U.S. patent number 3,873,467 [Application Number 05/438,542] was granted by the patent office on 1975-03-25 for hematologic reference control.
This patent grant is currently assigned to United Medical Laboratories, Inc.. Invention is credited to Roger A. Hunt.
United States Patent |
3,873,467 |
Hunt |
March 25, 1975 |
HEMATOLOGIC REFERENCE CONTROL
Abstract
A hematologic reference control provided for laboratory use in
the calibration and control of automated and manual hematologic
analyses. The reference control comprises a suspension of washed,
stabilized human red blood cells in a nonproteinaceous aqueous
suspension fluid that replaces the plasma in human blood. Stability
in the reference control is attained by conditioning the cells by
the inclusion in the aqueous suspension fluid of materials tending
to make the cells assume a spherical shape without substantial
change in the mean cell volume of the cells as well as imparting to
the cells a resistance to the normal tendency of degrading with
time. The aqueous suspension fluid furthermore produces an
environment for the cells inhibiting biological activity. In a
preferred embodiment there is further included in the reference
control a minor amount of fixed human red blood cells, processed to
have a substantially increased mean cell volume. The fixed cells
are resistant to a change in cell volume, and to dissolution under
the action of lysing agents producing lysing of the stabilized
cells. The fixed red blood cells in the reference control
substitute for the white cell population in human blood.
Inventors: |
Hunt; Roger A. (Woodland,
WA) |
Assignee: |
United Medical Laboratories,
Inc. (Portland, OR)
|
Family
ID: |
23741019 |
Appl.
No.: |
05/438,542 |
Filed: |
February 1, 1974 |
Current U.S.
Class: |
436/10; 436/17;
436/16; 436/18 |
Current CPC
Class: |
G01N
33/96 (20130101); Y10T 436/106664 (20150115); Y10T
436/108331 (20150115); G01N 2400/22 (20130101); G01N
2496/05 (20130101); Y10T 436/101666 (20150115); Y10T
436/107497 (20150115) |
Current International
Class: |
G01N
33/96 (20060101); G01n 033/16 () |
Field of
Search: |
;23/23B ;252/408
;424/3,2 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Serwin; R. E.
Attorney, Agent or Firm: Kolisch, Hartwell, Dickinson &
Stuart
Claims
It is claimed and desired to secure by Letters Patent:
1. A hematologic reference control comprising a suspension of
stabilized human red blood cells in a nonproteinaceous aqueous
suspension fluid, said blood cells retaining ability to respond to
a lysing agent by dissolution, and being conditioned in said
suspension by the inclusion in said suspension fluid of a
disulfonic acid salt of naphthol, and an alkaline tartrate.
2. The reference control of claim 1, which further includes Dextran
having a molecular weight within a range of 10,000 to 50,000
dissolved in said suspension fluid, and imparting to the suspension
fluid a specific gravity within the range of 1.01 to 1.03.
3. The reference control of claim 1, which further includes a minor
amount of fixed human red blood cells, swollen to significantly
greater mean cell volume than the mean cell volume of the
stabilized cells and functioning as a substitute for the white cell
population in human blood, the fixed cells having been fixed
through an aldehyde treatment so as to be resistant to a change in
mean cell volume, and resistant to dissolution by a lysing agent
producing dissolution of the stabilized cells.
4. The reference control of claim 1, which further includes Dextran
having a molecular weight within a range of 10,000 to 50,000, which
is dissolved in the suspension liquid and imparts to the suspension
fluid a specific gravity within the range of 1.01 to 1.03, and a
minor amount of fixed human red blood cells swollen to
significantly greater mean cell volume than the mean cell volume of
the stabilized red blood cells and functioning as a substitute for
the white cell population in human blood, said fixed cells being
fixed through an aldehyde treatment to be resistant to a change in
mean cell volume and resistant to dissolution by a lysing agent
producing dissolution of the stabilized cells.
5. In a hematologic reference control including a first group of
human red blood cells suspended in an aqueous suspension fluid, a
second group of human red blood cells suspended in said suspension
fluid functioning to substitute for the white cell population of
human blood, said second group of red blood cells consisting of
cells in a swollen state whereby the cells of the second group have
a significantly greater mean cell volume than the mean cell volume
of the cells in the first group, the cells of the second group
having been fixed in their swollen state whereby said cells are
more resistant to change in cell volume and to dissolution than the
remainder of the cells.
6. The reference control of claim 5, wherein fixing of the cells of
said second group is by submersing the cells in an aldehyde tanning
solution.
