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Laboratory Hematology 9:29-37 2003 Carden Jennings Publishing Co., Ltd.

Official Publication

Performance Evaluation of the Sysmex XT-2000i Automated Hematology Analyzer

K. LANGFORD, L. LUCHTMAN-JONES, R. MILLER, D. WALCK
Saint Louis Childrens Hospital Core Laboratory/Hematology, St. Louis, Missouri, USA
Received October 2, 2002; received in revised form January 13, 2003; accepted January 17, 2003

ABSTRACT
The Sysmex XT-2000i automated hematology analyzer was evaluated at Saint Louis Childrens Hospital (SLCH), St. Louis, MO, USA. Complete blood count results from the Sysmex XT-2000i were compared to results from the Sysmex XE-2100 for 114 pediatric and adult patient samples. Manual differentials were performed on each specimen by 2 experienced medical technologists using guidelines established in the National Committee for Clinical Laboratory Standards (NCCLS) document H20-A. Carryover, precision, linearity, correlation, stability, and mixing-test studies were also performed. The XT-2000i results showed excellent correlation with the results from the XE-2100 for the following parameters: white blood cells; red blood cells; hemoglobin; hematocrit; mean corpuscular volume; mean corpuscular hemoglobin; mean corpuscular hemoglobin concentration; red blood cell distribution width by standard deviation; red blood cell distribution width by coefcient of variation; mean platelet volume; platelets; percent neutrophils, lymphocytes, monocytes, eosinophils, and basophils; and reticulocyte percent and number. In our evaluation of the XT-2000i the correlation coefcients for all complete blood counts and differential parameters compared well with those of the XE-2100. We concluded that the XT-2000i demonstrated comparable analytical performance to its predecessor, the XE-2100. Lab Hematol.
2003;9:29-37.

KEY WORDS: Performance evaluation Automated hematology analyzer XT-2000i INTRODUCTION

The Sysmex XT-2000i is a new fully automated hematology analyzer that performs a complete blood count (CBC) with a 16-parameter hemogram, a 5-part white blood cell (WBC) differential, and reticulocyte (RET) analysis that includes the immature RET fraction (IRF) and a uorescent optical platelet count (PLT-O). The analyzer is designed for high-volume output in the clinical laboratory with a throughput of 80 samples per hour, but the instruments compact size allows it to fit in a physicians ofce lab. The aspirated sample volume required is 85 L of whole blood for the manual mode and 150 L for the closed mode [1]. The XT-2000i uses the newest in applications, including an Internet access line, flat-screen monitor, and easy-tonavigate software. This instrument uses the current technology of uorescent ow cytometry with a semiconductor laser to provide the differential, RET, and fluorescent optical PLT information. The purpose of this study was to evaluate the performance of the XT-2000i and compare its accuracy and precision to those of an already established hematology analyzer, the XE-2100. The performance of the XT-2000i was evaluated at the laboratory of Saint Louis Childrens Hospital (SLCH), the oldest pediatric hospital west of the Mississippi River. SLCH has 235 beds, including a 26-bed pediatric intensive care unit, a 52-bed neonatal intensive care unit, and a 5-bed pediatric bone marrow transplantation unit. The dedicated pediatric laboratories process specimens for hos29

Correspondence and reprint requests: Keith Langford, Saint Louis Childrens Hospital Core Laboratory/Hematology, One Childrens Place, St. Louis, MO 63110-1077, USA; 1-314-454-4268; fax: 1-314454-4156 (e-mail: kxl6966@bjc.org).

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pitalized patients, subspecialty clinics, and outpatient clinics in the St. Louis area. The hematology laboratory of Barnes Jewish Christian Hospital (BJC), which provided the adult samples, processes specimens from patients admitted to this tertiary hospital as well as from the subspecialty clinics and various ambulatory care centers in the community.

