reference standard the sensitivity and specificity were calculated with 59 % and 82.1 %, respectively. This resulted in a positive predictive value of 75.0% and a negative predictive value of 68.8%. In conclusion, the ‘Atypical Cells’ parameter bears the potential of an accessory test for urothelial carcinomas in context of routine urinary diagnostics, that might help to identify high-risk patients that require more specific follow-up and medical treatment.
Tınay İ et al. (2020) Bull Urooncol 19(1):17-19:
“Atypical Cell” Parameter in Automated Urine Analysis for the Diagnosis of Bladder Cancer: A Retrospective Pilot Study.
What we see as the essence:
This study evaluated the application of the UF-5000 and its research parameter ‘Atypical Cell’ in supporting the diagnosis of bladder cancer in a retrospective manner in a heterogenous study population. With an acceptable sensitivity of 75 % and a specificity of 100 %, the UF-5000 demonstrated potential value for diagnostic decisions on follow-up cystoscopy for patients with low-risk non-muscle invasive bladder cancer (NMIBC). For patients with high-risk NMIBC, sensitivity and specificity values are lower, but comparable or even better, if compared to cytology. The authors thus revealed the potential to avoid invasive procedures on patient side and to save costs for unnecessary treatments. To further investigate and validate the presented findings, a prospective study is in preparation.
Aydin O et al. (2020) Turk J Biochem; aop:
Atypical cells in Sysmex UN automated urine particle analyzer: a case report and pitfalls for future studies.
What we see as the essence:
The UF-4000 automatically detected atypical cells in the urine specimen of a 73-year old individual with recurrent high-grade urothelial carcinoma in an outpatient setting, which was confirmed by manual microscopy, demonstrating the potential of the UF-Series to detect malignancies.

Body fluid

Cho J et al. (2020) Ann Lab Med 40(2):122-130:
Performance Evaluation of Body Fluid Cellular Analysis Using the Beckman Coulter UniCel DxH 800, Sysmex XN-350, and UF-5000 Automated Cellular Analyzers.
What we see as the essence:
Different types of body fluid specimen were examined using manual counting and three the automated cellular analysers XN-350, UF-5000 and UniCel DxH 800. Additionally, 2,779 BF analysis results were retrospectively reviewed. All three analysers showed good agreement for total nucleated cell (TNC) and red blood cell (RBC) counts, except for the RBC count in CSF samples using the UniCel DxH 800. However, variable degrees of differences were observed during differential cell counting. In conclusion, the three automated analysers showed good analytical performances and proper reflex and interpretation guidelines can help to utilise the generated data.
Koo M et al. (2019) J Lab Med Qual Assur 2019; 41(3): 172-178:
Comparison of Red Blood Cell, White Blood Cell and Differential Counts between UF-5000 System and Manual Method.
What we see as the essence:
Analysis of body fluids provides important information for assessing various medical conditions. This study aims to validate the analytical and diagnostic performance of the UF-5000 for the analysis of different body fluids. The performance of RBC counts, WBC counts and differentiation of leucocytes was assessed in comparison to light microscopy for ascitic, pleural, and cerebrospinal and other body fluids. In conclusion, the body fluid application on the UF-5000 proved to be an effective and automated alternative to chamber counting in laboratory routine analysis, thereby enhancing laboratory workflow and clinical effectiveness.
Seghezzi M et al. (2017) Clin Chim Acta. 473:133-138:
Preliminary evaluation of UF-5000 Body Fluid Mode for automated cerebrospinal fluid cell counting.
What we see as the essence:
This study evaluated the body fluid mode of the UF-5000 for analysis of CSF in comparison to microscopy. The UF-5000 showed a high diagnostic accuracy for TNC, WBC and RBC counts, as well as high sensitivities and specificities and confirmed a low limit of detection for the RBCs. In conclusion, the UF-5000 body fluid mode offers rapid and accurate quantification of cells, including bacterial cells in CSF samples in clinically relevant concentration ranges, allowing the replacement of microscopy for CSF samples without abnormal cell counts or scattergrams.

Covid-19

Supraja et al. (2021) Diabetes & Metabolic Syndrome: Clinical Research & Reviews. Volume 15, Issue 1, January–February 2021, Pages 187-191:
Urine abnormalities predict acute kidney injury in COVID-19 patients: An analysis of 110 cases in Chennai, South India.
What we see as the essence:
Renal involvement in Covid-19 infection is varied and can affect glomeruli, tubules, interstitium and can cause acute kidney injury, a strong predictor of mortality. Routine urinalysis can provide insight into the renal pathology of the patient. Urinary abnormalities in hospitalised Covid-19 patients and their impact on development of AKI and mortality were evaluated in this study, including demographic data and information in comorbidities. Urine abnormalities were seen in 71% of the patients, including proteinuria (58.2 %), haematuria (17.3 %), pyuria (8.2 %) and AKI (28.2 %). In conclusion, a commonly available test like urinalysis can aid in early detection of renal impairment in context of COVID-19 to foster early intervention.

General / Review

Oyaert M and Delanghe JR (2019) Ann Lab Med 39(2):15-22.:
Progress in Automated Urinalysis.
What we see as the essence:
This publication is a comprehensive review of the current status of automated urinalysis, highlighting the potential quantitative reading of urinary test strips using CMOS technology for albuminuria testing and the value of urinary flow cytometry for the differentiation of urinary microorganisms, screening for urinary tract infections and clinical decision support in a variety of nephrological and urological diseases. In addition, progress in automated urinary microscopy and the improved pathogen identification by MALDI-TOF mass spectrometry is reflected and an outlook into future technologies, such as laboratory-on-a-chip approaches, use of microfluids and mobile applications is given.

