Coulter S-Plus Research Articles

The properties of Albizia ferruginea (Mimosaceae) stem bark aqueous extract on pro-inflammatory cytokines and hematological parameters among sub-chronic inflammation-induced rats

The present research was carried out to evaluate the properties of Albizia ferruginea aqueous stem bark extract (AFASBE) on the variation of some pro-inflammatory cytokines and haematological parameters during sub-chronic inflammation. Sub-chronic inflammation was induced in rats by the insertion of cotton pellets and then treated with AFASBE. Determination of the concentrations of TNF-α, IL-1β, IL-6 and INF-γ was carried out by the ELISA technique “Enzyme Linked Immuno Sorbent Assay” using the Quantikines kits (France). Haematological parameters were quantified using the Coulter S-Plus IV/D. The levels of TNF-α, IL-1β, IL-6 and INF-γ significantly (p

The properties of Albizia ferruginea (Mimosaceae) stem bark aqueous extract on pro-inflammatory cytokines and hematological parameters among sub-chronic inflammation-induced rats

The present research was carried out to evaluate the effects of Albizia ferruginea aqueous stem bark extract (AFASBE) on the variation of some pro-inflammatory cytokines and haematological parameters during sub-chronic inflammation. Sub-chronic inflammation was induced in rats by the insertion of cotton pellets and then treated with AFASBE. Determination of the concentrations of TNF-α, IL1-β, IL-6 and INF-γ was carried out by the ELISA technique “Enzyme Linked Immuno Sorbent Assay” using the Quantikines kits (France). Haematological parameters were quantified using the Coulter S-Plus IV/D. The levels of TNF-α, IL-1β, IL-6 and INF-γ significantly (p

Hemoglobin and hip fracture risk in older non-Hispanic white adults

The relationship between hemoglobin and hip fracture was examined in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III). Both low and high hemoglobin values were associated with increased hip fracture risk before and after adjusting for selected risk factors. The few studies to date that have examined the relationship between hemoglobin and fracture risk have focused on low hemoglobin values. The present study examined hip fracture risk across the hemoglobin distribution in older non-Hispanic white adults from the third National Health and Nutrition Examination Survey (NHANES III, 1988-1994). Hemoglobin was measured using a Coulter S-plus Jr.® (Coulter Electronics, Hialeah, FL) in 2,122 non-Hispanic whites age 65 years and older. Hip fracture cases were identified using linked Medicare and mortality records obtained through 2007. Cox proportional hazards models were used to assess the best-fitting model and to estimate the hazards ratio (HR) for hip fracture by hemoglobin decile before and after adjusting for selected confounders. There were 239 hip fracture cases in the analytic sample. The best fitting model was quadratic. When compared to values in the middle of the distribution, those with hemoglobin in the lowest and highest deciles had increased hip fracture risk (HRlowest decile = 2.96, 95 % confidence interval (CI) 1.44-6.08; HRhighest decile = 2.06, 95 % CI 1.09-3.92) after adjusting for age and sex. Both HRs remained significant after adjusting for additional confounders (HRlowest decile = 2.24, 95 % CI 1.09-3.92; HRhighest decile = 2.37, 95 % CI 1.35-4.16). Both low and high hemoglobin values were associated with increased hip fracture risk. The mechanism underlying the relationship is not clear, but there were some suggestions that it may differ for low versus high hemoglobin.

Analysis of leucocyte populations with the Coulter S-Plus STKR as a screening tool for haematological abnormalities

In two institutions at Rome and Florence we evaluated the clinical sensitivity of two Coulter STKR systems using the NCCLS standard H20-T for leucocyte differential count in a patient population with high prevalence of haematologic abnormalities. Reference ranges of normal leucocytes were obtained on 278 adult subjects. On a population of 455 patient specimens, 200 specimens (44%) were flagged by the STKR because of a distributional abnormality, and 122 (27%) because of a morphological abnormality. Percentage of subtotal agreements between the STKR and the reference manual differential count was 85.4%, with 67.5% full and 20.9% partial agreements. Eight specimens that showed a morphological abnormality with the reference manual differential count were classified as normal by the STKR, with a false normal rate of 6.6%. Analysis of the STKR performance for morphological abnormalities showed acceptable sensitivity (82.0%) and rather low specificity (71.5%), low predictive value of positive results (51.3), high predictive value of negative results (91.5%) and efficiency of 74.3%. The main problems of the STKR differential count were a high rate of false monocyte count, and the misidentification of eosinophilias and low-concentration abnormal cells.

