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The effect of smudge cells on leukocyte counting--are chamber counts necessary?

Leukocyte counts obtained in the Coulter Model S and Model F were compared with counts from hemocytometers and estimates from peripheral blood smears from 38 patients with increased numbers of smudge cells associated with chronic lymphocytic leukemia, with leukemias other than chronic lymphocytic leukemia, and without leukemia. The results indicate no method-dependent pattern of count loss. Cell counts were not related to the number of smudge cells present; the number of smudge cells were unrelated to the nature of the patient's disease state. We conclude that in the presence of smudge cells, leukocyte counts can be made as reliably by automated methods as by pipette and chamber technics. This conclusion is at variance with what has been previously reported. Although the basis for this discrepancy is not clear, it may be related in part to differences in the formulation of the lysing agents used.

Adolescent

Effects of dexamethasone on leukocyte counts in pregnant sheep and fetal lambs.

In adult nonpregnant animals and human beings, glucocorticosteroids increase circulating leukocytes (predominantly neutrophils) and decrease lymphocytes, monocytes, and eosinophils. We were interested in studying effects of glucocorticoids on leukocyte counts during pregnancy to determine any differences between responses in the nonpregnant and pregnant states. After general anesthesia was administered, we placed catheters in a carotid artery and a jugular vein in pregnant sheep and in fetal lambs. Six days after surgery, we administered dexamethasone intravenously to the mother (0.2 mg. per kilogram) or to the fetus (0.06 mg. per kilogram) and obtained maternal and fetal jugular venous blood samples immediately before (control) and 3, 6, 12, 24, 48, and 72 hours after steroid injection. Administration of dexamethasone to the mother significantly increased total leukocyte and neutrophil counts (leukocytes per cubic millimeter blood) and decreased lymphocyte and eosinophil counts, but it did not change monocyte counts. Leukocyte counts returned to control values within 48 hours. Administration of dexamsthasone to the fetus rapidly increased total leukocyte and neutrophil counts, decreased monocyte and eosinophil counts, and had not effect on lymphocyte counts. Fetal leukocyte counts returned to control values by 24 hours after dexamethasone injection. Our results suggest that maternal and fetal leukocytes can respond to glucocorticoids as they do in the adult nonpregnant state.

Animals

Pitfalls in the interpretation of leukocyte counts of newborn infants.

Some pitfalls in the interpretation of neonatal leukocyte counts are identified. The well-known variability in neonatal leukocyte counts was investigated by simultaneously sampling arterial, venous and capillary blood, and during periods of rest and mild and violent exercise. Venous blood leukocyte counts were 82% +/- 3.5 (mean +/- SE, P = less than .001) of counts in simultaneously drawn capillary blood from heel punctures; arterial blood counts were 77% +/- 5.3 (P less than .001) of capillary blood values. Following violent crying, capillary blood leukocyte counts increased to 146% +/- 6.1 (P less than .001) of baseline values, and a shift to the left occurred. Milder exercise induced an increase to 113% +/- 5.2 (P less than .05), without a leftward shift. Thus, counts from different vascular sources cannot be considered equivalent. Also, counts from vigorously crying babies may show leukocytosis and a leftward shift, and erroneously suggest bacterial infection. It is recommended that serial counts be obtained from a consistent vascular source in resting babies.

Arteries

Platelet and leukocyte counts in pregnancy.

Platelets and leukocytes in venous blood were counted with automated methodology in 23 women studied longitudinally throughout pregnancy and at six weeks after delivery. The average platelet count declined monotonically in a manner consistent with the gestational increase in blood volume. Total leukocyte count rose early in gestation and remained elevated, with neutrophils accounting for the changes. Absolute neutrophil counts during gestation were nearly twice those of the same women postpartum (5.76 vs 3.13/cu mm x 10(-3).) The monocyte count also tended to increase, whereas lymphocytes, eosinophils, and basophils declined in number.

Basophils

A comparative study of the Coulter Counter Model S, for the enumeration of peripheral leukocyte counts below 3.0 x 10(9)/l using whole blood and prediluted blood.

In this study low leukocyte counts were carried out using several methods. The results obtained by the visual method, the Coulter Model "S" using "whole blood", and the Coulter DN, show close correlation, but discrepancies exist when the Coulter S uses "prediluted blood". This is explained by excessive bubbles. This does not allow the Coulter Model S to be used with confidence for low leukocyte counts if "whole blood" is not available.

Capillaries

Visual and automated differential leukocyte counts. A comparison study of three instruments.

The authors compared referee (senior author) microscopic counts, microscopic counts by several technologists, and counts obtained with two pattern-recognition leukocyte classifiers, (1) Larc and (2) Hematrak, and a cytochemical automated method for leukocyte counting, (3) Hermalog D, using samples from (1) a random patient population, (2) a selected abnormal patient population, and (3) healthy individuals. All instruments showed good accuracy and flagged abnormal results for review. Variability in pattern-recognition counts was found to be due mainly to the distribution of the cells on prepared blood smears. The Larc classifier was found to be very sensitive to minor alterations in the cytoplasm or nucleus, and rejected a number of slides. The Hemalog D showed the greatest precision. The method of preparation of slides would be a major decision factor in selecting one pattern-recognition instrument over another.

