Glossary

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.

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.

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.

The Blood Bank mode is a new optional licence that can be installed on XN-1000 or XN-2000 analysers to enable the measurement of blood products namely red blood cell concentrates and platelet concen-trates.

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.

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.

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 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.

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.

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 Caresphere Academy services, digital training and onsite educational workshops and consultancy services.

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.

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.

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.

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.

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.

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.

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.

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.

Dedicated articles on clinical and diagnostic background topics with a scientific and educational focus. Topics include e.g. coagulation, haematology, urinalysis, body fluids, etc.

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.

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.

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.

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.

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.