Absolute TCD4+ counting by a minimalist dual-platform flow cytometric method

The aim of this work was to compare the performance of an absolute TCD4+ counting method based on total WBC gating versus the standard lymphocyte (Ly) gating method, in order to develop a flow cytometric (FCM) minimalist strategy for TCD4+ enumeration. METHOD: 132 routine peripheral blood samples, mainly from HIV infected patients, were labelled with CD3-FITC/CD4-PE/CD45-PECy5 and analyzed by two gating methods: a) standard method based on Ly immunological gating (CD45++SSClow), followed by the determination of CD3+CD4+ percentage and absolute number (# calculation using Ly # from hematological analyser (HA); b) total WBC immunological gate on biparametric scatter CD45/CD4, followed by CD4++SSClow percentage determination and absolute number calculation using WBC absolute number from hematological counter without using the WBC differential. Moreover on 63 samples Ly # based on Ly % from FCM and WBC counting from HA was compared with Ly # from HA. RESULTS: The TCD4+/microL ranged from 3 to 3277 and the statistical analysis results showed: a) linear regression: r2 = 0.9847; b) Bland & Altman analysis: difference mean = -56.22; agreement range = +95.68 / -208.12; c) the mean of result difference/mean value*100 between two methods was -9.06%; d) comparison between regression line and the boundaries for acceptable residual values based on regressed confidence limits found by A. Kunkl et al showed regression line within boundaries near the upper limits. The Ly/microL count ranged from 635 to 8752. The statistical analysis results showed: a) linear regression: r2 = 0.9764; b) Bland & Altman analysis: difference mean = -362.93; agreement range = +134.51 / -860.37; c) the mean of result difference/mean value*100 between two methods was -16.12%. CONCLUSIONS: Our results suggest a fair agreement between the two gating methods, but the one based on total WBC gate gives TCD4+/microL counts systematically higher than the standard method. This finding can be attributed to a systematic lower estimation of Ly% by HA.     

A cross-sectional study of umbilical cord blood donor profiles and their influence on umbilical cord blood collection in a Brazilian hospital

Background aimsUmbilical cord blood (UCB) cells are a new alternative to bone marrow source for hematopoietic stem cell transplantation and their use has increased in the last decade. Thus efforts are being made to improve the umbilical cord blood unit's quality. Besides compatibility, other factors, such as the total nucleated cell (TNC) count and the percentage of CD34⁺ cells in the product, are very important for a successful transplant outcome. Our aim was to describe our donor population and assess the best cord blood collection technique at Hospital Israelita Albert Einstein's cord blood bank (São Paulo, Brazil).MethodsThis was a retrospective study in which all analyses were performed simultaneously. A Student's t-test was used for qualitative variables for non-matched samples. For qualitative analyses, we used either the chi-square test or the exact Fisher's test.ResultsThe stratification of the population characteristics allowed us to determine which ones had an impact on unit volume, TNC count and percentage of CD34⁺ cells. A significant correlation was observed between donor characteristics and the quality of UCB units as related to maternal and gestational age, type of pregnancy, route of delivery, cord blood collection technique and birth weight.ConclusionsWe found that cord blood collection technique and newborn weight were significantly correlated with the TNC content. The collection technique used at our institution significantly improved the UCB unit volume and consequently the TNC count. Some findings, such as the impact of maternal age and newborn weight, have led us to re-evaluate our protocol in order to achieve better results.     

Initial cord blood unit volume affects mononuclear cell and CD34+ cell-processing efficiency in a non-linear fashion

Background aimsUmbilical cord blood (UCB) is a source of hematopoietic stem cells that initially was used exclusively for the hematopoietic reconstitution of pediatric patients. It is now suggested for use for adults as well, a fact that increases the pressure to obtain units with high cellularity. Therefore, the optimization of UCB processing is a priority.MethodsThe present study focused on parameters influencing total nucleated cell (TNC), mononucleated cell (MNC) and CD34 ⁺ cell (CD34C) recovery after routine volume reduction of 1553 UCB units using hydroxyethyl starch-induced sedimentation with an automated device, under routine laboratory conditions.ResultsWe show that the unit volume rather than the TNC count significantly affects TNC, MNC and CD34C processing efficiency (PEf), and this in a non-linear fashion: when units were sampled according to the collection volume, including pre-loaded anticoagulant (gross volume), PEf increased up to a unit volume of 110–150 mL and decreased thereafter. Thus units with initial gross volumes < 90 mL and > 170 mL similarly exhibited a poor PEf.ConclusionsThese data identify unit gross volume as a major parameter influencing PEf and suggest that fractionation of large units should be contemplated only when the resulting volume of split units is > 90 mL.     

