1
|
Tierney AJ, Williamson KC, Stewart VA, Mace CR. Hematocrit-Independent Sampling Enables White Blood Cell Counts from Patterned Dried Blood Spot Cards. Anal Chem 2024; 96:1993-1999. [PMID: 38266026 DOI: 10.1021/acs.analchem.3c04439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
The accurate and efficient measurement of white blood cell (WBC) counts is vital for monitoring general patient health and can aid in the diagnosis of a range of possible infections or diseases. Even with their importance universally acknowledged, access to WBC counts is largely limited to those with access to phlebotomists and centralized clinical laboratories, which house the instruments that perform the tests. As a result, large populations of people (e.g., those that are home-bound or live in remote locations) lack facile access to testing. Dried blood spot (DBS) cards are often used to bridge these gaps in access to testing by offering the ability to collect blood at home for ambient shipping to laboratories. However, it is well understood that these cards, which are prepared from cellulose cardstocks without further modification, suffer from variabilities in accuracy and precision due to uncontrolled sample spreading and hematocrit effects, which have hindered their use to determine WBC counts. In this paper, we present a method to obtain an accurate WBC count using a patterned dried blood spot (pDBS) card, which comprises collection zones that meter volumes of dried blood. Using an input volume of 75 μL of whole blood, we demonstrate that, unlike the gold standard DBS card (Whatman 903), our pDBS design allows for the collection of replicate zones containing a reproducible, average volume of dried blood (12.1 μL, 7.8% CV) over the range of hematocrits from 25 to 55%. We then used qPCR to quantify the 18S rRNA gene to determine WBC counts from the volumes of blood that are metered in pDBS zones. We observe that WBC counts generated from our method are comparable to those measured with a HemoCue point-of-care WBC analyzer. Our approach to using pDBS cards as a blood collection device has the potential to support at-home sampling and other patient populations that need WBC counts but lack access to clinical facilities.
Collapse
Affiliation(s)
- Allison J Tierney
- Department of Chemistry, Tufts University, Medford, Massachusetts 02155, United States
| | - Kim C Williamson
- Department of Microbiology and Immunology, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, United States
| | - V Ann Stewart
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland 20814, United States
| | - Charles R Mace
- Department of Chemistry, Tufts University, Medford, Massachusetts 02155, United States
| |
Collapse
|
2
|
Olliaro P, Nkeramahame J, Salami O, Moore CE, Horgan P, Baiden R, Kukula V, Adjei A, Kapisi J, Hopkins H, Kaawa-Mafigiri D, Ekusai-Sebatta D, Rutebemberwa E, Kitutu FE, Tinto H, Kiemde F, Compaoré A, Valia D, Dittrich S. Advancing Access to Diagnostic Tools Essential for Universal Health Coverage and Antimicrobial Resistance Prevention: An Overview of Trials in Sub-Saharan Africa. Clin Infect Dis 2023; 77:S125-S133. [PMID: 37490744 PMCID: PMC10368407 DOI: 10.1093/cid/ciad326] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Indexed: 07/27/2023] Open
Abstract
We introduce the Antimicrobial Resistance Diagnostic Use Accelerator program, and the articles in this Supplement, which cover the program in 3 sub-Saharan Africa countries.
Collapse
Affiliation(s)
- Piero Olliaro
- International Severe Acute Respiratory and Emerging Infection Consortium, Pandemic Sciences Institute, University of Oxford, Oxford, United Kingdom
- FIND, Geneva, Switzerland
| | | | | | - Catrin E Moore
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Centre for Neonatal and Paediatric Infection, Institute for Infection and Immunity, St George's University of London, London, United Kingdom
| | - Philip Horgan
- FIND, Geneva, Switzerland
- Nuffield Department of Medicine, Big Data Institute, University of Oxford, Oxford, United Kingdom
- Evidence & Impact Oxford, Oxford, United Kingdom
| | | | - Vida Kukula
- Dodowa Health Research Centre, Dodowa, Ghana
| | | | - James Kapisi
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Heidi Hopkins
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | | | - Elizeus Rutebemberwa
- Department of Health Policy and Planning, Makerere University School of Public Health, Kampala, Uganda
| | - Freddy Eric Kitutu
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
| | - Halidou Tinto
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - François Kiemde
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Adélaïde Compaoré
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Daniel Valia
- Clinical Research Unit of Nanoro, Institut de Recherche en Sciences de La Santé, Nanoro, Burkina Faso
| | - Sabine Dittrich
- FIND, Geneva, Switzerland
- Center for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Deggendorf Institute of Technology, European Campus Rottal Inn, Pfarrkirchen, Germany
| |
Collapse
|
3
|
Takenaka S, Moro H, Shimizu U, Koizumi T, Nagano K, Edanami N, Ohkura N, Domon H, Terao Y, Noiri Y. Preparing of Point-of-Care Reagents for Risk Assessment in the Elderly at Home by a Home-Visit Nurse and Verification of Their Analytical Accuracy. Diagnostics (Basel) 2023; 13:2407. [PMID: 37510151 PMCID: PMC10378029 DOI: 10.3390/diagnostics13142407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 07/30/2023] Open
Abstract
With the rising number of older adults residing at home, there is a growing need for risk assessment and patient management in home nursing. This study aims to develop point-of-care test (POCT) reagents that can aid in risk assessment and home care, especially in settings with limited resources. Our focus was on creating a C-reactive protein (CRP) POCT, which can accurately diagnose clinically significant judgment values in home nursing. Additionally, we assessed the utility of the HemoCue WBC DIFF system in providing differential counts of white blood cells (WBC). These performances were compared with a laboratory test using blood samples from patients with pneumonia. The CRP POCT showed a comparable result to that of a laboratory method, with an average kappa index of 0.883. The leukocyte count showed good agreement with the reference method. While the correlation coefficients for both neutrophil and lymphocyte counts were deemed acceptable, it was observed that the measured values tended to be smaller in cases where the cell count was higher. This proportional error indicates a weak correlation with the neutrophil-to-lymphocyte ratio. CRP POCT and WBC counts provided reliable and accurate judgments. These tools may benefit risk management for older adults at home, patients with dementia who cannot communicate, and those living in depopulated areas.
Collapse
Affiliation(s)
- Shoji Takenaka
- Division of Cariology, Operative Dentistry and Endodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Hiroshi Moro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Utako Shimizu
- Faculty of Medicine, Niigata University Graduate School of Health Sciences, Niigata 951-8514, Japan
| | - Takeshi Koizumi
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Kei Nagano
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Naoki Edanami
- Division of Cariology, Operative Dentistry and Endodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Naoto Ohkura
- Division of Cariology, Operative Dentistry and Endodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Hisanori Domon
- Division of Microbiology and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Yutaka Terao
- Division of Microbiology and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| | - Yuichiro Noiri
- Division of Cariology, Operative Dentistry and Endodontics, Niigata University Graduate School of Medical and Dental Sciences, Niigata 951-8514, Japan
| |
Collapse
|
4
|
Gasparin AT, Araujo CIF, Cardoso MR, Schmitt P, Godoy JB, Reichert ES, Pimenta ME, Gonçalves CB, Santiago EB, Silva ILR, Gaideski BDP, Cardoso MA, Silva FD, Sommer VDR, Hartmann LF, Perazzoli CRDA, Farias JSDH, Beltrame OC, Winter N, Nicollete DRP, Lopes SNB, Predebon JV, Almeida BMMD, Rogal Júnior SR, Figueredo MVM. Hilab System Device in an Oncological Hospital: A New Clinical Approach for Point of Care CBC Test, Supported by the Internet of Things and Machine Learning. Diagnostics (Basel) 2023; 13:diagnostics13101695. [PMID: 37238184 DOI: 10.3390/diagnostics13101695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/05/2023] [Accepted: 05/05/2023] [Indexed: 05/28/2023] Open
Abstract
The complete blood count (CBC) is a highly requested test that is generally restricted to centralized laboratories, which are limited by high cost, being maintenance-demanding, and requiring costly equipment. The Hilab System (HS) is a small, handheld hematological platform that uses microscopy and chromatography techniques, combined with machine learning (ML) and artificial intelligence (AI), to perform a CBC test. This platform uses ML and AI techniques to add higher accuracy and reliability to the results besides allowing for faster reporting. For clinical and flagging capability evaluation of the handheld device, the study analyzed 550 blood samples of patients from a reference institution for oncological diseases. The clinical analysis encompassed the data comparison between the Hilab System and a conventional hematological analyzer (Sysmex XE-2100) for all CBC analytes. The flagging capability study compared the microscopic findings from the Hilab System and the standard blood smear evaluation method. The study also assessed the sample collection source (venous or capillary) influences. The Pearson correlation, Student t-test, Bland-Altman, and Passing-Bablok plot of analytes were calculated and are shown. Data from both methodologies were similar (p > 0.05; r ≥ 0.9 for most parameters) for all CBC analytes and flagging parameters. Venous and capillary samples did not differ statistically (p > 0.05). The study indicates that the Hilab System provides humanized blood collection associated with fast and accurate data, essential features for patient wellbeing and quick physician decision making.
