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Pre-differentiation of the white blood cells into three subpopulations. The major advantage of automated cell differentiation is speed and enhanced precision and accurracy: In contrast to a 100-cell manual differential count, automated analysers count on average 15,000 cells/sample.
Sysmex distinguishes lymphocytes, neutrophils and a mixed population consisting of monocytes, basophils and eosinophils. With other technologies, one commonly finds the differentiation into lymphocytes, monocytes and the mixed population of granulocytes. To determine a separate neutrophil population is advantageous since neutrophils are earlier markers for inflammation and infectious conditions than monocytes.
Full differentiation of the white blood cells into the five major
subpopulations that physiologically appear in certain concentrations in
peripheral blood: lymphocytes, monocytes, eosinophils, basophils and
neutrophils. The ability of 5-part differential analysers to enumerate
also the less abundant cell types (monocytes, eosinophils and basophils)
separately is a significant enhancement.
The results are reported
in percentage counts of the total WBC count and in absolute counts ,
since absolute counts are more informative: In disease, ratios become
distorted and therefore percentage counts meaningless in the absence of
absolute values.
The principal difference to 3-part differential
technology is that cell identification relies on a three-dimensional
analysis rather than just on cell size, which allows the identification
of immature and abnormal cells, which in turn helps to identify the
possible cause of illness in sick people.
Newer automated
haematology analysers are able to classify immature granlulocytes (IG)
as a sixth population and report them as a percentage count of the total
WBC count and an absolute count.
The term ‘6-part differential’ generally refers to the classical 5-part differential and the additional quantification of immature granulocytes (IG) as the sixth white blood cell subpopulation. Sysmex’s XN-L Series and XN-Series analysers routinely report the IG count as a diagnostic parameter: as a percentage count of the total WBC count and an absolute count.
A
Principle for blood cell counting used in Sysmex analysers: the blood cell counts are determined from the number of pulses generated in a specific volume of blood. The advantage of this approach is that end-user calibration is not required.
Sysmex's method to evaluate individual cells' signals during measurement and determining the population cluster to which these cells belong. Since this method allows greater flexibility, biological variation between patients is taken into account, leading to more accurate differentiation results, particularly with pathological samples, where morphological appearance of the cells is likely to become altered in disease.
Extended parameters on selected Sysmex haematology analysers: IG, RET-He, IPF, NRBC, Extended Inflammation Parameters, XN Stem Cells; they offer added value exceeding the classical haematology analysis and the basis to generate clinical insight.
The use of the Aged Sample Identifier (a software feature that needs to be activated) on XN-Class analysers allows a reliable differentiation of samples with abnormal WDF scattergrams into truly pathologic samples or aged samples. This application effectively prevents false-positive flagging, especially with the ‘Blasts/Abn Lympho?’ flag, which leads to a smear rate reduction for such samples. It saves the effort spent on samples that are only old and allows focusing on the pathologic samples needing attention. Sysmex recommends using the Aged Sample Identifier in laboratories experiencing workflow challenges due to a high proportion of aged samples.
Albumin is a small soluble protein that is synthesized in the liver and contained in blood. Albumin is the most abundant protein in blood and serves as an important binding and transport protein. When kidneys are working correctly, they keep important elements such as albumin in the blood. Healthy individuals excrete only low levels of protein through urine on a daily basis. In contrast to this, albuminuria is a pathological condition with larger amounts (>30 mg/24 h) of albumin being present in urine over a longer period. This abnormal condition can be used for an early recognition of nephropathy. The early diagnosis of (micro-)albuminuria can prevent or postpone severe kidney damage.
Anaemia is generally defined as a reduction in haemoglobin (HGB) level below the lower limit of normal. The values that define the presence or absence of anaemia are both gender- and age-dependent. The haematocrit (HCT) is a related parameter that likewise is reduced in anaemia. Anaemia is a symptom, rather than a disease, with a multitude of causes, which have to be clarified to enable successful treatment.
B
Healthy urine usually does not contain bacteria. However, some bacteria can be present if the urine sample was not collected under sterile conditions or if the person is suffering from a urinary tract infection. Bacteria can be differentiated into Gram-positive and Gram-negative bacteria, based on their cell wall composition. Depending on the type of the cell wall, they are susceptible to different antibiotics.
Basophils are the white blood cells least represented in the peripheral blood and belong to the category of granulocytes. Similar to eosinophils, an increase in the basophil count often though not always points to allergy or parasitic infections. They function together with mast cells as effector cells in complex processes like chemotaxis or cell adhesion and fulfil an immune modulating role during allergic reactions.
Bilirubin is generated during the breakdown of haemoglobin which is mainly released during the degradation of old red blood cells in the reticuloendothelial system. It is then bound to albumin and transported through the blood to the liver.
Pathological processes that increase the concentration of conjugated bilirubin in plasma also lead to elevated levels of bilirubin in urine, such as fibrosis and swelling, or necrosis of liver cells.
Type of body fluid sample material, typically for veterinary samples.
C
Continuous ambulatory peritoneal dialysis (CAPD) is a dialysis involving the continuous presence of dialysate in the patient’s peritoneal cavity. CAPD fluid is analysed in order to rule out infection, which is the most common problem with peritoneal dialysis.
