Performance Evaluation of Samsung LABGEOHC10 Hematology Analyzer Il Joong Park, MD, PhD; Sunhyun Ahn, MD; Young In Kim, MD; Seon Joo Kang, MD; Sung Ran Cho, MD, PhD

 Context.—The Samsung LABGEOHC10 Hematology Analyzer (LABGEOHC10) is a recently developed automated hematology analyzer that uses impedance technologies. The analyzer provides 18 parameters including 3-part differential at a maximum rate of 80 samples per hour. Objective.—To evaluate the performance of the LABGEOHC10. Design.—We evaluated precision, linearity, carryover, and relationship for complete blood cell count parameters between the LABGEOHC10 and the LH780 (Beckman Coulter Inc) in a university hospital in Korea according to the Clinical and Laboratory Standards Institute guidelines. Sample stability and differences due to the anticoagulant used (K 2 EDTA versus K 3 EDTA) were also evaluated. Results.—The LABGEOHC10 showed linearity over a wide

A

utomated blood cell counters have been routinely used as cost-effective and valuable tools for the diagnosis and evaluation of blood disorders. Currrently, point-of-care testing is also becoming an important adjunct to hematology laboratory practice and is becoming widely available at primary health care clinics and in general practice. Although several hematologic tests, especially the measurement of hemoglobin concentration, are appropriate for point-of-care testing, other various hematologic tests are also required within such settings for the delivery of effective point-ofcare testing.1–3 Nevertheless, small to medium-sized laboratories usually prefer hematology analyzers that require minimal training for operation and deliver accurate test results in laboratory conditions. The Samsung LABGEOHC10 Hematology Analyzer (Samsung Electronics Co, Suwon, Korea) is a simple, compact, automated hematology analyzer that had been designed for Accepted for publication October 17, 2013. From the Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Republic of Korea. The authors have no relevant financial interest in the products or companies described in this article. This study was supported by a research fund from Samsung Electronics Company (Suwon, Korea). Presented in part at the XXVth International Symposium on Technological Innovations in Laboratory Hematology; May 21–24, 2012; Nice, France. Reprints: Sung Ran Cho, MD, PhD, Department of Laboratory Medicine, Ajou University School of Medicine, San 5, Woncheondong, Yeongtong-gu, Suwon 443–721, Republic of Korea (e-mail [email protected]). Arch Pathol Lab Med—Vol 138, August 2014

range and minimal carryover (,1%) for white blood cell, hemoglobin, red blood cell, and platelet parameters. Correlation between the LABGEOHC10 and the LH780 was good for all complete blood cell count parameters (R . 0.92) except for mean corpuscular hemoglobin concentration. The bias estimated was acceptable for all parameters investigated except for monocyte count. Most parameters were stable until 24 hours both at room temperature and at 48C. The difference by anticoagulant type was statistically insignificant for all parameters except for a few red cell parameters. Conclusions.—The accurate results achievable and simplicity of operation make the unit recommendable for small to medium-sized laboratories. (Arch Pathol Lab Med. 2014;138:1077–1082; doi: 10.5858/arpa.2013-0439-OA) small to medium-sized laboratories with limited laboratory space. The analyzer is composed of an automatic analysis area and supportive reagents (diluent, lysing reagent, and cleaner) area and uses impedance technology for cell counting and photometry for hemoglobin (Hb) assay. The analyzer provides 18 parameters, including 3-part differential at a maximum rate of 80 samples per hour, with a sample requirement of 25 ll of EDTA-anticoagulated blood. This study was performed to evaluate the performance of the LABGEOHC10 in terms of precision, linearity, carryover, difference by anticoagulant used (K2EDTA versus K3EDTA), stability during storage, and method comparison with the LH780 (Beckman Coulter Inc, Brea, California). We followed the Clinical and Laboratory Standards Institute (CLSI) guidelines EP5-A2,4 EP6-A,5 EP9-A2,6 and H26-A27 for evaluation of precision, linearity, and method comparison. Importantly, after method comparison, we will be able to interpret results and compare them to internal performance criteria according to the EP9-A2 of the CLSI to determine whether the candidate methods (LABGEOHC10) are suitable replacements for current methods. MATERIALS AND METHODS Instrumentation and Parameters The LABGEOHC10 weighs 13.5 kg, with dimensions of 344 mm (width) 3 293 mm (depth) 3 390 mm (height). The analyzer features a graphic color LCD module with a touch screen and builtin thermal printer module. Its internal memory is capable of storing 1000 records with full histograms and individual patient data. The analyzer can be connected to a host computer through a USB port Performance of Samsung LABGEOHC10 Analyzer—Park et al 1077

Table 1.