Banking strategies for improving the hematopoietic stem cell content of umbilical cord blood units for transplantation

Umbilical cord blood (UCB) has become an alternative source of hematopoietic progenitors (HSC) for transplantation. Although most CB transplants have been performed in children, unrelated donor-cord blood transplants in adults have been growing steadily in recent years. HSC content of CB units influence significantly the transplantation outcome, as shown by many clinical studies. UCB banks are fundamental to support this increasing clinical activity and one of their main goals must be to store good quality units. Strategies for increasing HSC content of UCB units are reviewed and also its influence on transplantation outcome. Our bank selected the UCB units for cryopreservation on the basis of their total nucleated cells (TNC) and CD34(+) cells content. We also reviewed the results of our UCB bank program.     

Expression of hyaluronan synthase genes in umbilical cord blood stem/progenitor cells

Scientific progress reveals an ever-expanding role of hyaluronan (HA) in diverse biological functions. It has become increasingly clear that HA might also be essential for certain functions of stem cells. CD133+ cells isolated from umbilical cord blood (UCB) seem to represent an alternative to CD34+ cells as a source of transplantable haematopoietic progenitor cells. The aim of this study was to investigate expression patterns of hyaluronan synthases (HAS) genes in freshly isolated and cultured UCB progenitor cells and to compare HAS mRNA levels to those found in non-progenitor cells. CD133+ stem cells were isolated from UCB using an immunomagnetic procedure. Investigation of HAS mRNA expression patterns in CD133+ and CD133- cells by RT-PCR was performed immediately after isolation as well as after cultivation towards myelomonocytic lineage. In addition, activation patterns of mitogen activated protein kinases (MAPK) were analyzed by Western blot experiments. mRNA for HAS1 is undetectable but HAS3 mRNA can be readily detected in freshly isolated CD133+ as well as in CD133- UCB cells. More importantly, our data demonstrate that mRNA for HAS2 can only be detected in CD133+ progenitor cells. In addition, while MAPK are slightly activated in CD133- UCB cells, no significant phosphorylation of MAPK could be observed in CD133+ cells, excluding a role of these kinases in the regulation of HAS2. HAS2 is expressed only in freshly isolated CD133+ cells and quickly diminishes during differentiation. Because of this, HAS2 gene expression might be suitable as a new marker for CD133+ UCB-derived stem cells.     

Feasibility of cord blood collection for autologous cell therapy applications in extremely preterm infants

Background aimsUmbilical cord blood (UCB)-derived cells show strong promise as a treatment for neonatal brain injury in pre-clinical models and early-phase clinical trials. Feasibility of UCB collection and autologous administration is reported for term infants, but data are limited for preterm infants. Here the authors assessed the feasibility of UCB-derived cell collection for autologous use in extremely preterm infants born at less than 28 weeks, a population with a high incidence of brain injury and subsequent neurodisability.MethodsIn a prospective study at a tertiary hospital in Melbourne, Australia, UCB was collected from infants born at less than 28 weeks and processed to obtain total nucleated cells (TNCs), CD34+ cells, mononuclear cells and cell viability via fluorescence-activated cell sorting prior to cryopreservation. Feasibility was pre-defined as volume adequate for cryopreservation (>9 mL UCB collected) and >25 × 10⁶ TNCs/kg retrieved.ResultsThirty-eight infants (21 male, 17 female) were included in the study. Twenty-four (63.1%) were delivered via cesarean section, 30 (78.9%) received delayed cord clamping before collection and 11 (28.9%) were a multiple birth. Median (interquartile range [IQR]) gestational age was 26.0 weeks (24.5–27.5) and mean (standard deviation) birth weight was 761.5 g (221.5). Median (IQR) UCB volume collected was 19.1 mL/kg (10.5–23.5), median (IQR) TNC count was 105.2 × 10⁶/kg (57.4–174.4), median (IQR) CD34+ cell count was 1.5 × 10⁶/kg (0.6–2.1) and median (IQR) cell viability pre-cryopreservation was 95% (92.1–96.0). Feasibility of collection volume and cell count suitable for cell cryopreservation was achieved in 27 (71%) and 28 (73.6%) infants, respectively.ConclusionsUCB-derived cell collection adequate for cryopreservation and subsequent autologous reinfusion was achieved in 70% of extremely preterm infants. Extremely preterm UCB demonstrated a higher CD34+:TNC ratio compared with published full-term values. Recruitment to demonstrate safety of UCB cell administration in extremely premature infants is ongoing in the CORD-SAFE study (trial registration no. ACTRN12619001637134).     

