Transcript Methods ADVIA 120


ADVIA
120
TECHNOLOGY
ADVIA 120
• Hematology Analyzer
• Complete Blood Count (CBC)
• White Blood Cell Differential (Diff)
• Reticulocyte Analysis (Retic)
• Analysis on one aspiration of whole blood
• 120 CBC/Diff samples per hour
• Random Access Test Selectivity
Sample Handling
3 Modes of Aspiration
• Multiple tube size
• Multiple tube types
• Small sample volume (157uL)
Auto
Open
Closed
Unified Fluidics Circuit
Unified Fluids Circuit (UFC)
The UFC assembly uses Unifluidics technology.
The UFC block is made up of eight acrylic
plates. Machined within these plates are the
pathways for the fluids and air flow, valves, and
four reaction chambers. An additional chamber
is mounted on the outside surface of the UFC
block.
The reagent pump assembly, mounted to the
bottom of the UFC block, is also acrylic.
Unified Fluids Circuit (UFC)
Dividing the Sample
The Sample Shear Valve divides the
sample into 5 aliquots for the
different types of tests. The
reagents and sample segments are
delivered to their respective reaction
chambers for mixing and aspiration.
Side View of UFC

ADVIA
120
METHODS
The HGB Method
ADVIA 120 HGB contains:
- Potassium cyanide, 20 mmol/L
- Dimethyllaurylamine oxide, 2.0%
Reaction:
- Red blood cells are lysed to release hemoglobin.
- The heme iron in the hemoglobin is oxidized from the ferrous to the ferric state,
and then it is combined with cyanide in the ADVIA 120 HGB reagent to form
the reaction product.
CYANISATION
HEMOGLOBIN + HGB reagent
Fe++
METHEMOGLOBIN
Fe+++
CYANIDE HGB
Fe+++.CN
The HGB Method
HGB reaction chamber
Lamp
assembly
UFC
Filter + Photodiode
Optical readings are obtained colorimetrically at 546 nm.
The HGB Method
1. ADVIA 120 Sheath/Rinse reading from previous cycle
2. Draining and refilling with the reaction solution
3. Reaction solution readings (Sample Mean)
4. Draining and refilling with the ADVIA 120 Sheath/Rinse
seconds
5. ADVIA 120 Sheath/Rinse readings (Baseline Mean)
The HGB Method
Calculating reported parameters
•
HGB
Hemoglobin (directly measured)
•
MCH
(Mean Corpuscular
Hemoglobin)
(HGB ÷ RBC) x 10
•
MCHC
(HGB ÷ [RBC x MCV]) x 1000
(Mean Corpuscular
Hemoglobin Concentration)
FLOWCELL TECHNOLOGY
Shuttle chamber
Sheath stream
Sample stream
ADVIA 120 SHEATH encases the sample stream
as the two fluids pass through the flowcell. Light
detects the cells as they pass through the light path.
The RBC Method
ADVIA 120 RBC/PLT contains:
-
Sodium dodecyl sulfate, 0.035 mmol/L
Disodium EDTA dihydrate, 4.03 mmol/L
Tetrasodium EDTA dihydrate, 3.36 mmol/L
Sodium chloride, 109.3 mmol/L
Glutaraldehyde, 0.11%
Buffer
Reaction:
- ADVIA 120 RBC/PLT reagent contains sodium dodecyl sulfate (SDS) and
glutaraldehyde that causes sphering of the red blood cells and platelets.
When red cells and platelets are isovolumetrically sphered, shape is eliminated
as a variability factor.
- RBCs and platelets are fixed
The RBC Method
No matter
what your shape
or size ....
We can make you
a SPHERE
The RBC Method
Low angle scatter 2o - 3o (Volume)
High angle scatter 5o - 15o (HGB concentration)
The RBC Method
Laserdiode
Sample stream
Beamsplitter
Dark stop
Mirror
Referentie signaal
Absorption
detector
Front view of the dark stop
Low-angle
scatter
detector
High-angle
scatter
detector
The RBC Method
The RBC Scatter cytogram is the graphical
representation of two light-scatter measurements:
the high-angle light scatter (5° to 15°) is plotted along
the x axis, and the low-angle light scatter (2° to 3°) is
plotted along the y axis.
