Dunphy Cherie H, O'Malley Dennis P, Perkins Sherrie L, Chang Chung-Che
Divisions of Hematopathology, Departments of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill, NC 27599-7525, USA.
Appl Immunohistochem Mol Morphol. 2007 Jun;15(2):154-9. doi: 10.1097/PAI.0b013e318030dec7.
Accurate bone marrow (BM) blast counts (BCs) are essential for diagnosis (dx) of myelodysplasia (MDS), MDS/myeloproliferative (MDS/MPD) disease, or acute myeloid leukemia (AML), and may be difficult in hemodiluted bone marrow aspirates (BMAs). Erythroid precursors (EPs) may be indistinguishable from myeloblasts in BM sections (aspirate clots/cores). We compare the usefulness of immunohistochemistry (IHC) [ie, CD34, CD117, myeloperoxidase (MPO), Hemoglobin A1 (HbA1), and terminal deoxynucleotidyl transferase (TdT)] of BM sections (IHC-BM) with BMA, bone marrow touch preparation (BMTP), and flow cytometry (FC) BCs.
The initial BC (48), percentage (%) of Eps (38) (both based on initial 100 to 600-cell counts), and FC expressions of CD34, CD117, Glycophorin A(GLY A), and TdT (44) were tabulated from 50 BMs (MDS, MDS/MPD, or AML). BMAs (48) and BMTPs (25) subsequently received 500-cell counts. IHC-BM was performed (45:formalin, 5:B5-fixed) [CD34 (46), CD117 (45), HbA1 (45), TdT (42), and MPO (45)].
Retrospective BMA BCs revealed a 31% (15/48) discrepant rate between the original/retrospective BMA BCs; 80% revealed an underestimated initial BC. There was a 28% discordance rate between the retrospective BMA and BMTP reviews; 77% showed a higher BMTP BC. IHC showed significantly higher BCs in 19% (9/47), resulting in a different dx (5). However, CD34 and CD117 IHCS revealed lower BCs in 38% and 48%, respectively. The CD34 IHC results were primarily due to CD34-negative blasts by FC. The CD117 IHC results were largely unexplained. EPs were CD34 and CD117-negative.
(1) Evaluation for MDS/AML requires 500-cell counts of BMAs and/or BMTPs. (2) CD34 and/or CD117 blasts by FC indicate IHC-BM may increase BC accuracy. (3) CD34 is more reliable than CD117 by IHC; however, in combination, they are most reliable and should be performed on BM clots/cores due to variable reactivity.
准确的骨髓原始细胞计数（BCs）对于骨髓增生异常综合征（MDS）、MDS/骨髓增殖性疾病（MDS/MPD）或急性髓系白血病（AML）的诊断至关重要，而在血液稀释的骨髓穿刺液（BMA）中进行计数可能具有挑战性。在骨髓切片（穿刺凝块/核心）中，红系前体细胞（EPs）可能与原始粒细胞难以区分。我们比较了骨髓切片免疫组化（IHC）[即CD34、CD117、髓过氧化物酶（MPO）、血红蛋白A1（HbA1）和末端脱氧核苷酸转移酶（TdT）]与BMA、骨髓印片（BMTP）及流式细胞术（FC）原始细胞计数的实用性。
从50例骨髓（MDS、MDS/MPD或AML）中列出初始原始细胞计数（48例）、EPs百分比（%）（38例）（均基于最初100至600个细胞计数）以及CD34、CD117、血型糖蛋白A（GLY A）和TdT的FC表达（44例）。随后对BMA（48例）和BMTP（25例）进行500个细胞计数。进行了免疫组化 - 骨髓检测（45例：福尔马林固定，5例：B5固定）[CD34（46例）、CD117（45例）、HbA1（45例）、TdT（42例）和MPO（45例）]。
回顾性BMA原始细胞计数显示，原始/BMA回顾性原始细胞计数之间的差异率为31%（15/48）；80%显示初始原始细胞计数被低估。回顾性BMA与BMTP评估之间的不一致率为28%；77%显示BMTP原始细胞计数更高。免疫组化显示19%（9/47）的原始细胞计数显著更高，导致诊断不同（5例）。然而，CD34和CD117免疫组化分别显示38%和48%的原始细胞计数更低。CD34免疫组化结果主要归因于FC检测为CD34阴性的原始细胞。CD117免疫组化结果在很大程度上无法解释。EPs为CD34和CD117阴性。
（1）对MDS/AML的评估需要对BMA和/或BMTP进行500个细胞计数。（2）FC检测的CD34和/或CD117原始细胞表明免疫组化 - 骨髓检测可能提高原始细胞计数的准确性。（3）免疫组化中CD34比CD117更可靠；然而，联合使用时它们最可靠，并且由于反应性可变，应在骨髓凝块/核心上进行检测。