A novel high-yield volume-reduction method for the cryopreservation of UC blood units

BACKGROUND: For the application of umbilical cord blood (UCB) units as hematopoietic grafts, a dose of 3.7 x 10(7) nucleated cells (NC)/kg body weight is required. NC can be lost during volume-reduction processing and during thawing. A novel modification of the double-processing protocol with the aim of minimizing NC loss is described and evaluated. METHODS: One-hundred and fifty UCB were collected. The volume was reduced by a centrifugation step following double-processing in the presence of 2% HES 200/0.5. Pre- and post-processing cell counts and platelet parameters were measured with an automatic counter. The number of viable CD34+ hemopoietic stem cells was measured by flow cytometry. In 25 of the samples, colony-forming units (CFU) were also determined. The same samples were thawed 6 months after cryopreservation and re-evaluated. RESULTS: The volume was reduced to 6 +/- 1.5 mL. The recovery of NC, MNC, CD34+ hemopoietic stem cells, RBC depletion and CFU following double-processing was 93.6 +/- 3.2%, 95.8 +/- 2.2%, 98.4 +/- 1.5%, 96.8 +/- 1.1% and 107.1 +/- 6.1% (for 25 samples), respectively. The post-thaw recoveries of NC, MNC, CD34+ hemopoietic stem cells and CFU (for 25 samples) were 78.6 +/- 5.4%, 90.8 +/- 4.4%, 96.4 +/- 2.5%, 89.1 +/- 4.1%, respectively. No post-thaw cell aggregation was observed. A significant (P<0.05) post-thaw loss of platelets and signs of platelet activation was observed. DISCUSSION: The protocol uses non-expensive equipment and clinically approved materials and results in samples that can be used in patients with a mean weight of 32.7 kg.     

Owl monkey vitreous: A novel model for hyaluronic acid structural studies

Circular dichroism (CD) studies have been made on hyaluronic acid (HA) obtained from dialyzed owl monkey vitreous. The protein content of these samples is low enough not to interfere with the CD measurements of hyaluronic acid. The ellipticity values of vitreous HA are higher than those of HA from other tissues, indicating a higher degree of preferred order. Since the purification procedures involve only dialysis, the owl monkey vitreous can be a model tissue for structural studies of HA close to its native state.     

Quantity and proliferation rate of mesenchymal stem cells in human cord blood during gestation

UCB (umbilical cord blood) as a resource of MSCs (mesenchymal stem cells) is widely accepted, but the quantity and characteristics of UCB-MSCs from different gestational ages have not been well studied. We have quantified the number of MSCs in UCB at different gestational ages using a multi-colour flowcytometer and compared the cell proliferation rates of these UCB-MSCs. Defining MSCs as CD44+/CD105+/CD34-/CD45 population, their numbers declined in the UCB at the gestational age. Proliferation rates were significantly higher in UCB before term than at full term. Non-full term UCB samples may be a better source of MSCs.     

