Stepping into the Future of

Hematology with the New XN-2000

Automated Hematology Analyzer

Debora A House MT-ASCP

Hematology Section Leader
Martha Jefferson Hospital
Charlottesville, VA

Disclaimer
I have nothing to disclose

Objectives
Describe the process used to determine the new
analyzer selection criteria and outline the steps
that were taken to ensure a smooth
implementation.
Explain the operational and workflow benefits of
the new XN-2000 analyzer.
Discuss the new XN technology and the impact it
has on result reporting and patient care.

Founded in 1903
June 2011 Merged with Sentra Health
System
10 Acute Care Hospitals
August2011New Hospital Opened
176 Beds
2 Full Service Emergency Departments
365 Affiliated Physicians
Specialities
Cancer Care Center
Digestive Care Center
Cardiology Care Center
Neuroscience / Stroke Care Center
Orthopedics including Spine Joint
Replacement Surgery
Womens Health
Bariatric Surgery

Clinical Laboratory
Total Lab Employees
89
Core Lab
Days 4 Techs
Evenings 4 Techs
Nights 2 Techs
ED Lab 1 Tech

Workload
Laboratory Testing
1.2 million CPT billables
annually
20% inpatient testing
80% outpatient testing

250 CBC / day

2 5 Body Fluids

Our Journey to New Hematology

Equipment
Spring 2006 2 Beckman/Coulter LH-750

Analyzers were 6 yrs old in 2012

Increasing down time
Left with 1 analyzer
Staff downsizing
Increased workload

Our Journey to New Hematology

Equipment
How we decided
Spring 2012 - Committee of 3
Allowed to evaluate multiple vendors
Needed Analyzers for Core Lab & ED Lab

Our Journey to New Hematology

Equipment
Key Objectives
Standardization Same Technology
Analyzer Reliability Less downtime
Improvements in workflow
Decreased flagging / manual confirmation
procedures
Body Fluids
Veterinary Testing

Our Journey to New Hematology

Equipment
The Search
Beckman / Coulter DxH / Sysmex XE-5000/ XT-V 2000i
Product overview presentations for the Techs
Fall 2012 - Local Site Visits
Observe analyzers running real world situation
Discussion with Key operators
Workflow and daily operations
Use of rules or middleware

Compiled data to present to Lab Management for final

decision.

Our Journey to New Hematology

Equipment
October 2012

Our Journey to New Hematology

Equipment
October 2012

PutontheBrakes!!!!

Sysmex XN-2000 Receives FDA

Clearance
New option presented
VIP Site visit to observe the XN-2000

Our Journey to New Hematology

Equipment
The Decision
XN-2000 with RU
XN-1000
XT-V 2000i

XT-2000iV(XT-V)
Additional Core Lab
analyzer
Specifically for
Veterinary sample

Size Matters
Footprint
XN 1000 Footprint 25.4 x 33.7 x 29.7
XN-2000 - Footprint 37.8x 33.7 x 29.7

Less Space - XN-2000

+1 IPU
+ 2 IPU
+ 2 IPU
+ 2 IPU

XN-2000: 37.8
2 x LH 500: 50.2 (+25%)
2 x DxH 800: 60 (+37%)
2 x LH 750: 78 (+52%)

Size Matters
Reagent Management
Standardization Share reagents
Inventory Space Saving
Smaller packaging
Concentrated reagent for the RU

Reagent Management
Use of concentrated
reagents RU-20
RFID barcodes for better
reagent management
Onboard reagent log
Color coded reagents
Easy to identify and
change
Clean, neat, easy storage

Size Matters
Sample Aspiration Volumes
Old analyzer 250L
XN-2000 - 88L

One sample pathway for closed, open, or

microtainer sampling

Single Aspiration Pathway

Sampler Analysis Rack
Manual Analysis Open or Closed
No Mode-to-Mode QC or Calibration
Manual ForwardPosition
Closedtube