Complete Blood Count Reference Interval Diagrams Derived from NHANES III: Stratification by Age, Sex, and Race

Comprehensive, up-to-date "health-associated" reference interval studies of North American populations are uncommon. The third US National Health and Nutrition Examination Survey (NHANES III) was concluded in 1994 and yielded important reference interval data. To obtain health-associated Coulter counter reference interval data from NHANES III according to age, sex, and race. Of the 29,314 civilian noninstitutionalized US citizens who participated in NHANES III, approximately 25,000 had a complete blood count, red cell distribution width (RDW), platelet count, and automated white blood cell (WBC) differential determined on a Coulter S-Plus Jr. To determine health-associated reference intervals, we used the following exclusion criteria: pregnancy, breast feeding, obesity (body mass index [BMI] >40 and >35 for females and males, respectively), diastolic blood pressure >100 mm Hg, any smoking, any drinking of alcohol, recent treatment for anemia, creatinine level >2.5 mg/dL, glucose level >126 mg/dL, excessive thinness (BMI <8), recent surgery or hospitalization, or having antibodies to hepatitis viruses A, B, or C. The Coulter counter data (hemoglobin, hematocrit, red blood cell count, mean corpuscular volume (MCV), mean cell hemoglobin concentration (MCHC), MCH, WBC count, platelet count, granulocyte count, monocyte count, lymphocyte count, RDW, platelet distribution width, and mean platelet volume) were separated into 6 sex/racial categories (female non-Hispanic white, female non-Hispanic black, female Mexican American, male non-Hispanic white, male non-Hispanic black, and male Mexican American) and 9 age groupings (10-14, 14-18, 18-25, 25-35, 35-45, 45-55, 55-65, 65-75, and >75 years). There was a high exclusion rate; for example, of the 20,685 individuals with measured hemoglobin levels, 12,688 (61.3%) were excluded. Percentile estimates could be derived accurately for almost all of the female age/sex categories. A few of the male Mexican American and non-Hispanic black categories contained observations for ages 45 to 75 years. There are age-dependent trends for many of the tests, notably in RDW, MCMV, platelet count, and granulocyte and lymphocyte percentages. Sex-dependent changes involved hemoglobin values, and race-related trends centered around mononuclear and lymphocyte percentages, hematocrit, MCHC, MCH, and hemoglobin. This study reveals the potential for using data mining of large samples to yield potentially useful reference ranges.

Determination of the kinetics of Na+/H+ exchange in platelets using the Coulter S-plus cell counter.

Cell swelling, as measured by electronic cell sizing, is a good indicator of the Na+/H+ exchange activation. In this study the kinetic properties of the Na+/H+ exchanger were determined with the aid of the Coulter S-Plus VI D haematological cell counter. Cell swelling was measured in platelets suspended in Na-propionate medium. The rapid entry and intracellular dissociation of propionic acid induces activation of the exchanger, and in turn the uptake of water by osmosis. The fractional volume increase measured by the Coulter S-Plus was dependent on the external Na-concentration, with Km = 86 mmol/l. Saturation was reached at a propionate concentration of 140 mmol/l. Inhibition by amiloride was dose-dependent with Ki = 24 mumol/l. The activity of the exchanger was not modified by ouabain. These data are generally consistent with those published in previous reports, and indicate that automated haematological analysers are appropriate for the study of this aspect of platelet function.