Urinary casts mainly consist of Tamm-Horsfall mucoprotein (THP). About 50 mg of liquid THP is excreted every day. Therefore, it is normal to find THP in urine.
Hyaline casts (Hy. CAST) are the most common types of casts in urine. They are cylindrical and appear almost transparent. Casts are a result of solidification of THP mucoprotein in the lumen of the kidney tubules. Hyaline casts can be found in urine due to dehydration, fever or vigorous exercise.
Pathological casts (Path. CAST) contain inclusions. They develop when particles – such as red blood cells or tubular epithelial cells – are present during the solidification process of THP. Particles adhere to the fibrillar protein network and get surrounded by it. These casts appear in urine when pathological processes take place in the kidney. Examples: Granular casts, cellular casts, waxy casts.
A new concept optionally embedded in the Extended IPU that becomes active if interferences in the measurement of red blood cells or related parameters (e.g. MCHC) are detected. This refers, for example, to cold agglutination, haemolysis or hypo-osmolarity. The algorithm delivers conclusive information about the cause of interference, suggests the replacement of the affected parameters with their counterparts from the RET analysis and automatically recalculates the RBC indices. In doing so, CBC-O relieves the laboratory by automating the workflow for certain problematic samples.
Implies the added value of parameters or their combinations for both diagnosis and therapy/monitoring, which is based on proven evidence only.
Classical 8 parameter haematological blood analysis comprising the counts of RBC, WBC and PLT, plus the determination of the HGB, HCT, MCV, MCH and MCHC values.
Creatinine is a breakdown product of creatine phosphate in muscles and depends on a person’s muscle mass. Creatinine is normally produced at a fairly constant rate (approx. 1 g of creatinine is excreted per day). Therefore, the creatinine concentration can be used to interpret results of spontaneously voided urine samples, which show variable dilutions, in a more consistent way.
Crystals can take many different shapes in urine. They are formed if urine solutes – such as inorganic salts or organic compounds – precipitate. Most of the time, crystals are not significant for clinical findings unless the patient has metabolic disorders, calculus formation (also called ‘urolithiasis’), or if medication needs to be regulated. The most important crystals in this context are cystine, tyrosine, leucine and cholesterol.
Sysmex method for measuring the haematocrit (HCT). HCT is a parameter that is a measure of the total or cumulative volume of red blood cells relative to the total volume of whole blood. It is expressed as a fraction with the unit L/L or as a percentage value.
On Sysmex analysers , the HCT is obtained - by using impedance technology - from the cumulative value of the individual cell pulse heights. It is therefore directly measured and not calculated, as is the case with some other technologies.
D
Parameters individually delivering diagnostically relevant information, intended to be transmitted to clinicians and wards or affiliated physicians outside the lab/hospital.
Technology/method used to differentiate stained cells from a blood film or a cytospin slide by image capturing and recognition, using artificial neural network technology. The high resolution cell images are presented on a screen for validation or further classification, allowing online result transmission and consultation of other experts.
Abbreviation for 'digital morphology', but also the DM-series analysers manufactured by CellaVision AB.
E
Modular and scalable software system, composed of different integrated parts (IPU,
Extended IPU, Remote/Web parts) with one harmonious user interface design, to cover workflow control, rule-based validation, system services, and networking of individual instruments or solutions across multiple disciplines or locations. For haematology, coagulation and urinalysis devices/work areas.
Eosinophils are in the granulocytes category because they are filled with granules containing different enzymes. They can move and phagocytise (roughly ingest) particles. As they kill parasites by releasing certain cytotoxic enzymes and are involved in hypersensitivity reactions, an increased eosinophil count is most likely associated with parasite infestation or allergy. Eosinophilia can also point to malignant diseases as it is evident in some types of neoplasia.
‘Epithelium’ is a general term for cellular tissue that wraps around certain surfaces. Inside the urinary tract, there are different types of epithelial cells: the squamous (Squa. EC) and the non-squamous epithelial cells (Non SEC). The non-squamous cells are further divided into transitional (Tran. EC) and renal tubular epithelial cells (RTEC).
Squamous epithelial cells (Squa. EC) are large, flat, irregularly shaped cells. They contain a small central nucleus and lots of cytoplasm. The cell edge is often folded over and the cell may be rolled up into a cylinder. It is normal to find squamous epithelial cells in urine. They come from the lower end of the urethra or from skin that the urine came into contact with during collection. As such, they may also represent a contamination typical for poorly collected mid-stream urine samples.
Transitional epithelial cells (Tran. EC, urothelial cells) vary in size and shape depending on their origin. They can come from the upper part of the urethra, from the ureters or the renal hilum. It is normal to find low numbers of transitional cells in urine.
Renal tubular epithelial cells (RTEC) are slightly larger than leucocytes and contain a large, round nucleus. They can appear flat, cube-shaped or as a column. They enter the urine from the tubule system of the nephrons. The presence of RTEC in urine indicates kidney problems.
