Analysis of serous body fluids using the CELL-DYN Sapphire hematology analyzer

Background: Correct cell enumeration and differential analysis of body fluids are important in the diagnosis and management of several diseases. Currently, microscopic analysis is still considered the "gold standard". The aim of the present study was to evaluate the analytical performance of the CELL-DYN Sapphire hematology analyzer for automated differentiation of cells in serous fluids and to explore whether manual analysis of the raw data files could improve the differential count compared with reference microscopy. Methods: A total of 105 serous fluids (39 peritoneal and 66 pleural effusions) were analyzed by the CELL-DYN Sapphire using standard whole-blood algorithm. Additionally, we performed optimized manual gating of the Sapphire raw data file using standard flow cytometry software. Results: The standard Sapphire algorithm showed substantial deviations from the reference microscopic differentiation: polymorphonuclear cell counts were too high because they contained some monocytic cells. However, when optimized manual gating strategy is used, a good correlation and negligible bias were found. Conclusions: We have demonstrated that with a modified algorithm, CELL-DYN Sapphire will provide reliable identification and enumeration of blood cells in peritoneal and pleural fluids