1. Low-angle light scatter (2° to 3°)
2. High-angle light scatter (5° to 15°)
3. Mie map containing RBCs
4. Platelets detected in RBC method
The RBC Method
The Volume/Hemoglobin Concentration
(V/HC) cytogram is a linear version of the RBC map
that appears on the RBC cytogram.
On the V/HC cytogram, hemoglobin concentration is
plotted along the x axis and cell volume is plotted along
the y axis. Only red blood cells appear on this cytogram.
1. 60 fL volume marker
2. 120 fL volume marker
3. 28 g/dL HC marker
4. 41 g/dL HC marker
The RBC Method
Volume - MCV
Normocytic
Normochromic
Microcytic
28
41
HGB Concentration - CHCM
Hyperchromic
Macrocytic
Volume - MCV
The RBC Method
HGB Concentration - CHCM
The RBC Method
28
41
The RBC Method
The RBC Volume histogram represents the
distribution of red blood cells by cell volume.
The histogram has a range from 0 fL to 200 fL.
Normal samples have a bell-curve shaped
distribution with a mode channel between
60 fL and 120 fL.
The mean corpuscular volume (MCV) and
the red cell distribution width (RDW) are
determined from this histogram.
• MCV is the mean of the of RBC Volume
histogram.
• RDW is the coefficient of variation of the
population.
The RBC Method
The RBC hemoglobin concentration (RBC HC)
histogram represents the distribution of red blood
cells by cellular hemoglobin concentration.
The histogram has a range from 0 g/dL to 50 g/dL.
Normal samples have a bell-curve shaped
Hgb concentration distribution with a mean
channel between 28 g/dL and 41 g/dL.
The cell hemoglobin concentration mean (CHCM)
and the hemoglobin distribution width (HDW) are
obtained from this histogram.
• CHCM is the mean of the RBC HC histogram.
• HDW is the standard deviation of the RBC HC
histogram.
The RBC Method
The RBC CH (cellular hemoglobin) histogram
represents the distribution of red blood cells by
the amount of hemoglobin present in each cell
independent of cell volume.
The histogram has a range from 0 picograms to
100 picograms.
•
Cellular Hemoglobin Content (CH) is the mean of
the RBC CH histogram.
•
Cell hemoglobin distribution width (CHDW)
is the standard deviation of the RBC CH histogram.
The RBC Method
Calculating reported parameters
•
RBC
(Red Blood cel Count)
Number of Red Cells (directly measured)
•
MCV
(Mean Corpuscular Volume)
Mean of RBC Volume histogram
•
HCT
(Hematocrit)
(RBC x MCV) ÷ 10
•
MCH
(Mean Corpuscular
Hemoglobin)
(HGB ÷ RBC) x 10
•
MCHC
(HGB ÷ [RBC x MCV]) x 1000
(Mean Corpuscular
Hemoglobin Concentration)
The RBC Method
Calculating reported parameters
•
CHCM
Mean of RBC HC histogram
(Corpuscular Hemoglobin
Concentration Mean)
•
CH
(Corpuscular Hemoglobin
content)
•
RDW
100 x (SD of RBC Volume histogram ÷ MCV)
(Red cell volume Distribution
Width)
•
HDW
(Hemoglobin concentration
Distribution Width)
Mean of RBC CH histogram
SD of RBC HC histogram
The RBC Method
Calculating reported parameters
•
%MICRO
Percent of red blood cells smaller than 60 fL
•
%MACRO
Percent of red blood cells larger than120 fL
•
%HYPO
Percent of red blood cells with less than 28 g/dL HGB
•
%HYPER
Percent of red blood cells with more than 41 g/dL HGB
The three severity levels are: +, ++ or +++ and are customized by Bayer for each customer site
based on the technologists severity levels on the manual differentials
The Platelet Method
The 2-Dimensional platelet analysis (2D-PLT method)
is based on the integrated analysis of red blood cell
and platelet measurements.
