Yoon Jung, Kwon Jung Ah, Yoon Soo Young, Jang Woong Sik, Yang Dong June, Nam Jeonghun, Lim Chae Seung
Department of Laboratory Medicine, Korea University College of Medicine, Seoul, South Korea.
Department of Laboratory Medicine, Korea University College of Medicine, Seoul, South Korea.
Acta Trop. 2019 May;193:7-11. doi: 10.1016/j.actatropica.2019.02.009. Epub 2019 Feb 12.
Microscopic examination of blood smears is the standard method for malaria diagnosis but is labor-intensive and requires expert staff. CellaVision DM96 (CellaVision, Lund, Sweden) is a digital hematology analyzer available for advanced morphological analysis of blood films including intracellular parasites. Here, we evaluated the CellaVision DM96 Advanced RBC Application for malaria detection in stained peripheral blood (PB) smears. Two hundred and twenty thin PB smear slides (84 P. vivax, 14 P. falciparum, 122 negative controls) were stained with Wright-Giemsa using automated slidemaker/strainers of Beckman Coulter hematology systems (LH780, Beckman Coulter Inc., Miami, FL). The slides were automatically analyzed by CellaVision, and images were manually reviewed by experts. The results of automatic and manual detection by CellaVision were compared to those of microscopic examination. The sensitivity and specificity of automatic detection by CellaVision were 23.5% (23/98) and 81.1% (99/122), respectively. When CellaVision images were manually reviewed, the sensitivity and specificity increased to 65.3% (64/98) and 90.2% (110/122), respectively. The detection of P. falciparum showed the highest sensitivity by both the automated (33.3%) and the manual (85.7%) method. CellaVision misinterpreted malaria parasites as Howell-Jolly bodies in 57.1%, as Pappenheimer bodies in 84.7%, and as basophilic stipplings in 75.5% of the slides. Malaria diagnosis using CellaVision DM96 requires further improvements. Manual review improves CellaVision performance, but confirmation by conventional microscopy remains essential.
血液涂片的显微镜检查是疟疾诊断的标准方法，但劳动强度大且需要专业人员。CellaVision DM96（瑞典隆德的CellaVision公司）是一款数字血液分析仪，可用于对血片进行高级形态学分析，包括细胞内寄生虫。在此，我们评估了CellaVision DM96高级红细胞应用程序在染色外周血涂片疟疾检测中的性能。使用贝克曼库尔特血液学系统（LH780，贝克曼库尔特公司，佛罗里达州迈阿密）的自动玻片制作仪/染色仪，对220张薄外周血涂片玻片（84张间日疟原虫涂片、14张恶性疟原虫涂片、122张阴性对照涂片）进行瑞氏-吉姆萨染色。玻片由CellaVision自动分析，图像由专家进行人工审核。将CellaVision自动和人工检测的结果与显微镜检查结果进行比较。CellaVision自动检测的灵敏度和特异性分别为23.5%（23/98）和81.1%（99/122）。当对CellaVision图像进行人工审核时，灵敏度和特异性分别提高到65.3%（64/98）和90.2%（110/122）。恶性疟原虫的检测在自动（33.3%）和人工（85.7%）方法中均显示出最高灵敏度。CellaVision将疟原虫误判为豪-焦小体的占57.1%，误判为帕彭海默小体的占84.7%，误判为嗜碱性点彩的占75.5%。使用CellaVision DM96进行疟疾诊断需要进一步改进。人工审核可提高CellaVision的性能，但传统显微镜检查的确认仍然至关重要。
