涂片检查通常是通过血液分析仪进行标记的差异计数进行的，尽管此类检查的临床价值尚不确定。因此，我们评估了 Sysmex XN-9000 和标记样本涂片检查之间差异计数的差异。此外，还对所鉴定的原始细胞的临床价值进行了调查。两年内进行的所有分类计数的数据均在两个实验室进行了鉴定。对爆炸患者的电子健康记录进行了审查。通过 Bland-Altman 图评估自动和手动差异计数之间的一致性。根据参考区间分类的两种方法之间的一致性进行了评估，并针对随机分析误差引起的不相关的不一致性进行了调整。总共，从 4,092 名患者中识别出 5,500 个标记的差异计数。所有细胞类型的自动和手动差异计数之间具有良好的一致性（-0.480 × 109/L 至 0.297 × 109/L）。对于所有细胞类型，两种方法之间的一致性都非常好，但单核细胞 (82%) 除外，其中 19% 的样品的自动估计值高于手动估计值。在 241 例 (1%) 涂片检查中发现了原始细胞。 13 名 (5%) 患者被诊断为急性白血病，只有一名患者因检测到原始细胞而怀疑患有急性白血病。我们的研究结果表明，对所有标记样本进行常规涂片检查并不能提供额外的重要信息。经过当地验证并与临床部门对话后，可能会省略此类审查，以提高成本效益并缩短周转时间。© 2024 作者，由柏林/波士顿 De Gruyter 出版。

A smear review is typically made in flagged differential counts performed with hematology analyzers although the clinical value of such reviews is uncertain. Therefore, we evaluated the differences in differential counts between Sysmex XN-9000 and a smear review in flagged samples. Furthermore, the clinical value of blasts identified was investigated.Data on all differential counts performed in a two-year period were identified at two laboratories. In patients with blasts, the electronic health record was reviewed. Agreement between automated and manual differential counts was evaluated by Bland-Altman plots. Concordance between the two methods categorized according to reference intervals was evaluated and adjusted for irrelevant non-concordance caused by random analytical error.In total, 5,500 flagged differential counts were identified from 4,092 patients. A good agreement between the automated and manual differential count was found for all cell types (-0.480 × 109/L to 0.297 × 109/L). The concordance between the two methods was excellent for all cell types, except for monocytes (82 %) where the automated estimates were higher than the manual in 19 % of samples. Blasts were identified in 241 (1 %) of smear reviews. Acute leukemia was diagnosed in 13 (5 %) patients, and only in one patient contributed the detection of blasts to the suspicion of acute leukemia.Our findings indicate that routine smear review of all flagged samples do not contribute with additional, significant information. After local validation and dialogue with clinical departments, such reviews may potentially be omitted to increase cost-effectiveness and reduce turn-around-time.© 2024 the author(s), published by De Gruyter, Berlin/Boston.