title: 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.
abstract: BACKGROUND
  Since the recent introduction of Sysmex hematology analyzers of the XN-series it can be expected that the values of individual hematological parameters might differ between the new XN and the well-established XE platform. One such parameter is called Neutrophil-Granularity-Intensity or NEUT-GI on the XN-series and NEUT-X on the XE-series. Both parameters are used by clinicians to calculate the Granularity-Index (GI-Index), an important tool to detect hypo- or hypergranulated neutrophils occurring during myelodysplasia or inflammation. The aims of this study were to determine if previously reported reference intervals for NEUT-X can be used for NEUT-GI as well and if the GI-Indices on both analyzer platforms correlate with each other.
  
  
  METHODS
  NEUT-GI and NEUT-X were assessed in a set of 789 blood samples (n = 543 samples from adult intensive care units and n = 246 samples from adult "blood-healthy" control patients) and the corresponding Granularity-Indices were calculated for all samples using data obtained from XE-5000 and XN-1000 hematology analyzers.
  
  
  RESULTS
  NEUT-GI and NEUT-X correlated significantly with each other (r2: 0.6512; p < 0.0001) with statistically significant higher values for NEUT-GI compared to NEUT-X in the control group (p < 0.0001) as well as in the ICU patients (p < 0.0001). This indicated that previously established reference intervals for NEUT-X cannot be used for NEUT-GI. In contrast, the GI-Indices showed no statistically significant difference between the analyzers in both groups. The GI-Indices were higher in the ICU patients compared to the control group on both analyzer platforms (p < 0.0001), as would be expected.
  
  
  CONCLUSIONS
  Our study revealed the emphatic need for a new reference interval for NEUT-GI on the XN platform. The resulting 95% reference intervals were 140.91 - 160.46 channels for NEUT-GI and 129.20 - 142.33 channels for NEUT-X. The GI-Indices showed no significant statistical difference between the XN- and XE-series in both cohorts.
authors.forename: Mathias
authors.initials: M
authors.lastname: Zimmermann
authors.forename: Pieter
authors.initials: P
authors.lastname: Steenhuis
authors.forename: Jo
authors.initials: J
authors.lastname: Linssen
authors.forename: Andreas
authors.initials: A
authors.lastname: Weimann
mesh_terms: D000210:Acute-Phase Reaction / Q000097:blood; D000328:Adult; D002138:Calibration; D002469:Cell Separation; D019411:Clinical Laboratory Techniques; D015331:Cohort Studies; D003422:Critical Care; D003593:Cytoplasm / Q000378:metabolism; D006405:Hematology / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D007249:Inflammation / Q000097:blood; D008027:Light; D016014:Linear Models; D015233:Models, Statistical; D009504:Neutrophils / Q000166:cytology*; D011786:Quality Control; D012016:Reference Values; D012044:Regression Analysis; D015203:Reproducibility of Results