7. A swelling fluid for the swelling of human red blood cells to
increase their mean cell volume and to promote aggregation of the
cells in their swollen state comprising an aqueous solution of
sodium bicarbonate, iodoacetamide, an alkali tartrate, and Dextran
having a molecular weight within a range of about 150,000 to
350,000.
8. A fixing fluid, for fixing swollen human red blood cells in
their swollen state and imparting resistance to dissolution by
lysing agents, comprising an aqueous solution of an alkali tartrate
and glutaraldehyde.
Description
This invention concerns generally what is referred to herein as a
hematologic reference control, such comprising a suspension of
human red blood cells in an aqueous suspension fluid usable in a
hematology laboratory in the obtaining of reference values in
connection with assays performed on human blood using manual and
automated procedures.
A need exists for such a reference control which is stable, in that
the same can be used over a long period of time without substantial
change occurring in the reference values obtained therefrom.
Preferably the reference control also should resemble human blood,
with respect to pertinent characteristics, such as coloring,
specific gravity, potassium and sodium ion concentrations, pH, and
the manner in which the constituents thereof remain in
suspension.
A general object, therefore, is to provide a reference control
exhibiting a stability that substantially exceeds that of controls
presently known.
Another object of the invention is to provide a reference control
which, with respect to pertinent physical characteristics, has a
close resemblance to human blood.
More specifically an object is to provide a reference control
including a population of human red blood cells suspended in a
suspension fluid, with the cells conditioned in their suspended
state so as to be resistant to degradation. The cells nevertheless
do respond to traditional lysing agents, whereby the reference
control may be used in a procedure which requires lysing of red
blood cells.
Another object is to provide a reference control which includes a
group of specially processed human red blood cells, referred to as
fixed cells, incorporated into the reference control to substitute
for the white blood cell population, unstable with time, normally
found in human blood. These specially processed cells, by reason of
a swollen condition produced therein, and by reason of a fixing of
the cells in their swollen condition, possess a specific gravity
significantly less than that of normal red blood cells and similar
to that of white blood cells, and will remain in this condition
with substantially no change during the life of the reference
control. The fixing of the cells furthermore makes them resistant
to dissolution or degradation under the influence of the usual
lysing agents used in hematologic test procedures. The fixed cells
in the reference control tend to remain in suspension in a manner
similar to white cells of human blood. Since the fixed cells are of
human origin, certain advantages result such as ease of clean up,
not attained with the use of other materials such as synthetic
particles for the replacement of the white cells in human
blood.
The reference control of the instant invention may be readily
formulated to provide reference values usable in making assays of
normal human blood. Additionally, if desired, the formulation of
the reference control may be such as to provide reference values
for abnormal ranges of blood.
The foregoing and other objects and advantages of the instant
invention will become more fully apparent from a reading of the
following description, to be taken in conjunction with the specific
examples set forth included to illustrate the invention
specifically.
Speaking in general terms, in a reference control according to a
preferred embodiment of the instant invention, human red blood
cells are initially washed with an aqueous washing fluid, for the
purpose of washing the cells free of plasma, anticoagulant, white
blood cells and other debris, and to initiate stabilization of the
cells, in a manner more fully to be described. The washed red blood
cells are suspended in an aqueous suspension fluid, formulated to
have many of the physical characteristics of human blood plasma.
The suspension fluid is free of protein, to inhibit such things as
bacterial growth in the fluid and surface accumulation of protein,
and free of materials which normally favor biological activity in
the cells. The suspension fluid further includes certain salts
dissolved therein, serving to condition the cells, whereby the
cells transform into substantially spherical bodies with somewhat
toughened cellular membranes. The cells, however, maintain
substantially their original mean cell volume. The cells in this
condition exhibit maximum stability over the life of the reference
control. Finally, there is included in the suspension fluid a minor
amount of swollen, fixed red blood cells, these specially processed
swollen red cells substituting for the white cell population found
in the usual human blood.
WASHING FLUID
The washing fluid which is used in the initial processing of the
so-called stabilized cells of the reference control, in addition to
cleansing the cells to rid them of traces of plasma, platelets and
other debris, is effective to initiate stabilization of the cells
by performing a number of different functions. Thus, the washing
fluid may include a sulfhydryl group reactant exemplified by
iodoacetamide, in sufficient quantity to react with and thus
deactivate the free sulfhydryl groups found on normal red blood
cells, to inhibit glycolysis and to prevent such sulfhydryl groups
from antagonizing merthiolate or other similar antiseptic included
in the suspension fluid for the purpose of inhibiting bacterial or
fungal growth. Stabilization of the cell membranes, and protection
against hemolysis, is gained by the inclusion of an ethylene
dinitrilo tetraacetic acid salt or salts, these functioning as a
chelating material effective to remove multivalent positive ions
from the cells, as exemplified by the calcium ion. The washing
liquid may further include a small amount of aldehyde, for the
purpose of toughening the cell membranes, and material or materials
promoting clumping or aggregating of the cells whereby after
washing their separation from the washing fluid is promoted.