A common, traditional laboratory test serving as a sensitive, yet non-specific marker of inflammation. It can serve to aid diagnosis, and manage and follow-up various autoimmune diseases, acute and chronic infections and tumours. The ESR is also used as a marker of the 'general physical condition' assessed together with the patient's clinical history and physical examination. Automated analysis of the ESR is facilitated with the XN Interrliner module, which can also be integrated into XN-9000/9100 configurations 'Sorting & Archiving' or 'Maximum Workload' including the tube-sorting process.
A set of haematological inflammation parameters that quantify and characterise particular lymphocytes (RE-LYMP, AS-LYMP) and the activation status of neutrophils (NEUT-GI, NEUT-RI). These diagnostic parameters provide additional information about the activation of the patients’ immune response and help clinicians monitor inflammatory conditions in more detail. They become available with licence activation on XN systems via XN-DIFF measurement. The use of WPC is of extra value here as it excludes malignancies reliably.
Software component for workflow standardisation and control, and
synchronising sample, order and data flow (e.g. advanced, rule-based
technical validation). With XN-Series, the Extended IPU offers a wide
range of standard and optional applications for the steps 'prior to
analysis', 'analysis' and 'post-analysis', plus 'work area management',
which includes tools for the standardisation of technical and biomedical
validation as well as workflow optimisation tools.
F
Flagging messages result from a sophisticated (full differential) analysis system, which enables the qualitative identification of immature and abnormal cells.
Flagging contributes to greater lab time- and cost efficiency by dramatically reducing the need to perform a manual differential count and directing the reviewer to the look for specific pathology by virtue of the flags generated. Manual microscopy will then play a critical role to record any noteworthy morphological features and confirm the presence of abnormal cell populations that the automated analysis has identified as suspect and flagged for the operator's attention.
Also in pre-differential analysers one can find flags, which mostly indicate abnormally low or high counts and low reliability of results, e.g. due to interferences.
Parameters that - in addition to and conjunction with the main parameters - deliver diagnostically relevant information for use exclusively inside the laboratory to validate the results and conclude the diagnostic findings. These parameter results are not to be transmitted directly e.g. to wards or clinicians, however, their diagnostic outcome in connection with the main parameters may do so.
Sysmex's technology used inside the differential haematology analysers of the X-Class and XN-Class, by which blood cells of all three major cell lines are detected and differentiated after supravitally labelling them with proprietary fluorescence markers and exposing them in a flow cell to laser light.
Chemical compound that can bind to other structures and shows the phenomenon of fluoresence: after excitation with light of a certain wavelength, light of a somewhat longer wavelength is given off by the molecule. Electrones within the molecule absorb the excitation light energy (e.g. laser light), are lifted to a higher energy level, and within a short time drop back to their initial level. At that moment they give off most of the excess energy in the form of light. A smaller part of the energy is given off as thermal energy, therefore the wavelength of the emitted light is longer (lower in energy) than the excitation wavelength. It depends on the properties of the fluorochrome which wavelengths are suitable for excitation and which wavelengths are given off.
Fluorochromes are used to label for instance specific cell components (e.g. nucleic acids), as the emitted fluorescence light can be measured. As a detector, usually a photo multiplier is used. This means the fluorochromes can serve as markers for these cell components, enabling their qualitative and quantitative analysis, as the intensity of the fluorescence light is proportional to the amount of the specific component, e. g. intracellular RNA and/or DNA.
G
Glomerular filtration is the first step in producing urine. The kidneys use this process to filter excess fluid and waste products out of the blood to eliminate them from the body.
The renal corpuscles filter about 1 L blood/min due to a pressure gradient exerted on the capillary walls. The resulting filtrate in the glomerular capsule containing water, glucose, amino acids, uric acid, urea, electrolytes, etc. is known as ‘glomerular filtrate’ or ‘primary urine’.
‘Glomerular filtration rate’ (GFR) is the volume of fluid filtered from the renal glomerular capillaries into the Bowman's capsule per minute. In healthy adults, GFR is about 125 mL/min (i.e. approx. 150 L of primary urine are formed per day) and is an important indicator of kidney function.
The urine of a healthy person only shows trace amounts of sugar, i.e. glucose. Glucose appears in urine when the blood glucose level rises because of an abnormality of the glucose metabolism. The determination of glucose in urine has a high diagnostic value for early detection of disorders such as diabetes mellitus.
A category of myeloid white blood cells characterised by the presence of granules in the cytoplasm. The granulocytes comprise the neutrophils, eosinophils and basophils. They make up the group of polymorphonuclear white blood cells as opposed to the mononuclear white blood cells (lymphocytes and monocytes).
In the body fluid modes of the Sysmex XN-Series and some of the X-Class analysers, the parameter 'PMN' is reported, covering the above mentioned granulocytic cells. Together with the parameter 'MN' covering the mononuclear cells it can help get an idea of the cause of a present infection or inflammation, for instance in CSF (cerebrospinal fluid) samples.
H
Haemoglobin is the iron-containing red blood pigment in red blood cells that enables the transport of oxygen in the body. The detection of haemoglobin in urine is due to either elevated haemoglobin levels or the presence of red blood cells in the sample. Elevated values of this parameter are an important symptom for injuries, crystals, glomerulonephritis, renal calculi, or urinary tract infections.
