Automation in Hematology: What to Measure and Why?

326 Pages·1981·35.167 MB·English

by  D. W. Ross, G. Brecher, M. C. Bessis

Automation
in Hematology
What to Measure and Why?
Editors:
D.W. Ross, G. Brecherand M. Bessis
With 10 6 Figures and 45 Tables
Springer-Verlag Berlin Heidelberg GmbH 1981
Acknowledgements
This Symposium, held at the Institut de Pathologie Cellulaire, (INSERM 48)
Höpital de Bid~tre, France, July 15-17, 1979 was made possible by the generosity
of Abbott Laboratories, Becton-Dickinson, Coulter Electronics, Geometrie
Data, Ortho Instruments and Technicon Instruments Corp.
Dennis Ross, University of North Carolina, School of Medicine, Chapel Hili, NC 27514,
USA
George BRECHER, University of California, Donner Laboratory, Berkeley, CA 94720,
USA
Marcel BEssis, Institut de Pathologie Cellulaire, Höpital de Bicetre, 94270 Bicetre, France
This monograph comprises Vol. 6, 2-3 of the international journal Blood Cells
(Editor: Marcel Bessis, Assistant Editors: N. Mohandas and D.W. Ross)
ISBN 978-3-540-10225-0 ISBN 978-3-642-67756-4 (eBook)
DOI 10.1007/978-3-642-67756-4
This work is subject to copyright. All rights are reserved, whether the whole or part of the material is
concerned, specifically those of translation, reprinting, re-use of illustrations, broadcastings, repro
duction by photocopying machine or similar means, and storage in data banks. Under §54 of the Ger
man Copyright Law, where copies are made for other than private use, fee is payable to the publisher,
the amount of the fee tobe determined by agreement with the publisher.
© by Springer-Verlag Berlin Beideiberg 1981.
The use of general descriptive names, trade names, trade marks etc. in this publication, even if the
former are not especially identified, is not be taken as a sign that such names, as understood by the
Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone.
2121/3140-543210
Table of Contents
INTRODUCTION
M. WINTROBE: To Measure or not to Measure? That Too Is a Question. 3
G. BRECHER: The Future of Automation in Hematology. . . . . . 7
Jean BERNARD, M. BEssis: The Impact of Automation on the Future of
Hematology . . . . . . . . . . . . . . . . . . . . . 11
SECTION 1: BIOPHYSICAL PRINCIPLES OF MEASUREMENTS
L.A. KAMENTSKY: Objective Measures of Information From Blood Cells . 17
Discussion . . . . . . . . . . . . . . . . . . . 32
W. GRONER, D. TYcKo: Characterizing Blood Cells by Biophysical
Measurements in Flow 3 7
Discussion . . . . . . . . . . . . . . . . . . . 51
F. MEYER: Quantitative Analysis of the Chromatin of Lymphocytes:
An Essay on Comparative Structuralism . . . . 55
Discussion . . . . . . . . . . . . . . 67
M.J. FuLWYLER: Flow Cytometry and Cell Sorting . 69
Discussion . . . . . . . . . . . . . . 79
R.S. GALEN: Predictive Value and Efficiency of Hematology Data . 81
Discussion . . . . . . . . . . . . . . . . . . . . 92
SECTION 11: PLATELETS
J .L. HAYNES: High Resolution Partie le Analysis-Its Application to Platelet
Counting and Suggestions for Further Application in Blood Cell Analysis 97
J.M. PAuLUs, J.F. DESCHAMPS, M. PRENANT, F.J. CASALS: Kinetics of
Platelets, Megakaryocytes, and Their Precursors: What to Measure? . 111
Discussion of papers by J.L. Haynes and J.M. Paulus et al.. . . . . . 122
G. DIGHIERO, C. LESTY, M. LEPORRIER, M.C. CouTY: Computer Analysis of
Platelet Volumes . 125
Discussion . . . . . . . . . . . . . . . . . . . . . . . 127
IV Table of Contents
SECTION III: RED BLOOD CELLS
J.W. BAcus: Quantitative Morphological Analysis of Red Blood Cells. 133
Discussion . 150
M. BEssrs, N. MoHANDAS, C. FEo: Automated Ektacytometry: A New
Method of Measuring Red Cell Deformability and Red Cell Indices . 153
N. MOHANDAS, M.R. CLARK, M.S. JACOBS, w. GRONER, S.B. SHOHET:
Ektacytometric Analysis of Factors Regulating Red Cell Deformability . 167
Discussion ofpapers by M. Bessis et al., and N. Mohandas et al.. 171
B.S. BuLL: Commentary of pap ers by M. Bessis et al., and N. Mohandas et al. 173
H.C. MEL: Ektacytometry and the Measurement of Cell Physical Properties.
