Automated Blood Count Research Articles

Authors' comments on: The platelet volume in patients with cardiac syndrome X

Dear Editor, We would like to thank Varol et al. (1) for their kind interest regarding our article. They indicated that a two-hour delay after blood sampling can cause abnormal mean platelet volume measurement results and that platelets exhibit time-dependent swelling when blood samples are collected in ethylenediaminetetraacetic acid We are in agreement on these issues; however, we did not wait two hours before analyzing the MPV measurements. As mentioned in the Methods section of our study, we gained vascular access via venipuncture prior to coronary angiography. We then waited two hours to allow for the stabilization of platelet shape changes. Finally, the blood was collected in tripotassium EDTA tubes; all of the samples from all of the groups were analyzed immediately using an automatic blood counter.

Chronic Lymphocytic Leukemia

Mohammed Shanshal, MD, and Rami Y. Haddad, MD, FACP hronic lymphocytic leukemia [chronic lymphoid leukemia (CLL)] is a onoclonal disorder characterized by a progressive accumulation of unctionally incompetent lymphocytes. The most characteristic feature of LL is a peripheral blood absolute lymphocytosis ( 5.0 10/L, but sually 15.0 10/L and sometimes 100.0 10/L). It is the most common form of leukemia (Table 1) found in adults in estern countries, accounting for approximately 30% of all leukemias in he USA. The proportion of cases diagnosed with the early stages of the isease [Rai Stage 0 (Table 2)] has risen from 10% to 50%, probably ecause of earlier diagnosis (routine automated blood counts). This xpansion is the result of prolonged cell survival, despite a varied cell urnover. The affected lymphocytes are of B-cell lineage in 95% of cases that arry CD5, and the remaining cases involve T lymphocytes, representing distinct disorder. Onset is insidious, and it is not unusual for CLL to be discovered ncidentally after a blood cell count is performed for another reason. nlarged lymph nodes are the most common presenting symptom, but atients may present with a wide range of symptoms and signs. hemotherapy is not needed in CLL until patients become symptomtic or display evidence of rapid progression of disease. A variety of hemotherapy regimens are used in CLL. These may include nucleoide analogues, alkylating agents, and biologics, often in combination. llogeneic stem cell transplantation is the only known curative herapy.

Increase in Mean Platelet Volume in Patients With Myocardial Bridge

Myocardial bridge is associated with atherosclerosis altered in shear stress and endothelial dysfunction. Mean platelet volume (MPV), a determinant of platelet activation, is shown to be related with atherosclerosis and endothelial dysfunction. In this study, we aimed to evaluate platelet function assessed by MPV in patients with myocardial bridge. Forty-two patients with myocardial bridge in the left anterior descending artery (LAD) and 43 age- and gender-matched healthy participants were included in the study. Myocardial bridging was defined as an intramyocardial systolic compression or milking of a segment of an epicardial coronary artery on angiography. For the entire study population, MPV was measured using an automatic blood counter. The study population consisted of 42 patients with myocardial bridge (52.7 ± 10.2, 76.2% male) and 43 age- and sex-matched healthy control participants (52.1 ± 10.4, 74.4% male). Compared to the control group, MPV value was significantly higher in patients with myocardial bridge (8.9 ± 1.24 vs 8.3 ± 0.78; P = .01). Further, there were no significant differences between groups regarding hemoglobin level, platelet count, fasting blood glucose, and creatinine levels. Our study findings indicated that myocardial bridge is associated with elevated MPV values. Our results might partly explain the increased cardiovascular events in patients with myocardial bridge.

Evaluation of Peripheral Blood Smear for Myelodysplasia in Breast Cancer Patients who Received Adjuvant Antracycline.

