The Picture of Inflammation: A New Concept That Combines the White Blood Cell Count and Erythrocyte Sedimentation Rate into a New Hematologic Diagnostic Modality

Abstract

Background: Physicians who work in small clinics, far away from medical centers, cannot obtain relevant information regarding the acute phase response at low cost and real time. Methods: We adopted a simple slide test and image analysis to determine the number of white blood cells in the peripheral blood, their degree of adhesiveness/aggregation as well as that of the red blood cells. Three independent observers scored the images into categories of no (1), mild (2), moderate (3) or severe (4) inflammation. Results: A substantial interobserver agreement was noted for all three observers. No patient classified as having no (1) inflammation was given a score of moderate (3) or severe (4) inflammation and vice versa. The one-way analysis of variance (age- and gender-adjusted) confirmed that the data obtained from the image analyzer are significantly different between the above-mentioned four categories. Conclusions: It is possible to use a simple slide test and image analysis to discriminate effectively between various degrees of inflammation intensity. Since it is possible to send the pictures via telephone, Inter- or Intranet to a physician somewhere else, it might be attractive for medical personnel who work in small clinics not equipped with sophisticated laboratory facilities. This technique is currently being evaluated for possible Telemedicine and E-Health uses.

Association of components of the metabolic syndrome with the appearance of aggregated red blood cells in the peripheral blood. An unfavorable hemorheological finding

“…When there is no aggregation, 100% of the slide area is covered with erythrocytes, while during aggregation this percentage is reduced owing to the appearance of clear areas between the groups of aggregated cells. The coefficient of variations of this methodology was depicted elsewhere [21][22][23].…”

Capillary and Venous Leukocyte Adhesiveness/Aggregation to Differentiate between Viral and Bacterial Infection

“…This means that if a person presents with 2.7% of the WBC in clusters of four or more cells, we could assume with 94% certainty that a bacterial infection is present. Also noteworthy is that the size distribution of clusters revealed that there are larger aggregates in the bacterial group compared to the viral and control groups, and this applied both for capillary and venous blood.The image analyzer is a simple, cheap and rapid tool to screen for the presence of relatively large leukocyte aggregates suggestive for the presence of a bacterial infection [43]. Based on the previous observations [14,26,[39][40][41][42], we do suggest that the determination of the size distribution of aggregated leukocytes be taken into consideration during the workup of a patient with an acute febrile condition and when the differentiation between viral and bacterial infection is relevant.…”

Spontaneous aggregation of leukocytes in active ulcerative colitis might be ICAM-1 dependent

“…The slides were scanned in an automated image analyzer (Inflamet TM ) as previously described [11]. Nine systematically chosen areas each covering 0.6 mm 2 were analyzed by the Inflammation Meter application software in respect to type of cell (based on cell size, shape, and density of the cytoplasma), the distance between neighboring cells, and the percentage of the areas covered by cells.…”

“…The aggregation level of a slide was then defined as the percentage of leukocytes in clusters of at least 2 cells. In the same manner, erythrocyte aggregation (or adhesiveness) was assessed as the percentage of the slide not covered by red blood cells (see [11] for details).…”