automated blood cell analyzer(510712)
TRANSCRIPT
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Automated Blood Cell Analyzer
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History• - 22172417First period ( BE) - M MMMMMMM
MMMMMMMMMM M MMMMM MMMMM MMMMM ,• - (2418 2495 ) - Manual CBC introduced• - (2496 2529 ) - MMMMM MMMMM MMMMMMMMMM• -Fourth period (2 5 3 0 present) - Advanced a
utomation introduced• MMMMMMMM MMM MMM() - M MM MMMMMMM MMMM MMMMMMMM
gy
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Major principles
1. Electrical impedance2. Light scattering
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Electrical Impedance
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Light Scattering
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Parameters generated from Automated Blood Analyzers
• Hb• Hct• RBC count• MCV• MCH• MCHC• CHCM• HDW
• Total WBC count• WBC Diff count• Plt count• PDW• MPV• Reticulocyte count
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Hemoglobin conc entration (Hb)
Techniques 1. Cyanmethemoglobin method
- 2. High angle light scattering method
MMMMMMMMMMM Evaluate anaemic status
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RBC countTechniques
1. Electrical impedance 2. Light scattering
Applications 1. Evaluate anaemic stutus 2. Evaluate polycythemic status
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Mean Corpuscular Volume (MCV)
Techniques 1. Electrical impedance : Height of MMMMM MMMMMMMMMM--M M MMM MMMMM M MMMMMMMMMMMM - -2 23. Light scattering : Low angle ( o ) -- l i ght scat t er i ng >Mean si ze MMMMMMMMMMMM 3. Calulation : MMM 10x RBCApplications Evaluate hypochromic microcytic anaemia
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Hematocrit (Hct)
Techniques 1. Calculation : MMM M MMM
2. Directly obtained : Mean pulse
Applications Evaluate anaemic and polycythemic
statuses
10
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Mean Corpuscular Haemoglobin (MCH)
Techniques Calculation : Hb 10 MMM
-Application (NR 29.5+/ 2.5pg) Evaluate microcytic hypochromic MMMMMMM
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Mean Corpuscular Haemoglobin Concentration (MCHC)
Technique Calculation : Hb 100 Hct
Application - (NR 33+/ 1.5 g/dl) Evaluate dehydration state of RBC High in HS
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Corpuscular Haemoglobin Conce ntration Mean (CHCM)
Technique Directly obtained (Only from light scattering) : High-angle (5-15o) light scattering
Application (NR ?) Still to be determined
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Haemoglobin Distribution Width (HDW)
Technique - SD of Hb concentration distribution h
istogram - Only obtained from Laser technology
3Application (NR < g/dl) - - Determine Hb content heterogeniety - Evaluate dehydration state of RBC
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Red Cell Distribution Width (RDW)
Techniques Calculation
- RDW CV = SD 100x MCV -RDW SD = SD of RBC histogram
-Application (NR 12.8 +/ 1.2%)- Determine anisocytosis- Evaluate hypochromic microcytic anaemia
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Total WBC count
Techniques 1. Eletrical impedance : No of pulse MMMMMMMMMM 2 . :Light scattering No of signal from MMM -MMMMM MMMMM MMMMMMMMMMApplications MMMMMMMMMM MM MMMMMMMMMM MMM MMMMMMM
MMMMM
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WBC differential count
Techniques 1. By volume 2 . + +By volume conductivity light MMMMMMMMMM 3 . +By light scattering cytochemistry 4 . +By light scattering RF impedanceTypes - - - -3 5 6 7part, part, part, part
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- Three part diff histogram
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- Five part diff histogram