Collapse
Affiliation(s)
- Aléxia Thamara Gasparin
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | | | - Mônica Ribas Cardoso
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Patricia Schmitt
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Juliana Beker Godoy
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Eduarda Silva Reichert
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Maria Eduarda Pimenta
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Caroline Bretas Gonçalves
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Erika Bergamo Santiago
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Ivan Lucas Reis Silva
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Bruno de Paula Gaideski
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Milena Andreuzo Cardoso
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Fernanda D'Amico Silva
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Viviane da Rosa Sommer
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | - Luis Felipe Hartmann
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | | | | | | | - Nicole Winter
- Erasto Gaertner Hospital, Curitiba 81520-060, PR, Brazil
| | | | | | - João Victor Predebon
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | | | - Sérgio Renato Rogal Júnior
- Department of Research and Development, Hilab, Jose Altair Possebom, 800, Curitiba 81270-185, PR, Brazil
| | | |
Collapse
|
5
|
Wright SE, Adkesson MJ, Schnelle AN, Allender MC, Cárdenas-Alayza S. Agreement Study between Total Leukocyte Count Methodologies in South American Sea Lions (Otaria byronia) and Peruvian Fur Seals (Arctocephalus australis). J Wildl Dis 2023; 59:315-321. [PMID: 37074799 DOI: 10.7589/jwd-d-22-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 11/23/2022] [Indexed: 04/20/2023]
Abstract
South American sea lions (Otaria byronia) and Peruvian fur seals (Arctocephalus australis) are sympatric species inhabiting the coastal Peruvian marine ecosystem. Declining abundance has prompted population health monitoring programs, including temporal monitoring of blood parameters. Several methods exist to determine total leukocyte count, yet no studies have evaluated agreement between methods in pinnipeds. We assessed agreement between total leukocyte counts determined by blood film estimate, Leuko-TIC, HemoCue, and UNOPETTE methods by using archival results from pinnipeds at Punta San Juan, Peru. Blood film estimates were prospectively performed, and resulting data were compared with retrospective leukocyte counts obtained from both species between 2009 and 2019 by using the other methodologies. Agreement in hematologic counts between methods was evaluated using Passing-Bablok regression and Bland-Altman plots (α=0.05). In total, 295 individuals (201 A. australis and 94 O. byronia) were included in the analysis. The blood film estimate method resulted in the highest leukocyte values (P<0.0001). Leuko-TIC counts were significantly higher than HemoCue counts (P<0.0001). Constant and proportional error was present in the agreement between the blood film estimate method and the other methods. Given the variation demonstrated between the different methodologies, additional research is needed to further evaluate agreement between these methodologies. The results underscore the importance of maintaining consistency in leukocyte count methodology for monitoring trends in population health over time. Method consistency may be the more important clinical consideration for assessing changes in leucocyte count over time and avoiding apparent changes depending on the methodology used.
Collapse
Affiliation(s)
- Sarah E Wright
- VCA Aurora Animal Hospital, 2600 West Galena Boulevard, Aurora, Illinois 60506, USA
| | - Michael J Adkesson
- Chicago Zoological Society, Brookfield Zoo, 3300 Golf Road, Brookfield, Illinois 60513, USA
| | - Amy N Schnelle
- Veterinary Diagnostic Laboratory, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, Urbana, Illinois 61802, USA
| | - Matthew C Allender
- Chicago Zoological Society, Brookfield Zoo, 3300 Golf Road, Brookfield, Illinois 60513, USA
- Wildlife Epidemiology Laboratory, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, 2001 South Lincoln Avenue, Urbana, Illinois 61802, USA
| | - Susana Cárdenas-Alayza
- Punta San Juan Program, Center for Environmental Sustainability, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 150102, Peru
- Centro para la Sostenibilidad Ambiental, Universidad Peruana Cayetano Heredia, Av. Armendáriz 445, Lima 15074, Peru
- Departamento de Ciencias Biológicas y Fisiológicas, Facultad de Ciencias y Filosofía, Universidad Peruana Cayetano Heredia, Av. Honorio Delgado 430, Lima 15102, Peru
| |
Collapse
|
6
|
Blackwell AD, Garcia AR. Ecoimmunology in the field: Measuring multiple dimensions of immune function with minimally invasive, field-adapted techniques. Am J Hum Biol 2022; 34:e23784. [PMID: 35861267 PMCID: PMC9786696 DOI: 10.1002/ajhb.23784] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/29/2022] [Accepted: 07/08/2022] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Immune function is multifaceted and characterizations based on single biomarkers may be uninformative or misleading, particularly when considered across ecological contexts. However, measuring the many facets of immunity in the field can be challenging, since many measures cannot be obtained on-site, necessitating sample preservation and transport. Here we assess state-of-the-art methods for measuring immunity, focusing on measures that require a minimal blood sample obtained from a finger prick, which can be: (1) dried on filter paper, (2) frozen in liquid nitrogen, or (3) stabilized with chemical reagents. RESULTS We review immune measures that can be obtained from point-of-care devices or from immunoassays of dried blood spots (DBSs), field methods for flow cytometry, the use of RNA or DNA sequencing and quantification, and the application of immune activation assays under field conditions. CONCLUSIONS Stable protein products, such as immunoglobulins and C-reactive protein are reliably measured in DBSs. Because less stable proteins, such as cytokines, may be problematic to measure even in fresh blood, mRNA from stabilized blood may provide a cleaner measure of cytokine and broader immune-related gene expression. Gene methylation assays or mRNA sequencing also allow for the quantification of many other parameters, including the inference of leukocyte subsets, though with less accuracy than with flow cytometry. Combining these techniques provides an improvement over single-marker studies, allowing for a more nuanced understanding of how social and ecological variables are linked to immune measures and disease risk in diverse populations and settings.
Collapse
Affiliation(s)
- Aaron D. Blackwell
- Department of AnthropologyWashington State UniversityPullmanWashingtonUSA
| | - Angela R. Garcia
- Research DepartmentPhoenix Children's HospitalPhoenixArizonaUSA,Department of Child HealthUniversity of Arizona College of MedicinePhoenixArizonaUSA
| |
Collapse
|
7
|
Meng Q, Li Y, Yu Y, Chu K, Smith ZJ. A Drop-in, Focus-Extending Phase Mask Simplifies Microscopic and Microfluidic Imaging Systems for Cost-Effective Point-of-Care Diagnostics. Anal Chem 2022; 94:11000-11007. [PMID: 35895976 DOI: 10.1021/acs.analchem.2c01421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Microscopic imaging and imaging flow cytometry have wide potential in point-of-care assays; however, their narrow depth of focus necessitates precise mechanical or fluidic focus control of a sample in order to acquire high-quality images that can be used for downstream analysis, increasing the cost and complexity of the imaging system. This complexity represents a barrier to miniaturization and translation of point-of-care assays based on microscopic imaging or imaging flow cytometry. To address this challenge, we present a simple drop-in phase mask with a physics-informed, circularly symmetric asphere phase profile that extends the depth of focus by >5-fold while largely preserving the image quality compared to other depth extending methods. We show that such a focus-extended system overcomes manufacturing tolerances in low-cost sample chambers, enlarges the useable field-of-view of low-cost objectives, and permits increased throughput and precision in flow imaging systems without the need for complex flow-focusing. As the image quality is preserved without the need for postacquisition image restoration, our solution is also highly appropriate for on-line applications such as cell sorting.
Collapse
Affiliation(s)
- Qi Meng
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yaning Li
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Yajun Yu
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui 230027, China
| | - Kaiqin Chu
- Suzhou Institute for Advanced Research, University of Science and Technology of China, Suzhou, Jiangsu 215123, China
| | - Zachary J Smith
- Key Laboratory of Precision Scientific Instrumentation of Anhui Higher Education Institutes, Department of Precision Machinery and Precision Instrumentation, University of Science and Technology of China, Hefei, Anhui 230027, China
| |
Collapse
|
8
|
Gasparin AT, Araujo CIF, Schmitt P, Cardoso MR, Perussolo MC, de Jesus TCS, Santiago EB, Silva ILR, de Sousa RG, Teng FZ, Severo EB, Ribeiro VHA, Cardoso MA, Silva FD, de Araujo Perazzoli CR, de Holanda Farias JS, de Almeida BMM, Rogal Júnior SR, Figueredo MVM. Hilab system, a new point-of-care hematology analyzer supported by the Internet of Things and Artificial Intelligence. Sci Rep 2022; 12:10409. [PMID: 35729182 PMCID: PMC9213419 DOI: 10.1038/s41598-022-13913-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 05/30/2022] [Indexed: 11/09/2022] Open
Abstract
The complete blood count (CBC) is one of the most requested tests by physicians. CBC tests, most realized in conventional hematological analyzers, are restricted to centralized laboratories due to frequent maintenance, large devices, and expensive costs required. On the other hand, most handheld CBC devices commercially available show high prices and are not liable to calibration or control procedures, which results in poor quality compared to standard hematology instruments. The Hilab system is a small-handed hematological platform that uses microscopy and chromatography techniques for blood cells and hematimetric parameters analysis through artificial intelligence, machine learning, and deep learning techniques. For clinical evaluation of the handheld CBC device, 450 blood samples were analyzed. The samples encompassed normal (82%) and pathological conditions (18%), such as thalassemias (2.2%), anemias (6.6%), and infections (9.2%). For all analytes, accuracy, precision, method comparison, and flagging capabilities of the Hilab System, were compared with the Sysmex XE-2100 (Sysmex, Japan) results. The sample source (venous and capillary) influences were also evaluated. Pearson correlation, Student t test, bias, and the Bland-Altman plot of each blood count analyte were calculated and shown. The significance level was set at p ≤ 0.05. For clinical evaluation, Hilab System and the Sysmex XE-2100 showed a strong correlation (r ≥ 0.9) for most evaluated parameters. In the precision study, analytes showed CV inside the limits established according to European Federation of Clinical Chemistry and Laboratory Medicine guidelines. The flagging capabilities of the Hilab system, compared to the manual microscopy technique, presented high sensibility, specificity, and accuracy. Venous and capillary samples (p > 0.05) do not differ statistically. Considering the need for point-of-care CBCs, the study indicated that the Hilab system provides fast, accurate, low cost, and robust analysis for reliable clinical use.
