Background Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, blood lost onto laparotomy sponges during surgical cases was measured using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. In this study we assessed the accuracy and performance of the system in surgical cases. Methods In this prospective, multicenter study, 46 patients undergoing surgery with anticipated significant blood loss contributed laparotomy sponges for hemoglobin (Hb) loss measurement using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Los Altos, USA). The Hb loss measured by the new system was compared to Hb loss measured by manual rinsing of the sponges. Accuracy was evaluated using linear regression and Bland-Altman analysis. In addition, the new system’s calculation of blood volume loss was compared with the gravimetric method of estimating blood loss from intraoperative sponge weights. Results A significant positive linear correlation was noted between the new system’s measurements and the rinsed Hb mass (r = 0.93, p < 0.0001). Bland-Altman analysis revealed a bias of 9.0 g and narrow limits of agreement (−7.5 g to 25.5 g) between the new system’s measures and the rinsed Hb mass. These limits were within the clinically relevant difference of +/−30 g, which is approximately half of the Hb content of a unit of allogeneic whole blood. Bland-Altman analysis of the estimated blood loss on sponges using the gravimetric method demonstrated a bias of 466 ml (overestimation) with limits of agreement of −171 ml and 1103 ml, due to the presence of contaminants other than blood on the laparotomy sponges. Conclusion The novel mobile monitoring system provides an accurate measurement of Hb mass on surgical sponges as compared with manual rinsing measurements and is significantly more accurate than the gravimetric method. Further study is warranted to assess the clinical utility of the technology.
Background Accurate measurement of intraoperative blood loss is an important clinical variable in managing fluid resuscitation and avoiding unnecessary transfusion of blood products. In this study, we measured surgical blood loss using a tablet computer programmed with a unique algorithm modeled after facial recognition technology. The aim of the study was to assess the accuracy and performance of the system on surgical laparotomy sponges in vitro. Study Design and Methods Whole blood samples of pre-measured hemoglobin (Hb) and volume were reconstituted from units of human packed red blood cells and plasma and distributed across surgical laparotomy sponges. Normal saline was added to simulate the presence of varying levels of hemodilution and/or irrigation use. Soaked sponges from four different manufacturers were scanned using the Triton System with Feature Extraction Technology (Gauss Surgical, Inc., Palo Alto, USA) under three different ambient light conditions in an operating room. Accuracy of Hb loss measurement was evaluated relative to the pre-measured values using linear regression and Bland-Altman analysis. Correlations between studied variables and measurement bias were analyzed using nonparametric tests. Results The overall mean percent error for measure of Hb loss for the Triton System was 12.3% [95% CI 8.2 to 16.4%]. A strong positive linear correlation between the pre-measured and actual Hb masses was noted across the full range of intraoperative lighting conditions, including (A) high (r = 0.95 [95% CI 0.93–0.96]), (B) medium (r = 0.94 [95% CI 0.93–0.96]), and (C) low (r = 0.90 [95% CI 0.87–0.93]) mean ambient light intensity. Bland-Altman analysis revealed a bias of 0.01 g [95% CI −0.03 to 0.06 g] of Hb per sponge between the two measures. The corresponding lower and upper limits of agreement were −1.16 g [95% CI −1.21 to −1.12 g] per sponge and 1.19 g [95% CI 1.15 to 1.24 g] per sponge, respectively. Measurement bias of estimated blood loss and Hb mass using the new system were not associated with the volume of saline used to reconstitute the samples (p = 0.506 and p = 0.469, respectively), suggesting that the system is robust under a wide range of sponge saturation conditions. Conclusion Mobile blood loss monitoring using the Triton system is accurate in assessing Hb mass on surgical sponges across a range of ambient light conditions, sponge saturation, saline contamination, and initial blood Hb. Utilization of this tool could significantly improve the accuracy of blood loss estimates.
