Utility of hyperchromic cell percentage, flags, and red cell cytograms generated by Advia-120 hematology analyzer as a potential screening tool in hereditary spherocytosis

Hereditary spherocytosis (HS) is the commonest inherited red cell membrane disorder seen in clinical practice. Modern hematology analyzers generate newer parameters that can help in screening of HS. The present study focuses on the utility of red blood cell data generated by Advia-120 hematology analyzer as a screening tool for patients with HS. Blood samples from 21 patients with HS were analyzed on Advia-120 (Technicon H*1 series) analyzer. The percentage of hyperchromic cells and hyperchromic and hemoglobin concentration variance flags along with the RBC cytogram were studied. A control group of 50 healthy individuals and 50 patients with other hematological disorders was also studied. Osmotic fragility test was done in all patients with suspected HS. All hematological parameters including percentage of hyperchromic red cells were compared between the study group, healthy controls, and other hematological disorders. Twenty of the 21 patients with HS were anemic. Peripheral blood smear in all patients showed variable numbers of spherocytes (5–50%). Osmotic fragility test was positive in all patients. The mean percentage of hyperchromic cells in patients with HS-18.2 ± 13.0% was significantly higher (p < 0.0001) than that seen in the control group and in patients with other hematological disorders. Hyperchromic RBC > 6% showed a sensitivity of 100% and specificity of 99% for the diagnosis of HS. All patients showed flagging for hyperchromic cells. The RBC cytograms in all 21 patients showed significant number of RBCs plotted in the hyperchromic zone. The percentage of hyperchromic cells, hyperchromic cell flagging, and RBC cytogram pattern generated by Advia-120 hematology analyzer are useful tools in the screening of patients with suspected HS.