MICROBIOLOGY & ANTIMICROBIAL RESISTANCE

Gilboe HM ET AL. (2021) PLoS ONE 16(7): e0254064:
Rapid diagnosis and reduced workload for urinary tract infection using flow cytometry combined with direct antibiotic susceptibility testing.
What we see as the essence:
This study evaluated the potential impact of urinary flow cytometry of the UF-5000 on the rapid identification of culture negative and contaminated samples prior to culture plating and on the prediction of positive samples for antibiotic susceptibility testing. Using a cut-off value with bacterial count ≥100,000/mL and WBCs ≥10/μL, urinary flow cytometry predicted 42.1% of samples with non-significant growth and for 52/56 positive samples containing Gram negative bacteria direct Antibiotic Susceptibility Testing (dAST) was identical to routine testing. Overall, there was concordance in 555/560 tested antibiotic combinations. In conclusion, flow cytometry offers improvements in UTI diagnostics by reducing the response times and workloads for negative samples on the day of arrival and by predicting Gram-positive samples for Antibiotic Susceptibility Testing (AST), allowing a same day report of antibiotic susceptibility profiles.
Oyaert M et al. (2020) Clin Chem Lab Med 58(4):597-604:
Renal Tubular Epithelial Cells Add Value in the Diagnosis of Upper Urinary Tract Pathology.
What we see as the essence:
Oyaert and colleagues evaluated the analytical performance characteristics of renal tubular epithelial cells (RTECs) and transitional epithelial cells (TECs) on the Sysmex UF-5000 urine sediment analyser, as well as the diagnostic performance of these parameters to differentiate between lower and upper UTI. In comparison to transitional epithelial cells (TEC), increased urinary levels of renal tubular epithelial cells (RTEC) demonstrated a good potential to serve as a marker for the diagnosis of upper UTI and outperforms α1-micrglobulin in the discrimination between upper and lower UTI. However, the diagnostic performance of these parameters is strongly depending on proper sample handling.
Mancini S et al. (2020) J Antimicrob Chemother 75(11):3218-3229:
Evaluation of standardized automated rapid antimicrobial susceptibility testing of Enterobacterales-containing blood cultures: a proof-of-principle study.
What we see as the essence:
In this study, the preparation of standardized bacterial inocula for Enterobacterales-containing clinical blood cultures and the automated assessment of data of a rapid antimicrobial susceptibility testing (RAST) is reported, aiming to accelerate antibiotic therapy decisions. The UF-4000 was used to enumerate bacteria to adjust the inocula to 106 cfu/mL. Disc diffusion plates were automatically streaked, incubated for 6, 8 and 18 h and imaged automatically. In conclusion, with the standardized and automated RAST method, consistent AST data from blood cultures containing Enterobacterales can be generated after 6–8 h of incubation and subsequently confirmed by standard reading of the same plate after 18 h.
Wagner K et al. (2019) J Glob Antimicrob Resist 19:8-13:
Evaluation of the AID AmpC line probe assay for molecular detection of AmpC Enterobacterales.
What we see as the essence:
This study investigated the use of commercially AID AmpC line probe assays for analysis of antibiotic resistance by detection of plasmid-mediated blaAmpC β-lactamase genes in Enterobacterales, which proofed to be an accurate, sensitive and easy-to-use test that can be readily implemented in any diagnostic laboratory. In this context, the UF-5000 has been demonstrated to be a reliable tool to judge samples, sent for molecular testing, for the presence of bacteriuria and to reduce the number of unnecessary molecular testing.
Öğüş E et al. (2019) ASMS 3(6):88-92:
Compatibility of the Results of an Automated Urine Analyzer with Urine Culture.
What we see as the essence:
This study evaluated the incidence of leukocyte esterase and nitrite positivity, leukocyte and bacterial counts in urine and Gram positive and negative bacterial results interpreted by the UF-5000 for compliance with urine culture results. Incorrect results for the Gram status in comparison to urine culture was obtained for three Gram-positive and three Gram-negative samples. Rates of leucocyte esterase, nitrite positivity, leukocyte and bacterial counts were higher in Gram negative group. In conclusion, especially Gram-negative bacterial interpretation obtained from the UF-5000 be beneficial for rapid typing of bacteria and early treatment in urinary tract infections.
De Rosa R et al. (2018) Clin Chim Acta 484:171-178:
Evaluation of the new Sysmex UF-5000 fluorescence flow cytometry analyser for ruling out bacterial urinary tract infection and for prediction of Gram-negative bacteria in urine cultures.
What we see as the essence:
De Rosa and colleagues investigated the potential of the UF-5000 to rule-out urinary tract infections and its ability to predict the presence of Gram-negative bacteria in urine samples with a request for urine culture in context of a suspected urinary tract infection. With neglectable carry-over and cross-contamination, the UF-5000 demonstrated a high screening performance for urinary tract infections with a high sensitivity and NPV for the bacteria using a cut-off of ≥58/μl. The ‘Gran Neg?’ flag predicted Gram negative urine cultures with good sensitivity and high specificity. In conclusion, the UF-5000 represents a reliable tool for ruling-out urinary tract infections with high diagnostic accuracy and offers the possibility to detect Gram-negative bacteria in very high agreement with urine culture. Further investigations might reveal the potential for the Gram information for targeted antibiotic.
Kim SY et al. (2018) J Clin Microbiol 56(8):e02004:
Rapid Screening of Urinary Tract Infection and Discrimination of Gram-Positive and Gram-Negative Bacteria by Automated Flow Cytometric Analysis Using Sysmex UF-5000.
What we see as the essence:
Kim and colleagues evaluated the performance of the UF-5000 in context of UTI screening, aiming to reduce unnecessary urine culture and improve the determination of antibiotic treatments. The performance to discriminate Gram-negative bacteria was superior to that for Gram-positive bacteria with high sensitivity and specificity in ≥105 CFU/ml monobacterial samples. In conclusion, the UF-5000 demonstrated a potential utility for the rapid screening of negative bacterial cultures, depending on the respective patient population, requiring cut-off optimization.
Duyeal Song et al. (2018) Ann Clin Microbiol 21(4):75-79:
Selection of Unnecessary Urine Culture Specimens Using Sysmex UF-5000 Urine Flow Cytometer.
What we see as the essence:
This study investigated the potential of the UF-5000 to support the reduction of unnecessary urine cultures by ruling-out bacterial and fungal urinary tract infections. Applying urinalysis cut-off values of 50/µl and 100/l for bacteria and YLC, respectively, 84 out of 126 requested urine cultures were negative and could have been ruled-out by the UF-5000. In conclusion, the bacteria and yeast-like cell counts delivered by the UF-5000 could be used to predict negative cultures and reduce the load of urine cultures by around 10% without sacrificing positive cultures.
Jurankova J et al. (2018) Poster on ECCMID 2018:
The importance of diagnosis gram-negative/gram positive bacteria in urine in the pre-culture screening of urine tract infections in the microbiology laboratory fluorescence flow cytometry on the UF-4000 urine analyser (Sysmex) for early initiation of targeted antibiotic therapy
What we see as the essence:
This study investigated sensitivity and specificity of the UF-4000 for the discrimination between Gram-positive and Gram-negative bacteria in pre-culture screenings for urinary tract infections in a microbiology laboratory using fluorescence flow cytometry. Gram-positive and Gram-negative bacteria have been detected in urine, with sensitivities 78 % and 89 % and specificities of 96 % and 89 %, respectively. In conclusion, UF-4000 demonstrated a high potential in pre-culture screenings of urinary infections in a microbiology laboratory and is of benefit to the patient for its role in early initiation of antibiotic therapy, targeting Gram-positive or Gram-negative bacteria.
Kawamura K et al. (2017) Jap J Med Technol 66(5):516-523 [Article in Japanese]:
Evaluation of automated urine particle analyzer, UF-5000, as a screening tool to identify Gram stainability of urinal pathogens.
What we see as the essence:
Kawamura and colleagues evaluated the performance of the UF-5000 with regards to the provision on information on the Gram status of bacterial cells via the BACT-info flag in comparison to conventional methods including Gram staining and quantitative bacterial culture. In summary, the UF-5000 presented in 83.2 % of UTI cases a Gram information, in line with classical Gram staining. The UF-5000 exhibited a high positive predictive value (93.3%) for both Gram negative staining and culture results. Thus, the UF-5000 using BACT-info shows great promise in screening for UTI pathogens and further improvements of judgement algorithms might make the Gram judgement even more reliable.
Geerts N et al. (2016) Clin Chim Acta 452:173–176:
Cut-off values to rule out urinary tract infection should be gender-specific.
What we see as the essence:
This study investigated the potential of urine flow cytometry of the UF-5000 to rule-out urinary tract infections and to reduce the load of urine culture samples. Applying cut-off value of >200 bacteria/μl, a sensitivity of 93.0%, a specificity of 63.5% and an NPV of 96.2% has been obtained. As a result, the culturing of 49% of all samples could be avoided. In addition, the data was retrospectively analyzed to determine if the introduction of gender-specific cut-off values could improve screening results. The obtained receiver operator curves are indeed significantly different when gender specific cut-offs were used. When an NPV of 95% is considered acceptable the unisex cut-off value of >200bacteria/μl can be used for women (NPV 94.9%), but the cut-off value for men could be raised to >400bacteria/μl without diminishing the NPV (NPV 95.0%).

