Optimizing Leukocyte Analysis for Pediatric Leukemia: A Comparison of Two Advanced Hematology Analyzers

Alifferdi Rahman  Wiyono; Aryati  Aryati; Yulia Nadar  Indrasari; Mia Ratwita  Andarsini

doi:10.18502/ijpho.v15i3.18917

Alifferdi Rahman Wiyono Clinical Pathology Specialization Program, Faculty of Medicine – Universitas Airlangga, Surabaya
Aryati Aryati Departement of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya
Yulia Nadar Indrasari Departement of Clinical Pathology, Dr. Soetomo General Academic Hospital, Surabaya
Mia Ratwita Andarsini Departement of Child Health, Dr. Soetomo General Academic Hospital, Surabaya

DOI: https://doi.org/10.18502/ijpho.v15i3.18917

Keywords: Leukemia, Leukocyte Count, Lymphoid, Pediatrics

Abstract

Background: Acute lymphocytic leukemia (ALL) is a hematologic malignancy affecting the lymphoid lineage, characterized by the uncontrolled proliferation of abnormal, immature lymphocytes and their precursors. The routine use of automated hematology analyzers has become a valuable aid for clinicians in diagnosing leukemia. This study aims to examine the correlation between two automated hematology analyzers in patients with leukemia, particularly in pediatric populations.

Materials and Methods: This cross-sectional study involved 57 pediatric patients diagnosed with leukemia who were referred to the Paediatric Hematology Outpatient Clinic at Dr. Soetomo General Academic Hospital, Indonesia. After obtaining informed consent, peripheral blood samples were collected in ethylenediaminetetraacetic acid (EDTA) tubes and analyzed using the Sysmex XN-Series and Horiba Yumizen H2500 automated hematology analyzers. Parameters measured included White Blood Cell (WBC) count, Neutrophil Percentage (NEU%), Lymphocyte Percentage (LYM%), Eosinophil Percentage (EOS%), and Monocyte Percentage (MON%). Data were analyzed using SPSS version 21. Statistical tests applied included the Kolmogorov-Smirnov test, Shapiro-Wilk test, paired t-test, Wilcoxon signed-rank test, Spearman’s and Pearson’s correlation test, Passing-Bablok regression, and Bland-Altman analysis. A p-value of < 0.05 was considered statistically significant.

Results: Statistically significant differences were observed between the two analyzers in the median values of WBC count (p = 0.001) and MON% (p = 0.006), as well as in the mean value of NEU% (p = 0.024). Despite these differences, strong correlations were found across all parameters, including WBC, NEU%, LYM%, MON%, and EOS% (p < 0.01). EOS% demonstrated higher variability (S_res) = 1.48.

Conclusion: The Sysmex XN-Series and Yumizen H2500 demonstrated a good correlation in the measurement of WBC parameters in pediatric leukemia patients. However, minor variations, particularly in eosinophil percentages, may arise due to differences in measurement techniques, reagent formulations, and interlaboratory variability. Despite these variations, both analyzers are reliable for clinical use.