GROUP D
AUTOMATED
HEMATOLOGICAL
ANALYZERS
Bautista | Cardeño | Casoco | Cortes | Ifurung | Labasan | Lagmay | Domato | Fernandez
Galamgam | Gianan | Gutierrez | Oviedo | Pecson | Primero | Singian | Turnuas
PRESENTATION
Introduction
OUTLINE
Sysmex XN-1000
Sysmex XN-550
Sysmex CS-1600
Summary & Conclusion
INTRODUCTION
Sysmex XN-550
A compact, fully automated hematology analyzer.
Performs Complete Blood Count (CBC) with 5-part
differential.
Uses fluorescence flow Cytometry, hydrodynamic focusing, and
impedance methods.
INTRODUCTION
Sysmex XN-1000
A high-throughput, advanced hematology analyzer.
Performs CBC, 5-part differential, and advanced research
parameters (e.g., immature granulocytes, NRBCs).
Suitable for large hospitals and reference laboratories.
Highly sensitive for abnormal cell detection.
INTRODUCTION
Sysmex CS-1600
An automated coagulation analyzer.
Performs routine and specialized coagulation tests such as:
PT
APTT
Fibrinogen
D-dimer
Factor assays
Uses optical clot detection.
INTRODUCTION
IMPORTANCE OF CBC
The Complete Blood Count (CBC) is one of the most important and
commonly requested laboratory tests because it provides a
comprehensive evaluation of a patient’s overall health and
hematologic status. It helps in the diagnosis and monitoring of
various conditions such as anemia, infections, inflammatory
disorders, and hematologic malignancies by assessing red blood
cells, white blood cells, and platelets.
INTRODUCTION
IMPORTANCE OF COAGULATION TEST
Coagulation tests are equally important as they assess the body’s
ability to form and regulate blood clots, which is critical in
preventing excessive bleeding or abnormal clot formation. These
tests are used to diagnose bleeding and thrombotic disorders,
monitor patients receiving anticoagulant therapy, and evaluate
patients prior to surgical procedures.
INTRODUCTION
IMPORTANCE OF CBC
The Complete Blood Count (CBC) is one of the most important and
commonly requested laboratory tests because it provides a
comprehensive evaluation of a patient’s overall health and
hematologic status. It helps in the diagnosis and monitoring of
various conditions such as anemia, infections, inflammatory
disorders, and hematologic malignancies by assessing red blood
cells, white blood cells, and platelets.
INTRODUCTION
Purpose of studying the principles
Understanding the principles of operation:
Helps you know how results are generated
Allows proper interpretation of values
Prevents misinterpretation due to technical errors
Enables correct troubleshooting and quality control
INTRODUCTION
Purpose of studying flags
Analyzer flags are alerts indicating possible abnormal findings.
Studying flags helps you:
Identify results that need manual smear review
Detect abnormal or immature cells early
Avoid reporting false or misleading results
SYSMEX XN-1000
OVERVIEW
The Sysmex XN-1000 is a fully automated, standalone hematology analyzer
designed for medium- to high-volume laboratories, capable of processing up to
100 samples per hour. It significantly reduces manual intervention and offers
reproducible, high-quality results in the shortest possible time.
Rapid Hematological Analysis
High-Sensitivity Testing
Small Sample Volume, requiring only 88 μL of whole blood, making it ideal
for pediatric or critical care samples.
SYSMEX XN-1000
LABORATORY USE
Routine Hematology (CBC/Diff)
PRINCIPLE
RET-He
IPF (Immature Platelet Fluorescent Flow Cytometry
Fraction) Hydrodynamic Focusing DC
PLT-F Detection (RBC/PLT)
Sodium Lauryl Sulfate (SLS)
Method
SYSMEX XN-1000
How flags are generated?
Fluorescent Flow Cytometry - Cells are stained with a
fluorescent dye that binds to DNA/RNA
Hydrodynamic Focusing DC Detection (RBC/PLT) -
Red blood cells and platelets are counted by electrical
impedance
Sodium Lauryl Sulfate (SLS) Method - Hemoglobin is
measured using a cyanide-free chemical method
SYSMEX XN-1000
RBC RBC-related flags are part of the instrument’s Interpretive
Program (IP) messages that alerts the user to possible
FLAGS sample abnormalities or other interferences involving RBCs
1. ‘Dimorphic Population’
2. ‘Turbidity/HGB Interf?’
3. ‘RBC Agglutination?’
4. ‘Iron Deficiency?’
