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Validation of the reticulocyte channel of Sysmex XN-9000 system for blood cell count in samples with suspected cold agglutination for use in a total laboratory automation setting
  1. Felicia Stefania Falvella,
  2. Ludovica Serafini,
  3. Sarah Birindelli,
  4. Mauro Panteghini
  1. Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan, Italy
  1. Correspondence to Felicia Stefania Falvella, Clinical Pathology Unit, ASST Fatebenefratelli-Sacco, Milan 20157, Italy; stefania.falvella{at}

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Modern haematology platforms provide information regarding blood cell count, differential cellular characteristics, leukopoiesis, erythropoiesis and thrombopoiesis. Among the disorders of red blood cells (RBC), anaemias are a common healthcare problem, for which effective treatment is possible if the cause is correctly recognised. For this purpose, a classification system based on the RBC indices, generated automatically by haematology systems, is used and has taken on clinical importance.1 Among RBC indices, the mean corpuscular haemoglobin concentration (MCHC) is one of the most indicative parameters. Elevated MCHC can be seen in RBC disease, in cold agglutination (CA) or in haemolysed or icteric samples.2 CA disease (CAD) is an antibody and complement-mediated haemolytic anaemia classified as primary, if associated with lymphoproliferative disease, and secondary CAD, when associated with malignant disease and infection, respectively.3 Diagnosis of CAD occurs by direct antiglobulin test. High mean corpuscular volume (MCV) and false reduction in RBC count are often seen in CAD, together with a false increase of mean corpuscular haemoglobin (MCH) and MCHC. In this condition, preheating at 37°C the blood sample for 2 hours permits to restore the correct values of the perturbed haematological parameters.

Previous studies reported the use of reticulocyte (RET) channel of Sysmex XN series (Sysmex, Kobe, Japan), which, through a short preheating (1 min) at 41°C, may return the correct RBC count and derived indices by spontaneous separation of agglutinated RBC.4 5 In this study, we aimed to further validate this approach for use in a total laboratory automation framework, with the aim …

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  • Handling editor Mary Frances McMullin.

  • Correction notice This article has been corrected since it was published. The expansion of CAD has been corrected to Cold Agglutinin disease.

  • Contributors All authors contributed to the conceivement and design of the study and to the collection, analysis and interpretation of data. The manuscript was written by FSF and MP and subsequently approved by all authors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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