MATERIALS AND METHODS Specimens Residual peripheral venous blood samples collected in K2EDTA and K3EDTA tubes were used in the comparison testing. These blood samples were sent to SLCH and BJC laboratories for routine CBC testing. The specimens were analyzed on the XE-2100 (Sysmex Corporation of America, Long Grove, Illinois, USA) and the XT-2000i (Sysmex) within 8 hours of collection. A few exceptions were made for very unusual CBC results because they were received in the evening and night shifts. These specimens were stored until the next morning in a refrigerator at 2C to 8C and analyzed within 24 hours. The specimens used in the study consisted of 50 samples with CBC results that fell within normal ranges according to SLCH/BJC parameters and 64 samples that were classied as abnormal. The 64 abnormal specimens were obtained from patients with various clinical diagnoses including leukemias, sickle cell disease, multiple myeloma, viral infections, idiopathic thrombocytopenic purpura, sepsis, pancytopenia, and iron deficiency. Samples were obtained from preterm and term sick and healthy infants and from patients in critical care units, including the bone marrow transplantation unit. These specimens were used to determine whether unusual CBC ndings could be evaluated appropriately on the XT2000i. Furthermore, the types of suspect and user-dened flags generated for each abnormality were evaluated. The variety of abnormal cells and cell parameters encountered included nucleated red blood cells (NRBCs), sickle cells, blasts, immature granulocytes, atypical lymphocytes, plasma cells, large PLTs, low PLT counts, high WBC counts, PLT clumps, and RBC fragments. Duplicate peripheral blood smear slides were made and stained with a Wright-Giemsa stain. A slide from each sample was given to each of 2 technologists, who performed blind manual differentials of 200 cells each. These differentials were performed according to the National Committee for Clinical Laboratory Standards (NCCLS) document H20-A [2]. The results from both smears were then averaged. If the difference in results varied signicantly between the technologists, then another technologist read a referee slide. The laboratory used the following criteria to determine if the differential was abnormal: >10 bands; >5 atypical lymphocytes; presence of any metamyelocyte, myelocyte, promyelocyte, or blast; and presence of any NRBCs.

Instruments The XT-2000i is a new hematology analyzer capable of providing a 16-parameter hemogram, a 5-part differential, and RET analysis including IRF information. The XT2000i stores 10,000 samples in a Windows 2000 package using a at-screen monitor and user-friendly software. Figure 1 is an example of a NEGATIVE XT-2000i screen print including the scattergrams and histograms. Figure 2 is an example of a POSITIVE XT-2000i screen print. The term POSITIVE indicates that the CBC was interpreted as abnormal and the XT-2000i alerted the operator of the suspect ags, which resulted because of the unusual ndings. The following is a list of suspect ags/interpreted messages generated with the presence of unusual measurements: immature granulocytes, left shift, blasts, abnormal lymphocyte/L-blasts, atypical lymphocytes, NRBCs, RBC fragments, RBC lyse resistance, RBC agglutination, dimorphic RBC population, turbidity/HGB interference, iron deciency, HGB defects, PLT clumps, and WBC, RET, and PLT abnormal scattergrams. User-defined flags are defined by each institution to identify abnormal numerical results within the population being tested. Examples of user-dened ags are neutrophilia, monocytosis, anisocytosis, macrocytosis, and leukocytopenia. The WBC count is determined by ow cytometry using forward-scattered and side-scattered light. The differential uses a specic nucleic acid dye to measure the cells by sideuorescent light and side-scattered light. The RBC and PLT impedance (I) are measured using direct-current detection. The hematocrit (HCT) is simultaneously determined using the RBC pulse-height detection method. RETs are analyzed using ow cytometry and a nucleic acid uorescent dye. The measurement uses both forward-scattered light and side uorescent information to determine the RET count, percentage, and immature RET information. The PLT-O is also performed in this channel. The following parameters are calculated from directly measured data: mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), RBC distribution width by standard deviation (RDW-SD), RDW by coefcient of variation (RDW-CV), platelet distribution width (PDW), mean platelet volume (MPV), platelet large cell ratio (P-LCR), IRF, low uorescence ratio (LFR), middle uorescence ratio (MFR), and high uorescence ratio (HFR). The Sysmex XE-2100 was used for the comparison study. This analyzer is used daily in the laboratory at SLCH. A CBC with a 5-part differential and an RET count was performed on both analyzers. Calibration At the time of its arrival, the XT-2000i was calibrated by Sysmex Corporation service engineers according to the manufacturers guidelines using the Sysmex recommended

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FIGURE 1. Example of negative XT-2000i screen print. WBC indicates white blood cells; RBC, red blood cells; HGB, hemoglobin; HCT, hematocrit; MCV, mean corpuscular volume; MCH, mean corpuscular hemoglobin; MCHC, MCH concentration; PLT, platelets; RDW-SD, RBC distribution width by standard deviation; RDW-CV, RDW by coefcient of variation; MPV, mean platelet volume; RET#, reticulocyte count; IRF, immature RET fraction; NEUT#, neutrophil count; LYMPH#, lymphocyte count; MONO#, monocyte count; EO#, eosinophil count; BASO#, basophil count.

