title: Comparison study of the rates of manual peripheral blood smear review from 3 automated hematology analyzers, Unicel DxH 800, ADVIA 2120i, and XE 2100, using international consensus group guidelines.
abstract: BACKGROUND
  In the clinical laboratory, it is important both to reduce the number of peripheral blood slide reviews to save time and money and to avoid reporting false results.
  
  
  OBJECTIVE
  To determine differences in the slide review rates of 3 widely used automated hematologic analyzers, the Unicel DxH 800 (Beckman Coulter Inc, Fullerton, California), ADVIA 2120i (Siemens Diagnostics, Tarrytown, New York), and XE 2100 (Sysmex, Kobe, Japan), using International Consensus Group for Hematology Review guidelines.
  
  
  METHODS
  A total of 1485 samples were tested, and 300 were manually reviewed. Slide review rates, sensitivity, specificity, and false-positive and false-negative rates were estimated using consensus group rules and compared using χ(2) tests, Fisher exact tests, or generalized estimating equations.
  
  
  RESULTS
  Unicel DxH 800, ADVIA 2120i, and XE 2100 showed 22.8%, 20.2%, and 28.6% slide review rates; 14.3%, 14.3%, and 9.7% false-negative rates; and 13.7, 11.3%, and 17.3% false-positive rates, respectively. All analyzers showed significantly higher false-negative rates than that of the consensus group (2.9%).
  
  
  CONCLUSIONS
  False-negative rates were higher than the recommended levels. Among 3 automated hematologic analyzers, XE 2100 showed the highest rate of slide review. Because the present study clearly shows that the slide review rates have distinct characteristics among the studied analyzers, each individual laboratory should consider selecting the most appropriate analyzer according to clinical characteristics. Analyzers with high sensitivity may be advantageous in outpatient settings for screening patients, whereas analyzers with high specificity may be beneficial in inpatient settings for efficient patient care.
authors.affiliation: Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Sue Jung
authors.initials: SJ
authors.lastname: Kim
authors.forename: Yoonjung
authors.initials: Y
authors.lastname: Kim
authors.forename: Saeam
authors.initials: S
authors.lastname: Shin
authors.forename: Jaewoo
authors.initials: J
authors.lastname: Song
authors.forename: Jong Rak
authors.initials: JR
authors.lastname: Choi
mesh_terms: D001772:Blood Cell Count / Q000295:instrumentation* / Q000592:standards / Q000706:statistics & numerical data; D005188:False Negative Reactions; D005189:False Positive Reactions; D006801:Humans; D017410:Practice Guidelines as Topic; D012680:Sensitivity and Specificity