 manual counts using randomly selected human subject's blood samples at the department of hematology. UNTH, Ituku-Ozalla, Enugu, Enugu State, Nigeria.
Methods
Venous blood samples were randomly collected from sixty (60) subjects. This comprised of both apparently healthy subjects (who came for medical examination) and those who have different blood disorders from University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Enugu State, Nigeria. Ethical approval was obtained from the ethical Review Board of the University of Nigeria Teaching Hospital, Enugu. Consent was obtained from each subject at the commencement of the study.
The study was conducted in a routine hematology laboratory at the same hospital. Three (3) mls of blood sample was collected aseptically from each subject into tri-potassium ethylenediamine tetra-acetic acid (K3EDTA) anticoagulant bottle. This was well mixed by gentle inversion for complete blood count (CBC) analysis. Blood sample was divided into 2 parts as follows: Two (2) mls for manual method and one (1) ml for automated method using hematology auto analyzer Sysmex KX-21N.
One hundred (100) White blood cell (WBC) was counted by one competent and experienced medical laboratory scientist for both total and differential leucocyte counts. All manual samples were analyzed using standard hematological method as described by Dacie and Lewis
Haemoglobin (Hb) was estimated by the cyan-methaemoglobin method: Packed Cell Volume was estimated by the microhaematocrit method: Total and differential leucocyte counts were done by visual method. Mean Cell Haemoglobin Concentration (MCHC) was calculated from a knowledge of the haemoglobin and PCV.
Statistical Analysis
The SPSS software was used in the statistical analysis. A p-value of less than 0.05 (p < 0.05) was considered significant.
Results
The differential leucocyte count by the automated method showed four (4) blood samples with incomplete differential white cell count (<100 cells). Also, thirty (30) blood films demonstrated normochromic-normocytic (50%), 12 (20%) normocytic-hypochromic, 1(6.66%) microcytic-normochromic, (3.33%) increased platelet distribution, 2 (3.33%) decreased platelet distribution, 1 (1.66%) target cells, 1 (1.66%) polychromacia, 2 (3.33%) rouleaux, band form neutrophil and 10 (16.60%) demonstrated microcytic and hypochromic blood pictures. There were no reactive lymphocytes (Table
Furthermore, hemoglobin, packed cell volume, platelet and total white cell counts only revealed statistically significant differences (p < 0.0001), and correlated positively (r = 0.7816, 0.9496, 0.7791 and 0.6717 respectively) when the mean and S.E values of the two methods (automated and manual) were compared (Figures
Figure 1
The correlation of Hb, PCV, MCHC and Platelet count (A, B, C and D respectively) between automated method and manual method
The correlation of Hb, PCV, MCHC and Platelet count (A, B, C and D respectively) between automated method and manual method.
Figure 2
The correlation of TWBC, Neutrophi l and Lymphocyte counts (A, B and C respectively) between automated method and manual method
The correlation of TWBC, Neutrophi l and Lymphocyte counts (A, B and C respectively) between automated method and manual method.
Table 1
Manual microscopic peripheral blood film assessment in all the subjects studied.
PARAMETER
NUMBER (n)
PERCENTAGE (%)
Normocytic-normochromic
30
50
Normocytic-hypochromic
12
20
Macrocytic-normochromic
1
1.66
Microcytic-hypochromic
10
16.60
Polychromacia
1
1.66
Increased platelet
2
3.33
Decreased platelet
2
3.33
Target cells
1
1.66
Rouleaux formation and
band form neutrophils
1
1.66
Discussion
Automated peripheral blood, leucocyte counts (LDCs) are widely accepted in routine practice. However, many laboratories still reflexively perform manual LDCs based solely on abnormal automated results or instruments "flags", before any manual triage step
The direct microscopic visualization of prepared blood film reported among the subjects (60) studied showed that 30 subjects (50%) were normocytic-normochromic, while the others (50%) revealed different abnormal blood pictures which are very important in the diagnosis of different blood disorders (Table
The result of the present study is in contrast with an earlier report by Pierre
In addition, the mean (S.E) values of hemoglobin, packed cell volume, platelet and total white blood cell counts, revealed statistically significant differences (p < 0.0001) (Table
Table 2
Comparison of the mean ± S.E of hematological profile of automated method with the manual method.
PARAMETER
AUTOMATED
(MEAN ± S.E)
MANUAL
(MEAN ± S.E)
HB (g/dl)
11.86 ± 0.30
12.07 ± 0.33***
PCV (%)
36.00 ± 0.91
37.00 ± 0.83***
MCHC (g/dl)
32.80 ± 0.19
33.24 ± 0.01
PLATELET(×109/l)
265.5 ± 18.94
251.7 ± 18.58***
TWBC(×109/l)
7.00 ± 0.50
11.41 ± 4.90***
NEUTROPHILS (%)
52.15 ± 1.77
54.68 ± 1.61
LYMPHOCYTES
44.42 ± 1.79
43.48 ± 1.59
***Significantly different to value for automated method (p < 0.0001).
Conclusion
The results of the present study confirm that the automated hematology analyzer readings are as reliable as the standard manual method even though the latter method gives additional diagnostic information through the blood pictures. Hence, manual microscopic blood examination should always be used to validate the automated methods as previously suggested by Lantis
Competing interests
The authors declare that they have no competing interests.
Authors' contributions
NT conceived of the study and participated in its design and coordination. EOU participated in the design of the study and revising it critically for intellectual content.
SOI participated in the design of the study, revising it critically for intellectual content and drafting of the manuscript. ENS participated in the design of the study and performed the statistical analysis. IJE participated in the design of the study and carried out the sample collection and processing. All authors read and approved the final manuscript.
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Pre-publication history
The pre-publication history for this paper can be accessed here:New York State legislators, formerly incarcerated individuals, families and faith leaders rallied at the state capitol calling for the passage of three new sentencing reform bills as part of the recently launched Communities Not Cages campaign.
Speakers called for the legislature to pass the Eliminate Mandatory Minimums Act, the Second Look Act, and the Earned Time Act to overhaul sentences that often target the most vulnerable communities in the state since the Rockefeller drug laws and to end New York’s legacy of indiscriminate and excessive punishment.
Proponents of the bills believe they will allow greater investments in community safety and healing by eliminating mandatory minimums, allowing judges to review and reconsider excessive sentences, and supporting transformation and the return of incarcerated community members through strengthened earned time laws.
Those familiar with the issues addressed in each measure of the proposed legislature emphasized how existing laws can be extremely prejudicial.
Advocates spoke further on the harm that they believe prisons and mass incarceration exact on low-income, Black and Brown communities, saying that under current sentencing laws most incarcerated people have no opportunity to demonstrate to a judge that they have changed or to ask for excessive or extreme sentences to be reconsidered to account for new laws and norms.
Individuals with loved ones currently incarcerated also emphasized just how unfair these laws can be and how they can keep people imprisoned for “indeterminate” amounts of time – regardless of how much time prior to sentencing has been served.
Currently there is a heated debate, spurred on by the recent mass shootings and events of the Iraq War, about State and Federal control of the armed forces and weapons in general. There are some who argue that the United States Military was originally set up as a decentralized force under the control of the States solely to be used in collective defensive efforts and believe