FIGURE 2. Example of positive XT-2000i screen print. See Figure 1 legend for abbreviation denitions.

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TABLE 1. Reagent Comparison*

Reagent CellPack Cell Sheath Sulfolyser Stromatolyser-FB Stromatolyser-DL/4DS Stromatolyser-IM Stromatolyser-NR Ret Search II Description Red blood cell/platelet and hemoglobin diluent that is used as the main rinse of the instrument. Diluent used as a sheath for cells owing through the aperture. Sodium lauryl sulfate hemoglobin measuring reagent. Basophil diluent and lyse. Lyses all cells except basophils. Differential reagents used to lyse red blood cells and dilute and stain white blood cells. Used to lyse red blood cells and white blood cell cytoplasm for detection of immature granulocyte information. Used as a lyse in the detection of nucleated red blood cells. Dilutes and stains reticulocytes and platelets for analysis XT-2100i X X X X X XE-2100 X X X X X X X X

*X indicates reagent is used on the system; , reagent is not used.

calibrator product. Three levels of quality control material e-Check were used (levels 1, 2, and 3) throughout the comparison study. Each day before specimen analysis shutdown and startup were performed with close attention to background counts. All instruments in the study had the same user-defined flag settings for flagging evaluation, thus ensuring that all conditions such as leukopenia, neutrophilia, and microcytosis would trigger the appropriate ag on both analyzers.

XE-2100. Table 1 lists the reagents required for both the XT2000i and XE-2100.

Precision Precision for both the closed mode (automated aspiration via cap-piercing) and manual open mode aspiration was evaluated by the performance of 10 consecutive measurements on fresh donor blood samples. Carryover Carryover was performed using the International Committee for Standardization in Hematology (ICSH) procedure for the following parameters: WBC, RBC, HGB, HCT, PLT, and numbers of RETs, neutrophils, lymphocytes, monocytes, eosinophils, and basophils. Carryover was assessed by 3 consecutive analyses of a patient sample with high analyte con-

Reagents By way of comparison, the XT-2000i and the XE-2100 use a common reagent system. The XT-2000i uses 3 fewer reagents than the XE-2100. The footprint of the XT-2000i is smaller because it does not use Cell Sheath, NRBC diluent and dye, or Stromatolyser IM, reagents that are unique to the
TABLE 2A. PrecisionOpen-Tube Analysis of the XT-2000i *
Open-Tube Analysis Mean SD CV% RBC, 106/L 5.15 0.03 0.6 HGB, g/dL 15.9 0.11 0.7 HCT, % 47.5 0.31 0.7 MCV, fL 92.3 0.3 0.3

PLT, 103/L 638 5.2 0.8

WBC, 103/L 12.22 0.19 1.6

NEUT, 103/L 6.41 .10 1.6

LYM, 103/L 4.36 0.08 1.9

MONO, 103/L 0.89 0.03 3.5

RET, 106/L 0.13 0.01 4.9

*RBC indicates red blood cells; HGB, hemoglobin; HCT, hematocrit; MCV, mean corpuscular volume; PLT, platelets;WBC, white blood cells; NEUT, neutrophils; LYM, lymphocytes; MONO, monocytes; RET, reticulocytes; CV, coefcient of variation.

TABLE 2B. PrecisionClosed-Tube Analysis of the XT-2000i *

Closed-Tube Analysis Mean SD CV% RBC, 106/L 4.35 0.02 0.6 HGB, g/dL 13.4 0.06 0.4 HCT, % 40.4 0.30 0.7 MCV, fL 92.9 0.28 0.3 PLT, 103/L 305 6.1 2.0 WBC, 103/L 8.54 0.10 1.1 NEUT, 103/L 4.46 0.07 1.5 LYM, 103/L 3.14 0.09 2.9 MONO, 103/L 0.60 0.03 4.8 RET, 106/L 0.08 0.01 6.3

*See Table 2A footnote for abbreviation denitions.