4737 Objective: Microscopic examination of peripheral blood cells is an important diagnostic tool. We evaluated the CellaVision DM96 (CellaVision AB, Lund, Sweden), an automated image analysis system for digital peripheral blood cell analysis, comparing the results with direct manual microscopy. The system obtains digital images of the blood cells at high magnification and these images are analyzed using a neural network based on a large database of cells. Material and Methods: We analyzed 234 PB films stained with May-Grünwald-Giemsa from patients of the Hospital Clínic of Barcelona. Leukocyte values were from 1.12 to 282 × 109/L (Advia 2120, Siemens Healthcare Diagnostics SL). 177 of the PB films were from patients with hematological diseases: lymphoid neoplasias: 83, acute leukemias: 52, chronic myeloproliferative diseases: 20, myelodisplastic syndromes: 18, paroxysmal nocturnal hemoglobinuria: 2, hemoglobin S: 1 and thrombotic thrombocytopenic purpura: 1. Manual differentials were performed using standard microscopy. After the microscopic analysis the slides were loaded into the CellaVision DM96 obtaining digital images of preclassified cells, which were verified or corrected when necessary by the hematologist (DM96POST). WBC differentials were abnormal in 120 cases. Statistical analysis was performed using correlation (Pearson) and concordance (Lin) tests. Results: Correlation coefficients between results obtained from the CellaVision DM96 preclassification and by conventional direct microscopy were excellent for segmented neutrophils, lymphocytes, monocytes and blasts (r>0.87<0.94 and p<0.0001) and good for band neutrophils, eosinophils, basophils and plasma cells (r>0.74<0.81 and p<0.0001). Concordance coefficients were higher than 0.7 for all of the white blood cell subtypes preclassified by the DM96. Pearson and Lin coefficients were higher when we compared DM96POST values. After the reclassification of the cells very good concordance coefficients were observed for promyelocytes and myelocytes (> 0.7), intermediates for reactive lymphocytes and erythroblasts (>0.5 and <0,7) and low (<0.5) for metamyelocytes. Whatever the pathology and the number of blasts on the manual review films all 97 patients were positive for blast detection on DM96. Pathological cells such as prolymphocytes, large granular lymphocytes, hairy cells, Sézary cells and other atypical lymphocytes were reclassified by the user. Digital images showed dysplastic features or inclusions in blood cells and morphologic alterations in red cells or platelets were easily identified. Conclusion: Comparison of morphological classification of blood cells by the automated system DM96 shows good correlation and concordance values with respect to manual differentials. Advantages of the Cellavision DM96 over direct microscopy includes that requires less time than manual differentiation, allows the verification of the results by an expert from another location (telehematology), digital images can be stored and therefore available for re-evaluation, is a good tool for educational purposes and can improve the efficiency of a modern Hematology Laboratory. Disclosures: No relevant conflicts of interest to declare.
1347 Poster Board I-369 Introduction Sepsis is among the top 10 causes of death, but improvements in the diagnostic tests for detecting and monitoring sepsis and infection have been limited in the last years. Neutrophil CD64 expression increases rapidly in the presence of inflammation mediators and in response to infection and tissue damage. We have evaluated changes in the expression of neutrophil CD64 in infected patients in comparison with other markers of infection and sepsis. Methods Prospective analysis of 56 blood samples from patients from the intensive care unit at our institution was performed for neutrophil CD64 expression, C-reactive protein (CRP), automated absolute neuthophil count (ANC), and complete manual leucocyte formula including % of bands (BANDS), and % of metamyelocytes and myelocytes (IG). Neutrophil CD64 expression was measured by flow cytometry using a quantitative method (Leuko64TM, Trillium Diagnostics, LLC). Patients were categorized into 5 groups (CLINIC) based on the clinical history and the degree of a systemic inflammatory response, from 1 (no inflammation) to 5 (septic shock). Statistics were performed using linear regression, correlation coefficient, and Passing-Bablock (P-B) regression. Sensitivity (S), specificity (SP), efficiency (E), and positive and negative predictive values (PPV and NPV respectively) were analyzed for all the parameters measured. Results Our results showed a correlation with CLINIC of 0.417, 0.552, 0.268, and 0.136 for CD64, CRP, BANDS, and ANC, respectively. P-B regression was only good for CD64, with a slope of 1.03 (0.6-1.4). Percentages (%) of S, SP, E, PPV, and NPV for CD64 were of 81%, 72%, 71%, 46% and 92%, respectively for groups 4 and 5. For CRP, S was of 93% with SP of 20%, E of 38%, PPV of 27%, and NPV of 91%. The remaining parameters showed deficient correlation with CLINIC. Correlations between CD64 and CRP, BANDS, and ANC were of 0.435, 0.342, and 0.01, respectively. Conclusions Neutrophil CD64 expression quantitation provides improved diagnostic detection of infection/sepsis compared with the standard diagnostic tests used in current medical practice. CD64 expression showed a better PPV than CRP, and an acceptable NPV. CRP showed deficient SP and E. BANDS, GI, and ANC showed no correlation with CLINIC. CD64 is a new indicator of infection that deserves consideration to be introduced in the daily hematology laboratory analysis. Disclosures No relevant conflicts of interest to declare.
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