Diagnostic performance of CellaVision DM96 for Plasmodium vivax and Plasmodium falciparum screening in peripheral blood smears

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.