METHOD FOR DETERMINING A COMPLETE BLOOD COUNT ON A WHITE BLOOD CELL DIFFERENTIAL COUNT
Systems and methods analyzing body fluids such as blood and bone marrow are disclosed. The systems and methods may utilize an improved technique for applying a monolayer of cells to a slide to generate a substantially uniform distribution of cells on the slide. Additionally aspects of the invention also relate to systems and methods for utilizing multi color microscopy for improving the quality of images captured by a light receiving device.
This application claims priority under 35 U.S.C. §119 to U.S. Provisional Application No. 61/047,920, filed Apr. 25, 2008, which is expressly incorporated herein by reference in its entirety. Further, the present application expressly incorporates herein by reference the application entitled “SYSTEMS AND METHODS FOR ANALYZING BODY FLUIDS,” which is being filed on the same date and by the same inventors as the present application.FIELD OF THE INVENTION
This invention relates to a system and process for determining composition and components of fluids. More specifically the present invention provides improved techniques for viewing cellular morphology, and determining the number of a particular type of cell in a portion of a body fluid.BACKGROUND OF THE INVENTION
Pathology is a field of medicine where medical professionals determine the presence, or absence of disease by methods that include the morphologic examination of individual cells that have been collected, fixed or air-dried, and then visualized by a stain that highlights features of both the nucleus and the cytoplasm. The collection of the cells often involves capturing a portion of a person's body fluid, placing the body fluid on a slide, and viewing the fluid on the slide using a microscope.
One of the most commonly performed pathologic studies is the CBC (the Complete Blood Count). To perform a CBC, a sample of blood is extracted from a patient and then the cells are counted by automated or manual methods. The CBC is commonly performed by using an instrument, based on the principal of flow cytometry, which customarily aspirates anticoagulated whole blood and divides it into several analysis streams. Using the flow cytometer a number of primary and derived measurements can be determined including: i) red blood cell (RBC) count, hemoglobin (Hb), hematocrit (Hct), red blood cell indices (mean corpuscular volume, MCV, mean corpuscular hemoglobin, MCH and mean corpuscular hemoglobin concentration MCHC), red blood cell distribution width, enumeration of other red blood cells including reticulocytes and nucleated red blood cells, and red blood cell morphology; ii) white blood cell (WBC) count and WBC “differential” count (enumeration of the different normal white blood cell types, including neutrophils, lymphocytes, eosinophils, basophils and monocytes, and the probable presence of other normal and abnormal types of WBC that are present in various disease conditions); and iii) platelet count, platelet distribution widths and other features of platelets including morphological features. In flow cytometers, red blood cell, WBC, and platelet morphological characterizations are typically made indirectly, based on light absorption and light scattering techniques and/or cytochemically based measurements. Some advanced flow cytometers calculate secondary and tertiary measurements from the primary measurements.
Flow based CBC instruments generally require extensive calibration and control, maintenance, and skilled operators, and they have substantial costs associated with acquisition, service, reagents, consumables and disposables. One significant problem with these systems in routine use is that a large proportion of blood specimens require further testing to complete the assessment of the morphologic components of the CBC. This involves placing a sample of blood on a slide, smearing the sample against the slide to form a wedge smear, and placing the slide under a microscope. This process is often done manually by skilled medical technologists, which increases the cost and time to receive results from the tests. The direct visualization of blood cells on a glass slide must be performed whenever the results of the automated test require further examination of the blood sample. For example, a “manual” differential count is performed by direct visualization of the cells by an experienced observer whenever nucleated immature RBCs are found or WBCs suspicious for infection, leukemias or other hematologic diseases are found.
The proportion of these specimens requiring further review generally ranges from 10% to 50%, depending on the laboratory policy, patient population and “flagging” criteria, with a median rate of around 27%. The most frequent reasons for retesting include the presence of increased or decreased number of WBCs, RBCs or platelets, abnormal cell types or cell morphology, clinical or other suspicion of viral or bacterial infections.
