Evaluating Unghosted Cells (UGC): An Automated Blood Cell Counter-Derived Novel Red Cell Research Parameter for Its Clinical Utility and Diagnostic Implications Across a Spectrum of Pathological Conditions.

Introduction: Automated estimation of poikilocytes by automated hematology analyzers remains challenging. The unghosted cells (UGC) parameter in Beckman Coulter UniCel DxH 800 analyzers has been reported to correlate with target cells and other conditions with increased erythrocytic osmotic resistance like microcytosis/hypochromia, sickle cells, and post splenectomy. We assessed UGCs' reference range and potential clinical utility in a specialist hematology laboratory.

Materials and methods: We prospectively enrolled 520 participants, encompassing healthy individuals (n = 45), β-thalassemia trait (n = 196), hemoglobinopathies (n = 104), iron deficiency anemia (n = 88), liver disease (n = 46), spherocytosis (n = 18), and neonatal cord blood samples (n = 23). Peripheral blood EDTA samples were analyzed. UGC data were correlated with peripheral smear findings. In addition, red cell parameters including UGC were compared to differentiate β-thalassemia trait (βTT) from iron deficiency.

Results: UGCs were undetectable or present in very low numbers in healthy individuals (range 0%-0.01%). They demonstrated a significant positive correlation with manual target cell counts on peripheral smear (correlation coefficient, r = 0.64, p < 0.001). The highest UGC levels were observed in those with liver disease, with a median value of 0.395% (range: 0%-8.23%). All non-control subgroups, except for spherocytosis, showed significantly increased UGC% (p < 0.0001) vis-à-vis healthy individuals. A novel formula at a cut-off of 0.77 demonstrated 86.22% sensitivity and 93.10% specificity in differentiating βTT and IDA.

Conclusions: UGC% represents an innovative, automated hematological red cell research parameter capable of screening target cells and quantifying them. UGC shows significant potential for clinical diagnostic applications across a wide range of disorders characterized by target cells, facilitating differential diagnoses in clinical practice.