Quantitative PCR for counting residual white blood cells in blood products.

Leukocyte depleted blood components are frequently used to reduce alloimmunization and the risk of transfusion transmitted infection. Counting residual white blood cells in filtered blood products requires sensitive and reliable techniques. After separation of white blood cells from 500 microliters of 20 non-filtered and 54 filtered blood products we used polymerase chain reaction (PCR) and fluorimetric detection for the quantification of genomic DNA. The results were compared with results from Nageotte chamber counting. The accurate limit of detection of PCR was determined at 1 WBC/microliter (intra-assay coefficient of variation: 16.3%). PCR correlated well with Nageotte chamber counts (r = 0.77, p < 0.001, n = 74). Concordant results were obtained in 51 filtered and 20 non-filtered blood products. Discrepant results were obtained in 3 filtered whole blood units: In these blood products > 12 WBC/microliters were counted in Nageotte chamber and PCR gave a negative result. After component preparation fresh-frozen plasma and red cell concentrates of these units contained < 1 WBC/microliter using both methods. In conclusion we describe a quantitative PCR method which had about the same sensitivity and specificity as Nageotte chamber testing. However, PCR is more laborious than the standard method. As well, as reliable PCR testing requires expensive instruments and staff experienced in molecular biology, the standard method is more cost effective.     

A platelet quality assessment scheme for comparing the performance of quality monitoring laboratories in the UK National Blood Service.

This exercise focused on performance of NBS quality monitoring establishments with respect to enumeration of low leucocyte and other quality indexes of platelet concentration. Paired identical leucodepleted platelet samples, spiked with WBC (20 cells/microl) in 'vacuette' or 'pouch' were assessed by participants (n = 20) on days 1, 2 and 5. For low WBC counting, all laboratories gave estimates within acceptable range (+/-25%) and good agreement between storage and assay methods was observed on days 1 and 2. Day 5 results showed greater variability. Under improved performance criteria (+/-15%), only one laboratory under-estimated at days 1 and 2. Similarly, other parameters demonstrated good agreement between storage methods on days 1 and 2. At day 5, mean results were often significantly different to previous days. Improved performance target (+/-15%) will allow identification of non-conformers.     

National external quality assessment scheme for lymphocyte immunophenotyping in Belgium.

In 2000, the Belgian Scientific Institute of Public Health introduced a voluntary external quality assessment scheme for lymphocyte immunophenotyping. This paper provides an analysis of the first six surveys. Specimens consisted of fresh EDTA-anticoagulated whole blood and were sent by overnight mail. The 41 participants were surveyed for methodology and were asked to report white blood cell count, percentage of lymphocytes, and percentages and absolute numbers of CD3+, CD4+, CD8+, and CD19+ cells. Median intralaboratory coefficients of variation were 1.0, 1.3, 1.7, and 3.2% for CD3+, CD4+, CD8+, and CD19+ cell percentages, respectively. Interlaboratory variability was consistently lower than 6.5% for CD3+ and CD4+CD3+ cell percentages, and lower than 9.5% for CD8+CD3+ cell percentages. Median coefficients of variation for the absolute values were higher, ranging from 10.1% for CD4+CD3+ cells to 16.5% for CD19+ cells. The percentage of CD4+CD3+ and CD8+ CD3+ cells was in several samples significantly lower than the percentage of total CD4+ and CD8+ cells. The number of laboratories measuring total CD4+ and CD8+ cells decreased by 30% during the programme. Between-laboratory variability remained stable over time. Analysis of individual laboratory performance indicated that some laboratories markedly improved their results.     

Comparison between Nageotte and flow cytometric counting of residual leucocytes in freshly prepared leucocyte-reduced red blood cell components

Background

Flow cytometry (FC) and Nageotte hemocytometry represent the most widely accepted methods for counting residual white blood cells (rWBCs) in leucocyte-reduced (LR) blood components. Our aim was to study the agreement between the two methods, under real working blood bank conditions.