Medicoeconomics

Herráez Carrera Ó and Jarabon Bueno MDM (2020) Pharmacoecon Open 10(22) [Online ahead of print]:
Cost analysis of the automated examination of urine with the Sysmex UN-SeriesTM in a Spanish population.
What we see as the essence:
This study aimed to investigate the potential of the Sysmex UN-Series to reduce high financial costs and high and time-consuming laboratory workloads of current urinalysis practice. By investigating more than 90,000 handled urine samples of a 10-year period, including financial data and alternative costs of reference and test scenarios, potential average cost savings of 340,000 € per year was identified for the use of automated urine examination, compared to the current urinalysis practice. On top, the UN-Series has the potential to reduce the annual working hours of laboratory personnel to up to 1615 hours. In conclusion, the implementation of the UN-Series within routine practice in clinical laboratories could minimise costs, provide substantial savings for investment, improve laboratory procedures and could contribute to synergy between clinical analysis and microbiology laboratories.

Performance Evaluation / Comparison

Yang et al. (2021) BMC Urol 21:24:
A performance comparison of the fully automated urine particle analyzer UF-5000 with UF-1000i and Gram staining in predicting bacterial growth patterns in women with uncomplicated urinary tract infections.
What we see as the essence:
This study aims to compare the performance of the new UF-5000 and the UF-1000i and Gram staining for determining bacterial patterns in urine samples. Mid-stream urine samples of women with symptoms suggestive of urinary tract infection were collected for gram staining, urine analysis and urine cultures. Bacterial patterns were classified using the UF-1000i, the UF-5000 and Gram staining. The collected data revealed a sensitivity/specificity of the UF-1000i of 81.8/91.1% for gram-negative rods and 23.5/96.9% for cocci/mixed. The sensitivity/specificity of the UF-5000 was 80.0/88.2% for gram negative rods and 70.0/86.5% for gram-positive cocci. In conclusions, the UF-5000 demonstrated good sensitivity and specificity for Gram-negative bacilli and demonstrated an improved sensitivity for detecting Gram-positive cocci compared with the UF-1000i.
Enko D et al. (2020) Clin Chem Lab Med 58(2):268-273 [Online version from 2019]:
Comparison of the diagnostic performance of two automated urine sediment analyzers with manual phase-contrast microscopy.
What we see as the essence:
Enko and colleagues demonstrate that the analytical performance of the UF-5000 is in strong concordance with manual phase-contrast microscopy and clearly outperforming the Roche cobas® u 701 module. This study included a broad spectrum of urine sediment pathologies, thereby proving the UF-5000 to be a reliable tool for automated urine sediment analysis in daily clinical practice.
Kucukgergin C et al. (2019) Scand J Clin Lab Invest. 79(7):468-474.:
Performance of automated urine analyzers using flow cytometric and digital image-based technology in routine urinalysis.
What we see as the essence:
This study evaluates the analytical performances of the UF-5000 and the Dirui FUS-200, to manual microscopy. Thereby, all available urinalysis aspects and sediment results were investigated within one hour after sample collection. Accurate results have been obtained from both analytical systems, the FUS-200 and the UF-5000, as good linearity without carry- over has been shown. Overall, the UF-5000 demonstrated better agreement in classification of WBCs, RBCs, ECs, positively affecting the morphologic recognition and enumeration of cells.
Cho J et al. (2019) Clin Chem Lab Med 57(11):1744-1753:
Comparison of five automated urine sediment analyzers with manual microscopy for accurate identification of urine sediment.
What we see as the essence:
This study evaluated the analytical and diagnostic performance of the Sysmex UF-5000, the Roche cobas® u 701 module, the URiSCAN PlusScope and the Iris iQ200SPRINT and the SIEMENS UAS800 in comparison to manual microscopy. Each automated urine sediment analyzer has certain distinct features, in addition to the common advantages of reducing the burden of manual processing. Therefore, laboratory physicians are encouraged to understand these features, and to utilize each system in appropriate ways, considering clinical algorithms and laboratory workflow.
Bakan E et al. (2018) Biochem Med (Zagreb) 28(2):020712:
Evaluation of the analytical performances of Cobas 6500 and Sysmex UN-Series automated urinalysis systems with manual microscopic particle counting.
What we see as the essence:
This study compared the diagnostic performance of the UF-5000 and the Roche cobas® u 701 module to manual microscopy. Comparing the quantification of WBCs and RBCs, the UF-5000 obtained the better sensitivities and specificities and showed high agreement with manual microscopy. In conclusion, the UF-5000 is a reliable tool for urine sediment analysis, but pathological samples should be confirmed by microscopy.
Previtali G et al. (2017) Clin Chim Acta 472:123-130:
Performance evaluation of the new fully automated urine particle analyser UF-5000 compared to the reference method of the Fuchs-Rosenthal chamber.
What we see as the essence:
Previtali and colleagues evaluated the analytical performance of the Sysmex UF-5000 for urine sediment samples compared manual particle counting using the Fuchs-Rosenthal chamber. The study demonstrated high linearity performances for RBCs, WBCs and epithelial cells, as well as high negative predictive values and good sensitivities and specificities for all parameters, especially those of clinical relevance. The authors conclude a high potential of the UF-5000 and its fluorescence flow cytometry technology to investigate urine sediment particles related to pathological conditions of the kidneys and the urinary tract.
White Blood Cells