Collapse
Affiliation(s)
- Aléxia Thamara Gasparin
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil.
| | | | - Patricia Schmitt
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Mônica Ribas Cardoso
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Maiara Carolina Perussolo
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | | | - Erika Bergamo Santiago
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Ivan Lucas Reis Silva
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Ricardo Gurgel de Sousa
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Flavia Zhu Teng
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Evair Borges Severo
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Victor Henrique Alves Ribeiro
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Milena Andreuzo Cardoso
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | - Fernanda D'Amico Silva
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | | | | | | | - Sergio Renato Rogal Júnior
- Research and Development Department, Hilab, Hilab Campus, José A. Possebom, 800, Curitiba, Parana, 81270-185, Brazil
| | | |
Collapse
|
9
|
Murray LP, Mace CR. Paper-Based Cytometer for the Detection and Enumeration of White Blood Cells According to Their Immunophenotype. Anal Chem 2022; 94:10443-10450. [PMID: 35696545 DOI: 10.1021/acs.analchem.2c01635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Total and differential white blood cell (WBC) counts are vital metrics used routinely by clinicians to aid in the identification of diseases. However, the equipment necessary to perform WBC counts restricts their operation to centralized laboratories, greatly limiting their accessibility. Established solutions for the development of point-of-care assays, namely lateral flow tests and paper-based microfluidic devices, are inherently limited in their ability to support the detection of WBCs─the pore sizes of materials used to fabricate these devices (e.g., membranes or chromatography papers) do not permit passive WBC transport via wicking. Herein, we identify a material capable of the unimpeded transport of WBCs in both lateral and vertical directions: a coffee filter. Through in situ labeling with an enzyme-labeled affinity reagent, our paper-based cytometer detects WBCs according to their immunophenotype. Using two cultured leukocyte lines (Jurkat D1.1 T cells and MAVER-1 B cells), we demonstrate the specific, colorimetric enumeration of each target cell population across the expected physiological range for total lymphocytes, 1000-4000 cells μL-1. Additionally, we highlight a potential application of this type of device as a screening tool for detecting abnormal cell counts outside the normal physiological range and in subclasses of cell types, which could aid in the identification of certain diseases (e.g., CD4+ T lymphocytes, an important biomarker for HIV disease/AIDS). These results pave the way for a new class of paper-based devices─those capable of controlled white blood cell transport, labeling, capture, and detection─thus expanding the opportunities for low-cost, point-of-care cytometers.
Collapse
Affiliation(s)
- Lara P Murray
- Department of Chemistry, Laboratory for Living Devices, Tufts University, Medford, Massachusetts 02155, United States
| | - Charles R Mace
- Department of Chemistry, Laboratory for Living Devices, Tufts University, Medford, Massachusetts 02155, United States
| |
Collapse
|
10
|
Blood cell quantification on dry blood samples: toward patient-centric complete blood counts. Bioanalysis 2022; 14:693-701. [PMID: 35593738 DOI: 10.4155/bio-2022-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Performing complete blood counts from patients' homes could have a transformative impact on e-based healthcare. Blood microsampling and sample drying are enabling elements for patient-centric healthcare. The aim of this study was to investigate the potential of dry blood samples for image-based cell quantification of red and white blood cells. Methods: A manual sample preparation method was developed and tested for image-based red and white blood cell counting. Results & conclusion: Dry blood samples enable image-based cell counting of red and white blood cells with a good correlation to gold standard hematology analyzer data (average coefficient of variation <6.5%; R2 >0.8) and resolve the basic morphology of white blood cell nuclei. The presented proof-of-principle study is a first step toward patient-centric complete blood counts.
Collapse
|
11
|
Gao M, Lee SH, Park SH, Ciaramicoli LM, Kwon H, Cho H, Jeong J, Chang Y. Neutrophil‐Selective Fluorescent Probe Development through Metabolism‐Oriented Live‐Cell Distinction. Angew Chem Int Ed Engl 2021. [DOI: 10.1002/ange.202108536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Min Gao
- Center for Self-assembly and Complexity Institute for Basic Science (IBS) Pohang 37673 Republic of Korea
| | - Sun Hyeok Lee
- School of Interdisciplinary Bioscience and Bioengineering Pohang University of Science and Technology (POSTECH) Pohang 37673 Republic of Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine University of Ulsan College of Medicine (UUCM) Ulsan University Hospital Ulsan 44033 Republic of Korea
| | - Larissa Miasiro Ciaramicoli
- Department of Chemistry Pohang University of Science and Technology (POSTECH) Pohang 37673 Republic of Korea
| | - Haw‐Young Kwon
- Center for Self-assembly and Complexity Institute for Basic Science (IBS) Pohang 37673 Republic of Korea
| | - Heewon Cho
- School of Interdisciplinary Bioscience and Bioengineering Pohang University of Science and Technology (POSTECH) Pohang 37673 Republic of Korea
| | - Joseph Jeong
- Department of Laboratory Medicine University of Ulsan College of Medicine (UUCM) Ulsan University Hospital Ulsan 44033 Republic of Korea
| | - Young‐Tae Chang
- Center for Self-assembly and Complexity Institute for Basic Science (IBS) Pohang 37673 Republic of Korea
- School of Interdisciplinary Bioscience and Bioengineering Pohang University of Science and Technology (POSTECH) Pohang 37673 Republic of Korea
- Department of Chemistry Pohang University of Science and Technology (POSTECH) Pohang 37673 Republic of Korea
| |
Collapse
|
12
|
Gao M, Lee SH, Park SH, Ciaramicoli LM, Kwon HY, Cho H, Jeong J, Chang YT. Neutrophil-Selective Fluorescent Probe Development through Metabolism-Oriented Live-Cell Distinction. Angew Chem Int Ed Engl 2021; 60:23743-23749. [PMID: 34415094 DOI: 10.1002/anie.202108536] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 08/06/2021] [Indexed: 11/07/2022]
Abstract
Human neutrophils are the most abundant leukocytes and have been considered as the first line of defence in the innate immune system. Selective imaging of live neutrophils will facilitate the in situ study of neutrophils in infection or inflammation events as well as clinical diagnosis. However, small-molecule-based probes for the discrimination of live neutrophils among different granulocytes in human blood have yet to be reported. Herein, we report the first fluorescent probe NeutropG for the specific distinction and imaging of active neutrophils. The selective staining mechanism of NeutropG is elucidated as metabolism-oriented live-cell distinction (MOLD) through lipid droplet biogenesis with the help of ACSL and DGAT. Finally, NeutropG is applied to accurately quantify neutrophil levels in fresh blood samples by showing a high correlation with the current clinical method.
Collapse
Affiliation(s)
- Min Gao
- Center for Self-assembly and Complexity, Institute for Basic Science (IBS), Pohang, 37673, Republic of Korea
| | - Sun Hyeok Lee
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea
| | - Sang Hyuk Park
- Department of Laboratory Medicine, University of Ulsan College of Medicine (UUCM), Ulsan University Hospital, Ulsan, 44033, Republic of Korea
| | - Larissa Miasiro Ciaramicoli
- Department of Chemistry, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea
| | - Haw-Young Kwon
- Center for Self-assembly and Complexity, Institute for Basic Science (IBS), Pohang, 37673, Republic of Korea
| | - Heewon Cho
- School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea
| | - Joseph Jeong
- Department of Laboratory Medicine, University of Ulsan College of Medicine (UUCM), Ulsan University Hospital, Ulsan, 44033, Republic of Korea
| | - Young-Tae Chang
- Center for Self-assembly and Complexity, Institute for Basic Science (IBS), Pohang, 37673, Republic of Korea.,School of Interdisciplinary Bioscience and Bioengineering, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea.,Department of Chemistry, Pohang University of Science and Technology (POSTECH), Pohang, 37673, Republic of Korea
| |
Collapse
|
13
|
Dickerson WM, Yu R, Westergren HU, Paraskos J, Schatz P, Tigerstrom A, Ekman A, Sánchez J, Cheng J, Li L, Chan EY. Point-of-care microvolume cytometer measures platelet counts with high accuracy from capillary blood. PLoS One 2021; 16:e0256423. [PMID: 34437590 PMCID: PMC8389400 DOI: 10.1371/journal.pone.0256423] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 08/07/2021] [Indexed: 01/10/2023] Open
Abstract
Background Point-of-care (PoC) testing of platelet count (PLT) provides real-time data for rapid decision making. The goal of this study is to evaluate the accuracy and precision of platelet counting using a new microvolume (8 μL), absolute counting, 1.5 kg cytometry-based blood analyzer, the rHEALTH ONE (rHEALTH) in comparison with the International Society of Laboratory Hematology (ISLH) platelet method, which uses a cytometer and an impedance analyzer. Methods Inclusion eligibility were healthy adults (M/F) ages 18–80 for donation of fingerprick and venous blood samples. Samples were from a random N = 31 volunteers from a single U.S. site. Samples were serially diluted to test thrombocytopenic ranges. Interfering substances and conditions were tested, including RBC fragments, platelet fragments, cholesterol, triglycerides, lipids, anti-platelet antibodies, and temperature. Results The concordance between the rHEALTH and ISLH methods had a slope = 1.030 and R2 = 0.9684. The rHEALTH method showed a correlation between capillary and venous blood samples (slope = 0.9514 and R2 = 0.9684). Certain interferents changed platelet recovery: RBC fragments and anti-platelet antibodies with the ISLH method; platelet fragments and anti-platelet antibodies on the rHEALTH; and RBC fragments, platelets fragments, triglycerides and LDL on the clinical impedance analyzer. The rHEALTH’s precision ranged from 3.1–8.0%, and the ISLH from 1.0–10.5%. Conclusions The rHEALTH method provides similar results with the reference method and good correlation between adult capillary and venous blood samples. This demonstrates the ability of the rHEALTH to provide point-of-care assessment of normal and thrombocytopenic platelet counts from fingerprick blood with high precision and limited interferences.
