Ann Lab Med.  2021 Jan;41(1):44-50. 10.3343/alm.2021.41.1.44.

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

• Park SJ
• Yoon J
• Kwon JA
• Yoon SY

• KMID: 2512732
• DOI: http://doi.org/10.3343/alm.2021.41.1.44

Abstract

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 withinone 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.

Keyword

Red blood cell; Morphology; Advanced RBC Application; CellaVision DM9600; International Council for Standardization in Haematology guidelines

Figure

• 

  Fig. 1 Overview of the CellaVision DM9600 Advanced RBC Application. (A) The software provides an overview image using the RBC morphological category results, which are graded semi-quantitatively in four flag levels. (B) Image depicting individual cells categorized into each RBC morphological abnormality. Abbreviation: RBC, red blood cell.

• 

  Fig. 2 Screenshots of the CellaVision Advanced RBC Application. (A) The overview image of a sample with acanthocytes (grade 2). (B) Pre-classification results showing some acanthocytes classified as schistocytes. (C) Image of individual cells showing that the acanthocyte grade was underestimated. Abbreviation: RBC, red blood cell.

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