Comparative assessment of nucleated red blood cells using a fully automated hematology analyzer versus slide examination.

Objective: To determine the sensitivity and specificity of fully automated hematology analyzer for nucleated red blood cells (NRBCs) keeping microscopic slide examination as gold standard. Study Design: Cross-sectional study. Setting: Department of Hematology, RMI Hospital, Peshawar. Period: 1st December 2023 to 29th Feb 2024. Methods: A total of 160 blood samples referred for assessment to the hematological department for the suspected abnormal NRBCs were included in the study through consecutive sampling. Fresh Blood samples were analyzed using fully automated hematology analyzer. Manual counting of the NRBCs of the same samples was done using manual blood smear slide examination. Findings of the automated nucleated red blood cell counting methods were statistically analyzed keeping microscopic slide examination as gold standard. Sensitivity, specificity, accuracy and negative and positive predictive values were calculated for diagnosis of NRBC (count >0.02 × 109/L). Clinical sensitivity of the test was determined by Receiver Operating Test (ROC). Results: The Mean±SD of patient’s age in this study was 46.78±14.89 years with an age range of 0.5 to 67 years. The male gender was 53.75% while female gender was 46.25%. Fully automated hematology analyzer detected 30 (18.75%) samples while slide examination detected 31 (19.37%) samples with NRBC count >0.02 × 109/L. Fully automated hematology analyzer has shown sensitivity of 93.55 %, specificity 99.23% and diagnostic accuracy by 98.13%. PPV was 96.67% and NPV was 98.46 (p < 0.000) for the diagnosis of NRBC. The cutoff value of 0.0175 × 109/L (20/µL) offered the best balance between sensitivity and specificity based on ROC curve. Conclusion: Association is present for the NRBC count among the fully automated hematology analyzer and microscopic slide examination.