5. ‘HBG Defect?’
6. ‘iRBC?’
7. ‘RET Abn Scattergram’
SYSMEX XN-1000
WBC When an abnormality in WBC is detected, the message “WBC
FLAGS
Abn Scattergram” appears.
Abnormalities can happen due to:
1. Different clusters in the WNR scattergram cannot
be differentiated.
2. WBC aggregates have been detected in the WNR
channel.
3. The appearance of abnormal particles extending
from the low FSC area in the WNR scattergram.
SYSMEX XN-1000
WBC FLAGS
Left Shift Malignant Samples
1. Left Shift?’ flag indicates that 1. ‘Blasts?’ - a myeloid
the instrument has detected malignancy or lymphoblasts
cells in the region for left shift 2. ‘Abnormal Lympho?’ -
(band cells) malignant (neoplastic)
2. The flag only occurs if disorder of lymphocytes
≧
WBC 0.50 x103/μL 3. ‘Atypical Lympho?’ - reactive
disorder
SYSMEX XN-1000
RET FLAGS
Quantifies both mature and immature reticulocytes
1. ‘RET Abn Scattergram’
[Link]
[Link]-Jolly Bodies
[Link]
[Link] reticulocytes
SYSMEX XN-1000
RET FLAGS
Quantifies both mature and immature reticulocytes
2. ‘RET Abn Scattergram’
[Link] - P. falciparum
[Link] stippling due to a genetic
haemoglobinmutation
[Link]
[Link] lymphocyte sare interfering with the RET-UPP
area
[Link] bodies
[Link] interference in the RET-UPP area
SYSMEX XN-1000
RET FLAGS
Quantifies both mature and immature reticulocytes
3. RET fragments (‘Fragments?’)
[Link] triggered by the RET scattergram
and/or the RBC histogram
SYSMEX XN-1000
PLT FLAGS
‘PLT Abn distribution’ IP is triggered when...
some certain parameters exceed the maximum thresholds
that cannot be analysed anymore such as PDW, PLT-I,
P-LCR, MPV, lower RBC histogram discriminator,
platelet upper discriminator)
SYSMEX XN-1000
PLT FLAGS
‘PLT Abn Scattergram’ IP message is triggered when...
There are clustering of platelets and IPF
(immature platelet fracture), measures the
percentage of young reticulated platelets
SYSMEX XN-1000
PLT FLAGS
When ‘PLT Clumps?’ IP message is triggered when...
Abnormalities present due FSCW in the WNR, WDF
and PLT-F(FSCW-FSC) plots
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
Normal:
RBC FLAGS
[Link] histogram does not
return to the baseline.
2.“Dimorphic Population” Abnormal:
Flag
3.“RBC Agglutination” Flag
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
WBC FLAGS
Normal:
1.“Greyed-out” Clusters
[Link] (*) or Dashes (--)
[Link] Positioning: *
Blasts
[Link] separation of
NRBCs Abnormal:
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
RET FLAGS Normal:
1.“RET abn Scattergram” Flag
2.“Fragments” Flag
Abnormal:
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
Abnormal:
RET FLAGS
1.“RET abn Scattergram” Flag
2.“Fragments” Flag
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
PLT FLAGS
Normal:
1.“PLT Abn Distribution” Flag
2.“PLT Abn Scattergram”
(PLT-F Channel)
3.“PLT Clumps” Flag
Abnormal:
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
PLT FLAGS
Normal:
1.“PLT Abn Distribution” Flag
2.“PLT Abn Scattergram”
(PLT-F Channel)
3.“PLT Clumps” Flag
Abnormal:
** Image retrieved from [Link]
SYSMEX XN-1000
HISTOGRAM/SCATTERGRAM FLAGS
PLT FLAGS
Normal:
1.“PLT Abn Distribution” Flag
2.“PLT Abn Scattergram”
(PLT-F Channel)
3.“PLT Clumps” Flag
Abnormal:
** Image retrieved from [Link]
SYSMEX XN-1000
WHEN TO REPEAT
Flag Actions:
[Link](s)
[Link]
present
Linearity: Perform
[Link] Message
manual dilution
(eg. “Vote Out”)
then rerun
[Link]
[Link] Lyse: Rerun
Linearity
in a different mode
[Link] Lyse
if possible or
Resistance
manual count.