Therapy-related myeloid neoplasms (t-MN) account for approximately 10% to 20% of all cases of AML (acute myeloid leukemia), MDS (myelodysplastic syndrome) and MDS/MPN (myelodysplastic syndrome/myeloproliferative neoplasms), MDS, and MDS/MPN. In our study, we evaluated peripheral blood smear samples and hemogram values in breast cancer patients who were receiving adjuvant anthracycline regimens and were in remission. A total of 78 patients receiving anthracycline-based adjuvant chemotherapy treatment from Kayseri Research and Training Hospital and Mersin State Hospital were enrolled in the study. Their adjuvant treatments had been completed at least 18 months prior to the study. Two patients complained of anemia (2.2%) (Hb<11 mg/dl), leukopenia was observed in seven patients (7.7%) (leukocytes<4000/ mm(3)), and thrombocytopenia was observed in four patients (4.4%) (PLT<150.000/mm(3)). In the blood smear samples, the following were observed: ovalomacrocytes (14%), macrocytes (37%), acanthocytes (1%), stomatocytes (12%), teardrops (12%), nucleated erythrocytes (1%), basophilic stippling (14%), and Howell-Jolly bodies (1%). Additionally, hypo-granulation (38%), Pelger-Huet abnormalities (26%), hypersegmentation (20%), immature granulocytes (8%), and blasts (6%) were observed. We also confirmed the presence of giant platelets (50%) and platelet hypogranulation (19%). According to the peripheral blood smear assessments in our study, we suggest that breast cancer patients should be evaluated for MDS in the early stages, starting from month 18, even if the automated blood counts are normal.

Leukoflow: Multiparameter extended white blood cell differentiation for routine analysis by flow cytometry

Differential white blood cell count (dWBC) is a frequently used diagnostic tool. For most patient samples an automated blood counter produces a five-part differential count. If this dWBC does not meet pre-set criteria, microscopic dWBC is performed. Microscopy is labor intensive and requires sustained training of technicians. Inter-observer variation and statistical variation are significant, due to limited numbers of cells counted. Flow cytometry is a candidate reference method for dWBC. Advantages are immunological definitions and large number of measured cells. Our goal was to replace (part of) the microscopic dWBC by a flow cytometric dWBC, that gives additional information on blasts, myeloid precursors, and lymphocyte subsets. We designed a cocktail of antibodies (CD4, CD14, CD34, CD16, CD56, CD19, CD45, CD138, CD3, and CD71) combined with a gating strategy and flow cytometric protocol for easy identification of leukocyte populations. This assay, called Leukoflow, requires low sample volume, has few manual handling steps, and a potential turn-around-time shorter than 2 h. We determine percentages and absolute concentrations of at least 13 different cell populations. For quantification of normoblasts a second flow cytometric staining was designed. We compared microscopic dWBC with that of the automated blood counter and Leukoflow for normal and abnormal blood samples. Leukoflow results correlate well with the automated blood counter for leukocytes, neutrophils, eosinophils, monocytes, and lymphocytes. Correlation with manual dWBC is lower. Blast counts reported by Leukoflow suffer less from inter-observer variation compared to manual dWBC. In addition to microscopic or cytometric dWBC-techniques T-lymphocytes, CD4-T-lymphocytes, B-lymphocytes, NK-cells, myeloid progenitors, plasma cells, and blasts are determined by Leukoflow. These populations give potential useful clinical information and are subject for future studies focusing on the additional clinical value. Leukoflow is a highly interesting and promising technique for clinical laboratories.

Multi-centric determination of reference ranges for automated blood counts1

Abstract The analysis of blood cell count including differential, is the most frequent laboratory test and has still essential diagnostic value in the diagnosis of primary or secondary diseases of the hematopoietic system. The interpretation is based on a comparison with age matched reference intervals, despite the fact that a comparison with the patients own preceding values allows a more precise statement. In the present study, blood counts and differential were performed in 1158 healthy males and females with an age ranging from 16 to 75 years were investigated using current hematology systems. The donors were examined by personnel physicians and those examining blood donors in transfusion medicine and in addition were asked via standardized questionnaire. The study resulted in reference ranges for the complete blood count, the differential blood count and reticulocytes. For several analytes, age-, gender- or analyzerspecific reference ranges were obtained. We found an age dependent decrease of the erythrocyte concentration and an increase for MCH and MCV as well as for basophils. These findings could be important for the diagnosis of diseases of the elderly like like myeloproliferative diseases (MPN) and myelodysplasias (MDS). Gender specific changes could be shown for the hemoglobulin-, the erythrocyte- and reticulocyte concentration, as well as for hematocrit and MCHC, being reduced in females. On the other hand, females showed significant higher levels for platelets and leukocytes, based on an increase of neutrophils and lymphocytes. The leukocytosis of smokers was confirmed for neutrophils and lymphocytes but lower than one could expect from recent studies. A multicentric study shows a broader distribution compared to unicentric data but this probably better reflects the reality and improves the applicability of the reference ranges.

