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Quantification of optical absorption gaps in nailfold capillaries has recently shown promise as a non-invasive technique for neutropenia screening. Here we demonstrate a low-cost, portable attachment to a mobile phone that can resolve optical absorption gaps in nailfold capillaries using a reverse lens technique and oblique 520nm illumination. Resolution μm within a 1mm2 on-axis region is demonstrated, and wide field of view (3.5mm × 4.8mm) imaging is achieved with resolution μm in the periphery. Optical absorption gaps (OAGs) are visible in superficial capillary loops of a healthy human participant by an ∼8-fold difference in contrast-to-noise ratio with respect to red blood cell absorption contrast. High speed video capillaroscopy up to 240 frames per second (fps) is possible, though 60fps is sufficient to resolve an average frequency of 37 OAGs/minute passing through nailfold capillaries. The simplicity and portability of this technique may enable the development of an effective non-invasive tool for white blood cell screening in point-of-care and global health settings.

Oblique plane microscopy (OPM) enables high speed, volumetric fluorescence imaging through a single-objective geometry. While these advantages have positioned OPM as a valuable tool to probe biological questions in animal models, its potential for in vivo human imaging is largely unexplored due to its typical use with exogenous fluorescent dyes. Here we introduce a scattering-contrast oblique plane microscope (sOPM) and demonstrate label-free imaging of blood cells flowing through human capillaries in vivo. The sOPM illuminates a capillary bed in the ventral tongue with an oblique light sheet, and images side- and back- scattered signal from blood cells. By synchronizing sOPM with a conventional capillaroscope, we acquire paired widefield and axial images of blood cells flowing through a capillary loop. The widefield capillaroscope image provides absorption contrast and confirms the presence of red blood cells (RBCs), while the sOPM image may aid in determining whether optical absorption gaps (OAGs) between RBCs have cellular or acellular composition. Further, we demonstrate consequential differences between fluorescence and scattering versions of OPM by imaging the same polystyrene beads sequentially with each technique. Lastly, we substantiate in vivo observations by imaging isolated red blood cells, white blood cells, and platelets in vitro using 3D agar phantoms. These results demonstrate a promising new avenue towards in vivo blood analysis., 12 pages, 6 figures

Febrile neutropenia (FN) is a common cause of hospitalization for cancer patients undergoing chemotherapy treatment. To screen for FN, patients require invasive blood draws and complete blood cell counts, which increases risk of nosocomial infection while in an immunocompromised state. There is a pressing clinical need for non-invasive, point-of-care technology to frequently screen for FN, which, if detected early, can be prophylactically managed. A promising approach to address this need is capillaroscopy, through which blood cells are imaged in capillaries non-invasively. Visualization of shadows caused by absorption of individual red blood cells is currently achievable, and correlation between the absence of optical absorption gaps and severe neutropenia has been observed. However, a completely accurate identification of the physical origin of these optical absorption gaps for conclusive neutropenia diagnosis remains an elusive task. Here we present scattering oblique plane microscopy as a means of imaging moving scattering particles within a turbid medium with the goal of eventually imaging and characterizing blood cells in vivo flowing in superficial capillaries. Our imaging system illuminates an oblique light sheet through a capillary bed and collects back-scatter using a single objective at frame rates of >200 Hz. To validate this system, we develop phantoms mimicking capillaries with 200 μm diameter lumens embedded deep in silicone doped with TiO2 and India ink. Single 3 μm diameter polystyrene beads flowing through the capillaries are resolved with a signal to noise ratio of approximately 5:1 at a depth of 1 mean free path.

We present a non-invasive, label-free method of imaging blood cells flowing through human capillaries in vivo using oblique back-illumination capillaroscopy (OBC). Green light illumination allows simultaneous phase and absorption contrast, enhancing the ability to distinguish red and white blood cells. Single-sided illumination through the objective lens enables 200 Hz imaging with close illumination-detection separation and a simplified setup. Phase contrast is optimized when the illumination axis is offset from the detection axis by approximately 225 um when imaging 80 um deep in phantoms and human ventral tongue. We demonstrate high-speed imaging of individual red blood cells, white blood cells with sub-cellular detail, and platelets flowing through capillaries and vessels in human tongue. A custom pneumatic cap placed over the objective lens stabilizes the field of view, enabling longitudinal imaging of a single capillary for up to seven minutes. We present high-quality images of blood cells in individuals with Fitzpatrick skin phototypes II, IV, and VI, showing that the technique is robust to high peripheral melanin concentration. The signal quality, speed, simplicity, and robustness of this approach underscores its potential for non-invasive blood cell counting., Comment: 10 pages, 7 Figures