A long-term monitoring parameter used to control diabetics' medical status. It has become a frequently ordered test in medical labs nowadays because of the increase in lifestyle diseases such as diabetes. Automated HbA1c testing is facilitated with the Tosoh HLC-723 G11 Analyser, which can also be integrated into XN-9000/9100 configurations 'Sorting & Archiving' or 'Maximum Workload' including the tube-sorting process.
Research parameter indicating the presence of highly fluorescent lymphocytes, which represent activated cells (antibody-secreting B lymphocytes/plasma cells) if systemic haematological diseases can be excluded.
Histograms (a diagram type) are generated by plotting the size (volume) of each individual cell, as determined from the pulse height generated as it passed through the impedance aperture, or by plotting other signals generated by the recorded cells, such as forward- or side-scattered light or fluorescence, which are then reflective of other cell properties, such as cross-sectional area size, inner cell structure complexity and nucleic acid content, respectively.
More than one cell population can be appreciated and displayed together (e.g. typically RBC and PLT; trimodal WBC distribution curves in 3-part differential analysers). These two or more distinct cell populations are differentiated from each other by so-called 'size discriminators'.
Sysmex's technology used inside haematology and urinalysis analysers to optimise cell/particle counting; by means of a sheath flow, the cells or particles are separated and aligned upon entering the flow cell or detection unit to effectively prevent coinciding or recirculation of cells/particles.
Particularly RBC change shape when exposed to rapid acceleration in a suspending fluid. With HDF, the degree of acceleration is significantly reduced, therefore the true cell properties are reflected more closely.
I
Fluorescence flow cytometry enables the identification of immature cells on the basis that they have higher nucleic acid content in comparison with their mature counterparts. This added the count of immature granulocytes (IG) as a distinct population to the WBC differential. This IG count includes promyelocytes, myelocytes and metamyelocytes but not band cells.
The presence of IG is always pathological with the exception of the immediate post-partum period and neonates less than 3 days old. The precision of the automated IG count is much better than manual microscopy counts making it ideal for serial monitoring of patients thereby eliminating labour-intensive manual counting.
Antibody-mediated flow cytometric analysis of cells by differentiation of surface characteristics; term is more generically used than
Antibody-mediated flow cytometric analysis of cells by differentiation of surface characteristics; term is most commonly used for the exact WBC differentiation within the scope of differential diagnoses of WBC disorders such as leukaemias and lymphomas.
If used in connection with platelets this refers to an extensive analysis including activity status, etc.
Impedance technology (DC) is based on the principle that an electrical field, created between two electrodes of opposite charge, can be used to count and determine the size of cells.
Blood cells are poor conductors of electricity. The diluent (reagent) in which they are suspended during counting is an isotonic solution which is a good conductor of electricity. Consequently, when the cells suspended in the diluent pass through an aperture (a narrowing) between the electrodes, each individual cell will momentarily increase the impedance (resistance) of the electrical path between the electrodes. Each cell generates an electrical pulse in proportion to its size (volume).
Software component (with hardware) that is steering/running the Sysmex analysers. With XN-Series, the IPU offers a range of standard applications for the 'analysis' step. They can be interwoven with the
Extended IPU applications for advanced functionalities.
Sysmex laboratory solutions are controlled intelligently by the embedded software concept. This harmonises and standardises the interplay between the physical sample and data workflow. From a single system to multiple work areas, even if your network spans multiple locations.
However, apart from software, we offer also much more including Sysmex Academy services, digital training and onsite educational workshops and consultancy services.
K
Ketones in urine indicate increased fat degradation in the body. This can be caused by an insufficient supply of energy from carbohydrates. During the degradation of fatty acids, intermediary compounds called ‘ketone bodies’ (acetoacetic acid, s-hydroxybutyric acid and acetone) are formed in the liver. Ketones can be detected in urine when increased fat degradation takes place and is particularly important in checking metabolic decompensation in diabetes mellitus.
The kidneys are two bean-shaped organs in the renal system. They perform essential functions, including the regulation of water and electrolyte balance, and the filtration and elimination of metabolic waste products (e.g. urea, uric acid and ammonia), medications and toxic substances. Kidneys also secrete hormones that help produce red blood cells (via the hormone erythropoietin, EPO), regulate blood pressure (via production of renin) and promote bone health (calcium absorption via conversion of calcidiol into calcitriol).
L
Leucocyte esterase is an enzyme produced in white blood cells – to be more precise, in granulocytes. Detection of leucocyte esterase reveals the presence of granulocytic leucocytes. Elevated values of this parameter are an important symptom for inflammatory diseases of the efferent urinary tract and kidneys.
When an object enters a ray of light, the light changes its direction. This phenomenon is called light scatter and occurs under all angles between 0° and 360°. Detection of the scattered light provides information on the size and quality of the object.
Especially light scattered in forward direction (low-angle scattered light) allows statements on the size of an object. Aside from its size, forward-scattered light is influenced by the object's form and refraction index. Detection of this light signal is usually done with a fast photo diode.
Light scattered from the side (wide-angle scattered light) provides information on the internal quality of an object. With cells, side-scattered light is influenced by the presence or absence of granules. This light signal requires a sensitive photo multiplier as detector, since its intensity – compared to forward-scattered light – is weaker by some powers of ten.
