title: Reflex Testing Rules for Cell Count and Differentiation of Nucleated Elements in Pleural and Ascitic Fluids on Sysmex XE-5000.
abstract: Flow cytometry is widely used in many laboratories for automated nucleated cell counts and their differentiation in body fluids. The implementation of new reflex testing rules on these automated instruments could open new frontiers in laboratory workflow, improving characterization of body fluids and clinical diagnosis and decreasing costs. Ascitic (150) and pleural (33) fluids were collected and assessed by XE-5000 and optical microscopy. Cell counts performed with the methods showed a Pearson's correlation of 0.98 (p < 0.0001), Passing-Bablok regression y = 0.99x + 2.44, and bias of 32.3. In ascitic fluids, the best diagnostic performance was found for polymorphonuclear and neutrophil counts on XE-5000, which exhibited areas under the curve (AUCs) 0.98 (p < 0.0001) and 0.99 (p < 0.0001), respectively. In pleural fluids the best diagnostic performance was found for polymorphonuclear percent parameter, which displayed 0.97 (p < 0.0001). Specific reflex test rules based on these parameters were characterized by 92% diagnostic concordance, 1.00 sensitivity, and 0.84 specificity with optical microscopy. The application of a set of reflex testing rules may improve the diagnostic performance of XE-5000, increasing its reliability for routine automated cell count in body fluids. We acknowledge that further studies should be planned to validate our findings according to clinical data.
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy sbuoro@hpg23.it.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Buoro
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Appassiti Esposito
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Vavassori
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Mecca
authors.affiliation: Clinical Chemistry and Hematology Laboratory, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Cosimo
authors.initials: C
authors.lastname: Ottomano
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Dominoni
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Seghezzi
authors.affiliation: Pathology Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Candiago
authors.affiliation: Microbiology Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Farina
authors.affiliation: Pathology Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Gianatti
authors.affiliation: Clinical Chemistry Laboratory, A.O. Papa Giovanni XXIII, Bergamo, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Crippa
authors.affiliation: Clinical Chemistry and Hematology Laboratory, Azienda Ospedaliero Universitaria di Parma, Parma, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
mesh_terms: D001826:Body Fluids / Q000737:chemistry* / Q000166:cytology*; D002452:Cell Count / Q000379:methods*; D005434:Flow Cytometry / Q000379:methods*; D006801:Humans; D008853:Microscopy / Q000379:methods; D012680:Sensitivity and Specificity
keywords: XE-5000; automated cell count; body fluids; reflex testing rules