International Journal of Laboratory Hematology The Official journal of the International Society for Laboratory Hematology
LETTER TO THE EDITOR
INTERNAT IONAL JOURNAL OF LABORATO RY HEMATO LOGY
Letter to the Editor Response to letter from Dr Jain Sir, Thank you for comments on our paper untitled ‘Use of Sysmex XE-2100 and XE-5000 hematology analyzers for the diagnosis of malaria in a nonendemic country (France)’ [1]. As far as malaria related to Plasmodium vivax, malariae, or ovale is concerned, abnormal WBC scattergrams generated by Sysmex hematology analyzers (the so-called DIFF) are almost the rule (> 80% cases). Mature schizonts are not destroyed by red blood cell lysis agents and, due to the presence of hemozoin, are detected by the analyzers as possible WBC. Due to the refraction and other conductivity parameters, relevant dots are located mainly in a region located between the neutrophil and the eosinophil areas. We observed several peculiar DIFF scattergrams in our patients diagnosed in a nonendemic country (see Fig 1 from our paper, published in 2013 [1]). Huh et al., and next Campuzano-Zualaga et al., observed similar DIFF pictures in malaria cases in endemic countries [2, 3]. Among these various DIFF scattergrams, it is possible to discriminate between pseudoeosinophilia in one hand and every among the other peculiar DIFF scattergrams in the other hand. In routine conditions, it is not relevant to control microscopically every ‘eosinophilia’ demonstrated by hematology analyzers, namely if number is only slightly elevated, as it is the case for ‘pseudoeosinophilia’ from patients with malaria. Huh et al. [2] observed previously that, in patients suspect for Plasmodium vivax malaria, spurious eosinophilia occurred frequently on Sysmex hematology analyzers. Spurious eosinophilia can be pointed out in that instance only because malaria is not known as responsible for eosinophilia. As a rule, every
References 1. Dubreuil P, Pihet M, Cau S, Croquefer S, Deguigne PA, Godon A, Genevieve F, De Gentile L, Zandecki M. Use of Sysmex XE2100 and XE-5000 hematology analyzers for the diagnosis of malaria in a nonendemic
e64
absolute eosinophil count slightly over the normal limits for age does not correspond to malaria. Dealing with the other abnormal DIFF scattergrams, out of patients with malaria, we observed them only in a very few instances, related to eosinophilia. So, we consider their occurrence in every full blood count analyzed as suspect for malaria. Jain, Gupta, and Grover show an example of neutrophilic leukocytosis with toxic granulations (from bacterial infection? bone marrow recovery after chemotherapy?) together with shift to the right of the neutrophil cloud which can mimic some peculiar DIFF scattergrams others and us reported in malaria [1– 3]. In conditions related to neutrophilic leukocytosis, such as in chronic myelocytic leukemia, abnormally large and/or right-shifted neutrophil cloud may be observed. However, DIFF scattergrams generated in conditions related to neutrophilic leukocytosis differ from those observed in malaria, as the cloud of dots related to neutrophils is quite large. In malaria, leukocytosis is quite rare and its occurrence leads to the hypothesis of bacterial infection to be added. Eventually, we cannot exclude that in some rare instances peculiar DIFF scattergrams mimicking those described in our papers [1–3] and unrelated to malaria may occur, but the use of all parameters from the full blood count, together with DIFF scattergrams, may help diagnosis of malaria (either P. vivax, ovale, or malariae).
M. Zandecki, P. Dubreuil CHU Angers, Angers, France E-mail: [email protected] doi: 10.1111/ijlh.12300
country (France). Int J Lab Hematol 2014;36:124–34. 2. Huh HJ, Oh GY, Huh JW, Chae SL. Malaria detection with the Sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram. Ann Hematol 2008;87:755–9.
3. Campuzano-Zuluaga G, Alvarez-Sanchez G, Escobar-Gallo GE, Valencia-Zuluaga LM, Rios-Orrego AM, Pabon-Vidal A, MirandaArboleda AF, Blair-Trujillo S, CampuzanoMaya G. Design of malaria diagnostic criteria for the Sysmex XE-2100 hematology analyzer. Am J Trop Med Hyg 2010;82:402–11.