Commentary of papers by M. Bessis et al., N. Mohandas et al., and B.S. Bull 177
M. BEssrs, N. MoHANDAS, C. FEo: Answer to Commentaries. 182
E.P. 0RRINGER, M.E.S. RoER, J.C. PARKER: Cell Density Profile as a
Measure of Erythrocyte Hydration: Therapeutic Alteration of Salt and
Water Content in Normal and SS Red Blood Cells 183
Discussion . 190
SECTION IV: WHITE BLOOD CELLS
A.M. SAUNDERS: White Blood Cells: What to Do Beyond Measurement. 195
Discussion . 199
G. DrGHIERO, E. BoDEGA, R. MAYZNER, J.L. BrNET: Two New Applications
of the Immunoperoxidase Method: Cell-by-Cell Quantitation of Surface
Immunoglobulins and Automated Recognition of B-Lymphocytes 203
Discussion . 207
L.G. LAJTHA: Strategic Reserves 213
Discussion . 219
J.W.M. VrssER, G.J. VAN DEN ENGH, D.W. VAN BEKKUM: Light Scattering
Properties of Murine Hemopoietic Cells . 223
Discussion . 239
SECTION V: WHITE CELL DIFFERENTIAL
B. BuLL, R.A. KoRPMAN: Characterization of the WBC Differential Count 243
Table of Contents V
R.A. KoRPMAN, B. BuLL: Whither the WBC Differential?-Some
Alternatives . . . . . . . . . . . . . . . . . . 253
G. BRECHER, R.E. ANDERSON, P.D. McMuLLEN: When to Do Diffs. How
Often Should Differential Counts be Repeated? . . . . . . . . . . 263
Discussion of papers by B. Bull and R.A. Korpman, R.A. Korpman and
B. Bull, and G. Brecher et al.. . . . . . . . . . . . . . . . 271
D.W. Ross, A. BARDWELL: Automated Cytochemistry and the White Cell
Differential in Leukemia . 287
Discussion . . . . . . . . . . . . . . . . . . . . . . 298
R.V. PIERRE: Automation of Blood Film Preparation and Staining Utilizing
the Technicon Autoslide 303
Discussion . . . . . . . . . . . . . . . . . . . . . . 312
T.C. KrNGSLEY: The Automated Differential; Pattern Recognition Systems,
Precision and the Spun Smear . . . . . . . . . . . . . . . 315
P.R. DAousT: The Clinical Detection of Variations in the Concentrations of
Normal Leukocyte Types . . . . . . . . . . 321
Discussionofpapers byT.C. Kingsley andP.R. Daoust. . . . . . . . 327
SUMMING UP
JEAN BERNARD: Summing Up 1 . 331
G. BRECHER: Summing Up II . 333
SUBJECT INDEX . . . . . 337
Participants and Discussants
JamesBACUS G. FLANDRIN
Rush-St Luke's Presbyterian Clinique des Maladies du Sang
Medical Center Hopital Saint Louis
1753 W. Congress Parkway 75012 Paris, France
Chicago, 111. 60112, USA
Louis FOISSAC
Marcel BESSIS President
Institut de Pathologie Cellulaire Technicon France
Hopital de Bicetre 39 Bd. de la Muette
94270 Bicetre, France 95140 Garges-les-Gonesse, France
Jean BERNARD Mack FULWYLER
Clinique des Maladies du Sang Becton & Dickinson Corp.
Hopital Saint Louis 506 Clyde Ave.
75012 Paris, France Mountain View, CA 94043, USA
Robert GALEN
Jacques-Louis BINET
Department of Pathology
Service d'Hematologie
Overlook Hospital
Hopital de la Salpetriere
Summit, N.J. 07901, USA
4 7 Bd. de l'Hopital
75013 Paris, France
Warren GRONER
Technicon Corp.
George BRECHER Tarrytown, NY 10591, USA
University of California
Donner Laboratory John HAYNES
Berkeley, CA 94 720, USA Becton & Dickinson Corp.
