Abstract
Background: In the Retic channel of DxH 800 (Beckman Coulter), the red blood cells (RBCs) resistant to hemoglobin clearing are counted as unghosted cells (UGCs). The aim of this study was to evaluate that the UGC is a surrogate marker for both the detection and counting of target cells.
Methods: In total, 1181 samples including 22 from iron deficiency anemia (IDA) patients, 95 from jaundice, 2 from sickle cell anemia, 3 from thalassemia, 1 cord blood, and 269 from normal controls were analyzed. Slides were prepared from all samples except normal controls and target cells were counted for correlation analysis of target cell counts to UGCs.
Results: The normal control samples showed 0.01% (0%–0.01%) UGCs, and the reference range was set at ≤0.02%. The IDA samples showed 0.015% (0.01%–0.03%) UGC count and 0.05% (0%–0.2%) target cell count. The jaundice samples showed 0.98% (0.1%–5.36%) UGC count, and 1.4% (0.1%–7.0%) target cell count. The two sickle cell anemia samples showed 0.41% and 3.74% UGC counts and 0.4% and 11.5% target cell counts. A cord blood sample showed 0.01% UGCs and 0% target cells. The three thalassemia samples showed 0.01%, 1.99%, and 7.82% UGC counts and 0%, 1.4%, and 15.5% target cell counts. The samples showing poikilocytosis other than target cells showed normal UGC count (≤0.02%). The positive predictive value of UGCs was 58.2% (124/213) and the negative predictive value was 96.8% (674/696). The UGC counts were well correlated to the manual target cell counts (r=0.944, p=0.000).
Conclusions: This study demonstrates for the first time in the literature that a hematological parameter obtained automatically every time a reticulocyte counting is performed can be used to both screen for the presence of target cells and reliably quantify them.
Acknowledgments
This study was supported by a grant from the Korean Healthcare Technology R&D Project, Ministry for Health and Welfare, Republic of Korea (A102065).
Conflict of interest statement
Authors’ conflict of interest disclosure: The authors stated that there are no conflicts of interest regarding the publication of this article. Research support played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Research funding: None declared.
Employment or leadership: None declared.
Honorarium: None declared.
References
1. Muir R, McNee JW. The anaemia produced by a haemolytic serum. J Path Bact 1912;16:410.10.1002/path.1700160132Search in Google Scholar
2. Crosby WH. The pathogenesis of spherocytes and leptocytes (target cells). Blood 1952;7:261–74.10.1182/blood.V7.2.261.261Search in Google Scholar
3. Edington GM, Singer K, Weisz L. The life cycle of the erythrocytes after splenectomy and the problems of splenic hemolysis and target cell formation. Am J Med Sci 1945;210:301.10.1097/00000441-194509000-00004Search in Google Scholar
4. Grace RF, Lux SE. Disorders of the red cell membrane. In: Orkin SH, Nathan DG, Gisburg D, Look AT, Fisher DE, Lux SE, editors. Hematology of infancy and childhood. Philadelphia, PA: Saunders, 2009:659–837.Search in Google Scholar
5. Heeney M, Dover DJ. Sickle cell disease. In: Orkin SH, Nathan DG, Gisburg D, Look AT, Fisher DE, Lux SE, editors. Hematology of infancy and childhood. Philadelphia, PA: Saunders, 2009: 949–1014.Search in Google Scholar
6. Cooper RA, Jandle JH. Bile salts and cholesterol in the pathogenesis of target cells in obstructive jaundice. J Clin Invest 1968;47:809–22.10.1172/JCI105775Search in Google Scholar