Area of Platelet Analysis
Volume = Size
The Platelet Method
Using the Mie theory of light scattering for homogeneous
spheres , the low-angle and high-angle light scatter signals
for each cell are transformed into volume and refractive index
values.
The PLT Scatter cytogram is the graphical representation
of two light-scatter measurements
• (5° to 15°), scatter is plotted on the x axis
• (2° to 3°), scatter is plotted on the y axis
Refractive Index = Platelet Content
The Platelet Method
PLATELET CYTOGRAM
2
5
3
1
4
1
2
3
4
5
Platelets
Large platelets
Red blood cells
RBC fragments
RBC ghosts
The Platelet Method
The 2D-PLT VOL histogram shows the distribution of cells
by volume. Volume data are obtained from the integrated
analysis.
The histogram has a range from 0 fL to 60 fL.
The Platelet Method
Calculating reported parameters
•
PLT
(Platelet count)
PLT Count x RBC Cal Factor x PLT Cal Factor
•
MPV
(Mean Platelet Volume)
Mean of 2D-PLT Vol histogram
•
Large LPLT
(Large Platelets)
Platelets with volumes greater than 20 fL
The Platelet Method
Morphology Flags
The three severity levels are: +, ++ or +++
•
LPLT
(Large Platelets)
The percentage of large platelets (%LPLT) is greater than
10% of the platelet count
•
RBCF
(RBC Fragments)
The presence of RBC fragments is suspected. This flag is
triggered if the number of events in the RBC Fragment area of
the PLT Scatter cytogram is greater than 100,000 cells/ul
•
RBCG
(RBC Ghosts)
The presence of RBC ghosts is suspected. This flag occurs if
the number of events in the RBC Ghost area of the PLT Scatter
cytogram is greater than 100,000 cells/ul
The Retic Method
ADVIA 120 autoRETIC contains:
- Oxazine 750, 11.4 mg/L
- Buffer
- N-Tetradecyl-N,N-dimethyl-3-ammonio-1-propane sulfonate, 0.023 mmol/L
Reaction:
The ADVIA 120 autoRETIC reagent contains a zwitterionic detergent (surfactant)
that isovolumetrically spheres the red cells.
It also contains a cationic dye, Oxazine 750, that stains cells according to their
RNA content.
The Retic Method
The Retic Method
Laserdiode
Sample stream
Beamsplitter
Dark stop
Absorption
detector
Low-angle
scatter
detector
Mirror
Referentie signaal
Front view of the dark stop
High-angle
scatter
detector
The Retic Method
The RETIC Scatter ABS cytogram is the graphical
representation of the absorption and light-scatter
measurements:
• absorption (cell maturation) is plotted along the x axis
• light scatter (cell size) is plotted along the y axis.
1
2
3
4
5
A
B
C
D
E
F
RTC Platelet threshold
RTC Coincidence threshold
RTC threshold
Low/Medium RTC threshold
Medium/High RTC threshold
Mature RBCs
Low absorption retics
Medium absorption retics
High absorption retics
Platelets
Coincidence events
The Retic Method
The RETIC Volume histogram represents the overlaid
distributions of mature RBCs and reticulocytes by cell
size only.
The histogram has a range from 0 fL to 200 fL..
The RETIC hemoglobin concentration (RETIC HC)
histogram represents the overlaid distributions of mature
RBCs and reticulocytes by cellular hemoglobin
concentration only.
The histogram has a range from 0 g/dL to 50 g/dL.
Mature RBC population (red)
Reticulocyte population (blue)
The Retic Method
The RETIC cellular hemoglobin (RETIC CH) histogram
represents the overlaid distributions of mature RBCs
and reticulocytes by the actual weight or mass of
hemoglobin present in each cell.
The histogram has a range from 0 pg to 100 pg.