Collapse
Affiliation(s)
| | - Rebecca Yu
- rHEALTH, Bedford, Massachusetts, United States of America
| | | | - Jonathan Paraskos
- Precision Medicine & Biosamples, R&D, AstraZeneca, Cambridge, United Kingdom
| | - Philipp Schatz
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Tigerstrom
- Precision Medicine & Biosamples, R&D, AstraZeneca, Gothenburg, Sweden
| | - Anna Ekman
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - José Sánchez
- Early Biometrics and Statistical Innovation, Data Science & AI, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden
| | - Jamie Cheng
- rHEALTH, Bedford, Massachusetts, United States of America
| | - Lillian Li
- rHEALTH, Bedford, Massachusetts, United States of America
| | - Eugene Y. Chan
- rHEALTH, Bedford, Massachusetts, United States of America
- DNA Medicine Institute, Bedford, Massachusetts, United States of America
- * E-mail:
| |
Collapse
|
14
|
Napolitano G, Caracciolo A, Apassiti Esposito S, Della Malva N, Manenti B, Guerra G, Ottomano C, Lippi G, Buoro S. Complete Blood Count as point of care testing QBC STAR™: Preliminary evaluation. Int J Lab Hematol 2021; 43:973-982. [PMID: 33750012 DOI: 10.1111/ijlh.13515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/01/2021] [Accepted: 03/03/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Point of care testing (POCT) represents a valuable option when laboratory data shall be urgently available for timely clinical management, with a turnaround time (TAT) that is unfeasible using conventional laboratory instrumentation. This study was aimed to compare the performance of QBC STAR™ compared to Sysmex XN-module and the reference optical microscopy (OM) assessment. MATERIAL AND METHODS One hundred peripheral blood samples, collected in K3 EDTA tubes, and 50 capillary blood samples obtained by finger stick were analyzed with QBC STAR™, Sysmex XN-module, and OM. Data were compared with Passing-Bablok regression and Bland-Altman plots. RESULTS The Passing-Bablok regression analysis (QBC STAR™ capillary sample vs XN-module) yielded slopes comprised between 0.30 and 1.37, while the intercepts ranged between -17.57 and 232.6. Bland-Altman plots yielded relative bias comprised between -4.87% (for MN QBC STAR™ capillary sample vs XN-module) and 27% (PLT QBC STAR™ capillary sample vs XN-module). A significant bias was found for all parameters except MN and WBC, RBC in all and pediatric samples, and HB in adults samples. CONCLUSION The results of this analytical evaluation suggest that QBC STAR™ may not be the ideal tool for performing complete blood count analysis for diagnostic purposes, while it could be more useful in urgent/emergent conditions, such as for rapid monitoring of some hematological parameters (eg, WBC and HB).
Collapse
Affiliation(s)
- Gavino Napolitano
- Clinical Chemistry Laboratory, Hospital ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | | | - Nunzia Della Malva
- Clinical Chemistry Laboratory, Hospital ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Barbara Manenti
- Transfusion Medicine, ASST Bergamo Ovest, Hospital Treviglio- Caravaggio, Treviglio, Italy
| | - Giovanni Guerra
- Clinical Chemistry Laboratory, Hospital ASST Papa Giovanni XXIII, Bergamo, Italy
| | | | - Giuseppe Lippi
- Section of Clinical Biochemistry, University of Verona, Verona, Italy
| | - Sabrina Buoro
- Regional Reference Center for the Laboratories Quality, Hospital ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| |
Collapse
|
15
|
Atkins M, McGuire P, Balgobin B, Patel P, Taylor D. Using a fingerstick test for haematological monitoring in patients treated with clozapine. Ther Adv Psychopharmacol 2021; 11:20451253211000865. [PMID: 33854764 PMCID: PMC8010800 DOI: 10.1177/20451253211000865] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Treatment with clozapine requires regular blood monitoring in order to minimise the risk of agranulocytosis. The demands on patients and clinicians associated with monitoring may be reduced by using point-of-care, as opposed to lab-based assessments. We assessed the utility of a device that can measure white blood cell (WBC) and neutrophil counts by capillary fingerstick blood. METHOD The performance of a small, portable device (HemoCue® WBC DIFF System) was compared with that of a widely used laboratory analyser (ADVIA® 2120i) for measuring WBC and neutrophil counts. Patients with schizophrenia who were being treated with clozapine (n = 201) provided a fingerstick capillary sample and a venous sample for the respective assays. RESULTS WBC counts and neutrophil counts from venous blood as determined by ADVIA 2120i, ranged from 3.0 × 109/l to 19.5 × 109/l, and 1.2 × 109/l to 15.9 × 109/l, respectively. There was a strong correlation between the results from venous and the capillary sample methods (WBC: R = 0.89, neutrophil: R = 0.92). By Passing-Bablok regression analysis, the slope of the association between ADVIA® 2120i and HemoCue WBC DIFF for WBC was 1.0 [95% confidence interval (CI) 0.944-1.086], with intercept at -0.9 (95% CI -1.43 to -0.45). For neutrophils, the slope was 0.870 (95% CI 0.817-0.923), with intercept at -0.19 (95% CI -0.43 to 0.02). Overall, mean biases of -0.95 × 109/l for WBC, and -0.91 × 109/l for neutrophils were observed for the capillary blood method compared with the venous blood method. Below the clinical cutoff intervals for clozapine monitoring WBC (<3.5 × 109/l) and neutrophils (<1.5 × 109/l) these biases were -1.1 × 109/l for WBC, and -0.25 × 109/l for neutrophils. CONCLUSION Results from the capillary blood HemoCue WBC DIFF analyser compared well with the venous blood ADVIA 2120i analyser for determining WBC and neutrophil counts. There was a slight overall bias, with the capillary method reporting lower values for both measures. Fingerstick point-of-care analysis is suitable for monitoring blood counts in patients on clozapine, although confirmatory standard venous testing is recommended for test results falling below accepted thresholds.
Collapse
Affiliation(s)
- Matthew Atkins
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK Maudsley Hospital, Denmark Hill, London SE5 8AZ, UK
| | | | - Bhirundra Balgobin
- Clozapine Clinic, South London and Maudsley NHS Foundation Trust, London, UK
| | - Pravinkumar Patel
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Taylor
- Pharmacy Department, South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
16
|
Abstract
Hematological analysis, via a complete blood count (CBC) and microscopy, is critical for screening, diagnosing, and monitoring blood conditions and diseases but requires complex equipment, multiple chemical reagents, laborious system calibration and procedures, and highly trained personnel for operation. Here we introduce a hematological assay based on label-free molecular imaging with deep-ultraviolet microscopy that can provide fast quantitative information of key hematological parameters to facilitate and improve hematological analysis. We demonstrate that this label-free approach yields 1) a quantitative five-part white blood cell differential, 2) quantitative red blood cell and hemoglobin characterization, 3) clear identification of platelets, and 4) detailed subcellular morphology. Analysis of tens of thousands of live cells is achieved in minutes without any sample preparation. Finally, we introduce a pseudocolorization scheme that accurately recapitulates the appearance of cells under conventional staining protocols for microscopic analysis of blood smears and bone marrow aspirates. Diagnostic efficacy is evaluated by a panel of hematologists performing a blind analysis of blood smears from healthy donors and thrombocytopenic and sickle cell disease patients. This work has significant implications toward simplifying and improving CBC and blood smear analysis, which is currently performed manually via bright-field microscopy, and toward the development of a low-cost, easy-to-use, and fast hematological analyzer as a point-of-care device and for low-resource settings.
Collapse
|
17
|
Luo J, Chen C, Li Q. White blood cell counting at point-of-care testing: A review. Electrophoresis 2020; 41:1450-1468. [PMID: 32356920 DOI: 10.1002/elps.202000029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2019] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 11/12/2022]
Abstract
White blood cells, which are also called leukocytes, are found in the immune system that are involved in protecting the body against infections and foreign invaders. Conventional methods of leukocyte analysis provide valuable and accurate information to medical specialists. Analyzing and diagnosing of a disease requires a combination of multiple biomarkers, in some cases, however, such as personal health care, this will occupy some medical resources and causes unnecessary consumption. Traditional method (such as flow cytometer) for WBC counting is time and labor consuming. Compared to gold standard (flow-based fraction/micropore filtration) or improved filtration methods for WBC counting, this is still a lengthy and time consuming process and can lead to membrane fouling due to the rapid accumulation of biological materials. Therefore, the analysis of WBC counts requires more compact and efficient equipment. The microfluidic technologies, powered by different field (force, thermal, acoustic, optical, magnetic) and other methods for leukocyte counting and analysis, are much cost-efficient and can be used in in-home or in resource-limited areas to achieve Point-of-Care (POC). In this review, we highlight the mainstream devices that have been commercialized and extensively employed for patients for WBC counting, Next, we present some recent development with regards to leucocyte counting (mainly microfluidic technologies) and comment on their relative merits. We aim to focus and discuss the possibility of achieving POC and help researchers to tackle individual challenges accordingly. Finally, we offer some technologies in addition to previous detection devices, such as image recognition technology and cloud computing, which we believe have great potential to further promote real-time detection and improve medical diagnosis.