Within-Run Imprecision Results for Blood Samples

Parameter

Range of Mean

Range of CV, %

Median CV, %

Manufacturer Quoted CV, %

WBC, /lL Hb, g/dL RBC, 3106/lL MCV, lm3 MCH, pg/cell MCHC, g/dL HCT, % RDW, % PLT, 3103/lL MPV, lm3 PCT, % PDW, % GRA%, % LYM%, % MON%, % GRA#, /lL LYM#, /lL MON#, /lL

4270~8430 10.7~15.1 4.24~5.06 74.93~96.49 23.81~30.41 30.55~32.02 33.68~48.41 12.19~15.88 191.75~379.8 7.39~9.90 0.17~0.31 35.69~40.61 42.92~84.28 11.96~51.82 3.76~9.77 2010~7100 1010~2770 210~630

1.25~1.91 0.71~1.22 0.93~1.76 0.42~1.14 0.86~1.23 0.89~1.44 0.99~1.82 1.23~1.49 2.32~3.99 1.36~2.59 3.43~5.53 0.96~2.66 0.95~2.48 2.31~7.65 8.27~21.90 1.47~3.33 2.74~8.07 8.33~22.6

1.58 0.84 1.28 0.54 1.07 1.24 1.37 1.37 3.33 1.82 4.42 1.60 1.82 3.97 14.58 2.17 4.44 14.75

3.4 2.4 2.2 2

3 7 10

Abbreviations: CV, coefficient of variation; GRA#, granulocyte count; GRA%, granulocyte percentage; Hb, hemoglobin concentration; HCT, hematocrit; LYM#, lymphocyte count; LYM%, lymphocyte percentage; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean corpuscular volume; MON#, monocyte count; MON%, monocyte percentage; MPV, mean platelet volume; PCT, plateletcrit; PDW, platelet distribution width; PLT, platelet count; RBC, red blood cell count; RDW, red blood cell distribution width; WBC, white blood cell count.

and allows stored records to be archived or restored. The operation of the analyzer requires minimal training of laboratory personnel. The analyzer is capable of determining 18 parameters including 3-part differential; white blood cell count (WBC), hemoglobin concentration (Hb), red blood cell count (RBC), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), hematocrit (HCT), RBC distribution width (RDW), platelet count (PLT), mean platelet volume (MPV), plateletcrit, platelet distribution width (PDW), granulocyte percentage, lymphocyte percentage, monocyte percentage (MON%), granulocyte count, lymphocyte count, and monocyte count (MON#).

Calibration and Quality Control The LABGEOHC10 and LH780 were calibrated according to the manufacturers’ recommendations before the study started. Manufacturers’ quality control material was run on both instruments on a daily basis during the entire study period.

Blood Samples Blood samples drawn from 244 patients and 26 healthy adults with informed consent were used for this study. Residual K2EDTA-anticoagulated blood samples were taken from the hematology laboratory of Ajou University Hospital, Suwon, Republic of Korea, after routine testing was complete. The leftover specimens were used for precision, linearity, stability, and method comparison. K2EDTA- and K3EDTA-anticoagulated blood samples were taken from participants with their prior agreement, and were used for evaluation of the difference by EDTA tube (K2/K3) usage. We used K2EDTA plastic tubes (Becton Dickinson, Franklin Lakes, New Jersey) and K3EDTA plastic tubes (Greiner Bio-One, Monroe, North Carolina) as containers. All specimens were stored at room temperature and were tested within 6 hours, except in the case of sample stability testing. This study was performed under the approval of the Ajou University Hospital Institutional Review Board.

Precision Within-run imprecision was established according to the H26A2 guideline.7 Twelve samples of various range were assessed by analyzing them 31 times consecutively by LABGEOHC10. 1078 Arch Pathol Lab Med—Vol 138, August 2014

Repeatability and device/method precision of LABGEOHC10 was also established according to the EP5-A2 guideline.4 Three levels of commercial quality control material (DiatroCont 3 Hematology Control, Clinical Diagnostic Solutions Inc, Plantation, Florida) were run in pairs, 2 times per day (with at least 5-hour intervals) for 25 operating days.

