We read with interest the table of contents of the “Early View—Online Version of Record before inclusion in an issue” of Cytometry Part B, Clinical Cytometry that you recently posted. We were especially caught by the publication of Shestakova et al., that we had not noticed as preview, reporting on the interest of automated leukocyte parameters to disclose patients with myelodysplastic syndromes (MDS). This topic is clearly of great interest, owing to the increased life expectancy and thus increased likelihood to see patients with pre-leukemic conditions in our routine screenings.

This work, relying on Beckman Coulter analyzers, seems to have only considered VCS parameters in neutrophils. We were surprised to see that this report omitted a MDS-suspicion score that was previously recently published with the same idea of detecting pre-MDS or MDS from white blood cell count (WBC) assays in routine laboratories. Indeed, Boutault et al. (2018) reported in 2018 on a score allowing for MDS suspicion on Sysmex instruments. Data from this study, that included more than 500 individuals, showed that research parameters allowed to propose a significant score, with much stronger positive and negative predictive values than those shown in the paper of Shestakowa et al. This study proposed to use mean corpuscular volume, absolute neutrophil count, median neutrophil complexity and width of dispersion of the events measured (Ne-WX). Even more recently (Ravalet et al., 2021), but after Shestakowa's preview issue, another study using data acquired in Beckman Coulter instruments was published in Cancers. In the latter, Ravalet et al., through repetitive assessments, identified 10 parameters found to provide a strong likelihood suspicion of MDS. It is important to note that these strategies and scores ultimately should lead to the morphologic examination of a blood smear, itself guiding or not bone marrow aspiration and additional explorations to support the diagnosis of MDS.

We feel that Cytometry Part B readers should also be aware of these two seminal studies strengthening the message of Shestakova et al., that is, that white blood cell count automated instruments may provide more information than that expected in routine laboratories, especially in suspecting MDS in elderly patients.

我们感兴趣地阅读了您最近发布的 Cytometry Part B，Clinical Cytometry 的“Early View - Online Version of Record before Inclusion”的目录。Shestakova 等人的出版物特别吸引了我们，我们没有注意到作为预览，报告了自动化白细胞参数对披露骨髓增生异常综合征 (MDS) 患者的兴趣。由于预期寿命延长，因此在我们的常规筛查中看到患有白血病前期疾病的患者的可能性增加，这一主题显然引起了极大的兴趣。

这项依赖贝克曼库尔特分析仪的工作似乎只考虑了中性粒细胞中的 VCS 参数。我们惊讶地发现，这份报告省略了之前最近发表的 MDS 可疑评分，该评分与在常规实验室中通过白细胞计数 (WBC) 检测检测 MDS 前或 MDS 的想法相同。事实上，Boutault 等人。( 2018) 于 2018 年报告的分数允许 MDS 怀疑 Sysmex 仪器。这项研究的数据包括 500 多人，表明研究参数可以提出一个显着的分数，其阳性和阴性预测值比 Shestakowa 等人的论文中显示的要强得多。本研究建议使用平均红细胞体积、绝对中性粒细胞计数、中性粒细胞复杂性中值和测量事件的分散宽度 (Ne-WX)。甚至最近（Ravalet 等人，  2021)，但在 Shestakowa 的预览版之后，另一项使用贝克曼库尔特仪器获得的数据的研究发表在 Cancers 上。在后者中，Ravalet 等人通过重复评估，确定了 10 个参数，这些参数被发现提供了对 MDS 的高度怀疑。重要的是要注意，这些策略和评分最终应该导致血液涂片的形态学检查，本身指导或不指导骨髓抽吸和额外的探索以支持 MDS 的诊断。

我们认为 Cytometry Part B 的读者也应该意识到这两项开创性研究加强了 Shestakova 等人的信息，即白细胞计数自动化仪器可能提供比常规实验室预期更多的信息，尤其是在怀疑 MDS 时在老年患者中。