Lymphocytes originate from the lymphoid lineage (as opposed to the myeloid lineage). Lymphoid cell development is not restricted to the bone marrow and takes place in primary and secondary lymphoid organs.
Lymphocytes defend the organism against infection by distinguishing the body’s own cells from foreign ones. Molecules recognised by the body as foreign are known as antigens. Each lymphocyte is only stimulated by one specific antigen. When lymphocytes recognise this antigen, they produce chemicals to fight it.
There are three main types of lymphocytes: B lymphocytes, T lymphocytes and natural killer (NK) cells. Lymphocytes belong to the mononuclear white blood cells. Although compared to other white blood cells all lymphocytes are small and round without granules, there is a large variety of different subtypes, and distinguishing between them morphologically is tricky.
Reasons for an increased lymphocyte count include infection or inflammation, as well as certain types of malignancies, especially haematological malignancies. Despite giving an absolute and relative lymphocyte count, several flags on Sysmex analysers can point to suspicious lymphocytes for which, if present, a follow-up test should be performed.
M
Parameters individually delivering diagnostically relevant information, intended to be transmitted to clinicians and wards or affiliated physicians outside the lab/hospital.
The average amount of haemoglobin per red cell is calculated from the RBC and HGB. MCH [pg] = HGB/RBC. The normal reference range for MCH is age-dependent. The MCH value tends to be proportional to MCV as the size of a cell is largely determined by the haemoglobin content.
Cells that have a normal MCH are referred to as normochromic whereas those with low and high values are termed hypochromic and hyperchromic. A low MCH indicates that cells contain too little HGB due to inadequate production. Such cells are termed hypochromic as they will look pale when examined under the microscope.
The mean cell haemoglobin concentration is calculated from HCT and HGB and reflects the proportion of amount of HGB in the red cell to the cell volume. MCHC [g/dL] = HGB/HCT. The MCHC normal reference range is remarkably constant throughout life and generally has a very tight range with minimal variation expected.
The MCHC is also used to define normo-, hypo- and hyperchromic red cell populations. Cells with too little HGB concentration are lighter in colour and have a low MCHC. An elevated MCHC for clinical reasons is rare and virtually only occurs if cells are spherocytic (due to loss of membrane) or significantly dehydrated. These hyperchromic red cells show an unusually high intracellular HGB concentration per individual red cell due to cell volume loss.
The MCHC is commonly used to monitor the technical performance of an analyser.
The mean cell volume is calculated from the RBC and HCT. MCV [fL] = HCT/RBC. The normal reference range for MCV is age-dependent. The terms 'normocytic', 'microcytic' and 'macrocytic' are used to describe red cell populations with normal, low and high MCV.
As the size of an RBC is dependent on its HGB content, failure to produce haemoglobin will result in smaller than normal cells, red cell microcytosis. Macrocytic cells occur when division of RBC precursor cells in the bone marrow is impaired.
Brand name of the methanol-free staining reagents manufactured by company RAL Diagnostics, used inside the RAL Stainer and the RAL semi-automated staining device to stain blood films.
The modularity of the XN concept allows a tailor-made solution. This applies to productivity values, clinical values and professional services alike.
Monocytes belong to the mononuclear cells like lymphocytes do, but they originate from the myeloid lineage, which cells are produced in the bone marrow.
Monocytes play a key role in the immune response. They can quickly move to infection sites and differentiate into macrophages and dendritic cells to provoke an immune response. Cells of the monocyte-macrophage system can engulf foreign particles and break them down to antigens, which they can then present at their surface.
Automated monocyte counts are available as the ratio of monocytes to the total number of white blood cells counted or as an absolute count. An increased monocyte count may be indicative of various disease states, e.g. chronic inflammation or infection, but it may also occur in malignant diseases such as chronic myelomonocytic leukaemia.
MWO embedded in the Extended IPU offers a concept to distinguish reactive monocytosis from monocytosis of suspected malignant origin. The MWO concept helps to decrease the number of unnecessary blood smear reviews while optimising the detection of CMML and ultimately improving the laboratory workflow.
N
A nephron is the microscopic structural and functional filtering unit of the kidney. Each kidney is made up of over one million nephrons that cleanse the blood and balance the constituents of the circulation. A nephron consists of a renal corpuscle, a sophisticated renal tubule system and the associated capillary network.
Nephrons process the blood supplied by afferent arterioles via glomerular filtration, tubular reabsorption and secretion. Many processes take place in different parts of the nephron before the filtrate (primary urine) is modified into the final product referred to as ‘urine’.
Neutrophils belong to the category of granulocytes. They play an important role in immune defense and are the first immune cells to arrive at a site of infection – usually within an hour. This happens through a process known as chemotaxis. Neutrophils can phagocytise other cells such as bacteria, which seem harmful to the organism. Yet they will not survive the act themselves. Pus consists mainly of dead neutrophils and digested bacteria. The absolute and relative neutrophil count can provide some information for diagnosis and monitoring of infections and is also taken into account during chemotherapy. An increased neutrophil count can also be found physiologically in non-pathological situations, e.g. after stress or in smokers.