Coulter Counter Identifies Cryptococcus neoformans as Leukocytes: A Case of Pseudopleocytosis

Cerebrospinal fluid from a 42-year-old man with acquired immune deficiency syndrome was processed in a Coulter S-plus counter and found to contain "4.8 x 10(9) leukocytes/L:56.1% granulocytes and 37.7% lymphocytes." Direct examination of the same specimen in a counting chamber revealed that the leukocytes were cells of Cryptococcus neoformans. Coulter analysis of cerebrospinal fluid may be inappropriate, particularly when yeast infection is a probable diagnosis.

Abnormalities of Leukocyte Histograms Resulting from Microorganisms

The authors report a series of 13 patients seen in their laboratory during October 1985 to August 1988 in which the presence of bacterial, fungal, or malarial parasites visible on peripheral smear was correlated with an abnormal leukocyte histogram. Samples submitted for complete blood count and differential counts were analyzed with Coulter S-Plus VI (seven specimens) or S-Plus STKR (six specimens) instrumentation. Organisms visualized on the Wright-stained peripheral smears included Histoplasma capsulatum (two), Candida sp. (four), Plasmodium sp. (three), and Staphylococcus sp. (four). Two patients had a diagnosis of acquired immune deficiency syndrome (AIDS); intravascular catheters were present in five other patients. In all cases the leukocyte histograms were abnormal. The instrument flagged abnormalities of the R1 region in four patients and multiple regions in nine patients. Similar flags were produced by the in vitro addition of bacteria or fungi to whole blood. These studies document that the presence of microorganisms in the peripheral blood can result in spurious white blood cell (WBC) counts or electronic differentials. The authors' findings indicate that the possibility of circulating organisms should be considered when abnormal WBC flags are detected with Coulter instrumentation.

Detection of a case of pseudolymphocytosis due to cryoglobulins

A new type of interference of cryoglobulins on hemocytometric tests is described. The precipitation of temperature-dependent proteins produced a pseudolymphocytosis on a three-part differential leukocyte count of Coulter S-Plus VI, whereas unaffected results, identical to the microscopical count, were obtained using the cytometer Coulter VCS. The laboratory detection of cryoglobulin interference on hematological data is very important in patients with underlying diseases, where the accuracy of absolute and differential leukocyte counts is critical for follow-up. Histograms from the Coulter S-Plus VI can help detect these cases.

Accurate quantitation of the low number of white cells in white cell‐depleted blood components

A simple method of accurate quantification of low concentrations of white cells (WBCs) in WBC-depleted blood components was developed by using propidium iodide (PI) to stain the nuclei of WBCs. The method was validated by correlating the PI-determined WBC concentrations with those determined with Coulter S-plus IV counter in units of packed red cells (PRBCs) or random-donor platelets (RDPs). The correlations were linear and had coefficients of 0.99. The sensitivity of PI staining permitted the detection of concentrations of WBCs as low as 1 cell per microL of RDPs or 11 cells per microL of PRBCs. Therefore, PI staining will be useful in investigating the role of transfused WBC-depleted blood components in the prevention of primary alloimmunization to HLA antigens, as well in evaluating various new procedures with high efficiency in depleting WBCs from blood components.

Laboratory Evaluation of Differential White Blood Cell Count Information from the Coulter S-Plus IV® and Technicon H-1® in Patient Populations Requiring Rapid “Turnaround” Time

Automated differential counts produced by the Coulter S-Plus IV (S + 4) and the Technicon H-1 (H-1) were compared with routine and reference manual differentials with the use of samples from the adult emergency room (ER) and the neonatal intensive care unit (NICU), populations in which rapid reporting of laboratory results is considered important. Error rates for routine technologists were 9.3% in the ER and 15.3% in the NICU. Error rates for the two instruments were higher than those for technologists with samples from the ER but could be reduced to 4-5% if instrument flags and additional criteria were used to signal the need for a conventional differential. Instrument error rates were higher yet with NICU samples, and specificity was very low (10% for each device). There were small differences between the instruments in detection of immature neutrophils, but flags from the H-1 were more specific (except for detection of nucleated red blood cells in samples from the ER). If either instrument were used in an adult ER and flags and additional criteria were used to signal the need for conventional differentials, 64-75% fewer manual counts would be performed with no decrease in accuracy and a considerable improvement in turnaround time.

