comparison-of-cerebro-spinal-fluid-csf-cell-counts

Cerebral Spinal Fluid (CSF) analysis is used for the diagnosis and monitoring of several pathological conditions (Eg. Meningitis). Manual CSF cell counting method is traditionally used by most laboratories. The limitations of the manual CSF count are high because it is time consuming, cost intensive and it requires experienced technical staff. Therefore, it influences to a greater interest for the automated analysis of CSF cell counts. In this study we compared both manual CSF cell count and automated cell count using BC-6800 hematology analyzer with regards to turnaround time, cost and reproducibility of the test. Linearity analysis was also done simultaneously. Research was designed to detect the ability of automated analyzer method for day to day practice. A total of 84 CSF samples were analyzed by manual microscopy and by BC-6800 hematology analyzer. An analytical performance which includes linearity of the analyzer and reproducibility were analysed. The comparison of turnaround time and cost of both the manual and automated methods was performed. Statistical analysis was done by using SPSS 20th version. Descriptive statistics, Pearson correlation and Bland and Altman difference plots were used to determine the correlation between variables. Analysis such as mean median and mean comparison were performed for turnaround time and cost analysis. It showed good correlation between the two methods. There was a strongly positive correlation between total white blood cells (WBC-CSF), Lymphocytes (L-CSF), Polymorphs (Poly-CSF), Red blood cells (RBC-CSF) in manual and automated methods with Pearson correlation values of 0.999, 0.981, 0.998 and 0.995 respectively. According to the Bland-Altman plots there were no proportional bias or systemic bias. In linearity analysis there was a good linearity in the BC- 6800 automated hematology analyzer. While comparing the cost, manual method is cost effective than automated method. When comparing the turnaround time manual method is more time consuming than automated method. In repeatability analysis, relative standard deviation, RSTD% (pool) for WBC, lymphocytes, polymorphs and RBC were 3.7, 8.4, 20.4, 21.3 in automated method and 4.4, 8.5, 89.5, 4.0 in manual method respectively. According to that WBC, Polymorphs and Lymphocytes counts in automated method were more precious than manual method. In conclusion, BC-6800 hematology analyzer provides a strong positive correlation with the manual CSF method. Introduction Cerebrospinal fluid (CSF) is a clear fluid present in the cerebral ventricles and subarachnoid space of the brain and spinal cord. It protects the brain and spinal cord from injuries and also serves as a nutrient reservoir and waste removal process [1]. CSF analysis is carried out to diagnose hemorrhages, inflammatory and infectious diseases such as meningitis, in the Central Nerve System (CNS). Meningitis is mainly caused by bacteria and viruses. The CSF cell count is used as an indicator of infections, hemorrhage and inflammations in CNS [2]. CSF cell counts traditionally have been determined by Fuchs Rosenthal manual counting chamber method [2]. This method is labor intensive, time consuming and less reproducible [3]. So, cell count analysis of various body fluids is now widely performed using various automated hematology analyzers in laboratories [4,5]. Journal of Uva Clinical Society | Volume 18: October 2024 40 A rapid and accurate CSF cell analysis reduces the turn-around time and inter-operator variability and directly affects the patients‘ mortality and morbidity. In this aspect, automated analysis of CSF cell count will be the best alternative method due to its simplicity, precision and sufficient accuracy. Although cell differentiation by automated devices provides only a rough estimation of lymphocytes, granulocytes and monocytes counts, this gross estimation is sufficient for early diagnosis [2]. Moreover, many scientific reports reveal that the automated CSF cell counting is an expensive, yet rapid, accurate and precise technique compared to manual microscopy. But still there are some contradictory findings regarding the cost efficacy, turnaround time, accuracy and precision of both manual and automated CSF cell counting [6]. Automated CSF cell counting methods are not widely used in the clinical laboratory setting due to shortage of facilities and high reagent cost. Because of the inter operator variability during the manual cell counting, introducing a reliable and efficient method for CSF cell counting is a necessity. But due to heavy work load in the laboratory, performing the time consuming CSF manual cell counting causes reduced productivity of the laboratory and also severely affects the turnaround time which ultimately causes a delay in diagnosis. So, implementing the automated method for CSF cell counting as an alternative for conventional CSF cell counting is beneficial for both patients and healthcare providers when a diagnostic laboratory is concerned. Even though the determination of analytical performance and cost efficacy is essential prior to implementing a suitable analytical technique, there are no sufficient scientific data regarding the analytical performance parameters and cost-performance analysis of automated and manual CSF cell counting in Sri Lankan clinical laboratory setting. The current study is designed to fill the aforementioned gap. The objectives of the current research are to compare cell counting, linearity, cost efficacy, turn-around time and reproducibility of CSF cell counts obtained from automated hematology analyzer, Mindray BC-6800 and manual microscopic method