Reliability of Parameters of Complete Blood Count With Different Storage Conditions

Evaluation of two temperature storage conditions for full blood count samples from Lifeblood's donors

BACKGROUND AND OBJECTIVES

Lifeblood completes full blood count samples for selected donors to assess their suitability for future donations. Removing the current practice for refrigerated (2-8°C) storage and aligning with room temperature (20-24°C) storage of other donor blood samples would produce significant efficiencies in blood donor centres. This study aimed to compare full blood count results under two temperature conditions.

MATERIALS AND METHODS

Paired full blood count samples were collected from 250 whole blood or plasma donors. These were stored either refrigerated or room temperature for testing on arrival at the processing centre and the following day. The primary outcomes of interest included differences between mean cell volume, haematocrit, platelet count, white cell and differential counts, and the need to produce blood films, based on existing Lifeblood criteria.

RESULTS

A statistically significant (p < 0.05) difference for most full blood count parameters results was found between the two temperature conditions. The number of blood films required was similar under each temperature condition.

CONCLUSION

The clinical significance of the small numerical differences in results is considered minimal. Furthermore, the number of blood films required remained similar under either temperature condition. Given the significant reductions in time, processing and costs associated with room temperature over refrigerated processing, we recommend a further pilot study to monitor the broader impacts, with the intent to implement national storage of full blood count samples at room temperature within Lifeblood.

Investigating the effects of maltreatment and acute stress on the concordance of blood and DNA methylation methods of estimating immune cell proportions

BACKGROUND

Immune cell proportions can be used to detect pathophysiological states and are also critical covariates in genomic analyses. The complete blood count (CBC) is the most common method of immune cell proportion estimation, but immune cell proportions can also be estimated using whole-genome DNA methylation (DNAm). Although the concordance of CBC and DNAm estimations has been validated in various adult and clinical populations, less is known about the concordance of existing estimators among stress-exposed individuals. As early life adversity and acute psychosocial stress have both been associated with unique DNAm alterations, the concordance of CBC and DNAm immune cell proportion needs to be validated in various states of stress.

RESULTS

We report the correlation and concordance between CBC and DNAm estimates of immune cell proportions using the Illumina EPIC DNAm array within two unique studies: Study 1, a high-risk pediatric cohort of children oversampled for exposure to maltreatment (N = 365, age 8 to 14 years), and Study 2, a sample of young adults who have participated in an acute laboratory stressor with four pre- and post-stress measurements (N = 28, number of observations = 100). Comparing CBC and DNAm proportions across both studies, estimates of neutrophils (r = 0.948, p < 0.001), lymphocytes (r = 0.916, p < 0.001), and eosinophils (r = 0.933, p < 0.001) were highly correlated, while monocyte estimates were moderately correlated (r = 0.766, p < 0.001) and basophil estimates were weakly correlated (r = 0.189, p < 0.001). In Study 1, we observed significant deviations in raw values between the two approaches for some immune cell subtypes; however, the observed differences were not significantly predicted by exposure to child maltreatment. In Study 2, while significant changes in immune cell proportions were observed in response to acute psychosocial stress for both CBC and DNAm estimates, the observed changes were similar for both approaches.

CONCLUSIONS

Although significant differences in immune cell proportion estimates between CBC and DNAm exist, as well as stress-induced changes in immune cell proportions, neither child maltreatment nor acute psychosocial stress alters the concordance of CBC and DNAm estimation methods. These results suggest that the agreement between CBC and DNAm estimators of immune cell proportions is robust to exposure to child maltreatment and acute psychosocial stress.

Assessment of chicken peripheral blood mononuclear cells isolated from freshly drawn blood versus 24 h refrigerated blood

Background and Aim:

The peripheral blood mononuclear cell (PBMC) is an excellent cell source for in vitro studies, particularly those involving immunology. The aim of this study was to determine the quality and quantity of chicken PBMCs isolated from freshly drawn blood as well as blood that had been chilled for 24 h. In addition, the survival of PBMCs cultured in medium was investigated.