Linearity Linearity for WBC, Hb, RBC, and PLT was evaluated according to the EP6-A guideline.5 Briefly, we prepared 5 levels of analytes by mixing, diluting, or concentrating blood samples. The prepared samples were tested 4 times each and the linearity was obtained by polynomial regression analysis for first-, second- and third-order polynomials.

Method Comparison (Correlation) The LABGEOHC10 was compared with the LH780 for the following parameters: WBC; the numbers and percentages of granulocytes, lymphocytes, and monocytes; RBC; Hb; HCT; MCV; MCH; MCHC; RDW; PLT; and MPV according to the EP9-A2.6 Briefly, each sample was measured in duplicates with both units, and the data of 40 samples were selected to cover clinically relevant ranges for each parameter. Another 24 samples with PLT less than 50 3 103/lL were used for an additional evaluation of low PLT.

Carryover Carryover for WBC, Hb, RBC, and PLT was assessed by following the recommendation of the International Council for Standardization in Haematology8 and the H26-A2 guideline.7 Briefly, 3 consecutive analyses of a patient sample with high analyte concentration (H1, H2, and H3) were followed by 3 consecutive analyses of a patient sample with low analyte concentration (L1, L2, and L3). Carryover (%) was calculated from the formula: 100 3 (L1–L3)/(H3–L3). This process was repeated 9 times and 95%, 97.5%, and 99% confidence intervals were calculated.

Stability During Storage Samples from 10 healthy adults were used for the evaluation of sample stability. Two sets of samples, which were drawn at the same time, were analyzed 10 times at 0, 6, 12, and 24 hours after blood collection, with 1 set stored at room temperature (RT) and the other at 48C. Performance of Samsung LABGEOHC10 Analyzer—Park et al

Table 2. Repeatability (A) and Device/Method Precision (B) of LABGEOHC10 Hematology Analyzera Medium Parameter WBC, /lL A B Hb, g/dL A B

Mean 7830

Low CV, % 1.13 1.67

Mean

High CV, %

3460

2.23 2.84

Mean

CV, %

18 980

Manufacturer Quoted CV, %

0.75 1.46

3 3.4

12.43

0.70 0.99

5.47

0.90 1.64

16.54

0.46 0.90

2 2.2

4.45

1.10 1.21

2.45

1.55 1.51

5.42

1.01 1.09

2 2.2

MCV, lm3 A B

91.55

0.48 0.86

70.09

0.30 0.97

101.62

0.23 0.67

1.7 2

HCT, % A B

40.75

1.17 1.37

17.16

1.52 1.82

55.13

0.98 1.10

RDW, % A B

15.53

1.25 1.18

14.63

0.92 1.29

19.68

1.19 1.33

2.5 3

3.41 3.62

87.83

7.01 7.10

500.88

2.16 2.27

6 7 8.7 10

RBC, 3106/lL A B

PLT, 3103/lL A B

215.5

MPV, lm3 A B

13.22

1.20 1.51

12.78

2.82 2.92

13.49

0.76 1.24

GRA%, % A B

53.39

1.58 1.65

39.25

1.49 1.55

58.42

2.17 2.13

LYM%, % A B

37.54

2.75 9.08

34.25

3.82 3.93

53.39

1.22 1.19

5.87

9.25 10.06

7.33

8.76 11.43

7.37

5.89 5.59

MON%, % A B

Abbreviations: CV, coefficient of variation; GRA%, granulocyte percentage; Hb, hemoglobin concentration; HCT, hematocrit; LYM%, lymphocyte percentage; MCV, mean corpuscular volume; MON%, monocyte percentage; MPV, mean platelet volume; PLT, platelet count; RBC, red blood cell count; RDW, red blood cell distribution width; WBC, white blood cell count. a Samsung Electronics Co, Suwon, Korea.

Difference by Type of Anticoagulant (K2EDTA Versus K3EDTA)

Data Analysis

We collected blood into 2 different EDTA tubes (K2EDTA and K3EDTA) from 50 patients and analyzed them to evaluate the difference of the results.

Table 3.

