Deformability cytometry (DC) is a type of imaging flow cytometry, which uses a camera-equipped device to measure cellular stiffness in addition to other cellular properties at high throughput. Cellular properties such as area and elongation can identify cell types, but this requires prior knowledge of distinguishing properties and cannot be applied to clinically important cell aggregates. Using DC data, we evaluated conventional multi-class (MC) classification and introduced a multi-label (ML) approach for identifying blood cells and their aggregates. In particular, an ML classifier can simultaneously assign multiple cell-type labels to a single imaged event. We show that, unlike MC classification, ML classification can identify cell aggregates not represented in the training data. It also avoids the need for exhaustive, strictly defined aggregate labels, thereby simplifying and speeding up annotation. Since automated blood analyzers do not reliably analyze cell aggregates, our approach may help address this clinical gap.

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