Materials and Methods:

Blood samples were collected from 12 Betong and 12 Leghorn chickens. Hemograms were analyzed. Density gradient centrifugation was used to isolate PBMCs. PBMCs (2×10⁶ cells/mL) were cultured in a culture medium and incubated in a CO₂ incubator for 5 consecutive days. The number of viable cells was determined using the trypan blue dye exclusion method.

Results:

Blood samples were obtained from healthy chickens. There was no statistically significant difference in the total amount of PBMC between fresh and refrigerated blood samples from both chicken breeds. The viability of PBMCs isolated from fresh blood (95%) was significantly greater than blood refrigerated for 24 h (90-92%) in both breeds. Furthermore, the viability of PBMCs isolated from both blood samples decreased significantly over time, from 90-95% to 60-65%.

Conclusion:

The total number of PBMC in fresh and refrigerated blood was not significantly different. Fresh blood-derived PBMCs had significantly higher viability than 24 h refrigerated blood PBMCs. Furthermore, the viability of PBMCs decreased significantly over time.

Effects of potential confounding variables on accuracy of a commercially available veterinary point-of-care hematocrit meter in the evaluation of blood samples from dogs and cats

OBJECTIVE

To assess the agreement in measurements of Hct values and hemoglobin (Hgb) concentrations in blood samples from dogs and cats between a commercially available veterinary point-of-care (POC) Hct meter and a laboratory-based (LAB) analyzer and to determine the effects of various conditions (ie, lipemia, hyperbilirubinemia, hemolysis, autoagglutination, and reticulocytosis) on the accuracy of the POC meter.

SAMPLES

Blood samples from 86 dogs and 18 cats.

PROCEDURES

Blood samples were run in duplicate on the POC meter, which reported Hgb concentration, measured via optical reflectance, and a calculated Hct value. The POC meter results were compared with results from a LAB analyzer. Blood samples with grossly visible lipemia, icterus, hemolysis, and autoagglutination were noted.

RESULTS

Mean ± SD values for LAB Hct were 33.9 ± 15.73% (range, 3.9% to 75.8%), and for LAB Hgb were 11.2 ± 5.4 g/dL (range, 1 to 24.6 g/dL). Mean bias between POC Hct and LAB Hct values was -1.8% with 95% limits of agreement (LOAs) of -11.1% to 7.5% and between POC Hgb and LAB Hgb concentrations was -0.5 g/dL with 95% LOAs of -3.8 to 2.8 g/dL. There was no influence of lipemia (14 samples), icterus (23), autoagglutination (14), hemolysis (12), or high reticulocyte count (15) on the accuracy of the POC meter. The POC meter was unable to read 13 blood samples; 9 had a LAB Hct ≤ 12%, and 4 had a LAB Hct concentration between 13% and 17%.

CONCLUSIONS AND CLINICAL RELEVANCE

Overall, measurements from the POC meter had good agreement with those from the LAB analyzer. However, LOAs were fairly wide, indicating that there may be clinically important differences between measurements from the POC meter and LAB analyzer.

The impact of different preanalytical methods related to CA 15-3 determination in frozen human blood samples: a systematic review

BACKGROUND

The determination of CA 15-3 is useful for monitoring breast cancer patients. Several retrospective studies determined CA 15-3 levels in frozen samples to evaluate the sensitivity and specificity of novel biomarkers in relation to breast cancer; however, freeze-thaw cycles, as well as preanalytical variables before sample storage, are not always reported. Here, we analyzed the current scientific literature to identify possible critical aspects related to CA 15-3 determination in frozen-stored human serum/plasma samples.

METHODS

We obtained data from 4 different bibliographic databases: Web of Science, Embase, PubMed, and Cochrane Library. We followed the PRISMA guidelines to screen and select the eligible articles discussed in the final revision.

RESULTS

Initially, 674 scientific papers were evaluated, and after the application of the screening and eligibility criteria, 18 studies were included in the qualitative synthesis. The analysis reported an important level of heterogeneity concerning the preanalytical phase before sample storage.