In addition to additional work involved in performing manual differential counts, this process has a number of additional technical limitations. These include distortions of cell morphology because of mechanical forces involved in smearing the cells onto the slide, and cells overlapping one another, which makes visualization of individual cell morphology difficult.SUMMARY OF THE INVENTION
The present invention provides systems and methods for placing cells on a slide. Additionally systems and method for imaging the cells are provided. The images may be later used to perform tests such as a complete blood count including image-based counting and assessment of the morphology of the formed elements of blood, including RBCs, WBCs, and platelets. Embodiments of the present invention may improve the accuracy of the CBC by providing improved visualization of the formed elements of blood. Aspects of the present invention may analyze and determine the presence of certain cell types, such as abnormal or immature WBCs that are found in cases of abnormal bone marrow function including hematological malignancies. Further, the configurations of the present invention may decrease costs associated with instrumentation, decrease costs of consumables and reagents, require less operator time and reagents, fewer repeated tests, and fewer moving parts than other prior art techniques. Configurations of the present invention may also reduce the turn around time for many of the CBC tests that currently require visualization of blood cells after the instrumental portion of the test is completed, by allowing cells to be visualized on a monitor instead of under a microscope.
Aspects of the present invention are effective at preserving cell morphology. This may be important for patients with hematological malignancies such as chronic lymphocytic leukemia (CLL) or acute myeloid leukemia (AML). The systems and methods relating to applying a monolayer of cells to a slide may enable detection of a larger number of morphologically well-preserved blast cells and other immature or fragile cells. This would allow their more accurate recognition at an earlier stage of the leukemic or other disease process. Certain aspects of the present invention provide for preparing a substantially uniform distribution of cells across a test area of a slide.
Aspects of the present invention also relate to collecting cells in a fluid (such as blood) from organic tissue, possibly mixing the cells contained in the fluid with a diluent, collecting a sub-sample (aliquot) of a known volume from the solution, and then depositing the aliquot onto a substratum such as a slide using a dispensing device or applicator. The cells may be allowed to air dry or may be fixed (using a fixative solution) or both, depending on the examination that is anticipated. The cells may also be stained. The stained cells on the substratum may be counted and examined by an automated imaging system utilizing a computer or viewed by manual microscopic examination. Digital images may be shown on a computer display to reduce the need for manual microscopic review.
With reference to
In embodiments which feature a platform 100, an advancer 110 may be configured to receive one or more slide apparatuses 700-700″. The advancer 110 may be attached to a surface, such as the top surface 101, of the platform. The advancer 110 may take the form of a belt as shown in
The platform 100 may also comprise a feeder 102 and a collector 106 for respectively feeding and collecting the slide apparatuses 700 from or to a stack or rack. The feeder 102 may be equipped with a feeder propulsion mechanism 103 (such as rubberized wheels) for pushing the slides down a ramp 104 onto the advancer 110. (Of course embodiments of the invention could be built without a ramp. For example, if the feeder is level with advancer 110, no ramp would be needed. Alternatively, a mechanical arm could be used to grab the slide apparatus 700 and place the slide apparatus 700 on the advancer directly.) Alternate mechanisms to propel the slide out of the feeder 102 may be used such as magnets or hydraulics. The feeder may comprise a sensor for determining how many slides are present. The sensor could measure the weight of the slide apparatuses 700 for example to determine how many slide apparatuses were present.
The light receiving device 200 may be a microscope (such as brightfield microscope), a video camera, a still camera, or other optical device which receives light. In embodiments using a standard brightfield microscope, one containing an automated stage (a slide mover 201) and focus may be selected. In one embodiment, a microscope may be attached to a motorized stage and a focus motor attachment. The microscope may have a motorized nosepiece, for allowing different magnification lenses to be selected under computer 300 control. A filter wheel may allow the computer 300 to automatically select narrow band color filters in the light path. LED illumination may be substituted for the filters, and use of LEDs may reduce the image acquisition time as compared to the time required for filter wheel rotation. A 1600×1200 pixel firewire camera may be used to acquire the narrow band images.
