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May 2021

Sysmex Connect In this issue The CN-Series Virtual Product Launch User Symposium - Save the Date Corporate Social Responsibility Sysmex Academy Online (SAO) Launch The Grange University Hospital Install

www.sysmex.co.uk

Sysmex Connect – May 2021

In this issue

Note from the Editor Welcome back to Sysmex Connect!

02 Note from the Editor & Sysmex News

Sysmex Connect shares updates from Sysmex UK and the latest news and innovations from the world of Pathology.

03 The CN-Series Virtual Product Launch

The May issue begins with an exciting introduction to the next generation family of haemostasis analysers, the CN-Series! We share details of the Virtual Product Launch event and are proud to announce the first installation of the CN-Series at Guy’s and St. Thomas’ Hospital, in London.

04 The First CN-Series Install at St. Thomas’ Hospital, London 06 Save the Date – Virtual Symposium 2021

We are delighted to confirm that our annual Sysmex UK User Symposium will be returning this year in a virtual format, turn to page 6 for dates and more information on the Call for Posters process. We share a unique update from our Environmental Committee on our Corporate Social Responsibility (CSR) including some revealing statistics on reduced paper and plastic consumption during COVID-19.

07 Call for Online Posters 08 Corporate Social Responsibility 09 Sysmex Academy Online (SAO) Launch

Sysmex Academy Online (SAO) is now live! Turn to page 9 to become familiar with all the important portal changes, gain access to our exclusive YouTube playlists and your own to-do checklist.

10 Embracing Statistics in the Modern Medical Laboratory

Sysmex UK have teamed up with Stephen MacDonald, a Principal Clinical Scientist Specialist in the Haemostasis Unit at Cambridge University Hospitals NHS Foundation Trust, to bring you a free-ofcharge series of educational webinars focusing on laboratory statistics. Turn to page 10 and 11 to discover dates and find out how to register for these informative webinars.

12 The Grange University Hospital Install 14 Scientific Trainee Placement 16 Growing Your Knowledge – Sysmex Scientific Focus

We share a special inter view with Stacey Wetherell, the Haematology Operational Manager ABUHB and Tim Walbyoff, the Pathology Procurement and Project Officer ABUHB, to take us through their unique experience of the installation and go-live process at The Grange University Hospital during the COVID-19 pandemic.

Turn to page 14 and 15 to read an exclusive interview on George Tarpley’s experience on his Scientific Trainee placement at the Haematology laboratory, Queen Elizabeth Hospital Gateshead during the circumstances incurred by the pandemic.

Sysmex Publications We have compiled a list of recent publications on the connection between COVID-19 and haematology and haemostasis parameters.

The publication list will be regularly updated as more studies are released. For articles of interest click the link below.

Finally, we provide information on our new regular feature ‘Growing Your Knowledge’ focusing on Haemoglobinisation parameters on the Sysmex XN-Series Haematology analysers.

Please do send us your suggested areas of improvement, recommendations and proposals for topics that might benefit inclusion. We love hearing from you and how we can make our newsletter most beneficial to you.

For more information about any of the articles included in this newsletter or to share your thoughts with us, please contact: marketing@sysmex.co.uk.

We hope that you enjoy this issue and look forward to sharing future issues with you.

Sysmex Connect Editorial Team Remember to connect with us on LinkedIn.

Sysmex

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Sysmex Connect – May 2021

Sysmex News Sysmex UK recognise that workload in laboratories can vary throughout the day, balancing varied shift systems to maintain essential services. We understand Instrument support is critical outside of our core business hours, with many laboratories operating early and late shifts.

Urgent Telephone Enquiries Please note our 0870 contact telephone numbers will no longer be in use from 8th June 2021. Please get in touch with our support teams on the below telephone numbers.

Product hotline: Service hotline: Poch-100i hotline: MSC hotline:

We have listened to customer needs and are now able to offer further support to our customers by introducing our newly extended opening hours, where you will be able to speak to a specialist for all instrument support and enquiries.

The Sysmex Laboratory Notification Sysmex (LNS) is also available FOC to all our customers and can facilitate communication regarding open cases.

Our new Customer Support Centre hours: Monday

Tuesday Wednesday Thursday Friday

0333 320 3466 0333 320 3467 0333 320 3463 0333 320 3464

08:30–17:30 08:30–17:30 08:30–17:30 08:30–17:30 08:30–17:30

Non-Urgent Enquiries Support mailboxes will also be monitored during these times. productmail@sysmex.co.uk for Product Applications queries. servicemail@sysmex.co.uk for Technical queries.

Your complete haemostasis solution brought to you virtually.

At Sysmex UK, we are committed to challenging ourselves continuously to offer innovative solutions that respond to increasingly varied and sophisticated customer needs. The new CN-Series has been designed to provide a highly powerful solution and to deliver answers to your haemostasis testing requirements in terms of productivity, services, analytical and operational performance.

We are continuing to embrace all things digital and are delighted to announce that the CN-Series will be launching virtually in a live streamed event.

The launch event programme will feature an in-depth product demonstration showcasing the full range of operational highlights that this analyser has to offer. Attendees will be invited to participate in a live questions and answers session with our Sysmex UK product expert, Krishna Ram and to explore an interactive 3D product tour for a close-up experience. Furthermore, a media centre of supplementary materials and resources will be made available.

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Free To Attend –Event– 17th June

The CN-Series Virtual Launch Event Date: Thursday 17th June 2021 Time: 2-5pm If you would like to attend, please email CN-Series@sysmex.co.uk

We would love to see you there!

Sysmex Connect – May 2021

The first CN-Series install at St. Thomas’ Hospital, London Sysmex UK are proud to announce the first installation of their next generation family of haemostasis analysers, the CN-Series at Guy’s and St. Thomas’ Hospital, in London.

At Guy’s and St. Thomas’ Hospitals, their need was for a compact yet high throughput solution for their routine laboratory. Two CN-6000 analysers have been installed into St. Thomas’ Hospital as a replacement for their current two CS-2100i’s for routine haemostasis testing, with a 22% saving on footprint delivering an unrivalled 900 test per hour capability, a 250% increase in throughput. Supported by an ever-expanding number of liquid ready-to-use reagents from HYPHEN Biomed SAS, improvements to the refrigerated reagent table allows the CN-Series to provide even longer on-board stability of reagents and reduce the frequency at which reagents require replacing.

“The faster turnaround times provided by the CN Series will benefit our staff and users enormously and I’m particularly looking forward to moving our platelet aggregometry assay to the fully automated CN platform.”