Materials of this latter category comprise Dextran, and sodium
bicarbonate. An alkali tartrate may be included as a membrane
strengthener. Thus, a typical washing fluid may comprise the
following materials, preferably in the ranges indicated, dissolved
in deionized or distilled water:
Material Molarity ______________________________________ Dextran
(molecular weight 150,000 to 350,000) 0.00009-0.00015
2-Iodoacetamide 0.00040-0.00070 Sodium bicarbonate 0.02000-0.04000
Sodium tartrate 0.05000-0.15000 Ethylene dinitrilo tetra acetic
acid, dipotassium salt (EDTA, potassium salt) 0.00180-0.00270
Ethylene dinitrilo tetra acetic acid, tetra sodium salt (EDTA,
sodium salt) 0.00040-0.00080 Glutaraldehyde 0-0.00008 Deionized or
distilled water to desired volume
______________________________________
Commercially available packed human red blood cells may be washed
with the washing fluid indicated above, as by introducing the blood
cells at room temperature into a separatory vessel containing the
washing fluid, and then gently mixing to prepare a suspension with
the cells dispersed throughout the fluid. About 1 liter of washing
fluid may be used in the washing of a unit of packed cells
containing about 330 ml of material. After the mixing, the mixture
is allowed to rest, which causes the red cells to aggregate and to
precipitate, with such promoted by the Dextran and sodium
bicarbonate in the washing fluid. The supernatant, containing white
blood cells, platelets, plasma, unprecipitated red blood cells and
other debris is syphoned off. The washed cells are then collected
in a receptacle by draining them from the vessel, preferably with
discarding of the first cells drained and discarding of the cells
forming the top surface region of the precipitated cells.
SUSPENSION FLUID
The suspension fluid which substitutes for plasma in natural blood
is an artificial nonplasma-type fluid substantially free of
chlorine ions. The fluid is buffered, to maintain a pH relatively
unaffected by the red cells introduced into the fluid, and is
formulated to have bactericidal and fungicidal qualities, so that
prolonged storage will not result in growth of contaminating
organisms. The suspension fluid also imparts a resistance to
degradation to washed red blood cells introduced into the fluid,
and is formulated to have certain characteristics resembling that
of human plasma, such as specific gravity, pH, and potassium and
sodium ion concentrations.
The suspension fluid further includes a material tending to make
the washed red blood cells substantially spherical in shape,
without substantially changing the mean cell volume of the cells.
As so conditioned, the cells have a stabilized shape while
possessing substantially the specific gravity of normal red blood
cells.
A typical formulation for a suspension fluid as contemplated herein
comprises the following dissolved in deionized or distilled water,
preferably in the ranges indicated:
Material Molarity ______________________________________ Dextran
(molecular weight 10,000 to 50,000) 0.00075 -0.00225 Ethanol 1.60
-1.95 Merthiolate 0.00020 -0.00030 Tetracycline hydrochloride 0
-0.00030 Tris Hydroxymethyl-2 Aminoethane sulfonic acid (TES) 0
-0.0175 N,N-Bis (2-Hydroxyethyl)-2- aminoethane-sulfonic acid (BES)
0 -0.0188 N-2-Hydroxyethyl-piperazine- N-2-ethane sulfonic acid
(HEPES) 0 -0.0168 2-Naphthol-3,6-disulfonic acid, disodium salt
0.0125 -0.0250 Sodium tartrate 0.0370 -0.0500 Ethylene dinitrilo
tetra acetic acid, dipotassium salt (EDTA, potassium salt) 0.00180
-0.00270 Ethylene dinitrilo tetra acetic acid, tetrasodium salt
(EDTA, sodium salt) 0.00040 -0.00080 Sodium hydroxide to pH of
7.0-7.5 0.004 -0.013 Deionized or distilled water to desired volume
______________________________________
The potassium ion concentration is preferably selected to be within
the range of 3 to 6 milliequivalents per liter, and the sodium ion
concentration between 120 and 160 milliequivalents per liter. The
Dextran in the above formulation imparts to the suspension fluid a
specific gravity (1.01-1.03) approximating that of normal plasma.
