An evaluation of the CELL-DYN 1700® haematology analyser: automated cell counting and three-part leucocyte differentiation

The performance of the CELL-DYN 1700® (Abbott Diagnostics, Abbott Park, IL, USA) was evaluated in a tertiary care hospital laboratory using the guidelines proposed by the German Society of Clinical Chemistry. Precision, accuracy, linearity, background counts, and carry-over were satisfactory for all measured standard parameters including haemoglobin concentration, haematocrit, red blood cell count, mean corpuscular volume (MCV), red cell distribution width (RDW), white blood cell count and platelet count. With 259 selected normal and abnormal blood samples the results of the CELL-DYN 1700® (CD1700) compared very well (r > 0.96 for all parameters with exception of RDW) with those obtained with the Bayer Diagnostic H-1 and the Hoffmann-La Roche Cobas Argos systems. This study considered in particular the performance of the CD1700 three-part leucocyte differential. For those samples without instrument-generated suspect flags, the neutrophil and lymphocyte percentages were highly correlated with the results of the H-1 blood cell counter (r = 0.97 and 0.98, respectively) and with manual 400-cell differentials (r = 0.91 and 0.88, respectively). In contrast, the CD1700 mid-fraction which comprised the composite total of mono cytes, eosinophils, basophils and precursor white cells (when present) could not be directly compared to the differentials from the H-1 system or from manual microscopy. For those samples with CD1700 instrument suspect flags, the neutrophil and lymphocyte differential results also compared well with both the H-1 (r = 0.93 and 0.93, respectively) and manual estimates (r = 0.89 and 0.87, respectively). In conclusion, the CD1700 is an accurate haematology analyser for cellular blood counts and three-part leucocyte differentiation.     

Evaluating the use of plerixafor in stem cell mobilisation – an economic analysis of the PHANTASTIC trial

Plerixafor is an effective haematopoietic stem cell mobilising agent in candidates for autologous transplantation, including patients with myeloma and lymphoma. Here we compare 98 plerixafor recipients in the PHANTASTIC trial with 151 historic controls mobilised by conventional chemotherapy (each with granulocyte colony‐stimulating factor, G‐CSF). Seventy (71.4%) plerixafor‐mobilised patients achieved the composite primary endpoint of ≥4 × 10⁶ CD34+ cells kg^?1 in ≤2 aphereses and no clinically significant neutropenia, compared to 48 (31.8%) historic controls (P < 0.001), and this significant advantage was maintained in scenario analyses testing components of this composite endpoint. A patient‐level cost analysis was undertaken for 249 patients, which included the cost of remobilising patients where initial mobilisation had failed. Combined mean treatment cost for plerixafor mobilised patients was £12,679 compared with £11,694 for historical controls. However, plerixafor produces an average saving of £3,828 per lymphoma patient but average cost increase by £5,245 per myeloma patient. The present data demonstrate cost‐effectiveness for plerixafor as a first line mobilisation agent, certainly for lymphoma patients, where substantial resource savings and achievement of the primary endpoint are likely. J. Clin. Apheresis 31:434–442, 2016. © 2015 Wiley Periodicals, Inc.     

First clinical evaluation of the CELL-DYN® 3200 haematology analyser

A prototype of the CELL-DYN 3200® haematology analyser was evaluated in a tertiary care hospital laboratory. Precision, effects of sample ageing, linearity, carry-over, and com-parability of cellular blood counts and five-part leucocyte differentiation were determined in accordance with the ICSH guidelines for the evaluation of blood cell analysers; the results were satisfactory for all parameters tested: haemoglobin concentration, RBC, MCV, WBC, platelet count, and counts of neutrophils, lymphocytes, monocytes, and eosinophils. Two-hundred and forty-seven routine blood samples were used for the comparability studies. The cellular blood count results from the CELL-DYN 3200® and the Bayer Diagnostic H-1 systems corresponded closely (correlation coefficient r > 0.96 for all parameters). For 201 samples without an instrument-generated suspect flag the same was true with regard to the dif-ferential parameters, although somewhat lower correlation was observed for monocyte counts (r = 0.88). Comparisons to 400-cell microscopic differentials gave similar results (r > 0.93 for neutrophil, lymphocyte and eosinophil counts). Our results suggest that the CELL-DYN 3200® analyser will serve the needs for automated blood cell counting and differential leucocyte counting in a tertiary care hospital laboratory.     