Leukoflow: Multi-Parameter Extended White Blood Cell Differentiation for Routine Analysis by Flow Cytometry

AbstractAbstract 4724 IntroductionDifferential white blood cell count (dWBC) is an important and frequently used diagnostic tool in Hematology. Automated blood counters produce a five-part differential count. If the five-part differential count does not meet pre-set criteria, microscopic dWBC is performed. This morphological based dWBC is labour intensive and requires intensive and sustained training of technicians. In addition to inter-observer variation, the statistical variation is significant. Offering reliable round the clock service for dWBC can be a logistic challenge, in particular in samples from patients with haematological disease.Flowcytometry is a candidate reference method for dWBC. It has several advantages over morphological identification such as immunological definition of cell populations and high number of measured cells. Our goal was to develop a flowcytometric dWBC, called Leukoflow, which is easy to perform in a single tube, can be interpreted rapidly and can be available in a 24h/7d laboratory setting with a short turn around time. MethodWe selected 100 normal and 100 abnormal EDTA blood samples based on the data of the automated blood counter (LH750, Beckman Coulter) and the CLSI H20-A2 criteria. For flowcytometric dWBC, 20 ul EDTA blood is stained with an antibody cocktail (CD4, CD14, CD34, CD16, CD56, CD19, CD45, CD138, CD3 and CD71). Erythrocytes were lysed with ammonium chloride. Flowcount beads were added to determine the absolute concentrations of the cell populations in addition to their percentages. Flowcytometric analysis was performed using five channels on a FC500 (Beckman-Coulter). Using sequential gating, 13 cell populations were defined. For comparison, two independent technicians each counted 200 white blood cells. The data from Leukoflow are compared with the automated blood cell counter and the average from the two microscopical dWBCs. ResultsLeukoflow results correlate very well with both the automated blood cell counter and microscopic differentiation for leukocyte count as well as five-part differentiation. This applies for both normal and abnormal samples. Even without the use of positive markers for basophils or eosinophils, we could successfully define these populations by subtracting other positively defined populations in the regions where basophils and eosinophils are found in the CD45 SS staining.Table 1:Cell class:Normal blood samplesAbnormal blood samplesCellcounter/flowMicroscope/flowCell counter/flowMicroscope/flowLeukocytes abs.0,98Not applicable0,99Not applicableNeutrophils %0,990,920,990,98Lymfocytes %0,990,910,990,95Monocytes %0,950,630,970,95Eosinophils %0,980,840,990,99Basophils %0,780,630,670,74Reproducibility experiments showed that Leukoflow differentiation performed better than both traditional dWBC techniques. For all populations, except the myeloid progenitors, the coefficients of variation (CV%) of Leukoflow were less than 5%. Myeloid left-shift is detected earlier by Leukoflow in the abnormal samples. Furthermore blast counts reported by Leukoflow suffer less from inter-observer variation compared to manual dWBC, and proved to be more relevant and fitting to the clinical diagnosis. The correlation for erytroblasts between an additional flowcytometric CD45 and DRAQ5 based staining, and microscopy was excellent (r=0,96). In addition to traditional dWBC-techniques, extra cell populations are determined by Leukoflow: T-lymphocytes, CD4-lymphocytes, B-lymphocytes, NK cells, myeloid progenitors, plasma cells and blasts. When blasts are present, the Leukoflow analysis also indicates if they are from B-cell (surface CD19) or T-cell (surface CD3) origin. ConclusionAccurate dWBC can be performed with Leukoflow. The assay requires a small amount of blood and can be performed round the clock. The additional cell populations determined by Leukoflow enable faster diagnosis and give useful clinical information. The large number of cells analysed, compared with standard dWBC techniques, favors detection of rare cell populations. Preliminary data revealed that Leukoflow can also be used for analysis of bone marrow samples. Ongoing studies are focussing on the additional clinical value of Leukoflow over traditional dWBCs. Leukoflow is a highly interesting technique to screen blood samples from patients with haematological diseases in clinical haematology laboratories. Disclosures:No relevant conflicts of interest to declare.