Benchmark for evaluating the quality of DNA sequencing: proposal from an international external quality assessment scheme

BACKGROUND: In the past 15 years, clinical laboratory science has been transformed by the use of technologies that cross the traditional boundaries between laboratory disciplines. However, during this period, issues of quality have not always been given adequate attention. The European Molecular Genetics Quality Network (EMQN) has developed a novel external quality assessment scheme for evaluation of DNA sequencing. We report the results of an international survey of the quality of DNA sequencing among 64 laboratories from 21 countries. METHODS: Current practice for DNA sequence analysis was established by use of an online questionnaire. Participating laboratories were provided with 4 DNA samples of validated genotype. Evaluation of the results included assessing the quality of sequence data, variant genotypes, and mutation nomenclature. To accommodate variations in mutation nomenclature, variants indicated by participants were scored for compliance with 3 acceptable marking schemes. RESULTS: A total of 346 genotypes were analyzed. Of these, 19 (5%) genotyping errors were made. Of these, 10 (53%) were false-negative and 9 (47%) were false-positive results. A further 27 (8%) errors were made in naming mutations. Results were analyzed for 3 indicators of data quality: PHRED quality scores, Quality Read Length, and Quality Read Overlap. Most laboratories produced results of acceptable diagnostic quality as judged by these indicators. The results were used to calculate a consensus benchmark for DNA sequencing against which individual laboratories could rank their performance. CONCLUSIONS: We propose that the consensus benchmark can be used as a baseline against which the aggregate and individual laboratory standard of DNA sequencing may be tracked from year to year.     

Chloride influx in human leucocytes: a triple-isotope technique for the assessment of chloride transporters.

1. A novel triple-isotope method using 3H2O, [14C]-sucrose and 36Cl- for measuring initial Cl- uptake rates in human leucocytes that had been preincubated in 10% (v/v) autologous serum is described. 2. There was a marked dependence of Cl- influx on intracellular pH, the flux at an intracellular pH of 7.20 being about 11.2% of that at an intracellular pH of 7.56. 3. This Cl- influx was inhibited by 4,4-di-isothiocyanatostilbene-2,2-disulphonic acid in a dose-dependent manner. Half-maximal inhibition by 4,4-di-isothiocyanatostilbene-2,2-disulphonic acid at an internal pH of 7.56 in the presence or absence of HCO3- was 0.30 or 0.35 mmol/l, respectively. 4. Depletion of intracellular Cl- resulted in a 70.7% decrease in Cl- influx, whereas depletion of cellular ATP led to a 37.7% decrease in Cl- influx. 5. The phorbol ester 12-O-tetradecanoyl phorbol acetate at a concentration of 0.1 mumol/l reduced Cl-influx, especially the 4,4-di-isothiocyanatostilbene-2,2-disulphonic acid-sensitive component. This effect was independent of intracellular pH changes or Na+/H+ antiport activity.     

血小板成分中残留白细胞的新检测方法

目的建立一种基于流式细胞术的灵敏、准确的残留白细胞检测方法。方法用CD45/CD61和核酸染料/CD612种标记方法分别对人工制备的含不同含量白细胞的血小板悬液进行流式细胞仪检测,并与理论值比较。取实际血小板成分样本,进行CD45/CD61标记法检测,并加入FlowCount参照荧光微球进行绝对计数。结果CD45/CD61标记法检测结果与理论值较为接近,二者间差异无显著性意义(P>0.05);核酸染料/CD61标记法检测值均高于理论值,特别是白细胞含量在50%以下的样本,二者间差异有统计学意义(P<0.05)。结论CD45/CD61法能较好地检测微量的白细胞,为准确检测少白细胞血小板成分中残留白细胞的含量打下基础,使少白细胞血小板成分的质量控制更为准确。     

Washing platelets with new additive solutions: aspects on the in vitro quality after 48 hours of storage

BACKGROUND: Rare clinical conditions cause the need for washed platelet (PLT) concentrates (PCs). Saline-washed PCs can only be stored shortly, however, owing to lack of substrates for PLT metabolism. New PLT additive solutions (PASs) contain such substrates and might be used alternatively. The in vitro quality of apheresis PCs washed with Composol-PS or modified PAS-III (PAS-IIIM) stored up to 48 hours after wash was compared. STUDY DESIGN and METHODS: Twelve blood donors underwent two apheresis procedures (A and B) collecting 6.0 x 10(11) PLTs in 500 mL of plasma with a least 2 weeks in between. The PCs collected by Apheresis A were stored for 3 days and then split in two equal units before washing with Composol-PS or PAS-IIIM. The PCs collected by Apheresis B were split after collection. One unit was released for transfusion and 1 unit was stored unwashed up to Day 6 and used as reference unit. In vitro testing was performed before and after washing as well as 24 and 48 hours after wash. RESULTS: After 48 hours of postwash storage, the units washed with either PAS showed acceptable results for hypotonic shock response (HSR), P-selectin expression, and pH, whereas PLT aggregability was significantly impaired. Throughout the storage, unwashed units showed better in vitro quality. HSR and P-selectin expression were similar before and immediately after the washing procedure. CONCLUSION: Based on these in vitro results, 48-hour postwash storage of washed PCs with the two PASs seems to be feasible. In vivo recovery studies, however, must confirm this finding in the future.     

