A parallel evaluation was performed on four automated hematology analyzers: the Celldyn 3000 (Unipath Corp., Mountain View, CA), the Coulter STKS (Coulter Electronics Inc., Hialeah, FL), the Sysmex NE-8000 (Baxter Healthcare Corp., McGaw Park, IL), and the Technicon H*2 (Miles Corp., Tarrytown, NY). The protocol included evaluation of the complete blood count and differential leukocyte count (DLC) parameters. The DLC evaluation was performed using the National Committee for Clinical Laboratory Studies H20-A protocol. Based on this evaluation, the authors could not identify a single instrument that was clearly superior to the others. Overall, the four instruments were found to be safe and effective for diagnostic use; however, there were areas in which their performance was less than optimal. Particular questions were raised regarding the clinical usefulness of instrumental "flags" to identify qualitative leukocyte abnormalities. The results are discussed in relation to the selection of instruments for specific clinical applications.

This study characterized women's concurrent and subsequent levels of emotional distress associated with a questionable mammogram screening and relationships between women's coping and psychosocial adjustment. State anxiety was assessed in 98 women 1 day after receiving a mammogram screening (Time 1), after notification of a questionable screening result that necessitated additional testing (Time 2), and after being informed of their breast-cancer-free status (Time 3). Key findings include (a) women reported a significant increase in anxiety following notification of the need to return for follow-up testing; (b) significant and positive associations were found between anxiety and behavioral approach, behavioral avoidance, cognitive approach, and cognitive avoidance coping in cross-sectional analyses; and (c) cognitive avoidance coping was a strong predictor of final levels of state anxiety in women. Findings suggest that cognitive avoidance coping plays an important role in reducing anxiety in women recalled to clarify an initially ambiguous screening procedure.

Although the use of bone marrow transplantation has increased greatly in recent years, the quality control procedures used in bone marrow processing laboratories remain less than ideal. Accurate marrow total nucleated cell (TNC) counts are essential for effective monitoring of bone marrow collection and processing. Aspirated marrow is variably contaminated by fat particles, resulting in overestimation of marrow TNC by automated analyzers. A recently-marketed hematological analyzer (Cobas-Helios; Roche Diagnostic Systems, Branchburg, NJ) offers the potential to correct marrow TNC counts for fat particles using available software. The authors investigated the accuracy of corrected TNC counts on 21 marrow samples, using a visual chamber count as the reference method. The correction methods studied were software correction, using the Cobas-Helios differential system, and replacement of the sample plasma with saline. Uncorrected automated marrow TNC counts (mean, 28.4 x 10(9)/L) were significantly higher than the visual reference counts (mean, 23.1 x 10(9)/L). Neither the mean corrected automated count (24.3 x 10(9)/L) nor the mean saline replaced count (24.6 x 10(9)/L) differed significantly from the mean visual reference count. For both the corrected automated and saline replaced counts, 20 of the 21 data points (95%) fell within a 95% confidence interval computed for the reference method. The authors conclude that both the corrected automated method, using the Cobas-Helios, and the saline replacement method are acceptable alternatives to the visual chamber count.

The Cobas-Helios (Roche Diagnostic Systems, Inc., Branchburg, NJ) is a new, fully automated hematology analyzer that performs a complete blood count and differential leukocyte count (DLC), classifying leukocytes by flow-cytochemical technology. The DLC component of the Cobas-Helios was evaluated according to the National Committee for Clinical Laboratory Standards H20-A protocol. Instrument performance was acceptable with respect to all parameters investigated, including imprecision, inaccuracy and clinical sensitivity for the identification of quantitative and qualitative leukocyte abnormalities. In a minority of samples with neutrophil left shift, neutrophils tended to overlap the monocyte domain, resulting in overestimation of monocytes and underestimation of neutrophils. This problem did not affect clinical sensitivity and was generally associated with a positive instrumental left-shift flag. Flags for the identification of specific qualitative abnormalities of the leukocyte population (atypical lymphoid cells, nucleated red cells, blast cells, immature granulocytes and neutrophil left shift) performed well. In addition to a conventional five-part DLC, the Cobas-Helios also identifies and quantitates atypical lymphoid cells and "large immature cells," the latter corresponding to bands and immature granulocytes. Counts of atypical lymphoid cells and large immature cells correlated well with the equivalent cell classes as enumerated by the reference method of the National Committee for Clinical Laboratory Standards. The Cobas-Helios offers the most reliable quantitative index of neutrophil left shift currently available in a commercial automated DLC analyzer.

We adapted previously published methods for nonspecific esterase and alkaline phosphatase staining of white blood cells in suspension for use on a Technicon H-1 hematology analyzer. The objective was to develop a semiautomated method using whole blood that could be employed on a large scale for hematology laboratory applications, including toxicology studies, measurement of neutrophil left shift, and cytochemical classification of myeloid leukemias. The nonspecific esterase method uses the pararosaniline stain, generating the unstable substrate from two stable precursors. Whole blood is added to the substrate plus dye mix. Next, acid lysis and fixation steps destroy red cells and stabilize the monocyte staining. The alkaline phosphatase stain employs a stable naphthy1 phosphate sulbstrate and fast blue B coupling dye. The red cells are lysed with a pH 10.3 propanediol buffer, and the white blood cells are then stabilized with formalin fixation. For both methods the staining is performed off-line, and the sample is then diluted with propanediol to match the refractive index of the sheath on the H-1 analyzer, before aspirationinto the direct cytomelxy port. A cytogram of scattered versus absorbed light is obtained. The number of cells staining and the intensity of the stain can be quantified from the cytogrann.