title: The usefulness of blast flags on the Sysmex XE-5000 is questionable.
abstract: Hematology analyzers generate suspect flags that involve microscopic reviews to confirm the presence of pathologic cells. This study investigated the reliability of the blast flag in a side-by-side evaluation of 3 Sysmex XE-5000 instruments (Sysmex, Kobe, Japan). The repeatability of the Q values reported by each instrument for 10 replicates of the same blood samples was low (intraclass correlation coefficient [ICC] values, 0.62-0.74). The reproducibility of the Q values obtained by analyzing 408 samples on all 3 instruments was reasonable (ICC value, 0.85). In addition, a systematic difference was observed among the instruments in the level of reported Q values. With cutoff commonly being 100, the observed reproducibility of the blast flagging among the instruments was evaluated as poor (κ = 0.73). Based on the observed low performances, we question the usefulness of the Q value as a predictor of blasts and whether a blast flag reported by the XE-5000 is sufficient as a criterion for performing a microscopic review.
authors.affiliation: Division of Diagnostics and Technology, Akershus University Hospital, Lorenskog, Norway. heidi.eilertsen@hioa.no
authors.forename: Heidi
authors.initials: H
authors.lastname: Eilertsen
authors.forename: Nina K
authors.initials: NK
authors.lastname: Vøllestad
authors.forename: Tor-Arne
authors.initials: TA
authors.lastname: Hagve
mesh_terms: D005189:False Positive Reactions; D019337:Hematologic Neoplasms / Q000175:diagnosis*; D006405:Hematology / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D007753:Laboratories / Q000592:standards*; D007958:Leukocyte Count; D007964:Leukocytosis / Q000097:blood / Q000175:diagnosis; D007970:Leukopenia / Q000097:blood / Q000175:diagnosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity