Phagocytosis of Escherichia coli KlZ strain bacteria was used to measure by flow cytometry the functional activities of human granulocytes in whole blood or huffy coat preparations. In a first measurement, the increase in electric cell volume and acridine orange (AO) green and red fluorescence were used to quantify the degree of phagocytosis. In a second measurement, the intracellular pH and esterase activity of each cell were determined with 1,4-diacetoxy-2,3-dicyanobenzene to obtain information on the metabolic activities during phagocytosis and degradation of bacteria. The DNA of dead cells was simultaneously counterstained with propidium iodide in both assays. The volume, the A 0 green and red fluorescence, the internal pH, and esterase activity were automatically averaged for all granulocytes or lymphocytes of a measurement. The calculated mean values were transferred into the self-learning database of the DIAGNOS1-program system. The functional granulocyte parameters of normal healthy individuals can be used as reference values for the automated diagnosis of abnormal granulocytes in various infectious disease states. The assays require 1 ml of heparinized whole blood and the results are available within 1 hour.Key terms: Neutrophils, phagocytosis, cytoplasmic hydrogen-ion concentration, cell volume Granulocytes play an important role in the defense of the organism through phagocytosis and degradation of bacteria, viruses, or fungi and through endocytosis of immune complexes. The number and activity of granulocyte change during severe infection (1,2,3),.and sepsis (6,32), but also after major surgery (9,401, polytrauma, and thermal injury (5,Zl).Activated granulocytes cause endothelial damage by the release of proteinases and oxygen radicals in the adult respiratory distress syndrome (41) and during hemodialysis (18).Analysis of granulocyte activation encounters difficulties in research and clinical laboratories because of the lack of fast, sensitive, and reliable in vitro methods for measurement of granulocyte functions.Microbiological methods require plating and culture of bacteria surviving after phagocytosis on agar plates (15). Microscopic methods for the quantification of phagocytosis (27) are time-consuming. In cuvette assays, only the total amount of phagocytosis but not the activity of single cells or granulocyte subpopulations can be measured. Chemiluminescence (11, the clearance of [140C]-labelled bacteria from suspension (4), the incorporation of t3H]-uridine into extracellular bacteria (26), the uptake of fluorescent latex beads, heat-killed bacteria coupled with FITC (231, latexbeads coupled to fluorogenic substrates (33), or phagocytosis of oil particles containing Oil Red 0 (7) are determined in such assays with suspensions of isolated granulocytes. The isolation of granulocytes by ficoll-hypaque or dextran sedimentation has been shown to induce spontaneous depolarization of the transmembrane potential (28), increased binding of C3b-coated microspheres, and morphological alteration of the ce...