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Comparing automated vs manual leukocyte differential counts for quantifying the ‘left shift’ in the blood of neonates

Journal of Perinatology volume 36, pages 843–848 (2016)Cite this article

Subjects

Abstract

Objective:

The neutrophil ‘left shift’ can be measured via the immature to total (I/T) neutrophil ratio or the absolute bands per μl using a manual differential count. It can also be measured from an automated differential count by the immature granulocyte percentage (IG%) or the absolute IG per μl. In neonates, it is unknown if the manual or automated differential count is superior.

Study Design:

We directly compared complete blood counts (CBCs) with manual and automated differential counts from infants <90 days old, and documented whether or not each neonate was infected. We developed reference intervals for I/T ratio, bands per μl, IG% and IG per μl using values from non-infected neonates.

Results:

The database had 10 714 CBCs. The upper reference interval for I/T ratio was 0.29 in the first 48 h and 0.31 thereafter; bands per μl was 3710 μl−1 in the first 48 h and 1785 μl−1 thereafter. IG% was 6.2% then 4.2%; IG per μl was 1460 μl−1 then 613 μl−1. Statistical performances of the four methods were equivalent for identifying infection.

Conclusions:

We developed reference intervals for four methods of quantifying a neonate’s ‘left shift’. The information from automated differentials is not inferior to that from manual differentials in identifying infections, but automated differentials have the advantages of a larger sample size, being less expensive, and faster performance times.

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Acknowledgements

We thank Theodore J. Pysher, Professor of Pathology, University of Utah and Director Of Clinical Pathology Primary Children’s Hospital, and Christopher M. Lehman, Professor of Pathology University of Utah and Medical Director Of Clinical Pathology, University of Utah Hospital for helpful discussions and for reviewing the manuscript. We also thank Dr. Jolanta Kunicka and Lance Kocherhans of Sysmex America Inc. for helpful discussions. We also thank the following members of the Intermountain Healthcare Clinical Laboratory staff for extracting data from the hematology analyzers; Robert Childs, Dereck Daniels, Robert Dallin, Rachael Ethington, Dave Garner, Laurie Jeffs, Jennessa Jessop, Heather Kuusela, Chris Partington, Tim Patten, Brooke Qi, Lauralyn Ragin, Tara Regginello, Aba Saunders, Alicia Simon, Jennifer Sorensen, Thomas Taylor, Ashley Windsor and Ryan Wilcox. The study was supported by a research grant (to RDC) from the Intermountain Research and Medical Foundation, Murray, UT, USA.

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Authors and Affiliations

  1. Division of Neonatology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    B C MacQueen, R D Christensen, B A Yoder & V L Baer

  2. Women and Newborn’s Clinical Program, Intermountain Healthcare, Salt Lake City, UT, USA

    R D Christensen, B A Yoder, E Henry & V L Baer

  3. Division of Hematology/Oncology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA

    R D Christensen & H M Yaish

  4. Institute for Healthcare Delivery Research, Salt Lake City, UT, USA

    E Henry

  5. Department of Pathology, Intermountain Medical Center, Murray, UT, USA

    S T Bennett

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  1. B C MacQueen
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  2. R D Christensen
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Correspondence to B C MacQueen.

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MacQueen, B., Christensen, R., Yoder, B. et al. Comparing automated vs manual leukocyte differential counts for quantifying the ‘left shift’ in the blood of neonates. J Perinatol 36, 843–848 (2016). https://doi.org/10.1038/jp.2016.92

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