Performance Evaluation of the Sysmex XN , XR, and DI ‐60 Body Fluid Applications for Leukocyte Differentiation

ABSTRACT Introduction In response to the growing demand for automation in body fluid (BF) analysis, we evaluated the research four‐part white blood cell (WBC) differentiation provided by the Sysmex XN and XR hematology analyzers (BF mode), as well as the Sysmex digital cell imaging analyzer DI‐60 (CellaVision) BF application for microscopic analysis. Methods Cerebrospinal, pleural, peritoneal, and synovial fluid samples were analyzed. The four‐part WBC differentiation (neutrophil, lymphocyte, monocyte, and eosinophil count (%)) provided by the XN‐ and XR‐BF mode and the DI‐60 BF application was compared to manual microscopic examination of May‐Grünwald Giemsa stained cytocentrifuge slides. Additionally, the DI‐60 BF application was assessed for its capability to detect malignancies. Results A total of 205 BF samples were included in the evaluation of the four‐part WBC differentiation of the XN‐ and XR‐BF mode. A very strong correlation coefficient (r s ) between the XN/XR analyzer and manual microscopic examination was observed for neutrophils (%): 0.851 (XN); 0.862 (XR) and lymphocytes (%): 0.833 (XN); 0.842 (XR). The XN and XR analyzers reported lower monocyte counts compared to manual microscopic examination (bias = −3.21% (XN); −1.16% (XR)). The eosinophil count (%) showed suboptimal correlation between the automated analyzers and manual microscopy (r s = 0.428 (XN); 0.555 (XR)), probably due to low levels and outliers. Out of 161 cytospin slides, 39 could not be processed by the DI‐60, resulting in 122 remaining samples. All WBC types showed strong correlation between the manual count and the DI‐60 count (r s values of 0.735–0.974). Conclusions The four‐part WBC differentiation provided by the Sysmex XN‐ and XR‐BF mode and the Sysmex DI‐60 BF application are valuable tools for automating and standardizing BF analysis.