Aine McCormick, Principal Biomedical Scientist for Viapath at St. Thomas’ Hospital

From Left to Right: Eleanor Foxton (Principal BMS), Kasia Mayger (Senior BMS), Aine McCormick (Principal BMS), Charlotte Noronha (Operations Manager), Clare Wigley (Senior BMS)

The introduction of the CN-Series to Guy’s and St. Thomas’ Hospitals as Sysmex UK’s first installation sites is made all the more special considering Sysmex’s history with this customer. From the CA-Series (with the CA-7000 and CA-1500 systems) to the CS-Series (with the CS-2000/2100i and CS-2400 systems), Sysmex UK have provided automated haemostasis analysers to Guy’s and St. Thomas’ hospitals for over 20 years!

St. Thomas’ hospital have been expert evaluators of analytical systems over that time and have conducted studies on Lupus 1,2,3,4, automated platelet aggregometry 5, and the importance of using an acceptable linear calibration curve for coagulation factor assays 6 using the CA and CS-Series analyers. The CN-Series offers the site advanced clinical services through haemostasis laboratory testing.

The CN-Series, Sysmex’s most advanced haemostasis systems to date, have been created to provide a highly powerful solution by delivering answers to laboratory haemostasis testing requirements in terms of productivity, services, analytical and operational performance.

“The smaller footprint, high throughput, reduced maintenance and increased audit trail made the CN Series analysers the best option for our analyser refresh programme. The opportunity to be among the first labs to be using the new generation, state of the art systems is very exciting.”

The CN-3000/6000 with Extended sampler provides a loading capacity of up to 120 samples at any one time

Jacqueline Cutler, Operations Manager for Viapath at St. Thomas’ Hospital

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Sysmex Connect – May 2021

“Enhanced Quality Control (QC) options makes QC management easier with current and new QC lots to be performed concurrently, making QC batch acceptance simple. Also, the ability to run plasma-based controls and calibrators from their original vials as this will save errors in decanting reagents and is environmentally better too as it will reduce the number of plastic cups we use and barcode labels we print, also reducing the chance of transcription errors.”

Clare Wigley, Senior Biomedical Scientist for Viapath at St. Thomas’ Hospital In the coming weeks, Sysmex UK will also be installing a CN-6500 system into St. Thomas’ Hospital. The CN-6500 offers integrated chemiluminescence enzyme immunoassay (CLEIA) testing alongside ‘classical’ haemostasis testing of clot-based, immunoturbidimetric, chromogenic and aggregation assays. This means that that CN-6500 will allow haemostasis service providers to consolidate the widest test portfolio onto a single platform located in the haemostasis laboratory.

With the increased walk-away time made possible with the CN-Series, this leaves more time to do other tasks in the laboratory (as well as enjoy the view).

“The biggest difference to service provision is actually the improvement to stop reading once a clot has been detected, so we don’t always have to wait for a standardised measurement time to get the result.

P e r s o n a l l y, I a m m o s t l o o k i n g f o r w a rd t o e x p l o r i n g t h e chemiluminescence on the CN-6500 and being able to streamline our testing through one analyser system.”

Designed to provide power in productivity, analytical and operational performance, the CN-Series: M aximises walk-away time with the extended sampler, with a loading capacity of 120 samples at any one time.

Eleanor Foxton, Principal Biomedical Scientist for Viapath at St. Thomas’ Hospital

S hortens the time to result for clot-based tests to less than 4.5 minutes from sample aspiration.

P rovides customisable multi-sample volume and assayspecific HIL checks to confirm sample fill volume & detect the presence of interfering substances in samples, to ensure sample quality.

R educes system down-time by the performance of automatic ‘self-checks’ and enhancements made to the sample probe and light source.

T h e C N - 6 5 0 0 a d ds ch emilumin e s cen ce te s ting of immunological assays to the 4 detection methods of the CN-6000 model. Resulting in random access CLEIA, clotbased, immunoturbidimetric, chromogenic and aggregation testing on one system.

References 1) Moore GW, Kumano O. (2020). Lupus anticoagulant assay cut-offs vary between reagents even when derived from a common set of normal donor plasmas. J Thromb Haemost.

5) Platton S, McCormick A, Bukht M, Gurney D, Holding I, Moore GW. (2018). A multicenter study to evaluate automated platelet aggregometry on Sysmex CS-Series coagulation analyzers-preliminary findings. Res Pract Thromb Haemost.

2) Kumano O, Moore GW. (2019). Ruling out lupus anticoagulants with the mixing test-specif ic cut-off assessment and the index of circulating anticoagulant. Res Pract Thromb Haemost.

6) Moore GW, Dunsmore C. (2017). The Importance of Using an Acceptable Linear Calibration Curve for Coagulation Factor Assays. Viapath News and Press. (http://www.viapath.co.uk/news-and-press/the-importance-of-usingan-acceptable-linear-calibration-curve-for-coagulation-factor)

3) Moore GW, Peyrafitte M, Dunois C, Amiral J. (2018). Newly developed dilute Russell’s viper venom reagents for lupus anticoagulant detection with improved specificity. Lupus.

4) Moore GW, Rangarajan S, Savidge GF. (2008). The activated seven lupus anticoagulant assay detects clinically significant antibodies. Clin Appl Thromb Hemost.

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Sysmex Connect – May 2021

ENGAGE

with presentations on a range of topics

Register

Login

Live

OPPORTUNITY

to gain CPD recognition

Live Webinars

PARTICIPATE

in live Q&A sessions with keynote speakers

Following the overwhelming success of last year’s first ever virtual Sysmex UK Virtual Symposium, we are continuing to embrace all things digital and are delighted to announce that the annual User Symposium will be returning this year in a virtual format!

We are looking forward to offering you a packed programme of quality scientific content featuring engaging presentations from keynote speakers.

Engage with presentations on a range of topics CPD recognition can be gained from attending

Free To Attend –Event–

Participate in live Q&A sessions with keynote speakers

17th June

The Virtual Symposium will be held Tuesday 23rd November – Thursday 25th November 2021 Please note that these sessions will be brought to you free-of-charge, there is no requirement to use training credits to attend.

Please put these dates in your diary. We would love to see you there!

Further programme information and details of how to participate will follow.

For the continued safety of our customers and our staff, the Sysmex UK User Symposium 2021 will not be held at the Midland Hotel Manchester. Hopefully we will be able to return there in 2022 in safer circumstances.

Introducing the Young Scientist Session It is our pleasure to be launching a NEW inclusion into the User Symposium programme for 2021 - the Young Scientists Session. This is a prestigious opportunity to be a part of the Symposium programme and is offered to early-career scientists working at Sysmex UK Direct MSC customer sites. This is a fantastic opportunity to demonstrate scientific knowledge and to gain the recognition and interest from the wider Sysmex UK scientific community.

To register interest in taking part, please ask your lab manager to nominate you by emailing usermeeting@sysmex.co.uk.

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Sysmex Connect – May 2021

Carol Briggs Award 2021 Call for Posters!

Sysmex UK Virtual Symposium 2021 Dates: Tuesday 23rd – Thursday 25th November 2021 We would like to invite you to submit a poster for the Sysmex UK User Symposium 2021.

