Evaluation of the CellaVision Advanced RBC Application for Detecting Red Blood Cell Morphological Abnormalities.

BACKGROUND: The Advanced RBC Application of the CellaVision DM9600 system (CellaVision AB, Lund, Sweden) automatically characterizes and classifies red blood cells (RBCs) into 21 morphological categories based on their size, color, shape, and inclusions. We evaluated the diagnostic performance of the CellaVision Advanced RBC Application with respect to the classification and grading of RBC morphological abnormalities in accordance with the 2015 International Council for Standardization in Haematology (ICSH) guidelines. METHODS: A total of 223 samples, including 123 with RBC morphological abnormalities and 100 from healthy controls, were included. Seven RBC morphological abnormalities and their grading obtained with CellaVision DM9600 pre- and post-classification were compared with the results obtained using manual microscopic examination. The grading cut-off percentages were determined in accordance with the 2015 ICSH guidelines. The sensitivity and specificity of the CellaVision DM9600 system were evaluated using the manual microscopic examination results as a true positive. RESULTS: In pre-classification, >90% sensitivity was observed for target cells, tear drop cells, and schistocytes, while >90% specificity was observed for acanthocytes, spherocytes, target cells, and tear drop cells. In post-classification, the detection sensitivity and specificity of most RBC morphological abnormalities increased, except for schistocytes (sensitivity) and acanthocytes (specificity). The grade agreement rates ranged from 35.9% (echinocytes) to 89.7% (spherocytes) in pre-classification and from 46.2% (echinocytes) to 90.1% (spherocytes) in post-classification. The agreement rate of samples with within-one grade difference exceeded 90% in most categories, except for schistocytes and echinocytes. CONCLUSIONS: The Advanced RBC Application of CellaVision DM9600 is a valuable screening tool for detecting RBC morphological abnormalities.

About the correct definition of acanthocytes for their use as markers of glomerular haematuria / Sobre la correcta definición de los acantocitos para su uso como marcadores de hematuria glomerular

Acanthocytes, when≥5% of urinary erythrocytes examined, are considered as the most reliable marker of glomerular haematuria. However, some uncertainties still exist in the literature about their morphological definition. The aim of this paper is to discuss this topic and to suggest a univocal definition of acanthocytes as erythrocytes with the shape of a ring with one or more protrusions

Los acantocitos, cuando son≥5% de los eritrocitos urinarios examinados, se consideran el marcador más fiable de la hematuria glomerular. Sin embargo, todavía existen algunas incertidumbres en la literatura acerca de su definición morfológica. El objetivo de este artículo es discutir este tema y proponer una definición unívoca de los acantocitos como eritrocitos con la forma de un anillo con una o más protuberancias

A useful new classification of dysmorphic urinary erythrocytes.

BACKGROUND: Among dysmorphic urinary erythrocytes (D cells), G1 cells or doughnut-shaped erythrocytes with one or more blebs are considered to be reliable markers for glomerular diseases. However, although there are many D cells with cytoplasmic color loss and without blebs in the urinary sediment, the significance of these cells is not clear. In this study, we devised a classification system for D cells and examined the relation between these cell types and urinalysis data. METHODS: We classified D cells into three types (D1, D2, and D3 cells): D1 cells showed a ring-like shape and severe loss of cytoplasmic color with protrusions or blebs; D2 cells showed a doughnut-like shape and moderate cytoplasmic color loss with protrusions or blebs; and D3 cells showed a doughnut-like shape and mild cytoplasmic color loss without protrusions or blebs. We calculated the numbers of D cells of each type in 45 patients with glomerular diseases and in 303 general outpatients. This was done by bright-field microscopy modified for the analysis of urinary sediment, and we also examined the significance of these cell types. RESULTS: In the 45 patients with glomerular diseases, the numbers of D1, D2, and D3 cells correlated with urine levels of proteinuria and hematuria and numbers of cellular and fatty casts. Numbers of D1 and D2 cells correlated with urine concentrations of albumin and N-acetyl-beta-D-glucosaminidase, and the proportions of D1 and D2 cells in D cells increased with the activity of glomerular diseases classified by urinalysis data. Only the number of D1 cells correlated with the urine concentration of potassium, which may increase in hemolysis. In the 303 outpatients, the sensitivity of D3 cells and D1 and/or D2 cells (G1 cells) was 73% and 46%, respectively, for the detection of glomerular diseases and the specificity was 93% and 99%, respectively. CONCLUSIONS: These data indicate that the D3 cell is a sensitive marker for glomerular diseases, and that D1 and/or D2 cells are markers for severe glomerular diseases.