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centration (H1, H2, H3) followed by 3 consecutive analyses of a patient sample with low analyte concentration (L1, L2, L3). The percentage of carryover for each parameter was calculated from the formula [3]: Carryover (%) = L1 L3 100. H3 L3

TABLE 4. Carryover of High Platelet and White Blood Cell Counts

Carryover Low 1 Low 2 Low 3 High 1 High 2 High 3 Carryover, % Platelet Count 60 57 52 6561 6558 6597 0.12 White Blood Cell Count 23.24 23.78 23.37 109.50 106.37 105.18 0.16

Linearity To assure the linearity of WBC, RBC, HGB, HCT, PLT, and RET results, blood samples were serially diluted to challenge the reportable range of the instrument. Data from these analyses were compared graphically using the actual values obtained plotted against values projected from the undiluted sample. High PLT-I linearity was evaluated using a single-donor pheresis product that had been volume reduced; the resulting platelet-rich product was added to a venous blood tube. High WBC linearity was established by using a specimen from a patient with chronic myeloid leukemia who had presented with a WBC count of 410 103/L. The following criteria were used for linear performance testing: the data must t a linearity regression line for which the coefcient of determination (R 2) must be >0.95; a minimum of 5 dilutions distributed throughout the linearity range must be used; the dilutions must cover the reportable range for the parameter; and each dilution result must be the mean value of duplicate or more measurements on the same range. Mixing Studies The XT-2000i mixes each tube 10 times by inversion in the automode prior to blood aspiration. The effectiveness of the 10-inversion mixing was validated by performance of 3 analyses of 14 samples in the automode and averaging of the RBC value. This value was used as the baseline comparison. The 14 samples were then allowed to sit undisturbed for 4 hours at room temperature. After 4 hours, the samples were placed on the analyzer without any manual mixing and analyzed in the automode. The specimens were then mixed well by hand and reanalyzed in the automode. Both of the
TABLE 3. Carryover*
WBC H1 H2 H3 L1 L2 L3 Carryover, % 12.05 12.18 12.07 3.73 3.57 3.66 0.83 RBC 5.11 5.07 5.15 1.52 1.53 1.52 0 HGB 15.8 15.8 15.8 4.7 4.7 4.7 0 HCT 47.6 47.2 47.8 14.5 14.5 14.4 0.30 PLT 645 638 638 131 134 129 0.39 RET# 0.1298 0.1278 0.1344 0.019 0.0252 0.0228 3.41

RBC obtained values were then compared to the baseline values and had to agree within 1.5% of the baseline.

Comparison Studies As discussed previously, a total of 114 venous blood samples were selected and analyzed on the Sysmex XT-2000i and the Sysmex XE-2100. For all specimens, 2 blood lms were prepared for a 400-cell manual differential that was performed by 2 technologists. The CBC and differential data were evaluated. RESULTS Precision Results from replicate open-tube and closed-tube analysis are shown in Tables 2A and 2B, respectively. The precision attained surpassed manufacturer specications for all parameters. RBC parameters showed exceptional precision, with coefcients of variation (CVs) less than 1.0%. The WBC and PLT parameters showed CVs of 2.0% or less. Precision of differentials for the primary cell typesneutrophils, lymphocytes, and monocytesalso was excellent, with CVs less than 5%. Carryover Carryover data are presented in Table 3 for total WBC, RBC, HGB, HCT, PLT, and RET number. Carryover on the XT-2000i for all parameters was of minimal magnitude. The results of high-to-low carryover testing were less than 1% for all determinations. Carryover was also performed on a manipulated singledonor pheresis PLT product and a specimen with a high WBC count to test the XT-2100i, and the results showed no signicant carryover even with extremely high parameters (Table 4).

TABLE 5. Linearity
Parameter White blood cell count Platelet count High platelet count Lowest Highest Correlation Value Value Coefcient Slope Intercept 0.39 2 102 401.83 1474 6560 1.00 1.00 1.00 1.00 1.01 1.00 1.11 4.23 100

*See Figure 1 legend for abbreviation denitions.

