{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T04:23:53Z","timestamp":1772598233815,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,20]],"date-time":"2023-11-20T00:00:00Z","timestamp":1700438400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2024,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Immature granulocyte percentage (IG%) is an important biomarker for infection control. We observed spurious cases where the IG% was dramatically underestimated on the automated Sysmex XN\u2010series hehmatology analyzer compared with manual differential. These cases were associated with high values of \u201cNeutrophil Reactivity Intensity\u201d (NEUT\u2010RI), which should reflect the metabolic activity of the neutrophils.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We conducted a three\u2010stage study to evaluate whether NEUT\u2010RI could be utilized to screen for misclassified IG% results defined as the manual differential estimating a 10 percentage points higher IG% compared with the automated Sysmex differential.<\/jats:p><jats:p>First, 124 patient samples were selected for 800\u2010cell manual smear analysis based on their NEUT\u2010RI values and compared with the automatic Sysmex IG% results. Next, 11\u2009098 routine 110\u2010cell manual smear analyses were compared with the corresponding Sysmex IG% results. Finally, during a 19\u2010day period 160 additional patient samples underwent smear based on NEUT\u2010RI values \u226556 fluorescence intensity (FI) to screen for misclassified results beyond our current smear practice.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>NEUT\u2010RI \u226556 predicted IG% misclassification with 91% sensitivity and 88% specificity, but primarily when the internal Sysmex flag \u201cAbnormal WBC Scattergram\u201d was present. 90.1% of misclassified results were identified by this flag. Beyond our existing smear rules including this flag, NEUT\u2010RI \u226556 FI had a positive predictive value below 1%.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Both NEUT\u2010RI and the internal Sysmex flag \u201cAbnormal WBC Scattergram\u201d work well to identify cases of IG% misclassification. However, in our setting NEUT\u2010RI \u226556 FI had no meaningful additional predictive capacity to identify misclassifications beyond our current smear rules.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ijlh.14204","type":"journal-article","created":{"date-parts":[[2023,11,21]],"date-time":"2023-11-21T13:08:30Z","timestamp":1700572110000},"page":"312-321","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Neutrophil Reactivity Intensity and misclassification of immature granulocytes"],"prefix":"10.1111","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2695-6337","authenticated-orcid":false,"given":"Elias Frost","family":"Wiwe","sequence":"first","affiliation":[{"name":"Department of Clinical Biochemistry, Nordsj\u00e6llands Hospital University of Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabella Katarina","family":"Kofoed","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Nordsj\u00e6llands Hospital University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Technology, Faculty of Health and Technology University College Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muriel Julie Falk","family":"Dufr\u00e9chou","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Nordsj\u00e6llands Hospital University of Copenhagen  Copenhagen Denmark"},{"name":"Department of Technology, Faculty of Health and Technology University College Copenhagen  Copenhagen Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jens Peter","family":"Philipsen","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry, Nordsj\u00e6llands Hospital University of Copenhagen  Copenhagen 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