© 2014 John Wiley & Sons Ltd, Int. Jnl. Lab. Hem. 2015, 37, e64
LETTER TO THE EDITOR
INTERNAT IONAL JOURNAL OF LABORATO RY HEMATO LOGY
Letter to the Editor Response to letter from Dr Jain Sir, Thank you for comments on our paper untitled ‘Use of Sysmex XE-2100 and XE-5000 hematology analyzers for the diagnosis of malaria in a nonendemic country (France)’ [1]. As far as malaria related to Plasmodium vivax, malariae, or ovale is concerned, abnormal WBC scattergrams generated by Sysmex hematology analyzers (the so-called DIFF) are almost the rule (> 80% cases). Mature schizonts are not destroyed by red blood cell lysis agents and, due to the presence of hemozoin, are detected by the analyzers as possible WBC. Due to the refraction and other conductivity parameters, relevant dots are located mainly in a region located between the neutrophil and the eosinophil areas. We observed several peculiar DIFF scattergrams in our patients diagnosed in a nonendemic country (see Fig 1 from our paper, published in 2013 [1]). Huh et al., and next Campuzano-Zualaga et al., observed similar DIFF pictures in malaria cases in endemic countries [2, 3]. Among these various DIFF scattergrams, it is possible to discriminate between pseudoeosinophilia in one hand and every among the other peculiar DIFF scattergrams in the other hand. In routine conditions, it is not relevant to control microscopically every ‘eosinophilia’ demonstrated by hematology analyzers, namely if number is only slightly elevated, as it is the case for ‘pseudoeosinophilia’ from patients with malaria. Huh et al. [2] observed previously that, in patients suspect for Plasmodium vivax malaria, spurious eosinophilia occurred frequently on Sysmex hematology analyzers. Spurious eosinophilia can be pointed out in that instance only because malaria is not known as responsible for eosinophilia. As a rule, every
References 1. Dubreuil P, Pihet M, Cau S, Croquefer S, Deguigne PA, Godon A, Genevieve F, De Gentile L, Zandecki M. Use of Sysmex XE2100 and XE-5000 hematology analyzers for the diagnosis of malaria in a nonendemic
e64
absolute eosinophil count slightly over the normal limits for age does not correspond to malaria. Dealing with the other abnormal DIFF scattergrams, out of patients with malaria, we observed them only in a very few instances, related to eosinophilia. So, we consider their occurrence in every full blood count analyzed as suspect for malaria. Jain, Gupta, and Grover show an example of neutrophilic leukocytosis with toxic granulations (from bacterial infection? bone marrow recovery after chemotherapy?) together with shift to the right of the neutrophil cloud which can mimic some peculiar DIFF scattergrams others and us reported in malaria [1– 3]. In conditions related to neutrophilic leukocytosis, such as in chronic myelocytic leukemia, abnormally large and/or right-shifted neutrophil cloud may be observed. However, DIFF scattergrams generated in conditions related to neutrophilic leukocytosis differ from those observed in malaria, as the cloud of dots related to neutrophils is quite large. In malaria, leukocytosis is quite rare and its occurrence leads to the hypothesis of bacterial infection to be added. Eventually, we cannot exclude that in some rare instances peculiar DIFF scattergrams mimicking those described in our papers [1–3] and unrelated to malaria may occur, but the use of all parameters from the full blood count, together with DIFF scattergrams, may help diagnosis of malaria (either P. vivax, ovale, or malariae).
M. Zandecki, P. Dubreuil CHU Angers, Angers, France E-mail: [email protected] doi: 10.1111/ijlh.12300
country (France). Int J Lab Hematol 2014;36:124–34. 2. Huh HJ, Oh GY, Huh JW, Chae SL. Malaria detection with the Sysmex XE-2100 hematology analyzer using pseudoeosinophilia and abnormal WBC scattergram. Ann Hematol 2008;87:755–9.
3. Campuzano-Zuluaga G, Alvarez-Sanchez G, Escobar-Gallo GE, Valencia-Zuluaga LM, Rios-Orrego AM, Pabon-Vidal A, MirandaArboleda AF, Blair-Trujillo S, CampuzanoMaya G. Design of malaria diagnostic criteria for the Sysmex XE-2100 hematology analyzer. Am J Trop Med Hyg 2010;82:402–11.
© 2014 John Wiley & Sons Ltd, Int. Jnl. Lab. Hem. 2015, 37, e64