Gegenwärtige Modelle der Thrombozytopoese

Platelets are essential corpuscular blood components required for hemostasis. They are released from precursor cells in the bone marrow by cellular fragmentation into the blood stream. Although some aspects of platelet biogenesis are well known, studying its occurrence in vivo has been mostly unsatisfactory. This article reviews some recent findings: It first introduces current models of thrombopoiesis including open questions on cell biology. Second, it presents current findings on the release of megakaryocytes over the endothelial barrier into the blood stream where platelet production takes place outside the bone marrow. Finally, it reports on the translation of the more basic science into an improved understanding of novel parameters from automated blood counters surveying platelet volume (MPV), distribution width (PDW), mass (PCT) and the immature platelet fraction (IPF) into clinics where platelet counts are often the only accessible parameter to evaluate the risk of bleeding. Combining the comprehension of these parameters with a more refined image of how and where platelets are born might help find the cause and best therapy when platelet counts are low.

Neutrophil dysplasia demonstrated on Sudan black B staining

Since the advent of immunophenotyping, cytochemical stains are much less used in the investigation of acute leukemia and the myelodysplastic syndromes. However, they remain of value for the identification of Auer rods, the recognition of myeloid differentiation in mixed phenotype acute leukemia, and the demonstration of dysplastic features in maturing cells. This blood film, stained with Sudan black B (SBB), is from a patient with acute myeloid leukemia that was preceded by chronic myelomonocytic leukemia. A proportion of the blast cells were strongly SBB-positive but many of the neutrophils and neutrophil band forms had only scanty SBB-positive granules or were completely agranular (three shown), thus providing evidence of dysplastic granulopoiesis. A myeloperoxidase (MPO) stain would show a similar staining pattern since MPO activity and SBB give parallel results. Dysplastic neutrophils may lack MPO protein and therefore MPO activity or may have a defective protein that lacks enzymatic activity. A lack of enzymatic activity can be detected not only by cytochemical stains for MPO or SBB but also by the use of automated blood counters that incorporate an MPO reaction. Sometimes, such automated instruments show two clusters of neutrophils, with normal and abnormal activity, respectively, while in other patients, the cluster is much more dispersed than normal.

Die Bestimmung der Retikulozytenzahl: Eine alte Methode gewinnt neue Bedeutung

In clinical practice, the reticulocyte count is the most useful method to estimate red cell life span and red cell production. However, experience of hematologists as well as surveys have shown that counting of reticulocytes is often neglected in the diagnostic work-up of unclassified anemias, and many physicians have difficulties in interpreting the results. Formerly, this was partly due to the low precision of manual counts. Today, this method is largely replaced by flow cytometry, available in almost all larger systems for automated blood count analysis, at low costs and sufficient analytic precision. Interpretation is supported by calculated parameters such as the Reticulocyte Production Index. Here, the authors discuss the limits of the analytic methods and the problems of interpretation in the context of the laboratory profile and the clinical setting.

The May-Hegglin anomaly in a kidney transplant recipient.