CONCLUSION

Although advances in healthcare have been achieved using certified workflows in medical diagnostics, standardized preanalytical processes are not always applied when referring to frozen-stored biosamples. Biobanks will guarantee the best possible conditions for the storage of human biological samples to be used in clinical research. The use of certified bioresources will favor the optimal development and introduction of new disease biomarkers.

Effects of storage time and temperature on highly multiparametric flow analysis of peripheral blood samples; implications for clinical trial samples

We sought to determine the effect of time and temperature of blood sample storage before preparation of human peripheral blood mononuclear cells (PBMCs) by Ficoll-hypaque density gradient centrifugation. Blood samples from healthy donors were stored at room temperature (RT) or refrigerated at 4°C before preparation of PBMCs. Cell yield and viability, and proportions of major cell populations within PBMCs, as determined by fluorescence flow cytometry, were assessed for both fresh and cryopreserved samples. Highly multiparametric mass cytometry was performed on cryopreserved PBMCs. We found that refrigeration had marked negative effects on subsequent PBMC yield. Storage at RT led to co-purification of low density neutrophils with PBMCs, but had no detectable effects on the proportions of multiple cell subsets including, but not limited to, monocytes, NK cells, B cells, Treg cells, and naïve, central memory and effector memory CD4⁺ and CD8⁺ T cells and CD45RA-positive terminal effector CD8⁺ T cells. Expression of a number of cell surface receptors, including CXCR5, CCR6, CXCR3 and TIGIT, but not CD247 was reduced after RT storage before PBMC preparation, and this effect correlated with the degree of low density neutrophil contamination. As such, when PBMC preparation cannot be undertaken immediately after blood draw, storage at RT is far superior to refrigeration. RT storage leads to neutrophil activation, but does not compromise measurement of PBMC subset distribution. However caution must be applied to interpretation of cytometric measurements of surface molecules such as chemokine receptors.

Stability of complete blood count parameters depends on the storage temperature, storage time, transport position and selected stability criterion

Purpose: To evaluate stability of CBC parameters in samples containing K₃-EDTA in Hema&Tube brand evacuated tubes stored at 4 °C and room temperature in upright, horizontal and upside-down transport positions for up to 240 min by comparing with different stability criteria. Methods: A total of 450 outpatient samples, 75 for each condition, were stored for 240 min. Blood samples were analyzed at baseline, 60th, 120th and 240th min of storage time using Sysmex® XT-4000i hematology analyzer. CBC results were compared according to the paired samples t-test, one CV% change, CVI, BV DES 2014, RCPA, IQMH, EFLM Biological Variation 2019, ESfEQAand CLIA stability criteria. Results: In all transport conditions, almost all CBC parameters were unstable according to the paired samples t-test. Based on one CV % change RBC, hemoglobin, hematocrit, RDW-CV, neutrophils, platelets, MPV, PDW and plateletcrit were unstable in some transport conditions. However, most parameters were stable at all conditions, except especially for MCH, MPV, PDW and plateletcrit, while just MPV and PDW were unstable at RT in all transport conditions according to the lower and higher CVI, respectively. Conclusions: Paired samples t-test and one CV% change stability criteria are not suitable for decision. Clinical laboratories should establish the impact of storage time, storage temperature and transport positions for each CBC parameter while paying attention to the brand of evacuated tube according to the lower CVI of biological variation data stability criteria since it is more related to the impact of analysis deviation on clinical decisions to prevent misdiagnosis.

