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Cytometers, Automated, Flow
Cytometers, Automated, Flow
Purpose
Flow cytometers allow technicians to evaluate the characteristics
of thousands of cells very rapidly. They separate, quantify, and
analyze cells by suspending them in a stream of fluid (sheathing
fluid) and passing them through a detection system. Clinical
applications of flow cytometers include detecting and enumerating
peripheral subsets of human T lymphocytes and performing
leukocyte differential cell counts, platelet autoantibody studies, cell
surface marker analysis, reticulocyte analysis, and bacterial
analysis. Flow cytometers also detect aneuploidy (any deviation from an exact multiple of the diploid number of
chromosomes, whether fewer or more) by performing intracellular measurements and analysis of DNA.
Clinicians can use the results of these studies, along with other clinical data, to diagnose and/or prognose
leukemia, lymphoma, immunodeficiency disorders such as human immunodeficiency virus (HIV) infection,
autoimmune disease, and fetal abnormalities, as well as evaluate the success of transplantation procedures. Flow
cytometry is commonly used in cancer diagnosis and research because it is ideal for evaluating drug resistance,
detecting tumor cell DNA aneuploidy, immunophenotyping, and analyzing tumor cell proliferation. In addition,
flow cytometry technology can be adapted to provide a rapid, sensitive, and cost-effective means for detecting,
characterizing, and identifying bacteria.
Principles of operation
Flow cytometers consist of three basic systems: the fluidic
component that transports cells to the analysis chamber, the optical UMDNS Information
system with detection devices, and the data analysis and display
components (see Figure 1). This Product Comparison covers the following
device term and product code as listed in
Immunofluorescence is the basis for most flow cytometric assays. ECRI Institute’s Universal Medical Device
Nomenclature System™ (UMDNS™):
This technique relies on the use of dyes and fluorochromes to mark
Cytometers, Automated, Flow [16-867]
specific structures in or on the cell. When cells are treated with Cytometers, Automated, Flow, Sorting [16-503]
fluorochromes, these dyes bind to specific cellular components, such as
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Cytometers, Automated, Flow
DNA, RNA, cellular enzymes, membrane surface markers, or other antigens. When exposed to light of a
particular wavelength, these fluorochromes will fluoresce, emitting light of a longer wavelength than that of the
incident light they absorb.
Two or more fluorochromes can be used simultaneously to label two cellular constituents (e.g., nuclear DNA
and cytoplasmic enzymes). In addition, multiple fluorochromes can be used to label the same cellular material.
Cellular components can also be labeled with a metachromatic stain such as acridine orange, whose molecular
location on different cellular components results in light emission at several different wavelengths.
Cells to be analyzed are mixed with specific reagents and then automatically suspended in a liquid stream that
is transported in a fluid medium under pressure to the analysis chamber. Before entering the chamber, the sample
stream is hydrodynamically focused by a sheathing solution that surrounds the stream, establishing a laminar
flow. This restricts the cells to a precise single-cell path that traverses the optical sensing area. Within this area,
the detection system analyzes each cell at a counting rate of up to 10,000 cells per second.
As the cells pass through the analysis chamber, they are illuminated by a beam of high-intensity
monochromatic light from a laser. The wavelength emitted by the laser needs to fall within the range of the
excitation energy of the chosen dyes/fluorochromes in order for fluorescence to take place. Many flow cytometers
today are equipped with two or more lasers, which can be used to excite a range of dyes and fluorochromes.
Argon lasers produce a strong emission at a wavelength of 488 nm. Argon lasers, which are air cooled, are
generally less expensive to operate and are the most common type used. Recently, with the development of solid-
state lasers, additional lasers at additional wavelengths can be used. Helium-neon (633 nm), helium-cadmium
(325 nm), and red-diode (635 nm) are a few other types of lasers that are now commonly used in flow cytometers.
These lasers are usually compact and made to work with typical voltage requirements; they can often be added to
existing flow cytometers. The use of additional lasers with different wavelengths has increased the number of
fluorescent probes that can be used and thus, the variety of tests that can be performed.
In addition to matching the excitation energy, it is also important that the wavelength emitted by the laser be
distinguishable from the wavelength of the fluorescence energy. (See table for a list of commonly used dyes and
fluorochromes.) As the light passes through the cells, the instrument measures the fluorescence and light scatter
that is emitted. Light scatter is a measure of the laser light that is reflected and refracted through the cell, as
opposed to the light that is emitted by the fluorescing dyes. Light scatter intensity measured in the forward
direction is generally proportional to the cell’s cross-sectional area, while the light scatter at a right angle to the
incident light generally relates to the internal structures of the cell (e.g., nuclear to cytoplasmic ratios, granularity
of the cytoplasm). Light scatter can distinguish live cells from dead ones in a homogeneous population of
lymphocytes.
