Research Article: Compare the accuracy and precision of Coulter LH780, Mindray BC-6000 Plus, and Sysmex XN-9000 with the international reference flow cytometric method in platelet counting

Date Published: May 24, 2019

Publisher: Public Library of Science

Author(s): Yi Sun, Zuojian Hu, Zhili Huang, Huaping Chen, Shanzi Qin, Zhong Jianing, Siyuan Chen, Xue Qin, Yi Ye, Chengbin Wang, Michael Nagler.


The aim of this study is to evaluate the performance of different platelet counting methods (optical, impedance, fluorescence and hand counting) applied in different analysers by comparing with the international flow cytometric reference method (IRM).

A total of 333 blood samples from different subgroups (168 cases with thrombocytopenia, 136 cases with normal platelet counts and 29 cases with thrombocytosis) were tested. Regarding IRM as the gold standard, we compared the accuracy and precision of different platelet count methods; i.e. LH780 (impedance), BC-6000 Plus (optical (O) and impedance (I)), Sysmex XN-9000 (optical (O), impedance (I), fluorescence (F)), and hand counting.

Sysmex XN-9000-F (r = 0.988) had the best correlation with IRM for thrombocytopenic samples; BC-6000 Plus-I (r = 0.966) was more relevant to IRM than any other method for samples with normal platelet counts. Correlation between Sysmex XN-9000-I (r = 0.960) and IRM was the highest among these methods for samples with thrombocytosis. For bias evaluation, the average bias of Sysmex XN-9000-F was -1.5 × 109/L (95% LA = -9.4 to +6.4) for samples with thrombocytopenia, compared with IRM. BC-6000 Plus-I had a small mean difference with IRM for samples with normal platelet counts or thrombocytosis. Moreover, all evaluated methods had acceptable sensitivity, specificity, and concordance rates as compared with IRM in the diagnosis of thrombocytopenia and thrombocytosis.

Platelet counting by Sysmex XN-9000-F is more accurate than other methods for thrombocytopenic samples. BC-6000 Plus-I has superior association and consistency for normal platelet counts. As for thrombocytosis patients, Sysmex XN-9000-I has the highest correlation with IRM while Sysmex XN-9000-O has the highest diagnosis efficacy.

Partial Text

The accuracy of platelet count is critical for clinical laboratories and clinicians to assess the risk of bleeding in patients [1]. Over the years, platelet counting has been performed by microscopic counting, automated blood cell analyzers, and the international reference method based on flow cytometry proposed by International Council for Standardization in Haematology (ICSH) [2]. The impedance method is a classic platelet counting method invented by Beckman Coulter [3]; but it has some limitations, such as being unable to distinguish platelets from particles whose size and volume are similar to platelets. Thus, many instrument manufacturers have applied a variety of measures to solve this problem. Advia 120, Cell-Dyn 4000, Mindray BC-6800 and Abbot Diagnostics are platelet counters using the optical counting method that can differentiate blood components according to the type and strength of light signals [4–6]. Another analyzer, the Sysmex XN-3000, is designed to use the method of fluorescent nucleic acid staining to count platelets [7]. The above methods have improved the ability of automatic blood analyzers to identify platelets.

Platelet count plays an indispensable role in the treatment of many clinical diseases, such as atherosclerosis, thromboembolism, leukemia, and cancer [13–15]. Low platelet counts can affect the speed of vascular repair and cause bleeding [16], while high-value platelets can easily induce thrombus formation [17]. Accurate counting of platelets is very important for clinicians in selecting theraputic strategies and monitoring medications. However, there are many factors influencing platelet count, such as large platelets, small red blood cells, and platelet aggregation [18]. Moreover, Kim et al. found that inaccurate platelet counts can lead to misdiagnosis of disseminated intravascular coagulation (DIC) [15]. Hence, our study used IRM as the gold standard to compare the accuracy of several platelet detection methods (LH780, BC-6000 Plus-O, BC-6000 Plus-I, Sysmex XN-9000-O, Sysmex XN-9000-I, Sysmex XN-9000-F, and hand counting) which are commonly used in China.