Adult

Leukocyte counts and arterial blood gases in nonrenal psoriatic patients treated with extracorporeal devices: Preliminary report.

Four psoriatic patients with normal renal function were treated with RP-6 dialyzers. There was a significant decrease in the leukocyte counts at 5 mins of hemofiltration and it remained the same without rebound leukocytosis at 60 mins. Leukopenia was not accompanied by changes in PaO2 or PaCO2 and thus not accompanied by hypoxemia. C3 values were also unchanged, although a tendency to decrease was noted. Leukopenia and hypoxemia may not be related.

Blood Gas Analysis

Evaluation of biologic sources of variation of leukocyte counts and other hematologic quantities using very precise automated analyzers.

The authors determined mean day-to-day (daily over five days), mean week-to-week (weekly over five weeks) and mean hour-to-hour (800 h, 1100 h, 1400 h) physiologic intra-individual variation of concentration values of leukocyte cell types, platelet count, and erythrocyte values (hematocrit, hemoglobin) for a group of 20 healthy adult volunteers. Total leukocyte counts and concentration values of leukocyte cell types were determined in duplicate on the Hemalong-DTM Automated Leukocyte Differential Cell Counter to minimize analytic variation. The data sets were analyzed according to an analysis of variance model. The mean physiologic hour-to-hour and week-to-week intra-individual variations in terms of % coefficient of variation included: hemoglobin, 2.5, 2.2; hematocrit, 2.6, 2.7; platelets, 1.6, 6.6; total leukocyte count, 9.4, 15.7; neutrophils, 12.9, 26.0; lymphocytes, 10.3, 13.2; monocytes, 18.6, 19.3; eosinophils, 19.9, 26.9; basophils, 7.4, 15.0; large unstained cells, 13.7, 16.0; "high-peroxidase" cells, 32.7, 25.7. Hour-to-hour variation was partitioned into random diurnal variation, group-consistent diurnal variation, and subject-specific unique individual variation. Subject-specific diurnal variation contributed greatly and statistically significantly to total diurnal variation for many of the leukocyte cell types--especially in the case of eosinophils, where it represented more than half of total diurnal variation.

Adult

Leukocyte counts in children with sickle cell disease. Comparative values in the steady state, vaso-occlusive crisis, and bacterial infection.

Total and differential WBC counts were measured in 88 children with sickle cell hemoglobinopathies during the steady state, vaso-occlusive crisis, and bacterial infection. Steady state leukocyte values were lower than anticipated on the basis of currently available information. Total and segmented leukocyte numbers were greatly increased during vaso-occlusive crisis and infection, but only with bacterial infection was there a consistent increase in bands or nonsegmented leukocytes (mean, 4,580/microliter). On the basis of these data we believe that total and differential leukocyte counts are of value for identifying those children with potentially serious bacterial infections.

Adolescent

Reversible respiratory failure due to intravascular leukostasis in chronic myelogenous leukemia. Relationship of oxygen transfer to leukocyte count.

In a 49 year old man with blast crisis and massive leukocytosis due to chronic myelogenous leukemia, severe hypoxic respiratory failure developed despite a normal chest film. Correction of hypoxemia was observed after reduction of the white blood cell count by hydroxy-urea therapy. A similar episode occurred prior to death, and necropsy examination revealed extensive plugging of the pulmonary vasculature by leukemic blast cells but no infection or pulmonary edema. An inverse linear correlation was demonstrated between the peripheral white blood cell count and the efficiency of oxygen transfer in the lung as determined by the arterial to alveolar oxygen tension ratio. We postulate that mechanical obstruction and/or leukocyte mediated capillary endothelial injury caused the severe leukocyte mediated capillary endothelial injury caused the severe hypoxemia. Abnormalities of pulmonary gas exchange may be common in leukemic patients with markedly increased leukocyte counts.

Humans

[A transplantable myeloid hamster leukemia with high peripheral leukocyte counts and C-particles. II. Histology and cytochemistry (author's transl)].

Results on morphologic and hematologic characterization of a hamster leukemia capable of both cellular and cellfree transmission are described. Solid tumors removed in the course of several passages of leukemia animals, after producing blood smears, and spleen, liver, lymph nodes, bone marrow, thymus, kidney and lung were investigated histologically and histochemically. The morphological picture of the hamster leukemia has not changed during several transplantation generations. In addition to solid tumours, typical leukemic infiltration were detected histologically in spleen, liver, lymph nodes, bone marrow, kidneys and lung. No leukemic proliferation was noticed in the thymus. The final stage of the disease is characterized by an abrupt occurrence of high leukemic cell counts. The demonstration of alkaline phosphatase, but especially of naphtol-AS-D-chloroacetate esterase, in the leukemic cells is interpreted as indicating malignization of cells of the granulocytic line.

Alkaline Phosphatase

[Interrelationship between the serum lysozyme level and the leukocyte count in Sonne and Flexner dysenteries].

Interrelation between the level of the serum lysozyme and the count of the leucocytes, as well as the severity of the disease was found in testing of the peripheral blood of 133 patients with acute Sonnei and Flexner dysentery. It is recommended to use the lysozyme index in the clinical practice as one of the additional criteria for estimation of the severity of acute dysentery.

Acute Disease