Blood Bank mode

Mack S et al. (2020) Transfusion; 60(1): 4:
Component residual white blood cell counting made easy?
What we see as the essence:
A short review on required detection levels for blood products in US and Europe, and currently used methods on residual white blood cell counting. An outlook is given based on the publication by Blanco et al. how XN-Series analysers could increase the efficiency and reduce costs in blood banks in the future.
Lagerberg JW et al. (2020) Transfusion; 60(10): 2456:
Improved accuracy in counting residual white blood cells in red cell concentrates using new blood bank mode software of SYSMEX XN-1000 hematology analyzer.
What we see as the essence:
The authors re-calculated their results with the updated XN software for Blood Bank mode and observed very good linear fit between expected and observed values for residual WBC in red cell concentrates (RCC). The previous underestimation of residual WBC in RCC (Blanco RA et al.) is solved with the updated XN software (XN IPU SW 22.15).
Blanco RA et al. (2020) Transfusion; 60(1): 155:
The use of a hematology analyzer with a new generation of software as an alternative to flow cytometry for enumerating residual white blood cells in blood components.
What we see as the essence:
In this study, the performance of the XN Blood Bank (BB) mode for residual WBC (rWBC) enumeration in blood components was analysed. In platelet, plasma and RBC components spiked with WBC, the BB mode demonstrated a LOQ of 2 WBC/μL and an excellent concordance with flow cytometry (FC) results. In components obtained from a routine blood bank, the BB mode successfully identified leukodepletion failures and met the guideline criteria of 90% of tested components containing less than 1x10^6 rWBC/unit, which was in agreement with FC results.

Flagging

Moioli V et al. (2020) Scand J Clin Lab Invest; 80(1): 55:
A specific abnormal scattergram of peripheral blood leukocytes suggestive for the presence of proerythroblast.
What we see as the essence:
Two cases of myeloproliferative disorder patients are described. Abnormal cell clusters in the WNR, WDF and WPC scattergrams were present. In oncological patients, this likely indicates the presence of proerythroblasts as a symptom of an erythroid leukaemia and therefore the XN scattergrams can support a rapid stratification.
Blomme S et al. (2020) Int J Lab Hematol; 43(2): 191:
The integration of Sysmex XN-9100’ WPC channel reflex testing in the detection of reactive versus malignant blood samples.
What we see as the essence:
The WPC reflex testing showed excellent sensitivity (99%), but low specificity (29%). Using reflex WPC to the WDF channel resulted in a 12% reduction of the smear review rate. The authors suggested workflow for the optimal use of the WPC channel in a routine setting.
Paridaens H et al. (2019) Ann Biol Clin (Paris); 77(4): 422:
Can the 72-hour rule based on "Blast/Abn Lymph" flag on Sysmex XN-10 optimize the workflow in hematology laboratory?
What we see as the essence:
The authors verified GFHC rules for reducing unnecessary smears and even extended the rules for further smear reduction when using XN analysers. The very good sensitivity (93%) and specificity (94%) of the Blast/Abn Lympho? flag was confirmed in line with smear reduction of 5.7% and associated cost reduction.
Schuff-Werner P et al. (2016) Clin Chem Lab Med; 54(9): 1503:
Performance of the XN-2000 WPC channel-flagging to differentiate reactive and neoplastic leucocytosis.
What we see as the essence:
The XN-1000 demonstrated an excellent performance for differentiation between neoplastic and reactive leukocytosis.
Jones AS et al. (2015) J Clin Pathol; 68: 161:
The value of the white precursor cell channel (WPC) on the Sysmex XN-1000 analyser in a specialist paediatric hospital.
What we see as the essence:
The flagging efficiency of the XE-5000 and XN-Series were compared in paediatric blood samples: sensitivity was improved when only the WDF channel of the XN was used while both sensitivity and specificity were improved when also the WPC channel was used.
Ulset R J et al. (2014) Clin Lab; 60(12): 1961:
“Aged Sample” Software on Automated Routine Hematology Analyzer Enables Differentiation Between Pathological and Non-Pathological WBC Flagging in Aging Samples.
What we see as the essence:
'Aged Sample Identifier' software not only detects and labels samples that are ageing or were stored under suboptimal conditions, but also prevents false positive flagging.
Hotton J et al. (2013) Am J Clin Pathol; 140: 845:
Performance and Abnormal Cell Flagging Comparisons of Three Automated Blood Cell Counters -Cell-Dyn Sapphire, DxH-800, and XN-2000.
What we see as the essence:
"Repeatability, linearity and carryover was good for all tested analysers, and correlation between the analysers was good for HGB, MCV, PLT and WBC.
Quotes: "The XN showed a higher sensitivity than the SAPH and DxH for all flags of interest." "For the first time, we have decreased the slide review for our laboratory from 20% with the SAPH to 9.3% with the XN."
Briggs CJ et al. (2011) Am J Clin Pathol; 136: 309:
Improved Flagging Rates on the Sysmex XE-5000 Compared With the XE-2100 Reduce the Number of Manual Film Reviews and Increase Laboratory Productivity.
What we see as the essence:
The increased specificity of the XE-5000 eMM (efficient multichannel messaging) flagging reduces the number of manual film reviews, particularly for blast and abnormal lymph flags.