Mature RBC population (red)
Reticulocyte population (blue)
The Retic Method
Calculating reported parameters
•
%RETIC
(%Reticulocytes)
100 x (RETIC Count) x % Retic Cal Factor
•
#RETIC
(#Reticulocytes)
RBC x (%Retic ÷ 100)
•
MCVr
(Mean Cell Volume
reticulocytes)
Mean of the RETIC Volume histogram for the reticulocyte
population
•
CHr
(Cellular Hemoglobin
content reticulocytes)
Mean of the RETIC CH histogram for the reticulocyte
population
•
CHCMr
Mean of the Retic HC histogram for the reticulocyte population
(Cell Hemoglobin
Concentration Mean reticulocytes)
The Retic Method
Calculating reported parameters
•
IRF-H
(Immature Reticulocytes
Fraction High)
100 x (#HRetic ÷ RETIC Count)
•
IRF-M+H
(Immature Reticulocytes
Fraction Medium + High)
100 x ([#HRetic + #MRetic] ÷ RETIC Count)
These Parameters Not FDA Cleared For Reporting - Investigational Use Only
The Retic Method
Erythropoietin Treatment
Beginning
After 2 weeks
After 4 days
After 1 month
The Perox Method
ADVIA 120 PEROX 1 contains:
-
Sodium dodecyl sulfate, 0.36 mmol/L
Sorbitol, 620 mmol/L
Sodium chloride, 8.35 mmol/L
Formaldehyde, 5.5%
BRIJ-35, 0.100 mmol/L
Buffer
Reaction:
- Surfactants (sodium dodecyl sulfate and Brij-35) in combination with thermal stress
lyse the red blood cells.
- Formaldehyde fixes the white blood cells.
The Perox Method
ADVIA 120 PEROX 2 contains:
- 4-Chloro-1-naphthol, 44.8 mmol/L
- Diethylene glycol, 99.2%
ADVIA 120 PEROX 3 contains:
- Stabilizer
- Hydrogen peroxide, 0.3%
Reaction:
- The 4-Chloro-1-naphthol in ADVIA 120 PEROX 2 serves as a substrate that enables the
hydrogen peroxide in ADVIA 120 PEROX 3 to form a dark precipitate at sites of peroxidase
activity in the granules of white blood cells as described by the following equation:
cellular peroxidase
H2O2 + 4-chloro-1-naphthol
dark precipitate within the cells
The Perox Method
If you have the granules - we have the stain
I’m
melting
PEROX
STAIN
But you
still look
pale
Boy,
your granules
look great !
The Perox Method
Number of neutrophil granules
Bone marrow
Blood
# granules
Promyelocytes
Myelocytes
Metamyelocytes
Band cells
Mature PMN
Blasts
Cell maturation
The Perox Method
Cytochemical classification according to peroxidase activity
Cel type
Peroxidase
Myeloblasts
Promyelocytes
Myelocytes
Metamyelocytes
Band cells
Neutrophils
Eosinophils
Basophils
Lymphoblasts
Prolymphocytes
Lymphocytes
Atypical lymphocytes
Monoblasts
Promonocytes
Monocytes
Plasma cells
Nucleated red blood cells
-, sometimes ½+ (especially micromyeloblasts)
3+
3+
3+
2-3+
2+
4+
½-1+ (stay unstained in the ADVIA 120)
½-1+
1+
-
The Perox Method
Absorption detector
Filter
Scatter detector
Tungsten lamp
Sample stream
Beam splitter
Dark
stop
The Perox Method
Scatter signal to measure the volume of
the cells
Absorption signal for peroxidase activity
measurement
Cells with medium peroxidase activity
absorbs less light
than cells with high peroxidase activity
The Perox Method
Light scatter = Cell Size
The PEROX cytogram is divided into 100 counting channels
on each axis. The cells absorb light proportional to the
amount of peroxidase stain present, and this is represented
on the x axis. Cells scatter light proportional to their size,
and this is represented on the y axis.
When the light scatter and absorption data are plotted,
distinct populations or clusters are formed. Cluster analysis
identifies each population based on its position, area, and
density, and then the number of cells in each population is
processed. The lines that separate the different cell
populations are calculated by the software on a sample-bysample basis.
