COULTER S+IV THREE PART DIFFERENTIAL SCREEN IN SELECTED PEDIATRIC PATIENTS

Abstract

Using descrimination of WBC volumes, the Coulter S+IV provides an automated three part differential (3PD). The validity of the 3PD is checked by computer via a system of algorithms that confirm the shape of the WBC volume histograms and flag the abnormalities into R-flag, (abnormal WBC volume distribution) and Backlight flag, (high WBC count, abnormal size distribution or mononuclear count > 1.5×10³/ul). We compared the 3PD in 525 samples from children age 1 mo. to 24 yrs. to those obtained by manual counting of 100 WBC cells. Samples were collected by finger-stick (n=109) or by vein (n=402) from a)same day surgery (n=162); b)general pediatric medical clinic (GPMC) (n=156); c)cardiology clinic (n=43); and d)hematology-oncology clinic (n=164). Specifically excluded were specimens from neonates and in-patients. The relationships between the manual and automated 3PD for S+IV using simple linear regression for venous samples was lymph r=.922, gran r=.919, mono r=.197, and for capillary samples was lymph r=.936, gran r=.914, mono r=.315. 49.9% of all specimens were flagged: 42.8% R flag + 7.1% backlight flag. The most frequent % flagging occured in the capillary specimens (63%) and in patients from hem/one (55.8%). The least amount of flagging was in cardiology (29.5%) and GPMC (30.3%) regardless of collection method. Current Coulter methodology makes the 3PD useful for only a small subsection of routine outpatient differentials.

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