White blood cell differential counts in severely leukopenic samples: a comparative analysis of different solutions available in modern laboratory hematology

Fabrication and Assessment of Diosgenin Encapsulated Stearic Acid Solid Lipid Nanoparticles for Its Anticancer and Antidepressant Effects Using in vitro and in vivo Models

Inflammatory cascade plays a pivotal role in the onset and progression of major depressive disorder (MDD) and glioblastoma multiforme (GBM). Therefore, questing natural compounds with anti-inflammatory activity such as diosgenin can act as a double-edged sword targeting cancer and cancer-induced inflammation simultaneously. The blood–brain barrier limits the therapeutic efficiency of the drugs against intracranial pathologies including depression and brain cancers. Encapsulating a drug molecule in lipid nanoparticles can overcome this obstacle. The current study has thus investigated the anticancer and antidepressant effect of Tween 80 (P80) coated stearic acid solid lipid nanoparticles (SLNPs) encapsulating the diosgenin. Physio-chemical characterizations of SLNPs were performed to assess their stability, monodispersity, and entrapment efficiency. In vitro cytotoxic analysis of naked and drug encapsulated SLNPs on U-87 cell line indicated diosgenin IC₅₀ value to be 194.4 μM, while diosgenin encapsulation in nanoparticles slightly decreases the toxicity. Antidepressant effects of encapsulated and non-encapsulated diosgenin were comprehensively evaluated in the concanavalin-A–induced sickness behavior mouse model. Behavior test results indicate that diosgenin and diosgenin encapsulated nanoparticles significantly alleviated anxiety-like and depressive behavior. Diosgenin incorporated SLNPs also improved grooming behavior and social interaction as well as showed normal levels of neutrophils and leukocytes with no toxicity indication. In conclusion, diosgenin and diosgenin encapsulated solid lipid nanoparticles proved successful in decreasing in vitro cancer cell proliferation and improving sickness behavioral phenotype and thus merit further exploration.

Accurate white blood cell differential by Alinity hq: A comparison with flow cytometry and manual differential

INTRODUCTION

White blood cell (WBC) differential by flow cytometry can report a six-part WBC differential and enumerate blasts. Some modern hematology analyzers are also able to provide a six-part WBC differential (including immature granulocytes). Our goal was to compare the WBC differential obtained by the Abbott Alinity hq hematology analyzer to an 8-color single-tube flow cytometry method and to manual WBC differential.

METHODS

Samples from 144 patients were tested with Alinity hq, flow cytometry, and microscopic WBC differential. The WBC count ranged from 1.22 to 359 × 10⁹ /L, and 34 samples were flagged by the analyzer for abnormal WBC morphology.

RESULTS

Strong concordance was demonstrated between Alinity hq and flow cytometry for all six components of the differential, with correlation coefficients ranging from 0.86 (basophils) to 1.00 (lymphocytes). Small, clinically insignificant positive difference was observed between Alinity hq and flow cytometry for mature and total neutrophils (2.51% and 1.85%) and eosinophils (0.14%), and small negative difference for immature granulocytes (-0.65%), lymphocytes (-0.61%), and basophils (-0.21%). No bias was detected between the Alinity hq and flow cytometry monocyte counts. Alinity hq and flow cytometry results agreed with the manual differential, apart from small, clinically insignificant differences. Alinity hq nucleated red blood cell concentrations were equivalent with the manual results (r = 0.95, slope = 1.16). The percentage of blasts by flow cytometry demonstrated good correlation and agreement with the manual count (r = 0.99, slope = 1.35).

CONCLUSION

Alinity hq has produced accurate six-part WBC differential in this three-way comparison, equivalent to flow cytometry and morphological classification.

[The application of CytoDiff for the differential diagnosis of reactive and tumor lymphocytosis.]

CytoDiff reagent was developed to optimize the performance of a WBC differential evaluation. It determines the main population of white blood cells by the expression of linear markers. One of the additional possibilities of using CytoDiff is the differential diagnosis of reactive and tumor lymphocytosis. We studied peripheral blood samples of 76 patients of the All-Russian Central Research Center A.M. Nikiforova EMERCOM of Russia with absolute lymphocytosis of more than 3,0x10⁹/l. The control group included 26 practically healthy people. All performed a clinical blood test on a 5Diff hematology analyzer with smear microscopy, and determination of leukocyte populations by phenotype using CytoDiff. Reference intervals were determined for subpopulations of lymphocytes using CytoDiff. An algorithm has been developed for evaluating the results obtained when determining leukocyte populations by phenotype using CytoDiff for differential diagnosis of reactive and tumor lymphoproliferation. To detect B-cell lymphoproliferative diseases, the use of a cut-off value of 13% or more of the number of leukocytes is optimal. At low values of the relative number of B-lymphocytes, it is important to take into account the results of microscopy of blood smears. If atypical mononuclear cells are absent in smears, then additional clinical and laboratory studies are necessary to establish the cause of lymphocytosis, including phenotyping of peripheral blood lymphocytes to exclude T-cell lymphoproliferative diseases. The expediency of using the CytoDiff reagent for the differential diagnosis of the reactive and tumor nature of lymphocytosis is shown. Already at the stage of primary screening studies, the use of CytoDiff makes it possible to efficiently collect blood samples from patients with possible lymphoproliferative diseases, which significantly reduces the time required for a diagnostic search.