Linearity and Carryover for WBC, Hb, RBC, and PLT of LABGEOHC10 Hematology Analyzera WBC, /lL

Linearity range Carryover, % Mean 95% CI 97.5% CI 99% CI

Data analysis was carried out by using Microsoft Excel 2007 (Microsoft, Redmond, Washington) and SPSS v11.0 (SPSS Inc, Chicago, Illinois). We performed polynomial regression analysis for first-, second-, and third-order polynomials for linearity access.5

300~71 000 0.10 0.02~0.18 0.01~0.19 0.01~0.21

RBC, 3106/lL

Hb, g/dL

PLT, 3103/lL

0.1~23.3

0~8.34

3~1033

0.03 0.09~0.15 0.11~0.17 0.13~0.19

0.06 0.36~0.24 0.41~0.29 0.46~0.34

0.23 0.06~0.41 0.03~0.44 0.00~0.47

Abbreviations: CI, confidence interval; Hb, hemoglobin concentration; PLT, platelet count; RBC, red blood cell count; WBC, white blood cell count. a Samsung Electronics Co, Suwon, Korea. Arch Pathol Lab Med—Vol 138, August 2014

Performance of Samsung LABGEOHC10 Analyzer—Park et al 1079

Comparison of the blood count parameters (A through O) between the LABGEOHC10 (Samsung Electronics Co, Suwon, Korea) and the LH780 (Beckman Coulter Inc, Brea, California). Abbreviations: GRA#, granulocyte count; Hb, hemoglobin concentration; HCT, hematocrit; Low PLT, less than 50 3 103/lL of platelet count; LYM#, lymphocyte count; MCH, mean cell hemoglobin; MCHC, mean cell hemoglobin concentration; MCV, mean corpuscular volume; MON#, monocyte count; MPV, mean platelet volume; PCT, plateletcrit; PLT, platelet count; RBC, red blood cell count; RDW, red blood cell distribution width; WBC, white blood cell count.

1080 Arch Pathol Lab Med—Vol 138, August 2014

Performance of Samsung LABGEOHC10 Analyzer—Park et al

Comparison and Bias Estimation of Blood Cell Count Parameters Between the LABGEOHC10a and the LH780b

Table 4.

Parameter WBC, /lL

Correlation Coefficient

Computed Line

0.9987

Y ¼ 1.0100X  329

0.9989

Y ¼ 0.9746X þ 0.1837

RBC, 310 /lL

0.9984

Y ¼ 1.0048X  0.0075

MCV, lm3

0.9720

Y ¼ 1.0715X  7.3817

3

PLT, 310 /lL

0.9930

Y ¼ 0.9633X þ 5.189

GRA#, /lL

0.9954

Y ¼ 1.0338X  82

LYM#, /lL

0.9906

Y ¼ 0.9890X  44

MON#, /lL

0.9309

Y ¼ 0.7248X þ 47

Hb, g/dL 6

Decision Point 5000 25 000 12 17 4 6 80 100 150 450 2000 10 000 1500 5000 1000

Acceptable Bias

95% Confidence Interval of Predicted Bias

Decisionc

6250 61250 60.24 60.34 60.12 60.18 61.6 62 67.5 622.5 6100 6500 675 6250 6100

345~213 290~130 0.157~0.085 0.303~0.193 0.001~0.024 0.001~0.044 2.534~0.795 0.893~0.422 5.731~5.089 17.835~4.849 145~116 108~405 84~36 206~9 267~189

B A A A A A B A A A B A B A C

Abbreviations: GRA#, granulocyte count; Hb, hemoglobin concentration; LYM#, lymphocyte count; MCV, mean corpuscular volume; MON#, monocyte count; PLT, platelet count; RBC, red blood cell count; WBC, white blood cell count. a Samsung Electronics Co, Suwon, Korea. b Beckman Coulter Inc, Brea, California. c Decision about whether candidate method (LABGEOHC10) is a suitable replacement for current method (LH780); A: performance of the LABGEOHC10 is equivalent to the LH780; B: Data do not show that the bias of the LABGEOHC10 is different from the acceptable bias; C: performance of the LABGEOHC10 is not equivalent to the LH780.

