clinical utilities of immature granulocytes
TRANSCRIPT
CLINICAL UTILITIES OF
IMMATURE GRANULOCYTES
1
What is Immature Granulocyte
Lymph nodes
and spleenThymus
Peripheral Blood
Blood-bone marrow barrier
Eosino
philNeutrophil
Baso-
phil
Myelocyte
Metamyelocyte
Bands
Segmented Cells
Promyelocyte
Myeloblast
Makrophage
Basophil in tissue
Reticulum cell
Monoblast
Monocyte
Pluri potent
Stem Cell
B1-Lymphocyte
Plasma cell
Lymphatic
stem cell
T2-LymphocyteB2-Lymphocyte
Plasma cell
Plasmoblast
B-Immuno-
blast
Centro-
blast
T-Immuno-blast
T0-Lymphocyte
T1-Lymphocyte
Centrocyte
Monocyte
Bands
Segmented Cells
Re
ticu
locy
tes
3
4
ErythrocytesThrombocytes
T2-LymphocyteB2-Lymphocyte
Plasma cell Re
ticu
locy
tes
Proerythroblast
PolychrErythroblast
OrthochrErythroblast
0
1
2
3
4
Erythrocytes
Megakaryocyte
Thrombocytes
Megakaryoblast
Juli Soemarsono SURAMADE I - 2011
MANUAL
MICROSCOPIC
Text1Text1Text1Text1
IMMATURE
GRANULOCYTE
3
Juli SoemarsonoSURAMADE I - 2011
MANUAL MICROSCOPIC
Text1Text1Text1Text1
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
IMMATURE GRANULOCYE
4
Juli SoemarsonoSURAMADE I - 2011
HEMATOLGY ANALYZER
IMMATURE GRANULOCYE
Text1Text1Text1
5
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
What is Immature Granulocyte
Lymph nodes
and spleenThymus
Peripheral Blood
Blood-bone marrow barrier
Eosino
philNeutrophil
Baso-
phil
Myelocyte
Metamyelocyte
Bands
Segmented Cells
Promyelocyte
Myeloblast
Makrophage
Basophil in tissue
Reticulum cell
Monoblast
Monocyte
Pluri potent
Stem Cell
B1-Lymphocyte
Plasma cell
Lymphatic
stem cell
T2-LymphocyteB2-Lymphocyte
Plasma cell
Plasmoblast
B-Immuno-
blast
Centro-
blast
T-Immuno-blast
T0-Lymphocyte
T1-Lymphocyte
Centrocyte
Monocyte
Bands
Segmented Cells
Re
ticu
locy
tes
3
4
ErythrocytesThrombocytes
T2-LymphocyteB2-Lymphocyte
Plasma cell Re
ticu
locy
tes
Proerythroblast
PolychrErythroblast
OrthochrErythroblast
0
1
2
3
4
Erythrocytes
Megakaryocyte
Thrombocytes
Megakaryoblast
Juli Soemarsono SURAMADE I - 2011
MANUAL
MICROSCOPIC
Text1Text1Text1Text1
IMMATURE
GRANULOCYTE
3
Juli SoemarsonoSURAMADE I - 2011
MANUAL MICROSCOPIC
Text1Text1Text1Text1
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
IMMATURE GRANULOCYE
4
Juli SoemarsonoSURAMADE I - 2011
HEMATOLGY ANALYZER
IMMATURE GRANULOCYE
Text1Text1Text1
5
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
MANUAL
MICROSCOPIC
Text1Text1Text1Text1
IMMATURE
GRANULOCYTE
3
Juli SoemarsonoSURAMADE I - 2011
MANUAL MICROSCOPIC
Text1Text1Text1Text1
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
IMMATURE GRANULOCYE
4
Juli SoemarsonoSURAMADE I - 2011
HEMATOLGY ANALYZER
IMMATURE GRANULOCYE
Text1Text1Text1
5
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
MANUAL MICROSCOPIC
Text1Text1Text1Text1
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
IMMATURE GRANULOCYE
4
Juli SoemarsonoSURAMADE I - 2011
HEMATOLGY ANALYZER
IMMATURE GRANULOCYE
Text1Text1Text1
5
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
HEMATOLGY ANALYZER
IMMATURE GRANULOCYE
Text1Text1Text1
5
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
DETECTION
of
INFECTION
BAND
COUNT
BAND ANC
(IT-RATIO)
6
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
7
bullRatio between immature neutrophyls to total neutrophils (IT ratio)
is the ratio between
the amount of immature neutrophils
against
the amount of total neutrophils
in a blood smear preparation
bullImmature neutrophils are cells at younger stage than neutrophil bands
metamyelocytes
myelocytes
promyelocytes
myeloblast)
Diana Aulia Arief I Sanjaya and Ina S Timan J Lab Med amp Quality Assurance 200325237-242
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
BAND
COUNTinaccurateimprecise
required to calculate an
immature to total neutrophil
ratio
(IT ratio)
has a long clinical tradition as
a diagnostic test for bacterial infection
Clinical utility of the band count
8
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Diagram
neutrophils more immature than bands
absolute neutrophil count
I T RATIO
DETECTION
of
INFECTION
Ardron MJ Westengard JC Dutcher TF Am J Clin Pathol 1994 Nov102(5)646-9
9
Juli Soemarsono SURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Immature granulocyte Reference Value
10
Juli Soemarsono SURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Samples size
bull 156 healthy blood donors
bull Male 80
bull Female 76
Reference values
Male 003X109L 05
Female 003X109L 04
No age dependency
Immature granulocyte Reference Value
Juli Soemarsono
SURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
12
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Correlation with flow cytometric reference method amp manual reference method
Briggs et al Hematology 20039117-124
Correlation Tests
XE-IG count vs flow cytometric ref method using monoclonal antibodies demonstrated excellent results (r=096 on data without asterisks)
XE-IG count vs manual ref count was lower (r=078) Reasons being
Smaller number of cells counted with manual method
Subjectivity involved in morphological classification of IG
Flow cytometric method
bull Anti-CD16 aniti-CD11b amp anti-CD45
bull Epics XL-MCL (BC)
Manual Differential Count
bull400 WBC count (NCCLS protocol)
13
