Validação de tecnologia 5diff do analisador hematológico Sysmex XS-1000i para laboratório de pequeno/médio porte / Validation of 5diff technologies of the Sysmex XS-1000i hematology analyzer for small and medium laboratories

O Sysmex XS-1000i® é um novo e compacto analisador hematológico com tecnologia 5diff e citometria de fluxo fluorescente, tecnologias até então presentes em equipamentos de grande porte e disponíveis apenas para equivalentes rotinas laboratoriais. Neste estudo avaliamos seu desempenho com equipamento de análise de impedãncia (Coulter T-890®) e à contagem diferencial de 200 leucócitos em microscópio. Foram analizadas 100 amostras paralelamente nos dois equipamentos e submetidas à contagem diferencial de 200 células em distensão sanguínea. Os resultados foram analisados mediante análise de correlação de Spearman para dados não paramétricos, mostrando correlação superior a 95 por cento para os parâmetros WBC, RBC, hemoglobina, hematócrito e neutrófilos; correlação entre 90 por cento e 94,9 por cento para VCM, HCM, linfócitos e eosinófilos ; correlação inferior a 89,9 por cento para CHCM, monócitos e basófilos. Os resultados obtidos sugerem que a tecnologia embarcada neste equipamento é uma versátil ferramenta para o analista na rotina de pequeno e médio porte. No entanto, em caso de emissão de "flags" não dispensa totalmente a confirmação ao microscópio para garantia da qualidade final do exame.

The Sysmex XS-1000i® is a new and compact blood analyzer with 5diff technology and fluorescent flow cytometry, technologies hitherto only present in large equipment and available only for laboratory equivalent routines. In this study its performance was compared with equipment for impedance analysis (Coulter T-890®) and the microscopic counting of 200 differential leukocytes. One hundred samples were evaluated in parallel by both apparatuses and subjected to differential counts of 200 cells. The results were analyzed using the Spearman correlation for parametric data showing no correlation greater than 95 percent for white blood cells, red blood cells, hemoglobin, hematocrit and neutrophils,; correlations between 90 percent and 94.9 percent for VCM, MCH, lymphocytes and eosinophils, and correlations lower than the 89.9 percent for MCHC, monocytes and basophils. The results suggest that this apparatus is a versatile tool for routine analyses in small and medium laboratories. However, in the case of flags, confirmation under a microscope is important to guarantee the quality of the final results.

Avaliação de eventos infecciosos oportunistas em crianças portadoras de leucemias / Evaluation of opportunistic infections in children suffering from leukemia

A leucemia é a principal neoplasia maligna de crianças e adolescentes, particularmente as leucemias agudas. A hiperproliferação clonal de precursores hematopoéticos, combinada à terapia antineoplásica, induz a um variável grau de comprometimento imunológico com consequente aumento da suscetibilidade a infecções oportunistas. O objetivo deste trabalho foi descrever a frequência das leucemias e os principais eventos infecciosos oportunistas em crianças e adolescentes atendidos na região de Passo Fundo-RS. Através de um estudo de coorte retrospectivo, foram analisados 92 prontuários de pacientes com idade de 8 meses a 17 anos, no período de janeiro de 2000 a dezembro de 2007. Foram encontrados 72 casos de LLA, 18 de LMA e 2 de LMC (78,2 por cento, 19,6 por cento e 2,2 por cento respectivamente). A doença infecciosa mais frequente foi a pneumonia, seguida da septicemia (principal causa de óbito), sendo as bactérias os principais microorganismos isolados, responsáveis por 52,4 por cento das infecções. Doenças parasitárias, virais e fúngicas corresponderam a 20,6 por cento, 19 por cento e 7,9 por cento, respectivamente. Estes resultados corroboram a condição de que doenças oportunistas são as principais complicações do paciente leucêmico, as quais aumentam a morbimortalidade dos mesmos.

The main malignant neoplasm that affects children and adolescents is leukemia, in particular acute leukemias. The clonal hyperproliferation of hematopoietic precursors combined with antineoplastic therapy leads to a variable degree of immunological involvement with a consequent increase in susceptibility to opportunistic infections. The objective of this work was to describe the frequency of leukemia and the major opportunistic infections in children and adolescents in the region of Passo Fundo, Brazil. In this retrospective cohort study, of cases from January 2000 to December 2007, 92 patients aged between 8 months to 17 years were reviewed. Seventy-two cases of ALL, 18 of AML and 2 of LMC (78.2 percent, 19.6 percent and 2.2 percent, respectively) were found. The commonest infectious disease was pneumonia, followed by septicemia (the leading cause of death). Bacteria, accounting for 52.4 percent of infections, were the most frequent microorganisms isolated with parasitic, viral and fungal diseases accounting for 20.6 percent, 19.0 percent and 7.9 percent of infections, respectively. The results of this study confirm that opportunistic diseases are the main complications of leukemia and increase the morbid-mortality of these patients.

Comparação entre diversos métodos de contagem diferencial de leucócitos em pacientes leucopênicos: [carta ao editor] / Comparison between different methods of differential counting of leukocytes in leukopenia patients: [letter to editor]

Leukopenia can be associated with the suppression of the bonemarrow by drugs, malignant disease, systemic lupus erythematosus,infections, and agranulocytosis. However some patients withoutapparent disease have leukocyte counts of less than 4.0 x 109/L. Thedifficulty in differential counting is related to the need of results thatare reliable enough for correct clinical interventions. The aim ofthis study was to compare the results of differential white blood cellcounts of leukopenia patients using different methodologies:electronic counting of cells utilizing the principle of impedanceanalysis and laser dissemination (Cell Dyn 3000), direct count underthe microscope of 200 cells in both whole blood and the leukocytelayer (Buffy coat). Eighty-four samples of blood whit leukocyte countsof less than 4.0 x 109/L were analyzed. The results of this studyshowed that by comparing the different leukocyte count methods,both direct and with automation, neutrophils and lymphocytes showedgood correlations (above 95%), eosinophils, basophils andmonocytes showed low correlation, and basophils, for at least twoof the four groups examined, showed a statistically significantdifference (p <0.05). These data suggest that despite of automationproviding more accurate and sensitive results, the technique ofanalyzing concentrated white blood cells in leukopenia patients cangreatly contribute to confirm electronic count flags and in theidentification of false-positive results.