The collection of fluorescent light emitted from the sample
stream usually occurs at a 90° angle from the beam of incident
light. Fluorescence detection is based on the specificity of a
fluorescent dye to some unique part of the cell. This interaction
aids in the analysis and separation of lymphocyte
subpopulations, the measurement of subsets of T-lymphocyte
populations, the evaluation of cell kinetics in normal and
neoplastic cell populations, the measurement of cell surface
antigens (tumor markers, receptors), and the separation of cells
by membrane characteristics.
Flow cytometers with multiple lasers may be set up to run a
sequential analysis, resulting in fluorescence signals that are
spatially separated. In these cases, the separate signals can be
sent in different directions for analysis by half-mirrors so that
no signal mixing takes place. However, in some instruments, all the signals are mixed as the light leaves the cell.
This setup relies on dichroic mirrors and signal filters to separate and refine the signals for analysis. Dichroic
mirrors are designed to reflect light above a specified wavelength while transmitting light at lower wavelengths.
Further filtration can also take place as the light enters the photomultiplier tubes. These detectors turn the light
emitted by the cells into electronic pulses, which are then amplified for digitization and subsequent computer
analysis.
Some flow cytometers have cell-sorting
capabilities and can separate and analyze the
specific cell types within the sample. As the
sample stream exits the detection chamber, a
piezoelectric crystal (a crystal in which an applied
voltage generates a proportional mechanical
force) vibrates, breaking the sample stream into
droplets that pass between two polarized
deflection plates. Based on predetermined
selection criteria, individual cells bearing a net-
positive or a net-negative charge are deflected
into their respective collection vessels, while the
remaining fluid and cells are discarded as waste.
One type of cell-sorting flow cytometer features a mechanical sorting mechanism in which a catcher tube
positioned inside the flow cell moves in and out of the sample stream to capture cells of interest. This type of
sorting technology does not depend on droplet formation and occurs in an enclosed environment, thus reducing
the formation of aerosols and the risk of contamination from biohazardous samples.
Once the cell data has been captured by the detector, software records, analyzes, and displays the data on a
computer screen. Most systems incorporate printers and archiving storage, and some systems interface to the
laboratory’s information system (LIS).
Many systems today have autoloading capabilities. Autoloaders accept trays or carousels of sample tubes and
use robotic arms to automatically load the samples into the analyzer. Systems with autoloaders typically include
bar-code readers to keep track of sample information. In addition, automated sample preparation systems
provide strict quality control and standardization of preparations and reduce preparation times of 1 to 2 hours to
10 minutes or less.
Reported problems
Analysis using flow cytometry requires that cells in suspension be monodispersed (i.e., each cell is surrounded
by a fluid matrix without aggregating to neighboring cells). Blood, bone marrow, and cell cultures readily form
single-cell suspensions; however, nonlymphoid solid tissue requires processing with either enzymes or chelating
agents to disrupt intercellular bonding. Unfortunately, this processing also produces cellular debris (cell stroma,
free nucleoplasm, and cytoplasm) that presents artifacts during analysis. Electronic discrimination of data can
prevent such debris from affecting the final results.
For a flow cytometer to work effectively, the point of intersection between the laser beam and the stream of
cells must be precisely maintained in relation to the detection pathway. This specific configuration requires
frequent performance checks on a daily basis to ensure proper instrument function.
Purchase considerations
ECRI Institute recommendations
Included in the accompanying comparison chart are ECRI Institute’s recommendations for minimum
performance requirements for flow cytometers. Because the applications of flow cytometry vary, buyers should
evaluate their needs and choose a device based on their specific requirements.
Flow cytometers should come equipped with software that performs immunophenotyping. Other software
applications (e.g., transplantation, DNA S-phase, microbiology) are optional and should be considered according
to the needs of a specific site.
Wavelength requirements for flow cytometers vary based on the fluorochromes being used in the analysis. A
wavelength of 488 nm is required when working with two or three colors; this laser wavelength is standard with
most flow cytometers. Additional laser wavelengths are preferable if the laboratory has additional detection
needs. ECRI Institute considers systems that detect two to three colors a requirement. Devices that can detect four
colors are preferred, and the analysis of six or more colors should be considered optional.
Cell sorting should be considered an optional feature. Buyers will need to evaluate whether sorting is a
required ability for their facility.
Other considerations
Because flow cytometer operation requires special training, manufacturers typically provide free instruction.
However, additional training and frequent operation of the instrument are needed for operators to become
proficient. For this reason, some facilities dedicate certain technicians for flow cytometry measurement. Hospitals
must also communicate with physicians to determine how these results will be used and what tests should be
performed.
