The quantitation of the non-heme porphyrin content of circulating erythrocytes is an important tool in the screening, diagnosis, and management of lead disease, iron deficiency anemia, and certain porphyrias. Useful information about these pathological conditions may be obtained from the distribution of the non-heme porphyrin content of individual red blood cells. An image-based cytometry system was developed and used to determine the cellular distributions of zinc protoporphyrin (ZPP) in the erythrocytes of normal and lead-exposed human subjects. The fluorescence cytometry system described here lends itself to a wide range of statistical studies of cell populations, in which extrinsic fluorescent probes or antibodies may be used instead of porphyrin. Image-based cytometry appears to offer a number of important advantages over the more conventional flow cytometry systems, including greater sensitivity, applicability to a wider range of cellular parameters, and the ability to retain images of each cell used in the survey for subsequent examination. Pairs of absorption and fluorescence images of many fields of dispersed immobilized red cells were acquired by means of a program which controls the microscope stage, focussing, shutters, filter wheels, and a cooled, slow-scan CCD camera. The observed marked differences in the ZPP distributions of erythrocytes from donors with chronic and acute lead exposure are discussed in terms of the metabolism of internalized lead. o 1992 Wiley-Liss, Inc.Key terms: Image analysis, fluorescence microscopy, lead disease In several pathological conditions, including chronic and acute lead disease, iron deficiency anemia, and certain porphyrias, the patient's erythrocytes contain significant levels of non-heme porphyrins. The quantitation of non-heme porphyrin has long been recognized as a n important diagnostic tool in these conditions (9) and the level of zinc protoporphyrin (ZPPj in blood is, for example, widely used in screening populations a t risk for undue lead exposure, such as various occupational groups and young children. In these porphyrin-based assays the average concentration of non-heme porphyrin in the erythrocytes is determined, either by solvent extraction (17) or, more usually, by a fluorometric method (lo), including the use of dedicated hematofluorometers (4,5). These fluorometric assays are based on the fact that free (unchelated) erythrocyte porphyrin (FEP), as well as Zn2 ' -chelated porphyrins (ZPP), fluoresce with significant quantum yields in the 600 nm region, while the heme is practically non-fluorescent, since the iron ion effectively quenches the red porphyrin fluorescence (7,151.The present paper describes an image-based methodology for measuring the distribution of the non-heme porphyrin content of individual erythrocytes and addresses the question of what information about the underlying pathological condition may be obtained from it. It is known, for example, that the plasma membrane of the circulating erythrocyte is permeable to unchelated porphyrin...