Single- versus dual-platform assays for human CD34+ cell enumeration

We comparatively assessed CD34+ cell quantification by two of the recently available single platform assays, the IMAGN 2000 STELLer (Immucor, Lisbon, Portugal) microvolume fluorimetry and the ProCOUNT (BD-ENZIfarma, Lisbon, Portugal) flow cytometry, with our "in-house" dual-platform flow cytometric assay. The performance of the methods was evaluated by linearity and reproducibility tests. The linearity study, over a range of 0-1,200 CD34+ cell/microl, gave a good linear relationship for the three methods, with R(2) > 0.99. Precision tested at three different concentrations gave coefficients of variation ranging from 3.6-26.4% for the STELLertrade mark, 2.4-13.8% for the ProCOUNT, and 3.2-6.4% for flow cytometry. CD34+ cells were quantified in umbilical cord blood (UCB), UCB enriched-leukocyte buffy-coat (BC), mobilized peripheral blood (PB) and mobilized peripheral blood progenitor cells (PBPC) collected by leucapheresis, from a total of 72 samples. Flow cytometric results showed good linear correlation to the absolute counts obtained by the STELLer and ProCOUNT for all samples (R > 0.90 for all methods), with no differences when compared by paired tests (P > 0.05). Linear correlations between methods were also found when individually looking at the different cell sources: UCB or PB, BC, and PBPC, with low, intermediate and high CD34+ cell concentrations, respectively. Furthermore, with the exception of a significant difference between the ProCOUNT and STELLer results for UCB (P < 0.05), no other difference between methods was found for each of the individual populations (P > 0.05). To our knowledge, this is the first report in which the results are presented and analyzed according to each source of CD34+ cells. Our results show that the STELLer and the ProCOUNT are equally efficient for the dual-platform flow cytometric assay in CD34+ cell quantification.     

Cord blood volume reduction using an automated system (Sepax) vs. a semi-automated system (Optipress II) and a manual method (hydroxyethyl starch sedimentation) for routine cord blood banking: a comparative study

Background With the development of cord blood banking, solutions have to be found to solve the storage space problem, by reducing the volume of cord blood units (CBU). Methods We compared total nucleated cell (TNC) and CD34(+) cell counts before and after processing with three different CBU volume reduction methods used consecutively in our bank: a manual method based on hydroxyethyl starch sedimentation (HES) (n=447), a top-and-bottom (TB) semi-automated method (n=181) using Optipress II, and the Sepax automated method (n=213). Statistical analysis was done using t-tests, linear regression and Spearman correlation coefficients. Adjusted variables included TNC, CD34(+) cell counts, CD34(+) cell percentage and CB volume before processing. Results TNC recovery was higher with Sepax (80.3+/-7.7%) than with HES (76.8+/-9.1%) and TB (60.7+/-13.5%) (P<0.0001, both). It was higher with HES than with TB (P<0.0001). CD34(+) cell recovery was higher with Sepax (86+/-11.6%) than with HES (81.5+/-12.5%) and TB (82.0+/-17.7%) (P<0.008 and <0.0001, respectively) and results with HES and TB were not significantly different (P=0.7). Interestingly, with Sepax, TNC and CD34(+) cell recoveries were not correlated with pre-processing values (P=0.8 and 0.4, respectively). Discussion In conclusion, the Sepax volume reduction method allows higher TNC and CD34(+) cell recoveries.     

MEK- 6318K 型血液分析仪对黄疸型肝病患者白细胞的检测

目的：探讨使用MEK-6318K血细胞分析仪时升高的胆红素对黄疸型肝病患者的白细胞结果影响程度及检测失败的原因,并提出解决方法。方法：对60例黄疸型肝病患者的标本分成两组：总胆红素在20—100umol／L范围30例,在100．1—250umol／L范围30例。均使用EDFA—K2抗凝真空采集病人静脉血2ml,分别用MEK-6318K血细胞分析仪和手工操作方法对同一标本进行血液细胞的分析测定。结果：总胆红素在20—100umol／L范围内30例患者的标本,两种方法测定白细胞结果经统计学处理P〉0．05无显著性差别;总胆红素在100．1—250umol／L范围内30例患者的标本,两种方法测定白细胞结果,经统计学处理P〈0．001有极显著性差别。结论：在使用MEK-6318K血细胞分析仪检测高黄疽标本时一定要注意白细胞结果,对报警标本,可以采用静脉血10ul测定模式,但最好采用手工操作来检测标本,这样才能为临床提供更准确结果。     

