Use of the Sysmex XT‐4000i hematology analyzer in the differentiation of cerebrospinal fluid cells in children

BACKGROUND: Routine analysis of pleocytosis and cellular composition of cerebrospinal fluid (CSF) is carried out with a phase-contrast microscope. The use of hematological analyzers seems to be an alternative to the manual method. The aim of the study was to assess the usefulness of the automated technique for counting and differentiating CSF cells in children. METHODS: The study group consisted of 59 children (28 girls and 31 boys) aged from 4 to 17 years suffering from viral and bacterial meningitis. Children were divided into three subgroups according to CSF cell count: 1st group had a pleocytosis of 6-50 cells/µL, 2nd group-51-100 cells/µL, and 3rd group->100 cells/µL. A reference group involved 32 children (17 girls and 15 boys) aged from 2 to 18 years with a normal range of 0-5 cells/µL. Examination of CSF was performed in parallel by two different method, manual and automated. RESULTS: The analysis of pleocytosis revealed that the values obtained by the manual method were statistically significantly lower in relation to the values obtained by automated technique in subgroups I and II. The number of mononuclear and polymorphonuclear cells in subgroups I, II, and III determined by both manual and automated methods was comparable. CONCLUSION: We conclude that automated method cannot fully replace the previously used manual method and some of the dubious cases, such as samples with low pleocytosis rates or abnormal cells indicated by the analyzer, will still require microscopic examination.