We spoke with János Sáfár and Gergő Kürtös from Budapest: Vet-Med-Labor Zrt. (Budapest), one of the largest providers of clinical laboratory diagnostics in Hungary for the last 20 years, about their experience installing Sysmex’ XN-V and DI-60V. They tell us how the new level of automation has cut hours of processing times, without sacrificing the detail of manual processing, which has allowed them to provide better diagnoses for their partner clinics around the country.

SYSMEX

How would you rate the reliability and consistency of the XN-1500V DI-60V?

Vet-Med-Labor Zrt.

The reliability is excellent, both for the XN-V and the DI-60V. In the first few months, we conducted parallel measurements using our old system and Sysmex. We compared the two and noticed that Sysmex is even more reliable than our old system. For example, in our old system, eosinophil counts were sometimes spuriously low when there was eosinophilia because it differentiated eosinophils based on myeloperoxidase activity. Sometimes, eosinophils were misclassified into the monocyte fraction of the differentials. However, Sysmex does not have this problem because it differentiates based on granularity and nucleic acid content.

Additionally, there were samples with pseudoreticulocytosis where Sysmex performed better, such as in chronic leukemias. Based on our manual examinations, the Sysmex results were much closer to the true values.

For the DI-60V, we also conducted parallel differentials initially, and the results were virtually identical to manual counts under the microscope. The DI-60V performs this digitally on the monolayer, so I no longer perform differentials manually under the microscope.

I completely trust the DI-60V, especially after reclassification.

SYSMEX

What has been your experience with the training and support provided by Sysmex, and what training do you need to provide to your team?

Vet-Med-Labor Zrt.

We are completely satisfied with the training. Initially, the Hungarian team was very supportive in initiating the Sysmex system order. Subsequently, they organised the installation and the initial steps, showing us the basics. Colleagues from Sysmex Europe also spent three days here, providing a more in-depth introduction to using the system. We continue to stay in contact with them for ongoing assistance.

The next step involves using the rules and the Sysmex system, and we anticipate needing their help with this. However, during their visit, we learned most of the basic functionalities.

Sysmex support extends beyond measurements to troubleshooting and maintenance. I am satisfied with this support and still communicate regularly with you about observations on the scattergrams.

The scattergrams are always enjoyable to review because I continually discover new information about the blood samples. I spend a significant amount of time analysing them.

I also train other staff members in the laboratory. Sometimes, when I notice something unusual, such as microfilariae on the scattergrams, I contact the support team.

SYSMEX

Could you explain in a bit more detail?

Vet-Med-Labor Zrt.

The scattergrams and images provide much more information than the numerical data alone. I’m pleased that this information is also shared with our customers, and that you acknowledge that simply viewing a scattergram offers extensive insights. Sometimes, just by looking at the scattergram, I can anticipate what to expect from the smear.

Sysmex has significantly improved our diagnostics. It has elevated haematology to a completely new level in our laboratory. One aspect is the identification of neutrophil changes on the scattergram, such as immature granulocytes or toxic changes indicating inflammation. When I observe an elevated neutrophil cloud on the scattergram, I know there is inflammation in the animal. We also report this to our colleagues and partners, providing them with this information even before smear examinations are conducted.

Currently, we only perform smears upon partner requests. However, in the future, especially with the rule system, we plan to implement reflex measurements and reflex smears. This helps me anticipate what to expect from the smears.

SYSMEX

So, when you see something on the scattergram, you can retrieve it in the DI-60V, and in the morphology?

Vet-Med-Labor Zrt.

Yes, I see the same. When there is a suspected left shift or toxic change on the scattergram, it is very specific, and I observe these changes on the DI-60V as well.

Additionally, it may provide insight into the severity of the change. When the neutrophilic cloud significantly elevates, akin to a volcano, the neutrophils are markedly toxic.

Another example that we have incorporated into our protocols is the small cloud in the microfilaria area of the WDF scattergram, which is highly specific. We always confirm it with a quick blood smear. I believe we identify many microfilaria-infected animals that otherwise would have gone undiagnosed. Although the sensitivity is not as high as the Knott test due to the small blood volume, in cases of heavy microfilaremia, we can make a diagnosis based on our experience. I am looking forward to someone publishing these findings.

But yes, this is beyond the counting. Similarly, for Babesia infections and the microfilaria: when there is heavy parasitaemia with Babesia infections, you can detect it on the reticulocyte scattergram. In the previous system, we had criteria for suspecting Babesia in blood samples, such as leukocytopenia and severe thrombocytopenia. However, with Sysmex, you can actually see the parasites on the scattergram. We provide Babesia suspect information to our partners well before smear examinations are performed.

Many of these dogs are critically ill, so providing an early diagnosis can make a significant difference. Time is a factor, and this is another advantage of Sysmex.

SYSMEX

What about cases with inflammation and nucleated red blood cells?

Vet-Med-Labor Zrt.

Our old system couldn't differentiate between lymphocytes and nucleated red blood cells and sometimes counted them as debris. In our experience, Sysmex is very reliable in this aspect.

When we see the nucleated red blood cell cloud on the scattergram, we always see it on the DI-60V. Initially, I verified the differential count and the enumeration of rubricytes, and it was accurate.

Now, we don't have to correct our haematology results based on smear examinations because Sysmex differentiates accurately. Sometimes, with the old system, if there was no anaemia but rubricytosis was present, we wouldn't have known without smears.

However, rubricytosis is a prognostic factor in many diseases, such as heat stroke and sepsis. This information is valuable for practitioners. Therefore, nucleated red blood cells, along with superior smears and staining, are important features.

SYSMEX

You mentioned maintenance, but what kind of maintenance do you perform on the system daily? Only the washing steps?

Vet-Med-Labor Zrt.

Yes, we add the washing solution, and it performs the washes automatically. I can just summarise it as requiring minimal maintenance, which also saves time, and when maintenance is needed, it is easy to resolve.

SYSMEX

Is there anything else you’d like to mention?

Vet-Med-Labor Zrt.

Regarding future plans with Sysmex, as I mentioned earlier, we will implement the rule system. This will further improve our workflow and diagnostic capabilities.

Another major focus is on exotic animals. We are in contact with some exotic veterinarians in Hungary and hope to gain experience with the PLT-F channel. Sysmex’s ability to analyse exotic and reptile blood with nucleated red blood cells is unique.

We are eager to gain more experience in this area and implement haematology examinations of exotics into our daily routine in the future.

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