Influence of hyaluronic acid binding on the actin cortex measured by optical forces

Melanoma cells are often surrounded by hyaluronic acid (HA) rich environments, which are considered to promote tumor progression and metastasis. Induced effects in compound materials consisting of cells embedded in an extracellular matrix have been studied, however, alterations of the single cells have never been addressed. Here, we explicitly addressed single cell properties and measured HA‐induced biomechanical changes via deformations induced solely by optical forces. With the optical stretcher setup, cells were deformed after culturing them in either the presence or absence of HA revealing the crucial interplay of HA with the CD44 receptor. To assess the role of CD44 in transducing effects of HA, we compared a CD44 expressing variant of the melanoma cell line RPM‐MC to its natural CD44‐negative counterpart. Our measurements revealed a significant stiffness change, which we attribute to changes of the actin cytoskeleton.     

An efficient two-step method to purify very small embryonic-like (VSEL) stem cells from umbilical cord blood (UCB)

The identification in murine bone marrow (BM) of very small embryonic-like (VSEL) stem cells, possessing several features of pluripotent stem cells, encouraged us to investigate if similar population of cells could be also isolated from the human umbilical cord blood (UCB). Here our approach to purify VSEL from human UCB is described by employing a two step isolation strategy based on i) hypotonic lysis of erythrocytes followed ii) by multi-parameter FACS sorting. Accordingly, first, erythrocytes are removed from the UCB samples by hypotonic ammonium chloride solution and next, the UCB mononuclear cells (UCB MNC) are stained with monoclonal antibodies against all hematopoietic lineages including the common leukocyte antigen CD45. The cells carrying these markers (lin+CD45+) are eliminated from the sort by electronic gating. At the same time the antibodies against CXCR4, CD34 and CD133 are employed as positive markers to enrich the UCB MNC for VSEL. This combined two step approach enables to purify VSEL stem cells, which are small and express mRNA for pluripotent stem cells (PSC) (Oct-4 and Nanog) and tissue-committed stem cells (TCSC) (Nkx2.5/Csx, VE-cadherin and GFAP) similarly to those isolated from the adult BM (3-5 microm cells with large nuclei).     

影响脐带血采集质量的相关性因素分析

目的回顾性分析影响脐带血采集质量的母婴因素和采集处理因素。 方法记录389份脐带血的采集量、母亲年龄、孕龄、新生儿体重、分娩方式、新生儿性别、胎次及脐带血采集至计数间隔以及采集方式。用KX-21型全自动血液分析仪进行细胞计数并计算有核细胞总数（TNC）。采用Pearson相关和Spearman秩相关进行相关性分析,采用t检验、Mann-Whitney U检验、方差分析及Kruskal-Wallis H检验进行分组比较,分析影响脐带血采集量和TNC的相关因素。? 结果脐带血采集量与TNC显著相关（r = 0.723,P < 0.001）,脐带血采集量大于80 ml时的TNC显著高于低体积者。在母婴因素中,母亲年龄与采集量及TNC差异均无统计学意义;孕龄与采集量负相关（r = -0.119,P = 0.019）,而与TNC正相关（r = 0.138,P = 0.007）,足月儿脐带血的TNC显著高于早产儿（P = 0.038）;婴儿出生体重与采集量及TNC均正相关（r = 0.236,P < 0.001;r = 0.275,P < 0.001）,体重较大婴儿脐带血的采集量和TNC均显著高于体重较小者（P?< 0.001）;剖宫产的脐带血采集量虽高于阴道分娩（P < 0.001）,但其TNC不及阴道分娩;男婴与女婴在脐带血采集量和TNC之间无显著差异。在采集处理因素中,脐带血采集至计数的时间间隔与采集量及TNC均无显著相关。 结论为提高脐带血的保存质量,应侧重选择胎儿体重较大、经阴道分娩的产妇作为脐带血供者,实验室应首先处理采集量较大的脐带血。     

