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Weekly UpdatesIn MLO May 2009, p. 41, Dr. Min Xu states that at the Children's Hospital and Regional Medical Center of Seattle, they do the manual differential on all patients younger than three months because the Sysmex XE-2100 does not give a band Neutrophil count. This is true, theoretically, but the instrument flags immature granulocytes, blasts, and atypical lymphocytes as well as any apparent deviation from the usually expected, and this automatically prompts a manual verification. One does not have to do "all specimens from patients under three months," and we have been following this policy since November 2007 with no clinician complaint. The clinicians will naturally try to fight such a change in the tradition to which they are accustomed, but should be educated and convinced that there is no such a need, as the system ensures that whatever patient has bands, he/she will be detected and will get a manual count.
--J-P deChadarevian, MD
Medical Director
Department of Pathology & Laboratory Medicine
St. Christopher's Hospital for Children
Philadelphia, PA
Dr. Min Xu's response: It is true that the instrument flags immature granulocytes, blasts, and atypical lymphocytes, as well as any apparent deviation from the usually expected, and this automatically prompts a manual verification. We review peripheral smears with the above flags. However, we do not perform manual differentials on all those situations unless we observe blasts, bands over 10%, or significant deviation of automated differential from the smear review. We believe that automated differential gives better precision than manual differential since it counts a lot more cells. Since we implemented Sysmex, we started to get physicians' feedback on band counts. For the emergency department, doctors use a band-to-Europhile ratio to determine whether infants can be discharged without antibiotics. This is the best available data to guide their care of these patients. Even with less than 10% band, they need to have a band count. That is the reason we decided to perform manual differential on all infants younger than three months.
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