Evaluation of the accuracy of the diff3/50 with a cell by cell comparison

The traditional approach to the evaluation of accuracy of discrete differential counters uses a graphic comparison of automated and manual counts. This type of comparison introduces so much sampling variation that significant differences often are obscured. To exclude this sampling variability, one of three technologists, a reference technologist and the Coulter diff3/50, each performed a differential count on exactly the same 100 cells of 47 normal and 56 abnormal blood smears. Linear regression analysis demonstrated excellent agreement between the technologists for all cell types with the exception of band neutrophils. Comparison of the instrument results with the technologists' results showed very good agreement for segmented neutrophils, lymphocytes, monocytes, and eosinophils. The identification of band neutrophils, basophils, immature granulocytes and atypical lymphocytes requires improvement. The overall performance is acceptable, with only 11 leukocytes, on the average normal smear, misclassified out of 100 normal leukocytes (four bands called segs, four segs called bands, and three non-neutrophils incorrectly classified). We recommend similar evaluations for all discrete differential counters.