Beckman Coulter Dxh Manual Differential Comparison

Each instrument was calibrated according to the manufacturers protocols, and all interval maintenance activities were performed according to the manufacturers recommendations.

Nava, CLS, Tracy I.

George, MD, Evaluation of the Beckman Coulter UniCel DxH 800, Beckman Coulter LH 780, and Abbott Diagnostics Cell-Dyn Sapphire Hematology Analyzers on Adult Specimens in a Tertiary Care Hospital, American Journal of Clinical Pathology, Volume 135, Issue 6, June 2011, Pages 939951.

The DxH 800 provided a CBC and differential that correlated well with those of the Sapphire and LH 780, with most parameters showing correlation coefficients (r) of more than 0.97.

Beckman Coulter Dxh Manual Differential Comparison

In the instrument vs 400-cell manual differential comparison, all 3 instruments showed similar and acceptable accuracy to the reference method except for nucleated RBC (NRBC) enumeration, in which the DxH 800 and Sapphire outperformed the LH 780.

We also compared clinical efficiency by determining whether flagged specimens showed abnormalities on a peripheral blood smear as defined by International Council for Standardization in Haematology criteria.

The efficiency, sensitivity, and specificity of the DxH 800 were 77.0, 87.1, and 73.0, respectively, compared with the Sapphire at 75.8, 93.5, and 68.8, respectively, and LH 780 at 66.1, 93.5, and 55.3, respectively.

However, some specimens require operator intervention or confirmatory studies, such as a smear review and manual differential cell count, and these additional steps impact laboratory turnaround time, efficiency, and labor costs.

Manufacturers design instruments intending to minimize interventions while maintaining sensitivity, and given the myriad technologies used by different manufacturers, each analyzer has particular performance characteristics that can be highly specimen-dependent.

Therefore, the most informative manner to select the optimum analyzer is to perform an in-house comparison of candidates using specimens that reflect their intended use.

In this report, we describe a 3-way comparison among the newly released UniCel DxH 800 (Beckman Coulter, Miami, FL), the LH 780 (Beckman Coulter), and the Cell-Dyn Sapphire (Abbott Diagnostics, Santa Clara, CA).

This study represents one of the few early reports on the DxH 800, which is a recently released, high-volume hematology analyzer intended to supplant the previous generation, Beckman Coulter LH 780.

The DxH 800 represents a new design from the manufacturer with less tubing and a smaller footprint than the LH 780.

The Cell-Dyn Sapphire represents a comparable high-volume analyzer from Abbott Diagnostics that has been studied extensively.

By using guidelines established by the Clinical and Laboratory Standards Institute (CLSI; formerly National Committee for Clinical Laboratory Standards) for evaluation of hematology analyzers, we ran a total of 430 adult specimens on all 3 instruments, side by side and under the same laboratory conditions.

We also performed a similar study on 156 pediatric specimens in Microtainer tubes (Becton Dickinson, Franklin Lakes, NJ) in parallel, the results of which are reported separately in an accompanying article.

For both studies, we compared the numeric results from each analyzer and compared each instruments WBC differential and nucleated RBC (NRBC) count with a reference 400-cell manual differential.

We also compared clinical efficiencies by determining whether flagged specimens showed abnormalities on a peripheral blood smear as defined by criteria established by the International Council for Standardization in Haematology (ICSH).

Our goal was to compare the performance of the DxH 800, LH 780, and Sapphire in an unbiased, systematic manner on adult specimens from a tertiary care hospital.

We performed these studies at the core laboratory of the Stanford Medical Center, Stanford, CA, using adult specimens obtained from Stanford Hospital and Clinics, which includes a 465-bed tertiary care hospital with a large number of hematology, oncology, and bone marrow transplant patients.

The analyzer uses new volume, conductivity, and scatter parameters for controlled flow cytometric analysis of WBC differential, reticulocytes, and NRBC detection.

Improvements over previous Beckman Coulter analyzers (including the LH 780) include a proprietary blood detection design to minimize sample volume requirements, solid-state diluter design that contains no pinch valves, and new modular construction with a front-loading sample track to facilitate linkage of multiple DxH 800 instruments in a linear arrangement.

A single DxH 800 was placed in the Stanford Clinical Laboratory during the period from July 22, 2009, to August 7, 2009.

The LH 780 is a fully automated hematology analyzer system capable of analyzing up to 110 samples per hour and providing a CBC, 5-part WBC differential, NRBC count, and reticulocyte count from 300 L of sample.

One particular feature of the LH 780 is the available LH slidemakerslidestainer that connects and combines with the LH 780 to offer rule-based, automated peripheral blood smear production from a single workstation.

The LH 780 has been in use at the Stanford Clinical Laboratory since 2008.

The Cell-Dyn Sapphire is a fully automated hematology analyzer capable of analyzing up to 106 samples per hour to provide a CBC, WBC differential, and NRBC count from 117 L of sample or 69 samples per hour with the addition of a reticulocyte count.

The instrument uses multiangle polarized scatter separation and 3-color fluorescence technologies to provide analysis of the WBC count and differential.

The Sapphire also offers unique extended features, including immunologic-based testing for platelets using antibodies against CD61 and automated counting of CD3CD4CD8 T-cell subsets.

The Sapphire has been in use at the Stanford Clinical Laboratory since March 2007.