If you or your colleagues would like to submit a poster, please read the key information below.

60%

60%

60%

To register your interest, please email the title of your poster to: usermeeting@sysmex.co.uk by Friday 23rd July 2021 Deadline for submitting posters: Friday 22nd October 2021 Prize: The Carol Briggs Award - £2,500 restricted educational grant*.

Please note, posters must be submitted in Portrait format.

If you require a layout guide template, please email usermeeting@sysmex.co.uk. *The restricted educational grant must be used for the winner's own professional development. A proposal must be submitted to Sysmex UK prior to the use of the grant.

Attendees of the Virtual Symposium 2021 will be sent the Poster submissions to browse at leisure in advance of the Symposium webinar sessions, in the format of a virtual ebrochure. The winner and runner-up of the Carol Briggs Award 2021 will be announced at the start of each session at the Virtual Symposium.

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Sysmex Connect – May 2021

Corporate Social Responsibility Sysmex UK is certified to ISO 14001:2015, the Environmental Management System, which is managed by our Business Management Systems (BMS) team. As you may be aware, part of this standard requires a commitment to continual improvement. Our Environmental Committee are involved in this, making recommendations to the leadership team, and then communicating these to the company and tracking progress.

Sysmex UK first started our environmental committee back in 2015, under the title 'Environmental Angels', before becoming a formal committee two years ago. All our committee members are volunteers, with a passion for environmental issues and a commitment for championing them within the company.

In 2020 our objectives were to reduce printed paper use by 25% over two years, raise awareness of the environmental committee and their activities, and to reduce plastic bottle waste at SUK by 25%.

Objectives: Reduction of Office Printed Paper & Plastic Bottles Printed paper

Plastic bottles

25%

25%

Black & White

Q1

Colour

Q2 2019-2020

Q3

Q1

Q4

Q2 2019-2020

2020-2021

There is a monthly newsletter from the committee distributed to the company outlining what we’ve been working on. During lockdown and working from home we’ve also been making good use of the Microsoft Teams channels with environmentally related conversation starters from committee members – discussing time and mileage saved during lockdown proved a good draw. As part of our engagement with the company we carried out a staff survey – the first of what we expect will be an annual occurrence. We hope to use the information to identify more ways to get people involved and develop company objectives that mean something to Sysmex’s employees. We got some great feedback and bits of information, for example 92% of those who responded still use a paper notebook, and 17% have saved over 10,000 miles since the start of the pandemic!

Q3

Q4

2020-2021

For our final objective, we successfully achieved our target, seeing a 60% reduction in plastic bottles, which equates to 78kg of plastic saved.

Our 2019 objectives were to reduce plastic bottle waste at SUK by 50%, increase awareness of the committee and its activities externally, and to investigate how to increase electric and hybrid cars in the company fleet by understanding the barriers that exist.

Moving into 2021 we want to go even further.

Our Environmental Management System was put through its paces in April with a recertification audit from BSI. We are pleased to say that not only did we have a successful audit with recommendation for recertification, but we did so with no non-conformances, a great result.

We are pleased to say that we achieved all three of our objectives, although admittedly the impact of coronavirus may have helped somewhat.

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Sysmex Connect – May 2021

Sysmex Academy Online (SAO) Launch We are pleased to announce that the Sysmex Academy Online is now LIVE!

Access Sysmex Academy Online In addition to the above, Training Officers will notice the following changes:

Training Exams xisting training exams will no longer be available, all E competency and resit exams will need to be taken on Sysmex Academy Online.

Academy Home > Information >

Reagent Delivery Dates

T's & C's >

Book a Course >

Self Testing Details and Certificates >

xisting reagent delivery dates will remain visible, future E updates will only be available via Sysmex Academy Online.

Onsite Training >

User Symposium Registration >

Previous credit usage and staff testing information will remain available to allow customers to record this data if required until the current portal is deactivated.

FSCA/Software Upgrade Information

Sysmex News Centre

Credit Usage >

Training Academy functionalities - Book a course, onsite training, T&Cs, User Symposium registration and E-Book requests will be transferred to Sysmex Academy Online and made available under the Lab Manager role.

The following services will be transferred to Sysmex Academy Online: Digital Library

E-Book Request >

NEW - Online Training

The existing Customer Portal will remain active for a limited period following the launch of SAO, after this time previous training history will only be available upon request from Sysmex UK. We advise customers to begin documenting laborator y training records if they wish to retain this information locally.

Webinars will now be booked and hosted via Sysmex Academy Online.

Document resources will be available on Sysmex Academy Online under Regulatory and Knowledge Base.

Quality manager update notifications will continue from Sysmex Academy Online.

SAO – General User YouTube playlist:

SAO – Lab Manager YouTube playlist:

Scan the QR code to access the playlist which includes the following videos: Course Enrolment Login from Google User Overview User Profile

Scan the QR code to access the playlist which includes the following videos: Login from Google

Lab Manager – Course Enrolment & Onsite Training Lab Manager – Manage your Organisation

CLICK HERE TO ACCESS LAB MANAGER PLAYLIST

CLICK HERE TO ACCESS GENERAL USER PLAYLIST

Your SAO checklist Sysmex Academy Online is a separate entity to the existing Customer Portal. As part of the transition over to Sysmex Academy Online, there are a few things to do. To make it easier, we have created a SAO checklist:

General User: Download all your current training certificates Please click on the button below to gain access to the ‘SAO – How to guide’ which details how to download and save your training history in preparation for uploading onto Sysmex Academy Online.

DOWNLOAD

Upload all your training certificates to Sysmex Academy Online Click on the button below to gain access to the ‘SAO – How to guide’ which details how to upload all your training certificates onto Sysmex Academy Online.

DOWNLOAD

Lab Managers: Sign-up to Sysmex Academy Online To help initiate the new sign-up process, please click on the button below to access and download the Sysmex Academy Online user creation DOWNLOAD form and please fill out the required fields.

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If you have any further questions, please feel free to contact: SAOenquiries@sysmex.co.uk

Sysmex Connect – May 2021

Embracing Statistics in the Modern Medical Laboratory Webinars from Stephen MacDonald

What are they?

Sysmex are excited to announce that we have teamed up with Stephen MacDonald to bring our customers a free of charge series of educational webinars focusing on laboratory statistics.

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Sysmex Connect – May 2021

What is included in the embracing statistics in the modern medical laboratory series?

Webinar 1: Introduction to laboratory statistics

Session 3: Batch acceptance testing and method comparisons

Content summary This webinar introduces common statistical terms, their meaning, and how they apply to the medical laboratory. It will also look at statistical processes and their inter relationships within the laboratory.

Content summary This webinar will look at when reagent acceptance testing is required and explains the critical difference between lots and methods. It details what samples you can use when performing a batch acceptance test and how to statistically compare reagents.

