title: Flow cytometric white blood cell differential using CytoDiff is excellent for counting blasts.
abstract: BACKGROUND
  The usefulness of the CytoDiff flow cytometric system (Beckman Coulter, USA) has been studied in various conditions, but its performance including rapidity in detecting and counting blasts, the most significant abnormal cells in the peripheral blood, has not been well evaluated. The objective of this study was to evaluate the performance of the CytoDiff differential counting method in challenging samples with blasts.
  
  
  METHODS
  In total, 815 blood samples were analyzed. Samples flagged as "blasts" or "variant lymphocytes" and showing <10% blasts by manual counts were included. In total, 322 samples showed blasts on manual counts, ranging from 0.5% to 99%. The CytoDiff method was performed by flow cytometry (FC500; Beckman Coulter, USA) with a pre-mixed CytoDiff reagent and analyzing software (CytoDiff CXP 2.0; Beckman Coulter).
  
  
  RESULTS
  The average time required to analyze 20 samples was approximately 60 min for manual counts, and the hands-on time for the CytoDiff method was 15 min. The correlation between the CytoDiff and manual counts was good (r>0.8) for neutrophils and lymphocytes but poor (r<0.8) for other cells. When the cutoff value of the CytoDiff blast count was set at 1%, the sensitivity was 94.4% (95% CI; 91.2-96.6) and specificity was 91.9% (95% CI; 89.0-94.1). The positive predictive value was 88.4% (95% CI; 84.4-91.5) (304/344 cases) and negative predictive value was 96.2% (95% CI; 93.9-97.7) (453/471 cases). The CytoDiff blast counts correlated well to the manual counts (r=0.9223).
  
  
  CONCLUSIONS
  The CytoDiff method is a specific, sensitive, and rapid method for counting blasts. A cutoff value of 1% of at least 1 type of blast is recommended for positive CytoDiff blast counts.
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Jimin
authors.initials: J
authors.lastname: Kahng
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yonggoo
authors.initials: Y
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Myungshin
authors.initials: M
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Eun-Jee
authors.initials: EJ
authors.lastname: Oh
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Yeon-Joon
authors.initials: YJ
authors.lastname: Park
authors.affiliation: Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Kyungja
authors.initials: K
authors.lastname: Han
mesh_terms: D000328:Adult; D005260:Female; D005434:Flow Cytometry / Q000295:instrumentation*; D006801:Humans; D007958:Leukocyte Count; D007962:Leukocytes / Q000166:cytology*; D008214:Lymphocytes / Q000166:cytology; D008297:Male; D009504:Neutrophils / Q000166:cytology
keywords: Blasts; CytoDiff; Differential; Flow cytometry; Performance