7. Cunningham MJ, Sankaran VG, Nathan DG, Orkin SH. The thalassemias. In: Orkin SH, Nathan DG, Gisburg D, Look AT, Fisher DE, Lux SE, editors. Hematology of infancy and childhood. Philadelphia, PA: Saunders, 2009:1015–106.Search in Google Scholar
8. James SH, Meyers AM. Microangiopathic hemolytic anemia as a complication of diabetes mellitus. Am J Med Sci 1998;315:211–5.Search in Google Scholar
9. Tucker LB. Vasculitis, Kawasaki disease, and hemolytic uremic syndrome. Curr Opin Rheum 1994;6:530–6.10.1097/00002281-199409000-00013Search in Google Scholar
10. Hariharan D, Manno CS, Seri I. Neonatal lupus erythematosus with microvascular hemolysis. J Pediatr Hematol Oncol 2000;22:351–4.10.1097/00043426-200007000-00014Search in Google Scholar
11. Brown DL, Nelson DA. Surface microfragmentation of red cells as a mechanism for complement-mediated immune spherocytosis. Br J Haematol 1973;24:301–5.10.1111/j.1365-2141.1973.tb01654.xSearch in Google Scholar
12. Eber SW, Armbrust R, Schroeter W. Variable clinical severity of hereditary spherocytosis: relation to erythrocytic spectrin concentration, osmotic fragility and autohemolysis. J Pediatr 1990;177:409–16.10.1016/S0022-3476(05)81081-9Search in Google Scholar
13. Kim JE, Kim BR, Woo KS, Kim JM, Park JI, Han JY. Comparison of capillary electrophoresis with cellulose acetate electrophoresis for the screening of hemoglobinopathies. Ann Lab Med 2011;31:238–43.10.3343/kjlm.2011.31.4.238Search in Google Scholar PubMed PubMed Central
14. Pornprasert S, Wiengkum T, Srithep S, Chainoi I, Singboottra P, Wongwiwatthananukit S. Detection of α-thalassemia-1 southeast Asian and Thai type deletions and β-thalassemia 3.5-kb deletion by single-tube multiplex real-time PCR with SYBR Green1 and high-resolution melting analysis. Ann Lab Med 2011;31:138–42.10.3343/kjlm.2011.31.3.138Search in Google Scholar PubMed PubMed Central
15. Klee GG, Fairbanks VF, Pierre RV, O’Sullivan MB. Routine erythrocyte measurements in diagnosis of iron deficiency anemia and thalassemia minor. Am J Clin Pathol 1976;66:870–7.10.1093/ajcp/66.5.870Search in Google Scholar PubMed
16. Sahli CA, Bibi A, Ouali F, Fredj SH, Dakhlaoui B, Othmani R, et al. Red cell indices: differentiation between β-thalassemia trait and iron deficiency anemia and application to sickle cell disease and sickle cell thalassemia. Clin Chem Lab Med 2013;51:1595–603.10.1515/cclm-2012-0842Search in Google Scholar PubMed
17. Jayabose S, Giavanelli J, Levendoglu-Tugal O, Sandoval C, Ozkaynak F, Visintainer P. Differentiating iron deficiency anemia from thalassemia minor by using an RDW-based index. J Pediatr Hematol 1999;21:314.10.1097/00043426-199907000-00040Search in Google Scholar
18. England JM, Fraser PM. Differentiation of iron deficiency from thalassemia trait by routine blood count. Lancet 1973;1:449–52.Search in Google Scholar
19. Ricerca BM, Stortis S, d’Onofrio G, Mancini S, Vittori M, Campisi S, et al. Differentiation of iron deficiency from thalassemia trait: a new approach. Haematologica 1987;72:409–13.Search in Google Scholar
20. Ehsani M, Darvish A, Aslani A, Seighali F. A new formula for differentiation if iron deficiency anemia (IDA) and thalassemia trait (TT). Turk J Hematol 2005;22:268.Search in Google Scholar
21. Sirdah MI, Tarazi E, Al Najjar E, Al Haddad R. Evaluation of the diagnostic reliability of different RBC indices and formulas in the differentiation of the β-thalassemia minor from iron deficiency in Palestinian population. Int J Lab Hematol 2008;30:324–30.10.1111/j.1751-553X.2007.00966.xSearch in Google Scholar PubMed
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