Learning outcomes:

Learning outcomes:

Understand basic probability as it applies to statistics

Understand the commonly used metrics in the laboratory setting, including accuracy, precision, sensitivity, specificity, positive predictive value, negative predictive value, and many more

U nderstand design of experiments for comparisons of lots and methods

How to use statistics in an applied setting within the laboratory

Be comfortable with sample selection for comparisons

Be able to define what acceptable differences are Be aware of some hidden dangers of trending

Webinar 2: Statistical quality control

Session 4: Measurement uncertainty

Content summary This webinar answers the "Why "statistical" quality control?". It will guide the attendee through how to assess performance using quality control, and how to plan a quality control policy. The webinar will also show you when statistical quality control detects an error and how to continue to statistically assess quality control.

Content summary This webinar will look at the concepts of measurement uncertainty alongside the sources of measurement uncertainty.

The webinar will then detail the importance of measurement uncertainty and explain how to interpret the data.

Learning outcomes:

Learning outcomes:

Understand the importance of measurement uncertainty in all aspects of laboratory science

Understand that there is no one size fits all for IQC processes

U nderstand how bias, traceability and calibration are all central to complete uncertainty estimation, not just IQC

Introduce risk based IQC and its implications to patient results U nderstand the framework for designing, implementing, and reviewing a statistical quality control process

R eview applications of measurement uncertainty in processes other than measurement uncertainty alone

Understand what to do when assays don’t fit into the standard model of uncertainty

Who will be presenting these webinars?

Stephen MacDonald is a Principal Clinical Scientist from Cambridge University Hospitals NHS Foundation Trust, with a strong interest in the statistical assessment of laboratory assay performance, including the interpretation of internal quality control data, batch acceptance testing, and the determination of the uncertainty of measurement.

internal quality control and its statistical analysis in laboratory medicine. Stephen has recently begun a third series in Pathology in Practice looking at method comparison.

Stephen is delighted to be hosting these webinars on behalf of Sysmex UK and is looking forward to passing on his wealth of experience and knowledge in a subject field he feels passionately about.

You may have read the articles that Stephen has recently published in Pathology in Practice on these topics. The first article series centred on the individual aspec t s of the uncer taint y of measurement, and the second article series followed on with

When will the webinars be running?

Each webinar in the embracing statistics in the modern medical laboratory series is currently scheduled to be delivered twice, once in June and once in July, all webinars will start at 10:30am.

Title

Date

Introduction to laboratory statistics

1st June & 1st July 2021

Statistical quality control

8th June & 8th July 2021

Batch acceptance testing and method comparison

15th June & 15th July 2021

Measurement uncertainty

22nd June & 22nd July 2021 11

How do I register for these webinars?

To register your interest please contact the Sysmex UK Haematology team: haematology@sysmex.co.uk

Sysmex Connect – May 2021

The Grange University Hospital Install The Grange University Hospital is a new hospital located in Gwent, South Wales. Originally due to open in Spring of 2021, the hospital opened ahead of schedule in November 2020 to assist with the demands of the second wave of COVID-19 and other winter season health pressures.

Sysmex UK manage a Primary Managed Service Contract for ABUHB (Aneurin Bevan University Health Board), which includes the provision of haematology and haemostasis services, blood transfusion, allergy testing and the provision of HbA1C at The Grange University Hospital.

Having no experience with using SmartSheet ® before this installation both Stacey and Tim commented on the ease of use of the tool and how clear and concise the information provided via the project management tool was.

Installation for these services at The Grange University Hospital were planned for the beginning of 2021, ahead of the scheduled opening of the new hospital. However, in order to meet the demands of additional pressures on healthcare services caused by the second wave of COVID-19, in July 2020 Sysmex UK were asked to bring the installation forward. This would mean the entire installation and go-live would have to be completed in just over 3 months.

“We [Sysmex and ABUHB] do work well together. I think we both compliment each other. Our Sysmex MSC is the benchmark that I measure the other ones. As it stands, no one comes close to you, so it is an absolute credit to everyone involved.” – Tim Walbyoff, Pathology Procurement and Project Officer ABUHB.

To reflect on the installation and go-live process, we spoke with Stacey Wetherell, the Haematology Operational Manager ABUHB and Tim Walbyoff, the Pathology Procurement and Project Officer ABUHB, to take us through this very unique experience.

Could you comment on the channels of communication that were used throughout the process and how that helped with the ease of sharing information between everyone who was involved in this project?

Collectively, we installed and went live at The Grange Hospital in just over 3 months, that is quite the turnaround! Obviously, we were working in unprecedented times with the COVID-19 pandemic, can you start by describing the initial experience and move to The Grange Hospital?

Stacey: Milly Mitchell, the Project Manager was instrumental throughout the whole process. Everyone who was involved in the project knew exactly what was happening and their responsibilities in the project. We were all given training on how to use SmartSheet® which was great. It is such an easy tool to navigate around. Through SmartSheet® we were able to track the major milestones that needed to be hit and I think most of those milestones were hit ahead of schedule. The whole project was managed so well.

Stacey: We were really pleased with how the whole process went. The installation process and then the go-live was seamless. The support we received from the Sysmex engineers responsible for the install was first class. We were working ahead of schedule and everything was completed in a timely manner, the commitment shown by the engineers was fantastic. We really couldn’t have done it without them onsite day and night. The training plan that was created by Training Specialist Natalie Bowen was very useful. We received bespoke training support which was enhanced with the training webinars that were provided by Sysmex Training Academy. I was, and still am, very happy and pleased with the whole process.

Tim: All communication was done virtually, there were no face-to-face meetings, no site visits during the pandemic because of the restrictions in place. By using SmartSheet® we were able to share photos, showing access points within the new laboratory and all decisions made about the layout of the new lab were done via SmartSheet® too. It was a very, very good tool to use.

Tim: From my point of view, we have a great relationship with Sysmex, it’s definitely a true partnership that we have. There is certainly a heightened level of trust there, it’s not your usual pigeonholed customer-supplier relationship. I think Sysmex go above and beyond the normal contractual expectations and that has been proven with this move to our new hospital; things would have been tricky anyway, but the relationship we have built with Sysmex over the years helped out in this installation process.

The installation at The Grange Hospital was overseen by Milly Mitchell, Project Manager at Sysmex UK. The installation process and all communication relating to the installation was distributed on a project management tool called SmartSheet® which is used universally throughout the Project Management Team at Sysmex UK.

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Sysmex Connect – May 2021

From start to finish, the installation and go-live process happened in just over 3 months, all ahead of the new opening of The Grange Hospital in November 2020. With additional pressures within the laboratory such as a rotational staff rota to comply with COVID-19 guidance, ensuring social distancing and also working at a newly built hospital site where facilities are limited, the teams who collaborated on this project worked with agility to ensure this process was as smooth and as streamlined as possible.

