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A Comparison of Automated and Manual Leukocyte Differential Counts and The Detection of Lymphoid Blast Cells For Diagnosis and Treatment Decisions in Pediatric Oncology.

The absolute granulocyte count (AGC) is one of the most useful laboratory values used in pediatric oncology. AGCs can be derived from manual or automated leukocyte differential (LD) counts. We wondered whether a primarily automated system could reliably be used for making decisions regarding treatment in pediatric oncology and how this might affect diagnoses of acute leukemia in childhood. We retrospectively collected all pediatric oncology complete blood cell counts at our institution with matched automated and manual LD counts over a one-month period (n = 439) and conducted correlation analyses. Following an initial analysis of automated compared to manual AGCs, correlation analyses of three sub-groups based on treatment protocols were conducted: AGCs of <0.5 × 109/L (n = 110); >0.5–1.0 × 109/L (n = 55); and >1.0 × 109/L (n =274). In addition, we analyzed the sensitivity and specificity of the machine to detect blast cells. We subsequently collected all available matched automated and manual LD counts at the time of diagnosis of acute leukemia (ALL and AML) over a two-year period (n = 33) and analyzed the sensitivity and specificity of the machine to detect blast cells in the peripheral blood. There was a highly positive correlation between automated and manual AGCs (R2 = 0.879). Sub-group analyses revealed that automated and manual AGCs of 0.00–0.5 × 109/L were not correlated (R2 = 0.565) and of >0.5–1.0 × 109/L were not correlated (R2 = 0.268). There was a strong positive correlation between automated and manual AGCs of >1.0 × 109/L (R2 = 0.826). The sensitivity of the machine to detect blast cells was 37% and the specificity was 74.3%. The sensitivity of the machine to detect blast cells at the time of diagnosis of ALL or AML was 41.4% and the specificity was 66.7%. Overall, automated AGCs are predictive of manual AGCs in pediatric oncology patients. Automated AGCs of <1.0 × 109 /L, however, are not satisfactory for decisions regarding treatment. Further, automated detection of blast cells is poor, even at the time of diagnosis of acute leukemia. Therefore, we recommend that both automated and manual LD counts be completed on pediatric oncology patients with automated AGCs of <1.0 × 109 /L. Automated counts for AGCs >1.0 × 109 /L are sufficient on their own, however, it is recommended that these samples be manually scanned by a technician for abnormal cellular morphology.