Absorbed light = Peroxidase Activity
1
2
3
4
5
6
7
8
Noise
Nucleated Red Blood Cells
Platelet Clumps
Lymphocytes and Basophils
Large Unstained Cells
Monocytes
Neutrophils
Eosinophils
The Perox Method
The Perox Method
Calculating reported parameters
•
WBCP
•
%NEUT
(%Neutrophils)
([100 x Neutrophil Count] + %HPX) ÷ PHA Cells
•
#NEUT
(#Neutrophils)
(%NEUT ÷ 100) x WBC
•
%LYMPH
(%Lymphocytes)
([100 x Lymphocyte Count] ÷ PHA Cells) - %BASO
•
#LYMPH
(#Lymphocytes)
(%LYMPH ÷ 100) x WBC
•
%MONO
(%Monocytes)
(100 x Monocyte Count) ÷ PHA Cells
•
#MONO
(#Monocytes)
(%MONO ÷ 100) x WBC
RawWBC x (PeroxCalFactor)
(White Blood cell Count Perox)
The Perox Method
Calculating reported parameters
•
%EOS
(100 x Eosinophil Count) ÷ PHA Cells
(%Eosinophils)
•
#EOS
(%EOS ÷ 100) x WBC
(#Eosinophils)
•
%LUC
(100 x LUC Count) ÷ PHA Cells
(%Large Unstained Cells))
•
#LUC
(%LUC ÷ 100) x WBC
(#Large Unstained Cells)
The Perox Method
Morphology Flags
The three severity levels are: +, ++ or +++
•
ATYP
(Atypical Lymphocytes)
The presence of atypical lymphocytes is suspected.
•
IG
(Immature Granulocytes)
The presence of immature granulocytes is suspected.
•
MPO
•
NRBC
The presence of nucleated red blood cells is suspected.
(Nucleated Red Blood Cells)
•
PLT-CLM
(Platelet Clumps)
Sample is a weak peroxidase stainer.
(Myeloperoxidase deficiency)
Presence of clumped platelets is suspected.
The Baso Method
ADVIA 120 BASO contains:
-
Hydrochloric acid, 9.00 mmol/L
Phthalic acid, 21.49 mmol/L
Preservative
Surfactant
Reaction:
- The ADVIA 120 BASO reagent contains phthalic acid and a surfactant which lyses
the red cells, platelets, and the cytoplasm of all white cell types except basophils.
The Baso Method
The Baso Method
Laserdiode
Sample stream
Beamsplitter
Dark stop
Absorption
detector
Low-angle
scatter
detector
Mirror
Referentie signaal
Front view of the dark stop
High-angle
scatter
detector
The Baso Method
When the high-angle light scatter (nuclear configuration) is
plotted on the x axis, and the low-angle light scatter (cell
size) is plotted on the y axis, distinct populations or clusters
are formed. Cluster analysis identifies each population based
on its position, area, and density, and then counts the
number of cells/nuclei in each population.
The BASO cytograms is representative of a patient specimen.
Nuclear Configuration
1
2
3
4
5
6
7
Noise
Blast cell nuclei
Mononuclear WBCs (Monocyte and Lymphocyte nuclei)
Basophils
Baso Suspect
Saturation
Polymorphonuclear WBCs (Neutrophil and Eosinophil
nuclei)
The Baso Method
The Baso Method
Calculating reported parameters
•
WBCB
RawWBC x (BasoCalFactor)
(White Blood cell Count Baso)
•
%BASO
(%Basophils)
100 x (BASO Count ÷ BASO PHA Cells )
•
#BASO
(#Basophils)
(%BASO ÷ 100) x WBCB
•
%BLAST
(%Blasts)
100 x (Blasts ÷ BASO PHA Cells )
•
%MN
100 x (MN ÷ BASO PHA Cells )
(%Mononuclear cells)
•
%PMN
•
%BASO Suspect
(%BASO Suspect)
100 x (PMN ÷ BASO PHA Cells )
(%Polymorphonuclear cells)
100 x (BASO Suspect ÷ BASO PHA Cells )
The Baso Method
Morphology Flags
The three severity levels are: +, ++ or +++
•
BLASTS
(Blasts)
The presence of blasts is suspected.
•
LS
(Left Shift)
The presence of nonsegmented neutrophils (bands) is suspected.
THE END