Medical Forum / General / Laboratory / February 2008
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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