Manual back
position
Opentube

Sampler(rack)
Closedtube

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Operational Efficiencies
Easy to use
IPU organization and icons

On board QC including outlier documentation

94 QC files & 5 XbarM files

Compact Automation
Benefits of automation for the smaller user
Load Balancing
Onboard Rules

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XN-Series On-board Rules

Enhanced Walk-Away Capabilities
Automated Reflex or Rerun testing
No Need to Search for Tube

Efficient QC Management
Fewer files to manage
Tri-level QC for all reportable hematology tests
2-level BFQC for all reportable parameters

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Efficient QC Management
Multi-module overlay
Automated IQAP system - Insight
Automatic transmission of data after analysis
Prompt access to peer data via internet

Efficient QC Management
Documentation of out-of-range
points
Within IQAP system
On-board XN software

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Sysmex XN Technology

RBC,
PLT,
Hgb

WNR

WDF

NEW

NEW

RET

PLT-F

NEW

WNR Channel
BASO

Granulocyte
NRBC

MONO

LYMPH

Fluorescent NRBC with every

CBC
No additional steps or
reagents
Accurate WBC counts in the
presence of NRBCs

Virtually eliminates
interferences from
Lyse resistant RBCs
Lipids

Maximize efficiency
Improves turnaround time

RBC
Debris

14

WDF Channel
Enhanced Flagging
Better detection of Platelet
Clumps
Atypical LYMPH

Better separation between

Monos and Lymphs

MONO

6-part differential with

reportable including IG% / #

ImmatureWBC

Improved efficiencies
Rapid TAT
LYMPH

More reportable automated

differential

EO

NEUT

Decreased manual
interventions

Low WBC Analysis Mode

WB (Whole Blood) mode
Dilution Rate : x 61.1
Analysis Volume : 58.2L
Whole Counts *2 : 9,530

LW (Low WBC) mode

Dilution Rate : x 61.1
Analysis Volume : 174.6L
Whole Counts *2 : 28,600

Analysis Time extended to 3 times the Whole Blood WBC count time

15

PLT-F Channel
Second, reportable,
method of platelet
enumeration

RBC

IPF

Extended count time for

accuracy, especially in
low platelet counts
Good comparison with
CD41/CD61

PLT

PLT-F Channel
Fluorescent Dye specific for
platelet organelles

RBC

IPF

Minimizes interference from RBC

fragments, microcytic RBCs and
WBC fragments
Automated action message and
reflex action (XN rules)
Generates reportable:
PLT-F & IPF (Immature platelet
fraction)

PLT

Accurate low level platelet counts

Fewer manual interventions
Improved turnaround times

16

RET Channel
RET

LFR

RBC

MFR

HFR

IRF

Reportable
parameters
%/# Retic
IRF
RETHe

PLT

Reticulocyte Channel
Operational Efficiency

Reduced Interference From:

WBCs
Howell Jolley Bodies
Parasites
Sickle cells

Quick and automatic

Monitor RBC development at the cellular level

IRF for Retic production
RET-He direct cellular measurement of iron availability in the
bone marrow

Clinically relevant information for the management

of anemia in conjunction with other available
clinical information.

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Body Fluid Analysis

Body fluid mode
HF-BF

Cerebrospinal fluid (CSF)

MN

Pleural fluid
Peritoneal fluid

MO-BF

LY-BF
PMN
NE-BF

Synovial fluid

EO-BF

Training
2 Techs for XN School
e-learning
Made techs feel like they were included

CRC Valuable Resource Information

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Operational Benefits of the

XN-2000

True back up
Standardization between Core & ED Lab
Compact automation
Decreased aspiration volume
Single Aspiration Pathway
Onboard / Automatic reflex testing
Ease of QC Management

Clinical Benefits
Improved turn-around times
Especially for the Infusion Center

Decreased Manual Slide Review

Decreased Manual Body Fluid Counts

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Questions

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