Hi everyone,

 

We are implementing a new hematology analyzer (Sysmex XN series), and will be performing automated body fluid counts on this platform.

 

For those of you who perform automated counts - do you report a total nucleated cell count, a white blood cell count, or both?  What cells are included in your differential?

 

We had planned to report WBC and RBC counts off the analyzer.  Our differentials include neutrophils, lymphs, monos/macrophages, mesothelial cells, and "other" cells.  Since our differential includes non-WBC nucleated cells - some techs feel that means we need to include the total nucleated cell count on the report (not just the WBC count). 

 

Thoughts?

Unless your instrument can differentiate between hematopoietic cells and the "lining" cells and not count them, then you are actually counting nucleated cells and you should report that.  I believe the Sysmex counts nucleated cells.  Your apps person can tell you what it counts.  You could report an "estimated WBC" by using the % neuts, lymphs, monos, eos, basos from your manual diff and calculating a WBC.  It's only an estimate though.  A cytospin prep doesn't have random distribution on a slide due to the centrifugal forces present. 

Hi Joseph! Our Sysmex XN series analyzers do, in fact, differentiate between nucleated cells and WBCs. It will give both a total nucleated cell count AND a WBC count.

We had planned to simply report the WBC and continue counting all nucleated cells in our diffs (neutrophils, lymphs, monos, macrophages, mesothelial cells, etc).

Some of our techs are thinking that, if we provide a differential that includes non-WBCs, then we need to report the total never of nucleated cells (not just the WBC count). On the other hand, if you look at all results as an evaluation of the fluid as a whole ("here's my diff on the fluid as a whole" instead of "here's my diff on the WBCS I reported"), I'm not sure how important the actual TNC number really is. Our medical director feels the providers will be more interested in the separated WBC count.

Any other thoughts?

Hi Joseph! Our Sysmex XN series analyzers do, in fact, differentiate between nucleated cells and WBCs. It will give both a total nucleated cell count AND a WBC count.

We had planned to simply report the WBC and continue counting all nucleated cells in our diffs (neutrophils, lymphs, monos, macrophages, mesothelial cells, etc).

Some of our techs are thinking that, if we provide a differential that includes non-WBCs, then we need to report the total never of nucleated cells (not just the WBC count). On the other hand, if you look at all results as an evaluation of the fluid as a whole ("here's my diff on the fluid as a whole" instead of "here's my diff on the WBCS I reported"), I'm not sure how important the actual TNC number really is. Our medical director feels the providers will be more interested in the separated WBC count.

Any other thoughts?

We don't issue anything other than a RBC and WBC as we do not have a NEQAS programme we can join for a reasonable price so we can't validate the process fully.

We recently started running our body fluids on the Sysmex XN. We haven't been able to get much help from Sysmex on running the more viscous fluid through except the statement that some places add a few flakes of hyaluronidase. Any help with what kind of hyaluronidase, how much to add and even any written procedure would be greatly appreciated.

Add up to 1mL of the fluid to approximately 5 mg of Hyaluronidase in an appropriately labeled 12x75 plastic tube.

Allow the specimen to mix for 10 minutes to decrease the sample viscosity.

If not fluid in 10 minutes, place the sample at 37C for 5 minutes.

Mix thoroughly by gentle inversion.

CAUTION: If the fluid does not become liquid after treatment with Hyaluronidase, DO NOT proceed with analysis on the DxH800.

 

Refer to procedure Body Fluid Analysis – Manual and perform a manual cell count on the specimen.

Where do you purchase the hyaluronidase from. Rabbit or sheep or some other animal....

http://www.sigmaaldrich.com/catalog/product/sigma/h3506?lang=en&region=CA

 

http://www.alibaba.com/showroom/hyaluronidase.html

Thanks much!