General WBC

Comar SR et al. (2021) Int J Lab Hematol; Online ahead of print:
Early detection of Candida parapsilosis sepsis in peripheral blood as a result of cytografic changes on the Sysmex XN-3000 hematology analyzer.
What we see as the essence:
A case review that describes specific WNR and WDF scattergram patterns of a patient with Candida parapsilopsis sepsis. The authors propose careful overall observation of all information provided by the automated blood count including thorough analysis of scattergrams that might enable early diagnosis of invasive fungal infection.
Debus J et al. (2021) Clin Chem Lab Med; 59(7): e285:
A case of methaemoglobinaemia interference on the WDF channel on Sysmex XN-Series analysers.
What we see as the essence:
This report is about a case of acquired methaemoglobinaemia resulting in “WDF abnormal scattergram” flagging on XN-1000 and XE-2100. Interferences were shown to be reduced in the course of therapy. The authors suggested interferences with the reagent reaction in line with existing literature.
Ortiz A et al. (2020) Sysmex J Int; 30(1): 9:
Performance Comparison of Sysmex Hematology Analyzers XN-550 and XN-10.
What we see as the essence:
The XN-550 is highly reliable with functionality comparable to the XN-10. It has shown high correlation coefficients and excellent comparative performance in all CBC, DIFF and RET parameters (except BASO%). The overall flagging comparison was excellent among the XN-10, the XN-550 and the manual differential.
Cao J et al. (2017):
Establishing a Stand-Alone Laboratory Dedicated to the Care of Patients With Ebola Virus Disease.Lab Med; 48(2): 188
What we see as the essence:
The pocH-100i was used in a laboratory dedicated to detection of Ebola virus disease. Its accuracy was verified by comparison with the XE-2100 in the main laboratory, and its precision and reportable range were also consistent with Sysmex's claims
Cornet E et al. (2016) Scand J Clin Lab Invest; 76(6): 465:
Evaluation and optimization of the extended information process unit (E-IPU) validation module integrating the sysmex flag systems and the recommendations of the French-speaking cellular hematology group (GFHC).
What we see as the essence:
Using the biomedical validation criteria, 21.3 % of samples triggered
a smear review. Modification of four criteria reduced the number of smears from 21.3 % to 15.0 % without loss of clinical value.
Van Dievoet MA et al. (2016) Int J Lab Hematol; 38(5): 490:
Performance evaluation of the Sysmex® XP-300 in an oncology setting: evaluation and comparison of hematological parameters with the Sysmex® XN-3000. Int J Lab Hematol early online
What we see as the essence:
"The XP-300 showed very good precision and linearity results, comparable with the XN-3000 analyser."
Tabe Y et al. (2015) Clin Chem Lab Med; 53(2): 281:
Performance evaluation of the digital cell imaging analyzer DI-60 integrated into the fully automated Sysmex XN hematology analyzer system.
What we see as the essence:
This performance evaluation of the digital imaging analyser DI-60 showed a good agreement between results from the DI-60 and manual microscopy. In addition, blasts were correctly classified with 95 % sensitivity and 99 % specificity.
Takagi Y et al. (2015) Microscopy (Oxf); 64(5): 305:
Comparison of optical data from flow cytometry and microscopy of leukocytes after exposure to specific reagents.
What we see as the essence:
Flow cytometry software and electron microscopy methods were used to confirm the positions and fluorescence intensity of WBC populations in the XN-WDF scattergram.
Arneth B et al. (2015) J Clin Lab Anal; 29(3): 175:
Technology and New Fluorescence Flow Cytometry Parameters in Hematological Analyzers.
What we see as the essence:
This paper gives a good overview of the technology behind the
XE-series and the benefits of flow cytometry and automatic cell counting. It shows that the XE-5000 delivers faster accurate results than older analysers.
Bruegel M et al. (2015) Clin Chem Lab Med 53(7): 1057:
Comparison of five automated hematology analyzers in a university hospital setting: Abbott Cell-Dyn Sapphire, Beckman Coulter DxH 800, Siemens Advia 2120i, Sysmex XE-5000, and Sysmex XN-2000
What we see as the essence:
A comparison of Abbott, Beckman Coulter, Siemens and Sysmex analysers found superior flagging performance of the XN-2000, especially for blasts and variant lymphocytes. Otherwise, the analysers were comparable.
Genevieve F et al. (2014) Feuillets de Biologie VOL LVI N° 317:
Smear microscopy revision: propositions by the GFHC.
What we see as the essence:
The GFHC reviewed in detail the criteria used within the CBC to generate blood smears and has decided on a number of minimum recommendations, defining threshold values and various situations in which the blood smear review is desirable.
Kawauchi S et al. (2013) Sysmex J Int; 23(1): 1:
The Positions of Normal Leukocytes on the Scattergram of the Newly Developed Abnormal Cell-detection Channel of the XN-Series Multi-parameter Automated Hematology Analyzers.
What we see as the essence:
Using purified leukocyte populations, the paper confirms the position of those populations within the WPC scattergrams. Interestingly, two populations of lymphocytes with a different resistance to WPC reagents were found.
Briggs C et al. (2012) J Clin Pathol; 65: 1024:
Performance evaluation of the Sysmex haematology XN modular system.
What we see as the essence:
The XN showed reduced sample turnaround time and reduced number of blood film reviews than the XE-2100 without loss of sensitivity and with more precise and accurate results for both platelets and low WBC counts.

