Scattergram patterns of hematological malignancies on sysmex XN-series analyzer

BACKGROUND: Automated hematology analyzers effectively reduce turnaround time and generates scattergrams which can be used to screen for different hematological conditions. AIMS: We wish to study the scattergrams generated by the Sysmex XN-series analyzer for confirmed cases of hematological malignancies and evaluate for the specific patterns to these malignancies. METHODS: Two hundred and ninety-one newly diagnosed cases of various hematological malignancies were included in the study. All these cases were diagnosed and classified in accordance with flow cytometry, bone marrow morphological study, immunohistochemistry, and molecular studies. Forty-eight cases of leukemoid reaction were also included in the study. We retrieved the scattergrams and complete blood count data of all these cases which were processed in the Sysmex XN-analyzer before their diagnosis. Along with scattergrams, the peripheral blood smear findings of all the cases were extracted too. The scattergram patterns in the white blood cell differential (WDF) and white cell nucleated region (WNR) channels were evaluated and correlated with their peripheral blood smear findings. RESULTS: All the scattergrams in the WDF and WNR channels were studied. Patterns seen in acute lymphoblastic leukemia (ALL) and acute myeloid leukemia (AML) were striking and distinctly separate. After correlating with the peripheral smear and immunophenotyping, AML patterns were subtyped by the French American British classification. Acute promyelocytic leukemia as well as different phases of chronic myeloid leukemia had unique patterns. Scattergram patterns of ALL had minute difference with that of chronic lymphoproliferative disorder. CONCLUSION: In high-volume laboratories, the patterns on Sysmex XN-series analyzer scattergrams can be used as a valuable aid for suspecting and triaging cases of hematological malignancies.