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The hematology analyzer – A real work horse for clinical laboratories

Complete blood count is the basic test, required to evaluate a patient’s general health status. Modern analyzers are compact, sturdy, high-end, and high-volume processing machines. These are available as 3, 5, 6, and 7-parts differential analyzers suitable for low-volume to high-volume work load in laboratories.

The analyzer scans 18–50 parameters including clinical and research parameters. Automatic smear preparation and staining is also available with the high-end models. Hematology market in India has yielded approximately `1500 crore in 2019. Hematology instruments’ installation base in India today is around 100,000 3PDAs and around 20,000 5PDAs, and it increased by approximately 12,000 3PDAs and 1000 5PDAs in the last year.

Three-part analyzers provide sufficient information in most clinical settings and are cheaper, whereas accuracy and speed of testing is improved with five-part analyzers. The reagents are available with sufficiently long shelf life and on-board stability. Apart from the volume of reagents used in testing, costing is also dependent on volume of reagents consumed in various cycles like start-up, sleep-wake up, shut down, and frequency of controls and calibration.

In terms of technology, electrical impedance has firm foothold on determining overall number and size of cells, and flowcytometry has proven its worth in differentiating WBCs and identifying abnormal cells. But emergence of optical counting and use of fluorescence for advanced parameters have proved to be a boon to hematology practice.

Special parameters on high-end models include reticulocyte count with hemoglobin content within (RetHe) – sensitive indicator of iron-deficient erythropoiesis, immature platelet fraction (IPF) – and offers guidance on the etiology of thrombocytopenia, and helps anticipate bone-marrow and platelet recovery; early sepsis indicator – new emerging parameter. By utilizing this indicator in the sepsis-management strategy, early treatment of patients leading to reduced sepsis cost burden is anticipated; body fluid cells and NRBC counting – leading to reduced laborious and time-consuming manual processing and inter-observer variability; and detection of hemoparasites (malaria).

Hematology analyzers are the real work horses of clinical laboratories. The advent of digital image-based cell counting and application of artificial intelligence will add more value to patient care, but microscopic examination by experienced personnel is still the gold standard in diagnosis of hematological abnormalities.

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