Granulocytes

Kim H et al. (2021) Int J Lab Hematol; 43(2): e54:
Screening of myelodysplastic syndrome using cell population data obtained from an automatic hematology analyzer.
What we see as the essence:
A study on 63 myelodysplastic syndrome (MDS) patients identified RBC, PLT, NE-FSC and NE-SSC as independent predictors for the presence of the disease with high AUC values (from 0.87 to 0.94). The combination of these four parameters achieved a 100% sensitivity for identifying MDS (one out of four cutoff criteria had to be fulfilled).
Stiel L et al. (2019) Thromb Res; 183: 153:
First visualization of circulating neutrophil extracellular traps using cell fluorescence during human septic shock-induced disseminated intravascular coagulation.
What we see as the essence:
The authors reported direct visualisation of circulating neutrophils extracellular traps (NETs) in patients with septic shock induced disseminated intravascular coagulation (DIC). The in vivo relevance of previously reported indirect marker of NETosis (NEUT-SFL) was confirmed.
Ustyantseva M et al. (2019) Sysmex Journal International; 29(1): 8:
Innovative Technologies in the Evaluation of the Neutrophil Functional Activity in Sepsis.
* Free online after free registration
What we see as the essence:
The study revealed significantly higher values of neutrophil fluorescence intensity (NEUT-RI) in critically ill patients with sepsis (NEUT-RI = 70 FI) compared to the non-septic control group (NEUT-RI = 53 FI). Furthermore, strong correlations between the levels of NEUT-RI and generally recognized biomarkers of sepsis (PCT, CRP) were found.
Porizka M et al. (2019) Interact Cardiovasc Thorac Surg; 28(6): 845:
Immature granulocytes as a sepsis predictor in patients undergoing cardiac surgery.
* Free online after free registration
What we see as the essence:
Porizka et al. investigated the ability of IG, Procalcitonin (PCT), WBC, body temperature and combinations in a cohort of cardiac surgery patients for the ability to identify sepsis. IG and PCT exhibited an AUC of 0.71 and 0.72, whereas in combination AUC increased to 0.8. IG is considered as a valuable additional parameter to PCT that improves sepsis identification in this special patient cohort.
Huang Y et al. (2019) J Crit Care; 50: 303:
Immature granulocytes: A novel biomarker of acute respiratory distress syndrome in patients with acute pancreatitis.
What we see as the essence:
In patients with acute pancreatitis, immature granulocytes (IG%) could facilitate the identification of patients with a high risk for developing acute respiratory distress syndrome (ARDS). IG% is a potential indicator of ARDS incidence and has predictive power similar (or greater) than other biomarkers.
Ünal Y et al. (2018) Ulus Travma Acil Cerrahi Derg; 24(5): 434:
A new and early marker in the diagnosis of acute complicated appendicitis: immature granulocytes.
What we see as the essence:
IG# is a more reliable marker in predicting acute appendicitis than WBC, neutrophil lymphocyte ratio (NLR) and IG%, whereas IG% is more reliable in discriminating simple and complicated appendicitis.
Delabranche X et al. (2017) J Crit Care; 47(3): 313:
Evidence of Netosis in Septic Shock-Induced Disseminated Intravascular Coagulation.
What we see as the essence:
Neutrophil fluorescence intensity (NEUT-RI) in blood samples of patients with septic shock was significantly higher in septic shock-induced disseminated intravascular coagulation (DIC) patients compared with non-DIC septic shock patients (70.0 vs. 50.7 FI).
Ronez E et al. (2017) Scand J Clin Lab Invest;77(6): 406:
Usefulness of thresholds for smear review of neutropenic samples analyzed with a Sysmex XN-10 analyzer.
What we see as the essence:
A multi-center study showed that 1031 smear reviews triggered by isolated neutropenic samples (NEUT# < 1.5 G/L) resulted in the detection of only one positive sample (containing blasts). The authors recommend using a lower cutoff of 1.0 G/L for smear review.
Hampson P et al. (2017) Ann Surg; 265(6): 1241:
Neutrophil Dysfunction, Immature Granulocytes, and Cell-free DNA are Early Biomarkers of Sepsis in Burn-injured Patients: A Prospective Observational Cohort Study.
What we see as the essence:
Neutrophil and IG counts correlated with sepsis risk in burn patients.
They could be used as predictive markers of sepsis in burn patients together with other markers such as the phagocytic index and cell free DNA.
Stiel L et al. (2016) Crit Care Med; 44(11): e1132:
Neutrophil Fluorescence: A New Indicator of Cell Activation During Septic Shock-Induced Disseminated Intravascular Coagulation.
What we see as the essence:
Neutrophil fluorescence (NEUT-RI) above 57.3 FI had a sensitivity of 90.9 % and a specificity of 80.6 % for diagnosis of disseminated intravascular coagulation in patients with septic shock.
Park SH et al. (2015) Int J Lab Hematol; 37(2): 190:
Sepsis affects most routine and cell population data (CPD) obtained using the Sysmex XN-2000 blood cell analyzer: neutrophil-related CPD NE-SFL and NE-WY provide useful information for detecting sepsis.
What we see as the essence:
NE-SFL and NE-WY parameters have a good potential as sepsis markers and have a high specificity and sensitivity to differentiate between sepsis and non-sepsis groups.
Ha SO et al. (2015) Scand J Clin Lab Invest; 75(1): 36:
Fraction of immature granulocytes reflects severity but not mortality in sepsis.
What we see as the essence:
Sepsis patients with an IG count on the XE-2100 of more than
0.5 % were more likely to suffer from severe sepsis or septic shock, while WBC, CRP and PCT were not predictive of sepsis severity. None of the tested markers could predict 28-day mortality.
Wiland EL et al. (2014) Acta Paediatr.: 103(5): 494.:
Adult and child automated immature granulocyte norms are inappropriate for evaluating early-onset sepsis in newborns.
What we see as the essence:
"A study on the XE-5000 showed that IG counts were increased during the first 2 days after birth. Therefore, the authors conclude that the use of adult and child norms for IG% is not appropriate for newborns when evaluating early-onset sepsis."
Nierhaus A et al. (2013) BMC Immunology 14: 8:
Revisiting the white blood cell count: immature granulocytes count as a diagnostic marker to discriminate between SIRS and sepsis - a prospective, observational study.
What we see as the essence:
"Direct quote: Our findings demonstrate that sepsis is associated with an increased immature granulocyte count. The IG count can differentiate between patients with an infection and those who are not infected, particularly within the first critical hours after an initial SIRS alert. Using ROC analysis we found the IG count a superior biomarker for sepsis compared to C-reactive protein, lipopolysaccharide binding protein and interleukin-6."
Cimenti C et al. (2012) Clin Chem Lab Med; 50: 1429:
The predictive value of immature granulocyte count and immature myeloid information in the diagnosis of neonatal sepsis.
What we see as the essence:
Compared to a manual smear review, automated detection of IG # and IMI # represents a fast, accurate and less labour-intensive method and could improve screening and monitoring for early onset sepsis in neonates.
Zimmermann M et al. (2011) Clin Chem Lab Med; 49: 1193:
Granularity Index of the SYSMEX XE-5000 hematology analyzer as a replacement for manual microscopy of toxic granulation neutrophils in patients with inflammatory diseases.
What we see as the essence:
The Granularity Index (GI) is suited to quantify the degree of toxic granulation of neutrophils. The GI is a parameter calculated from automated, standardised measurements. The authors suggest that it should replace the time-consuming and subjective microscopic procedure
Le Roux G et al. (2010) Int J Lab Hematol; 32: e237:
Routine diagnostic procedures of myelodysplastic syndromes: value of a structural blood cell parameter (NEUT-X) determined by the Sysmex XE-2100™.
What we see as the essence:
"NEUT-X and the calculated granularity index GI help to screen for myelodysplastic syndromes (MDS) with increased sensitivity without increasing unnecessary smears."
Furundarena JR et al. (2010) Int J Lab Hematol 32: 360–366.:
The utility of the Sysmex XE-2100 analyzer's NEUT-X and NEUT-Y parameters for detecting neutrophil dysplasia in myelodysplastic syndromes.
What we see as the essence:
"The parameters NEUT-X and NEUT-Y can be used to detect neutrophil dysplasia arising from MDS and chronic myelomonocytic leukaemia (CMML)."
Linssen J et al. (2008) Cytometry B (Clin Cytometry); 74: 295:
Automation and validation of a rapid method to assess neutrophil and monocyte activation by routine fluorescence flow cytometry in vitro.
What we see as the essence:
Fluorescence flow cytometry can measure activation steps of monocytes and polymorphonuclear neutrophils to defined external stimuli. This may potentially be applied as a screening and surveillance method for inflammatory diseases.
Fernandes B (2007) Am J Clin Pathol; 128: 454:
Automated enumeration of immature granulocytes.
What we see as the essence:
The results indicate that the automated IG count can replace the manual morphology count and is superior to it.
Ansari-Lari A et al. (2003) Am J Clin Pathol 120: 795–799.:
Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis.
What we see as the essence:
"The automated IG count matches the manual IG count very well. At significantly elevated levels, it is a very specific predictor of sepsis. Multiparameter algorithms might be more successful at lower concentrations."
Briggs C et al. (2000) Clin Lab Haematol; 22: 345:
New quantitative parameters on a recently introduced automated blood cell counter – the XE 2100.
What we see as the essence:
The IG count correlated with visual counts thus potentially improving screening and monitoring of various pathological conditions and reducing turnaround time.

Low WBC mode

SEO JY et al. (2015) Int J Lab Hematol; 37(2): 155:
Performance evaluation of the new hematology analyzer Sysmex XN-series.
What we see as the essence:
A good correlation was found between the XN- and XE-series
for all parameters. The XN-Series dramatically reduced the smear rate (by 58 %). Even at counts below 500/µL the XN provided an accurate WBC count using the Low WBC mode.
Tanaka Y et al. (2014) Int J Hematol. 36(4): e50:
Elimination of interference by lipids in the Low WBC mode in the automated hematology analyzer XN-2000.
What we see as the essence:
"The study shows that potential interferences by the contamination of lipids have been eliminated in the two leukocyte channels of the XN-series, particularly compared to non-fluorescent methods. Furthermore, the new Low WBC mode showed better precision for leukopenic samples than the whole blood (WB) mode."