SYSMEX XN-1000
WHEN TO SMEAR
Flag Actions:
[Link] suspected Flags suspected:
(eg. “?”) Check for
[Link](es) present leukemia, viral
infections, reactive
[Link]
lymphocytes,
Thresholds
early-stage
[Link] neutrophils, or
difference in schistocytes
Delta Check Dashes: Manual
differential
SYSMEX XN-1000
WHEN TO REJECT
Flag Actions:
Clotted: Recollect
1. Clotted Samples
blood
2. Severe hemolysis MCHC > 37.0 g/dL:
3. Short Saline
draw/Inadequate replacement
specimen Warm the
4. MCHC > 37.0 g/dL sample 37oC
for 1 hour
SYSMEX XN-1000
GENERAL FLAG ACTION
Check Sample Integrity
↓
Rerun/Reflex
↓
Smear Review/Manual Differentiation
SYSMEX XN-550
The Sysmex XN-550 is a small
automated hematology analyzer that
is mostly used in clinical laboratories
for differential blood counts and
routine blood tests. It performs a
complete blood count (CBC) with a
six-part white blood cell differential.
SYSMEX XN-550
PRINCIPLE:
1. Fluorescence Flow Cytometry
2. Flow Cytometry (Non-fluorescent)
3. DC Impedance with Hydrodynamic
Focusing
4. Cyanide-free SLS Method
SYSMEX XN-550
CLINICAL USE:
[Link] CBC and differential testing
[Link] treatment and disease progression
[Link] counts in body fluids
[Link] manual differentials
[Link] CBC parametes
[Link] major WBC subtypes
[Link] reticulocyte counts
[Link] diagnostic decisions
SYSMEX XN-550
DIFFERENCE FROM XN-1000:
SYSMEX XN-550
RBC FLAGS:
Microcytosis and macrocytosis (low or high MCV)
Anisocytosis (increased RDW)
Dimorphic RBC populations (two histogram peaks)
RBC fragments or schistocytes (which may falsely
increase platelet counts and suggest MAHA, DIC, or
TTP)
RBC agglutination (causing falsely low RBC counts and
high MCV/MCHC, as seen in cold agglutinin disease)
Hypochromia or Hyperchromia (low or high hemoglobin
concentration per cell, seen in iron deficiency,
thalassemia, or hereditary spherocytosis)
SYSMEX XN-550
WBC FLAGS:
The Sysmex XN-550 uses fluorescent flow
cytometry to identify WBC flags and assess cell size,
internal structure (granularity), and DNA/RNA
content.
Mechanism of Sysmex XN-550:
Fluorescence Flow Cytometry
WDF Channel (White Blood Cell
Differential)
WNR Channel (WBC/Neutrophil Channel)
Flagging Abnormalities
Scattergram Analysis
SYSMEX XN-550
PLT FLAGS:
OVERVIEW
• Platelet flags warn unreliable counts
• XN-550 uses impedance counting
• Histogram and scattergram evaluated
• Checks size and signal separation
• Detects RBC fragment interference
• Flags suggest review or rerun
• Analyzer does not auto-correct
SYSMEX XN-550
PLT FLAGS:
SPECIFIC PLATELET FLAGS
• Abn Distribution: irregular histogram curve
• Causes: microcytes, fragments, giant platelets
• PLT Clumps: aggregates cause low counts
• Often EDTA or partial clot
• Abn Scattergram: poor signal separation
• Debris or abnormal platelet morphology
• Thrombocytopenia/osis: outside limits
SYSMEX XN-550
PLT FLAGS:
SYSMEX CS-1600
ROLE IN HEMATOLOGY SECTION:
1. Performs Coagulation Testing
(Hemostasis)
2. Assists in Diagnosis & Monitoring of
Hematological Conditions
3. Improves Laboratory Workflow &
Quality Assurance
SYSMEX CS-1600
DIFFERENCE FROM SYSMEX XN-550 and SYSMEX XN-1000
SYSMEX CS-1600
DETECTION PRINCIPLES
Uses multi-wavelength transmitted light detection
Wavelengths: 405, 575, 660, and 800 nm
Optical fiber delivers light to the reaction cuvette
SYSMEX CS-1600
HOW FLAGS ARE GENERATED
Liquid level detecrion during first aspiration
Verifies CLSI-recommended 9:1 blood to
anticoagulant ratio
Flags samples with inappropriate volume
Continuous monitoring of reaction curves
Comparison with expected optical patterns
Automatic flagging when abnormalities are detected
Automatically selects optimal wavelength
Reduces interference from lipemia and icterus
Switches to secondary wavelength if signal is weak
SYSMEX CS-1600
FLAG GENERATION OVERVIEW
The analyzer automatically generates flags to ensure:
1. Result accuracy
2. Sample integrity
3. Instrument reliability
4. Patient safety
Flags are categorized into:
1. Instrument-related
2. Sample-related
3. Reagent/System-related
SYSMEX CS-1600
Instrument-Generated Flags
Generated when abnormal reaction patterns occur:
No coagulation detected
Abnormal reaction curve
Out of measuring range
Clot detection error
Indicates possible factor deficiency, anticoagulant
therapy effect, or instrument issue.
