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Pre-differentiation of the white blood cells into three subpopulations. The major advantage of automated cell differentiation is speed and enhanced precision and accurracy: In contrast to a 100-cell manual differential count, automated analysers count on average 15,000 cells/sample.
Sysmex distinguishes lymphocytes, neutrophils and a mixed population consisting of monocytes, basophils and eosinophils. With other technologies, one commonly finds the differentiation into lymphocytes, monocytes and the mixed population of granulocytes. To determine a separate neutrophil population is advantageous since neutrophils are earlier markers for inflammation and infectious conditions than monocytes.
Full differentiation of the white blood cells into the five major subpopulations that physiologically appear in certain concentrations in peripheral blood: lymphocytes, monocytes, eosinophils, basophils and neutrophils. The ability of 5-part differential analysers to enumerate also the less abundant cell types (monocytes, eosinophils and basophils) separately is a significant enhancement.
The results are reported in percentage counts of the total WBC count and in absolute counts , since absolute counts are more informative: In disease, ratios become distorted and therefore percentage counts meaningless in the absence of absolute values.
The principal difference to 3-part differential technology is that cell identification relies on a three-dimensional analysis rather than just on cell size, which allows the identification of immature and abnormal cells, which in turn helps to identify the possible cause of illness in sick people.
Newer automated haematology analysers are able to classify immature granlulocytes (IG) as a sixth population and report them as a percentage count of the total WBC count and an absolute count.
The term ‘6-part differential’ generally refers to the classical 5-part differential and the additional quantification of immature granulocytes (IG) as the sixth white blood cell subpopulation. Sysmex’s XN-L Series and XN-Series analysers routinely report the IG count as a diagnostic parameter: as a percentage count of the total WBC count and an absolute count.
Principle for blood cell counting used in Sysmex analysers: the blood cell counts are determined from the number of pulses generated in a specific volume of blood. The advantage of this approach is that end-user calibration is not required.
Adaptive cluster analysis system (ACAS)
Sysmex's method to evaluate individual cells' signals during measurement and determining the population cluster to which these cells belong. Since this method allows greater flexibility, biological variation between patients is taken into account, leading to more accurate differentiation results, particularly with pathological samples, where morphological appearance of the cells is likely to become altered in disease.
Advanced clinical parameters
Aged Sample Identifier
The use of the Aged Sample Identifier (a software feature that needs to be activated) on XN-Class analysers allows a reliable differentiation of samples with abnormal WDF scattergrams into truly pathologic samples or aged samples. This application effectively prevents false-positive flagging, especially with the ‘Blasts/Abn Lympho?’ flag, which leads to a smear rate reduction for such samples. It saves the effort spent on samples that are only old and allows focusing on the pathologic samples needing attention. Sysmex recommends using the Aged Sample Identifier in laboratories experiencing workflow challenges due to a high proportion of aged samples.
Albumin is a small soluble protein that is synthesized in the liver and contained in blood. Albumin is the most abundant protein in blood and serves as an important binding and transport protein. When kidneys are working correctly, they keep important elements such as albumin in the blood. Healthy individuals excrete only low levels of protein through urine on a daily basis. In contrast to this, albuminuria is a pathological condition with larger amounts (>30 mg/24 h) of albumin being present in urine over a longer period. This abnormal condition can be used for an early recognition of nephropathy. The early diagnosis of (micro-)albuminuria can prevent or postpone severe kidney damage.
Anaemia is generally defined as a reduction in haemoglobin (HGB) level below the lower limit of normal. The values that define the presence or absence of anaemia are both gender- and age-dependent. The haematocrit (HCT) is a related parameter that likewise is reduced in anaemia. Anaemia is a symptom, rather than a disease, with a multitude of causes, which have to be clarified to enable successful treatment.
Healthy urine usually does not contain bacteria. However, some bacteria can be present if the urine sample was not collected under sterile conditions or if the person is suffering from a urinary tract infection. Bacteria can be differentiated into Gram-positive and Gram-negative bacteria, based on their cell wall composition. Depending on the type of the cell wall, they are susceptible to different antibiotics.
Urinary casts mainly consist of Tamm-Horsfall mucoprotein (THP). About 50 mg of liquid THP is excreted every day. Therefore, it is normal to find THP in urine.
Hyaline casts (Hy. CAST) are the most common types of casts in urine. They are cylindrical and appear almost transparent. Casts are a result of solidification of THP mucoprotein in the lumen of the kidney tubules. Hyaline casts can be found in urine due to dehydration, fever or vigorous exercise.
Pathological casts (Path. CAST) contain inclusions. They develop when particles – such as red blood cells or tubular epithelial cells – are present during the solidification process of THP. Particles adhere to the fibrillar protein network and get surrounded by it. These casts appear in urine when pathological processes take place in the kidney. Examples: Granular casts, cellular casts, waxy casts.