Lymphocytes

Rutkowska E et al. (2021) Cells; 10(1): 82:
Usefulness of the New Hematological Parameter: Reactive Lymphocytes RE-LYMP with Flow Cytometry Markers of Inflammation in COVID-19.
What we see as the essence:
A study on patients with viral infections showed that RE-LYMP% correlated with the presence of plasmablasts (activated B cells). RE-LYMP also correlated with activation markers on CD4+ and CD8+ T cells in COVID-19 (CD8+ CD45RO+) or other infections (CD38+ and HLA-DR+).
Henriot l et al. (2017) Int J Lab Hematol; 39(1): 14:
New parameters on the hematology analyzer XN-10 (SysmexTM) allow to distinguish childhood bacterial and viral infections.
What we see as the essence:
New parameters from the Sysmex XN allowed to differentiate between inflammation and infection in children. The parameter AS-LYMP (AUC=0.83) had the same discrimination power as procalcitonin (AUC=0.82) to distinguish between bacterial and viral infections.
Sale S et al. (2016) J Clin Lab Anal; 30(5): 779:
Detection of Apoptotic Lymphocytes Through Sysmex XN-1000 As a Diagnostic Marker for Mononucleosis Syndrome.
What we see as the essence:
The study reveals a new algorithm that integrates the 'Atypical Lympho?' flag, lymphocyte structural parameters (LY-WX, LY-WY, LY-WZ) and presence of events in area of the FCS-SSC and SFL-SSCscattergrams and could aid in the diagnosis of infectious mononucleosis.
Oehadian A et al. (2015) Int J Lab Hematol; 37(6): 861:
New parameters available on Sysmex XE-5000 hematology analyzers contribute to differentiating dengue from leptospirosis and enteric fever.
What we see as the essence:
The detection of atypical lymphocytes, high-fluorescent lymphocytes and immature granulocytes on the XE-5000 supports the differentiation between common causes of febrile illnesses with thrombocytopenia in dengue areas.
Brisou G et al. (2015) J ClinLab Anal: 29(2): 153:
Alarms and Parameters Generated by Hematology Analyzer: New Tools to Predict and Quantify Circulating Sezary Cells.
What we see as the essence:
"Combining the 'Blasts/Abn Lympho?' flag with the Ly-X and Ly-Y parameters it was possible to differentiate Sezary patients from control patients (sensitivity 89%; specificity 98%) or from patients with chronic lymphoproliferative diseases (sensitivity 89%; specificity 94%). The proposed algorithm may alert the microscopist that a sample likely contains Sezary cells."
Van Mirre E et al. (2011) Clin Chem Lab Med; 49: 685:
Sensitivity and specificity of the high fluorescent lymphocyte count-gate on the Sysmex XE-5000 hematology analyzer for detection of peripheral plasma cells.
What we see as the essence:
The Sysmex XE-5000 is suitable for screening blood samples for the presence of elevated numbers of plasma cells in peripheral blood.
Linssen J et al. (2007) Cytometry B (Clin Cytometry) 72: 157–166. Reprinted in: Sysmex J Int 19(1): 19–25.:
Identification and quantification of high fluorescence-stained lymphocytes as antibody synthesizing/secreting cells using the automated routine hematology analyzer XE-2100.
What we see as the essence:
"The Sysmex high-fluorescence lymphocyte count quantifies activated B-lymphocytes with high precision and reliability in patients without haematological systemic diseases, thus providing a potential screening and monitoring tool for a suspected infection."

Monocytes

Zhu J et al. (2019) Int J Lab Hematol; 41(6): 782:
A hierarchical approach in the diagnostic workflow of chronic myelomonocytic leukemia: Pivotal role of the "Mono-dysplasia-score" combined with flow cytometric quantification of monocyte subsets.
What we see as the essence:
The authors set up a workflow for monocytosis samples including Mono-dysplasia score, smear review and flow cytometry. Mono-dysplasia score was shown to be a valuable filter for reducing the number of smears without losing sensitivity for CMML suspicious samples.
Buoro S et al. (2018) Int J Lab Hematol; 40(5): 577:
Evaluation and comparison of automated hematology analyzer, flow cytometry, and digital morphology analyzer for monocyte counting.
What we see as the essence:
Comparison of the XN-9000, CyFlow Space System and DI-60 compared with OM (optical microscopy) for the monocyte count revealed a better performance and higher values for flow cytometry than OM and DI-60 which have also a higher imprecision. The authors conclude also that the absolute monocyte count may be more reliable.
Schillinger F et al. (2017) Scand J Clin Lab Invest; 78(3):159:
A new approach for diagnosing chronic myelomonocytic leukemia using structural parameters of Sysmex XN analyzers in routine laboratory practice.
What we see as the essence:
A score derived from Sysmex XN parameters identifies possible CMML samples by excluding reactive monocytes. This reduces the smear review work load.
Mazumdar R et al. (2013) Leukemia Research; 37(6): 614:
The automated monocyte count is independently predictive of overall survival from diagnosis in chronic lymphocytic leukaemia and of survival following first-line chemotherapy.
What we see as the essence:
A monocyte count >0.91 ×109/L at the time of diagnosis was associated with a shortened overall and treatment-free survival in CLL patients.

