In the study "Red and white blood cell morphology characterization and hands-on time analysis by the digital cell imaging analyzer DI-60" conducted by Kweon, Lim, Lee, and Kim (2022), they evaluated the performance of the Sysmex DI-60 on the precision of RBC morphology characterization, WBC differentials, and hands-on time analysis. For the RBC characterization, most RBC morphologies such as polychromatic cells, target cells, spherocytes, ovalocytes, teardrop cells, acanthocytes, and basophilic stippling showed inconsistent results, except for elliptocytes. The analysis of schistocytes showed high sensitivity with poor specificity.

For WBC analysis, neutrophils, lymphocytes, monocytes, and eosinophils showed validity in pre-classification and verification, while immature granulocytes, blasts, and normoblasts showed high sensitivity and specificity. DI-60 showed unreliable results for basophils, which caused false-positive results for classifying other WBCs as basophils. For hands-on time analysis, the performance was considerably shorter, and the total assay time is longer than the manual procedure. It was unacceptably long for routine tests that lead to low WBC counts.

The study had many limitations, yet Sysmex DI-60 has demonstrated acceptable performance in RBC morphology characterization, WBC differentials, and hands-on time analysis. Through training, careful utilization, and elaborate workflow processes, Sysmex DI-60 can contribute to the improvement of the efficiency of the hematology laboratory.

According to Kweon et.al ( 2022), They evaluate the Sysmex DI-60 performance in terms of RBC morphological characterization precision, WBC differentials, and the total assay time including hands-on time.

Except for elliptocytes, most RBC morphologies (polychromatic cells, target cells, spherocytes, ovalocytes, teardrop cells, acanthocytes, and basophilic stippling) produced conflicting results when characterized. The study of schistocytes revealed great sensitivity but poor specificity. Moreover, Neutrophils, lymphocytes, monocytes, and eosinophils performed well in pre-classification and verification of WBCs, but immature granulocytes, blasts, and normoblasts demonstrated excellent sensitivity and specificity. Sysmex DI-60 produced inaccurate results for basophils, resulting in false-positive results when identifying other WBCs as basophil. The performance for hands-on time analysis was significantly lower, although the total assay time was longer than the manual technique. It was too long for routine tests that resulted with low WBC counts.

The study had a number of drawbacks, although Sysmex DI-60 performed well in RBC morphological characterization, WBC differentials, and hands-on time analysis. Sysmex DI-60 can help to improve the efficiency of the hematology laboratory by providing training, careful utilization, and detailed workflow protocols.

Reference:

Kweon, O. J., Lim, Y. K., Lee, M., & Kim, H. R. (2022). Red and white blood cell morphology characterization and hands-on time analysis by the digital cell imaging analyzer DI-60. PLOS ONE, 17(4), e0267638. https://doi.org/10.1371/journal.pone.0267638

According to the evaluation performance of Sysmex DI-60 by Kweon, et al (2022), in comparison to manual slide inspection, DI-60 recognized polychromasia, target cells, and ovalocytes with satisfactory accuracy. However, DI-60 had low specificity (10.4%) for schistocytes despite its great sensitivity (97.2%). In the precision analysis of RBC morphological characterization, borderline samples containing specific RBCs revealed variations in the positive results over 20 replicates. In particular, six out of ten samples showed discrepancies in schistocyte precision. For WBC differentials, the overall agreement between pre-classification results and user-verified results was 89.4%. Except for basophils, normal WBCs had a strong connection with DI-60 (after user verification) and manual counts.

In conclusion, DI-60 performed satisfactorily with normal samples. However, it should be used cautiously, though, for aberrant WBC differentials and RBC morphological characterization. But it is also important to take note that DI-60 has the potential to enhance laboratory productivity while increasing viability.