Serum LPS Associated with Hantavirus and Dengue Disease Severity in Barbados

Hantavirus and dengue virus (DENV) infections are caused by RNA viruses which infect immune systems’ cells including monocytes, macrophages and dendritic cells and occur year-round in Barbados. A retrospective serological study (2008–2015) was conducted on hantavirus and dengue patient sera confirmed by IgM and IgG ELISA, NS1 and RT-PCR using Limulus amoebocyte lysate (LAL) kinetic turbidimetric method to determine serum endotoxin levels. Hantavirus patients were categorized into two groups, namely (a) hospitalized and (b) non-hospitalized. Dengue patients were categorized into 3 groups using 2009 WHO dengue guidelines (a) severe dengue (SD), (b) hospitalized non-severe dengue (non-SD) and (c) non-hospitalized non-SD. Statistical analyses were conducted to determine the association of endotoxin levels with hantavirus disease severity based on hospitalization and dengue disease severity. Serum endotoxin levels are associated with hantavirus disease severity and hospitalization and dengue disease severity (p < 0.01). Similar studies have found an association of serum endotoxin levels with dengue disease severity but never with hantavirus infection. Co-detection of hantavirus- and DENV-specific IgM in some patients were observed with elevated serum endotoxin levels. In addition, previous studies observed hantavirus replication in the gut of patients, gastrointestinal tract as a possible entry route of infection and evidence of microbial translocation and its impact on hantavirus disease severity. A significant correlation of serum endotoxin and hantavirus disease severity and hospitalization in hantavirus infected patients is reported for the first time ever. In addition, serum endotoxin levels correlated with dengue disease severity. This study adds further support to the role of endotoxin in both hantavirus and dengue virus infection and disease severity and its role as a possible therapeutic target for viral haemorrhagic fevers (VHFs).

Effect of time and storage on toxic or pseudo-toxic change in canine neutrophils

BACKGROUND

The presence of toxic change in neutrophils is frequently used as a biomarker of inflammation in dogs.

OBJECTIVE

We aimed to evaluate the effect of time and storage on toxic change in canine neutrophils.

METHODS

One hundred and fifty microliters of EDTA blood were obtained from eight dogs with no toxic neutrophil changes observed on fresh blood smears (T0). Blood was stored at room temperature (RT), in a box with an icepack (ICE), and at 4°C. For each storage condition, smears were prepared 2 (T2), 4 (T4), 8 (T8), and 24 (T24) hours post blood draw. Smears were randomized, and each smear was evaluated for the presence of toxic neutrophil change.

RESULTS

A statistically significant effect of time and storage on the presence of toxic neutrophil change was observed. Compared with T0, the number of neutrophils containing Döhle bodies was significantly higher at T8 and T24 for the RT (P < 0.0001) and ICE (P < 0.0001) samples and at T24 for 4°C samples (P < 0.0001). Additionally, smears were falsely classified as having 1+ toxic change in 0/8 (T2), 1/8 (T4), 3/8 (T8), and 8/8 (T24) for RT samples; 0/8 (T2 and T4), 2/8 (T8), and 5/7 (T24) smears for ICE samples; and 0/8 (T2, T4, and T8) and 2/8 (T24) for 4°C samples.

CONCLUSIONS

Smears can be falsely classified as having neutrophils with toxic change as early as 4 hours post blood draw in samples stored at RT, 8 hours when stored with icepacks, and 24 hours when stored at 4°C. Canine blood smears should be prepared and evaluated for toxic neutrophil change as early as possible.

No associations exists between red blood cell distribution width and serum uric acid in both sexes

The aim of this study was to determine whether there was a significant association between red blood cell distribution width (RDW) and uric acid (UA) in a large Chinese population.This was a cross-sectional study with an enrollment of 80,298 ostensibly healthy participants (48,971 males, 31,327 females) during the period from 2011 to 2015. In the study, database was grouped by sex and the association between RDW and UA was analyzed by quartiles of RDW.UA values between different sexes and RDW subgroups were analyzed by 2-way analysis of variance and Bonferroni t tests. Prevalence of hyperuricemia in different sexes was calculated. The relationship between risks of hyperuricemia and RDW level was analyzed by binary logistic regression with or without adjustment for age and body mass index.UA values were not all the same between different sexes and RDW subgroups. Males had significantly higher hyperuricemia prevalence than females (20.00% vs 6.48%, P < .01). In addition, hyperuricemia prevalence in males decreased slightly across RDW quartiles, but was stable in females. No significant association between hyperuricemia risk and RDW was found in both sexes according to the results of multivariate logistic regression analysis. Similarly, negative results were also observed in multivariate linear analysis when both RDW and UA were considered as continuous variable.We could not find any significant relationship between RDW and UA in both sexes.

