{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T03:39:59Z","timestamp":1792381199015,"version":"4.4.0"},"reference-count":20,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T00:00:00Z","timestamp":1778025600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Int J Lab Hematology"],"published-print":{"date-parts":[[2026,10]]},"abstract":"ABSTRACT<\/jats:title>\n \n Objectives<\/jats:title>\n Haemoglobinopathies are among the most common inherited disorders worldwide. Early detection of heterozygous carriers remains essential for appropriate diagnosis and counselling. The Sysmex \u2018RBC Defect Workflow Optimisation\u2019 (RWO) flag is a recently introduced automated tool designed to identify red cell abnormalities suggestive of heterozygous haemoglobinopathies (HGB HTZ), sickle cell disease (SCD), and iron deficiency anaemia (IDA). This study evaluated the diagnostic performance of the RWO flag in routine practice.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Over 6 months (March\u2013August 2025), 405 samples flagged by RWO (HGB HTZ, SCD, IDA) were prospectively evaluated, and positive predictive values (PPVs) were calculated. In addition, a retrospective analysis of the RWO HGB HTZ, SCD flag was performed on 122 consecutive haemoglobin analyses to assess diagnostic accuracy metrics. Finally, the HGB HTZ \u03b2\u2010thalassaemia flag was compared with an external discriminant index, %MicroRBC\/%HypoHe ratio (cut\u2010off of 3.7).<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Prospectively, the Sysmex\n RWO<\/jats:styled-content>\n flag demonstrated\n PPVs<\/jats:styled-content>\n of 81.9% for\n HGB HTZ<\/jats:styled-content>\n , 68.7% for\n IDA<\/jats:styled-content>\n , and 100% for\n SCD<\/jats:styled-content>\n (\n n<\/jats:italic>\n \u2009=\u20091). For\n IDA<\/jats:styled-content>\n ,\n PPV<\/jats:styled-content>\n increased when analysis was restricted to different exclusion criteria. Retrospective sensitivity for\n HGB HTZ<\/jats:styled-content>\n and\n SCD<\/jats:styled-content>\n was only 25.0%, further clarified in this study. Diagnostic performance of the\n HGB HTZ<\/jats:styled-content>\n \u03b2\u2010thalassaemia flag was broadly comparable to that of the %\n MicroRBC<\/jats:styled-content>\n \/%\n HypoHe<\/jats:styled-content>\n ratio.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The Sysmex RWO flag represents a feasible and effective screening tool for heterozygous haemoglobinopathies and sickle cell disease in routine clinical practice. Despite modest retrospective sensitivity, its high predictive value and workflow efficiency support its use as a trigger for targeted haemoglobin analysis in everyday laboratory diagnostics.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ijlh.70135","type":"journal-article","created":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T09:15:31Z","timestamp":1778058931000},"page":"1211-1217","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Performance Evaluation of the Sysmex \u2018RBC Defect Workflow Optimisation\u2019 Flag for the Detection of Haemoglobinopathies and Iron Deficiency Anaemia"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-6252-851X","authenticated-orcid":false,"given":"M.","family":"Van Vlierberghe","sequence":"first","affiliation":[{"name":"Departement of Laboratory Medicine General Hospital AZ Sint\u2010Lucas Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H.","family":"Louagie","sequence":"additional","affiliation":[{"name":"Departement of Laboratory Medicine General Hospital AZ Sint\u2010Lucas Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"T.","family":"Ghys","sequence":"additional","affiliation":[{"name":"Departement of Laboratory Medicine General Hospital AZ Sint\u2010Lucas Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Degandt","sequence":"additional","affiliation":[{"name":"Departement of Laboratory Medicine General Hospital AZ Sint\u2010Lucas Ghent Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,6]]},"reference":[{"key":"e_1_2_13_2_1","unstructured":"Centers for Disease Control and prevention \u201cHemoglobinopathies: Current Practices for Screening Confirmation and Follow\u2010up \u201d2025 https:\/\/www.cdc.gov\/sickle\u2010cell\/media\/fact\u2010sheets\/best\u2010practices\/hemoglobinopathies\u2010current\u2010practices\u2010nbs.pdf."},{"key":"e_1_2_13_3_1","unstructured":"Centrum voor Medische Analyse \u201cNieuwsbrief Hemoglobinopathie\u00ebn \u201d2024 https:\/\/www.cma.be\/nl\/nieuwsbrief\u2010hemoglobinopathieen\/."},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0223(199612)16:13<1181::AID-PD93>3.0.CO;2-N"},{"key":"e_1_2_13_5_1","first-page":"73","volume-title":"Essential Haematology","author":"Hoffbrand A. 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