Sysmex DI-60 is an hematology automated analyzer and it has a capability to recognize specific red blood cells and differentiation of white blood cells is ideal. However, there are some abnormal red blood cells or white blood cells that show high sensitivity but low specificity in the machine.
Unfortunately, I did not use Sysmex DI-60 and only use the CellaVission DM and in general it is acceptable. With any digital microscope, I think need to review the morphology and double check all the sorted cells to identify any suspicious cells and you can use the manual and normal microscope to confirm any doubtful morphology.
The most frequent and widespread error in the use of microscopic digital image digitization systems, including Sysmex DI-60, is to consider these tools as the final step of the process of hematological morphological diagnosis.
Actually, these tools should be used for cellular PRE-CLASSIFICATION only, followed by two other steps: visual RE-CLASSIFICATION and, where appropriate, direct microscopy.
Most digitization systems must standardize the image obtained with automated editing systems (such as Photoshop) that ward off cell morphology from REAL light microscopy.
See the attached paper as an example.
Yes, there is a specific leukemia that fails to show in Sysmex DI-60.
In the study "Red and white blood cell morphology characterization and hands-on time analysis by the digital cell imaging analyzer DI-60" by Kweon, Lim, Lee, and Kim (2022), it was noted that the Sysmex DI-60 demonstrated a sensitivity of only 37.5% in detecting atypical lymphocytes, a performance level deemed as "unsatisfactory" by the authors. Sensitivity, operationally defined as the instrument's capacity to accurately identify a specific cell type, is of concern given the notably low sensitivity observed for atypical lymphocytes. This limitation may potentially impede the precise identification and classification of certain leukemia types, particularly Chronic Lymphocytic Leukemia (CLL) and Acute Lymphoblastic Leukemia (ALL).
Atypical lymphocytes are typified by their enlarged size and often exhibit heightened protein synthesis, leading to a deeper blue hue of the cytoplasm when subjected to Romanowski staining (Rastogi & Campbell, 2021). Although the presence of these cells in peripheral blood smears may not be considered pathognomonic for CLL and ALL, their identification can nonetheless contribute significantly to the accurate diagnosis of these leukemia subtypes (Koprowski, 2023; Rastogi et al., 2021). This underscores the significance of augmenting the sensitivity of Sysmex DI-60 in discerning atypical lymphocytes.
While CBC testing, including Sysmex DI-60 analysis, can detect abnormalities in blood cell counts that may suggest the presence of leukemia, additional diagnostic tests such as peripheral blood smear examination, bone marrow aspiration and biopsy, flow cytometry, cytogenetic analysis, and molecular testing are often required for accurate diagnosis and classification of leukemia subtypes.
In summary, while Sysmex DI-60 is a valuable tool for initial screening and monitoring of leukemia patients, it may not always provide a definitive diagnosis, especially for rare or atypical leukemia subtypes. A comprehensive diagnostic approach involving clinical evaluation and multiple laboratory tests is necessary for accurate diagnosis and classification of leukemia.
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