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ABSTRACT
The Beckman Coulter compact 5-part differential hematology analyzer, the AcT 5diff analyzer, was evaluated. It
provides up to 26 parameters with a throughput of 60 samples/hour on a selectable mode: complete blood count
(CBC) or CBC plus 5-part differential leukocyte count
(DLC), with a minimal sampling size (53 L for CBC plus
DLC and 30 L for CBC). The AcT 5diff analyzer was
evaluated on the basis of a simplified protocol based on the
routine workload. The sample stability was excellent for all
CBC parameters (up to 72 hours) and for DLC parameters
(up to 48 hours) with a slight shift on monocyte counts.
Correlation coefficients for all CBC parameters were excellent for neutrophils, lymphocytes, and eosinophils and
acceptable for monocytes. The clinical sensitivity of the
white blood cell flagging system performed well with a sensitivity of 92.8% and a specificity of 87.2%. The instrument was easy to use and offered a sample-by-sample selection for CBC only or CBC plus DLC. Lab. Hematol.
2000;7:125129
KEY WORDS:
INTRODUCTION
The AcT 5diff analyzer (Beckman Coulter, Miami, FL) is a
highly compact automated hematology analyzer designed to
provide the parameters of a complete blood count (CBC) and
Blood Samples
Samples drawn into 3-mL K3 EDTA vacuum tubes were
selected on a random basis from our routine workload over a
4-week period. All samples were analyzed on both instruments within 4 hours of draw. Five normal samples were
kept at room temperature for the stability study.
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RESULTS
Long-term Stability
CBC parameters were very stable over the 72-hour period (Table 1). The differential parameters showed acceptable stability. Neutrophil and lymphocyte values were stable up to 48 hours. A minor shift occurred in neutrophil
and lymphocyte populations 9 hours after sampling with
no clinical significance. The monocytes increased slightly
after 24 hours.
CBC Correlation
As shown in Figure 1, there was excellent CBC correlation, with all correlation coefficients greater than 0.98 except
mean corpuscular volume (MCV), which exhibited an
acceptable correlation, r = 0.93.
Leukocyte Differential Count Comparison
All leukocyte differential parameters of the AcT 5diff
analyzer showed acceptable results when compared to the
100-cell manual differential (Figure 2). Results were in
accordance with those reported by other authors [2,3].
Monocytes showed a lower correlation coefficient without
clinical significance. Other authors have reported such differences between monocyte counts on automated instruments versus manual counts [4].
Clinical Sensitivity
During this evaluation, positive samples were identified
on the AcT 5diff analyzer when any of the leukocyte flags
were present. Samples were identified as positive by the
Mean at baseline
9 hours
24 hours
32 hours
48 hours
72 hours
7.57
4.12
114
0.345
84.2
13.7
369
4.62
1.97
0.61
0.23
0.03
0.01
0.00
0.02
0.01
0.02
0.02
0.11
0.13
0.03
0.03
0.03
0.00
0.01
0.00
0.00
0.01
0.04
0.03
0.03
0.03
0.03
0.03
0.01
0.00
0.01
0.01
0.01
0.01
0.05
0.01
0.16
0.38
0.02
0.00
0.01
0.01
0.01
0.01
0.02
0.01
0.10
0.15
0.02
0.01
0.00
0.01
0.01
0.01
0.01
0.06
0.22
0.22
0.48
0.01
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FIGURE 1. Regression analysis for complete blood count parameters in a comparison of the AcT 5diff and the CD 1600. A, Red
blood cells (RBC). B, White blood cells (WBC). C, Platelets (PLT). D, hemoglobin. E, Mean corpulscular volume (MCV).
manual differential when one or more of the criteria of positivity (Table 2) were met.
Table 3 shows the clinical sensitivity of the AcT 5diff and
the CD1600 analyzers in this study.
DISCUSSION
The AcT 5diff hematology analyzer provided complete
CBC and leukocyte differential using impedance (Coulter
Principle) and cytochemistry leading to specific staining of
cell granules.
All CBC parameters were stable up to 72 hours and differential parameters were stable up to 48 hours. This result is
of high value for centers that receive samples from outside
collection points because such samples usually travel several
hours prior to being tested.
Prior to the comparison between the 2 analyzers, each
instrument was calibrated using calibrator bloods according
to manufacturer recommendations. Excellent correlation was
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FIGURE 2. Regression analysis for differential leukocyte count in a comparison of the AcT 5diff and manual DLC. A, Neutrophils.
B, Lymphocytes. C, Monocytes. D, Eosinophils.
The AcT 5diff analyzer required no routine daily maintenance. A daily automatic shutdown ensured the proper
cleaning of the system. Overall, this instrument was perceived as very convenient for a laboratory performing about
40 to 50 samples a day.
The AcT 5diff analyzer model we tested was an open-vial
system; a model with closed-vial sampling and a database
management system is also available.
TABLE 3. Morphological Classification
AcT 5diff
CD 1600
75
26
2
41
6
92.8%
87.2%
89.3%
75
8
21
42
4
27.6%
91.3%
66.6%
Blasts
Promyelocytes
Myelocytes
Reactive lymphocytes
Erythroblasts
1
1
>2
2
2
Total
True positive
False negative
True negative
False positive
Sensitivity
Specificity
Efficiency
REFERENCES
1. Kass L. Staining of granulocytic cells by Chlorazol Black E. Am J
Clin Pathol. 1981;76:810-812.
2. Bentley SA, Johnson A, Bishop CA. A parallel evaluation of four automated hematology analyzers. Am J Clin Pathol. 1993;100:626-632.
3. Butarello M, Gadott M, Lorenz C. Evaluation of four automated
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