Storage of blood samples at or above 33℃ leads to rapid appearance of appreciable systemic bias in platelet and mean corpuscular volume related parameters: an important pre-analytical factor in tropical conditions

There is scant documentation of the stability of common haematological parameters on storage of blood samples under tropical conditions. K₂EDTA samples in multiple vials were taken from 20 healthy blood donors, baseline readings taken, and stored at 33°C and 37°C. Readings from the stored vials were taken after 1, 3 and 6 h. The percent change against the baseline readings at each time point for each storage temperature was calculated. Platelet counts showed an unacceptable shift within 1 h at 37°C and 3 h at 33°C; red cell volume related parameters showed an unacceptable shift within 3 h at 37°C and 6 h at 33°C. Haemoglobin, red blood cell count, white blood cell count and mean corpuscular haemoglobin remained stable for 6 h at both temperatures. The unacceptable change for many parameters on storage at ≥33°C demonstrates the importance of ensuring pre-analytical control in regions experiencing such climatic conditions.

Storage stability of commonly used haematological parameters at 33 °C: Electronic supplementary material available online for this article

Introduction

This study aimed to investigate the analytical bias in haematological parameters induced by storage at 33 ºC.

Materials and methods

Blood from the diversion pouch of 20 blood donors were collected in K₂EDTA vials and stored at 33 ºC. Readings from each vial were taken at 0, 4, 6, 12, 24, 48 and 72 hours after collection on the Sysmex XP-100 analyser (Sysmex Corporation, Kobe, Japan). The percent difference from the baseline readings were calculated and subjected to a Wilcoxon signed rank test at a Holm corrected significance level of 0.05. A median percent difference, which was statistically significant and greater than the maximum acceptable bias (taken from studies of biological variation), was taken as evidence of unacceptable shift. If the median shift was lesser than the maximum acceptable bias, two one-sided Wilcoxon signed rank tests for equivalence were used to determine whether the percent differences were significantly lesser than the maximum acceptable bias.

Results

Haemoglobin, red blood cell count, white blood cell count, mean corpuscular haemoglobin and lymphocyte count showed acceptable bias after storage for at least 24 hours at 33 ºC. Haematocrit, mean corpuscular volume, mean corpuscular haemoglobin concentration, platelet count and mean platelet volume showed unacceptable shift in less than 4 hours when stored at 33 ºC.

Conclusions

Since many haematological parameters show unacceptable bias within 4 hours of sample storage at 33 ºC, the recommended limit of time from collection to processing should be revised for areas where high environmental temperatures are common.

How Long can we Store Blood Samples: A Systematic Review and Meta-Analysis

OBJECTIVE

To assess the effect of storage time and temperature on complete blood count (CBC) and comprehensive metabolic panel (CMP) testing.

METHODS

PubMed, EMBASE, the Cochrane Library of Systematic Reviews, Web of Science (WOS), China National Knowledge Infrastructure (CNKI), WanFang databases and SinoMed databases were searched up to May 2017. Clinical trials with adult whole blood samples were identified. Paired reviewers independently screened, extracted data and evaluated the quality of evidence (MINORS tool). Analyses were conducted using Revman 5.3 and Stata 14.0.

RESULTS

A total of 89 studies were confirmed. For CBC, except MPV, most parameters were stable at least for 24h. Some indices, such as WBC, PLt, HCT, HGB and MCH were stable up to 3 d. However, stable CMP test results could only be acquired within 12h. at 4°C, including GLU, AST, ALT, Na, ALB, Cl, DBIL, TC, TG and ALP. Values were less stable when stored at RT.

CONCLUSIONS

Specimens stored >12h. for CMP may generate unreliable results. For CBC, samples could reliably be stored for 24h. For longer storage, refrigeration (at 4°C) would be a better choice.