Improved automated leucocyte counting and differential in newborns achieved by the haematology analyser CELL-DYN 3500

The dilution evaluation as a corrective measure for interference in the white blood cell scattergram in Beckman Coulter DxH 900

BACKGROUND

The Beckman Coulter DxH 900 is a haematological analyser capable of counting and sizing blood cells, and obtaining a complete blood cell count (CBC). This analyses different parameters of red blood cells (RBC), platelets and white blood cells/leukocytes. Some automated CBC counters present limitations due to specimen characteristics, abnormal cells or both factors. In the presence of abnormalities, the DxH 900 has a flagging system, warning the laboratory technician that something needs to be verified. In the present work, we evaluated samples from oncologic patients, presenting a population erroneously perceived as being lymphocytes. The most common explanations for this situation are RBC resistant to lysis or serum hyperbilirubinaemia.

METHODS

In an attempt to solve and understand what the cause of this problem might be, we diluted our samples (1:3) and analysed the serum total bilirubin. To identify cells' abnormalities, the samples were also analysed by manual DLC counts. During the study, we also checked the different flags presented by the equipment.

RESULTS

The results evidenced that the major interference was due to RBC lysis resistance, corresponding to 94.7% of the cases, while hyperbilirubinaemia was only present in 73.4%. Besides, we determined that some samples with normal bilirubin levels also presented interference, suggesting that hyperbilirubinaemia was not the main cause of the error. The most recurrent flag observed was "High event rate".

CONCLUSION

The dilution solved all of the observed interferences. The results between diluted and manual counts showed a strong correlation, leading us to introduce dilution in our laboratory routine.

Hematologic Values in Healthy and Small for Gestational Age Newborns

Many of the published reports of reference values in neonates are found in older medical literature. Recognition of abnormalities in blood cell morphology and hematologic parameters depend on well-established normative data; it is essential that each neonatal medical unit have its own reference ranges. We give the umbilical cord blood complete blood count reference values from 142 healthy, appropriate for gestational age (AGA) newborns and 58 small for gestational age (SGA) newborns (term and preterm). Our data, obtained by automated blood cell counter analysis of umbilical cord blood samples taken at birth, are comparable to other previously published data. The correlation between previous data and our reference data confirms that in term AGA newborns, values for red blood cells, hemoglobin, and hematocrit are higher and mean corpuscular volume values lower than in preterm AGA newborns. Also, we found that platelet levels are reduced in SGA newborns, in accordance with the literature. These findings further support the fact that preterm SGA infants are truly growth restricted, whereas term SGA infants are most likely small but otherwise healthy babies.

Comparison of total nucleated cell measurements of UC blood samples using two hematology analyzers

BACKGROUND

The total nucleated cell (TNC) content of umbilical cord blood (UCB) units currently serves as the most important measure for determining suitability for transplantation. Hence it is important that TNC measurements are performed in an accurate manner. TNC content is evaluated routinely by hematology analyzers (HA) as WBC counts. The objective of the study was to compare TNC content utilizing two different HA, one utilizing an impedance channel and optical channel, and the other using only an optical channel.

METHODS

The HA utilized in this study used two different modes of operation for lysis, regular mode (RM) and extended lysis mode (ELM). Cell-Dyn 3200 (CD3.2) utilizes optical technology for WBC measurements, involving WBC optical count (WOC) and nuclear optical count (NOC), whereas the Cell-Dyn 3700 (CD3.7) utilizes both the impedance (WIC) and optical technology (WOC) for WBC measurements. TNC content was determined with 17 identical samples using CD3.2 in one laboratory and CD3.7 in the other laboratory. Cord blood samples processed to concentrate nucleated cells by either of the laboratories were sent by overnight courier and assays were performed on the same day by both laboratories.

RESULTS

For CD3.7, the WOC values were consistently lower than the WIC using the regular mode, but showed no significant differences (P>0.05). The WIC and WOC values were comparable on using the ELM and RM. For CD3.2, WOC values using RM and NOC values using ELM showed no significant differences (P>0.05), even though the WOC measurement was lower than the NOC values for most samples. The best comparison of TNC measurement between the two HA could be achieved by comparing CD3.7-WIC with CD3.2-NOC values. The results were equivalent (P>0.05) and 12 of 17 samples had equal to or less than 10% difference (mean 9.5%).

DISCUSSION

TNC measurements of UCB samples were essentially identical using the WIC channel of the Cell-Dyn 3700 and the NOC channel of the Cell-Dyn 3200.

The NMR-derived solution structure of a new cationic antimicrobial peptide from the skin secretion of the anuran Hyla punctata

Amphibian skin secretions constitute an important source of molecules for antimicrobial drug research in order to combat the increasing resistance of pathogens to conventional antibiotics. Among the various types of substances secreted by the dermal granular amphibian glands, there is a wide range of peptides and proteins, often displaying potent antimicrobial activities and providing an effective defense system against parasite infection. In the present work, we report the NMR solution structure and the biological activity of a cationic 14-residue amphiphilic alpha-helical polypeptide named Hylaseptin P1 (HSP1), isolated from the skin secretion of the hylid frog Hyla punctata. The peptide antimicrobial activity was verified against Candida albicans, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa, whereas no significant lytic effect was detected toward red or white blood cells.

Reticulocyte analysis by flow cytometry and other techniques

Enumeration of peripheral blood reticulocytes is an essential part of the diagnosis and management of anemic patients, since the number of reticulocytes in the peripheral blood reflects the erythrocytic activity of the bone marrow. Reticulocyte enumeration using flow cytometric methodology is rapidly replacing the inaccurate, imprecise manual counting technique used in the past. This article explores the pathophysiology of the reticulocyte, the various means of counting reticulocytes, and the diverse clinical applications of reticulocyte data.

Malaria diagnosis with the haematology analyser Cell-Dyn 3500: What does the instrument detect?

The Cell-Dyn 3500 instrument could become a sensitive and specific tool in the diagnosis of malaria. The instrument appears to detect malaria-pigment within monocytes and granulocytes. A case of P. vivax malaria in a patient with increased osmotically resistant erythrocytes illustrates the potential of the instrument to detect intraerythrocytic parasites with pigment. However, in most malaria-patients with normal red cell osmotic resistance the observed phenomena seem rather to represent intraleukocytic pigment. This can remain in the circulation of clinically and parasitologically cured individuals and thus may not indicate acute infection. While the instrument can indicate those patients who have been infected a diagnosis of acute malaria must be established independently.