Establishment And Discussion Of Re - Examination Rules For Automated Urine And Body Fluid Routine Analysis

Background:This study intends to develop the microscopic review criteria for automated urine chemistry analyzer and integrated urine chemistry and formed-element analyzer, and discuss the review criteria for automated body fluid (BF) routine analysis.Methods:1,058 samples were analyzed using chemistry analyzer (Siemens Atlas) and four different instruments, IRIS IQ200, AVE-766, US 2026, and Sysmex UF-1000i. A phase-contrast microscopy was used as reference to develop the microscopic review criteria by false-negative rate (FNR) and review rate (RR).150 BF specimens were collected,cell and differential counts were measured by the BF mode of XE-5000 hematology analyzer, and compared to the microscopy analysis, Wright’s-Giemsa and Hematoxylin-Eosin (HE), to discuss the review criteria.Results:The optimized review criteria for Atlas were either PRO 2+, or BLD 2+, or WBC 2+, or specimen from nephrology department. FNR was 4.65% and RR was 40.41%. The optimized criteria for integrated Atlas and IQ200, or AVE-766 or US 2026 or UF-1000i were either BLD> 2+(> 2+ for females), or RBC count ≥ 2 times reference range, or different WBC results between chemistry and formed-element analysis, or PRO≥2+ or CAST> the reference range. One additional rule was different results between BLD and RBC count for integrated Atlas and UF-1000i. FNR was 1.94%,2.03%,1.74%,1.65%, and RR was 41.09%,40.12%,44.86%,50.39%, respectively. The consistency for serous cavity effusion and CSF was superior to that of BALF. The consistency of differential count for serous cavity effusion were superior to that for CSF and BALF. The area under ROC curve of HF for predicting large cells was 0.806,which was better than tumor cells,the cut-off value was 3.60,the sensitivity and specificity for predicting large cells of HF were 0.83 and 0.71,respectively.When the cell number was less than 490x106/L,both precision and accuracy were poor.Conclusions:Specific review criteria could ensure a low missed-diagnosis rate and a reasonable workload in practice. Cell and differential counts for serous cavity effusion are better than that of CSF and BALF, and the HF for predicting the large cells is superior to tumor cells by the BF mode of XE-5000 analyzer.