Collapse
Affiliation(s)
- Jianke Luo
- College of Glasgow, University of Electronic Science and Technology of China, Chengdu, P. R. China
| | - Chunmei Chen
- Department of Laboratory Medicine, Health Industry Co., Ltd of the Fifth Xiangya Hospital, Hunan, P. R. China.,The Second Xiangya Hospital Central South University, Changsha, P. R. China
| | - Qing Li
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, P. R. China
| |
Collapse
|
18
|
Kur DK, Agersnap N, Holländer NH, Pedersen OBV, Friis‐Hansen L. Evaluation of the HemoCue WBC DIFF in leukopenic patient samples. Int J Lab Hematol 2020; 42:256-262. [DOI: 10.1111/ijlh.13158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Dår K. Kur
- Department of Clinical Biochemistry North Zealand Hospital University of Copenhagen Hilleroed Denmark
| | | | - Niels Henrik Holländer
- Department of Oncology and Palliative Units Zealand University Hospital Naestved Denmark
| | - Ole B. Vesterager Pedersen
- Department of Clinical Immunology Zealand University Hospital Naestved Denmark
- Institute of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Lennart Friis‐Hansen
- Department of Clinical Biochemistry North Zealand Hospital University of Copenhagen Hilleroed Denmark
- Department of Clinical Biochemistry and Pharmacology Odense University Hospital Odense Denmark
- Institute of Clinical Medicine University of Southern Denmark Odense Denmark
| |
Collapse
|
19
|
Otto Mattsson T, Lindhart CL, Schöley J, Friis‐Hansen L, Herrstedt J. Patient self‐testing of white blood cell count and differentiation: A study of feasibility and measurement performance in a population of Danish cancer patients. Eur J Cancer Care (Engl) 2019; 29:e13189. [DOI: 10.1111/ecc.13189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 05/26/2019] [Accepted: 10/24/2019] [Indexed: 12/26/2022]
Affiliation(s)
| | | | - Jonas Schöley
- Department of Public Health University of Southern Denmark Odense Denmark
| | | | - Jørn Herrstedt
- Department of Clinical Oncology Zealand University Hospital Roskilde Denmark
- University of Copenhagen Copenhagen Denmark
| |
Collapse
|
20
|
Mooney C, Byrne M, Kapuya P, Pentony L, De la Salle B, Cambridge T, Foley D. Point of care testing in general haematology. Br J Haematol 2019; 187:296-306. [PMID: 31578729 DOI: 10.1111/bjh.16208] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
|
21
|
Karigowda L, Deshpande K, Jones S, Miller J. The accuracy of a point of care measurement of activated partial thromboplastin time in intensive care patients. Pathology 2019; 51:628-633. [PMID: 31445807 DOI: 10.1016/j.pathol.2019.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 05/20/2019] [Accepted: 05/26/2019] [Indexed: 11/28/2022]
Abstract
Point of care (POC) devices are increasingly being used in intensive care units to obtain faster results. Data are limited on the performance of these devices in critically ill patients, especially those on heparin infusion. The objective of this study was to assess the agreement between POC activated partial thromboplastin time (APTT) and laboratory APTT results in patients on heparin infusion and to determine its impact on the clinical decisions regarding heparin dosage. We screened all patients admitted to the intensive care unit (ICU) at St George Hospital, Sydney, over a 7-month period and enrolled those who were receiving intravenous heparin infusion. We measured APTT by two methods: bedside POC test (Hemochron Junior Signature Plus) and central laboratory method (STA analyser). We used the Bland-Altman method to test the statistical agreement between the two measurements and Cohen's kappa statistic to test the clinical agreement regarding heparin dosing decision. A total of 176 paired samples from 44 patients (mean age 63 years, 64% males, mean APACHE 18) were analysed. The mean turnaround time for the point of care APTT result was significantly shorter than the central laboratory result (5.0±0.2 min vs 64.6±2.7 min, p<0.0001). Despite the statistically significant correlation, the overall agreement tested by the Bland-Altman method was poor. The 95% limits of agreement were widest (-27.266 to 64.791) and mean percentage bias was highest (24%) for the comparison between POC APTT using citrated blood and laboratory APTT. When POC APTT results of less than 90 seconds using whole blood were compared to laboratory APTT results, the limits of the agreement became narrower (-23.243 to 28.419), and the mean percentage bias decreased to 5%. The agreement between clinical decisions regarding heparin dosage based on the two methods was poor for plain and citrated blood (kappa 0.35 and 0.11, respectively). The POC APTT results were not sufficiently accurate for use in patients on heparin infusion compared to laboratory APTT assay.
Collapse
Affiliation(s)
- Lohith Karigowda
- Department of Intensive Care, St George Hospital, Kogarah, NSW, Australia.
| | - Kush Deshpande
- Department of Intensive Care, St George Hospital, Kogarah, NSW, Australia
| | - Sarah Jones
- Department of Intensive Care, St George Hospital, Kogarah, NSW, Australia
| | - Jennene Miller
- Department of Intensive Care, St George Hospital, Kogarah, NSW, Australia
| |
Collapse
|
22
|
Ordóñez-Mena JM, Fanshawe TR, McCartney D, Shine B, Van den Bruel A, Lasserson D, Hayward G. C-reactive protein and neutrophil count laboratory test requests from primary care: what is the demand and would substitution by point-of-care technology be viable? J Clin Pathol 2019; 72:474-481. [PMID: 30992343 DOI: 10.1136/jclinpath-2018-205688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/05/2019] [Accepted: 04/03/2019] [Indexed: 11/04/2022]
Abstract
AIMS : C-reactive protein (CRP) and neutrophil count (NC) are important diagnostic indicators of inflammation. Point-of-care (POC) technologies for these markers are available but rarely used in community settings in the UK. To inform the potential for POC tests, it is necessary to understand the demand for testing. We aimed to describe the frequency of CRP and NC test requests from primary care to central laboratory services, describe variability between practices and assess the relationship between the tests. METHODS We described the number of patients with either or both laboratory tests, and the volume of testing per individual and per practice, in a retrospective cohort of all adults in general practices in Oxfordshire, 2014-2016. RESULTS 372 017 CRP and 776 581 NC tests in 160 883 and 275 093 patients, respectively, were requested from 69 practices. CRP was tested mainly in combination with NC, while the latter was more often tested alone. The median (IQR) of CRP and NC tests/person tested was 1 (1-2) and 2 (1-3), respectively. The median (IQR) tests/practice/week was 36 (22-52) and 72 (50-108), and per 1000 persons registered/practice/week was 4 (3-5) and 8 (7-9), respectively. The median (IQR) CRP and NC concentrations were 2.7 (0.9-7.9) mg/dL and 4.1 (3.1-5.5)×109/L, respectively. CONCLUSIONS The high demand for CRP and NC testing in the community, and the range of results falling within the reportable range for current POC technologies highlight the opportunity for laboratory testing to be supplemented by POC testing in general practice.
Collapse
Affiliation(s)
- José M Ordóñez-Mena
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK .,NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Thomas R Fanshawe
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - David McCartney
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Brian Shine
- Biochemistry, Oxford University Hospitals, Oxford, UK
| | - Ann Van den Bruel
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.,Academic Centre for Primary Care, KU Leuven, Leuven, Belgium
| | - Daniel Lasserson
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Gail Hayward
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| |
Collapse
|
23
|
Majors CE, Pawlowski ME, Burke DC, Tkaczyk TS, Rieber A, Richards-Kortum R. Clinical training and validation of the LeukoScope: a low-cost, point-of-care device to perform white blood cell and neutrophil counts. RSC Adv 2019; 9:27324-27333. [PMID: 35529242 PMCID: PMC9070624 DOI: 10.1039/c9ra06433h] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 08/22/2019] [Indexed: 11/21/2022] Open
Abstract
We present a novel, point-of-care method to perform WBC and neutrophil counts with a drop of blood and portable reader.
Collapse
Affiliation(s)
| | | | | | | | - Alyssa Rieber
- Department of General Oncology
- The University of Texas MD Anderson Cancer Center
- Houston
- USA
| | | |
Collapse
|
24
|
Lohman AC, VAN Rijn I, Lindhardt CL, Vonthein R, Rades D, Holländer NH. Preliminary Results from a Prospective Study Comparing White Blood Cell and Neutrophil Counts from a Laboratory to Those Measured with a New Device in Patients with Breast Cancer. In Vivo 2018; 32:1283-1288. [PMID: 30150458 DOI: 10.21873/invivo.11378] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/16/2018] [Accepted: 07/19/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM If blood tests were performed at home, unnecessary trips of patients for chemotherapy could be avoided. The HemoCue® WBC DIFF device was tested at home by 14 patients with breast cancer. MATERIALS AND METHODS A total of 42 measurements of white blood cell (WBC) and neutrophil counts with the device at home were compared to laboratory measurements performed within 3 hours. Bland-Altman plots were created for limits of agreement that should be less than 1.0×109/l for WBC and 0.5×109/l for neutrophils to indicate a similar grade of intensity. RESULTS Limits of agreement were -1.61×109/l and +2.34×109/l for WBC and -1.15×109/l and +1.39×109/l for neutrophils. All patients considered the device advantageous, particularly because they did not have to travel or wait for results. Most patients experienced problems with the lancet when taking blood samples. CONCLUSION Disagreement of WBC and neutrophil counts between methods appeared clinically relevant. Findings need to be verified in a larger cohort, including the use of a different type of lancet.
