Evaluation of ‘CellaVision Advanced RBC application’; new software for reporting erythrocyte morphology.

Eva Grönlund1,*, Margit Döry2, Agnetha Evers1, Soheir Beshara2

1Klinisk Kemi Södersjukhuset, 2Klinisk Kemi, Karolinska Universitetslaboratoriet, Stockholm, Sweden

Introduction: Cellavision has been in routine at our laboratory and was included in accreditation of differential count for white blood cells. However, it has limitation regarding erythrocyte morphology that is of importance in specific clinical situations. In such cases, the morphology is reported using microscopy, where the numbers of examined fields and findings that generate a positive result are standardized.

Objectives: To evaluate ‘CellaVision Advanced RBC application’

Methods: Two smears per sample for 30 normal and 94 pathological samples were examined by two certified examiners. The results were compared to microscopy using Miller-ocular (counting 1000 erythrocytes in 10 fields at 1000x magnification), and evaluated whether they generate a positive or negative result.

Samples showing significant variation, i.e. positive result from one system or examiner but negative from the other, were re-examined by a third examiner.

Results: The pathological samples showed sickle cells in 22, malaria in 16, schistocytes in 31 and spherocytes in 35 samples. Twenty-three samples required a third examiner. The number of counted cells by the software ranged 1000 to 3000.

There was a good agreement between both systems in all samples showing sickle cells and malaria, in 30 of 31 showing schistocytes but only in 14 having spherocytes.

There was a general tendency to identify more positive findings using Cellavision.

Conclusion: There was an agreement in morphological abnormalities but spherocytes, where improvement in the neural network is required. For malaria, it had an excellent agreement that can serve as part of screening; however, larger study is needed to confirm this observation.

The new software can serve as a tool to standardize the reports and build up a morphology database. It has an advantage in cases with specific requests, but can be time consuming in smears with no request. Selecting specific functions for routine, e g inclusions, needs further evaluation.

Keywords: Blood, Method