Individuazione imprevista di cellule potenzialmente cancerose
Riconoscere i segni precoci della leucemia già dall’analisi standard dell’emocromo.
L’emocromo completo (CBC) è il test di laboratorio più frequentemente richiesto sia in ambito ospedaliero che ambulatoriale. I moderni analizzatori ematologici automatizzati vengono utilizzati per analisi ad alto throughput degli emocromi completi. Inoltre, questi analizzatori sono ampiamente impiegati per l’identificazione sensibile di campioni patologici, con risultati evidenti indicati da diversi alert per la successiva revisione dello striscio, ad esempio al microscopio.
Gli analizzatori delle serie XR e XN di Sysmex consentono di rilevare cellule patologiche in un campione di sangue con un elevato grado di sensibilità, per cui l’emocromo eseguito su un analizzatore ematologico all’avanguardia offre la possibilità di un primo alert di molti campioni sospetti maligni in fase precoce, che altrimenti sarebbero rimasti non riconosciuti. Il fatto che ogni minuto, in qualche parte del mondo, venga diagnosticata una neoplasia ematologica dimostra quanto ciò sia importante.
Vantaggi dell’analisi dei campioni di sangue su un analizzatore Sysmex
- Individuazione tempestiva di campioni potenzialmente maligni mediante la rilevazione sensibile di varie cellule patologiche [1-4].
- Rilevazione molto sensibile di eritrociti nucleati [1,2], indicativi di stress o danno al midollo osseo – eseguita con ogni emocromo.
- Utilizzo di algoritmi proprietari best-in-class sui nostri moderni analizzatori ematologici, che segnalano in modo sensibile e specifico precursori cellulari immaturi [1-4] – con ogni emocromo differenziale.
- Uno score per la rilevazione tempestiva di campioni potenzialmente non riconosciuti di leucemia mielomonocitica cronica (CMML) [5].
- Parametri unici che supportano l’identificazione di pazienti con alta probabilità di malattie mieloproliferative [6-8].
Scarica il white paper
Questo white paper descrive come un emocromo completo misurato sugli analizzatori della serie Sysmex XN possa rivelare anomalie significative e ottimizzare l’identificazione imprevista di neoplasie ematologiche o la recidiva precoce di tumori mentre il paziente è sotto terapia.
Cases
Early indication of a chronic myelomonocytic leukaemia sample
A 62-year-old man visited his general practitioner for an annual preventive health check. At the time of visiting the physician, he did not suffer from any noticeable symptoms. The routine differential blood count performed on a Sysmex analyser showed all values within normal limits except for a mild monocytosis (MONO 1.3×10^3 cells/µL). Although this value was below the conventional cut-off for a monocytosis smear review, the sample was guided for microscopic examination in search of potential chronic myelomonocytic leukaemia (CMML) abnormalities.
The reason was that the laboratory had implemented the ‘Mono-dysplasia’ score and the result of this patient turned out to be positive. Careful examination of the blood smear showed marked dysplasia in neutrophils, which was also confirmed in several follow-up tests. Finally, this led to the suspicion of CMML sample , the diagnosis of which was confirmed by cytogenetic testing.
NRBC as early sign of malignancy
A 76-year-old man was admitted to a hospital’s emergency room for suspected heart failure. A blood count was performed on a Sysmex analyser and revealed the presence of mild monocytosis and circulating NRBC (0.02×10^3 cells/µL), which was confirmed by smear review. Due to the sudden appearance of acute ischaemia, the patient underwent an emergency aortocoronary bypass surgery. After one month, the man was discharged with a diagnosis of ischaemic heart disease. After 14 months, the patient returned to the hospital’s emergency room with a new acute exacerbation of chronic heart failure. A differential blood count analysis showed various pathologic cells including NRBC, immature granulocytes, blasts, and an abnormal morphology of RBC. Further tests lead to the diagnosis of primary myelofibrosis (PMF). The initial blood count by the Sysmex analyser had shown the presence of NRBC in peripheral blood more than one year before the diagnosis of PMF [9]. The excellent performance at low concentrations of NRBC shown by the Sysmex analysers is of valuable help in routine blood analysis, for instance when screening for many relevant malignancies in an early subclinical stage [1].
Our solutions
References
[1] Da Rin G et al. (2017): Performance evaluation of the automated nucleated red blood cell count of five commercial hematological analyzers. Int J Lab Hematol. Dec; 39(6): 663–70.
[2] Bruegel M et al. (2015): Comparison of five automated hematology analyzers in a university hospital setting: Abbott Cell-Dyn Sapphire, Beckman Coulter DxH 800, Siemens Advia 2120i, Sysmex XE-5000, and Sysmex XN-2000. Clin Chem Lab Med. Jun; 53(7): 1057–71.
[3] Blomme S et al. (2021): The integration of Sysmex XN-9100’ WPC channel reflex testing in the detection of reactive versus malignant blood samples. Int J Lab Hematol. Apr; 43(2): 191–198.
[4] Schuff-Werner P et al. (2016): Performance of the XN-2000 WPC channel-flagging to differentiate reactive and neoplastic leukocytosis. Clin Chem Lab Med. Sep 1; 54(9): 1503–10.
[5] Schillinger F et al. (2018): A new approach for diagnosing chronic myelomonocytic leukemia using structural parameters of Sysmex XN analyzers in routine laboratory practice Scand J Clin Lab Invest. May; 78(3): 159–64.
[6] Panova-Noeva M et al. (2011): JAK2V617F mutation and hydroxyurea treatment as determinants of immature platelet parameters in essential thrombocythemia and polycythemia vera patients. Blood. Sep 1; 118(9): 2599–601.
[7] Strati P et al. (2017): Novel hematological parameters for the evaluation of patients with myeloproliferative neoplasms: the immature platelet and reticulocyte fractions. Ann Hematol. May; 96(5): 733–8.
[8] Johnson S et al. (2019): ): A CBC algorithm combined with immature platelet fraction is able to identify JAK2 V617F mutation-positive polycythaemia vera patients. Int J Lab Hematol. Apr; 41(2): 271–6.
[9] Buoro S et al. (2016): Which clinical significance has automatic detection of very low levels of nucleated red blood cells in the peripheral blood? Ann Transl Med. Jun; 4(11): 230–4.