Collapse
Affiliation(s)
- Anna C Lohman
- Department of Oncology and Palliative Units, Zealand University Hospital, Naestved, Denmark
| | | | | | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Lübeck, Lübeck, Germany.,Centre for Clinical Trials Lübeck, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Niels Henrik Holländer
- Department of Oncology and Palliative Units, Zealand University Hospital, Naestved, Denmark
| |
Collapse
|
25
|
Balter ML, Leipheimer JM, Chen AI, Shrirao A, Maguire TJ, Yarmush ML. Automated end-to-end blood testing at the point-of-care: Integration of robotic phlebotomy with downstream sample processing. TECHNOLOGY 2018; 6:59-66. [PMID: 30057935 PMCID: PMC6058193 DOI: 10.1142/s2339547818500048] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Diagnostic blood testing is the most commonly performed clinical procedure in the world, and influences the majority of medical decisions made in hospital and laboratory settings. However, manual blood draw success rates are dependent on clinician skill and patient physiology, and results are generated almost exclusively in centralized labs from large-volume samples using labor-intensive analytical techniques. This paper presents a medical device that enables end-to-end blood testing by performing blood draws and providing diagnostic results in a fully automated fashion at the point-of-care. The system couples an image-guided venipuncture robot, developed to address the challenges of routine venous access, with a centrifuge-based blood analyzer to obtain quantitative measurements of hematology. We first demonstrate a white blood cell assay on the analyzer, using a blood mimicking fluid spiked with fluorescent microbeads, where the area of the packed bead layer is correlated with the bead concentration. Next we perform experiments to evaluate the pumping efficiency of the sample handling module. Finally, studies are conducted on the integrated device - from blood draw to analysis - using blood vessel phantoms to assess the accuracy and repeatability of the resulting white blood cell assay.
Collapse
Affiliation(s)
- M L Balter
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| | - J M Leipheimer
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| | - A I Chen
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| | - A Shrirao
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| | - T J Maguire
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| | - M L Yarmush
- Department of Biomedical Engineering, Rutgers University, Piscataway NJ 08854, USA
| |
Collapse
|
26
|
Hambleton K, Connolly CM, Borg C, Davies JH, Jeffers HP, Russell RE, Bafadhel M. Comparison of the peripheral blood eosinophil count using near-patient testing and standard automated laboratory measurement in healthy, asthmatic and COPD subjects. Int J Chron Obstruct Pulmon Dis 2017; 12:2771-2775. [PMID: 29026294 PMCID: PMC5627756 DOI: 10.2147/copd.s147216] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Near-patient testing (NPT) allows clinical decisions to be made in a rapid and convenient manner and is often cost effective. In COPD the peripheral blood eosinophil count has been demonstrated to have utility in providing prognostic information and predicting response to treatment during an acute exacerbation. For this potential to be achieved having a reliable NPT of blood eosinophil count would be extremely useful. Therefore, we investigated the use of the HemoCue® WBC Diff System and evaluated its sensitivity and specificity in healthy, asthmatic and COPD subjects. This method requires a simple skin prick of blood and was compared to standard venepuncture laboratory analysis. The HemoCue® WBC Diff System measured the peripheral blood eosinophil count in healthy, asthma and COPD subjects with very close correlation to the eosinophil count as measured by standard venepuncture. The correlations were unaffected by disease status. This method for the measurement of the peripheral blood eosinophil count has the potential to provide rapid near-patient results and thus influence the speed of management decisions in the treatment of airway diseases.
Collapse
Affiliation(s)
- Kirsty Hambleton
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Clare M Connolly
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Catherine Borg
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Joanne H Davies
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Helen P Jeffers
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Richard Ek Russell
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Mona Bafadhel
- Respiratory Medicine Unit, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| |
Collapse
|
27
|
Karawajczyk M, Haile S, Grabski M, Larsson A. The HemoCue WBC DIFF system could be used for leucocyte and neutrophil counts but not for full differential counts. Acta Paediatr 2017; 106:974-978. [PMID: 28218961 DOI: 10.1111/apa.13790] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 01/03/2017] [Accepted: 02/16/2017] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the HemoCue WBC DIFF system for point of care testing of fingerstick samples from paediatric patients. METHODS We analysed 158 white blood cell counts on both the point of care HemoCue WBC DIFF instrument and the Cell Dyn Sapphire cell counter used by our central laboratory and compared the results. The measurements were performed using fingerstick samples drawn by nurses working in paediatric emergency and paediatric oncology units. RESULTS There was good agreement between the two instruments for white blood cell and neutrophil counts. The correlation was weaker for lymphocytes, and the correlations were poor for monocytes and eosinophils. The HemoCue WBC DIFF flagged 56 of the 148 capillary drawn samples as abnormal, but none of the 10 venously collected samples. Only two of the flagged samples differed significantly between the instruments, with regard to the cell counts. CONCLUSION The correlations between the white blood cell counts and neutrophil counts in this real-life study were good enough to diagnose children in emergency department and oncology unit settings. However, the high number of pathological flags from fingerstick samples, which made reruns necessary, limited the usefulness of the instrument.
Collapse
Affiliation(s)
- Malgorzata Karawajczyk
- Section of Clinical Chemistry; Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - Saba Haile
- Section of Clinical Chemistry; Department of Medical Sciences; Uppsala University; Uppsala Sweden
| | - Magnus Grabski
- Department of Pediatrics; Uppsala University; Uppsala Sweden
| | - Anders Larsson
- Section of Clinical Chemistry; Department of Medical Sciences; Uppsala University; Uppsala Sweden
| |
Collapse
|
28
|
Smith S, Madzivhandila P, Sewart R, Govender U, Becker H, Roux P, Land K. Microfluidic Cartridges for Automated, Point-of-Care Blood Cell Counting. SLAS Technol 2016; 22:176-185. [PMID: 27856945 DOI: 10.1177/2211068216677820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Disposable, low-cost microfluidic cartridges for automated blood cell counting applications are presented in this article. The need for point-of-care medical diagnostic tools is evident, particularly in low-resource and rural settings, and a full blood count is often the first step in patient diagnosis. Total white and red blood cell counts have been implemented toward a full blood count, using microfluidic cartridges with automated sample introduction and processing steps for visual microscopy cell counting to be performed. The functional steps within the microfluidic cartridge as well as the surrounding instrumentation required to control and test the cartridges in an automated fashion are described. The results recorded from 10 white blood cell and 10 red blood cell counting cartridges are presented and compare well with the results obtained from the accepted gold-standard flow cytometry method performed at pathology laboratories. Comparisons were also made using manual methods of blood cell counting using a hemocytometer, as well as a commercially available point-of-care white blood cell counting system. The functionality of the blood cell counting microfluidic cartridges can be extended to platelet counting and potential hemoglobin analysis, toward the implementation of an automated, point-of-care full blood count.
Collapse
Affiliation(s)
- Suzanne Smith
- 1 Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Phophi Madzivhandila
- 1 Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | | | - Ureshnie Govender
- 1 Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | | | - Pieter Roux
- 1 Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| | - Kevin Land
- 1 Materials Science and Manufacturing, Council for Scientific and Industrial Research, Pretoria, South Africa
| |
Collapse
|
29
|
White Blood Cell Count in Primary Care. POINT OF CARE 2016. [DOI: 10.1097/poc.0000000000000090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
30
|
Evaluation of point-of-care testing in critically unwell patients: comparison with clinical laboratory analysers and applicability to patients with Ebolavirus infection. Pathology 2016; 47:405-9. [PMID: 26126049 DOI: 10.1097/pat.0000000000000296] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Data on the performance of point-of-care (POC) or near-patient devices in the management of critically unwell patients are limited, meaning that there are demands for confirming POC test results in the routine clinical laboratory and so potentially leading to delay in treatment provision. We evaluated the performance of the i-STAT CHEM 8+ and CG4+, Hemochron Signature Elite, HemoCue Hb 201+ and WBC Diff Systems on whole blood collected from medical and surgical patients admitted to the intensive care unit at an Australian tertiary care hospital. Measurements obtained for haematology, coagulation, biochemistry and arterial blood gas parameters using POC devices were compared against clinical laboratory analysers (XE-5000, STA-R Evolution, Dimension Vista 1500 and ABL800 FLEX). Bland-Altman and Passing-Bablok regression plots were constructed to assess agreement. Good correlation was defined as a bias of <10% between the POC device and the reference method. Forty arterial blood samples were collected from 28 patients. There was good correlation demonstrated for sodium, potassium, chloride, ionised calcium, glucose, urea, haemoglobin and haematocrit values (i-STAT Chem 8+); pH, pCO(2), bicarbonate and oxygen saturation (i-STAT CG4+); haemoglobin, white cell, neutrophil count and lymphocyte counts (Hemocue); and internationalised normal ratio (INR; Hemochron Signature Elite), but not creatinine, anion gap, pO(2), base excess, lactate, eosinophil count, prothrombin and activated partial thromboplastin time. POC devices were comparable to clinical laboratory analysers in measuring the majority of haematology, biochemistry and coagulation parameters in critically unwell patients, including those with infections. These devices may be deployed at the bedside to allow 'real-time' testing to improve patient care.
Collapse
|
31
|
Forcucci A, Pawlowski ME, Majors C, Richards-Kortum R, Tkaczyk TS. All-plastic, miniature, digital fluorescence microscope for three part white blood cell differential measurements at the point of care. BIOMEDICAL OPTICS EXPRESS 2015; 6:4433-46. [PMID: 26601006 PMCID: PMC4646550 DOI: 10.1364/boe.6.004433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 07/23/2015] [Accepted: 07/28/2015] [Indexed: 05/20/2023]
Abstract
Three-part differential white blood cell counts are used for disease diagnosis and monitoring at the point-of-care. A low-cost, miniature achromatic microscope was fabricated for identification of lymphocytes, monocytes, and granulocytes in samples of whole blood stained with acridine orange. The microscope was manufactured using rapid prototyping techniques of diamond turning and 3D printing and is intended for use at the point-of-care in low-resource settings. The custom-designed microscope requires no manual adjustment between samples and was successfully able to classify three white blood cell types (lymphocytes, granulocytes, and monocytes) using samples of peripheral whole blood stained with acridine orange.