Because flow cytometers are open-platform instruments, reagents can be purchased from many suppliers, and
it is generally not necessary to standardize the manufacturer of the flow cytometer and reagents. ECRI Institute’s
PriceGuide provides benchmark pricing data on reagents, sample vials, and other consumables; facilities should
contact PriceGuide for assistance securing the best price on consumables.
Laptop or desktop computers are typically included in the quoted price; printers are frequently an add-on
feature. Although most flow cytometers come standard with one or two basic software applications, there are
numerous applications available. Facilities may choose to purchase additional software packages from other
suppliers; some suppliers may offer custom-designed packages. Other basic software programs for research use
can be downloaded at no cost from university Web sites. Software should be chosen based on the tests currently
being performed and tests expected to be performed in the near future, and whether the instrument will need to
be upgraded to accommodate new software installs.
Autosamplers, which help streamline laboratory workflow by increasing walkaway time, are often available as
upgradable options if the laboratory does not choose to purchase a system with an autosampler initially.
Environmental considerations
Developments in so-called “smart” solid-state light source technology have enabled the use of solid-state lasers
in flow cytometry. Solid-state light sources are extremely energy efficient and may improve the clarity of images.
Some systems may offer other energy-saving features, such as standby mode.
Facilities should consider flow cytometers with biohazard containment a required feature. In addition,
components made from recyclable materials and systems manufactured in green plants are desirable.
End-of-life costs need to be considered as well. Facilities should look for manufacturers who offer take-back
programs on system components such as monitors. If a supplier does not offer such an arrangement, the
laboratory must absorb the costs of disposing the system according to local environmental protection laws when
it is replaced.
Cost containment
Facilities should negotiate the service contract price from the manufacturer of the flow cytometer at the time of
purchase. Service contracts typically cost between 11% and 14% of the purchase price; in general, service contracts
must be purchased from the manufacturer because the instruments are highly sophisticated.
The cost of the reagents is a significant expenditure over the useful life of the instrument. Users need to be
aware that reimbursement policies regarding flow cytometry tests vary by state and by medical insurance carrier
and that these policies are in transition.
Because flow cytometers entail ongoing maintenance and operational costs, the initial acquisition cost does not
accurately reflect the total cost of ownership. Therefore, a purchase decision should be based on issues such as
life-cycle cost (LCC), local service support, discount rates and non-price-related benefits offered by the supplier,
and standardization with existing equipment in the laboratory (i.e., purchasing all flow cytometers from one
supplier).
Because it examines the cash-flow impact of initial acquisition costs and operating costs over a period of time,
LCC analysis is most useful for comparing alternatives with different cash flows and for revealing the total costs
of equipment ownership. One LCC technique—present value (PV) analysis—is especially useful because it
accounts for inflation and for the time value of money (i.e., money received today is worth more than money
received at a later date). Conducting a PV/LCC analysis often demonstrates that the cost of ownership includes
more than just the initial acquisition cost and that a small increase in initial acquisition cost may produce
significant savings in long-term operating costs. The PV is calculated using the annual cash outflow, the dollar
discount factor (the cost of capital), and the lifetime of the equipment (in years) in a mathematical equation.
The following represents a sample PV/LCC analysis for a flow cytometer.
Capital Costs
System = $140,000
Total Capital Costs = $140,000
Operating Costs
Service contract, years 2 through 5 = $14,000/year
Reagents = $105,000/year
Total Operating Costs = $145,000 for year 1; $159,000/year for years 2 through 5
PV = ($608,007)
Other costs not included in the above analysis that should be considered for budgetary planning include those
associated with the following:
Software upgrades not included under warranty or in service contract
Utilities
Salary for 1 full time employee and related staffing expenses
Contributions to overhead
As illustrated by the above sample PV/LCC analysis, the initial acquisition cost is only a fraction of the total
cost of operation over 5 years. Therefore, rather than making a purchase decision based solely on the acquisition
cost of a flow cytometer system, buyers should consider operating costs over the lifetime of the equipment.
For further information on PV/LCC analysis, customized analyses, and purchase decision support, readers
should contact ECRI Institute’s SELECTplus™ Group.
Stage of development
One direction flow cytometers may take in the near future is toward more affordable, durable light sources.
Researchers are investigating the replacement of laser light sources with high-power LEDs.
Data analysis software is continually being updated and expanded to improve the classification, presentation,
and analysis of data. Newer systems can accommodate more types of sample vials, and some can detect 15 or
more colors.
One flow cytometer currently available offers imaging capabilities. The technology, which combines flow
cytometry with microscopy, performs cell quantifying and labeling and also allows technicians to view images of
each individual cell.