In some cases, the light receiving device will receive light reflected off slide apparatus 700″ and store an image of that light. In some embodiments fluorescent emission from the cellular objects may be detected in the light receiving device 200. However, since the light emission source 600 can be positioned below the platform, the light emission source may direct light so that it passes through the platform 100 and the slide 701 into the light receiving device 200. The light receiving device may be connected to a computer through a link 11, and may be capable of X, Y, and Z axial movement (in other embodiments a motorized stage or slide mover 201 may provide X, Y, and Z movement.) The light receiving device may comprise a link 11 such as a wire as shown in
The computer 300 may be a laptop as shown in
Although shown as one component, computer 300 may comprise multiple computers and a first computer could be used for controlling the components and a second computer could be used for processing the images from the light receiving device 200. In some embodiments, the various computer may be linked together to allow the computer to share information. The computer 300 may also be connected to a network or laboratory information system to allow the computer to send and receive information to other computers.The Applicator 400
In certain embodiments, the applicator 400 may comprise a syringe, a manual or motor driven pipettor or using a motor controlled pump attached through a tube to a pipette tip. While many different types of pipettes or syringes could be used, test results have shown improved results can be obtained through using an applicator 400 having better than 2% accuracy. The pump may be a peristaltic pump, a syringe pump, or other similar device that allows small volumes to be aspirated and dispensed through an orifice. Typically such an orifice will be contained in a tip 405 that is two to five millimeters in outside diameter with an inner diameter of 0.5 millimeters. The tip 405 may be disposable or washable. The tip 405 may be rounded to facilitate insertion and cleaning of the tip. Fluid flow through the tip is controlled to allow a thin layer of blood or diluted blood to be deposited onto the slide. By optimizing flow rate through the tip and the relative speed and height of the tip over the slide an appropriate density of cells can be deposited onto the slide. Each of these factors influences the other, so the proper combination of height, flow rate through the tip, and speed over the slide must be determined. In one embodiment the flow rate through the tip is 0.1 microliters per second while the tip is moving at a speed of 30 millimeters per second over the slide surface at a height of about 70 microns.
In use, the applicator 400 may comprise a known volume of body fluid such as 30 microliters (ul). The applicator may mix this fluid with a stain or diluent, and eject a portion of this fluid onto the slide apparatus 700 (particularly the specimen zone 710,
The system 10 or applicator 400 may contain one or more dispensers 800. The dispenser 800 (or 450 in
In the embodiment shown in
Various fixatives and diluents may be used with the present invention. For example 85% methanol can be used as the fixative. For some stains an ethyl alcohol or formaldehyde based fixative might be used. Diluents useful for diluting whole blood for example, may include salt solutions or protein solutions. Salt solutions range from “physiological saline” (0.9N), to complex mixtures of salts, to the commercial preparation Plasmalyte that simulates virtually all the salts found in human blood serum. Protein solutions can range from simple solutions of bovine albumin to Plasmanate, a commercial preparation with selected human plasma proteins. Such preparations can vary in protein concentrations, buffers, pH, osmolarity, osmalality, buffering capacity, and additives of various types. Synthetic or “substitute” versions of these solutions may also be usable, including Ficoll or Dextran or other polysaccharides. Other substitutes may be used. An example of a diluent is Plasmalyte plus Plasmanate in the proportion of 4:1 (Plasmalyte:Plasmanate). Another example of a diluent is 5% albumin. When analyzing whole blood, a dilution of 2 parts blood to 1 part diluent can be used, where the diluent is a physiologically compatible solution, but a range of dilution from 0:1 (no dilution) to 10:1 (diluent:blood) may be used in alternate embodiments.