A Multiparameter Automated Hematology Analyzer: The ELT-15

The performance of the Ortho ELT-15 hematology analyzer was evaluated in the high volume, computerized clinical hematology laboratory at M.D. Anderson Hospital and Tumor Institute, Houston, and compared with that of reference instrumentation currently in use for routine patient care, the Coulter S-Plus II. The within-run precision, linearity, and lack of carryover was excellent, and the day-to-day precision was acceptable for the entire range of tested parameters. Coefficients of correlation for these parameters were 0.99 or greater, with the exception of the mean corpuscular volume, where r = 0.95. Special emphasis was placed on the correlation study of white blood cells and platelets at low ranges. Correlation was extremely good (r = 0.97) for white blood cell counts less than 4.0 x 109 L (4.0 x 103/ μL) as well as for PLT counts (r = 0.93) less than 50 x 109/L (50 x 103/μL). These excellent performance characteristics for the complete blood cell parameters make the ELT-15 another superior advance over previous instrumentation in the field of automated hematology.

EDTA-dependent pseudothrombocytopaenia: a 12-month epidemiological study.

The phenomenon of in vitro platelet clumping and consequent pseudothrombocytopaenia in the presence of EDTA has been studied in 33,623 subjects referring to a general hospital in a 1-year period. The observed frequency was 0.13%. EDTA-dependent pseudothrombocytopaenia (PTP) was suspected when a routine blood counting by the Coulter S-Plus IV/D showed a peculiar leucocyte histogram and pseudoleucocytosis. Confirmation was obtained by the manual count and by the finding of platelet aggregates in a stained blood smear. EDTA-dependent PTP was diagnosed when the platelet number and the morphological examination of blood anticoagulated with sodium citrate from the same patient were normal. EDTA-dependent PTP was found in 23 subjects aged from 19 to 79 years (0.068% of the study population): 17 were patients suffering from miscellaneous diseases, while six were apparently healthy. As a rule, platelet clumping was evident within 60 minutes from blood collection, but a longer latency (2-3 h) was observed in a few cases. EDTA-dependent PTP is a rare, but misleading phenomenon, the recognition of which is important in order to avoid expensive and potentially harmful procedures.

Evaluation of the Coulter Counter S‐Plus VI

This article reports an evaluation of the Coulter Counter model S-Plus VI automatic analyser for haematology, and data are presented on linearity, carry-over, precision, accuracy and stability of the instrument, when compared with a model S-Plus IV/D. The three-part differential count provided by Coulter S-Plus VI has been compared with manual eye counting. The results show a good agreement with only 2.5% of discrepancies in 2271 routine samples. Advantages of the new instrument include: reduction of running costs, largely due to manpower saving; simple and easy use, and improved operator safety, there being no need for human contact with blood.

Evaluation of the Toa E-5000 Automated Hematology Analyzer.

A three-phase evaluation of the Toa E-5000 Automated Hematology Analyzer was performed. The first phase consisted of evaluation of linearity, carryover, precisions, accuracy, sample stability, and effectiveness of the mixing and sampling mechanism. The second phase was comparison of erythroid and platelet parameters with results from a Coulter Counter Model S-Plus IV. The third phase consisted of comparison of the trimodal leukocyte differential count of the Toa E-5000 in 300 patients with four other differential methods. The first-phase studies showed excellent performance characteristics. Stability of samples at room temperature was good for a minimum of 12 hours, but storage for longer than 12 hours requires refrigeration to maintain stable values. The erythrocyte and platelet parameters showed good correlation with the Coulter S-Plus IV values except for the erythrocyte distribution width that is calculated differently. The third-phase studies are published elsewhere.

Evaluation of the automated leukocyte differential count in emergency department patients

This study compares the results of the leukocyte three-part differential count as determined by the Coulter S-Plus IV in 104 consecutive patient samples from the emergency department with results obtained by conventional visual differential. A high rate (40%) of instrument rejection was found, reflecting the high prevalence of disease and hematologic abnormalities in the patient population. No clinically significant abnormality went undetected, demonstrating that the automatedleukocyte three-part differential is effective as a screening test in the emergency department patient population.