Comparability of method results and performance in a national external quality assessment scheme between 1993 and 2003 using thyroid associated analytes as examples

Six thyroid analytes (free and total triiodothyronine and thyroxine, thyrotropin and thyroglobulin) have been followed up over a 10 year period in a national external quality assessment scheme (EQAS) organised by the Institute for Standardisation and Documentation in the Medical Laboratory (INSTAND). I. The following points were observed: II. The introduction of samples with properties similar to patient serum (filtered, recalcified defibrinated plasma without stripping) improved performance and inter-method comparability for the free thyroid hormones. III. In general, the performance in EQAS has improved over the past decade, an exception being thyroglobulin, where precision has improved at the expense of inter-method comparability. IV. Regular statistical analysis of EQAS data allows adjustment of target ranges to be made when necessary. V. Analytes which are not dependent on binding proteins--thyrotropin and the total thyroid hormones--give rise to similar performance when stripped and spiked plasma or recalcified non-stripped and spiked plasma is used as sample. VI. Whereas certain analytes have had a relatively constant number of participants over the past decade (total thyroid hormones), others have shown a drastic increase (free thyroxine from 67 to 620; thyrotropin from 295 to 724) reflecting the medical demand for the analytes.     

Comparability of method results and performance in a national external quality assessment scheme between 1993 and 2003 using thyroid associated antibodies as examples

Four thyroid antibodies (antibodies to microsomes [MAb], thyroid peroxidase [anti-TPO], thyroglobulin [anti-Tg] and TSH-receptor [TRAB, THYBIA]) have been followed up over a 10-year period in a national external quality assessment scheme (EQAS) organised by the Institute for Standardisation and Documentation in the Medical Laboratory (INSTAND e.V.). The following points were observed: I. The introduction of samples with properties similar to patient serum (filtered, recalcified defibrinated plasma without stripping) improved performance and inter-method comparability for thyroid antibodies. II. Regular statistical analysis of EQAS data allows adjustment of target ranges to be made when necessary. III. There are large inter-method variations in reporting, both on qualitative and quantitative results. IV. The samples often gave rise to different constellations of antibodies, which were kit-dependent. V. Despite use of international reference preparations, there was no numerical comparability between quantitative methods for the same analyte. In general, the performance in EQAS for thyroid antibodies has improved over the past decade. There is still a real need for standardisation in the field of thyroid antibody analysis.     

A whole blood control for blood count analysers, and source material for an external quality assessment scheme

An inexpensive and simple to prepare stable whole blood control material for blood count analysers has been evaluated. The material has been used for an external quality assessment scheme for 3 years, and during part of this period as a calibrant for two aperture impedance devices.     

Factors associated with the quality of laboratory performance in the United Kingdom external quality assessment scheme for serum growth hormone

A search was made for associations between poor performance in the UK External Quality Assessment Scheme (EQAS) for serum growth hormone (GH), and a range of factors including assay method, laboratory workload and staffing, and Internal Quality Control (IQC) procedures. On the basis of the factors identified as being associated with poor performance we recommend the following. 1. Laboratories using RIA for GH should routinely analyse samples at two dilutions and report a mean result. 2. The use of 125I-GH which is 5 or more weeks old should be avoided. Tracer should also be chromatographed to remove aggregate before use. 3. Laboratories using RIA should avoid using a standard curve which covers too wide a range concentration; a curve midpoint (ie GH concentration to reduce the zero standard binding by 50%) of about 8 mU/l or less is probably acceptable. 4. It should be noted that high workloads present a risk of some loss in quality of responsible for checking IQC data. 6. Laboratories which do not have the resources to maintain fully their own RIA as outlined above should carefully consider use of an unbiased, precise IRMA. The UK EQAS has identified two assays (Boots-Celltech Sucrosep, NETRIA) that appear to meet these criteria [2]. The above observations may also be relevant to immunoassays for other peptide hormones.