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Point-of-Care White Blood Cell Differential Testing in Pediatric Inpatients (2 Months-17 Years): How Does HemoScreen
Alessio Correani1, Beatrice Niccoletti1, Marianna Pavani1
1SOD Medicina di Laboratorio, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy.
Insights
This study shows the HemoScreen device accurately performs five-part white blood cell (WBC) differentials in pediatric patients. Its abnormal cell flagging can help prioritize review, but workflow impact needs more study.
Area of Science:
- Pediatric Hematology
- Point-of-Care Diagnostics
- Clinical Laboratory Science
Background:
- Point-of-care (POC) hematology testing is increasingly important in pediatric care.
- Previous evaluation of HemoScreen focused on total blood counts.
- WBC differentials are crucial for pediatric diagnostics.
Purpose of the Study:
- To evaluate the HemoScreen POC analyzer for five-part WBC differential counts in pediatric venous samples.
- To assess the analytical and diagnostic performance of HemoScreen for pediatric WBC differentials.
Main Methods:
- Prospective analysis of 141 pediatric venous samples.
- Comparison of HemoScreen results with Sysmex XN-1000 and digital microscopy.
- Assessment of analytical agreement, diagnostic concordance, and flagging performance.
Main Results:
- Strong to excellent correlations for WBC subsets (ρ = 0.625-0.977).
- Good diagnostic agreement for various WBC types, with excellent agreement for neutropenia, neutrophilia, and lymphocytopenia.
- HemoScreen flagged 31.9% of samples, demonstrating good sensitivity and specificity for abnormal cells.
Conclusions:
- HemoScreen demonstrates good analytical and diagnostic performance for five-part WBC differentials in pediatric venous samples.
- The device's abnormal cell flagging may aid in prioritizing morphological review.
- Further evaluation is needed to determine the workflow impact of HemoScreen in clinical practice.
Background:
Point-of-care (POC) hematology testing is of growing interest in pediatric practice. We previously evaluated an image-based POC hematology analyzer (HemoScreen, PixCell Medical, Yokneam Illit, Israel) for total white blood cell (WBC), red blood cell, and platelet counts and associated indices in pediatric inpatients. Given the diagnostic importance of WBC differentials, this study aimed to extend the evaluation to five-part differential counts.
Methods:
We prospectively analyzed 141 venous K2-EDTA samples from pediatric inpatients aged 2 months-17 years. Complete blood counts were obtained with the Sysmex XN-1000 (Sysmex Co., Kobe, Japan) and reanalyzed with HemoScreen. Blood smears were digitized with CellaVision DC-1 (CellaVision AB, Lund, Sweden) and reviewed by cytologists. HemoScreen WBC differential percentages were directly compared with cytologist-reviewed digital microscopy, whereas absolute counts were compared with composite values calculated from microscopy-derived percentages and the Sysmex WBC count. Analytical agreement, diagnostic concordance and flagging performance were assessed.
Results:
Of 141 samples, 138 were suitable for analysis. Correlations for WBC subsets were strong to excellent (ρ = 0.625-0.977). Mean bias was within or close to EFLM-derived acceptable limits for neutrophils and lymphocytes. Diagnostic agreement was excellent for neutropenia, neutrophilia, and lymphocytopenia, and good for lymphocytosis, monocytosis, and eosinophilia. HemoScreen flagged 31.9% of samples for abnormal cells, with sensitivity 74.1%, specificity 78.4%, positive predictive value 45.5%, negative predictive value 92.6%, and overall efficiency 77.5%.
Conclusions:
In pediatric venous samples, HemoScreen showed good analytical and diagnostic performance for the five-part WBC differentials. Its abnormal-cell flagging may support prioritization of morphological review, although its workflow impact requires further evaluation.