Nitrite is the result of nitrate reduction. Various bacteria that cause urinary tract infections (UTI) produce enzymes that turn nitrate into nitrite. The presence of nitrite in urine is an indirect confirmation of bacterial infection (bacteriuria). Common microorganisms that can cause urinary tract infections, such as Escherichia coli, Enterobacter, Citrobacter, Klebsiella, and Proteus species, produce enzymes that reduce urinary nitrate to nitrite.
A negative NIT test strip result does not exclude a urinary tract infection because there could be bacteria present which do not produce nitrite. Therefore, nitrite is specific but not sensitive for UTI. Furthermore, with strong bacterial growth, nitrite may eventually be degraded to nitrogen, which means that remaining nitrite levels in the sample may be below the limit of detection.
Normocytic anaemia may be caused by decreased RBC production, increased RBC destruction or blood loss. The RBC count is low, but the cell size and the amount of HGB in the cells are normal.
P
The pH describes how acidic or alkaline a substance is based on the hydrogen ion concentration. If urine is persistently acidic or alkaline, this can indicate a disturbed acid-base balance. Persistently alkaline pH values point towards urinary tract infection. For microscopy, it is good to bear in mind that at pH levels above 7, cells can lyse faster than under normal (slightly acidic to nearly neutral) conditions.
Platelets parameter, which is equivalent (by meaning) to haematocrit, but calculated from MPV and PLT count (PCT = MPV x PLT).
Clinical value APP optionally available on the XN-Series analysers to measure platelets, thanks to specific fluorescence labelling, with high precision and accuracy also in the thrombocytopenic range. A very good correlation with the reference method (CD41/61) has been shown.
PLT-F also determines the immature platelet fraction (IPF) reflecting thrombopoietic bone marrow activity, making it particularly useful for tracking down thrombocytopenia and its possible causes.
A group of compounds used (besides their widespread industrial use) for supravital cell labelling as fluorochrome markers, together with a semi-conductor laser as light source, in Sysmex's haematology and urinalysis devices (Sysmex-proprietary use).
There are several advantages of these compounds: Their absorption maximum can be tailored to the exact laser wavelength, their cell and nucleus permeability can be customised, and the affinity to specific cell components, such as nucleic acids, can be generated as necessary – through changes in the molecular structure. Polymethines show an excellent signal-to-noise ratio, are broken down easily in aqueous waste, and in terms of mutagenicity, they are described as safe compared to other nucleic acid-bonding fluorochromes.
In Sysmex's X-Class and XN-Series analysers, several different polymethine-containing reagents are used for specific differentiation analysis of mature and immature cells of all three cell lines.
Primary urine is the fraction of blood plasma, which is filtered out by renal corpuscles. Due to the massive blood supply to the kidneys and the large number of glomerular filtration units, the body produces about 150 litres of primary urine daily. Approximately 99% of primary urine is reabsorbed through the tubule epithelium so that only 1.8 litres have to be excreted every day. The components of primary urine correspond to the composition of protein-free blood plasma.
Optimisation and harmonisation of integrated lab processes with the focus on total cost of ownership and their contribution to deliver fast and high-quality results.
Most proteins are normally contained in blood because they are too large to fit through the glomerular membrane. However, if these filters are damaged, proteinuria – the presence of protein in urine – can occur. Protein in urine is a frequent symptom of renal diseases, but it is not very specific. Protein levels in urine can be temporarily increased due to exercise, fever or stress.
R
Red blood cells deliver oxygen to the body’s tissues by travelling through the circulatory system. They are round, smooth and have a red tinge. If red blood cells appear in this intact shape, they are called isomorphic or eumorphic and do not come from the glomerulus. If red blood cells become damaged, they are called dysmorphic red blood cells. Their deformation occurs when they pass through the glomerular structures of the kidney, but it can also happen when they are exposed to urine for a prolonged time. The term for pathological dysmorphic red blood cells is ‘acanthocytes’. Their presence can indicate a glomerular disease such as glomerulonephritis.
If there are a few red blood cells in urine, this can be considered normal. A high number of red blood cells, however, can indicate the presence of injuries, crystals, renal calculi or urinary tract infections.
An automated parameter providing information on the degree of variation of red blood cell (RBC) size: It is a quantitative measure of how variable the size of the individual red cells is. This is provided as an RDW-SD and an RDW-CV value.
A large RDW indicates abnormal variance in individual RBC size, termed anisocytosis, when viewed under the microscope. The RDW assists in the differentiation of anaemias that have similar red cell indices.
The CBC parameters MCV, MCH and MCHC, which are related to red blood cells, are commonly referred to as the red cell indices. In conjunction with the RDW, the indices are used to narrow down the possible causes of anaemia in an individual patient. The MCHC is an early sensitive marker since MCH and MCHC will drop before the red cells become microcytic.
Rule-based re-measurement of a sample with a different or an extended analysis profile to obtain more reliable results.
Analysers utilising this blood cell counting principle determine the blood cell counts from the number of pulses generated in a fixed time period. Such systems are prone to errors due to aperture clogging, which means they require regular calibration.