Diagnostic value of serum human Galactomannan aspergillus antigen and 1,3‐beta‐D‐glucan in immunocompromised patient suspected fungal infection

BackgroundThe prevalence of fungal infection (FI) in developing countries is high, but the diagnosis of FI is still challenging to determine, so it is needed evaluation of biomarkers other than microbiological culture, because the culture has low sensitivity, high cost, not available in every laboratory and needs a long time. The detection of human galactomannan Aspergillus antigen (GAL) and 1,3‐beta‐D‐glucan (BDG) on the fungal cell wall could be the promising biomarkers for fungal infection. Neutropenia, lymphopenia and CD4T cells in the immunocompromised patients are essential factors, but these cell associations with BDG and GAL levels have not been evaluated yet. The study aimed to evaluate GAL and BDG for detecting fungal infection and their association with total leucocyte count, neutrophil, monocyte, lymphocyte and CD4T cells.MethodA cross‐sectional study was conducted among 86 patient with suspected FI. Fungal infection established using EORTC/MSG criteria. Serology test performed using ELISA. Leucocyte cells were measured using a haematology autoanalyser, and CD4T cells were analysed using BD FACSPresto. Statistical analysis obtained using Spearman''s correlation coefficient, ROC curve analysis and 2 × 2 contingency table.ResultsSerum Galactomannan and BDG had a significant correlation with CD4T cells and total lymphocyte count (p < 0.05). The cut‐off OD GAL >0.3 had sensitivity 54.6%, specificity 87.5% and AUC 0.71; meanwhile, the BDG cut‐off >115.78 pg/ mL had sensitivity 71.2%, specificity 52.4% and AUC 0.63 for detecting fungal infection.ConclusionsThe immunocompromised patients can undergo GAL for determining the diagnose of FI. The lower the CD4T cells and total lymphocyte count, the higher the GAL and BDG serum levels.     

The MYSTerious MOZ,a histone acetyltransferase with a key role in haematopoiesis

The MOnocytic leukaemia Zing finger (MOZ; MYST3 or KAT6A¹) gene is frequently found translocated in acute myeloid leukaemia. MOZ encodes a large multidomain protein that contains, besides others, a histone acetyl transferase catalytic domain. Several studies have now established the critical function of MOZ in haematopoiesis. In this review we summarize the recent findings that underscore the relevance of the different biological activities of MOZ in the regulation of haematopoiesis.     

Shwachman–Diamond syndrome (SDS) in a preterm neonate

A preterm neonate at 29‐week gestational age was born with intrauterine growth restriction, severe pancytopaenia and gross skeletal dysplasia. Antenatal screening bloods, TORCH/parvovirus tests and karyotype were unremarkable. Postnatally, he had normal microarray comparative genomic hybridization and serum B12/folate levels, and human immunodeficiency virus and cytomegalovirus polymerase chain reaction and antoimmune screening were negative. Targeted gene testing for Shwachman–Diamond syndrome (SDS) revealed the pathognomic mutation (c.183_184delTAinsCT). His postnatal clinical course was complicated by: (i) Ventilator dependency because of a combination of a pathologically compliant chest wall and preterm‐associated chronic lung disease. (ii) Progressive bone marrow failure, resulting in transfusion dependence and profound neutropenia associated with recurrent sepsis. (iii) Gastrointestinal failure and TPN dependency. (iv) Poor postnatal growth with weight/length/head circumference all <3rd centile. (v) Prognostication was complicated by the lack of published literature on the presentation of SDS in a preterm infant. However, because of inexorable progression of multiorgan failure, intensive care was withdrawn on day 54 of life. SDS is a rare autosomal recessive disorder characterised by haematological abnormalities, skeletal dysplasia and exocrine pancreatic dysfunction. Neonatal presentation is thought to be extremely rare. However, with the availability of genetic testing, it has now become clear that because of overlap in clinical presentation, term‐born infants with skeletal dysplasia and severe respiratory distress may initially be misdiagnosed as asphyxiating thoracic dystrophy. This case report highlights the complexities of preterm birth complicating clinical manifestations of SDS.     

Comparative study on the effects of aqueous extracts of viscum album (mistletoe) from three host plants on hematological parameters in albino rats

Background

The extract of the leaves of Viscum album (mistletoe) has been used for centuries in traditional medicine in many parts of the world. However, like many medicinal plants, the belief that things of natural origin are safe may not be entirely true. The blood is a good indicator of health and pathological mirror of the entire body.

Objective

Therefore, in this study, the acute effects of extracts of mistletoe, harvested from three hosts, on haematology indices of wistar albino rats was investigated.

Methods

Graded doses (400, 800, 1600 and 3200mg/kg body weight) of aqueous extracts of mistletoe from three different host plants, coffee (Coffee arabica), kola (Kola nitida), cocoa (Theobromae cacao), were administered orally to wistar albino rats for 14 days. Full haematological parameters were evaluated on whole blood collected from rats twenty four hours after the administration of the last dose.

Results

Mistletoe from kola caused a concentration dependent and statistically significant (p<0.05) reduction in platelets count in rats. Administration of mistletoe extract from cocoa and coffee led to reduction in hemoglobin concentration. Reductions in packed cell volume (PCV) and red blood cell (RBC) and increase in white blood cells (WBC) were also observed in rats administered all the extracts.

Conclusion

Increase in the WBC count observed in rats administered mistletoe suggests that mistletoe extract contains agents that could stimulate the production of leucocytes and could serve as immune booster. However, there is need to be cautious in administration at high doses to prevent the risk of anaemia.