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TABLE 6. Mixing Studies*

RBC 1 Run 1 Run 2 Run 3 Average 4 h unmixed 4 h premixed Change unmixed, % Change premixed, % 1.5% 4.1 4.12 4.11 4.11 4.09 4.13 0.49 0.49 OK RBC 2 4.45 4.47 4.46 4.46 4.44 4.41 0.45 1.12 OK RBC 3 2.23 2.26 2.25 2.25 2.25 2.28 0.15 1.48 OK RBC 4 4.88 4.87 4.88 4.88 4.89 4.9 0.27 0.48 OK RBC 5 5.7 5.69 5.67 5.69 5.73 5.72 0.76 0.59 OK RBC 6 5.49 5.49 5.45 5.48 5.48 5.46 0.06 0.30 OK RBC 7 2.97 2.98 2.98 2.98 2.97 2.94 0.22 1.23 OK RBC 8 4.49 4.51 4.49 4.50 4.49 4.51 0.15 0.30 OK RBC 9 2.79 2.82 2.8 2.80 2.84 2.78 1.31 0.83 OK RBC 10 RBC 11 RBC 12 RBC 13 RBC 14 4.86 4.86 4.83 4.85 4.79 4.84 1.24 0.21 OK 4.13 4.11 4.09 4.11 4.12 4.11 0.24 0.00 OK 4.63 4.61 4.62 4.62 4.62 4.62 0.00 0.00 OK 3.92 3.95 3.96 3.94 3.97 3.97 0.68 0.68 OK 4.45 4.45 4.44 4.45 4.48 4.43 0.75 0.37 OK

*RBC indicates red blood cell.

Linearity The linearity results looked very good on all parameters, with special attention given to the WBC and PLT counts. Table 5 shows the WBC linearity with an upper reportable range veried at 410 103/L and the upper reportable PLT value of 1474 103/L. A specimen was obtained from a single-donorpheresis PLT product, and the volume was reduced to yield a very high PLT count of 6560 103/L. Table 5 also shows the results of this high linearity. Mixing Studies The data from the mixing studies indicated that even after 4 hours of sitting undisturbed, the samples were adequately mixed on the XT-2000i and showed no signicant difference from those specimens that were mixed thoroughly before
TABLE 7. Comparison of XT-2000i and XE-2100 Complete Blood
Count and Differential*
Parameter WBC RBC HGB HCT MCV MCH MCHC RDW-SD RDW-CV PLT NEUT# LYMPH# MONO# EO# BASO# RET% RET# IRF% Correlation Coefcient 1.00 1.00 1.00 0.99 0.98 0.99 0.86 0.99 1.00 0.98 1.00 0.98 0.98 0.99 0.99 0.99 0.99 0.97 Slope 1.12 1.03 1.02 1.00 0.99 1.03 0.84 0.92 0.99 1.04 1.01 0.96 1.10 1.02 1.09 1.22 1.20 1.19 Intercept 0.63 0.12 0.16 0.43 0.51 0.33 5.93 2.72 0.22 4.55 0.01 0.04 0.05 0.01 0.01 0.22 0.01 1.22 N 114 114 114 114 114 114 114 114 114 114 114 114 114 114 114 114 114 114

being analyzed. All changes in the RBC count were less than 1.5%. The data are displayed in Table 6.

Comparison Studies As shown in Table 7, overall correlation between the XT2000i and the XE-2100 for all measured parameters was excellent, with R2 values for all parameters >0.92. The only exception was the MCHC, which showed an R2 value of 0.8552. Only 64 of the 114 specimens used in the comparison testing were abnormal. These specimens with unusual measurements were selectively picked to challenge the linearity of the analyzer and its capability to categorize the cells in the automated differential. See Figure 3 for graphic display of key parameters. Comparison of XT-2000i with the Manual Differential Reference Method The correlation coefficients, slope, intercept point, and number of comparison results are shown in Table 8. Experienced technologists performed the two 200-cell reference manual differentials. The autodifferential results obtained on the XT-2000i compared very well with the manual differential results. More than half of the specimens used in the comparison had abnormal differential ndings, and excellent correlation between the 2 instruments was demonstrated. See Figure 4 for graphic display. Morphologic Abnormality Flagging Efciency The results of the reference 400-cell differential indicated that immature or morphologically abnormal cells were present in 48 of the 114 samples. The XT-2000i generated a morphologic flag on 46 of these samples. Two samples, both showing NRBCs present at very low levels (less than 1/100 WBCs) were not agged. Both of these samples had WBC counts less than 1.8 103/L. No immature or morphologically abnormal cells were found by the manual differential on the remaining 66 samples, although distributional abnormalities were present in some cases. The XT-2000i correctly identied 60 of these samples. The remaining 6 samples had false-positive ags; 1 had a left shift ag, 1 had an

*See Figure 1 legend for abbreviation denitions.

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FIGURE 3. Comparison graphs of results for white blood cells (WBC), red blood cells (RBC), and hemoglobin (HGB) obtained on
the XT-2000i and those obtained on the XE-2100.

