Utility of automated counting to determine absolute neutrophil counts and absolute phagocyte counts for pediatric cancer treatment protocols

Authors

  • Nobuko Hijiya M.D.,

    Corresponding author
    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    • Department of Hematology-Oncology, St. Jude Children's Research Hospital, 332 North Lauderdale, Memphis, TN 38105-2794
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    • Fax: (901) 521-9005

  • Mihaela Onciu M.D.,

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Scott C. Howard M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Zhe Zhang M.S.,

    1. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Cheng Cheng Ph.D.,

    1. Department of Pathology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    2. Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • John T. Sandlund M.D.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Emily P. Kyzer M.S.N., R.N., C.P.N.P.,

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
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  • Fred G. Behm M.D.,

    1. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pathology, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
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  • Ching-Hon Pui M.D.

    1. Department of Hematology-Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee
    2. Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
    3. Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
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    • Dr. Pui is the American Cancer Society F.M. Kirby Clinical Research Professor.


Abstract

BACKGROUND

Absolute neutrophil counts (ANCs) and absolute phagocyte counts (APCs) are used to guide cancer treatment. Although automated counting could replace manual counting, data showing correlations are lacking. By analyzing blood samples from children undergoing cancer treatment, the authors determined whether ANCs and APCs obtained by automated methods correlated positively with ANCs and APCs obtained manually.

METHODS

The authors analyzed 3640 consecutive peripheral blood samples. Leukocyte counts determined by Beckman-Coulter Gen-S or HmX analyzers (Beckman-Coulter, Miami, FL) were used to calculate counts obtained by automated or manual methods. Automated differential counts were obtained by automated analyzers and manual differential counts were performed by medical technologists. Counts underwent linear regression analysis. The authors evaluated 5 cutoff values for ANCs and APCs commonly used in decision-making related to cancer treatment: 300/μL, 500/μL, 750/μL, 1000/μL, and 1500/μL. Manually determined ANCs and APCs served as standards to determine the sensitivity, specificity, positive and negative predictive values, and kappa coefficient for automated counting.

RESULTS

R2 values were 0.81 for ANCs determined by manual and automated methods and 0.84 for APCs determined by both methods. The specificity of the automated method was > 90% for all ranges of ANCs and APCs, except one (APCs < 300/μL). There was excellent agreement (κ > 0.9) between ANCs determined by manual and automated methods and APCs calculated by both methods.

CONCLUSIONS

Automated methods of determining ANCs and APCs for children undergoing cancer treatment were reliable and can replace manual counting. Blood smear examination to validate ANCs and APCs determined by automated methods was needed only in selected cases. Cancer 2004. © 2004 American Cancer Society.

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