Email this article 
Hide
Show all
Original Research
Performance of the automated Sysmex XN-3000 analyser for detecting white blood cell abnormalities in South Africa
Submitted: 07 December 2022 | Published: 19 July 2023
About the author(s)
Jasmine Ramiah, Department of Haematology, National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, School of Laboratory Medicine, University of KwaZulu-Natal, Durban, South AfricaDashini Pillay, Department of Haematology, National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, School of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa
Nadine Rapiti, Department of Haematology, National Health Laboratory Services, Inkosi Albert Luthuli Central Hospital, Durban, South Africa; and, Department of Haematology, School of Laboratory Medicine, University of KwaZulu-Natal, Durban, South Africa
Abstract
Background: Automated haematology analysers such as the Sysmex XN-3000 (Sysmex Corporation, Kobe, Japan) utilise white blood cell (WBC) flags to identify quantitative and qualitative abnormalities. Owing to clinical and biological factors, the sensitivity and specificity of the flags vary when compared to microscopy, the gold-standard method for assessing peripheral blood smear (PBS) morphology.
Objective: This study assessed the performance of the Sysmex XN-3000 haematology analyser in comparison to PBS microscopy for the detection of WBC abnormalities.
Methods: We collected 250 random full blood count samples from the haematology laboratory at Inkosi Albert Luthuli Central Hospital, Durban, KwaZulu-Natal, South Africa, from March 2022 to April 2022. The performance of the automated WBC flags of the Sysmex XN-3000 was assessed in comparison to PBS microscopy, and the impact of established clinical variables on the performance of the flags was determined.
Results: The sensitivity of the ‘blast’ flag was 96.3%, and the specificity was 84.9%. The efficiency of the flag was adversely impacted by low white cell counts (< 1.5 × 109/L; p < 0.001), chemotherapy (p = 0.002), malignancy (p = 0.02), and infection (p = 0.02). The ‘abnormal lymphocyte’ flag demonstrated a sensitivity of 90% and a specificity of 96.2%, and its performance was adversely impacted by chemotherapy exposure (p = 0.03). Three cases (1.2%) erroneously flagged as ‘monocytosis’ demonstrated blasts on microscopy.
Conclusion: In our setting, PBS microscopy remains necessary to confirm blasts, abnormal lymphocytes, and monocytosis in patients with malignancy, current chemotherapy exposure, low white cell counts, and infection.
What this study adds: This study adds evidence that PBS morphology remains the gold standard for confirming WBC abnormalities in patients with a history of malignancy, chemotherapy, and leucopenia.
Keywords
Sustainable Development Goal
Metrics
Total abstract views: 4551Total article views: 7447
Crossref Citations
1. Pseudomonocytosis on a Sysmex XN haematology analyser masking the monocytopenia of hairy cell leukaemia in a South African woman
Stephanie J. Kennedy, Anne-Cecilia van Marle
African Journal of Laboratory Medicine vol: 14 issue: 1 year: 2025
doi: 10.4102/ajlm.v14i1.2617
2. Performance of Automated Hematology Analyzer Criteria in Detecting Peripheral Blood Smear Abnormalities: A Systematic Literature Review
Elizabeth L. Courville, Michelle Grant, Emily Mason, Xueyan Chen, Giuseppe d'Onofrio, Ben Hedley, John L. Frater, Madhu M. Ouseph, Gina Zini, Stefanie McFadden, Jin‐Yeong Han, Cara Shirai, Amrom Obstfeld, Lauren H. Yaeger, Olga Pozdnyakova
International Journal of Laboratory Hematology vol: 48 issue: 5 first page: 1008 year: 2026
doi: 10.1111/ijlh.70139
3. Diagnostic accuracy of automated hematology analyzer abnormal flags for detecting hematological malignancies: A systematic review and meta-analysis
Zewudu Mulatie, Bruktawit Eshetu, Afewerk Habtamu, Sisay Desale, Saleamlak Sebsibe, Yonas Erkihun, Yeshimebet Kassa, Tesfaye Gessese, Mihreteab Alebachew, Mikiyas Shimeles, Mahider Shimelis Feyisa, Dereje Mengesha Berta, Marwan Salih Al-Nimer
PLOS One vol: 21 issue: 7 first page: e0354619 year: 2026
doi: 10.1371/journal.pone.0354619
4. Optimization of Reflex Testing Rules on the Sysmex XN‐9100 Automated Hematology Line Improves Efficiency and Reduces Repeat Testing in Different Work Areas
Lianhui Yu, Min Zhang, Jianying Li, Ping Deng, Haoting Zhan, Wei Wu
Journal of Clinical Laboratory Analysis vol: 40 issue: 18 year: 2026
doi: 10.1002/jcla.70285
5. Hematology instruments don’t speak the same language: a comparison study between flagging messages of sysmex XN-1000 and alinity H
Oana Roxana Oprea, Elena-Cristina Preda, Bogdana Dorcioman, Hannelore Doris Bucur, Minodora Dobreanu
Journal of Laboratory Medicine vol: 49 issue: 2 first page: 76 year: 2025
doi: 10.1515/labmed-2024-0046
6. Evaluation of analytical performance of AQUIOS CL flow cytometer and method comparison with bead-based flow cytometry methods
Andrada S. Chiron, Lucy Locher, Aurélie Sarthou, Aude Gleizes, Roman Krzysiek, Pascale Chretien, Salima Hacein-Bey-Abina
Clinical Chemistry and Laboratory Medicine (CCLM) vol: 62 issue: 10 first page: 2011 year: 2024
doi: 10.1515/cclm-2023-1498
7. Development of criteria to optimize manual smear review of automated complete blood counts using a machine learning model
Jennifer M. Hayes, Mitchell R. Hayes, Kristen R. Friedrichs, Heather A. Simmons
Veterinary Clinical Pathology vol: 54 issue: S2 year: 2025
doi: 10.1111/vcp.13400
8. Real-World Evaluation of the Sysmex XN-9100 WDF–WPC Workflow: Diagnostic Performance, False-Negative Burden, and Potential Optimization of Smear Review Workload
Francesca Romano, Domenico Romeo, Sara Ciullini Mannurita, Edda Russo, Eva Milletti, Alessandra Fanelli, Alessandro Bonari
Diagnostics vol: 16 issue: 15 first page: 2387 year: 2026
doi: 10.3390/diagnostics16152387
9. Clinician-Ordered Peripheral Smear Review by a Pathologist Has Low Clinical Utility—A Reference Laboratory Perspective
Sanjai Nagendra, Jamie Mongillo, Krystin Dodge, Pratistha Ranjitkar, Betty Burns, Lavonda Allen
The Journal of Applied Laboratory Medicine vol: 10 issue: 2 first page: 352 year: 2025
doi: 10.1093/jalm/jfae101
