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Rheumatology Advance Access originally published online on October 1, 2003
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Rheumatology 2004; 43: 170-173
© British Society for Rheumatology 2003; all rights reserved

Basic Science

Automated counting of white blood cells in synovial fluid

R. de Jonge, R. Brouwer, M. Smit, M. de Frankrijker-Merkestijn, R. J. E. M. Dolhain1, J. M. W. Hazes1, A. W. van Toorenenbergen and J. Lindemans

Departments of Clinical Chemistry and 1Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Correspondence to: R. de Jonge, Department of Clinical Chemistry (L154), Erasmus MC, University Medical Center Rotterdam, POB 2040, 3000 CA Rotterdam, The Netherlands. E-mail: r.dejonge{at}erasmusmc.nl

Objectives. To evaluate the performance of automated leucocyte (white blood cell; WBC) counting by comparison with manual counting.

Methods. The number of WBC was determined in heparinized synovial fluid samples by the use of (i) a standard urine cytometer (Kova) and a microscope (reference method) and (ii) a haematology analyser (Sysmex XE-2100; WBC/BASO and DIFF channels). Imprecision within and between days was determined by replicate analysis of a low (level A; WBC ~0.560 x 109/l) and a high (level B; WBC ~1.081 x 109/l) dedicated synovial fluid control (Quantimetrix).

Results. The WBC count of the DIFF channel was highly correlated with the WBC count of the microscopic reference method (r = 0.99; WBC analyser = 0.870 x WBC reference method + 0.413). In contrast, no agreement existed between WBC counts generated by the WBC/BASO channel of the analyser and the reference method (r = 0.52; WBC analyser = 0.008 x WBC reference method + 0.079). Within-day imprecision (4–7%) and between-day imprecision (10%) of the haematology analyser were smaller than the within-day imprecision (12%) and the between-day imprecision (20–22%) of the manual reference method. For manual counting, inter-observer coefficients of variation were 35.9% (control level A) and 21.0% (control level B).

Conclusions. The WBC count in synovial fluid can be reliably determined using the DIFF channel of the Sysmex XE-2100. Automated counting of WBC in synovial fluid offers more precise and faster results than manual counting.

KEY WORDS: Synovial fluid, Sysmex XE-2100, Automated, Leucocytes.


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