Reference intervals

Wilson S et al. (2021) Int J Lab Hematol; Online ahead of print:
Continuous reference curves for common hematology markers in the CALIPER cohort of healthy children and adolescents on the Sysmex XN-3000 system
What we see as the essence:
First study that generated continuous reference intervals (curves) of healthy children and adolescents for 19 haematological XN parameters. Seven parameters required sex-specific reference curves. Continuous reference intervals were found to be accurate estimate of haematological reference ranges over the paediatric age range.
Angelo A et al. (2021) BMC Pediatrics; 21: 275:
Umbilical cord blood hematological parameters reference interval for newborns from Addis Ababa, Ethiopia.
What we see as the essence:
This pilot study enrolled 139 umbilical cord blood samples from healthy newborns to establish reference values for the KX-21N. For WBC, RBC, and NEUT significant differences were found between caesarean and natural birth.
Bohn MK et al. (2020) Int J Lab Hematol; 42(6): 759:
Complex biological patterns of hematology parameters in childhood necessitating age- and sex-specific reference intervals for evidence-based clinical interpretation.
What we see as the essence:
The study establishes a comprehensive paediatric (birth to 21 years) reference intervals for haematology parameters using the XN analyser. The data highlight the dynamic haematological profiles observed in healthy children and adolescents and the need for reference interval stratification by age and sex.
Florin L et al. (2020) Int J Lab Hematol; 42(3): e110:
Establishment of common reference intervals for hematology parameters in adults, measured in a multicenter study on the Sysmex XN-series analyzer.
What we see as the essence:
The study provides reference intervals (CBC+DIFF+RET) that could serve as reference values for haematology parameters in adults for laboratories that use the XN-Series analysers.
Arbiol-Roca A et al. (2018) EJIFCC; 29(1): 48:
Reference intervals for a complete blood count on an automated haematology analyser Sysmex XN in healthy adults from the southern metropolitan area of Barcelona.
What we see as the essence:
The aim of the study was to establish reference intervals for CBC, DIFF and reticulocytes for a Spanish population. Significant gender differences were found for RBC, PLT, HCT and HGB.
Ozarda Y et al. (2017) Clin Chem Lab Med; 57(1): 30:
Verification of reference intervals in routine clinical laboratories - practical challenges and recommendations.
What we see as the essence:
The opinion paper summarises guidelines and approaches for the verification of reference intervals (RI) in routine clinical laboratories. It gives definitions for common terms, refers to examples and covers challenges such as RI for geriatric and paediatric populations.
Cornet E et al. (2015) Int J of Lab Hematol.: 37(5): e123:
Contribution of the new XN-1000 parameters NEUT-RI and NEUT-WY for managing patients with immature granulocytes.
What we see as the essence:
Normal values were determined on the XN-Series for the structural neutrophil parameters NEUT-GI, NEUT-RI and NEUT-WY. In addition, it was shown that NEUT-RI and NEUT-WY can be used to predict IG% values within a 72 h time frame.
Zimmermann M et al. (2015) Clin Lab; 61: 235:
Detection and quantification of hypo- and hypergranulated neutrophils on the new Sysmex XN hematology analyzer: establishment of an adapted reference interval for the neutrophil-granularity-intensity compared to XE-technology in adult patients.
What we see as the essence:
The reference intervals for NEUT-GI (XN-Series) and NEUT-X
(XE-series) were determined using 246 blood-healthy control patients: 140.91 - 160.46 channels and 129.20 - 142.33 channels, respectively. Neutrophil granularity was higher in ICU patients.
Roehrl MHA et al. (2011) Arch Pathol Lab Med; 135: 471:
Age-dependent reference ranges for automated assessment of immature granulocytes and clinical significance in an outpatient setting.
What we see as the essence:
The use of appropriate reference ranges makes the IG count a powerful haematologic parameter for outpatient care that is associated with differential diagnoses that are distinctly characteristic of that setting.

XN Stem Cells

Reberšek K et al. (2021) J Clin Apher; Online ahead of print:
Hematopoietic progenitor cell counting can optimize peripheral blood stem cell apheresis process.
What we see as the essence:
This study in autologous and allogeneic stem cell donors showed that HPC correlated well with CD34+ cell count, had a very good diagnostic accuracy to identify the apheresis starting point (AUC 0.852), and to predict both an insufficient (AUC 0.884) or sufficient (AUC 0.769) harvest.
Mishra S et al. (2020) Int J Lab Hematol; 43(1): 76:
A study to compare Hematopoietic Progenitor Cell count determined on a next-generation automated cell counter with flow cytometric CD34 count in peripheral blood and the harvested peripheral blood stem cell graft from autologous and allogenic donors.
What we see as the essence:
A study on allogeneic and autologous haematopoietic stem cell donors showed that HPC had a very good correlation with CD34+ count in peripheral blood and in the final harvest product, and was an efficient predictor for the optimal time of harvesting of stem cells.
Dima F et al. (2020) Blood Transfus; 18(1): 67:
Assessment of haematopoietic progenitor cell counting with the Sysmex® XN-1000 to guide timing of apheresis of peripheral blood stem cells.
What we see as the essence:
The XN Steam Cell application can assess the timing of apheresis and thus improve the apheresis workflow by reducing CD34 tests. The parameter shows excellent diagnostic accuracy in different donor subsets, high precision and a very good correlation with CD34.
Furundarena JR et al. (2020) Int J Lab Hematol; 42(2): 170:
Evaluation of the predictive value of the hematopoietic progenitor cell count using an automated hematology analyzer for CD34+ stem cell mobilization and apheresis product yield.
What we see as the essence:
The authors established two decision trees using XN haematopoietic progenitor cells count for decision making in autologous transplants. One for optimising the rational use of plerixafor in poor mobilisers and the second for decision on the optimal starting point of apheresis.
Grommé M et al. (2017) Transfusion; 57(8): 1949:
Multicenter study to evaluate a new enumeration method for hematopoietic stem cell collection management.
What we see as the essence:
The XN Stem cell method correlates well with the gold standard of CD34 flow cytometry during stem cell mobilisation phase to determine apheresis start time, during apheresis for real-time monitoring and for QC of the final stem cell harvest.
Park SH et al. (2015) Ann Lab Med; 35(1): 146:
The New Sysmex XN-2000 Automated Blood Cell Analyzer More Accurately Measures the Absolute Number and the Proportion of Hematopoietic Stem and Progenitor Cells Than XE-2100 When Compared to Flow Cytometric Enumeration of CD34(+) Cells.
What we see as the essence:
Stem cell counts from the XN-Series were more accurate than stem cell counts from the XE-Series when compared to CD34 flow cytometry.
Peerschke El et al. (2015) Transfusion; 55(8): 2001:
Evaluation of new automated hematopoietic progenitor cell analysis in the clinical management of peripheral blood stem cell collections.
What we see as the essence:
XN-Stem Cells is a functional equivalent of CD34 analysis and may
be a surrogate for CD34 analysis to predict optimal timing of stem cell collections from mobilised peripheral blood.
Tanosaki R et al. (2014) Int J Lab Hematol; 36(5): 521:
Novel and rapid enumeration method of peripheral blood stem cells using automated hematology analyzer.
What we see as the essence:
This study found that CD34-positive cells fall in the XN stem cell gate in the WPC scattergram. The final yield of collected CD34-positive cells could be predicted from the XN-HPC value in pre-apheresis blood and apheresis products.
Copyright © Sysmex Europe GmbH. All rights reserved.
Dear customer,

Thank you very much for your interest in our products. Due to legal restrictions, advertising for medical products that detect COVID-19 infections is not permitted outside of specialist fields. Therefore we ask you to confirm below that you belong to one of the following groups:

- health care professional
- a facility that serves human or animal health
- a person who lawfully works with medicine or medical devices, processes or treatments

This site is for 'Professionals' only. You are not authorised to view this page.

Customize your experience

We use cookies to enable you to optimally use our Website and to improve our communication with you. We shall take your selection into account and use only the data for which you give us your consent.

* May lead to restrictions in content and in the user experience
Detail about cookies
Essential cookies
These cookies help to make our website usable by enabling basic features such as page navigation and access to secure areas of our website. Our website cannot function properly without these cookies.
Statistics cookies
By collecting information anonymously, these cookies help us to understand how visitors interact with our website. This information enables us to continually improve our platform.
Marketing cookies
are used to track visitors on websites. The intention is to show advertisements that are relevant and appealing to the individual user and are, therefore, valuable to publishers and third-party advertisers.