Collapse
|
32
|
Accuracy and feasibility of point-of-care white blood cell count and C-reactive protein measurements at the pediatric emergency department. PLoS One 2015; 10:e0129920. [PMID: 26034987 PMCID: PMC4452774 DOI: 10.1371/journal.pone.0129920] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 05/14/2015] [Indexed: 11/24/2022] Open
Abstract
Background Several point-of-care (POC) tests are available for evaluation of febrile patients, but the data about their performance in acute care setting is sparse. We investigated the analytical accuracy and feasibility of POC tests for white blood cell (WBC) count and C-reactive protein (CRP) at the pediatric emergency department (ED). Methods In the first part of the study, HemoCue WBC and Afinion AS100 CRP POC analyzers were compared with laboratory’s routine WBC (Sysmex XE-2100) and CRP (Modular P) analyzers in the hospital central laboratory in 77 and 48 clinical blood samples, respectively. The POC tests were then adopted in use at the pediatric ED. In the second part of the study, we compared WBC and CRP levels measured by POC and routine methods during 171 ED patient visits by 168 febrile children and adolescents. Attending physicians performed POC tests in capillary fingerprick samples. Results In parallel measurements in the laboratory both WBC and CRP POC analyzers showed good agreement with the reference methods. In febrile children at the emergency department (median age 2.4 years), physician performed POC determinations in capillary blood gave comparable results with those in venous blood analyzed in the laboratory. The mean difference between POC and reference test result was 1.1 E9/L (95% limits of agreement from -6.5 to 8.8 E9/L) for WBC and -1.2 mg/L (95% limits of agreement from -29.6 to 27.2 mg/L) for CRP. Conclusions POC tests are feasible and relatively accurate methods to assess CRP level and WBC count among febrile children at the ED.
Collapse
|
33
|
|
34
|
Vercruysse D, Dusa A, Stahl R, Vanmeerbeeck G, de Wijs K, Liu C, Prodanov D, Peumans P, Lagae L. Three-part differential of unlabeled leukocytes with a compact lens-free imaging flow cytometer. LAB ON A CHIP 2015; 15:1123-32. [PMID: 25537881 DOI: 10.1039/c4lc01131g] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
A compelling clinical need exists for inexpensive, portable haematology analyzers that can be utilized at the point-of-care in emergency settings or in resource-limited settings. Development of a label-free, microfluidic blood analysis platform is the first step towards such a miniaturized, cost-effective system. Here we assemble a compact lens-free in-line holographic microscope and employ it to image blood cells flowing in a microfluidic chip, using a high-speed camera and stroboscopic illumination. Numerical reconstruction of the captured holograms allows classification of unlabeled leukocytes into three main subtypes: lymphocytes, monocytes and granulocytes. A scale-space recognition analysis to evaluate cellular size and internal complexity is also developed and used to build a 3-part leukocyte differential. The lens-free image-based classification is compared to the 3-part white blood cell differential generated by using a conventional analyzer on the same blood sample and is found to be in good agreement with it.
Collapse
|
35
|
Kokko E, Korppi M, Helminen M, Hutri-Kähönen N. Rapid C-reactive protein and white cell tests decrease cost and shorten emergency visits. Pediatr Int 2014; 56:698-701. [PMID: 24689910 DOI: 10.1111/ped.12353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Revised: 02/24/2014] [Accepted: 03/11/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Elevated white blood cells (WBC) in blood and C-reactive protein (CRP) in serum are often used as non-specific markers for bacterial etiology of infection in children. The aim of the present study was to evaluate how rapid WBC and CRP testing influences patient flow and cost in the pediatric emergency room (ER). METHODS This study was a retrospective chart review. In all, 166 children who were treated during 3 months in the ER of a children's hospital, and in whom rapid tests for WBC and CRP were done, were included. The association between rapid testing and length of ER stay was evaluated, and the cost of rapid tests was compared with the corresponding cost if done in the hospital laboratory. RESULTS Median ER stay was 147.5 min, if no examinations other than rapid CRP and WBC tests were done and if no emergency treatment was given, compared with 201.5 min for laboratory tests or emergency treatment given (P < 0.001). The respective figures were 142.5 min and 179.5 min in those 96 children discharged home (P = 0.003). The cost of rapid testing was only 41.5% of the corresponding laboratory cost. CONCLUSION The simultaneous rapid testing of CRP and WBC in children with presumable infection decreased cost and shortened the length of ER stay, if no other examinations or emergency treatment were needed. The cost of rapid testing was less than half of the corresponding cost in laboratory.
Collapse
Affiliation(s)
- Eeva Kokko
- Tampere Centre for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | | | | | | |
Collapse
|
36
|
Park IJ, Ahn S, Kim YI, Kang SJ, Cho SR. Performance evaluation of Samsung LABGEO(HC10) Hematology Analyzer. Arch Pathol Lab Med 2014; 138:1077-82. [PMID: 25076297 DOI: 10.5858/arpa.2013-0439-oa] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT The Samsung LABGEO(HC10) Hematology Analyzer (LABGEO(HC10)) is a recently developed automated hematology analyzer that uses impedance technologies. The analyzer provides 18 parameters including 3-part differential at a maximum rate of 80 samples per hour. OBJECTIVE To evaluate the performance of the LABGEO(HC10). DESIGN We evaluated precision, linearity, carryover, and relationship for complete blood cell count parameters between the LABGEO(HC10) and the LH780 (Beckman Coulter Inc) in a university hospital in Korea according to the Clinical and Laboratory Standards Institute guidelines. Sample stability and differences due to the anticoagulant used (K₂EDTA versus K₃EDTA) were also evaluated. RESULTS The LABGEO(HC10) showed linearity over a wide range and minimal carryover (<1%) for white blood cell, hemoglobin, red blood cell, and platelet parameters. Correlation between the LABGEO(HC10) and the LH780 was good for all complete blood cell count parameters (R > 0.92) except for mean corpuscular hemoglobin concentration. The bias estimated was acceptable for all parameters investigated except for monocyte count. Most parameters were stable until 24 hours both at room temperature and at 4°C. The difference by anticoagulant type was statistically insignificant for all parameters except for a few red cell parameters. CONCLUSIONS The accurate results achievable and simplicity of operation make the unit recommendable for small to medium-sized laboratories.
Collapse
Affiliation(s)
- Il Joong Park
- From the Department of Laboratory Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
| | | | | | | | | |
Collapse
|
37
|
Kotani K, Minami T, Abe T, Sato J, Taniguchi N, Yamada T. Development of a new point-of-care testing system for measuring white blood cell and C-reactive protein levels in whole blood samples. Clin Chim Acta 2014; 433:145-9. [DOI: 10.1016/j.cca.2014.03.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/31/2014] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
|
38
|
Crucian B, Quiriarte H, Guess T, Ploutz-Snyder R, McMonigal K, Sams C. A Miniaturized Analyzer Capable of White-Blood-Cell and Differential Analyses During Spaceflight. Lab Med 2013. [DOI: 10.1309/lmd3thaychicf2xt] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
39
|
Cure MC, Cure E, Kirbas A, Cicek AC, Yuce S. The effects of Gilbert's syndrome on the mean platelet volume and other hematological parameters. Blood Coagul Fibrinolysis 2013; 24:484-8. [PMID: 23348429 DOI: 10.1097/mbc.0b013e32835e4230] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The protective effect of increased levels of indirect bilirubin on atherosclerotic heart disease in patients of Gilbert's syndrome is well known. The aim of the study was to investigate the effects of increased levels of bilirubin on the mean platelet volume (MPV) and other hematological parameters. Thirty-two men and 36 women (a total of 68 Gilbert's syndrome patients) and a similar age group of 68 healthy individuals (32 men and 36 women) were included in the study. Hematologic tests, C-reactive protein (CRP) and biochemical values of the two groups were checked. MPV level of Gilbert's syndrome group was 7.8±1.0fl and CRP 0.2±0.27mg/dl. In the control group MPV was 8.6±1.0fl and CRP 0.3±0.38mg/dl. MPV of patients group (P<0.001) and CRP (P=0.037) were significantly lower than the control group. When dividing Gilbert's syndrome and control groups according to sex into subgroups the level of indirect bilirubin in men with Gilbert's syndrome (1.8±0.8mg/dl) was found to be higher than other groups. Healthy men had higher levels of MPV (8.8±0.9fl) whereas Gilbert's syndrome male patients had lower levels (7.7±1.1fl), (P<0.001). The elevated levels of bilirubin and decreasing levels of MPV and CRP in Gilbert's syndrome patients may have an effect on the slowing down of the atherosclerotic process.
Collapse
Affiliation(s)
- Medine C Cure
- Department of Biochemistry, University of Recep Tayyip Erdogan, Rize, Turkey.
| | | | | | | | | |
Collapse
|
40
|
|
41
|
Briggs C, Kimber S, Green L. Where are we at with point- of- care testing in haematology? Br J Haematol 2012; 158:679-90. [DOI: 10.1111/j.1365-2141.2012.09207.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/17/2012] [Indexed: 12/31/2022]
Affiliation(s)
- Carol Briggs
- Department of haematology; University College London Hospital; London
| | - Simon Kimber
- Institute of Healthcare Science; Manchester Metropolitan University; Manchester
| | - Laura Green
- Barts and the London NHS Trust & NHSBT; London; UK
| |
Collapse
|
42
|
POINT-OF-CARE HEMATOLOGY AND COAGULATION TESTING IN PRIMARY, RURAL EMERGENCY, AND DISASTER CARE SCENARIOS. POINT OF CARE 2012; 11:140-145. [PMID: 23843728 DOI: 10.1097/poc.0b013e31825a9d3a] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this article is to review current principles and criteria for obtaining Clinical Laboratory Improvement Amendments of 1988 (CLIA '88) waiver, identify existing point-of-care (POC) coagulation and hematology technologies, and analyze regulatory challenges regarding CLIA-waiver for those and future devices. CLIA '88 documentation requires tests performed by laboratories with a Certificate of Waiver to be so simple that the likelihood of erroneous results by the user is negligible, or poses no unreasonable risk of harm to the patient if performed incorrectly as determined by the Secretary of Health and Human Services. "Simple" means that the test uses unprocessed samples, has a direct read-out of test results, does not have specifications for user training, and includes instructions for confirmatory testing when advisable. Currently the CLIA-waived hematology and coagulation POC devices only test for hemoglobin (Hb), hematocrit (Hct), and prothrombin time/international normalized ratio (PT/INR). The problem with these devices is the lack of multiplexing. POC coagulation and hematology devices face challenges for obtaining a waiver. These challenges include the lack of clinical needs assessment, miniturized assays that correct for interfering substances, and assays simple enough to be combined in a multiplex platform. Several scenarios demonstrate how POC coagulation or hematology devices can improve crisis care. Industry should perform needs assessment on clinicians and emergency responders to determine which analytes to incorporate on multiplex POC coagulation and hematology devices, and produce devices that address confounding factors.
