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Cytographic changes on BC-6800 Haematological Analyzer related to the presence of Candida albicans in peripheral blood. A new tool to suspect candidemia?
  1. Antonio La Gioia1,
  2. Alessandra Devito2,
  3. Fabiana Fiorini1,
  4. Maria Bombara3,
  5. Patrizia Isola3,
  6. Barbara Spinale2,
  7. Lucia Francioni1,
  8. Domenico Salamone1,
  9. Paola Marelli3,
  10. Sabrina Buoro4,
  11. Marcello Fiorini3
  1. 1U.O. Patologia Clinica, Ospedale “F. Lotti”, Pontedera, Italy
  2. 2Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
  3. 3UOC Medicina di Laboratorio Livorno, Azienda USL Toscana Nord Ovest, Livorno, Italy
  4. 4Clinical Chemistry Laboratory, Papa Giovanni XXIII Hospital, Bergamo, Italy
  1. Correspondence to Dr Antonio La Gioia, U.O. Patologia Clinica, Ospedale “F.  Lotti” via Roma, 147, 56025 Pontedera, Pisa, Italy; ant.lagioia{at}


Background We studied the quantitative and cytographic changes that the presence of Candida albicans (C. albicans) in peripheral blood (PB) samples causes on the Mindray BC-6800 Haematological Analyzer.

Methods A simulated in vitro candidemia was obtained by adding a different amount of C. albicans to discarded remnants of PB samples. Quantitative data and cytographic features were evaluated immediately as well as after 120 and 240 min of the yeast addition. A microscopic slides review was even performed at the same time.

Results After yeasts addition, an increase of total leucocytes, neutrophils and basophils have been observed, but these increases are not certainly descriptive of C. albicans presence.

Instead, extracellular blastospores cause a false increase in nucleated red blood cells (nRBCs), which appear as a new population in the specific counting channel for erytroblasts (NRBC channel). Regardless of the numbers, C. albicans form a pseudo-erythroblastic cluster in the NRBC channel whose resulting shape is so different than the ‘normal’ nRBC that it demands a microscopic review. Even cytographic changes related with the neutrophilic phagocytic activity have been observed on leucocyte's differential count citogram (DIFF) of the BC-6800.

Conclusions Our observations suggest that the results of the BC-6800, which are due to C. albicans' presence, might be useful to speculate earlier diagnosis of sepsis.


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  • Handling editor Slade Jensen

  • Contributors ALG, FF and AD contributed to conception and design of the work. PI, BS, LF and DS performed the acquisition and interpretation of microbiological data. ALG, MB and MF performed the acquisition and interpretation of instrumental and haematological data. SB performed statistical analysis. PM and AD provided for preparation and review of work. ALG approved the final version published.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.