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Medical Forum / General / Laboratory / February 2008

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Flow cytometry: an automated blood smear?

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douglas - 22 Feb 2008 09:59 GMT
Isn't flow cytometry essentially an expensive, automated blood smear
that can do complex surface protein analyses, among other cool,
complex things?

If you put a bone marrow or blood sample from a patient w/ HCL into a
flow cytometer, tagged the cells w/ fluoroantibodies for fibronectin,
CD19, CD20, CD22, CD11c, CD25, CD103, FMC7, and "pressed start", what
would the readout look like?

Which would be better for detecting SLE, ANA and Anti-Sm titers, LE
Prep, or flow cytometry of blood w/ fluoroantibodies for CD68?

Thanks!!! Esp. you, Ms. Dilworth!!!
Manky Badger - 22 Feb 2008 22:57 GMT
> Isn't flow cytometry essentially an expensive, automated blood smear
> that can do complex surface protein analyses, among other cool,
> complex things?

In a word, no.

> If you put a bone marrow or blood sample from a patient w/ HCL into a
> flow cytometer, tagged the cells w/ fluoroantibodies for fibronectin,
> CD19, CD20, CD22, CD11c, CD25, CD103, FMC7, and "pressed start", what
> would the readout look like?

Type "flow cytometry print out" into Google Images.
I realise that's not very helpful, but what exactly are you asking here?

> Which would be better for detecting SLE, ANA and Anti-Sm titers, LE
> Prep, or flow cytometry of blood w/ fluoroantibodies for CD68?

LE preps....... does anyone do these any more?
douglas - 22 Feb 2008 23:44 GMT
> > Isn't flow cytometry essentially an expensive, automated blood smear
> > that can do complex surface protein analyses, among other cool,
[quoted text clipped - 14 lines]
>
> LE preps....... does anyone do these any more?

Ah, thanks for the quick answers. Now, can someone give me the long
answers?

Doug
Manky Badger - 23 Feb 2008 09:43 GMT
On Feb 22, 2:57 pm, "Manky Badger" <you.m...@be.joking> wrote:
> "douglas" <Protoman2...@gmail.com> wrote in message
>
[quoted text clipped - 18 lines]
>
> LE preps....... does anyone do these any more?

Ah, thanks for the quick answers. Now, can someone give me the long
answers?
______________________________________________________

Yes - if you'd actually give a meaningful question.
JEDilworth - 23 Feb 2008 03:23 GMT
Douglas,

I know absolutely nothing about flow cytometry. This is a branch of the
Hematology Department and the last time I did any hematology was twenty
years ago, and it was only basic stuff. Flow didn't exist when I trained
back in the 70's.

ANA's (antinuclear antibodies) are done at a screening dilution. If
negative there, no further testing is done. If the screening dilution is
positive, then the serum is further diluted or "titered" out to the end
point. Certain patterns indicate further tests to be run. That's about
all I know about them. This test was only beginning to be used when I
trained and it was a sendout then. We did not start to do them until
much later, and I personally have never performed them, as they are done
in the Serology department of most labs. I've only ever performed very
basic serology testing - usually STAT stuff. ANA's are not a STAT
procedure, and it takes a lot of training to be able to know how to read
the patterns and properly interpret them.

http://en.wikipedia.org/wiki/Anti-nuclear_antibody - more information
http://arthritis.webmd.com/antinuclear-antibodies-ana
http://tinyurl.com/238nap
http://tinyurl.com/22nfhc - pics of some of the fluorescent patterns
here - test is performed on special slides with cells (various types)
and read under a fluorescent microscope. There is a table down near the
bottom that lists the various patterns that correlate with disease
processes. All positive patterns are co-signed by a pathologist before
charting. It takes quite awhile to become proficient in reading these
tests.

I don't think anyone does LE preps any more. There are more modern ways
to diagnose lupus nowadays. The preps itself exposed the technologist to
large amounts of blood and aerosols, which would not be acceptable in
these days of HIV and Hepatitis B and C. The way we did them in the
70's, when I trained, was to draw a tube of blood, allow it to clot.
Then the actual clot was forced through a special copper (?) sieve with
something that mashed it through. The mashed blood clot was put onto
slides (specially prepared pull-apart slides). It was an art form to get
them done correctly. Then the techs had to manually scan at least four
of these slides (I think) from end to end, row after row, looking for
the special LE cells. I don't remember what they were supposed to look
like. They were tedious to read, took forever, and depended on the
technologist knowing what the cells looked like and not giving into
scanning fatigue. You had to traumatize the cells in order to get the LE
cells to form, assuming that the antibodies were present. At another
hospital we used to draw them in tubes with beads inside to traumatize
them that way. I never saw how they made their preps as I worked in
micro there and only drew the blood when I went on the floor in the
morning.

http://www.thecrookstoncollection.com/v/tests/LE-cellprep-zoom.jpg.html  
- here's some more information.

http://en.wikipedia.org/wiki/Flow_cytometry - basic information, not
very medically oriented
http://biology.berkeley.edu/crl/flow_cytometry_basic.html - more
extremely technical stuff

I know they use flow to stage breast tumors, but how this is done I
cannot say. Sorry I can't help you out.