Collapse
|
43
|
Evaluation of the veterinary application of a point-of-care device measuring white blood cell counts. Vet J 2012; 194:124-7. [PMID: 22503717 DOI: 10.1016/j.tvjl.2012.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Revised: 01/30/2012] [Accepted: 03/06/2012] [Indexed: 11/23/2022]
Abstract
A point-of-care device (POCD) for measuring total white blood cell count was evaluated for feline, canine, equine and bovine blood samples collected into EDTA. Mean biases were -9.2% (range, -12% to -6.3%) for feline samples, 20.2% (range, 15.3-25.1%) for canine samples, -7.1% (range, -8.3% to -5.9%) for equine samples, and 0.7% (range, -1.1% to 2.5%) for bovine samples. The results were influenced by the presence of nucleated red blood cells. The POCD provided precise, reliable data for feline, equine and bovine samples but the values obtained for the canine counts were overestimations.
Collapse
|
44
|
Osei-Bimpong A, McLean R, Bhonda E, Lewis SM. The use of the white cell count and haemoglobin in combination as an effective screen to predict the normality of the full blood count. Int J Lab Hematol 2012; 34:91-7. [PMID: 21883968 PMCID: PMC3298644 DOI: 10.1111/j.1751-553x.2011.01365.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Accepted: 06/23/2011] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The utility of the full blood count (FBC) is vast with each parameter serving as a tool to aid diagnosis and monitor disease progression. However, the effectiveness of the test is hampered because of increased workload and lack of interpretation. In the effort to redress this issue, the combined use of the white blood cell count (WBC) and haemoglobin in predicting the normality of the FBC is evaluated. METHOD FBC data were collated from 2191 patients and classified into two groups depending on whether the WBC and the haemoglobin were within the reference range. Blood films were examined on the abnormal FBC samples in each group and graded on morphology. RESULTS The FBC was normal in 89.6% of cases in the presence of a normal WBC and haemoglobin with subtle abnormalities in the remainder; 1+ grading of abnormal morphology in 93%. However, when the WBC and/or haemoglobin was abnormal, the remaining FBC was significantly abnormal (P < 0.05) and the corresponding blood films were grossly abnormal; 2+/3+ grading in 96% of cases. CONCLUSION We concluded that in the presence of a normal WBC and haemoglobin, the FBC is normal in almost all cases and measuring these two parameters could be used as an effective screen to predict FBC normality.
Collapse
Affiliation(s)
- A Osei-Bimpong
- Imperial College Healthcare NHS Trust, Department of Haematology & WHO Collaboration Centre for Haematology Technology, London, UK.
| | | | | | | |
Collapse
|
45
|
Glencross DK, Coetzee LM, Faal M, Masango M, Stevens WS, Venter WF, Osih R. Performance evaluation of the Pima™ point-of-care CD4 analyser using capillary blood sampling in field tests in South Africa. J Int AIDS Soc 2012; 15:3. [PMID: 22284546 PMCID: PMC3310849 DOI: 10.1186/1758-2652-15-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Accepted: 01/30/2012] [Indexed: 11/12/2022] Open
Abstract
Background Point-of-care CD4 testing can provide immediate CD4 reporting at HIV-testing sites. This study evaluated performance of capillary blood sampling using the point-of-care Pima™ CD4 device in representative primary health care clinics doing HIV testing. Methods Prior to testing, prescribed capillary-sampling and instrument training was undertaken by suppliers across all sites. Matching venous EDTA samples were drawn throughout for comparison to laboratory predicate methodology (PLG/CD4). In Phase I, Pima™ cartridges were pipette-filled with EDTA venous blood in the laboratory (N = 100). In Phase II (N = 77), Pima™ CD4 with capillary sampling was performed by a single operator in a hospital-based antenatal clinic. During subsequent field testing, Pima™ CD4 with capillary sampling was performed in primary health care clinics on HIV-positive patients by multiple attending nursing personnel in a rural clinic (Phase-IIIA, N = 96) and an inner-city clinic (Phase-IIIB, N = 139). Results Pima™ CD4 compared favourably to predicate/CD4 when cartridges were pipette-filled with venous blood (bias -17.3 ± STDev = 36.7 cells/mm3; precision-to-predicate %CV < 6%). Decreased precision of Pima™ CD4 to predicate/CD4 (varying from 17.6 to 28.8%SIM CV; mean bias = 37.9 ± STDev = 179.5 cells/mm3) was noted during field testing in the hospital antenatal clinic. In the rural clinic field-studies, unacceptable precision-to-predicate and positive bias was noted (mean 28.4%SIM CV; mean bias = +105.7 ± STDev = 225.4 cells/mm3). With additional proactive manufacturer support, reliable performance was noted in the subsequent inner-city clinic field study where acceptable precision-to-predicate (11%SIM CV) and less bias of Pima™ to predicate was shown (BA bias ~11 ± STDev = 69 cells/mm3). Conclusions Variable precision of Pima™ to predicate CD4 across study sites was attributable to variable capillary sampling. Poor precision was noted in the outlying primary health care clinic where the system is most likely to be used. Stringent attention to capillary blood collection technique is therefore imperative if technologies like Pima™ are used with capillary sampling at the POC. Pima™ CD4 analysis with venous blood was shown to be reproducible, but testing at the point of care exposes operators to biohazard risk related to uncapping vacutainer samples and pipetting of blood, and is best placed in smaller laboratories using established principles of Good Clinical Laboratory Practice. The development of capillary sampling quality control methods that assure reliable CD4 counts at the point of care are awaited.
Collapse
Affiliation(s)
- Deborah K Glencross
- Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, 2198, Johannesburg, South Africa.
| | | | | | | | | | | | | |
Collapse
|
46
|
|
47
|
Zhu H, Mavandadi S, Coskun AF, Yaglidere O, Ozcan A. Optofluidic fluorescent imaging cytometry on a cell phone. Anal Chem 2011; 83:6641-7. [PMID: 21774454 DOI: 10.1021/ac201587a] [Citation(s) in RCA: 324] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Fluorescent microscopy and flow cytometry are widely used tools in biomedical sciences. Cost-effective translation of these technologies to remote and resource-limited environments could create new opportunities especially for telemedicine applications. Toward this direction, here we demonstrate the integration of imaging cytometry and fluorescent microscopy on a cell phone using a compact, lightweight, and cost-effective optofluidic attachment. In this cell-phone-based optofluidic imaging cytometry platform, fluorescently labeled particles or cells of interest are continuously delivered to our imaging volume through a disposable microfluidic channel that is positioned above the existing camera unit of the cell phone. The same microfluidic device also acts as a multilayered optofluidic waveguide and efficiently guides our excitation light, which is butt-coupled from the side facets of our microfluidic channel using inexpensive light-emitting diodes. Since the excitation of the sample volume occurs through guided waves that propagate perpendicular to the detection path, our cell-phone camera can record fluorescent movies of the specimens as they are flowing through the microchannel. The digital frames of these fluorescent movies are then rapidly processed to quantify the count and the density of the labeled particles/cells within the target solution of interest. We tested the performance of our cell-phone-based imaging cytometer by measuring the density of white blood cells in human blood samples, which provided a decent match to a commercially available hematology analyzer. We further characterized the imaging quality of the same platform to demonstrate a spatial resolution of ~2 μm. This cell-phone-enabled optofluidic imaging flow cytometer could especially be useful for rapid and sensitive imaging of bodily fluids for conducting various cell counts (e.g., toward monitoring of HIV+ patients) or rare cell analysis as well as for screening of water quality in remote and resource-poor settings.
Collapse
Affiliation(s)
- Hongying Zhu
- Electrical Engineering Department, University of California, Los Angeles, Los Angeles, California 90095, USA
| | | | | | | | | |
Collapse
|
48
|
|
49
|
van Berkel C, Gwyer JD, Deane S, Green NG, Holloway J, Hollis V, Morgan H. Integrated systems for rapid point of care (PoC) blood cell analysis. LAB ON A CHIP 2011; 11:1249-55. [PMID: 21331413 DOI: 10.1039/c0lc00587h] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Counting the different subpopulations of cells in a fingerprick of human blood is important for a number of clinical point-of-care (PoC) applications. It is a challenge to demonstrate the integration of sample preparation and detection techniques in a single platform. In this paper we demonstrate a generic microfluidic platform that combines sample processing and characterisation and enumeration in a single, integrated system. Results of microfluidic 3-part differential leukocyte (granulocyte, lymphocyte and monocyte) counts, together with erythrocyte and thrombocyte (platelet) counts, in human blood are shown and corroborated with results from hospital clinical laboratory analysis.
Collapse
Affiliation(s)
- Cees van Berkel
- Philips Research Laboratories, 101 Cambridge Science Park, Milton Road, Cambridge CB4 0FY, UK
| | | | | | | | | | | | | |
Collapse
|