The effect of EDTA tube (K2 versus K3) was analyzed by paired t test and the sample stability by 1-way analysis of variance test. For the method comparison and bias estimation, we computed 95% confidence interval of predicted bias and compared it to internal performance criteria.6

RESULTS Precision Within-run precision for normal and abnormal patient sample results is shown in Table 1; results are shown to satisfy the manufacturer’s specification for all of the measured parameters. Repeatability and device/method precision is shown in Table 2; results are shown to satisfy the manufacturer’s specification for all of the measured parameters, except for low PLT. No technologic problems with the instrument occurred during the evaluation period of 8 weeks. Linearity Linearity analysis for WBC, Hb, RBC, and PLT is shown in Table 3; it showed nonsignificance for all nonlinear coefficients for all 4 parameters measured. Method Comparison and Bias Estimation Results for the method comparison of the LABGEOHC10 with the LH780 are presented in the Figure. All parameters showed r values .0.95 with the exception of MON# (r ¼ 0.9309), MCHC (r ¼ 0.3778), and MPV (r ¼ 0.9259). Results for the bias estimation of the LABGEOHC10 with the LH780 are presented in Table 4. Carryover Minimal carryover (,1%) was observed for all the parameters investigated (Table 3). Stability During Storage All parameters, except for the percentage and count of monocytes, showed 24-hour long-term stability for normal samples both at RT and at 48C. The MON% and MON# Arch Pathol Lab Med—Vol 138, August 2014

showed statistically significant differences even after only 6 hours at 48C, but were stable up to 6 hours and 12 hours, respectively, at RT. Difference by EDTA Tube (K2 Versus K3) All parameters except Hb, RBC, and HCT showed no statistically significant differences by the type of EDTA tubes used. The difference of the 3 red cell parameters was minimal (,1%) and the correlation between the different tubes was excellent for Hb (r ¼ 0.997), RBC (r ¼ 0.992), and HCT (r ¼ 0.993). COMMENT Despite the application of previously proven technology to a commercial product, instruments of such critical importance as hematology analyzers should be validated technically before implementation in daily practice. The automated LABGEOHC10 Hematology Analyzer is easy to use and requires minimal training for operation. This study showed that the analyzer provides reliable and comparable results to instruments that are currently used in clinical laboratories.9–12 Overall results of the repeatability and device/method precision satisfied the manufacturer’s specifications, except for low PLT. The coefficient of variation at low PLT was slightly higher than the coefficient of variation claimed by the manufacturer, though it was still acceptable according to EP5-A2 specifications.4 The imprecision of automated platelet counts in the thrombocytopenic range is a welldocumented problem.11,13–15 The LABGEOHC10 showed an overall good correlation with the LH780, except for MCHC. The poor correlation of MCHC has also been previously reported in the literature.9,11,12,16 We determined if the LABGEOHC10 is a suitable replacement for the LH780, even though the 2 analyzers are very different in terms of their scale. The LABGEOHC10 showed an acceptable bias for most parameters investigated. Nonequivalence for MON# is thought to be due to the difference between LH780 providing a 5-part differential Performance of Samsung LABGEOHC10 Analyzer—Park et al 1081

and LABGEOHC10, a 3-part differential. Limitation of LABGEOHC10 that provides 3-part differential and no flags other than numerical flag (high or low) might require an application of broader criteria for slide review. Our study showed that most parameters were stable for at least 24 hours at RT and at 48C while the monocyte count was unstable at both RT and 48C, with an unexpectedly shorter stability of refrigerated samples than for samples at RT, and opposite directional change dependent on the storage temperature, using the LAGBEOHC10. Imeri et al17 reported that the stability of CBC parameters varied not only according to the investigated parameter but also according to storage temperature and the measurement system used. In addition, sample stability is substantially shorter than that stated by the manufacturers of hematology analyzers.17,18 Therefore, laboratory physicians might need to validate stability before the introduction of a new hematology analyzer in their laboratories. All parameters, except Hb, RBC, and HCT, did not show statistically significant differences according to the different EDTA tubes. In this study, we used spray-dried K2EDTA plastic tubes and K3EDTA plastic tubes and therefore, the previously reported dilution effect of K3EDTA can be excluded.19 The lower MCV value of K3EDTA-anticoagulated blood by RBC shrinkage, reported in the previous studies,19,20 was not observed in this study. Although Hb, RBC, and HCT were statistically significantly lower in samples collected into K2EDTA tubes than in those collected into K3EDTA tubes, they showed excellent correlation between tubes. The differences of these parameters were minimal (,1%) and were not likely to be of any clinical relevance. In conclusion, the overall performance of the LABGEOHC10 is comparable to that of the LH780. The accurate results and simplicity of operation make it recommendable for small to medium-sized laboratories and applicable as a back-up instrument in larger laboratories. References 1. Morris LD, Pont A, Lewis SM. Use of a new HemoCue system for measuring haemoglobin at low concentrations. Clin Lab Haematol. 2001;23(2): 91–96. 2. Lewis SM, Osei-Bimpong A, Bradshaw A. Measurement of haemoglobin as a screening test in general practice. J Med Screen. 2004;11(2):103–105. 3. Osei-Bimpong A, Jury C, McLean R, Lewis SM. Point-of-care method for total white cell count: an evaluation of the HemoCue WBC device. Int J Lab Hematol. 2009;31(6):657–664.