Judy Dilworth, M.T. (ASCP)
Microbiology

> Thanks!!! Esp. you, Ms. Dilworth!!!
douglas - 23 Feb 2008 04:43 GMT
On Feb 22, 7:23 pm, "JEDilworth" <bactit...@nospamhortonsbay.com>
wrote:
> Douglas,
>
[quoted text clipped - 59 lines]
>
> - Show quoted text -

That was a cool response, though!!!! One time, on House MD, they had
to perform an LE Prep w/ a paperclip! And my urologist friend, Dr Ray
A. Sleiman, said he'll put me in touch w/ a radiologist and
pathologist, so I can do rotations in their departments!!! That's
going to be cool!!!
JEDilworth - 23 Feb 2008 16:27 GMT
Douglas,

I searched in vain for a procedure for LE preps. A paperclip? That makes
no sense at all. Hollywood is full of a bunch of idiots. They have been
replaced by ANA's and are not done any more. I could not find a
procedure anywhere. Whoever is the medical source for HOUSE, MD must be
older than dirt, because new docs have probably never heard of or
ordered LE preps. I think they've been off lab menus for at least 15
years, probably much longer.  I can't even watch that show any more
because the lab medicine and the situations are so ridiculously out of
the norm. Doctors do NOT perform lab work - let alone in dark labs with
theater lighting. The tests they perform are mostly send-outs that take
a week to get back. At least they could have the courtesy to set up a
"real" lab with "real" technical people doing the work.

Congrats on the rotations. I know you're eager. Just listen and don't
bombard the people with question after question right out of the box.
I'm not saying NOT to ask questions, but if you're insanely eager it
could backfire on you. We teach MT students all the time. The ones I
like are the ones that are INTERESTED but let me say my piece. The ones
that don't ask ANY questions are suspect also.

Good luck.

Judy Dilworth, M.T. (ASCP)
Microbiology

That was a cool response, though!!!! One time, on House MD, they had
to perform an LE Prep w/ a paperclip! And my urologist friend, Dr Ray
A. Sleiman, said he'll put me in touch w/ a radiologist and
pathologist, so I can do rotations in their departments!!! That's
going to be cool!!!
Manky Badger - 23 Feb 2008 17:43 GMT
> Douglas,
>
> I searched in vain for a procedure for LE preps. A paperclip? That makes
> no sense at all.

Yes - paperclips :o)

When I was a lad we would take 10ml of blood into a "universal" container
with a few paperclips and shake it with all our might for 10 minutes as the
first stage of an LE preparation - the idea being to defibrinate the blood
and to damare the neutrophils so's the monocytes would engulf them - ie to
cause LE cell formation.
JEDilworth - 24 Feb 2008 05:06 GMT
Okay - THAT makes sense. We did it by the aforementioned mashing of the
clot through a metal sieve or drawing in a heparainized tube with glass
beads. I believe they put the beaded tubes on a tilter thingie and the
beads were what damaged the cells.

I was trying to imagine making a smear with a paperclip and it wasn't
working for me. Thanks for clearing that up.

Judy Dilworth, M.T. (ASCP)
Microbiology

> Yes - paperclips :o)
>
[quoted text clipped - 3 lines]
> defibrinate the blood and to damare the neutrophils so's the monocytes
> would engulf them - ie to cause LE cell formation.
douglas - 24 Feb 2008 08:05 GMT
On Feb 23, 9:06 pm, "JEDilworth" <bactit...@nospamhortonsbay.com>
wrote:
> Okay - THAT makes sense. We did it by the aforementioned mashing of the
> clot through a metal sieve or drawing in a heparainized tube with glass
[quoted text clipped - 16 lines]
>
> - Show quoted text -

I meant using the paperclip as a sub for the glass beads.
Manky Badger - 24 Feb 2008 20:32 GMT
"douglas" <Protoman2050@gmail.com> wrote in message
news:84421a5f-979c-445e-9ad5-

I meant using the paperclip as a sub for the glass beads.
______________________________________________________

Yes - that is what happens. Or, should I say "happened".
This is now many years out of date.
Vincenzoni aioe - 23 Feb 2008 16:54 GMT
"douglas" <Protoman2050@gmail.com> ha scritto nel messaggio
news:af071acc-bde3-4b75-b811-

> Isn't flow cytometry essentially an expensive, automated blood smear

Only in that it yields some percentages dealing with the distribution of
white blood cells subpopulations.

Subpopulation classification criteria differ from the "acid dye vs basic dye
affinity" criteria (eventually leading to what we call "morpholgy patterns")
the classic smear is based upon.

> Which would be better for detecting SLE,

SLE diagnostic criteria encompass more than  laboratory tests.

>  ANA and Anti-Sm titers,

this one,

ciao
 
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