The routine haematology laboratory of the future

Abstract

Flow Cytometry has now been successfully incorporated into automated blood cell counters to allow routine reporting of five cell differentials of up to 100 samples per hour. Sophisticated flagging of abnormal red cell, platelet and white cell parameters will reduce film inspection to under 10% of the total peripheral blood counts. Using the flow cytometer a routine reticulocyte count could also be incorporated into the standard print out. Reticulocyte RNA is stained with thiazole orange and according to staining intensity reticulocyte maturation indexes could be produced which may enable prediction of recovery from aplastic events. As well as the standard lymphocyte count, lymphocyte subset analysis particularly of T4 and T8 counts can also be incorporated into a routine report. This will become an increasing necessity for monitoring chronic viral diseases such as HIV positive conditions. Further subset analysis of the T8 lymphocyte populations including division of the T8 population into cytotoxic killer cells/suppressor cells can also be performed by using specific labelled monoclonal antibodies. For diagnostic investigation of haemotological malignancies in both peripheral blood and bone marrow samples several additional fluorescent monoclonal antibodies can be used in the flow cytometer as appropriate. This will also allow monitoring of response to intensive treatment. For the investigation of thrombocytopenia or neutropenia cell bound associated immunoglobulin can be quantified by a labelling index and specific cell fluorescence. Thus immune meditated thrombocytopenia and neutropenia can be rapidly diagnosed and the response to treatment monitored. All these applications should be possible by the end of the decade with a single automated blood cell counter incorporating versatile flow cytometry.