Fragmented red cells reference range (Sysmex XN(®) automated blood cell counter)

Area of Science:

• Hematology
• Clinical Pathology
• Laboratory Medicine

Background:

• Fragmented red cells (FRCs) are a novel parameter from automated blood cell counters.
• FRCs are considered indicators of schistocytes, which are typically assessed via manual microscopy.
• Automated FRC counts are influenced by the detection methodology, necessitating device-specific reference ranges.

Purpose of the Study:

• To establish a reference range for Fragmented Red Cells (FRCs) using the Sysmex XN-9000 automated hematology analyzer.
• To investigate the correlation between FRCs and red blood cells with low hemoglobin content (Hypo-He).

Main Methods:

• Analysis of 2389 control blood samples using the Sysmex XN-9000 analyzer.
• Statistical calculation of mean, standard deviation, and median for FRC percentages.
• Correlation analysis between FRC counts and Hypo-He percentages.

Main Results:

• The established reference range for FRCs on the Sysmex XN-9000 was a mean of 0.32% ± 0.81, with a median of 0.02%.
• A significant correlation was observed between increased FRC counts and elevated percentages of Hypo-He red blood cells.
• Hypo-He was identified as a factor contributing to spurious overestimation of FRCs.

Conclusions:

• The derived reference range for FRCs on the Sysmex XN-9000 aids laboratory staff in identifying blood smears requiring manual review.
• This data can assist Sysmex in optimizing automated rules for blood smear analysis and automated slide making.
• Accurate FRC quantification is essential for reliable schistocyte detection and interpretation in automated hematology.