Lympho-epithelial interactions in rat thymus during pregnancy

Alterations in the thymic epithelial cell activity were analysed during pregnancy and lactation in Wistar rats by examining the presence and in situ distribution of lymphoepithelial complexes formed by thymic nurse cells (TNC). TNC were identified in paraffin sections by their expression of MHC class II antigens, CD54 molecule and a neuromarker, protein gene product 9.5 (PGP9.5). On the first days of pregnancy (gestational days, GD) the number of PGP9.5+ TNC was found to decrease abruptly. On GD 14, a transient increase was noted in the number of PGP9.5+, MHC+, CD54+ TNC. Another increase was observed in the course of lactation, when the weight of the thymus reached the lowest values. While the increase in TNC numbers during lactation may be linked to the process of reconstruction of the thymic lymphoid population, the augmented activity of lymphoepithelial interactions on GD14 may be associated with thymic engagement in pregnancy-induced immune processes.     

A comparison of CFU-GM, BFU-E and endothelial progenitor cells using ex vivo expansion of selected cord blood CD133(+) and CD34(+) cells

BACKGROUND: CD133 is a newly developed hematopoietic stem cell marker but little is known about its function. Whether CD133(+) cell selection provides any advantage over CD34(+) selection for hematopoietic stem cell isolation and transplantation is unclear. The present study compared colony formation and endothelial cell differentiation of these two cell types from umbilical cord blood (UCB). METHODS: Mononuclear cells from the same UCB samples were used for both CD133(+) and CD34(+) cell selection. Cells with 97.1% purity were incubated in semi-solid culture medium containing stem cell growth factor (SCGF) and G-CSF or erythropoietin (EPO). Purified cells were also cultured in M199 containing vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and insulin-like growth factor-1 (IGF-1). RESULTS: CD34(+) and CD133(+) cells produced similar numbers of CFU-GM colonies (median 43.25 and 30.5, respectively; P>0.2). However, a greater than four-fold difference in BFU-E colony formation was observed from CD34(+) cells compared with CD133(+) cells (median 35 and 8, respectively; P<0.04). CD34(+) cells gave rise to endothelial-like cells when stimulated with VEGF, bFGF and IGF-1. CD133(+) cells were unable produce this cell type under the same conditions. DISCUSSION: CD133(+) cells produced smaller BFU-E colonies and were unable to differentiate into mature endothelial cells. CD34(+) cells contained endothelial progenitors that could differentiate into mature cells of this lineage. Based on these data, it appears that CD133 offers no distinct advantage over CD34 as a selective marker for immunoaffinity-based isolation of hematopoietic stem cells and endothelial progenitor cells.     

Isolation of three important types of stem cells from the same samples of banked umbilical cord blood

It is known that umbilical cord blood (UCB) is a rich source of stem cells with practical and ethical advantages. Three important types of stem cells which can be harvested from umbilical cord blood and used in disease treatment are hematopoietic stem cells (HSCs), mesenchymal stem cells (MSCs) and endothelial progenitor cells (EPCs). Since these stem cells have shown enormous potential in regenerative medicine, numerous umbilical cord blood banks have been established. In this study, we examined the ability of banked UCB collected to produce three types of stem cells from the same samples with characteristics of HSCs, MSCs and EPCs. We were able to obtain homogeneous plastic rapidly-adherent cells (with characteristics of MSCs), slowly-adherent (with characteristics of EPCs) and non-adherent cells (with characteristics of HSCs) from the mononuclear cell fractions of cryopreserved UCB. Using a protocol of 48?h supernatant transferring, we successfully isolated MSCs which expressed CD13, CD44 and CD90 while CD34, CD45 and CD133 negative, had typical fibroblast-like shape, and was able to differentiate into adipocytes; EPCs which were CD34, and CD90 positive, CD13, CD44, CD45 and CD133 negative, adherent with cobble-like shape; HSCs which formed colonies when cultured in MethoCult medium.     

Does erythrocyte infusion improve 3.2-km run performance at high altitude?

