Intensive care patients may show an increased immature granulocyte (IG) count which provides im-

portant information on the patient’s prognosis. [1] sysmex xe- and xt-series instruments can be updated

with ig master software in order to report a fully automated immature granulocyte count, which con-

sists of the sum of myelocytes, promyelocytes and metamyelocytes in the blood sample. ig master

software is already standard incorporated in the latest fully automated haematology analyser by

sysmex, the xe-5000 case manager.

Some of the critical care patients show DIFF scattergrams (Fig. 1)

with typical clusters of neutrophils and immature granulocytes with

low sideward scattered light signals. Also on many of these ICU

samples the ‘Imm Gran?’ suspect flag was generated with previous

xe-2100 software versions, suggesting the need for a review of the

blood film and a manual differential count.

To solve this issue, the scattergram data of a selected group of only

ICU patients’ samples was evaluated by sysmex corporation’s

Research and Development Division in Japan (n = 243 samples).

An improved Adaptive Cluster Analysis Software and an improved

flagging algorithm for the IG count were developed, which results

in an excellent correlation (R2 = 0.91) with the manual differential

method (Fig. 2) and at the same time a much lower manual differ-

ential review rate. Samples which showed a ‘Blast’ flag or ‘Left Shift’

flag were excluded from the study. The positive ‘Imm Gran?’ flagging

rate on this selected patient group was reduced from 70 % with the

old software to only 8 % with the newly released software.

The immature granulocyte (IG) count with intensive care patients using XE-IG MASTER and XT-IG MASTER

The immature granulocyte count using XE-IG MASTER and XT-IG MASTER 1/2

Each dark blue dot in the scattergram represents an immature granulocyte.

Fig. 1 ICU patient’s sample with 8.3% immature granulocytes

Fig. 2 IG count on ICU patients’ samples reported by the xe-5000 versus a 200-cell manual differential

xe-5

000

Ref (micro. diff)

IG# (x 10/µL) y = 1,0394 x + 6,338 R2 = 0,9103

This new IG count and flagging algorithm has been implemented in the latest released software of xe-

and xt-series analysers as follows:

n xe-5000: software version 00-02 and higher

n xe-2100: software version 00-33 and higher

n xt-series: xt-ig master software version 00-01 and higher

This advanced feature of xe/xt analysers permits the lab to provide the clinician with fast analysis

results for the immature granulocyte count at day and night time, 7 days/week, with an improved

reproducibility showing e.g. an average CV of 7 % at an IG count of 4 %. The manual differential IG

count is reported to show a mean CV of 50 % on the routine 100-cell differential count. [3] The

excellent reproducibility of the xe-/xt-ig master is due to the fluorescence flow cytometry principle

which analyses up to 8,000 white blood cells in normal patient samples. In ICU patients, the WBC

concentration tends to be much higher, and therefore in such samples more than 10,000 WBC are

differentiated fully automatically on the sysmex xe/xt instruments and reported within only 2 minutes

after aspiration.

References

[1] Frings DP, Montag B, Heydorn A, Friedemann M, Pothmann W, Nierhaus A.

Immature granulocytes, immature myeloid cells and outcome in adult severe sepsis and septic shock. The poster was presented at the 16th Annual

Congress of the European Society of Intensive Care Medicine (ESICM), October 5 - 8, 2003, Amsterdam, The Netherlands.

[2] Briggs C, Kunka S, Fujimoto H, Hamaguchi Y, Davis BH, Machin SJ.

Evaluation of Immature Granulocyte Counts by the xe-ig master: Upgraded Software for the xe-2100 Automated Hematology Analyzer.

Laboratory Hematology 9:117-124 (2003)

[3] Weiland Th, Kalkman H, Heihn H.

Evaluation of the Automated Immature Granulocyte Count (IG) on sysmex xe-2100 Automated Haematology Analyser vs. Visual Microscopy

(NCCLS H20-A). sysmex J Int 12:63-70, 2002

[4] Bruegel M, Fiedler GM, Matthes G, Thiery J. Reference values for immature granulocytes in healthy blood donors generated on the sysmex xe-2100

automated hematology analyser. sysmex J Int 14:5-7, 2004

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