Researchers are beginning to explore the possibility of using flow cytometers as virus detectors. Viruses,
however, are much smaller than bacteria or cancer cells, with diameters of 100 to 250 nm. Their minute size
makes it difficult to distinguish their light scatter signals from general background noise. As researchers continue
to work on maximizing the sensitivity of flow cytometers, the role of these devices as virus detectors will
continue to develop. In addition, analyses of tumor-cell DNA, as well as many clinical microbiological
applications, continue to be investigated as the uses for flow cytometry grow steadily in scope and importance.
In general, manufacturers strive to increase the sensitivity and complexity of flow cytometers while
maintaining a user-friendly platform, as the number of applications for flow cytometry continues to expand.
Bibliography
Agrawal S. Immunophenotyping using flow cytometry [online]. Express Healthc Manage 2004 Jul [cited 2009 Nov
12]. Available from Internet: http://www.expresshealthcaremgmt.com.
Alvarez-Barrientos A, Arroyo J, Canton R, et al. Applications of flow cytometry in clinical microbiology. Clin
Microbiol Rev 2000 Apr;13(2):167-95.
Dessing M. Cell sorting and flow cytometry [online]. Euro Lab Sci 2004 Aug [cited 2009 Nov 12]. Available from
Internet: http://www.scientistlive.com.
Dijkstra-Tiekstra MJ, Schrijver JG, van der Meer PF, et al. Crossover study of three methods for low-level white
blood cell counting on two types of flow cytometer. Cytometry B Clin Cytom 2003 Jul;54(1):39-45.
Maino VC, Maecker HT. Cytokine flow cytometry: a multiparametric approach for assessing cellular immune
responses to viral antigens. Clin Immunol 2004 Mar;110(3):222-31.
McCoy, JP Jr. Basic principles of flow cytometry. Hematol Oncol Clin N Am 2002 Apr;16(2):229-43.
Minerd J. Buyer’s guide to flow cytometers. The Scientist 2005 Oct;19(20):28.
Reeve L, Rew DA. New technology in the analytical cell sciences: the laser scanning cytometer. Eur J Surg Oncol
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Shapiro HM. Practical flow cytometry. 4th ed. Hoboken (NJ): Wiley-Liss; 2003.
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Supplier information
ACCURI CYTOMETERS
Accuri Cytometers Inc [452700]
173 Parkland Plaza
Ann Arbor, MI 48103
Phone: (734) 994-8000 Fax: (734) 994-8002
Internet: http://www.accuricytometers.com
E-mail: info@accuricytometers.com
AMNIS
Amnis Corp [454607]
2505 Third Ave Suite 210
Seattle, WA 98121
Phone: (206) 374-7000, (800) 730-7147 Fax: (206) 576-6895
Internet: http://www.amnis.com
E-mail: sales@amnis.com
BD BIOSCIENCES
BD Biosciences (CA) Div BD [378353]
2350 Qume Dr
San Jose, CA 95131-1807
Phone: (408) 432-9475, (877) 232-8995 Fax: (408) 954-2347
Internet: http://www.bdbiosciences.com
E-mail: bdbcustomerservice@bd.com
Gurgaon 122001
India
Phone: 91 (124) 238356671 Fax: 91 (124) 23832242526
Internet: http://www.bd.com
E-mail: bd_india@bd.com
BECKMAN COULTER
Beckman Coulter Inc [340083]
4300 N Harbor Blvd PO Box 3100
Fullerton, CA 92834-3100
Phone: (714) 871-4848, (800) 232-3828 Fax: (714) 773-8283, (800) 643-4366
Internet: http://www.beckmancoulter.com
E-mail: askpcd@beckman.com
PARTEC
Partec GmbH [452983]
Otto-Hahn-Strasse 32
Muenster D-48161
Germany
Phone: 49 (2534) 80080 Fax: 49 (2534) 800890
Internet: http://www.partec.com
E-mail: info@partec.com
STRATEDIGM
Stratedigm Inc [454606]
1300 White Oaks Rd Suite 105
Campbell, CA 95008
Phone: (408) 512-3901 Fax: (408) 351-7700
Internet: http://www.stratedigm.com
E-mail: info@stratedigm.com
Note: The data in the charts derive from suppliers’ specifications and have not been verified through
independent testing by ECRI Institute or any other agency. Because test methods vary, different products’
specifications are not always comparable. Moreover, products and specifications are subject to frequent changes.
ECRI Institute is not responsible for the quality or validity of the information presented or for any adverse
consequences of acting on such information.
When reading the charts, keep in mind that, unless otherwise noted, the list price does not reflect supplier
discounts. And although we try to indicate which features and characteristics are standard and which are not,
some may be optional, at additional cost.
For those models whose prices were supplied to us in currencies other than U.S. dollars, we have also listed the
conversion to U.S. dollars to facilitate comparison among models. However, keep in mind that exchange rates change
often.
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These specifications
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