Stacey: If you said to us 24 months ago that we would be completing an entire install and go-live in a new hospital, with all communication being done virtually, we wouldn’t have thought it was possible!

Due to the logistical obstacles of the COVID-19 pandemic, a new way of virtually operating had to be adopted. The way in which Sysmex communicated, provided training, conducted site surveys and site visits all had to be adapted to this new way of working.

Utilising digital technology to provide new innovative ways in which Sysmex could keep lines of communication open with ABUHB was key to ensuring that ever yone knew what was happening throughout this project.

“If I am being honest I don’t think we ever had any real concerns. We have worked with Sysmex for a long time and know that they are reliable. The analysers are robust and the engineers that we work with are great; so we were always confident that Sysmex could deliver this project.” – Stacey Wetherell, Haematology Operational Manager ABUHB How would you summarise your experience of the installation at The Grange Hospital?

Stacey: I would say it has been very successful. A streamlined process which has been well managed. I think the fortnightly catch-up meetings that were organised by Milly were key to the success of this project. The meetings made sure everyone knew where we were, what milestones we had hit, what the next key milestones were and ultimately that everyone was on the same page. There were a lot of staff who were involved in making this work, so it really was amazing work. It was seamless. Looking back over what we achieved over those months, even now it is all a bit of a haze and I think to myself; did I dream this? But it actually happened and we did a great thing.

As part of this installation, all analysers were pre-built off site at the Sysmex UK offices in Milton Keynes, and then transported to The Grange Hospital site once the pre-build was completed.

Streamlining this part of the installation process ensured efficiency, reducing time on site for the engineers and further reducing any risks identified due to the COVID-19 pandemic.

The majority of the training support provided by Sysmex UK was delivered virtually by the Training Academy and all staff at The Grange Hospital had access to these webinars. By providing the training virtually we were again able to reduce any health and safety risks due to COVID-19, but also provide flexibility to ABUHB for when and where they completed the training.

Tim: As I have said, for me Sysmex is the benchmark that I measure up all the other suppliers and they don’t come close. I think when we look back on the whole process, it really is a great achievement. We have something to shout about with what was achieved with this project, and the time it took to achieve it really is unbelievable! It really was a seamless transition and Sysmex are true professionals in their field.

As the project happened on such short notice, what challenges and experiences did you face along the way and how were they resolved?

We would like to thank everyone who had contributed to this incredible project, the achievements along the way during a time of pressure and uncertainty. The installation at The Grange Hospital was a huge success and Sysmex UK are delighted to continue our relationship with ABUHB in the future.

Stacey: One concern that we had was around contingency and what would happen if one of the other sites went down during the transition. Sysmex were soon able to put our minds at ease which gave us the confidence to eliminate this concern. We had enough analyser capacity across the other sites, along with a robust system at The Grange Hospital too. So much planning went into the installation and the transition that I was confident that we would have been well equipped to deal with any challenges.

Tim: From my point of view, cost was the biggest concern. But again, we were able to extend our contract with Sysmex full term which then allowed for a neutral transition with an equipment refresh as well so it really was a win-win situation.

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Sysmex Connect – May 2021

Scientific Trainee placement: Haematology laboratory at the Queen Elizabeth Hospital Gateshead Over the past 18 months, George Tarpley has completed the scientific trainee internship at Sysmex UK and we are now delighted to announce that George will soon be joining our Haemostasis Team as an Application Specialist. During his time as the scientific trainee, George spent 18 months on a placement at the Haematology Laboratory at Queen Elizabeth Hospital Gateshead, South of Tyne and Wear Clinical Pathology Services.

At Sysmex UK, the development of our young scientists within the industry is something we continue to support through opportunities such as The Carol Briggs Award – the poster competition that is linked with our annual user symposium. Another avenue of support was the scientific trainee internship that George has just completed.

As George’s placement comes to an end, and having recently become HCPC registered, we thought it would be great for him to share his experience of the past 18 months as a young scientist and the challenges faced completing his placement during the COVID-19 Pandemic.

current clinical knowledge and application in my role as a Haemostasis Application Specialist at Sysmex UK. My project topic was selected as ‘a retrospective study to investigate the potential contribution of novel haemocytometric parameters in the differential diagnosis of viral / bacterial infection through routine full blood count analysis’ where data was obtained during my laboratory placement and will be analysed in the near future.

Tell us about your educational background before starting as the scientific trainee at Sysmex UK. Prior to commencing the scientific trainee role at Sysmex UK, I had spent 4 years completing a BSc in Human Biolog y from Loughborough University. During this time, I spent a year in an industry setting as part of the haematology product team at Sysmex UK. Throughout this initial placement at Sysmex UK, I gained exposure to instrument installations and verifications, customer training, software upgrades, software installations, regulatory administration tasks, and experience in the customer support centre to name a few. I was also given the opportunity to support the initial studies of XN blood bank mode in collaboration with the Component Development Laboratory at NHSBT. As a young scientist, the experience I gained during my year in an industry setting primed me for the scientific trainee placement through developing instrument expertise, in particular automated haematology solutions, however at this point I still had no real working experience within a clinical laboratory.

How do you balance your MSc studying schedule with your work schedule?

The MSc is entirely coursework based. Time management is critical for the completion of the modules and Gantt planning charts have been utilised over the previous semesters to ensure specific tasks are complete with weekly deadlines. Ultimately part-time study alongside work requires self-sacrifice out of personal time for completion.

Are there any areas of training you would like to focus on next?

I would like to further develop my clinical and practical experience with Sysmex haemostasis instrumentation – in particular specialist assays such as fibrinolytic inhibitors, thrombophilia screening and platelet function testing.

Did you complete any formal educational studies whilst on the scientific trainee programme?

During the first 12 months of my placement I completed a PostGraduate Diploma in Biomedical Sciences via distance learning at the University of Ulster, in order to top up my Human Biology BSc for IBMS accreditation. This consisted of four 20 credit modules including Haematology and Transfusion, Clinical Immunology, Medical Microbiology and Clinical Biochemistry. After completion, I then completed the IBMS registration portfolio and after verification gained HCPC registration as a Biomedical Scientist.

In your opinion, how would you describe the characteristics of a good Biomedical Scientist?

From my experience, a good BMS is one who pays attention to detail, who can communicate effectively and one who is able to multi-task under pressure. Collaboration between staff members with accurate information is pivotal for maintaining high throughputs, escalating results and handing over information between shifts.

What MSC are you doing now and what modules are you taking?

What laboratory skills did you develop during your placement in the role of scientific trainee?