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- Six part diff histogram
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Mean Peroxidase Activity Index (MPXI)
• - Derived by cytochemistry based technique (Technicon)
• MMMMMMMMMM MMM MM MMMM, ,ctions
• MMMMMMMM MM MMMMM MMMMMMMMM
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Platelet count
Techniques 1. Electrical impedance : Volume c
- -ut off at 2fl 20fl - 2. Light scattering : High angle ligh
t scattering for size and Hb contentApplication Evaluation of thrombocytosis and t
hrombocytopenia
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Platelet histogram
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Platelet Distribution Width (PDW)
Techniques Calculation PDW-CV = SD x 100 MPVApplication (NR < 20%)1. High : AA, MA, CML, on
chemotherapy2. Low : still in observations
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Mean Platelet Volume (MPV)
Techniques 1. Calculation : Mean volume of platele
M MM MMMMMM MMMMM 2 . :Calculation Mode of platelet volum
M distribution
- 9098Applications (NR . . fl) 1. High : ITP, Post splenectomy, DIC 2. Low : AA, MA, post chemotherapy
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MPV nomogram
MPV
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Reticulocyte count
Techniques1. Fluorescence detection of red cel
ls stained with RNA specific fluoroc hroms ( Auramine O, Ethidium bro
mide, Oxazine 750, Thiazole orange)
2. Direct count via volume, light sc attering and opacity of cells
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Reticulocyte count
Types after fluorescence detection
1. Low Fluorescence Ratio (LFR): Most mature
2. Middle Fluorescence Ratio (MFR): mid mature
3. High Fluorescence Ratio (HFR): Most immature
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Reticulocyte count
Application (NR 0.5-2.5%) Evaluation of BM efficiency
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RBC maturation
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Maturation time of reticulocytes
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NRBC enumeration
• Stain DNA with fluorescence dye (polymethine) and measure for size and intensity by light scattering to differentiate NRBC from WBC (Sysmex XE-2100, Abbott CELL-DYN 4000, Abbott CELL-DYN Sapphire)
• Detect NRBC under lymphocyte region in WBC volume/scatter plot and count NRBC by extrapolation of low-volume peak of WBC distribution curve (Beckman Coulter LH750)
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MMM M MMMMM MMMM MMMMM MMMMMMMMMMM T oday Market
• MMMMMMM-MMMMMMM MMMMMM MMMM, LHM M MMM• Sysmex : EI + LS + MM MMMMMMMMM• Abbott CELL-DYN : EI + LM + MAPSS
(Multi Angle Polarized Scatter Separation) + Fluorescence staining
• Bayer Advia : LS + Cytochem
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1. ธานิ�นิทร์ อิ�นิทร์กำ าธร์ชั�ย (บร์ร์ณาธ�กำาร์ ) โลหิ�ตวิ�ทยาในิเวิชัปฏิ�บ�ต� . กำร์�งเทพ : บร์�ษั�ท บ ยอินิด์ เอินิเตอิร์ไพร์ซ์ จำ ากำ�ด์ , 2542.
2 8. Dacie JV, Lewis SM. Practical Haematology ( th edition). 1995London : Churchill Livingstone, .
3. Koepke JA. Practical Laboratory Hematology. New York : ,1991.
4 3. Turgeon ML. Clinical Hematology ( rd Edition) : Theory and Procedures. 1999Philadelphia : Lippincott Williams & Wilkins ; A Wolters Kluwer Company, .
5 2. Hall R & Malia RG. Medical Laboratory Haematology ( nd Edition). - :, 1991.
6. นิวิพร์ร์ณ จำาร์�ร์�กำษั . กำร์ณ ศึ&กำษัาทางโลหิ�ตวิ�ทยา : กำาร์ตร์วิจำวิ�เคร์าะหิเล)อิด์ด์*วิยเคร์)+อิงอิ�ตโนิมั�ต�ท +ใชั*ปฎิ�กำ�ร์�ยาเคมั . กำร์�งเทพ : หิจำกำ โร์งพ�มัพชัวินิพ�มัพ 2540, .
7. นิวิพร์ร์ณ จำาร์�ร์�กำษั . เคร์)+อิงวิ�เคร์าะหิเมั.ด์เล)อิด์อิ�ตโนิมั�ต� : เทคโนิโลย แหิ0งป1จำจำ�บ�นิและอินิาคต . วิาร์สาร์โลหิ�ตวิ�ทยาและเวิชัศึาสตร์บร์�กำาร์โลหิ�ต -2545 12 309329; : .
References