Diagnostic Performance of the Sysmex XN-31™ Automated Analyzer for Detecting Asymptomatic Malaria Among Blood Donors: A Comparative Cross-Sectional Study at the Regional Blood Transfusion Center of Abidjan, Côte d’Ivoire
1 Medical Mycology Laboratory, National Institute of Public Health, P.O. Box V 47, Abidjan, Côte d’Ivoire; (E.Y.); (A.J.S.M.); (W.Y.)
2 Parasitology and Mycology Department, Pharmaceutical and Biological Sciences Training Research Unit, University of Félix Houphouet-Boigny, P.O. Box V 34, Abidjan, Côte d’Ivoire; (K.E.A.); (L.H.E.K.); (V.A.B.-T.); (G.M.E.K.); (A.H.V.-B.); (F.K.K.); (A.K.-T.); (V.D.); (E.I.H.M.)
* Author to whom correspondence should be addressed.
Received: 16 Aug 2025 / Accepted: 31 Mar 2026 / Published: 22 Jun 2026
Abstract
Introduction: In malaria-endemic regions, asymptomatic Plasmodium carriage among blood donors poses a persistent threat to transfusion safety. The Sysmex XN-31™, an automated hematology analyzer that uses fluorescence flow cytometry, is a promising tool for rapidly detecting and analyzing malaria-infected red blood cells. Methods: We conducted a comparative cross-sectional study at the Regional Blood Transfusion Center of Abidjan during a low-transmission season. Blood samples from asymptomatic adult donors were screened using both Sysmex XN-31™ and microscopy on Giemsa-stained blood smears. The diagnostic performance was assessed using microscopy as the reference method, and inter-method agreement was determined using Cohen’s kappa. Molecular confirmation was not performed. Results: Among 520 donors (78% male; mean age 34.7 ± 11 years), Sysmex XN-31™ detected 10 Plasmodium-positive cases (prevalence 1.92%; 95% CI: 1.04–3.50) compared to 4 cases detected by microscopy (0.77%; 95% CI: 0.30–1.96). Half of the Sysmex XN-31™-positive samples had low parasitemia (20–100 parasites/µL), sensitivity was 100% (95% CI: 39.8–100), specificity was 98.8% (95% CI: 97.4–99.5), and Cohen’s kappa was 0.57. Five samples (1.0%) yielded indeterminate Sysmex XN-31™ results. Conclusion: Sysmex XN-31™ proved to be highly sensitive and specific in identifying asymptomatic malaria, particularly for the detection of low parasitemia levels. An integrative algorithm combining primary Sysmex XN-31™ screening with molecular confirmation for positive or indeterminate results is recommended. Multicenter evaluations that incorporate molecular confirmation and cost-effective analysis are warranted to further validate these findings.
Keywords: asymptomatic malaria; blood donors; Sysmex XN-31™; diagnostic performance; screening algorithm
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CITE
Kiki Barro, P.C.; Yaudé, E.; Angora, K.E.; Kouadio, L.H.E.; Miézan, A.J.S.; Bédia-Tanoh, V.A.; Koné, G.M.E.; Vanga-Bosson, A.H.; Kassi, F.K.; Konaté-Touré, A.; Djohan, V.; Menan, E.I.H.; Yavo, W. Diagnostic Performance of the Sysmex XN-31™ Automated Analyzer for Detecting Asymptomatic Malaria Among Blood Donors: A Comparative Cross-Sectional Study at the Regional Blood Transfusion Center of Abidjan, Côte d’Ivoire. AJPME 2026, 3, 14.
Kiki Barro PC, Yaudé E, Angora KE, Kouadio LHE, Miézan AJS, Bédia-Tanoh VA, Koné GME, Vanga-Bosson AH, Kassi FK, Konaté-Touré A, Djohan V, Menan EIH, Yavo W. Diagnostic Performance of the Sysmex XN-31™ Automated Analyzer for Detecting Asymptomatic Malaria Among Blood Donors: A Comparative Cross-Sectional Study at the Regional Blood Transfusion Center of Abidjan, Côte d’Ivoire. AJPME. 2026; 3(2):14.
Kiki Barro, Pulchérie Christiane; Yaudé, Eugénie; Angora, Kpongbo Etienne; Kouadio, Lemaitre Hardy Emmanuella; Miézan, Assohoun Jean Sébastien; Bédia-Tanoh, Valérie Akoua; Koné, Gnanyo Massafoma Estelle; Vanga-Bosson, Abo Henriette; Kassi, Fulgence Kondo; Konaté-Touré, Abibatou; Djohan, Vincent; Menan, Eby Ignace Hervé; Yavo, William. 2026. "Diagnostic Performance of the Sysmex XN-31™ Automated Analyzer for Detecting Asymptomatic Malaria Among Blood Donors: A Comparative Cross-Sectional Study at the Regional Blood Transfusion Center of Abidjan, Côte d’Ivoire." AJPME 3, no. 2: 14.
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