The applicator may comprise a hydraulic piston for pushing the fluid out of fluid chamber 410 (like a syringe or a pipette). A tip 405 may be provided for adjusting the flow rate of the fluid. While size of the tip does not affect the speed (μl/sec) in which the solution flows out of the tip, generally, the smaller the opening in the tip, the greater the force (μg*distance/seconds2). Additionally, the size of the tip affects thickness of the fluid flows 750 shown in
To physically place the cells on the slide 701, the computer 300 could direct the applicator controller 490 to perform the body fluid application process 7B (see
The computer 300 may be connected to the applicator controller 490 to control this movement. In the embodiment shown in
The number of cells placed on the slide 701 using this method will vary depending on the type of fluid being examined and the dilution ratio. Assuming whole blood were being analyzed with a 1:3 (blood:diluent ratio), about 900,000 red blood cells, 45,000 platelets, and 1,000 white blood cells would be placed on the slide. Though
Gas movement device 500 may comprise a fan (such as shown in
Two different embodiments of light emission device 600 are illustrated. In
Various wavelengths of light may be directed by the light emission device 600. Two-eight or more different wavelengths of light may be directed at the slide apparatus 700. Wavelengths such as 430 nm are useful for imaging a hemoglobin-only image for assessing RBC morphology and hemoglobin content. Using an image taken with such a wavelength which is designed to show only red blood cells, it may also show red blood cells which are touching white blood cells. The touching red blood cells may be digitally removed from images to make it easier for the computer to detect the white blood cell borders in order to make more accurate cellular measurements and enumeration. Light emitted at 570 nm may be useful to provide high contrast images for platelets and nuclei. Other wavelengths may be chosen in order to best discriminate the colors of basophils, monocytes, lymphocytes (all shades of blue), eosinophils (red), and neutrophils (neutral color). For counting platelets, for example, two colors of illumination may be used (such as 430 nm and 570 nm). A high contrast image may be obtained by subtracting the 430 nm image from the 570 nm image. Light having a wavelength of 430, 500, 525 and 600 are particularly effective at showing cell color information, but light at wavelengths between 400 nm and 700 nm inclusive may be used. These wavelengths will also be used for the display of the color images if appropriate. Otherwise one or two additional images may need to be taken for the 200+ cells that will be analyzed for the differential count and which may be shown on the display 320. Typically the narrow-band images will be chosen from the range of 400 nm to 750 nm. Test results have shown that 2-8 separate light colors to work well, with 3-4 separate light colors being optimal. The computer 300 may be able to further refine the images by compensating for spatial shifts. Also the computer may combine the various colored images to generate multi color images for display or analysis. Numeric descriptors of the individual images or combined images can be used to determine spatial, densitometric, colorimetric and texture features of the cells for classification of the cell types. A further advantage of using narrow band illumination is that using narrow band illumination allows for the elimination of the use of oil objectives or coverslips. Light is refracted when the light passes from glass to air. Prior art systems have used oil objectives or coverslips to minimize this refraction at air to glass transitions, but having to add oil or coverslips adds steps to processing the slides, and increases the per slide analysis cost. To overcome, the need to use coverslips or oil, a combination of narrow band LEDS or filtered light can be used. Reducing the variance or bandwidth in the wavelengths of the light decreases the distortion in the image captured by the light receiving device 200 when the light passes through the slide 701. The computer 300 may also instruct the light emission device 600, to focus the light from the light source (either 610 or 630) so that the light is properly focuses on the slide. To do this, the computer 300 may instruct a focus adjustor to optimize the focus for each color of light.The Slide Apparatus 700
The Discharge Device 900
With reference to
The system 10 may optionally include a slide labeler 1000 and optionally a slide label reader 1100. The slide label reader 1000 may situated on the platform 100 near the feeder 102 as shown in
The system 10 may comprise a slide label reader 1100. Slide label reader 1100 may read markings placed on the slide from the slide labeler 1000 or by labelers external to the system. The slide label reader 1100 could comprise an interrogator, a bar code reader, or other optical device. In some embodiments, the system 10 may be able to determine information from the labels 770 without a slide label reader 1100 by using the light receiving device 200 to capture an image of the label 770. The computer 300 or the light receiving device (if it contains a processor and memory) could perform imaging processing on the image containing the label and determine the information about the label 770.Bone Marrow
As discussed above, the present invention may be used to analyze peripheral or whole blood. The invention can also be used, however, to study cells of various types of body fluids. For example, the preparation methods and analysis techniques described here can also be applied to bone marrow aspiration samples. Bone marrow samples have a higher cellular density and contain many immature red and white blood cell types that are seldom found in peripheral blood. The technique of preparing a thin layer of cells, staining with a Romanowsky stain and analyzing with image analysis can be applied to bone marrow aspirates as well, however more sophisticated image analysis may be needed to discriminate the additional types of cells.
