The immature granulocyte (IG) count

with intensive care patients using

XE-IG MASTER and XT-IG MASTER

Intensive care patients may show an increased immature granulocyte (IG) count which provides im-
portant information on the patient’s prognosis. [1] sysmex xe- and xt-series instruments can be updated
with ig master software in order to report a fully automated immature granulocyte count, which con-
sists of the sum of myelocytes, promyelocytes and metamyelocytes in the blood sample. ig master
software is already standard incorporated in the latest fully automated haematology analyser by
sysmex, the xe-5000 case manager.

Some of the critical care patients show DIFF scattergrams (Fig. 1)

Each dark blue dot in the
scattergram represents an
immature granulocyte.
with typical clusters of neutrophils and immature granulocytes with
low sideward scattered light signals. Also on many of these ICU
samples the ‘Imm Gran?’ suspect flag was generated with previous
xe-2100 software versions, suggesting the need for a review of the
blood film and a manual differential count.

To solve this issue, the scattergram data of a selected group of only

ICU patients’ samples was evaluated by sysmex corporation’s
Fig. 1 ICU patient’s sample with 8.3% immature Research and Development Division in Japan (n = 243 samples).
granulocytes
An improved Adaptive Cluster Analysis Software and an improved
IG# (x 10/µL) y = 1,0394 x + 6,338 R2 = 0,9103 flagging algorithm for the IG count were developed, which results
in an excellent correlation (R2 = 0.91) with the manual differential
method (Fig. 2) and at the same time a much lower manual differ-
ential review rate. Samples which showed a ‘Blast’ flag or ‘Left Shift’
xe-5000

flag were excluded from the study. The positive ‘Imm Gran?’ flagging
rate on this selected patient group was reduced from 70 % with the
old software to only 8 % with the newly released software.

Ref (micro. diff)

Fig. 2 IG count on ICU patients’ samples reported

by the xe-5000 versus a 200-cell manual differential

The immature granulocyte count

1/2 using XE-IG MASTER and XT-IG MASTER
 This new IG count and flagging algorithm has been implemented in the latest released software of xe-
and xt-series analysers as follows:
n xe-5000: software version 00-02 and higher
n xe-2100: software version 00-33 and higher
n xt-series: xt-ig master software version 00-01 and higher

This advanced feature of xe/xt analysers permits the lab to provide the clinician with fast analysis
results for the immature granulocyte count at day and night time, 7 days/week, with an improved
reproducibility showing e.g. an average CV of 7 % at an IG count of 4 %. The manual differential IG
count is reported to show a mean CV of 50 % on the routine 100-cell differential count. [3] The
excellent reproducibility of the xe-/xt-ig master is due to the fluorescence flow cytometry principle
which analyses up to 8,000 white blood cells in normal patient samples. In ICU patients, the WBC
concentration tends to be much higher, and therefore in such samples more than 10,000 WBC are
differentiated fully automatically on the sysmex xe/xt instruments and reported within only 2 minutes
after aspiration.

References
[1] Frings DP, Montag B, Heydorn A, Friedemann M, Pothmann W, Nierhaus A.
Immature granulocytes, immature myeloid cells and outcome in adult severe sepsis and septic shock. The poster was presented at the 16th Annual
Congress of the European Society of Intensive Care Medicine (ESICM), October 5 - 8, 2003, Amsterdam, The Netherlands.

[2] Briggs C, Kunka S, Fujimoto H, Hamaguchi Y, Davis BH, Machin SJ.

Evaluation of Immature Granulocyte Counts by the xe-ig master: Upgraded Software for the xe-2100 Automated Hematology Analyzer.
Laboratory Hematology 9:117-124 (2003)

[3] Weiland Th, Kalkman H, Heihn H.

Evaluation of the Automated Immature Granulocyte Count (IG) on sysmex xe-2100 Automated Haematology Analyser vs. Visual Microscopy
(NCCLS H20-A). sysmex J Int 12:63-70, 2002

[4] Bruegel M, Fiedler GM, Matthes G, Thiery J. Reference values for immature granulocytes in healthy blood donors generated on the sysmex xe-2100
automated hematology analyser. sysmex J Int 14:5-7, 2004

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