I am currently studying an MSc in Biomedical Science via distance learning at Anglia Ruskin University. Modules to date have included: general pathology, moving towards aastery, introduction to management in biomedical sciences and research methods. In year 2 of the MSc I will be studying the epidemiology, pathogenesis, diagnostics and treatment of a chosen topic within the field of haemostasis – with the mind set for these modules to develop my

Having no prior laboratory experience outside of my academic programme, my laboratory placement exposed me to basic fundamental laboratory skills such as laboratory health and safety, manual handling, data protection, collaboration with patient care teams, sample pre-analytics and more specific skills such as clinical result interpretation, blood film examination, blood grouping, 14

Sysmex Connect – May 2021

instrument operation, instrument maintenance, instrument troubleshooting and the familiarisation with quality management systems. The placement also provided me with the opportunity to develop my experience with designing and carrying out research projects, and thus gained exposure and understanding to the NHS ethical approval process and human research authority. During my role as scientific trainee I was also exposed to an annual UKAS inspection and the validation of new blood transfusion analysers – this experience provided great insight to all of the regulatory and quality documentation that is required to meet these standards.

10. During your time working in the NHS, what have you learnt about the challenges that laboratories are facing?

The NHS is highly constrained from a resource perspective and thus any solution that we can implement to save time and resource is greatly favoured. The laboratory staff are working hard with a 24/7 approach 365 days a year so all the more support as a manufacturer we can provide, the better rapport we will establish.

What are your top learning outcomes from working in an NHS Laboratory for the past 18 months?

I would say I developed a much greater understanding of laboratory workflows and the resource pressures that the NHS face. This was particularly exacerbated during the pandemic due to track and trace legislation which on occasion resulted in staff shortages and the requirement to readjust shifts and workflows. I also developed a much greater clinical background through exposure to the hospital environment and patient care teams – I would often collaborate with haematology consultants about patient results. I would also state that I received great exposure to quality management systems, their requirements, UKAS inspections and regulatory guidelines that the laboratory must adhere to. Finally, I received some exposure to the work required for the implementation of new analysers and the verification of different assays.

What affect did the COVID-19 Pandemic have on the laboratory you were working in? Did your laboratory experience change at all during the COVID-19 Pandemic?

I am confident in saying that the COVID-19 Pandemic had minimal influence on my laboratory experience and if anything provided greater insight into how laboratories and management are required to adapt in the face of change. From the very beginning of the COVID-19 Pandemic it was an inquisitive period for BMS’ where patterns and trends were observed within full blood counts and coagulation screens. Based on initial publications of a COVID-19 associated coagulopathy, the laboratory experienced an increase in the number of D-Dimer requests. The experience of the pandemic to date has been a huge transitional period for the laboratory. At the beginning air flow cabinet hoods were implemented in the absence of literature on transmission routes, initial research into antibody assays, the implementation, validation and verification of additional PCR instrumentation to cope with COVID sample volumes, and the establishment of a new dedicated COVID-19 laboratory. Within the Haematology and Blood Transfusion department, the laboratory actively participated in the research of COVID-19 therapeutics, such as that of REMAP-CAP and RECOVERY trials for the prescription of convalescent plasma. The implication of reducing elective surgery and non-urgent GP appointments led to a significant reduction in sample throughput for the department and facilitated the implementation of reduced shift patterns. Additionally, all IBMS verifications moved to a virtual nature which changed the current methods of IBMS assessment for both registration and specialist portfolios.

“It has certainly given George some experience around risk assessment and enabled George to research how COVID-19 has impacted both haematological parameters and testing strategies particularly around Haemostasis.” Nicola Keepin, Haematology Technical Manager, South of Tyne and Wear Clinical Pathology Services.

Having just completed your placement, do you have any advice for individuals starting their career in the field of biomedical sciences?

My advice to anyone early in their career as a BMS, would be to focus on the main objective, for example, completing the registration portfolio, learning essential laboratory skills, and understand instrumentation and their technology. Additionally, I would recommend getting exposure to other duties within the lab, such as implementation projects, new assay verifications, statistical analysis of QC, and academic projects that could add clinical value. For me personally, it was these additional projects and tasks that challenged me the most during my 18 months in the laboratory, and further consolidated theoretical knowledge into practice. Such projects are very relevant for submission to the annual Carol Briggs award at the Sysmex User Symposium – this provides new enthusiastic scientists with a fantastic opportunity to present their work to their colleagues and peers and receive valuable feedback from key opinion leaders and experienced scientists within the field. My final piece of advice to anyone starting their career as a BMS would be to continue to learn from the senior scientists in your laboratory. This is possibly the best available resource available to you when working in a laboratory as these individuals have a wealth of experience.

“Despite the difficulties within the ever changing environment, I hope this has given George a unique perspective on how a laboratory has to adapt to new challenges, alongside the restrictions we face with some time s ver y limited re source s .” Nicola Ke epin , Haematology Technical Manager, South of Tyne and Wear Clinical Pathology Services.

How would you describe the support you received from the laboratory staff during your 18 months as scientific trainee at the Haematology Laboratory in Gateshead?

From beginning to end the support provided from the laboratory has been second to none. I completed a thorough and comprehensive training plan with a dedicated training officer, who oversaw all of my additional studies, assessments, portfolio production, feedback and training and competencies. The years of experience and expertise within the laboratory significantly influenced my experience, where senior members of staff were very keen to teach and train new graduates. The Trust has a successful long standing placement programme in collaboration with local universities, where they recruit students ever y year as par t of the sandwich degree and peer-to-peer programmes, and many have later returned as Trainee BMS’. I have established great rapport with the laboratory staff at the South of Tyne and Wear Clinical Pathology Group and have made some life-long friends. Not only did the staff provide training resource they also provided personal support during what was an uneasy time for everyone during the pandemic, especially when relocated away from family. This will forever be a memorable stage during my career.

But most importantly, enjoy the developmental stage of your career as it only comes around once.

“It has certainly been an interesting time to be on placement!

Despite the awful circumstances incurred by the pandemic George has shown himself to be incredibly adaptable and very much part of our hardworking team throughout this hopefully once in a lifetime period.” Nicola Keepin, Haematology Technical Manager, South of Tyne and Wear Clinical Pathology Services.

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Sysmex Connect – May 2021

Growing Your Knowledge Sysmex Scientific Focus

Sysmex is one of the world’s leading healthcare companies. We work hard to retain these distinctions. One of the ways we excel at what we do is by focusing on knowledge.

Sysmex stands out from other companies in our areas of expertise in terms of substantiated, scientific knowledge and its application. As we increase the clinical significance and applicability of our analyses, however, we fully appreciate the importance of providing comprehensive backgrounds and explanations. After all, while our findings can increasingly help clinicians and other specialists determine the root causes and developments of illnesses or other scientific investigations, this also means you, as our user, have to trust these findings.

The following paper provides the scientific and, where applicable, clinical backgrounds so you can make the most of our analysers in your daily work.