We report a 37-year-old renal transplanted patient with thrombocytopaenia. He had May–Hegglin anomaly (MHA) inherited from his father, who died due to myocardial infarction subsequent to two renal transplantations. At the age of 15 years, proteinuria was found, but he was not biopsied. In 1982, he underwent splenectomy because of trauma. In 1989, when he was 17, renal function was found to be decreased. Five years later, he started haemodialysis and at 24 years he underwent live related kidney transplantation. Serum creatinine was always found stable around 1.9 mg/dl on cyclosporine, azathioprine and steroids. Automated blood count reported a number of platelets around 8000/μl with a mean volume of 20.3 fl (normal range 7.2– 11.1 fl). However, blood cell counters have a defined volume window for platelet counting and large macrothrombocytes are classified as red blood cells, meaning that platelet number is underestimated (Figure 1). The true value of platelets after count with the microscope was around 30 000/μl. He was completely asymptomatic, without any bleeding tendency. MHA is a rare autosomal dominant platelet disorder, characterized by macrothrombocytopaenia and granulocyte inclusion bodies. The mutation involves the MYH9 gene, localized in chromosome 22q, which encodes a heavy chain of non-muscle myosin IIA. MYH9-related hereditary macrothrombocytopaenia disorders include: MHA, Ebstein, Fechtner and Sebastian syndromes, which are characterized by nephritis, hearing loss and cataract [1]. In 1992, Nel et al. [2] reported two cases of MHA incidentally discovered in a patient and his brother during investigation for end-stage renal failure and workup for renal transplantation. Alhindawi and Al-Jbour [3] described an association between Epstein syndrome and chronic nephropathy. Recently, Singh et al. [4] suggested that MYH9 gene alterations are associated with a greater risk of focal segmental glomerulosclerosis and hypertensive nephrosclerosis in African Americans.

Assessment of Immature Platelet Fraction in Patients with Ph-Negative Myeloproliferative Disorders and Thrombocytosis.

Abstract 4980 BackgroundMyeloproliferative disorders (MPD) in general result from proliferation of a clone of myeloid cells derived from a neoplastic pluripotent precursor or from connective tissue elements in bone marrow. This leads to increased numbers in one or more blood cell lines in peripheral blood. Some MPDs can be associated with thrombocytosis (MPD-T): essential thrombocythaemia (ET), polycythaemia vera (PV) and early stages of chronic idiopathic myelofibrosis (CIMF). Usually in MPD-T the thrombocytosis is caused by increased platelet production from proliferating mature megakaryocytes, especially in ET. Elevated platelet counts in these patients are often associated with both thromboembolic events and bleeding. One of the goals of MPD treatment is the control of platelet count. Immature platelets mirror the platelet production in bone marrow. In certain automated blood count analyzers it is possible to measure Immature platelet fraction (IPF) from the routine CBC samples sent to haematology lab. Reference range for IPF parameter for method used in this study is 1,1-6,1%. ObjectiveMeasurement of IPF parameter by fully automated analyzer (XE-2100, Sysmex, Kobe, Japan) in optical channel and analyzing it ( software IPF Master) in patients treated for Ph-negative MPD. We enrolled 85 pts- 67 ET (79%), 10PV(12%) and 8 CIMF (9%) patients; 57 were women and 28 men; median age 56 years ranging from 20 up to 83 years. We analyzed and evaluated IPF in whole group as well as in subgroups depending on diagnosis, gender, age, JAK-2 mutation and platelet count. ResultsAt the time of assessment the majority of our pts were already commenced on treatment for their MPD. Platelet counts (plt) in whole cohort ranged from 164 up to 2148 ×109/l, with median 374 ×109/l. Thirty eight pts (45%) had plt < 350 ×109/l. Plt <450 ×109/l (WHO 2008 recommended cut off level for thrombocytosis) were found in 59 pts (69%). IPF median in whole cohort was 5,9% (0,7-14,4%). When comparing IPF in subgroups mentioned above statistically significant differences (p<0,05) was found only between subgroups with normal and abnormal plt counts: IPF median 7,45% (0,8-14,4%) resp. 4,6% (0,7-11,9%), (p=0,002) and between subgroups with less and more than 450×109/l plt (IPF median 6,6% (0,8-14,4%) resp. 3,85% (0,7-9,6%), (p<0,001). Fact, that patients with higher plt had lower IPF and vice versa, was confirmed also by Spearman correlation coefficient. When correlating results of plt a IPF in the whole cohort, we found the trend to indirect dependence (rs= –0,386). ConclusionsMPD-T patients in our cohort did not have marked elevation of IPF parameter, neither those with high platelet counts (so far untreated pts). Thus we can speculate, that increased number of Plts in peripheral blood is caused by increased number of mature megacaryocytes in bone marrow which produce adequate numbers of platelets without increase of immature fraction rather than increased number of immature platelets released from megacaryocytes appearing in normal numbers in bone marrow Thus it seems that negative feedback of increased Plt counts on releasing of Plts from megacaryocytes is maintained also in patients with MPD-T. Further assessment is needed and should further determine, what is the clinical relevance (if any) of measurement of IPF in patients treated for MPD-T. DisclosuresBlatny:Sysmex, Czech Republic: Consultancy.