Hematologic parameters and leukocyte histogram patterns in infectious mononucleosis.

Blood samples from 60 patients with serologically positive infectious mononucleosis were analyzed on the Coulter S-Plus IV. Hemoglobins and platelet counts were essentially normal, and leukocyte counts were elevated in less than half the cases. Reactive lymphocytes were present on blood smears from all patients. The S-Plus IV automated three-part leukocyte differentials showed significantly lower numbers of lymphocytes and more mononuclears and granulocytes than manual microscopic differentials. On the leukocyte histograms, lymphocyte peaks were consistently wider than normal and asymmetrical. The instrument generated R2 flags on 43 of 60 (72%) of the samples. Using a combination of "R" flags, mononuclear backlighting, and "H" flags, the Coulter S-Plus IV identified 59 of 60 infectious mononucleosis samples as requiring further review.

Evaluation of the technicon H-1 hematology analyser

The Technicon H-1 is a new, random-access hematology instrument performing a full blood count with leukocyte differential including eosinophils and basophils. Technical assessment showed good linearity and precision. Comparison with a Coulter S-PLUS (II) showed close correlation for all full blood count parameters except MPV and MCHC on 149 unselected hospital inpatients over a wide clinical range. No significant carry-over was detected in hemoglobin, red cell, white cell and platelet estimations. Differentials agreed closely with Technicon H6000 results for neutrophils, lymphocytes, monocytes and eosinophils. Poorer correlation with 100-cell manual differentials for all cell types except neutrophils probably reflects the relative lack of precision in manual methods. Technological innovations on the H-1 include a laser-based optical system from which several new hematological parameters are derived. The contribution they make towards improved patient care awaits assessment.

Evaluation of the Coulter S-Plus V three-part differential in a community hospital, including criteria for its use.

The Coulter S-Plus V three-part differential was evaluated for its precision, correlation with 100-cell manual differentials, ability to process routine specimens without flagging, and ability to detect abnormalities as defined by manual differential. The instrument's precision is markedly greater than that of manual methods, especially in the mononuclear category. Correlation with manual differential lymphocyte, mononuclear, and granulocyte percentages was 0.91, 0.54, and 0.94, respectively. Eighty-four percent of routine samples could be processed by the instrument without further review. With the use of a combination of S-Plus V-generated flags and preset laboratory criteria, only 9% of abnormal manual differentials would have been undetected. Three-fourths of these undetected cases involved low-frequency abnormalities of questionable clinical significance. The three-part differential should be able to decrease the number of manual differentials that are performed, which would result in a cost savings to the laboratory.

Evaluation of the Sysmex CC-800. An automated eight-parameter hematology instrument.

An evaluation of the Sysmex CC-800 hematology analyzer (TOA Medical Electronics, Kobe, Japan, and distributed by American Scientific Products, Chicago, IL) was performed at University Hospital at Boston University Medical Center to assess the analytic performance and ease of use of the instrument. The Sysmex CC-800 is the first self-contained, fully automated, eight-parameter hematology analyzer. It can handle as many as 100 whole blood specimens without constant operator intervention. Stat and predilute modes are also available. The optional PDA-410 (particle distribution analyzer) was not evaluated in this study. Precision, linearity, carryover, and reproducibility of values over time in the automode were well within the manufacturer's specifications. The correlation study was performed with the existing Coulter S-Plus (Coulter Electronics, Hialeah, FL). The Sysmex CC-800 allowed us to expand the linear range without dilution for white blood cells to 160 X 10(3)/microL, hemoglobin to 26 g/dL, and platelets to 2,000 X 10(3)/microL. The samples on the automode exposed to normal laboratory atmosphere for up to 120 minutes showed no significant difference from baseline. The two instruments correlated well (r greater than 0.99). The authors concluded that the Sysmex CC-800 would be a reliable and time saving instrument in their laboratory.