As with peripheral blood samples, bone marrow samples may be collected into a container with an anticoagulant. This anticoagulant may be EDTA or heparin. Additional diluting or preserving fluid may be added to the sample. In the instrument described here a bone marrow sample would be prepared by first agitating the sample to provide a thorough mixing. Due to the uncertain cellular density of such samples one or more dilutions may be prepared and pipetted onto the slide or slides. In one embodiment, a triple dilution process may be used to create three specimens. A first specimen may be created by adding 2 parts diluent to one part bone marrow. The first specimen may then be ejected onto a first portion of the specimen zone 710 of the slide 701. A second specimen may be created by adding four parts diluent to the bone marrow. The second specimen may then be ejected onto a second portion of the specimen zone 710 of the slide 701. A third specimen may be created by adding eight parts of diluent to the marrow. The third may then be ejected onto a third portion of the specimen zone 710 of the slide 701.
For the image analysis, a low magnification assessment of the cellular area on the slide could choose the optimum one third for subsequent analysis. Once the proper area of the slide is selected, 200+ bone marrow cells would be measured to determine the differential count.Reticulocytes
The system 10 may also count the number of reticulocytes in a blood sample. Using a Romanowsky stain to mark RNA, the computer 300 can count the number of reticulocytes present in the specimen. When a Romanowsky stain is used, the reticulocytes appear slightly bluer than other red blood cells, and are usually slightly larger. The computer 300 can use its analysis process (16A or 17B, of
Embodiments of the present invention are contemplated to process multiple slide apparatuses 700 in a pipelined series as shown in
In the embodiment shown in
A second process flow is shown in
To determine the accuracy of this method, computer algorithms were developed to count RBCs and WBCs from digital images.
Table 1 below shows a summary of data for 34 slides. “Invention” data represents red and white blood cell counts from slides produced using the method described above, and analyzed using image analysis counting algorithms. “Sysmex” data represents red and white blood cell counts from a commercial “flow-based” automated CBC analyzer. Note that the specimens include very high and very low red blood cell counts and white blood cell counts.
Table I shows the raw data from counts performed on 34 vials. The second and third columns shows the red blood cell counts expressed as millions per microliter of patient blood for the invention count and the Sysmex count, respectively. The fourth and fifth columns shows the white blood cell counts expressed as thousands per microliter of patient blood for the invention count and the Sysmex count, respectively.
Table 2. Table 2 shows the raw data from counts performed on 34 vials. The 2nd column gives the reference (Sysmex) RBC counts, while the 3rd column reports the automated counts from the microscope slide. The 4th column scales the counts to million cells per microliter, assuming a 1:4 dilution. The 5th-7th column show the data for the WBC counts. At the bottom of the table are the calculated correlation coefficients (R-squared).
The data was obtained from 34 patient samples during two sessions of preparing slides. The data is representative of typical patients, although the tubes were selected from patients with a wide distribution of red and white cell counts. Most, if not all of the 34 samples, were obtained from specimens “archived” during the day in the refrigerator, and then pulled and prepared on the instrument in the late afternoon. Once the tubes were pulled, they were processed consecutively.
The algorithms were first validated by comparing manually counted microscope fields to the automated counts. There is a high correlation between the manually counted cells and the automatically counted cells.