1082 Arch Pathol Lab Med—Vol 138, August 2014

4. Clinical and Laboratory Standards Institute. Evaluation of Precision Performance of Quantitative Measurement Methods; Approved GuidelineSecond Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2004. CLSI document EP5-A2. 5. Clinical and Laboratory Standards Institute. Evaluation of the Linearity of Quantitative Measurement Procedures: A Statistical Approach; Approved Guideline-Second Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2003. CLSI document EP6-A. 6. Clinical and Laboratory Standards Institute. Method Comparison and Bias Estimation Using Patient Samples; Approved Guideline-Second Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2002. CLSI document EP9-A2. 7. Clinical and Laboratory Standards Institute. Validation, Verification, and Quality Assurance of Automated Hematology Analyzers; Approved GuidelineSecond Edition. Wayne, PA: Clinical and Laboratory Standards Institute; 2010. CLSI document H26-A2. 8. International Council for Standardization in Haematology. Guidelines for the evaluation of blood cell analysers including those used for differential leucocyte and reticulocyte counting and cell marker applications; International Council for Standardization in Haematology: prepared by the ICSH Expert Panel on Cytometry. Clin Lab Haematol. 1994;16(2):157–174. 9. Langford K, Luchtman-Jones L, Miller R, Walck D. Performance evaluation of the Sysmex XT-2000i automated hematology analyzer. Lab Hematol. 2003; 9(1):29–37. 10. Lehto T, Hedberg P. Performance evaluation of Abbott CELL-DYN Ruby for routine use. Int J Lab Hematol. 2008;30(5):400–407. 11. Ghys T, Malfait R, Van den Bossche J. Performance evaluation of the Sysmex XS-1000i automated haematology analyser. Int J Lab Hematol. 2009; 31(5):560–566. 12. Longair I, Briggs C, Machin SJ. Performance evaluation of the Celltac F haematology analyser. Int J Lab Hematol. 2011;33(4):357–368. 13. Kunz D. Possibilities and limitations of automated platelet counting procedures in the thrombocytopenic range. Semin Thromb Hemost. 2001;27(3): 229–235. 14. Segal HC, Briggs C, Kunka S, et al. Accuracy of platelet counting haematology analysers in severe thrombocytopenia and potential impact on platelet transfusion. Br J Haematol. 2005;128(4):520–525. 15. Briggs C, Harrison P, Machin SJ. Continuing developments with the automated platelet count. Int J Lab Hematol. 2007;29(2):77–91. 16. Corberand JX, Segonds C, Fontanilles AM, Cambus JP, Fillola G, Laharrague P. Evaluation of the Vega haematology analyser in a university hospital setting. Clin Lab Haematol. 1999;21(1):3–10. 17. Imeri F, Herklotz R, Risch L, et al. Stability of hematological analytes depends on the hematology analyser used: a stability study with Bayer Advia 120, Beckman Coulter LH 750 and Sysmex XE 2100. Clin Chim Acta. 2008;397(1–2): 68–71. 18. Bourner G, Dhaliwal J, Sumner J. Performance evaluation of the latest fully automated hematology analyzers in a large, commercial laboratory setting: a 4way, side-by-side study. Lab Hematol. 2005;11(4):285–297. 19. Van Cott EM, Lewandrowski KB, Patel S, et al. Comparison of glass K3EDTA versus plastic K2EDTA blood-drawing tubes for complete blood counts, reticulocyte counts, and white blood cell differentials. Lab Hematol. 2003;9(1): 10–14. 20. International Council for Standardization in Haematology. Recommendations of the International Council for Standardization in Haematology for Ethylenediaminetetraacetic Acid Anticoagulation of Blood for Blood Cell Counting and Sizing. International Council for Standardization in Haematology: Expert Panel on Cytometry. Am J Clin Pathol. 1993;100(4):371–372.

Performance of Samsung LABGEOHC10 Analyzer—Park et al