Original Article

Ann Lab Med 2015; 35(1): 28-34

Published online January 1, 2015

Copyright © Korean Society for Laboratory Medicine.

Flow Cytometric White Blood Cell Differential Using CytoDiff is Excellent for Counting Blasts

Jimin Kahng, M.D., Yonggoo Kim, M.D., Myungshin Kim, M.D., Eun-Jee Oh, M.D., Yeon-Joon Park, M.D.,
and Kyungja Han, M.D.

Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea

Correspondence to: Kyungja Han
Department of Laboratory Medicine, College of Medicine, The Catholic University of Korea, Seoul St. Mary’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea
Tel: +82-2-2258-1644
Fax: +82-2-2258-1719

Received: June 23, 2014; Revised: August 27, 2014; Accepted: October 25, 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.


Background: The usefulness of the CytoDiff flow cytometric system (Beckman Coulter, USA) has been studied in various conditions, but its performance including rapidity in detecting and counting blasts, the most significant abnormal cells in the peripheral blood, has not been well evaluated. The objective of this study was to evaluate the performance of the CytoDiff differential counting method in challenging samples with blasts. Methods: In total, 815 blood samples were analyzed. Samples flagged as “blasts” or “variant lymphocytes” and showing <10% blasts by manual counts were included. In total, 322 samples showed blasts on manual counts, ranging from 0.5% to 99%. The CytoDiff method was performed by flow cytometry (FC500; Beckman Coulter, USA) with a pre-mixed CytoDiff reagent and analyzing software (CytoDiff CXP 2.0; Beckman Coulter). Results: The average time required to analyze 20 samples was approximately 60 min for manual counts, and the hands-on time for the CytoDiff method was 15 min. The correlation between the CytoDiff and manual counts was good (r>0.8) for neutrophils and lymphocytes but poor (r<0.8) for other cells. When the cutoff value of the CytoDiff blast count was set at 1%, the sensitivity was 94.4% (95% CI; 91.2-96.6) and specificity was 91.9% (95% CI; 89.0-94.1). The positive predictive value was 88.4% (95% CI; 84.4-91.5) (304/344 cases) and negative predictive value was 96.2% (95% CI; 93.9-97.7) (453/471 cases). The CytoDiff blast counts correlated well to the manual counts (r=0.9223). Conclusions: The CytoDiff method is a specific, sensitive, and rapid method for counting blasts. A cutoff value of 1% of at least 1 type of blast is recommended for positive CytoDiff blast counts.

Keywords: CytoDiff, Flow cytometry, Differential, Blasts, Performance