JPH02304360A - Analysis of blood data - Google Patents

Abstract

PURPOSE:To exactly and efficiently inspect blood by inputting the data from a blood cell counter to an analyzing apparatus and deciding that the presence of nucleated red blood cells is suspected by specific decision conditions. CONSTITUTION:The blood cell counter 1 dilutes and hemolyzes the blood, reduces the red blood cells and platelets, determines a white blood cell grain size distribution from a white blood cell sample, and inputs the same to the analyzing apparatus 2. The apparatus 2 sets the boundaries between the ghost components and small-size particles in the grain size distribution and decides the size of the particles and the number of the particles in the boundaries XWL, YWL. The apparatus designates a, b, c as constants and decides that the presence of the nucleated red blood cells is suspected in the case of equation I. The blood inspection is exactly and efficiently executed in this way without depending on inspector's skill.

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial Application Field] The present invention relates to a blood data analysis method for obtaining specimen information useful in clinical tests from data obtained by counting blood cells or the like.

[Traditional technique (nei)]

2. Description of the Related Art Blood cell counters that count the number of white blood cells, red blood cells, etc. in blood are widely used in the field of clinical testing, and the obtained data is used as diagnostic data. The basic function of a blood cell counter is to obtain numerical data such as white blood cell count, red blood cell count, hemoglobin amount, and platelet count, but recently it has become possible to also obtain particle size distribution maps of white blood cells, red blood cells, and platelets. It is becoming. A particle size distribution diagram is a graph showing the relationship between particle size and frequency, with particle size plotted on the horizontal axis (X-axis) and frequency plotted on the vertical axis (Y-axis), for example.

For example, the particle size distribution of standard white blood cells is represented by a particle size distribution diagram as shown in Figure 5, and if there is an abnormality in the sample, this particle size distribution curve will show various changes. Based on e.g. neutropenia,
Various abnormalities can be determined, such as neutrophilia, lymphopenia, and lymphocytosis.

[Problem to be solved by the invention]

However, conventionally, such abnormalities have been determined by visually observing the particle size distribution map, and with this method, one has to rely on experience, making the determination of abnormalities uncertain. There are problems in that individual differences arise and it is inefficient. Furthermore, the representation format of particle size distribution is not necessarily uniform among multiple types of blood cell counters, and therefore particle size distribution charts are generally difficult to use.

By the way, when counting white blood cells, a sample for white blood cells that is prepared by subjecting blood to pretreatment such as dilution and hemolysis to destroy red blood cells is used. In this case, the contents of the red blood cells are eluted, the red blood cell membrane is reduced in size, and the platelets are also reduced in size.

This reduced red blood cell membrane and platelets become shadow components (ghost components). When blood cells are counted using such a sample for white blood cells, the distribution of the ghost component appears in the part where the particle size is small in the particle size distribution diagram. However, since the size of white blood cells is larger than the ghost component, it is possible to divide the number of white blood cells while excluding the influence of red blood cells and platelets.

However, when nucleated red blood cells are present, ghost components with large particles appear in the white blood cell sample, which interferes with white blood cell counting. Diagnosis using distribution cannot be performed accurately.

In addition, nucleated red blood cells can cause malignant Mm tumors, leukemia, hemolytic anemia,
It is seen in severe cases such as iron deficiency anemia and megaloblastic anemia, and therefore it is important to determine the possibility of the presence of nucleated red blood cells. Judgments regarding the possibility of the presence of nucleated red blood cells are made by referring to white blood cell particle size distribution, red blood cell particle size distribution, etc., but when testing a large number of samples, it is difficult to determine the probability of abnormality occurring. If high-quality samples are screened in advance, testing efficiency will be greatly improved.

An object of the present invention is to make a blood data analysis method that makes it easy to make a determination when the presence of nucleated red blood cells is suspected, thereby significantly improving blood testing efficiency. The goal is to provide the following.

[Means to solve the problem]

In the blood data analysis method of the present invention, blood is diluted and hemolyzed to reduce the size of red blood cells and platelets, reduce the size of lymphocytes to small particles, and reduce the size of monocytes, 5 eosinophils, and monocytes.