SYSMEX CS-1600
Sample-Related Flags
Indicate specimen problems:
Hemolysis
Lipemia
Insufficient volume
Sample handling error
Interference detected through optical monitoring.
SYSMEX CS-1600
Reagent and System Flags
Ensures system reliability:
Expired reagent
Low reagent volume
Probe aspiration error
Temperature error
Prevents release of inaccurate results.
SYSMEX CS-1600
INTRUMENT ERROR ALERTS:
SYSMEX CS-1600
ACTION FLAGS: WHEN TO REPEAT OR RECOLLECT:
Repeat Analysis (Same Sample):
"Analysis Time Over" / "No Coagulation"
Action: Repeat with Extended Measurement Time or
use a different dilution.
"Coagulation Curve Error"
Action: Check for bubbles or fibrin strands and re-run.
"Slight Coagulation"
Action: Verify the curve visually; if consistent, the
result may be reportable with a comment.
SYSMEX CS-1600
ACTION FLAGS: WHEN TO REPEAT OR RECOLLECT:
Sample Recollection (New Sample)
"Sample Volume Error"
Action: Must recollect.
"Clot Detected" (Aspiration)
Action: Recollect. The sample is consumed/activated and
unusable for coagulation testing.
Severe Hemolysis (H-Flag)
Action: Recollect to avoid false shortening of APTT due
to released intracellular clotting factors.
SYSMEX CS-1600
CLINICAL SIGNIFICANCE OF FLAGS
Lipemia (L) / Icterus (I) Flags: These often signify
high bilirubin or triglycerides.
Asterisk (*) or Question Mark (?): These appear next
to results when the internal algorithm is uncertain.
Early Reaction Error: Often points toward a
"hypercoagulable" state or a technical issue like an
improperly mixed reagent.
CONCLUSION
1. Sysmex XN analyzers provide accurate and efficient complete
blood count analysis.
2. Flagging systems play a crucial role in identifying abnormal
samples and ensuring result reliability.
3. Proper interpretation of histograms, scattergrams, and IP
messages enhances diagnostic accuracy.
4. The Sysmex CS-1600 complements hematology analyzers by
providing essential coagulation testing.
5. Strict adherence to flag action protocols maintains laboratory
quality and patient safety.
REFERENCES
Sysmex Corporation. (2013). CS-1600 automated blood coagulation analyzer:
Instructions for use. Sysmex Corporation.
Favaloro, E. J., & Lippi, G. (2017). Interference in coagulation testing: Focus on
spurious hemolysis, icterus, and lipemia. Seminars in Thrombosis and Hemostasis,
43(3), 258–267. [Link]
Lippi, G., Salvagno, G. L., Montagnana, M., Brocco, G., & Guidi, G. C. (2006).
Influence of hemolysis on routine coagulation testing. Clinical Chemistry and
Laboratory Medicine, 44(3), 311–316. [Link]
Adcock, D. M., & Kressin, D. C. (2019). Preanalytical variables in coagulation
testing. In L. McPherson & M. Pincus (Eds.), Henry’s clinical diagnosis and
management by laboratory methods (23rd ed.). Elsevier.
Kitchen, S., McCraw, A., & Echenagucia, M. (2010). Diagnosis of hemophilia and
other bleeding disorders: A laboratory manual (2nd ed.). World Federation of
Hemophilia.
Siemens Healthineers. (2019). Sysmex CS Systems coagulation curve errors (No.
2–5). [Link]
content/uploads/2022/12/T05012.002-Sysmex-CS-Systems-Sample-Result-
Evaluation-Clotting-Assays_eff-[Link]
Group D
THANK YOU
FOR LISTENING!
Bautista | Cardeño | Casoco | Cortes | Ifurung | Labasan | Lagmay | Domato | Fernandez
Galamgam | Gianan | Gutierrez | Oviedo | Pecson | Primero | Singian | Turnuas