O papel do RDW, da morfologia eritrocitária e de parâmetros plaquetários na diferenciação entre anemias microcíticas e hipocrômicas

As anemias microcíticas e hipocrômicas atingem grande parcela da população mundial. Entre estas, significativa porcentagem de casos se deve à deficiência do ferro, enquanto em algumas regiões a frequência de talassemia menor se torna importante. Por outro lado, a anemia de doença crônica é a causa mais comum de anemia em pacientes hospitalizados. O diagnóstico diferencial destas doenças é clinicamente importante, e é atualmente realizado através dos exames padrão ouro envolvendo a avaliação do metabolismo do ferro e dosagem de HbA2. Embora dotados de grande utilidade, estes testes podem apresentar uma metodologia mais demorada e onerosa que, em casos de concomitância de doenças, comuns na prática clínica, não conseguem proporcionar um correto diagnóstico. Na tentativa de otimizar e direcionar o diagnóstico destas anemias, o uso de alguns parâmetros derivados dos modernos contadores automáticos tem sido sugerido. Neste estudo, o papel do RDW, parâmetros plaquetários (número de plaquetas, PDW, VPM) e morfologia eritrocitária como parâmetros diferenciadores, foi avaliado em um grupo de 159 pacientes portadores de anemia microcítica e hipocrômica devido à deficiência do ferro, anemia de doença crônica e talassemia beta menor, comprovado pelos exames padrão ouro. Foi possível observar que o RDW não se mostrou um bom discriminante, enquanto o índice plaquetário PDW pode ser um parâmetro auxiliar no diagnóstico diferencial das anemias microcíticas e hipocrômicas. Com relação às alterações morfológicas dos eritrócitos, o pontilhado basófilo foi um achado bastante comum apenas em pacientes portadores de talassemia beta menor, com indícios de potencial utilidade na elucidação de casos de microcitose.

Age-Related Reference Intervals of the Main Biochemical and Hematological Parameters in C57BL/6J, 129SV/EV and C3H/HeJ Mouse Strains

BackgroundAlthough the mouse is the animal model most widely used to study the pathogenesis and treatment of human diseases, reference values for biochemical parameters are scanty or lacking for the most frequently used strains. We therefore evaluated these parameters in the C57BL/6J, 129SV/EV and C3H/HeJ mice.Methodology/Principal FindingsWe measured by dry chemistry 26 analytes relative to electrolyte balance, lipoprotein metabolism, and muscle/heart, liver, kidney and pancreas functions, and by automated blood counter 5 hematological parameters in 30 animals (15 male and 15 female) of each mouse strain at three age ranges: 1–2 months, 3–8 months and 9–12 months. Whole blood was collected from the retro-orbital sinus. We used quality control procedures to investigate analytical imprecision and inaccuracy. Reference values were calculated by non parametric methods (median and 2.5th and 97.5th percentiles). The Mann-Whitney and Kruskal-Wallis tests were used for between-group comparisons. Median levels of GLU, LDH, Chol and BUN were higher, and LPS, AST, ALP and CHE were lower in males than in females (p range: 0.05–0.001). Inter-strain differences were observed for: (1) GLU, t-Bil, K+, Ca++, PO4 − (p<0.05) and for TAG, Chol, AST, Fe++ (p<0.001) in 4–8 month-old animals; (2) for CK, Crea, Mg++, Na++, K+, Cl− (p<0.05) and BUN (p<0.001) in 2- and in 10–12 month-old mice; and (3) for WBC, RBC, HGB, HCT and PLT (p<0.05) during the 1 year life span.Conclusion/SignificanceOur results indicate that metabolic variations in C57BL/6J, 129SV/EV and C3H/HeJ mice after therapeutic intervention should be evaluated against gender- and age-dependent reference intervals.

