Evaluation of Four Automated Hematology Analyzers: A Comparative Study of Differential Counts (Imprecision and Inaccuracy)

Abstract

The authors evaluated the performance of four modern, commercially available hematology analyzers for imprecision and inaccuracy in determining the leukocyte differential count. The evaluation was performed according to International Committee for Standardization in Haematology protocols and the National Committee for Clinical Laboratory Standards H20-T standard, using the same group of patients simultaneously. Imprecision was very low among all the analyzers for neutrophils and lymphocytes (coefficient of variation maximum = 4.12%), whereas for the other leukocyte populations it tended to increase as their presence percentage decreased. The imprecision of the analyzers was still lower than that of the microscopic method. The correlation with the manual 800 cell count (inaccuracy) was good for neutrophils, lymphocytes, and eosinophils (r = 0.974 to 0.888), less so for monocytes (r = 0.757 to 0.490), whereas it was poor for basophils (r = 0.532 to 0.078).

Historical data decrease complete blood count reflex blood smear review rates without missing patients with acute leukaemia

“…Automated blood cell counters have undergone a technological evolution, providing more information1 with greater precision than manual determinations 2 3. The traditional microscopic method based on the count of 100 cells suffers from imprecision1 that is greater than that based on cell counts of thousands of cells provided by automated counters.…”

The rate of manual peripheral blood smear reviews in outpatients

“…Automated laboratory hematology analyzers provide cell counts, flags, cell plots (instrumental morphology) and distributional histograms with greater precision and accuracy than that provided by manual determinations (1,2). However, for pathological conditions such as acute leukemia, a manual peripheral blood smear review is required to make the presumptive diagnosis.…”

The Diagnostic Value of the Neutrophil Left Shift in Predicting Inflammatory and Infectious Disease

“…16 " 19 The latest generation of analyzers also uses advanced laser technology and data analysis to produce a series of WBC morphology flags, including left-shift indicators. The availability of these automated left-shift indicators has further challenged the role of the manual WBC differential as a screening method; in many laboratories, the microscopic examination of blood smears is now used only to confirm the hematologic abnormalities found by automated analyzers.…”