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
10
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
11
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
12
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
13
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.
17
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
18
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
19
Questions
20