Sysmex Scientific Focus

Haemoglobinisation parameters on the Sysmex XN-Series Haematology analysers Reticulocyte haemoglobin content is a marker that provides a snapshot of iron availability for erythropoiesis in the bone marrow, an indicator of iron therapy response, and an early marker of iron-deficient erythropoiesis.

As well as providing the standard parameters for red blood cell and reticulocyte counting, the Sysmex XN-Series systems can analyse the cell-by-cell haemoglobin content of both mature RBC’s and reticulocytes. These parameters have been shown in independent studies to provide clinically relevant insight into RBC metabolism including direct assessment of the incorporation of iron into haemoglobin, and a faster indication of response to changes from therapy. They provide a sensitive indicator of iron deficient erythropoiesis.

Read the full article on the next page 16

Sysmex Connect – May 2021

Measurement The haemoglobin content of a red blood cell can be calculated from its index of refraction in the forward scattered light generated as it passes in front of a laser beam. In the XN-Series, both mature RBC’s and reticulocytes are analysed by fluorescence flow cytometry in the reticulocyte channel using three detectors including one for forward scattered light (Figure 1).

Use in anaemia differentiation Iron deficiency (ID) is a major but highly underestimated health problem worldwide, which in the long run can lead to iron deficiency anaemia (IDA) and impaired erythropoiesis. Assessment of erythropoietic activity is therefore of prime importance in anaemia diagnostics. Conventional biochemical markers of iron status, such as ferritin or transferrin, are influenced by an acute phase response or by clinical conditions like chronic inflammation, cancer, or end stage renal failure.

RET-He enables an early detection (Levy & Schapkaitz 2018) and indication (Joosten et al 2013) of Iron deficiency owing to not only its short life span (1-2 days) in the circulation as compared to mature erythrocytes (120 days) but also its better predictive value (Schoorl 2016) than hemocytometric parameters, for example, MCV, red cell distribution width (RDW), and Hb. These are insensitive markers in detecting early erythropoietic disturbances as their changes (MCV: 21 days, RDW: 30 days, and Hb: 60 days (Sunkara & Kotta 2016) are observed when Iron deficiency anaemia has already taken place. In contrast, RET-He is a peripheral blood count marker that is abnormal in the presence of iron deficiency (Powers & Buchanan 2014). It is also an early indicator of response to iron therapy, of which effect is detected about two days after initiation of the optimal treatment (Doig 2016) as opposed to ferritin, of which first response occurs in 1-2 weeks (Powers & Buchanan 2014). The measurement is not affected by physiologic interferences, except in cases of thalassemia (Skarmoutsou 2003) and macrocytosis/megaloblastosis (Mast et al 2002).

Fig 1: XN-Series Fluorescent flow cytometry system

Values for mean RBC haemoglobin content (RBC-He) and mean reticulocyte haemoglobin content (RET-He) are generated. RBC-He can be thought of as an alternative MCH value, except that it is measured optically rather than by impedance. RET-He has a reference range of 28 - 36 pg.

The difference between the RET-He and RBC-He value for a particular patient is displayed as the Delta-He in pg (Figure 2). The values can be either positive or negative and the reference range is in the region of +2 to +8pg. Negative values indicate an impaired haemoglobinisation of newly formed reticulocytes compared with mature erythrocytes.

Several studies are now available that consistently suggest a reticulocyte count with reticulocyte haemoglobin measurement may be a vital tool for determining both simple IDA as it evolves, and for defining more complicated situations. A reduction of the reticulocyte haemoglobin below the lower limit of normal (28 pg) indicates that only limited iron is available to the erythropoietic marrow. A recent example is the paper by Ucar et al (2019) that found RET-He was significantly lower in IDA, compared to other groups (IDA: 21.0 ± 4.1, ID: 26.0 ± 4.9, non-ID anaemia: 32.1 ± 6.8, control: 36.6 ± 7.0; < 0.001). The ID group had a lower RET-He compared to the non-ID anaemia group and the control group. On the 5th day of treatment, the ID and IDA group showed no significant differences in terms of Hb while the RET-He level demonstrated a significant increase. The increase in the RET-He level observed in the IDA group on the 5th day was significantly higher compared to the increase observed in the ID group. In the International consensus statement on the management of postoperative anaemia after major surgical procedures (Munoz et al 2018) it is stated that postoperatively, iron deficiency should be defined by ferritin concentration < 100 lg, ferritin < 100–300 lg and transferrin saturation < 20%, or reticulocyte haemoglobin content < 28 pg.

Fig 2: Retic channel scatterplot showing haemoglobinisation parameters on the Forward scatter (FSC) axis

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Sysmex Connect – May 2021

Hema-plot Researchers from Germany have published data looking at the difference between the reticulocyte and erythrocyte haemoglobin content (Delta-He) to differentiate between various diseasespecific types of anaemia. In their paper Weimann et al (2016) describe a matrix which they call the ‘Hema-plot’ and how they feel it is a helpful tool for differential diagnosis and disease-monitoring in various types of disease-specific anaemia, especially in anaemia of chronic disease (ACD) and mixed ACD/IDA.

Studies in children have demonstrated that measurements of reticulocyte Hb content have greater success than other traditional parameters in determining both the present state of and the future likelihood of iron deficiency (Ullrich 2005).

Weimann and his colleagues found that negative values for DeltaHe were seen in all of their patients with ACD who were not undergoing therapy, as well as those with combined ACD/IDA, sepsis, or inflammatory diseases. Patients with IDA alone had positive values. RET-He values did not distinguish between the ACD/IDA and IDA patients.

The researchers then created a nine-bay Hema-Plot with RET-He on the y-axis and Delta-He on the x-axis and marked out various quadrants to specific anaemia causing diseases. In particular they identified the area where both RET-He and Delta-He were below the normal range as the place where ACD or combined ACD/IDA patients would fall if they were not undergoing therapy. Untreated sepsis or acute inflammatory patients also fell in this area but IDA and Haemoglobinopathy patients did not and could be separated out into a quadrant with normal Delta-He (2 – 8pg) and low RET-He (<28pg).

Changes in the Delta-He value could occur within a few hours following therapy and this led the authors to suggest that t reat m e n t co ul d b e m o nito re d by p l ot t in g s u cce s si ve measurements using the Hema-plot. It would in theory be possible to directly report the plot to a clinician using a web-based client.

Role in renal failure management

It has been suggested that RET-He could be used to detect latent ID in blood donors (Tiwari et al 2018).

National Institute for Health and Care Excellence (NICE) guidelines for managing anaemia in chronic kidney disease (NICE Guidelines NG8, Published June 2015) recommend the RET-He value as a method for evaluating and monitoring iron status in renal patients.

Physicians dosing chronic kidney disease (CKD) patients with erythropoietic stimulating agent (ESA) therapy can use a RET-He cut off value of 29pg to determine iron status, predict response to iron therapy and monitor iron status during treatment. Functional iron deficiency (FID) may occur in these patients when sufficient iron is in the body stores but cannot be made available for erythropoiesis.