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TABLE 8. Comparison Results of XT-2000i to the Manual Differential

Reference Method
Parameter Neutrophils Lymphocytes Monocytes Eosinophils Basophils Correlation Coefcient (r) 0.95 0.96 0.90 0.94 0.76 Slope 0.95 0.85 1.37 0.87 0.48 Intercept 3.38 1.67 1.89 0.04 0.24 N 114 114 114 114 114

immature granulocyte flag, 3 had abnormal lymphocyte ags, and 1 had multiple abnormal/immature ags. The XT2000i agging sensitivity and specicity are shown in Table 9. The XT-2000i showed very good agging efciency for both adult and pediatric samples. Separate analysis of the NRBC and blast ags also showed good efciency. Blasts were identied on 9 of the manual dif-

ferentials. The XT-2000i agged 6 of these samples as having blasts present. The 3 samples not agged by the XT-2000i all had a manual blast count of <1.0%. All 3 of these samples had other ags that would have prompted a manual review. On these 3 samples, a rare blast was reported by only 1 of the 2 technologists doing a 200-cell differential. On further review, the referee could not positively determine whether the cells were blasts without performing cytochemical stains. According to the referee, the cells appeared to be abnormal immature lymphocytes with only a rare blast. Detection of a blast cell during a manual review of 100 cells is an extremely rare occurrence. An additional 3 samples had generated a false-positive blast ag; however, all 3 samples had signicant numbers of pathologically abnormal lymphocytes. The blast flag alone had a negative clinical accuracy of 97% and an efciency of 94.7%. NRBCs were identied on 24 of the samples in a range of 0.25 to 84/100 WBCs. The XT-2000i generated an NRBC ag on 20 of these samples. The 4 samples not agged all had NRBCs present at less than 1/100 WBCs.

FIGURE 4. Comparison graphs of results obtained on the XT-2000i and those obtained with the manual differential reference method.

Performance Evaluation of the Sysmex XT-2000i TABLE 9. Flagging Efciency

Positive Manual differential XT-2000i Sensitivity Specicity Positive clinical accuracy Negative clinical accuracy Efciency 48 52 95.8% 90.9% 88.5% 96.8% 92.9% Negative 66 62

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A false-positive NRBC ag was generated on 6 of the 114 samples. The NRBC flag alone showed a negative clinical accuracy of 95.5% and an efciency of 91.2%.

DISCUSSION AND CONCLUSION

Our evaluation has shown that the XE-2100 and the XT2000i have excellent correlation statistics for all CBC, RET, and differential values. Because the technology is very similar in both analyzers, this result is not surprising. The use of uorescent ow cytometry for the CBC differential gives very good correlation with the manual reference method. By challenging the linearity of the instrument with extremely high- and low-count samples, we validated the linearity of the XT-2000i for WBC counts up to 410 103/L and PLT counts up to 6560 103/L. This extended linearity could eliminate the labor-intensive and error-prone manual dilutions required when dealing with specimens with drastically increased values. The condence that comes from knowing that PLT counts can be measured accurately

by the uorescent optical method also reduces the need for the technologist to perform a manual microscopic PLT count to verify results on a specimen that contains enlarged PLTs or RBC fragments, both of which interfere with the impedance PLT methodology. PLT testing is of great importance in the pediatric population because the majority of capillary specimens received have a higher incidence of PLT clotting or clumping. The technical comparison performed resulted in outstanding statistical results indicating that the XT-2000i is a very precise and accurate hematology analyzer that would perform well in any clinical setting. Our laboratory personnel were impressed that the XT-2000i uses the already proven Sysmex methodologies from the XE-2100 [4] and improves on them, resulting in an instrument that is more user friendly and a little more compact without sacricing any technical reliability.

REFERENCES
1. XT-2000i Product Brochure. Long Grove, Ill: Sysmex Corporation of America; 2002. 2. National Committee for Clinical Laboratory Standards. Reference leukocyte differential count (proportional) and evaluation of instrument method. Villanova, Pa: NCCLS; 1992. Approved standard, NCCLS Document H20-A. 3. International Committee for Standardization in Hematology. Protocol for evaluation of automated hematology analyzer. ICSH. 1984:;6:69. 4. Gould N, Connell B, Dyer K, Richmond T. Performance evaluation of the Sysmex XE-2100, automated hematology analyzer. Sysmex J Int. 1999;9:120-125.