A white blood cell sample is prepared in which basophils and blast cells are medium-sized particles and neutrophils are large particles, and the white blood cell particle size distribution is determined from this leukocyte sample. Then, in this white blood cell particle size distribution, a boundary is set between the ghost component consisting of the reduced red blood cells and platelets and the small particles,
The size and number of particles at this boundary are respectively XWL.

Let YWL be YWL, and let xscp be the particle size that takes a peak value in the distribution area of the small particles, a, b.

When X W L < a and Y W L > b and X5CP < c, where C is a constant, it is determined that there is a suspicion that nucleated red blood cells are present.

[Effect]

According to the structure of the present invention, a white blood cell sample is subjected to dilution and hemolysis treatment, whereby red blood cells and platelets are reduced in size, lymphocytes are reduced to relatively small particles, and neutrophils are reduced to relatively small particles. Large particles such as monocytes, eosinophils,
Basophils and blastocytes are intermediate-sized particles.

In the particle size distribution of this white blood cell sample, ghost components consisting of red blood cell membranes and platelets that have been reduced in size due to hemolysis treatment are
It appears in the area of even smaller particles than small particles (lymphocytes). and small particles.

Mountains appear in the particle size distribution curve for each of medium-sized particles and large-sized particles (neutrophils fig). The classification of these particles is
This is done by setting boundaries at the valleys (minimum points) between the distributions of each particle in the particle size distribution curve.

If the blood collected from the specimen contains nucleated red blood cells, the nuclei of these nucleated erythrocytes are not destroyed by the hemolytic treatment, so they may be treated as ghost components of relatively large particles in the white blood cell sample. Become.

This large ghost component is found in the white blood cell particle size distribution.
It is distributed in a region from the distribution region of ghost components to the distribution region of small particles, and therefore the distribution of the large ghost component overlaps with the distribution region of relatively small particles among the small particles. If a large amount of this large ghost component exists, the peak of the particle size distribution curve in the distribution region of small particles will be formed by the ghost component, and therefore, this peak will be larger than in the normal case.
It is formed by shifting to the ghost component side. That is, assuming that the size of the particle at the peak is X5CP, and setting aside a constant, the following holds true: X5CP<c.

Furthermore, the boundaries that classify ghost components and small particles are
The distribution of the large ghost component and the normal ghost component (
This boundary will be set closer to the ghost component than usual since the boundary will be set between the reduced red blood cell membrane and the distribution of platelets). That is, the particle size XWL at the boundary between the ghost component and the small particle satisfies XWL<a, where a is a constant.

Further, when there are a large amount of large ghost components distributed overlapping the distribution area of small particles, the number of particles having an intermediate size between small particles and normal ghost components also increases. That is, the portion where the two distribution areas overlap becomes relatively large.

Therefore, the number of particles YW at the boundary between the ghost component and small particles (including large ghost components)
L will increase more than usual.

Assuming that the constant is b, Y W L > b holds true.

In this invention, when both of the first two equations are satisfied, it is determined that there is a suspicion that a child nuclear red blood cell is present.

〔Example〕

FIG. 1 is a block diagram showing the overall configuration for implementing an embodiment of the present invention. Data from the blood cell counter 1 is input to the data analysis device 2 as a serial signal.

In the data analysis device R2, the serial signal is input to the data communication circuit 4 via the line driver 3 and converted into a parallel signal. This parallel signal is cpv
(Central processing unit) 5 and arithmetic means 7 comprising memory 6
is man-powered. In this calculating means 7, the data from the blood cell counter 1 is analyzed, and the results are printed out to a printing device 9 via a human output interface 8, and are also printed out to a printing device 9 such as a CRT (scanthray tube) or a liquid crystal display device. display device I
It is displayed and output to O.

The contents output to the printing device 9 or the display device 10 include detection data from the blood cell counter t and various messages based on the analysis results thereof. This message includes: ■ Abnormal message indicating that there is clearly an abnormality in the sample, ■ Suspicious message indicating that there is a high possibility that an abnormality exists in the sample, ■ The sample is normal with a high degree of darkness. There is a normal message that indicates the above, and an action message that instructs the next action to be taken in response to the above messages.

The calculation means 7 has the above-mentioned values (1) to (2) corresponding to white blood cells, red blood cells, and salivary platelets, respectively. Although a message is prepared, the suspect message regarding 0 blood Lg will be explained in more detail below.

