Sysmex Journal International

2008Vol.18 No.2


The Correlation of Abnormal Information in Sysmex Hematology Analyzers XE-2100 and XS-1000i with Diagnosis of Plasmodium Infection


Fan YAN, Yan DAI, Zhiying ZHANG and Haiying WAN

Tongji Hospital of Tongji University


Purpose : To study the correlation of the interpretive messages ( IP message or "flag" ) from the automated hematology analyzers XE-2100 and XS-1000i ( Sysmex Corporation, Kobe, Japan, hereinafter called "XE-2100" and "XS-1000i " ) and plasmodium infection based on abnormal scattergram in routine hematology analysis.

Method : Blood films were examined microscopically for Plasmodium parasites in erythrocytes, when increasing eosinophils ( EO ) were not detected on the smear even though the " Eosinophilia " IP message and/or EO abnormal scattergram was shown by XE-2100 and XS-1000i .

Results : In 9 out of 1501 cases with " Eosinophilia " or " EO abnormal scattergram " on the XE-2100, microscopic EO results were normal. In 6 out of 9 cases that displayed the
" Eosinophilia " flag an alteration in the scattergram could be detected, where the space between the EO and the neutrophils ( NEU ) population had narrowed. In the other 3 cases from the XE-2100, the analyzer showed " WBC Abn Scattergram ", and EO and NEU results were not obtained. Upon re-examination of these 3 cases on the XS-1000i ,    
" Eosinophilia " and the narrow space between EO and NEU on the scattergram were displayed. In a retrospective study, 289 cases from XS-1000i  analysis showed an
" Eosinophilia " message and/or EO abnormal scattergram. Only 3 out of the 289 cases were inconsistent with microscopic results, and plasmodium trophozoites, schizonts or gametocytes were found in the erythrocytes of those specimens.

Conclusion : If EO results obtained by XE-2100 and XS-1000i  in routine hematology analysis are inconsistent with microscopic examination even though " Eosinophilia " and/or EO abnormal scattergram was shown by XE-2100 and XS-1000i , the blood smear should still be examined microscopically for the presence of malaria parasites in the erythrocytes.


Hematology Analyzer, Malaria Plasmodium, Eosinophil ( EO )