The Astrim is a noninvasive hemoglobin monitoring device that uses near-infrared radiation. We studied the usefulness of this device for patients with hematological disorders. We measured hemoglobin levels 309 times in 140 subjects, using an automated hematology analyzer (K-4500) and the Astrim. The coefficient of correlation between Hb levels with the K-4500 (K-Hb) and the Astrim (A-Hb) was r = 0.591 (P < 0.001). The coefficient of correlation between A-Hb and K-Hb from 174 specimens with anemia and 135 without anemia was r = 0.531 (P < 0.001) and r = 0.345 (P < 0.001), respectively. In the 309 specimens, the Astrim showed a diagnostic sensitivity and specificity for anemia of 78.3% and 69.0%, respectively. While the r-values, sensitivity, and specificity were passable, they appeared to be insufficient for an accurate evaluation. We believe this was caused by the measurement conditions (i.e., the finger selected for measurement, the finger position in relation to the CCD camera, and the finger temperature). On the other hand, the precision test results were good. Therefore, if careful attention is paid to measurement conditions, the noninvasive Astrim is clinically useful for continuous hemoglobin monitoring of hematological disorders and patients with hemorrhagic diseases, such as perioperative hemorrhage and gastrointestinal bleeding. However, it is difficult to determine Hb concentrations in one measurement using the Astrim because the r-values, sensitivity, and specificity are insufficient for accurate evaluations of in-patients, particularly patients with advanced diseases. Therefore, we believe it is necessary to improve the system so that A-Hb can be accurately determined in one measurement.
A 68-year-old male visited Hospital A for treatment of epistaxis, his chief complaint. He was told that he had an easily-bleeding tumor in the nasal cavity. Based of biopsy, a diagnosis of amelanotic melanoma was made. Operation was performed for removal of the tumor. About 8 months after discharge, he visited Hospital B with complaints of lumbar pain and epistaxis. After biopsy at Hospital B, malignant lymphoma (diffuse large cell) was diagnosed, and the patient was referred to our hospital. On bone marrow puncture and biopsy, tumor cell infiltration was observed. Flow cytometric surface marker analysis revealed that these tumor cells were negative for CD45. Results of HE staining of the nasal cavity tumor were insufficient for diagnosis, and staining by immunohistochemistry was necessary to confirm the diagnosis. On immunohistochemical staining of the nasal cavity tumor tissue and bone marrow biopsy tissue, LCA, L26 and UCHL-1 were negative, and S-100 and HMB-45 positive. Recurrence of amelanotic melanoma accompanied by bone marrow infiltration was therefore diagnosed. The incidence of amelanotic melanoma with primary lesions in the nasal cavity is low. However, in making the diagnosis of a nasal cavity lesion, the possibility of such a melanoma should be kept in mind. In many cases, it is difficult to diagnose amelanotic melanoma with HE staining alone, and immunohistochemistry must be used.
Peripheral blood reticulocytes are routinely measured with an automatic blood cell analyzer. We compared the reticulocyte ratio of peripheral blood with bone marrow using the XE-2100 automated hematology analyzer (Sysmex, Kobe, Japan). Bone marrow and the peripheral blood specimens were collected at the Osaka City University Hospital and the Wakakoukai Hospital between June and October 2001. Fifty-six specimens, none with hematopoietic malignancies, were selected for XE-2100 analysis. The XE-2100 differentiates five types of WBC and determines nucleated red blood cells, reticulocytes, and platelets by flow cytometry, emitting a semiconductor laser beam, and detecting three optical signals: forward scatter, side scatter, and side fluorescence [1]. Blood is diluted with RET SEARCH diluent to a preset concentration. RET SEARCH staining solution is also added to stain WBC DNA and RNA and reticulocyte RNA. The sample is then analyzed by flow cytometry using a semiconductor laser to detect forward scattering light and side fluorescence information, upon which a reticulocyte scattergram is based. By analyzing this scattergram, reticulocyte counts, reticulocyte ratios for individual fluorescence intensity zones [low fluorescence ratio (LFR), middle fluorescence ratio (MFR), high fluorescence ratio (HFR)] and immature reticulocyte fraction (IRF) are obtained.There are many reports regarding peripheral blood reticulocytes [2, 3, 4], but few about bone marrow reticulocytes using an automated hematology analyzer [5, 6, 7, 8, 9]. We compared the reticulocyte ratio of peripheral blood with that of bone marrow using XE-2100. The reticulocyte ratio of bone marrow (2.9 ± 2.2%) is reportedly 3 times that of peripheral blood (1.6 ± 1.0%) [5], but it was 1.8 times in this study. There was a significant correlation (r = 0.80) between reticulocyte ratio of bone marrow and peripheral blood. The reticulocyte analysis of bone marrow was as follows: LFR 75.3 ± 7.0%, MFR 18.4 ± 4.5%, HFR 6.3 ± 2.8%, and IRF 24.7 ± 7.0%. We did not do an analysis of peripheral blood reticulocytes, but it was reported as follows: LFR 84.4–97.2%, MFR 12.8–14.2%, HFR 0–1.9%, and IRF 7.0–16.4% [10]. These findings suggest there are more immature reticulocytes in bone marrow than in peripheral blood.We plan to study patients whose differential diagnosis includes anemia, by comparing reticulocyte ratio and analysis of bone marrow with those of peripheral blood using XE-2100.
Connectin is known to be an anchoring protein of actomyosin filaments in skeletal muscle. Attempts were made to extract this protein from white blood cells and platelets in order to investigate its properties. The purified connectin-like protein obtained had a rubbery appearance and was insoluble in water and immobile on SDS gel-electrophoresis. Amino acid composition and electron microscopic features of the protein were similar to those of skeletal muscles. FITC-labeled antibody to the protein showed a positive reaction to the membrane fractions of red cells, white cells and platelets. In moving cells fluorescence was observed not only in pseudopod, but also in whole cytoplasm. No changes in the fluorescence patterns were observed with respect to moving stages or cell types. The presence of the protein beneath the cell membrane was also confirmed electron micrographically.
Click to increase image sizeClick to decrease image sizeKeywordsSialyl-Lewis x AntigenCancer-associated AntigenHaematologic MalignanciesEnzyme Immunoassay
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