Regarding the inner plate fJ, the following suspect message is prepared.

(a) RBCInLf: Red blood cells may affect the white blood cell count.

(b) E○/BASO/Bj! a s t s:
Eosinophil.

There is a suspicion that either basophils or blast cells are increasing.

(C) MONO/EO/B l a s t s
: There is a suspicion that there is an increase in monocytes, eosinophils, or blast cells.

(d) Incr, Monocytes: An increase in monocytes is suspected.

(e) Blas'ts/1mm, Ce1ls
: The presence of blasts or immature leukocytes is suspected.

(f) React, Lymph: Presence of atypical lymphocytes is suspected.

(g) 1mm, Neut, /LeftShift:
Immature neutrophils are present, and the nucleus is shifted to the left (Left 5hif).
t) is suspected.

(h) NRBC/PLT Cffiumps/F
ib.

Intf: There are any of the following: Nuclear base cells, platelet aggregation, or fibrin precipitation, which is suspected to be affecting the white blood cell count.

(i) NRBC: The presence of nucleated red blood cells is suspected.

0) Incr, EO: An increase in eosinophils is suspected.

(k) Large Ce11. s: The presence of large white blood cells is suspected.

(m) TzMiss-3et: A setting error in the boundary T2 is suspected (the boundary T2 will be described later).

In this embodiment, (i) “N RB C”
This relates to the determination when outputting a suspect message.

Counting of white blood cells, nosebleed f,

First, blood collected from a specimen is subjected to anticoagulation treatment, and then subjected to the blood cell counter 1. Inside the hemocytometer,
Pretreatment such as blood dilution and hemolysis is performed, and the sample subjected to this pretreatment is introduced into a detection section having micropores, and blood cells are counted.

For white blood cell samples, dilution and hemolytic treatment destroy red blood cells that can get in the way when counting white blood cells.

That is, the contents of the red blood cells are eluted, the red blood cell membrane is reduced in size, and the platelets are further reduced in size. In the hemolytic treatment, white blood cells also shrink, but since they have a nucleus, they remain as particles. By performing this hemolysis treatment under certain conditions, the lymphocytes in the white blood cell sample are made into relatively small particles, the neutrophils are made into relatively large particles, and other monocytes and eosinophils are made into particles in between. It can be made into particles of a certain size.

Furthermore, between monocytes and eosinophils, eosinophils can be made into slightly larger particles.

The white blood cell sample subjected to such hemolytic treatment is introduced into the leukocyte system detection section in the hemocytometer 1, and the red blood cell and platelet samples that have not been subjected to hemolytic treatment are introduced into the red blood cell system detection section. Each detection section includes, for example, a first chamber and a second chamber separated by a partition wall with micropores formed therein, and allows the sample to pass through the partition wall to separate the first and second chambers when particles pass through the partition wall. It is designed to detect changes in impedance between. This change in impedance corresponds to the size of particles passing through the micropores, and therefore the size of particles passing through the micropores can also be detected. The signal from such a detection unit is converted from analog to digital, etc.
By counting each digital individual, white blood cells,
Particle size distributions of red blood cells and platelets can be obtained.

The standard distribution of particles in a leukocyte sample after hemolysis is shown in FIG. In the leukocyte test rl, ghost components G (miniaturized base f, E membranes and platelets) are present.
, small particles SC (such as lymphocytes).

Medium-sized particles MC (single LX, eosinophils, etc.) and large particles LC (neutrophils, etc.) are mixed, each having variations in size. The particle size distribution obtained from a leukocyte sample having such a distribution is a composite of the above-mentioned components, and the particle size distribution diagram is shown in FIG. 3. That is, reference symbols Nl and II correspond to small particles SC5, medium particles MC, and large particles LC, respectively.
! 2. A mountain is formed as indicated by f3.

Boundary WL at the valley part of the particle size distribution curve as shown in 2.

T7. By setting Tz, it is possible to count the number of small, medium, and large particles in white blood cells.If there is no valley in the particle size distribution curve, it is possible to count the number of small, medium, and large particles in white blood cells. good. In addition, in the medium-sized particles MC, monocytes are distributed biased toward relatively small size, and eosinophils are distributed biased toward relatively large size.

