Evaluation of automated immature granulocyte percentage by sysmex xn-3000 for predicting immature granulocyte in peripheral blood

Utility of automated immature granulocyte count for predicting myeloid cell series


  • Piyanut Songsonthi Department of Medical Technology and Clinical Pathology, Saraburi Hospital


immature granulocyte, %IG, hematological application


Immature granulocytes including promyelocyte, myelocyte, metamyelocyte and other myeloid series are premature white blood cells that are released from bone morrow during infection and inflammatory conditions. The presence of immature granulocytes in peripheral blood indicates leukopoiesis and may represent the earliest indicator of bone marrow stimulation by infection, inflammation, or any other stimuli. Recent studies have reported immature granulocyte percentage (%IG) by Sysmex hematology XN-3000 for predicting hematological diseases. However, the predictive value of %IG demonstrates immature granulocytes in peripheral blood smear that remains unclear and rarely used in hematological application in Thailand. In this study, we assessed the ability of this marker in guiding myeloid series differentiation. The pilot cohort study 145 samples were collected from clinical specimens of hematology laboratory unit at Saraburi Hospital. Compared with manual microscopic differentiation as a standard method and %IG of the automated hematology analyzer, the data were analyzed cutoff value, sensitivity and specificity using Receiver operating characteristic (ROC) curve. The cutoff valuer of %IG level greater than 3.95% (AUC = 0.971; 95% CI: 0.946 – 0.997) that illustrates the presence of in vivo immature granulocytes with exhibited sensitivity of 95.3% and specificity of 92.3%. Therefore, %IG level has high accuracy and specificity and used as an early marker for predicting immature granulocyte in peripheral blood. Moreover, this study may be helpful in guiding severe hematological diseases and supporting the value of the %IG parameter for further hematological application for immature granulocytes detection combined with daily routine peripheral blood smear.


Monteiro, W. O., Bo, S. D., Farias, M. G. & Castro, S. M. Definition of Reference Range for the Immature Granulocytes Parameter Provided by a Hematology Analyzer. Clin Lab 67, doi:10.7754/Clin.Lab.2020.200439 (2021).

Ansari-Lari, M. A., Kickler, T. S. & Borowitz, M. J. Immature granulocyte measurement using the Sysmex XE-2100. Relationship to infection and sepsis. Am J Clin Pathol 120, 795-799, doi:10.1309/LT30-BV9U-JJV9-CFHQ (2003).

Briggs, C. et al. Evaluation of immature granulocyte counts by the XE-IG master: upgraded software for the XE-2100 automated hematology analyzer. Lab Hematol 9, 117-124 (2003).

Jeon, K., Lee, N., Jeong, S., Park, M. J. & Song, W. Immature granulocyte percentage for prediction of sepsis in severe burn patients: a machine leaning-based approach. BMC Infect Dis 21, 1258, doi:10.1186/s12879-021-06971-2 (2021).

Maenhout, T. M. & Marcelis, L. Immature granulocyte count in peripheral blood by the Sysmex haematology XN series compared to microscopic differentiation. J Clin Pathol 67, 648-650, doi:10.1136/jclinpath-2014-202223 (2014).

Fernandes, B. & Hamaguchi, Y. Automated enumeration of immature granulocytes. Am J Clin Pathol 128, 454-463, doi:10.1309/TVGKD5TVB7W9HHC7 (2007).

Lwanga, S. K., Lemeshow, S. & World Health, O. (World Health Organization, Geneva, 1991). [Available from: https://apps.who.int/iris/handle/10665/40062]

Lakschevitz, F. S., Visser, M. B., Sun, C. & Glogauer, M. Neutrophil transcriptional profile changes during transit from bone marrow to sites of inflammation. Cell Mol Immunol 12, 53-65, doi:10.1038/cmi.2014.37 (2015).

Bhansaly, P. et al. Evaluation of Immature Granulocyte Count as the Earliest Biomarker for Sepsis. Indian J Crit Care Med 26, 216-223, doi:10.5005/jp-journals-10071-23920 (2022).

Hotton, J., Broothaers, J., Swaelens, C. & Cantinieaux, B. Performance and abnormal cell flagging comparisons of three automated blood cell counters: Cell-Dyn Sapphire, DxH-800, and XN-2000. Am J Clin Pathol 140, 845-852, doi:10.1309/AJCPE5R4SOQBUULZ (2013).


เนตรชนก เตืองพลี, มณเฑียร พันธุเมธากุล, สุรัส วิจิตรวงศ์, ไพเกษม แสนยานุสิน. ความสามารถของเครื่อง Sysmex XT-2000i ในการตรวจพบเซลล์เม็ดเลือดขาวตัวอ่อน. ปริญญานิพนธ์ สาขาเทคนิคการแพทย์ คณะเทคนิคการแพทย์ มหาวิทยาลัยขอนแก่น; 2558





How to Cite

Songsonthi, P. (2022). Evaluation of automated immature granulocyte percentage by sysmex xn-3000 for predicting immature granulocyte in peripheral blood: Utility of automated immature granulocyte count for predicting myeloid cell series . Saraburi Hospital Medical Journal, 36(2), 257797 : 1– 8. Retrieved from https://he01.tci-thaijo.org/index.php/SHMJ/article/view/257797



Research Articles