An assessment of the Ortho ELT-8

The Ortho ELT-8 is an automated blood counter which appears to be safe, precise and free from carry-over. Red and white cell results generally agree with those on the Coulter Counter, Model S, though discrepancies were noted with the WBC and PCV. Reference methods showed the Model S WBC results tended to be inaccurate on the discrepant samples though neither instrument was predominantly responsible for the PCV discrepancies. The ELT-8 platelet count tended to be higher than with the Thrombocounter/Thrombofuge system. When packed cells were diluted in autologous plasma serious variations in the red cell indices (MCV, MCH & MCHC) were first found due to incorrect voltage-frequency converter setting. Even after this setting had been corrected some variations in the MCH and MCHC were still apparent. In the UK National External Quality Assessment Scheme the ELT-8 results on animal bloods did not agree with those produced by Model S users; this discrepancy probably being due to differences between the light-scattering and aperture-impedance technology.

Testing of calibration and quality control material used with automatic blood counting apparatus: application of the protocol devised by the British Committee for Standardization in Haematology.

Summary. In 1979 the British Committee for Standardization in Haematology published a draft protocol for assigning values to quality control materials used with automated blood counters. Work to test the draft protocol and refine the methodology is described in this paper. The protocol which was finally adopted was capable of very precisely assigning values to quality control materials.

Discriminant function using red cell indices to distinguish between HbC and HbE traits.

Values for MCV, MCH, MCHC and red cell distribution width (RDW) derived from subjects with HbC and HbE traits using a Technicon H*1 automated blood count analyser were compared. Significantly higher MCH, MCHC and RDW values were found in those with HbC trait. By use of a simple discriminant function (MCHC2 x RDW/1000), 19/20 subjects with HbC trait gave a value > or = 16.3, and 20/21 subjects with HbE trait gave a value < or = 16.2. The function described may be of value as an adjunct to electrophoresis in intralaboratory quality control.

Automated blood counts and identification of thalassemia carriers

Automated blood counts and identification of thalassemia carriers

Predictive value of discrimination indices in differential diagnosis of iron deficiency anemia and beta‐thalassemia trait

Iron deficiency anemia (IDA) and beta-thalassemia trait (B-TT) are the most common causes of hypochromic microcytic anemias. Many indices have been defined to quickly discriminate these similar entities via parameters obtained from automated blood count analyzers. The purpose of the study was to evaluate the predictive value of these indices in differential diagnosis of IDA and B-TT in adult cases. This study consists of 45 IDA cases, 36 women and nine men, whose mean age is 33.87 +/- 11.59 (mean +/- SD) (range 17-57 yr) and 66 B-TT cases, 41 women and 25 men, whose mean age is 33.26 +/- 13.36 (mean +/- SD) (range 14-74 yr). IDA cases with Hb value <8.7 g/dL have been excluded because these cases are not confused with B-TT cases in practice. Patient groups have been evaluated according to red blood cell (RBC), red blood cell distribution width (RDW), Mentzer index, Shine and Lal indices, England and Fraser indices, Srivastava index, Green and King indices, RDW index and Ricerca index. Sensitivity, specificity, positive and negative predictive values and Youden's index have been calculated. Finally, none of these different formulations are superior to RBC value obtained from automated analyzers in adult cases with IDA and B-TT. Total body iron status and hemoglobin A(2) level should be obtained for accurate differential diagnosis of IDA and B-TT until more efficient tools develop.

Clinicians′ response to red cell parameters on automated blood counts indicative of thalassemia trait

Clinicians′ response to red cell parameters on automated blood counts indicative of thalassemia trait