Analytical comparison between two hematological analyzer systems: CAL-8000 vs. XN-9000

SummaryIntroduction This study was aimed to compare the analytical performance of traditional and new parameters and morphological flags of CAL-8000 and XN-9000. The automated differential leukocyte count (DIFF profile) and morphological flags were compared with optical microscopy (OM). Methods A total of 1025 peripheral blood samples, collected in K3EDTA tubes, were analyzed by CAL-8000, by XN-9000, and by OM. Within-run imprecision was performed in low cellularity samples. The comparison was made using Spearman's correlation, Passing–Bablok regression, Bland–Altman bias, and Cohen's K test. Results Within-run imprecision in low cellularity samples yielded reproducible data between the instruments (imprecision was higher than 10% on samples with platelet count <21 × 109/L using impedance technology). Passing–Bablok regression (CAL-8000 vs. XN-9000) yielded slopes ranging between 0.2 to 1.16 and intercepts from −6.54 to 21.63. The bias for leukocytes parameters ranged from −1.8% to −82.2%, the red blood cell parameters from −2.9% to 3.1%, platelets parameters from −27.8% to 26%, and reticulocyte parameters from −115.3% to 4.5%. The comparison of morphological flags yielded a K value always <0.55. The DIFF profile vs. OM had a Passing–Bablok regression with slopes ranging between 0.34 to 1.00 and intercepts from −0.01% to 0.11 and bias ranging from −42.9% to 2.6% for XN-9000 parameters and from −2.7% to 35.0% for CAL-8000 parameters. The comparison of morphological flags showed a K value ranging from 0.35 to 0.77 for XN-9000 and from 0.17 to 0.54 for CAL-8000. Conclusion Differences exist between the two analyzers, especially in the generation of morphology flags, thus emphasizing the need of pursuing a major degree of harmonization and/or adopting instrument-specific reference ranges.