The renal corpuscle is the site of the filtration of blood plasma. It consists of the glomerulus, and the glomerular capsule, or ‘Bowman's capsule’. Afferent arterioles form a network of high-pressure capillaries called the ‘glomerulus’. The tuft of glomerular capillaries filters the blood based on particle size and the filtrate is captured by the surrounding cup-shaped chamber, the Bowman’s (glomerular) capsule.
The renal tubule is a long and convoluted structure that emerges from the glomerulus and is divided into three main parts based on function: the proximal convoluted tubule, the loop of Henle (with descending and ascending limbs) and the distal convoluted tubule. After passing through the renal tubule, the filtrate continues to the collecting duct system.
Automatic re-measurement of a sample to obtain analysis results when certain analyser errors occurred (e.g. pressure, temperature
Related to imprecision: repeated serial measurements under
same conditions.
Related to imprecision: repeated serial measurements of control blood under
changed conditions: other operator, other lots, other lab.
Rule-based re-measurement of a sample with a profile identical to the initial order, to obtain reliable results.
Parameters that - in addition to and conjunction with the diagnostic/reportable parameters - deliver diagnostically relevant information for use exclusively inside the laboratory to validate the results and conclude the diagnostic findings. These parameter results are not to be transmitted directly e.g. to wards or clinicians, however, their diagnostic outcome in connection with the reportable/diagnostic parameters may do so.
Value derived from the RET scattergram to determine the RET-H
e value, which reflects the haemoglobinisation of the reticulocyte population.
Clinical value APP optionally available on the XN-Series analysers to quantify and differentiate reticulocytes according to their maturity stages (HFR, MFR, LFR) thanks to specific fluorescence labelling. An optical platelet count (PLT-O) can also be provided.
RET also determines the immature reticulocyte fraction (IRF=HFR+MFR) and the reticulocyte haemoglobin equivalent (RET-He), assessing both the quantity (erythropoietic activity) and the quality (haemoglobin synthesis and incorporation) of the newly formed red cells. This is important with anaemia differential diagnostics. RET-He is also an early indicator for changes in the red cell haemoglobinisation, which is helpful e. g. in therapy monitoring.
The RPI reflects the erythropoietic bone marrow response in anaemic patients. This index, rather than merely the RET count alone, is used to assess the adequacy of the bone marrow response to anaemia in patients. It is not useful in the absence of anaemia.
RPI is defined as follows: RPI = (RET% × HCT) : (0.45 × days in blood). 0.45 represents the ideal haematocrit in the formula. At this 'ideal' HCT of 0.45, RPI is identical to the reticulocyte percentage, which is 'ideally' about 1% in normal healthy individuals. In an anaemic patient with adequate bone marrow response, the RPI should be > 2.0. However, the reverse conclusion (if RPI is < 2.0, the bone marrow response is considered inadequate) is not necessarily true.
A good marker of appropriate bone marrow response to anaemia is the increase of the absolute reticulocyte concentration, together with a marked increase of the immature reticulocyte fraction (IRF).
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The scalability of the XN concept allows upgrading a solution by keeping the tailor-made solution. This applies to productivity values, clinical values and professional services alike.
Scattergrams (a diagram type) are generated by plotting for each counted cell two different recorded signals against each other, meaning a two-dimensional analysis. Signals may be obtained from volumetric impedance, high-frequency electromagnetic energy, optical (forward- and side-scattered light) and cytochemical labelling (side fluorescence light) techniques.
More than one cell population can be appreciated and displayed together. These two or more distinct cell populations are differentiated from each other with the help of ACAS (not used in all devices and channels), which is superior (for WBC differentiation) to using fixed gating.
There may be more than two different signals recorded per cell, so more than one scattergram may be derived from these to distinguish and display the different cell populations.
Laser type (also called 'diode laser') used in Sysmex haematology and urinalysis flow cytometers of the later generations.
In contrast to formerly used gas lasers these lasers comsume less energy (they usually operate in the red light spectrum), are ready to operate within much shorter time (meaning system start up is fast) and have a longer life span.
Function allowing immediate measurements of individual, urgent samples.
Sysmex's design concept that contributes to a more enjoyable workplace experience by putting people first and optimising the interaction between the individual and the devices they use day in, day out.
Within our SILENT DESIGN® concept, we are focusing on five main principles to continuously improve the user experience: person - space - surface - series - longevity. Our SILENT DESIGN® products take into account all five principles to create a positive experience.
Sysmex's cyanide-free measuring method for HGB, which delivers particularly reliable results thanks to the effective lysis of RBC, WBC and lipids, leading to a reduction in potential interferences.
Urinary specific gravity is based on the concentration of solutes in urine. It measures the ratio of urine density compared to water and provides information on the kidney’s ability to concentrate urine. If the specific gravity values drop below 1.010 g/mL urine, cells undergo faster lysis than in normal conditions (1.010 to 1.030 g/mL).
Software component for performance monitoring of the whole XN analysis system: there is an application protecting the operational environment plus others supervising maintenance needs and technical performance control.
Dedicated articles on clinical and diagnostic background topics with a scientific and educational focus. Topics include e.g. coagulation, haematology, urinalysis, body fluids, etc.