The effects of autologous erythrocyte infusion on improving exercise performance at high altitude have not previously been studied. The effects of erythrocyte infusion on 3.2-km (2-mile) run performance were evaluated during 3 days (HA3) and 14 days (HA14) exposure to high altitude (4300 m) in erythrocyte-infused (ER) and control (CON) subjects that were initially matched (P>0.05; n = 8 in each group) for age, body size and aerobic fitness. After sea-level runs (SL; 50 m), unacclimated-male subjects received either 700 ml of saline and autologous erythrocytes (42% hematocrit; ER) or saline alone (CON). The 3.2-km run times (min:s) did not differ (P>0.05) between groups at SL [mean (SEM) ER, 13:14 (00:19); CON, 13:39 (00:32)] or during HA3 [ER, 19:02 (00:18); CON, 19:44 (00:43)] and HA14 [ER, 17:44 (00:27); CON, 18:45 (00:55)] but times were slower (P<0.05) when comparing HA3 or HA14 to SL. Heart rates (HR) did not differ between groups at SL [ER, 188 (3) beats x min(-1); CON, 191 (3) beats x min(-1)], or during HA3 [ER, 170 (4) beats x min(-1); CON, 178 (4) beats x min(-1)] and HA14 [ER, 162 (6) beats x min(-1); CON, 169 (5) beats x min(-1)], but HR were lower (P<0.05) when comparing HA3 or HA14 to SL. Ratings of perceived exertion (local, central, and overall ratings) did not differ between groups at SL, HA3 or HA14, but local ratings were higher (P<0.05) at HA3 and HA14 compared to SL, and overall ratings were higher for HA3 than SL. Analysis of covariance (adjusted for SL group run times) revealed (min:s) 00:14 (HA3) and 00:28 (HA14) mean improvement tendencies (P>0.05) for ER compared to CON. Thus, no significant improvements in 3.2-km run performance were associated with erythrocyte infusion, although the ER group showed a tendency to run slightly faster at high altitude.     

Cell analysis in cerebrospinal fluid (CSF) using Sysmex? hematology analyzers XT-4000i and XE-5000: evaluation with CSF controls of the Joint German Society for Clinical Chemistry and Laboratory Medicine (DGKL)

In cerebrospinal fluid (CSF) analysis, hematology analyzers (HAs) Sysmex? XT-4000i and XE-5000, equipped with flow cytometry (FCM), were used to count cells and differentiate leukocytes into mononuclear and polymorphonuclear cells (MNCs, PMCs) applying body fluid mode. FCM was evaluated with 20 DGKL CSF controls containing viable human leukocytes and erythrocytes. HA values were compared with reference values by Passing/Bablok regression analysis to reveal conformity. Conformity of white blood cells (WBCs) was obtained with native leukocytes, counted in calibrated Fuchs-Rosenthal chamber as reference; red blood cell counts proved inaccurate. CV <40% with WBC counts <20 per μL impairs accuracy. Reference WBC differentiation was assayed using FACS Canto II? and FC-500 SN with anti-CD45, anti-CD14, anti-CD16, anti-CD16/56 [Becton Dickinson (BD); Beckman Coulter (BC)]. BD FACS lysing solution?-no-wash-procedure was applied. BC pretreatment with Versalyse lysing solution was not recommended. MNCs (lymphocytes + monocytes) were significantly lower (～14%) on both HAs; PMCs (granulocytes or sum of neutrophils + eosinophils + basophils: range 1-86 M/L) were significantly higher (～2.2-fold). WBC HA differentiation is not reliable because MNC/PMC differentiation yielded lower and higher values than FACS-FCM references, respectively. This is attributed to incorrect discrimination of leukocytes with rounded/nonrounded nuclei; adding leukocytes with nonrounded nuclei to too low HA MNCs (about 40% not-activated) yielded P/B conformity; subtraction of leukocytes with nonrounded nuclei from elevated HA PMCs showed conformity (about 85% activated). Nucleus/activation state of leukocytes was assessed using microhistology. Sysmex XT-4000i and XE-5000 HAs systems are inappropriate for complete CSF cell analysis.