Research Center
Brian BULL Triangle Park, NC 27709, USA
Loma Linda University
Louis KAMENTSKY
School of Medicine
Ortho Instruments
Loma Linda, CA 92354, USA
410 University Ave.
Westwood, Mass. 02090, USA
Phillip DAOUST
Department of Pathology Thomas KINGSLEY
Tufts Medical Center Department of Pathology
Boston, Mass. 021 O1 , USA
Kenneston Memorial Hospital
Marietta, Georgia 30060, USA
G. DIGHIERO
Service d'Hematologie Robert KLEIN
Hopital de la Salpetriere Coulter Electronics
4 7 Bd. de l'Hopital 590 W. 20th Street
75013 Paris, France Hialeah, Flo. 33010, USA
VIII Participants and Discussants
Ralph KORPMAN Dennis Ross
Loma Linda University University of North Carolina
School of Medicine School of Medicine
Loma Linda, CA 92354, USA Chapel Hill, NC 27514, USA
Laszlo LAJTHA
Christie Hospital
Alex SAUNDERS
Paterson Laboratories
Geometric Data
Manchester, M20 9BX, England 999 W. Valley Road
Wayne,Penna. 19087, USA
Fran~ois MEYER
Ecole Nationale Superieure des Mines
35 Rue Saint Honore
Elkin SIMSON
77305 Fontainebleau, France
Technicon Instruments Corp.
Eugene 0RRINGER Tarrytown, NY 10591, USA
Division of Hematology
School of Medicine
University of North Carolina Pierre STRYCKMANS
Chapel Hill, NC 27514, USA Institut Jules Bordet
7 Rue Heger-Bordet
Jean-Michel PAULUS Brussels 1000, Belgium
Institut de Medecine
Hâpital de Baviere
4020 Liege, Belgium
Jan VISSER
Radiobiological Institute
Robert PIERRE
TNO
Mayo Clinic
Rijswyjk, The Netherlands
Hematology Laboratory
Rochester, Minn. 55901, USA
Rod RAYNOVICH Max WINTROBE
Ortho Instruments University of Utah Medical Center
410 University Ave. 50 North Medical Drive
Westwood, Mass. 02090, USA Salt Lake City, Utah 84132, USA
INTRODUCTION
To Measure or not to Measure? That Too Is a Question
Maxwell M. WINTROBE
For the physician, there is not only a question as to what to measure and
why, but equally important is the question of whether to measure or not.
The patient of today cannot avoid the impression that the modern physician
measures and measures - and then tests some more. The number and variety
of investigative procedures to which a patient is subjected sometimes reaches
enormous proportions and, in part as a consequence of this, the cost of medical
care has grown to unreasonable levels.
At one time superstition, hearsay, magic, and dogma were the stuff of medical
practice. The unique feature of the teachings of the Hippocratic School was
the admonition that observation and experience should guide the physician,
in addition to the rules and formulations he had learned. So novel was this
idea, however, that it was followed far more in the breach than in the practice.
For centuries, physicians continued to practice by rote rather than by reason,
merely attempting to square their observations with the teachings of Hippocrates
and the system of Galen. Their concept that all truth had been revealed in
the past rather being something to be achieved through observation and experi
ment was of course in keeping with the spirit of the times. From childhood,
medieval people had been brought up to accept authority. For the most part,
this was the attitude even in the 18th and 19th centuries and advances in
medicine, which had come to a standstill in the Dark Ages and in medieval
times, were few in number. Only the very exceptional dared to inquire and
explore and, for them, the means were meager and rudimentary and the atmos
phere was prohibitive. It was dangerous to think for oneself.
The invention of the micrsocope in the 17th century and its application
to the study of biology provided an opportunity to gain insight into a totally
unsuspected and, until then, unseen world. Leeuwenhoek, in what was probably
the first measurement on blood, wrote: 'The red globules of the Blood 1 reckon
to be 25,000 times smaller than a grain of sand which perhaps will to many
seem incredible.' This remarkably accurate observation was made with an instru
ment which was very simple. The method, however, required infinite patience
and time.
Methodology improved very slowly and few could believe that microscopy
had anything to offer the physician. Even by the mid-19th century when Donne
and Andral sought to show the usefulness of ths study of the blood in gaining
an understanding of disease, their attempts were met with indifference, when
not with ridicule. Only after the aniline dyes were introduced by Ehrlich toward
The University of Utah Medical Center, Department of Interna! Medicine, 50 N. Medical Drive,
Salt Lake City, Utah 84132, USA