High correlation between the two methods was found for both the red blood cell counts and the white blood cells counts (see Tables 1 and 2 and
The following sequence of steps may be performed in any order and some steps may be omitted or replaced with other steps.
- Step 1. Extract a known volume of blood from a tube filled with a patient's blood.
- Step 2. Dilute the blood if necessary. For example, one may use 5% albumin in distilled water as a diluent.
- Step 3. Spread a known volume of blood or blood plus diluent over an area on a glass microscope slide in a thin layer. The slide may be treated to produce a hydrophilic surface to spread the cells better. The slide may be treated to allow optimal adherence of the blood elements to the slide.
- Step 4. Allow the slide to dry in the air, or assist the drying using light air or heat.
- Step 5. Capture an image without a coverslip using a “dry” objective that is corrected for no coverslip, for example one may use a 10× or 20× objective coupled to a CCD camera. Determine the count in each image frame including Red Blood Cells (RBCs), and possibly White Blood Cells (WBCs), and platelets. One or more colors may be used, for example using a color camera or using narrow band illumination produced by an interference filter or LED. Measurement of hemoglobin content may be done at this time as well.
- Step 6. Fix and stain the cells on the slide. Fixation may be a separate step or combined with staining.
- Step 7. Capture an image of stained slide without coverslipping, using a “dry” objective, to count RBCs, WBCs, and platelets and hemoglobin. This step may be in place of or in conjunction with step 5.
- Step 8. Perform WBC differential count from high resolution images acquired without a coverslip, using a “dry” objective, for example with a 40× or 50× objective that is not corrected for a coverslip. A color camera or multiple black & white images taken using color filters or using LED illumination may be used. This step may be in addition to, or combined with step #7.
- Step 9. Calculate desired parameters and derived parameters required for the CBC.
- Step 10. Display all CBC parameters to an operator in a Graphical User Interface (GUI).
- Step 11. Display results of WBC differential to an operator in the GUI.
- Step 12. Display images of RBCs, WBCs, platelets and any unusual/abnormal blood elements to an operator.
- Step 13. Allow an operator to interact with the images and the parameters to “sign off” the CBC, WBC differential count, and identification of unusual or abnormal objects.
- Step 14. If needed, update results of CBC and WBC counts depending on operator interaction in step #13.
- Step 15. Optionally, allow objects of interest to be relocated on a microscope that has a motorized, computer controllable stage to allow automated relocation of the objects for viewing.
- Step 16. Optionally, update the results of the CBC and WBC counts depending on the microscopic operator interaction.
52. An automated system for analyzing a fluid containing blood cells, the system comprising:
- an applicator arranged to dispense a portion of the fluid onto a substrate;
- an applicator controller arranged to regulate relative movement of the applicator with respect to the substrate or a substrate controller arranged to regulate relative movement of the substrate with respect to the applicator, or both an applicator controller and a substrate controller;
- a light source arranged to emit light onto or through blood cells on the substrate;
- a light receiving device arranged to capture light transmitted through or reflected by blood cells on the substrate;
- a computer comprising one or more processors, wherein the computer is arranged to send or receive instructions and to send or receive information to or from the applicator controller, the substrate controller, the light source, and the light receiving device;
- a display arranged to present information about the blood cells to an operator; and
- software instructions stored on a storage device for controlling the system, wherein when the one or more processors execute the software instructions, the computer causes the system to: fill the applicator with a volume of the fluid containing blood cells; position the applicator at a height above the substrate, wherein the height is measured along a direction perpendicular to a surface of the substrate; dispense a known volume of the fluid containing blood cells out of the applicator and while ejection of the fluid onto the substrate is occurring, maintaining relative movement between the applicator and the substrate to lay down the entire known volume of fluid in two or more rows over a defined area of the substrate, wherein the applicator height above the substrate, a flow rate of the fluid out of the applicator, and a speed of the relative movement are selected such that the cells in the fluid settle onto the slide in a layer that is about one cell thick and such that morphology of the blood cells is sufficiently preserved to enable image-based cell analysis and calculation of a total cell count per microliter in the fluid; illuminate the blood cells on the slide with light from the light source; capture at least one image of the blood cells corresponding to light in a first wavelength range of about 400 to 470 nm transmitted through or reflected by the cells, and at least one image of the blood cells corresponding to light in a second wavelength range of about 470 to 750 nm transmitted through or reflected by the cells; analyze the images of the blood cells, calculate a total count of red blood cells, white blood cells, and platelets per microliter in the volume of fluid on the substrate, and determine a complete blood count (“CBC”) and a white blood cell (“WBC”) differential for the fluid; and present the images of the blood cells, the results of the CBC, and the results of the WBC differential in a graphical user interface (GUI) on the display.