It is also suggested that RET-He can be a useful tool in the developing area of patient blood management (PBM). This international campaign aims to reduce the requirement for blood transfusions, one of the most overused treatment in modern medicine with > 50% of transfusions possibly being inappropriate or avoidable (Anthes 2015). PBM is a multidisciplinary, evidence-based approach to optimising the care of patients who might need a blood transfusion following several international initiatives over the past 20 years (NHSBT 2020). It was launched in England in June 2012 and its recommendations had the support of NHS England.

PBM is founded on three pillars;

The guidelines recommend that clinicians should offer iron to people receiving ESA maintenance therapy to keep their:

Optimise RBC mass Minimise blood loss Manage anaemia

It is the third of these pillars where haemoglobinisation parameters can be of benefit. Within a PBM program, low preoperative Hb and iron deficiency are two of the few modifiable risks factors for reducing RBC transfusion and improving a patient’s condition.

Being able to identify IDA reliably and take appropriate steps prior to surgery will help prevent the need for transfusion in these cases if measurements are taken with sufficient time to instigate therapy (approx. 1 month).

p ercentage of hypochromic red blood cells less than 6% (unless serum ferritin is greater than 800 micrograms/litre) or

R ET-He above 29 pg (unless serum ferritin is greater than 800 micrograms/litre) The marker of iron status should be monitored every 1–3 months in people receiving haemodialysis.

In people who are pre-dialysis or receiving peritoneal dialysis, levels are typically monitored every 3 months. If these people have a normal full blood count there is little benefit in checking iron status.

Once RET-He is above 29 pg, or transferrin saturation is greater than 20% and serum ferritin level is greater than 100 micrograms/ litre, it is suggested to offer maintenance iron to people with anaemia of CKD who are receiving ESA’s.

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Sysmex Connect – May 2021

Other applications The dosing regimen will depend on modality, for example haemodialysis patients will need the equivalent of 50–60 mg intravenous iron per week (or an equivalent dose in children of 1mg/kg/week).

A special algorithm combining RBC-He, RET-He and lactate dehydrogenase has potential as a marker of haemolysis strongly correlated with albuminuria in sickle cell anaemia patients (MaierRedelsperger et al 2010).

Use in thalassaemia diagnosis

Conclusion

Lian (2019) found significantly higher RET-He and lower RBC distribution width (RDW) were prominent in thalassemia trait compared to congenital sideroblastic anaemia (CSA) and IDA and the combination was powerful in the differentiation of these conditions.

The cell-by-cell haemoglobin content measurements provided by the Sysmex XN-Series Reticulocyte channel are proven tools to assist in the assessment of the incorporation of iron into haemoglobin. They feature in NICE guidelines for the management of renal anaemia and consensus statements on the management of postoperative anaemia as well as being shown to be valuable in many other areas.

Use in detection of bacterial infection Reduction in Delta-He resulting in a value less than 2 or negative, has been identified in patients with a bacterial infection when compared to a control group (Henriot et al 2017). It is hypothesised that the reduced values of Delta-He result from the sequestration of iron in the body as a response to a bacterial challenge, withdrawing the iron that invading bacteria need for their growth.

A rise in certain cytokines, such as interleukin-6 triggers an increase in hepcidin, an acute phase protein. Hepcidin ensures that transmembrane iron-export proteins are internalised from the cell surface. There is a resultant reduction in iron availability for erythropoiesis and as a result the haemoglobin content of Reticulocytes drops within a day or so but the RBC-He value does not alter until much later. It is projected that including Delta-He in algorithms to identify infection could be beneficial.

Focus on science Do you have a specific topic you would like to see in the Sysmex Scientific Focus? Let us know at marketing@sysmex.co.uk.

References • Anthes 2015. Evidence-based medicine: Save blood, save lives. Nature; 520, 24–26 • Doig 2016. Disorders of iron kinetics and heme metabolism. In: Keohane EM, Jm W, Smith LJ, eds. Rodak’s Hematology: Clinical Principles and Applications (5th edn). St.Louis, Missouri: Elsevier Saunders; 297-305 • Henriot et al 2017. New parameters on the hematology analyzer XN -10 (Sysmex™) allow to distinguish childhood bacterial and viral infections. Int J Lab Hematol; 39: 14-20 • Joosten et al 2013. Is analysis of the reticulocyte haemoglobin equivalent a useful test for the diagnosis of iron deficiency anaemia in geriatric patients?

Eur J Intern Med; 24: 63-66 • Levy & Schapkaitz 2018. The clinical utility of new reticulocyte and erythrocyte parameters on the Sysmex XN 9000 for iron deficiency in pregnant patients. Int J Lab Hematol; 40: 683-690 • Mast et al. 2002. Clinical utility of the reticulocyte hemoglobin content in the diagnosis of iron deficiency. Blood; 99: 1489-1491 • Munoz et al 2018. An international consensus statement on the management of postoperative anaemia after major surgical procedures Anaesthesia. 2019, 73, 1418–1431 • NHSBT 2020. https://hospital.blood.co.uk/patient-services/patientbloodmanagement/ (Last accessed July 2020).

• Powers & Buchanan 2014. Diagnosis and management of iron deficiency anemia. Hematol Oncol Clin North Am; 28: 729-745 • Schoorl 2016. Innovative haematological parameters in clinical practice. Ned Tijdschr Klin Chem Labgeneesk; 41: 6-16

• Skarmoutsou 2003: Ery throid bone marrow activity and red cell hemoglobinization in iron sufficient beta-thalassemia heterozygotes as reflected by soluble transferrin receptor and reticulocyte hemoglobin in content: correlation with genotypes and Hb A(2) levels. Haematologica; 88: 631-636 • Sunkara & Kotta 2016. Evaluation of red cell indices and reticulocyte maturity indices including reticulocyte haemoglobin concentration in iron deficiency anaemia adult female population. J Evid Based Med Healthc; 3: 5315-5318 • Tiwari et al 2018. Applying newer parameter RET-He (reticulocyte haemoglobin equivalent) to assess latent iron deficiency (LID) in blood donorsstudy at a tertiary care hospital in India. Vox Sang; 113: 639 • Ucar et al (2019). The importance of RET-He in the diagnosis of iron deficiency and iron deficiency anemia and the evaluation of response to oral iron therapy. J Med Biochem 38: 496 –502 • Ullrich 2005. Screening healthy infants for iron deficiency using reticulocyte hemoglobin content. JAMA; 294: 924–30 • Weimann et al 2016. Delta-He, RET-He and a New Diagnostic Plot for Differential Diagnosis and Therapy Monitoring of Patients Suffering from Various Disease-Specific Types of Anemia. Clin Lab; 62: 667-77

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Sysmex Connect – May 2021

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