Generally, the valley of the particle size distribution moves under the influence of the frequency of adjacent particle groups. That is, for example, particle A
Assume that the particle size distribution of a particle group including particles B and particles B, which are larger than particles A, becomes deafening as shown in FIG. However, the mountain indicated by the reference symbol NA is caused by the particle A, and the mountain indicated by the reference symbol fB is caused by the particle B. Furthermore, the frequencies of particles B are different in FIGS. 4(1) and (2), and the frequency of particles B is greater in the case shown in FIG. 4(2).

As is clear from the comparison of FIG. 4 (1) and (2), the valley (2) of the particle size distribution shifts toward the particle distribution as the frequency of particles B increases. That is, when the frequency of particle A is constant, it is possible to determine whether the frequency of particle B increases or decreases by shifting the valley V.

Furthermore, due to the increase in the frequency of the particles B, the frequency at the valley V becomes a high value. This can also be used as a criterion for determining an increase or decrease in the number of particles B.

FIG. 5 shows an example of a standard particle size distribution of a leukocyte sample. The horizontal axis is the particle size, and the joint axis is the relative frequency (%) with the peak of the distribution as 100. Boundary WL
, T1. Tt is ghost component G and small autologous blood cell S, respectively.
C, medium-sized inner dish File MC is set in the valley between the distributions of large white blood cells LC.

Numerical data regarding this leukocyte sample are as follows.

White blood cell count 63 XIO"/μ! Small white blood cell ratio 3G, 8 to medium white blood cell ratio 1010% Large white blood cell ratio 53.2% Small daily fast cell count 23 XIO"/μ2 Medium white blood cell count 6 XIO"/μ! Large white blood cell count 34 XIO ”/μl Each data regarding the above white blood cell sample is given from the hemocytometer I to the data analysis device 2 together with each data regarding the red blood cell and platelet samples.

White blood cells are composed of many types of particles, and their content ratios vary widely. Furthermore, depending on the disease, cells that do not normally appear may appear. For this reason, the particle size distribution of the leukocyte sample is highly variable, and it is possible to judge various abnormalities such as Φ from the particle size distribution of the leukocyte sample.

In the following, the procedure until 'NRBC' shown in (i) is output in the above-mentioned suspect message will be explained.

This suspect message indicates that there is a suspicion that nucleated red blood cells are present. As mentioned above, the white blood cell sample is subjected to hemolysis treatment, and at this time, the red blood cells are hemolyzed and reduced in size, and the platelets are also reduced in size, forming small particles S.
The ghost component G is a particle even smaller than the lymphocyte C. Therefore, in normal cases, small particles SC and ghost components G can be classified well and white blood cells can be counted. However, when nucleated red blood cells are present, their nuclei remain even after hemolysis, and ghost components with large particle sizes remain in the white blood cell sample, and the distribution of these large ghost components and the distribution of the small particles SC overlap, and it is not always possible to classify the small particles SC and the ghost component G well, which causes problems in counting white blood cells. Furthermore, nucleated red blood cells are associated with malignant tumors, leukemia, and hemolytic anemia.

It is seen in severe cases such as iron deficiency anemia and megaloblastic anemia, and it is important to determine the possibility of its existence.

The particle size distribution of the white blood cell sample when nucleated red blood cells are clearly present is shown in FIG. If nucleated red blood cells are present in the blood collected from the specimen, their nuclei are not destroyed by the hemolytic treatment, and therefore the ghost components of these nucleated red blood cells are slightly smaller than those of lymphocytes, which are small particle SCs. becomes small particles. Therefore, the distribution of large ghost components due to the nucleated red blood cells and the small particles S
The distribution of C is synthesized in the region from the distribution region of the normal ghost component G to the distribution region of the small particles SC in the particle size distribution of the sample for white blood cells.

If the blood collected from the specimen contains a large amount of nucleated red blood cells, the particle size distribution of the sample for inner dish f;
The frequency of the large ghost component caused by the nucleated red blood cells increases, and as a result, a peak (maximum point) SCP is formed by the large ghost component in the particle size distribution curve. In other words, in the particle size distribution curve in this case, in the distribution area of small particles SC, at positions where the particle size is smaller than usual,
A beak SCP will be formed. As a result, if nucleated red blood cells are clearly present, small particle SC
Particle size in the beak SCP in the distribution area.

