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Abstract
Background:
Automated blood cell analyzers often read leukemic blasts as normal cells. In this study, we evaluated the 5-part differential patterns of blasts using automated analyzers to determine if they can differentiate among blast types.
Methods:
Blood samples containing 10% or more blasts were collected from patients with acute leukemia (N=175). The 5-part differential count was conducted using DxH 800 (Beckman Coulter, USA) and XE-2100 analyzers (Sysmex Co., Japan), and the results were compared with manual differential counts, which was used as a reference method.
Results:
The DxH 800 reported the 5-part white blood cell differential count in 98.9% of the cases. The XE-2100 provided an invalid automated differential count in 72% of the cases. Both analyzers counted most lymphoblasts as lymphocytes and most myeloblasts as monocytes. In 11 cases, the DxH 800 reported a 5-part differential count without a blast flag.
Conclusions:
Some automated analyzers are able to recognize and count blasts according to their characteristic cell types. Therefore, complete blood counts obtained automatically can provide valuable data for making provisional decisions regarding the lineage of leukemia cells before further investigation.
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Fig. 1.
(A) A lymphoblast from an ALL case in which the blasts were counted as monocytes in the DxH 800; it showed irregularly shaped nuclei and cytoplasmic vacuoles. (B) A lymphoblast from a case of ALL in which the blasts were counted as lymphocytes in the DxH 800; it showed round nuclei with dispersed chromatin. (C) A lymphoblast from a case of T-ALL that did not generate blast flags; it showed coarse chromatin and abundant cytoplasm. All photomicrographs are ×1,000 magnification.
Table 1.
Automated differential count results of peripheral blood samples containing 10% or more blasts obtained using the DxH 800 and XE-2100 according to the type of cells which were counted as blasts (% of valid results)
Table 2.
Blast flag results of the peripheral blood samples containing 10% or more blasts obtained using DxH 800 according to the final diagnosis
Table 3.
Total WBC count, percentage of blasts, the cell types that were counted as blasts, and WBC flags in the cases without blast flags by DxH 800
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