Toward new insights on the white blood cell differential by flow cytometry: A proof of concept study on the sepsis model

Abstract

Background: We sought to evaluate, on a model of sepsis, the clinical relevance of new parameters obtained on a white blood cell (WBC) differential by flow cytometry, implemented in the routine workflow of our hematology laboratory.Methods: A WBC with differential by flow cytometry was done on 459 patients at admission in intensive care unit. They were retrospectively categorized in having (i) infection or not or (ii) a high gravity score (severe sepsis or septic shock) or not. We analyzed by hierarchical clustering, in a multidimensional manner, 50 parameters provided by the flow cytometric platform in place of the standard seven parameters for a standard differential.Results: Our approach allows to discriminate on the basis of a WBC differential (i) infected patients at admission based on a 16 parameter signature, with a concordance rate of 72.7% and a specificity of 79.9% and (ii) patients with high gravity score (septic shock or severe sepsis) at admission with a signature of eight parameters, with a concordance rate of 74.7% and a specificity of 75.9%.Conclusions: This study shows the clinical relevance of an extended WBC differential to obtain by a flow cytometer integrated into a routine hematology laboratory workflow. Development of such approach implicates the redefinition of the WBC differential by integrating new parameters. V C 2012 International Clinical Cytometry Society

Circulating Immature Granulocytes With T-Cell Killing Functions Predict Sepsis Deterioration*

“…It belongs historically to biological diagnostic criteria of SIRS (9). Recently, multicolor flow cytometry (FCM) immunophenotyping has been proposed for the characterization of circulating WBCs in patients with sepsis (12). Recently, multicolor flow cytometry (FCM) immunophenotyping has been proposed for the characterization of circulating WBCs in patients with sepsis (12).…”

Assessing the Immune Status of Critically Ill Trauma Patients by Flow Cytometry

“…The limitations of the CBC/differential and CRP, coupled by the complexity of immune system dysregulation, suggest that another approach is needed to assess the immune status of critically ill trauma patients. Flow cytometry significantly enhances the potential for characterization and/or enumeration of leukocyte subtypes, leukocyte activation, leukocyte-derived cytokines and microparticles, and leukocyte function (Roussel et al, 2012). Furthermore, in facilities with access to an instrument, the flow cytometry process will be as efficient and timely as obtaining a CBC and differential.…”

Issue Highlights—January 2013

“…There is accumulating evidence that a diminished expression of human leukocyte antigen-DR on circulating monocytes (mHLA-DR) measured by flow cytometry is considered a reliable indicator of immunosuppression in critically ill patients (36,37). It is also known that monocytes with low HLA-DR expression are known to be unable to mount a proinflammatory response to any subsequent bacterial challenge or to properly present antigens to T cells (37).…”

“…It is also known that monocytes with low HLA-DR expression are known to be unable to mount a proinflammatory response to any subsequent bacterial challenge or to properly present antigens to T cells (37). HLA-DR expression on monocytes has been shown to be predictive of both adverse outcome and septic complications after trauma, surgery, pancreatitis, burn, and septic shock.…”