Derived from the printed Sysmex customer magazine 'Sysmex Xtra', which is published locally in some countries, Sysmex Xtra Online is a dedicated section on the Sysmex Europe Website offering a wide variety of articles on products and other related topics.
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TWO streamlines the entire platelet analysis workflow in the laboratory as it optimises the triggering of PLT-F reflex tests and supports the differential diagnosis of thrombocytopenic patients and their monitoring.
The new TWO algorithm is embedded in the Extended IPU and can be used in conjunction with the PLT-F application.
U
The ureter is a tube that carries urine from the kidney to the urinary bladder. There are two ureters, one attached to each kidney.
The urethra arises from the base of the bladder and transports urine to the outside of the body for disposal. The urethra is the only urinary structure that differs significantly between females and males, due to the dual role of the male urethra in transporting both urine and semen.
The urinary bladder (also called ‘urocyst’ or ‘vesica’) is a hollow muscular organ that collects and stores urine from the kidneys via the ureters before disposal by urination. It is a highly distensible (or elastic) organ. A typical adult human bladder will hold between 300 and 500 mL before the urge to empty occurs, but it can hold considerably more.
Sysmex's technology used inside the urinalysis analysers of the UX- and UF-series, by which urinary cells and particles are detected and classified after labelling them with proprietary fluorescence markers and exposing them in a flow cell to laser light.
Urobilinogen is a colourless by-product of bilirubin reduction. It is excreted in increased amounts in urine when the functional capacity of the liver is impaired or overloaded, or when the liver is bypassed. However, a value of zero is also critical since this may indicate biliary obstruction.
W
White blood cell pathologies may affect either the myeloid or the lymphoid lineage. They can be the result of both reactive and non-reactive (neoplastic or malignant) disease. Reactive changes are observed in the course of infectious or inflammatory diseases whereas malignant alterations point to leucaemias, lymphomas and other haematological malignancies.
To distinguish between different diseases related to white blood cells, determining both their number and their exact type and maturity status is crucial. Automated haematology analysis is a vital component in the diagnostic process and helps identify the presence of disease by providing accurate cell counts and by highlighting conspicuous cell populations. In white blood cell diseases, finding the right diagnosis is complex and needs to consider all the information available from the complete and differential blood count, morphology, immune phenotyping, and other tests.
White blood cells, also called leucocytes, are vital parts of the immune system. They help protect the body against infections and foreign invaders. WBC are round and, if they are granulocytes, granulated. They measure approximately 1.5 to 2 times the diameter of a red blood cell. In urine, the most common type of WBC are neutrophils (i.e. neutrophilic granulocytes), whereas lymphocytes or eosinophils (eosinophilic granulocytes) are rare findings in urine. A small number of WBC can be present in healthy urine but increased counts can point towards inflammation or infection within the urinary system.
Clinical value APP optionally available on the blue XN-Series analyser type to measure white precursor cells, thereby delivering an excellent dual-level flagging (in combination with the standard XN-DIFF APP) for both myeloid and lymphatic white blood cell abnormalities. This helps to cut down on false-positive sample flags and manual differentiations, and focus on the samples showing neoplastic disorder types.
X
A group of Sysmex automated haematology analysers consisting of different XS-series models, all based on fluorescence flow cytometry technology and delivering a 5-part blood differential plus a varying array of extended parameters offering further diagnostic possibilities.
A new measurement option utilising the WPC measurement channel for the quantification of haematopoietic progenitor cells (HPC). The XN Stem Cells method has been shown to be comparable with the CD34 immune flow cytometry count in mobilised peripheral blood.
Clinical value APP optionally available on the XN-Series analysers for the automated and standardised measurement of different body fluids. This offers fast analysis without sample pre-treatment available at any time of day with excellent reproducibility of the results, and allows a reduction in the number of time-consuming manual chamber counts.
Besides the quantification of WBC and RBC, a total nucleated cell count is determined and WBC are differentiated into mononuclear and polymorphonuclear cells, supporting rapid indications of infectious conditions and other abnormalities.
Clinical value APP available as standard on the XN-Series analysers for the complete blood cell count analysis.
Added value over the standard CBC is given through the counting of nucleated red blood cells (NRBC) as a distinct population, which can be important in recognising critical developments in ICU patients, and which also means the WBC count values are not affected by the presence of NRBC, e.g. in neonates, where their concentrations are relatively high. This eliminates the need for manual NRBC counting, speeds up turnaround time and advances standardisation.
Clinical value APP available as standard on the XN-Series analysers for the white blood cell differential analysis of blood samples. Added value over the standard 5-part differential is given through the counting of immature granulocytes (IG) as a distinct population and a 3-dimensional flagging with great sensitivity and dedicated messages offering additional diagnostic information to the physician.
A special 'low WBC' mode, which is triggered automatically when needed, permits to differentiate also samples with low WBC counts with improved reliability, due to an extended counting volume.
Y
Yeast cells are smooth, colourless and usually egg-shaped. They have birefringent walls, come in different sizes and often show budding. The most common type of yeast found in urine is Candida albicans. Yeast cells in urine can come from either skin-related or vaginal contaminations or can indicate mycotic urinary tract infections.
