Reduce unnecessary smear reviews for reactive monocytosis and focus on true positive samples
Proven balance between clinical insight (sensitivity) and workflow (specificity)
Save TAT and costs
Detect signs suggestive of dysplasia from your routine CBC+DIFF analysis
Add-on that incorporates some research use-only parameters
Add-on that requires validation by the user before implementing it in routine clinical work

Where do you set your MONO# cut-off for smears? Balancing the burden of the smear workload with the risk of missing critical samples is not easy. The Monocytosis Workflow Optimisation (MWO) offers an evidence-based* optional rule set embedded in the Extended IPU to distinguish reactive monocytosis from monocytosis of suspected malignant origin.

Features

Monocytosis management – The dilemma with selecting the optimum criteria for morphological review

Existing criteria for monocytosis management differ in the MONO cut-off criteria - ISLH/GFHC suggest a smear review for MONO# > 1.5 x10³/µL, while according to the WHO (2022), chronic myelomonocytic leukaemia (CMML), a rare leukaemia, is characterised by a MONO# ≥ 0.5 x 10³/μL and ≥ 10% of the WBC count.

Reactive cases are most commonly the cause of monocytosis. However, there is a small possibility that the monocytosis is of malignant origin. This suspicion leads to microscopic examination, generating a high number of unnecessary smears. This leads to the dilemma of finding a balance between a significant increase of smears on false-positive samples to not miss a single case of suspected CMML and the reduction of the manual workload with the inherent risk of missing a rare abnormality due to a low sensitivity for CMML detection.

The MWO concept - How does it work?

MWO combines the so-called ‘mono-dysplasia score’, the monocyte counts and information from the WDF scattergram to recommend samples with monocytosis for microscopic examination.

The ‘mono-dysplasia score’, established and assessed by Schillinger et al., is calculated from three analytical components obtained from the WDF measurement in the search for dysplastic abnormalities typical for CMML.

Parameters

Mono #
Neut #/Mono #
NE-WX

Scatterplot showing the dispersion of the neutrophil population from which the NE-WX is obtained

References

*Schillinger F et al. (2018): A new approach for diagnosing chronic myelomonocytic leukemia using structural parameters of Sysmex XN^TM analyzers in routine laboratory practice. Scand J Clin Lab Invest. Vol. 78(3):159–164.

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