Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter November 7, 2006

Automated analysis of pleural fluid total and differential leukocyte counts with the Sysmex XE-2100

Robert de Jonge, Rob Brouwer, Marcel van Rijn, Bernadette A.C. van Acker, Henk J.A.M. Otten and Jan Lindemans


Background: Determination of leukocyte (WBC) counts in pleural fluid is routinely performed by microscopic examination. In this study, we evaluated the performance of automated (differential) WBC counting in comparison with manual counting.

Methods: Pleural fluid samples (n=45) were obtained from patients undergoing diagnostic thoracocentesis. The manual total WBC count was determined after Samson staining in a Fuchs-Rosenthal hemocytometer; microscopic differential counts were performed on May-Grünwald Giemsa-stained cytospin slides. The Sysmex XE-2100 hematology analyzer was used for automated (differential) WBC counting. The functional detection limit was determined by serial dilution of continuous ambulatory peritoneal dialysis (CAPD) fluid and replicate measurements of each dilution.

Results: The automated WBC count (×106/L) was highly correlated with that of the microscopic reference method (r2=0.95; WBC-analyzer=0.97×WBC-reference method+16; n=45). Good agreement was also observed for the absolute lymphocyte count (r2=0.92; WBC-analyzer=0.99×WBC-reference method+32; n=36), neutrophil count (r2=0.94; WBC-analyzer=0.91×WBC-reference method+6; n=35), and monocyte count (r2=0.73; WBC-analyzer=0.83×WBC-reference method+6; n=38). The functional detection limit for WBCs was calculated at 50×106/L (coefficient of variation 20%).

Conclusions: With some limitations, total and differential WBC counts in pleural fluid can be reliably determined using the Sysmex XE-2100 instrument.

Clin Chem Lab Med 2006;44:1367–71.

Corresponding author: Dr. Robert de Jonge, Department of Clinical Chemistry (L-137), Erasmus MC, POB 2040, 3000 CA Rotterdam, The Netherlands


1. Balfour-Lynn IM, Abrahamson E, Cohen G, Hartley J, King S, Parikh D, et al. BTS guidelines for the management of pleural infection in children. Thorax 2005; 60(Suppl 1):i1–21.10.1136/thx.2004.030676Search in Google Scholar PubMed PubMed Central

2. Light RW, Erozan YS, Ball WC, Jr. Cells in pleural fluid. Their value in differential diagnosis. Arch Intern Med 1973; 132:854–60.10.1001/archinte.1973.03650120060011Search in Google Scholar

3. Maskell NA, Butland RJ. BTS guidelines for the investigation of a unilateral pleural effusion in adults. Thorax 2003; 58(Suppl 2):ii8–17.10.1136/thx.58.suppl_2.ii8Search in Google Scholar

4. Salinas M, Rosas J, Iborra J, Manero H, Pascual E. Comparison of manual and automated cell counts in EDTA preserved synovial fluids. Storage has little influence on the results. Ann Rheum Dis 1997; 56:622–6.10.1136/ard.56.10.622Search in Google Scholar PubMed PubMed Central

5. Aune MW, Sandberg S. Automated counting of white and red blood cells in the cerebrospinal fluid. Clin Lab Haematol 2000; 22:203–10.10.1046/j.1365-2257.2000.00275.xSearch in Google Scholar PubMed

6. Aulesa C, Mainar I, Prieto M, Cobos N, Galimany R. Use of the Advia 120 hematology analyzer in the differential cytologic analysis of biological fluids (cerebrospinal, peritoneal, pleural, pericardial, synovial, and others). Lab Hematol 2003; 9:214–24.Search in Google Scholar

7. de Jonge R, Brouwer R, Smit M, de Frankrijker-Merkestijn M, Dolhain RJ, Hazes JM, et al. Automated counting of white blood cells in synovial fluid. Rheumatology (Oxford) 2004; 43:170–3.10.1093/rheumatology/keh021Search in Google Scholar PubMed

8. Ziebig R, Lun A, Sinha P. Leukocyte counts in cerebrospinal fluid with the automated hematology analyzer CellDyn 3500 and the urine flow cytometer UF-100. Clin Chem 2000; 46:242–7.10.1093/clinchem/46.2.242Search in Google Scholar

9. Hoffmann JJ, Janssen WC. Automated counting of cells in cerebrospinal fluid using the CellDyn-4000 haematology analyser. Clin Chem Lab Med 2002; 40:1168–73.Search in Google Scholar

10. Aune MW, Becker JL, Brugnara C, Canfield W, Dorfman DM, Fiehn W, et al. Automated flow cytometric analysis of blood cells in cerebrospinal fluid: analytic performance. Am J Clin Pathol 2004; 121:690–700.10.1309/EKFW9E3LLFXE15X9Search in Google Scholar

11. Kresie L, Benavides D, Bollinger P, Walters J, Pierson D, Richmond T, et al. Performance evaluation of the application of body fluids on the Sysmex XE-2100 series automated hematology analyzer. Lab Hematol 2005; 11:24–30.10.1532/LH96.04067Search in Google Scholar PubMed

12. Angeloni S, Nicolini G, Merli M, Nicolao F, Pinto G, Aronne T, et al. Validation of automated blood cell counter for the determination of polymorphonuclear cell count in the ascitic fluid of cirrhotic patients with or without spontaneous bacterial peritonitis. Am J Gastroenterol 2003; 98:1844–8.10.1111/j.1572-0241.2003.07620.xSearch in Google Scholar PubMed

13. Conner BD, Lee YC, Branca P, Rogers JT, Rodriguez RM, Light RW. Variations in pleural fluid WBC count and differential counts with different sample containers and different methods. Chest 2003; 123:1181–7.10.1378/chest.123.4.1181Search in Google Scholar PubMed

14. Wyler D, Marty W, Bar W. Correlation between the postmortem cell content of cerebrospinal fluid and time of death. Int J Legal Med 1994; 106:194–9.10.1007/BF01371336Search in Google Scholar PubMed

15. Spencer CA, Takeuchi M, Kazarosyan M, MacKenzie F, Beckett GJ, Wilkinson E. Interlaboratory/intermethod differences in functional sensitivity of immunometric assays of thyrotropin (TSH) and impact on reliability of measurement of subnormal concentrations of TSH. Clin Chem 1995; 41:367–74.10.1093/clinchem/41.3.367Search in Google Scholar

Received: 2006-5-11
Accepted: 2006-8-29
Published Online: 2006-11-7
Published in Print: 2006-11-1

©2006 by Walter de Gruyter Berlin New York