By the inclusion of the ethanol, an antiseptic is introduced and
also a membrane-active compound serving to strengthen the membranes
of washed cells introduced into the fluid which stabilizes the
cell. The merthiolate and tetracycline hydrochloride are
antibacterial and antifungal in activity. The sodium tartrate
imparts resistance to cell degradation. The sodium and potassium
salts of EDTA are chelating agents, and introduce strength to cell
membranes. The BES, TES and HEPES are introduced for buffering
purposes. Various ratios of the three compounds are used according
to the pH desired, their pK.sub.a points at 20.degree.C. being
7.15, 7.50 and 7.55, respectively.
By the inclusion of the disulfonic acid salt of naphthol, it is
observed that washed red blood cells suspended in the fluid tend to
round out and assume spherical shapes, without a substantial change
in mean cell volume. This spherical shape is stable and maintained
over the life of the reference control.
Washed red blood cells, when suspended in a suspension fluid of the
type indicated above, while being stable and resistant to
degradation of the type that would adversely affect the stability
of the reference control for hematologic measurements, nevertheless
are susceptible to lysing when subjected to the usual lysing agents
employed in hematologic procedures, such agents usually containing
saponin or membrane-active detergent compounds.
As previously indicated, this invention contemplates a small
fraction of so-called fixed red blood cells in the reference
control which substitute for white cell population in the usual
blood. These are processed by first treating them with a swelling
fluid, to induce swelling of the cells to a significantly greater
mean cell volume. The swelling, however, is not so great as to
produce hemolyzing and bursting of the cells. The swollen cells are
then treated with a fixing fluid, which in effect subjects the
cells to a tanning operation. The cells when so fixed maintain
their swollen condition, and are resistant to the usual lysing
agents used in hematologic procedures.
SWELLING FLUID
A swelling fluid as contemplated herein may comprise the following,
preferably in the ranges indicated, dissolved in deionized or
distilled water.
______________________________________ Material Molarity
______________________________________ Sodium bicarbonate 0.0200
-0.0400 2-iodoacetamide 0-0.00070 Potassium sodium tartrate 0.0200
-0.0400 Dextran (clinical grade, 150,000 to 350,000 M.W.)
0.00009-0.00015 Deionized or distilled water to desired volume
______________________________________
Swelling of the red blood cells when such are immersed in the
swelling fluid is the result of osmosis, the swelling fluid having
a solute concentration which is reduced from the solute
concentration within the cells themselves. Thus, the sodium and
potassium concentration in the swelling fluid may typically be in
the range of 50 to 60 milliequivalents, with the concentration
within a typical cell being in the neighborhood of 140
milliequivalents. With the concentration of water outside the cells
being greater than the concentration inside the cells, there is a
tendency for the water concentration to equilibrate, with water
moving inside the cells to swell them. The normal specific gravity
of a cell may be within the range of 1.10 to 1.12. With swelling to
approximately 50 percent greater volume, the specific gravity is
reduced, to be within the range of 1.06 to 1.08.
Referring to the formulation for the swelling fluid set forth
above, the pH of the fluid normally would be within the range of
7.0 to 9.0. The presence of the sodium bicarbonate and Dextran is
to promote aggregation of the swollen red cells, to promote their
separation from the swelling fluid. The iodoacetamide, while not
strictly necessary, is included to inhibit glycolysis and to
inactivate sulfhydryl groups, and performs a function similar to
the functioning discussed in connection with the washing fluid. The
potassium sodium tartrate is a membrane strengthening agent, and
functions to inhibit bursting of the cells under swelling
conditions.
FIXING FLUID
Human red cells swollen to approximately 150 percent their normal
mean cell volume by the swelling fluid set forth above are fixed
permanently in this swollen condition with a fixing fluid. The
fixing fluid is essentially a tanning medium, rendering the cells
stable and impervious to the usual lysing agents. A typical fluid
may have the following composition:
Material Molarity ______________________________________ Potassium
sodium tartrate 0.0075 - 0.0095 Glutaraldehyde 0.0015 - 0.0025
Deionized or distilled water to desired volume
______________________________________
It should be noted that there is a relatively high concentration of
the aldehyde in the above formulation, such being the tanning
agent. The potassium sodium tartrate is preferably included, to
maintain the swollen cells in their swollen condition during the
tanning of the cells with the aldehyde.
PRODUCTION OF ALDEHYDE FIXED RED BLOOD CELLS
In preparing the fixed red blood cells, a unit of packed human
blood cells (about 330 ml) may be deposited in a separatory funnel
and a liter of swelling fluid added thereto. With gentle swirling,
a suspension is produced. During swirling, the cells swell to about
150 percent their original mean cell volume, the unit of blood
thereby increasing to about 500 ml.
