Development of the personalized criteria for microscopic review following four different series of hematology analyzer in a Chinese large scale hospital

Background A generally accepted guideline （＂41 rules＂） published by the International Consensus Group for Hematology Review （ICGHR） can not be suitable for all the laboratories because the facility type, laboratory requirements, sample volume, review rate, turn around time, instrument model and characters etc. are quite different from each other, which may cause a higher workload for microscopy review or lead to false or misleading results. Therefore, we decided to develop the personalized review criteria for 4 series of hematology analyzers in the same hospital, and describe all the implement procedures in detail. Methods The total 1770 blood samples were collected from Peking Union Medical College Hospital. Referring to the suggested criteria by international consensus group for hematology review （＂41 rules＂）, the personalized review criteria for 4 series of hematology analyzers including Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i were established and validated by adjusting the rules in order to reduce the false positive rate and keep the false negative acceptable by clinical. Results Using the ＂41 rules＂, high review rates of 37.94%, 35.56%, 33.44% and 37.94% were got respectively in Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i. Three false positive rules mainly were observed in all of 4 analyzers： white blood cell 〈3×10^9/L or 〉30×10^9/L, platelet 〈100×10^9/L or 〉1000×10^9/L and immature granulocyte. Specialized rules were observed in different series of analyzers, atypicaVvariant lymphs flag were found mainly in Sysmex XE-2100, Aniso-RBC were found mainly in Sysmex XT-1800i, flag of ＂immature granulocyte＂ mainly in Sysmex XS-800i, Micro-RBC, Macro-RBC and Aniso-RBC mainly in Siemens Advia 2120. Rules of immature granulocyte blast, and NRBC flag would be mainly triggered by hematology malignant tumor. We could not delete these rules due to the risk of false negative of serious disease, other rules were deleted or revised. After continually optimizing to the rules, we finalized the criteria suitable for Siemens Advia 2120, Sysmex XE-2100, Sysmex XT-1800i and Sysmex XS-800i in our laboratory. The false negative rates were 2.94%, 2.86%, 3.10% and 2.78%, the review rates were 31.07%, 30.00%, 30.01% and 30.09%, and there was no hematology malignant tumor missed. Validated by 547 samples, the false negative rates of our optimized rules were 0.37%, 0.55%, 0.55%, and 0.91% respectively. Conclusion The criteria can be based on the criteria established by International Consensus Group for Hematology Review but must be optimized according to the different requirements.

Expression of matrix metalloproteinase-1 mRNA in peripheral blood mononuclear cells of systemic lupus erythematosus patients and its relationship with atherosclerosis

Background Matrix metalloproteinase-1 （MMP-1） plays an important role in atherosclerosis. This study was to examine expression of MMP-1 mRNA in peripheral blood mononuclear cells （PBMCs） of patients with systemic lupus erythematosus （SLE）, and to explore its relationship with atherosclerosis in SLE. Methods Fluorescent quantitative reverse transcription polymerase chain reaction （RT-PCR） was used to examine the expression of MMP-1 mRNA in PBMCs in 80 SLE patients, including 39 prone to atherosclerosis （Group A） and 41 unprone to atherosclerosis （Group B）. Meanwhile, 30 patients who were free of cardiovascular diseases and 30 healthy individuals were selected as disease and normal control group （Groups C and D）. The changes of MMP-1 gene expression were analyzed by differences of cycle threshold （ACt）, with the following formula： ACt = Cttarget gene - Ctreference gene. Results The expression level of MMP-1 mRNA in Group A was significantly higher than that of group B （ACt=8.64±2.43 vs ACt=12.09±2.26, t=6.588, P 〈0.01）. The expression level of MMP-1 mRNA of SLE patients was significantly higher than that of Group C （ACt=10.41±2.90 vs ACt=12.29±2.51, t=3.135, P 〈0.01） and Group D （ACt=10.41±2.90 vs ACt=12.48±1.69, t=3.675, P 〈0.01）. Conclusions In comparison to disease and control group, expression of MMP-1 mRNA in PBMCs of SLE patients was significantly elevated, and significant difference of MMP-1 mRNA expression was also found between SLE patients prone and unprone to atherosclerosis, indicating that expression of MMP-1 mRNA may be correlated with the pathogenesis and activity of atherosclerosis in SLE.