Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal
The analysis of cells in the cerebrospinal fluid (CSF) is a routine procedure that is usually performed manually using the Fuchs–Rosenthal chamber and cell microscopy for cell counting and differentiation. In order to reduce the requirement for manual assessment, automated analyses by devices mainly...
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MDPI AG
2021-05-01
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| Online Access: | https://www.mdpi.com/2073-4409/10/5/1232 |
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| author | Manfred Wick Catharina C. Gross Hayrettin Tumani Brigitte Wildemann Martin Stangel on behalf of the German Society of CSF Diagnostics and Clinical Neurochemistry, DGLN e.V. |
| author_facet | Manfred Wick Catharina C. Gross Hayrettin Tumani Brigitte Wildemann Martin Stangel on behalf of the German Society of CSF Diagnostics and Clinical Neurochemistry, DGLN e.V. |
| author_sort | Manfred Wick |
| collection | DOAJ |
| description | The analysis of cells in the cerebrospinal fluid (CSF) is a routine procedure that is usually performed manually using the Fuchs–Rosenthal chamber and cell microscopy for cell counting and differentiation. In order to reduce the requirement for manual assessment, automated analyses by devices mainly used for blood cell analysis have been also used for CSF samples. Here, we summarize the current state of investigations using these automated devices and critically review their limitations. Despite technical improvements, the lower limit for reliable leukocyte counts in the CSF is still at approximately 20 cells/µL, to be validated depending on the device. Since the critical range for clinical decisions is in the range of 5–30 cells/µL this implies that cell numbers < 30/µL require a manual confirmation. Moreover, the lower limit of reliable erythrocyte detection by automated devices is at approximately 1000/µL. However, even low erythrocyte numbers may be of clinical importance. In contrast, heavily hemorrhagic samples from neurosurgery may be counted automatically at an acceptable precision more quickly. Finally, cell differentiation by automated devices provides only a rough orientation for lymphocytes, granulocytes and monocytes. Other diagnostically important cell types such as tumor cells, siderophages, blasts and others are not reliably detected. Thus, although the automation may give a gross estimate sufficient for the emergency room situation, each CSF requires a manual microscopy for cytological evaluation for the final report. In conclusion, although automated analysis of CSF cells may provide a first orientation of the cell profile in an individual sample, an additional manual cell count and a microscopic cytology are still required and represent the gold standard. |
| first_indexed | 2024-03-10T11:18:57Z |
| format | Article |
| id | doaj.art-42beaf76ac994c14a75fdcb217d3779d |
| institution | Directory Open Access Journal |
| issn | 2073-4409 |
| language | English |
| last_indexed | 2024-03-10T11:18:57Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cells |
| spelling | doaj.art-42beaf76ac994c14a75fdcb217d3779d2023-11-21T20:09:52ZengMDPI AGCells2073-44092021-05-01105123210.3390/cells10051232Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical AppraisalManfred Wick0Catharina C. Gross1Hayrettin Tumani2Brigitte Wildemann3Martin Stangel4on behalf of the German Society of CSF Diagnostics and Clinical Neurochemistry, DGLN e.V.Institute for Laboratory Medicine, Ludwig-Maximilians-University Hospital, 81366 München, GermanyDepartment of Neurology with Institute of Translational Neurology, University and University Hospital Münster, 48149 Münster, GermanyCSF Laboratory, Department of Neurology, University of Ulm, 89081 Ulm, GermanyMolecular Neuroimmunology Group, Department of Neurology, University Hospital Heidelberg, 69120 Heidelberg, GermanyClinical Neuroimmunology and Neurochemistry, Department of Neurology, Hannover Medical School, 30559 Hannover, GermanyThe analysis of cells in the cerebrospinal fluid (CSF) is a routine procedure that is usually performed manually using the Fuchs–Rosenthal chamber and cell microscopy for cell counting and differentiation. In order to reduce the requirement for manual assessment, automated analyses by devices mainly used for blood cell analysis have been also used for CSF samples. Here, we summarize the current state of investigations using these automated devices and critically review their limitations. Despite technical improvements, the lower limit for reliable leukocyte counts in the CSF is still at approximately 20 cells/µL, to be validated depending on the device. Since the critical range for clinical decisions is in the range of 5–30 cells/µL this implies that cell numbers < 30/µL require a manual confirmation. Moreover, the lower limit of reliable erythrocyte detection by automated devices is at approximately 1000/µL. However, even low erythrocyte numbers may be of clinical importance. In contrast, heavily hemorrhagic samples from neurosurgery may be counted automatically at an acceptable precision more quickly. Finally, cell differentiation by automated devices provides only a rough orientation for lymphocytes, granulocytes and monocytes. Other diagnostically important cell types such as tumor cells, siderophages, blasts and others are not reliably detected. Thus, although the automation may give a gross estimate sufficient for the emergency room situation, each CSF requires a manual microscopy for cytological evaluation for the final report. In conclusion, although automated analysis of CSF cells may provide a first orientation of the cell profile in an individual sample, an additional manual cell count and a microscopic cytology are still required and represent the gold standard.https://www.mdpi.com/2073-4409/10/5/1232cerebrospinal fluidcell differentiationautomationCSF diagnostics |
| spellingShingle | Manfred Wick Catharina C. Gross Hayrettin Tumani Brigitte Wildemann Martin Stangel on behalf of the German Society of CSF Diagnostics and Clinical Neurochemistry, DGLN e.V. Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal Cells cerebrospinal fluid cell differentiation automation CSF diagnostics |
| title | Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal |
| title_full | Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal |
| title_fullStr | Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal |
| title_full_unstemmed | Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal |
| title_short | Automated Analysis of Cerebrospinal Fluid Cells Using Commercially Available Blood Cell Analysis Devices—A Critical Appraisal |
| title_sort | automated analysis of cerebrospinal fluid cells using commercially available blood cell analysis devices a critical appraisal |
| topic | cerebrospinal fluid cell differentiation automation CSF diagnostics |
| url | https://www.mdpi.com/2073-4409/10/5/1232 |
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