53. The system of claim 52, further comprising
- a fixative dispenser arranged to apply a fixative to blood cells on the substrate; and
- a stain dispenser arranged to apply a stain to the blood cells on the substrate;
- wherein when the one or more processors execute the software instructions, the computer causes the system to fix and stain the blood cells on the substrate.
54. The system of claim 53, further comprising a slide tilter arranged to remove excess fixative or stain or both from the substrate.
55. The system of claim 52, wherein the GUI is configured to allow an operator to interact with the images and sign off on the CBC results and the WBC differential results.
56. The system of claim 52, further comprising a gas moving device arranged to move air over the substrate to dry the fluid.
57. The system of claim 52, wherein the applicator controller and the substrate controller are configured as one component of the system.
58. The system of claim 52, wherein when the one or more processors execute the software instructions, the computer causes the system to further determine a hematocrit level or a hemoglobin level, or both.
59. The system of claim 52, further comprising a first reservoir for storing the fluid, a second reservoir for storing a diluent, and a mixer for mixing the fluid with the diluent to form a diluted fluid to be dispensed onto the substrate.
60. The system of claim 52, wherein when the one or more processors execute the software instructions, the computer causes the system to
- refine the images of the blood cells by compensating for spatial shifts or other distortions; and
- combine two or more black and white images captured by the light receiving device to generate a multi-color image for presentation on the display.
61. The system of claim 52, wherein when the one or more processors execute the software instructions, the computer causes the system to determine spatial, densitometric, colorimetric, and texture features of the blood cells for classification of cell type.
62. The system of claim 52, wherein the two or more rows are formed by the applicator tip dispensing the fluid in a first row in a first direction and then quickly turning and moving in a second direction opposite the first direction and in parallel to the first row to lay down a second row adjacent the first row.
63. The system of claim 52, wherein the applicator controller is instructed to
- adjust the height of the applicator above the substrate to be less than about 110 microns;
- eject the fluid out of the applicator at a flow rate of less than about 0.1 microliters per second; and
- regulate the speed of the relative movement between the applicator and substrate to be about 10 to 100 mm per second.
64. The system of claim 52, wherein the light source comprises:
- a first light filter to produce filtered light corresponding to the first wavelength range of about 400 to 470 nm; and
- a second light filter to produce filtered light corresponding to the second wavelength range of about 470 to 750 nm.
65. The system of claim 64, wherein the light source further comprises a third light filter to produce filtered light corresponding to a third wavelength range.
66. The system of claim 52, wherein the first wavelength range is selected from a range of about 400 to 430 nm.
67. The system of claim 52, wherein the light source comprises:
- a first light emitting diode (LED) that emits light at the first wavelength range; and
- a second LED that emits light at the second wavelength range.
68. The system of claim 67, wherein the light source further comprises a third LED that emits light corresponding to a third wavelength range.
69. The system of claim 52, wherein when the one or more processors execute the software instructions, the computer causes the system to further determine one or more of a red blood cell count and a platelet count from the at least one image of the blood cells at each of the first and second wavelength ranges.
70. The system of claim 52, wherein when the one or more processors execute the software instructions, the computer causes the system to further determine a reticulocyte count from the at least one image of the blood cells at each of the first and second wavelength ranges.