Evaluation of a 10color protocol as part of a 2tube screening panel for flow cytometric assessment of peripheral blood leukocytic subsets

Peripheral blood (PB) immunophenotyping is commonly required for initial evaluation of various suspected disease entities. Several approaches have been proposed. The objective of this work is to explore the value of a 10color protocol developed in our laboratory for flow cytometric assessment of PB leukocytic subsets, as part of a 2tube screening panel. A combination of CD16/CD56/CD34/CD33/CD19/CD4/CD8/CD3/CD20/CD45 antibodies in 1 tube was applied routinely during flow cytometric analysis of PB samples for diagnostic purposes. The protocol was systematically complemented by a 2nd tube with anti-kappa, anti-lambda, CD5, CD19, and CD45 antibodies for adults and selected pediatric patients, and specifically oriented panels when necessary. 25 samples with no detectable neoplastic PB involvement and 31 samples with a hematolymphoid disorder were investigated retrospectively. The contribution of CD33 in the separation of leukocytic populations, as well as the benefits from the simultaneous assessment of CD20/CD19/CD45, CD16/CD56 and the detection of CD34+ cells were examined. The gating strategy with the use of CD33 provided additional information in certain cases. The protocol enabled recognition of differential expression of CD20 and CD45 in CD19+ cells with chronic lymphocytic leukemia phenotype, overall evaluation of NK and NK like T cells, estimation of CD16- granulocytes and CD56/CD16 expression in monocytes, as well as identification of minor cell subsets, such as CD34+ cells. The proposed 10color combination of antibodies analyzed in a standardized manner can offer significant information in the initial evaluation of PB samples, thus, guiding subsequent investigation if needed.

Validation of an automated cell counter to determine leukocyte differential counts in neonatal Holstein calves

Recent advances in the understanding of risk factors and biomarkers in calves entering rearing facilities show promise for identifying high-risk calves on arrival at veal and dairy beef operations. Rapid automated leukocyte differential cell counts may be a good addition for augmenting or refining calf risk identification on-farm. The objective of this study was to validate an automated leukocyte cell counter, the QScout BLD test (Advanced Animal Diagnostics, Morrisville, NC), for its ability to determine leukocyte differential cell counts in neonatal Holstein calves. From June to July 2018, blood samples collected in EDTA anticoagulant from 235 calves upon arrival at an independent veal research facility in Ontario, Canada, were evaluated using the QScout BLD test and manually by microscopy. We compared these leukocyte differential counts using Lin's concordance correlation coefficient (ρ) and found very good agreement between tests for neutrophil counts (ρ = 0.83); fair agreement for lymphocyte counts (ρ = 0.32); fair agreement for the ratio of neutrophils to lymphocytes (ρ = 0.36); slight agreement for monocyte counts (ρ = 0.14); and slight agreement for eosinophil counts (ρ = 0.20). We further examined test results to determine if they differed in their classification of samples as being above, within, or below reported 95% reference intervals for neonatal Holstein calves. Classification between tests resulted in very good agreement for neutrophils and lymphocytes, with only 4.2% and 5.8% disagreement in classification, respectively. We observed moderate agreement for monocytes, with 23.3% classified differently, and poor agreement for eosinophils, with 70.3% classified differently. Further study is required to determine the role of leukocyte profiling in the risk assessment of calves arriving at calf-rearing facilities.

Development of a Novel Flow Cytometry-Based System for White Blood Cell Differential Counts: 10-color LeukoDiff

BACKGROUND

Flow cytometry (FCM) is commonly used to identify many cell populations. We developed a white blood cell (WBC) differential counting system for detecting abnormal cells using FCM incorporating 10 colors and 11 antibodies in a single tube, called "10-color LeukoDiff," and evaluated its performance.

METHODS

Ninety-one EDTA-anti-coagulated peripheral blood samples from 76 patients were analyzed using 10-color LeukoDiff. We compared 10 color LeukoDiff results with the results of manual differential count (manual diff). WBCs were classified into 17 cell populations: neutrophils, total lymphocytes, T lymphocytes, B lymphocytes, CD5 and CD19 co-expressing lymphocytes, natural killer cells, total monocytes, 16+ monocytes, eosinophils, immature granulocytes, basophils, myeloblasts, B-blasts, T-blasts, myeloid antigen-positive B-blasts, CD19- plasma cells, and 19+ plasma cells.

RESULTS

The correlations between the 10-color LeukoDiff and manual diff results were strong (r>0.9) for mature neutrophils, lymphocytes, eosinophils, immature granulocytes, and blasts and moderate for monocytes and basophils (r=0.86 and 0.74, respectively). There was no discrepancy in blast detection between 10-color LeukoDiff and manual diff results. Furthermore, 10-color LeukoDiff could differentiate the lineage of the blasts and separately count chronic lymphocytic leukemic cells and multiple myeloma cells.