Juli Soemarsono SURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Good correlation
bull CRP
bull ESR
bull CD64
bull IL-6
Clinical Significance
ReferenceBriggs et al Evaluation of Immature Granulocyte Counts by the XE-IG Masrer Upgraded software for the XE-2100 Automated Hematology Analyzer Laboratory Hematology 20039117-124
Positive sample rate in samples with high IG (20 or higher)
Conclusion
IG count can highlight a potential acute infectious inflammatory response at a relatively early stage of development of clinical features when other blood count parameters (eg Neutropils) are in the overall normal range and are generally non-specific as indicators
14
Juli Soemarsono SURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
IG count in infection and sepsis 15
Juli Soemarsono SURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
IG as a predictor of infections and sepsis bull IG is higher in infected patients and positive blood cultures
bull IG is better predictor of infection than WBC count
bull IG is comparable to the absolute neutrophil count
bull High IG helps direct molecular testing leading to a more rapid diagnosis of severe infection
bull Low sensitivity as a screening tool but prediction of infection bacteremia may be improved by
incoporating IG measurement with other tests to help in early detection of infection in patients
bull gt 3 IG is a very specific predictor of sepsis (gt90)
(Ansari-Lari et al 2003)
ReferenceAnsari-ari et al Immature Immature Granulocyte Measurement using the Sysmex XE-2100 Relationship of Infection and Sepsis Am J Clin Pathol 2003120795-799
16
Juli Soemarsono SURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
IG ratio amp IT ratio inSepsis
Study objectives
To determine if IG IG ratio and IT ratio can be used as a early indicator of sepsis
To determine If IG count can provide a fast reliable and more cost effective method
of diagnosis in comparison with other diagnostic tools such as blood culture or CRP
17
Juli Soemarsono SURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Comparison of IG ratio and IT ratio with blood culture
All 7 patients with negative blood culture showed IT ratio gt 065
6 of the 7 patients with negative blood culture having a raised IG ratio
IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture
18
Juli Soemarsono SURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
bull IG Ratio of 035 gives the best sensitivity amp specificity
IT Ratio of 065 gives the best sensitivity amp specificity
IT ratio vs IG ratio as indicator of Sepsis
19
Juli Soemarsono SURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
bull IT ratio though has the same sensitivity amp specificity as IG ratio it gives a better overall positive and negative predictive values than IG ratio
bull IT ratio provides a useful tool in diagnosing those sepsis patients who have a negative blood culture (100 PPV)
IT ratio vs IG ratio as indicator of Sepsis
20
Juli Soemarsono SURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
bull 12 (71) of 17 patients studied showed an IT ratio gt 065 in samples taken on 3 days pre diagnosis
bull =gt IT ratio can be used as early indicator of sepsis
IT ratio and the day of Diagnosis
29 71
3 days post diagnosis
18 (72) of 25 septic patients studied showed an IT ratio gt 065 in samples on 3 days post diagnosis
=gt post sample detected 1 more patient
=gt IT ratio can be used throughout the course of disease
=gt may be used to monitor patient recovery
21
Juli Soemarsono SURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
XE-5000
XE-2100 (w XE IG Master)
XE-2100L (w XE IG Master)
XE -2100D (w XE IG Master)
How to measure IG
XE-seeries (5 +1) part diff automated hematology analyzer
22
Juli Soemarsono SURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
IG count
Measure in Diff Channel and report in
IG (103microl)
IG
Detect in IMI channel and display as flags
Constitute of Promyelocytes Myelocytes amp Metamyelocytes
23
Juli Soemarsono SURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
bull Automated enumeration of IG using proprietary Fluorescent Flow Cytometery eliminatesndash immature granulocyte flag
ndash false positives
ndash the need to perform unneccessary manual smear reviews
bull Improved sensitivity amp accuracy compared to manual Diff-Count
ndash Small no of IG particularly in leukopenic sample are often missed in a std 100-cell DC
ndash Wide inter-examiner and inter-laboratory variation
bull Reduce manual reviews ndash saves times amp effort of MT
ndash allow results to be delivered to physicians sooner -gt reduce TAT
bull User defineable setting for Diff Review (IG gt 2 3 4 or 5)
bull Fast simple and inexpensive method
ldquoAnti-smear campaignrdquo
Benefits of quantitative IG count Using Sysmex XE
24
Juli Soemarsono SURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Clinical Utilities of XErsquos IG Count
1 provides an rapid accurate and inexpensive method to detect
inflammation and diagnosis of sepsis
2 early indicator of inflammation and sepsis to facilitates timely
treatment
25
Juli Soemarsono SURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011
Juli SoemarsonoSURAMADE I - 2011