Reis-Alves Suiellen C, Traina Fabiola, Metze Konradin, Lorand-Metze Irene
Hematology and Hemotherapy Center, University of Campinas, Carlos Chagas Street, 480, 13083-878 Campinas, São Paulo, Brazil.
Faculty of Medicine of Ribeirão Preto, University of São Paulo, Vila Monte Alegre, 14048-900, Ribeirão Preto, Sao Paulo, Brazil.
Diagn Pathol. 2015 Apr 29;10:44. doi: 10.1186/s13000-015-0259-3.
Immunophenotyping is a valuable ancillary technique for the differential diagnosis between myelodysplastic syndromes (MDS) with low bone marrow (BM) blast counts and a normal karyotype, and reactive peripheral (PB) cytopenias. Our aim was to search for the most important variables for this purpose. We also analyzed the age variation of BM B-cell precursors (BCP) and its differences in reactive and clonal cytopenias.
Immunophenotypic analyzes were performed in BM of 54 patients with MDS (76% with BM blasts <5%) and 35 cases of reactive cytopenias. Healthy allogeneic BM transplantation donors (n = 41) were used as controls. We used a four-color panel of antibodies analyzing 9 granulocytic, 8 monocytic and 6 CD34(+) cell features.
Asynchronous shift to the left in maturing granulocytes and increase in CD16(+) monocytes were also found in reactive PB cytopenias, but the most important aberrancies in MDS were seen in myeloid CD34(+) cells. Decrease in BCP, that is a hallmark of MDS, could also be found in reactive cytopenias, especially in patients >55 years. % BM BCP could be calculated by the formula: (-7.97 × log age) + (4.24 × log % CD34 (+) cells) - (0.22 x nr. alterations CD34 (+) cells) + 0.577. Corrected R(2) = 0.467.
Analysis of myelomonocytic precursors and CD34(+) cells was satisfactory for the differential diagnosis between reactive PB cytopenias and MDS. The most specific alterations were found in CD34(+) cells. Comparison of the values obtained with those of normal age-matched controls is recommended.
The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1975931809154663.
免疫表型分析是一种有价值的辅助技术，可用于鉴别骨髓原始细胞计数低且核型正常的骨髓增生异常综合征（MDS）与反应性外周血细胞减少症。我们的目的是寻找用于此目的的最重要变量。我们还分析了骨髓B细胞前体（BCP）的年龄变化及其在反应性和克隆性血细胞减少症中的差异。
对54例MDS患者（76%的患者骨髓原始细胞<5%）和35例反应性血细胞减少症患者的骨髓进行免疫表型分析。健康的同种异体骨髓移植供体（n = 41）用作对照。我们使用一组四色抗体分析9种粒细胞、8种单核细胞和6种CD34(+)细胞特征。
在反应性外周血细胞减少症中也发现成熟粒细胞向左异步移位和CD16(+)单核细胞增加，但MDS中最重要的异常出现在髓系CD34(+)细胞中。反应性血细胞减少症中也可发现BCP减少，这是MDS的一个标志，尤其是在年龄>55岁的患者中。骨髓BCP百分比可通过以下公式计算：（-7.97×log年龄）+（4.24×log CD34(+)细胞百分比）-（0.22×CD34(+)细胞改变数量）+0.577。校正R(2)=0.467。
骨髓单核细胞前体和CD34(+)细胞分析对于鉴别反应性外周血细胞减少症和MDS是令人满意的。最特异的改变出现在CD34(+)细胞中。建议将获得的值与年龄匹配的正常对照的值进行比较。
本文的虚拟切片可在此处找到：http://www.diagnosticpathology.diagnomx.eu/vs/1975931809154663。