CONCLUSIONS

The 10-color LeukoDiff provided an accurate and comprehensive WBC differential count. The most important ability of 10-color LeukoDiff is to detect blasts accurately. This system is clinically useful, especially for patients with hematologic diseases, such as acute leukemia, chronic lymphocytic leukemia, and multiple myeloma. Application of this system will improve the development of FCM gating strategy designs.

Reference Values for WBC Differential by Hematoflow Analysis

Objectives

WBC differentials performed using flow cytometry with monoclonal antibodies have been developed in the last decade and are nowadays integrated into the routine workflow of some laboratories. Definition of reference values for each population is required in order to achieve an automatic validation of the results by laboratory software.

Methods

We analyzed 584 samples from three hospitals using the Hematoflow solution to define the reference values.

Results

Reference values are presented for five groups according to age (0-5, 6-11, 12-19, 20-69, and >69 years).

Conclusions

These normal values will be helpful in the definition of relevant threshold for the automatic validation of samples analyzed by flow cytometry and the flagging of pathologic samples.

Association of neutrophil-to-lymphocyte ratio and natural killer cell activity revealed by measurement of interferon-gamma levels in a healthy population

BACKGROUND

While a method of assaying natural killer (NK) cell activity by measuring the amount of interferon (IFN)-γ released from NK cells has been proposed, no data are available about the factors that influence IFN-γ levels related to NK cell activity. NLR has recently been reported to be a predictor of several diseases. In the present study, we investigated the pre-analytical variables for NK cell activity using measurements of IFN-γ and the relationship between NLR and NK cell activity.

METHODS

The NK cell activity was assessed with the measurement of IFN-γ after stimulation with an NK cell-specific stimulant (NK Vue^™ , ATgen, Sungnam, Korea). One hundred and six adult volunteers were recruited and analysis of their complete blood count data and serum C-reactive protein was done. Blood sample from 59 of the participants was also used for analysis of lymphocyte subpopulations.

RESULT

Natural killer cell activity varied widely (range, 44.2-1775.6 pg/mL). NK cell activity was higher in females than in males (P = 0.014). NK cell activity decreased with increasing NLR (P = 0.004, r = -0.32) but NK cell activity showed no significant association with NK cell count or other lymphocyte subpopulations. NK cell activity levels according to CRP quartile were significantly different (P = 0.025).

CONCLUSION

We have observed that NK cell activity when assessed by IFN-γ level measurement was negatively correlating with NLR. This result can be helpful in interpreting or predicting NK cell activity in the clinical environment.

Prognostic implication of leucocyte subpopulations in diffuse large B-cell lymphoma

BACKGROUND

Recent studies have suggested that variables related to host adaptive immunity and the tumor microenvironment may predict the outcome in patients with non-Hodgkin's lymphoma. This study was undertaken to determine the prognostic value of peripheral blood leucocyte subpopulations in diffuse large-B-cell lymphoma patients.

METHODS

We prospectively analyzed the 16 leukocyte subpopulations using Cytodiff flow cytometric technique in a cohort of 45 diffuse large-B-cell lymphoma patients at a single institution between February and December 2014. The Cox proportional hazards model was used to evaluate prognostic factors for overall survival and progression free survival.

RESULTS

Diffuse large-B-cell lymphoma patients had decreased cytotoxic and non-cytotoxic NK&T cells as well as increased CD16+ monocytes, CD16- monocytes and mature neutrophils. The decreased CD16- monocyte/CD16+ monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio were related to poor progression-free and overall survival outcome in single and multivariate analysis. The co-constructed model using International Prognostic Index and mature neutrophil/cytotoxic NK&T cell ratio can also help discriminate the clinical outcome.

CONCLUSIONS

The decreased CD16-monocyte/CD16+monocyte ratio and increased mature neutrophil/cytotoxic NK&T cell ratio predict poor prognosis in diffuse large-B-cell lymphoma patients. This finding provides a strong rationale for the study of cellular immunotherapy in B-cell lymphoma.

A Comparison of Mindray BC-6800, Sysmex XN-2000, and Beckman Coulter LH750 Automated Hematology Analyzers: A Pediatric Study

BACKGROUND

Modern automated laboratory hematology analyzers allow the measurement of over 30 different hematological parameters useful in the diagnostic and clinical interpretation of patient symptoms. They use different methods to measure the same parameters. Thus, a comparison of complete blood count made by Mindray BC-6800, Sysmex XN-2000 and Beckman Coulter LH750 was performed.

MATERIALS AND METHODS

A comparison of results obtained by automated analysis of 807 anticoagulated blood samples from children and 125 manual microscopic differentiations were performed. This comparative study included white blood cell count, red blood cell count, and erythrocyte indices, as well as platelet count.

RESULTS

The present study showed a poor level of agreement between white blood cell enumeration and differentiation of the three automated hematology analyzers under comparison. A very good agreement was found when comparing manual blood smear and automated granulocytes, monocytes, and lymphocytes differentiation. Red blood cell evaluation showed better agreement than white blood cells between the studied analyzers.

CONCLUSION

To conclude, studied instruments did not ensure satisfactory interchangeability and did not facilitate a substitution of one analyzer by another.