Let the size be X5CP, and let the constant be C, then X5CP<
c (f l)...(1) holds true.

In addition, in the distribution area of small particles SC, the number of relatively small particles increases, resulting in ghost component G and small particles S.
The trough of the particle size distribution curve between G and C is formed to be shifted to the ghost component G side compared to the normal case shown in FIG. Therefore, the size XWL of the particle at the boundary WL between the ghost component G and the small particle SC becomes a smaller value than in the normal case. This means that if the constant is a,
XWL<a (f ff1) −(2)
It is expressed as Furthermore, due to the presence of ghost components caused by nucleated base metals ■ and y, the number of relatively small particles increases in the distribution area of small particles SC. ) and the overlapping portion of each distribution becomes large. Therefore, the relative frequency YWL at the boundary WL is larger than in the normal case shown in FIG. This is expressed as YWL>b (%) (3), where b is a constant.

In this embodiment, each determination according to the above-mentioned equations (1)2 to (3) is performed in the data analysis device 2, and
When all of formulas to formula (3) are satisfied, the presence of nucleated red blood cells is suspected, and a suspect message 'NRBC' is output to the printing device 9 or display device 10.At this time, an action As a message, “Rev, S++*r, (ReviewSmear
)' and "Verify WB C (white blood cell count)"
is output, prompting the examiner to check the sample and instructing him to confirm the number of bleeding 11i by &1.

It has been confirmed that highly accurate determination can be made by setting the constants a, b, and c within the following ranges.

a...31-36 b...15-25 C...49-54 As described above, according to this example, it is determined that nuclear red blood cells are present under certain determination conditions. It is determined whether or not there is a suspicion that the data is being used, this determination is performed in step 2 by the data analysis device, and the results are displayed and output on the display device 10 or the like. Therefore, such a determination is made accurately without depending on the experience of the inspector, and there are no individual differences among the people who examine the particle size distribution.Also, since the above-mentioned determination is automatic, so to speak, it is possible to First, the samples are sieved, and then samples suspected of having an abnormality can be tested using the sample, which greatly improves the efficiency of testing. .

[Effects of the Invention] As described above, according to the blood data analysis method of the present invention, it is determined whether or not the presence of nucleated red blood cells is suspected based on certain determination conditions. Judgments can be made accurately and efficiently without depending on the experience of the examiner. That is, when testing blood, first sieving out abnormal samples according to the present invention, and then conducting more detailed tests on samples suspected of having abnormalities,
Blood tests can be performed with good workability and accuracy.

[Brief explanation of the drawing]

FIG. 1 is a block diagram showing the overall configuration for carrying out an embodiment of the present invention, FIG. Figure 3 is a particle size distribution diagram corresponding to the distribution state of particles shown in Figure 2;
The figure is a particle size distribution diagram to explain changes in the particle size distribution curve due to changes in particle size distribution, Figure 5 is a particle size distribution diagram showing the standard particle size distribution of white blood cell samples, and Figure 6 is a particle size distribution diagram that clearly shows nuclear red blood cells. FIG. 3 is a particle size distribution diagram showing the particle size distribution of a leukocyte sample when the sample is present in white blood cells. l...Hematology counter, 2...Data analysis equipment 1
Picture number 2! Insertion of a÷ - 笥 3 Fig. a> Mangigo - Ripple of yi + □ Fig. 5 sep Fig. 6

Claims (1)

[Claims] Blood is diluted and hemolyzed to reduce red blood cells and platelets, lymphocytes into small particles, monocytes, eosinophils, basophils and blasts into medium-sized particles, and neutrophils into medium-sized particles. A white blood cell sample made into large particles is prepared, a white blood cell particle size distribution is determined from this white blood cell sample, and in this white blood cell particle size distribution, a boundary is set between the ghost component consisting of the reduced red blood cells and platelets and the small particles. Then, the size and number of particles at this boundary are respectively XWL and YWL, and in the white blood cell particle size distribution, the particle size that takes a peak value in the distribution area of small particles is XSCP, and a, b, and c are A method for analyzing blood data, characterized in that when the constants are XWL<a, YWL>b and XSCP<c, it is determined that there is a suspicion that nucleated red blood cells are present.