The swollen cells then may be permitted to settle or precipitate
for 1 hour. The swollen cells may be drained from the base of the
funnel. Preferably, the first few milliliters of the packed cells
drained are discarded as well as the cells making up the top layer
in the separatory funnel in order to obtain a pure sample.
The swollen cells so produced may be introduced into 2 liters of
fixing fluid which is being rapidly stirred. The rapid stirring is
continued for a period of about 24 hours. The molarity of the
glutaraldehyde is then approximately doubled from the molarity of
the original fixing fluid, and stirring continued for another 24
hours. While this rapid stirring continues, some energy may be
introduced at about 100 watts/cm.sup.2 to physically clean the
cells and destroy those of marginal stability. The fixed cells
produced are then gently centrifuged, and the supernatant
discarded. The swollen fixed cells may then be washed with
deionized or distilled water, or a physiological salt solution if
desired. A suspension may then be prepared from the remaining
clean, fixed cells through addition of some suspension fluid, which
conveniently may be about twice the volume of the fixed cells. A
cell count of the fixed cells in the fixed cell suspension so
produced may be performed by a counting device such as a Coulter
Counter, a conventional commercially available automatic blood
counter which counts cells electronically as such are caused to
pass through an orifice in the machine. For a discussion of a
Coulter Counter Model S, reference is made to the article of
Pinkerton, et al., entitled "An Assessment of the Coulter Counter
Model S" appearing in the Journal of Clinical Pathology 1970, 23,
68-76.
PREPARATION OF REFERENCE CONTROL
Describing the preparing of a typical reference control, and one
usable to provide reference values generally paralleling those
found in normal blood specimens, a measured volume of washed,
unfixed, red blood cells prepared as described above was gently
mixed with suspension fluid also prepared as described above, to
produce a suspension of the washed, unfixed, red blood cells. The
volume of suspension fluid added was 0.7 times the volume of the
washed red blood cells, since this results in a red blood cell
concentration in the final control approximating that of normal
blood.
A typical fixed cell suspension prepared as described above had a
cell count performed thereon using a Coulter Counter Model F,
indicating a cell count of fixed red cells of 1.5 million per
mm.sup.3. In making the cell count, a voltage threshhold was used
in the counter similar to the threshhold used when making white
cell counts of normal blood.
Employing the formula V=(WS/F- W), wherein V is the volume in mls
of fixed cell suspension to be added, W is the desired white cell
count in cells per mm.sup.3, S is the volume in mls of suspension
of washed unfixed red blood cells to receive V, and F is the fixed
cell suspension count in cells per mm.sup.3, it was determined that
4.2 mls of the fixed cell suspension should be introduced to one
liter of washed unfixed red cell suspension to produce the
reference control desired. The resulting reference control was
allowed to stand for a period of 14 days, to permit the washed
unfixed cells to become fully stabilized in the suspension.
A reference control so produced was used in obtaining reference
values with a Coulter Counter Model S. Thus, and following typical
procedures with such a counter, a red cell count was performed on a
fraction of the reference control, yielding a count of 4.82 .+-.
0.10 million per mm.sup.3. A white blood cell count was performed
on another fraction (with lysing of the red cells using
cyanmethemoglobin solution) yielding a count of 5.9 times 10.sup.3
.+-. 0.4 thousand cells per mm.sup.3. The hemoglobin concentration
as measured by the machine yielded a value of 15.4 .+-. 0.2 gms per
100 ml sample. The mean cell volume as measured by the counter was
92.2 .+-. 2.2 cubic microns. The values indicated are the mean plus
or minus twice the standard deviation from the mean. The values
indicated, which are typical of normal blood, held constant for
more than 60 days after first assay. The values obtained were
confirmed using known manual techniques.
Typically, the reference control as contemplated herein may be
assigned a refrigerated lifetime of at least 60 days from date of
assay, during which time the hematologic values obtainable
therefrom are expected to remain stable. Usually, longer lifetimes
are expected. At room termperatures, stability is good, with the
shelf life of the control usually exceeding 1 week. The color of
the reference control remains red until well after the expected
life of the control, permitting its use as a quality control item.
The mean cell volume of the stabilized red cells of a typical
reference control as measured directly or by calibrated automated
devices stabilizes at about 90 cubic microns. The specific gravity
of the usual reference control for standard use is within the range
of 1.045 and 1.070, and the pH between 7.0 and 7.5. The potassium
ion concentration of the usual control ranges from 3 to 6
milliequivalents per liter, and the sodium ion concentration
between 120 and 160 milliequivalents per liter.
* * * * *