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Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches

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Abstract

Flow cytometry (FCM) is being increasingly evaluated for the diagnosis of myelodysplastic syndrome (MDS). We employed multiple FCM approaches to assess MDS. Five-color FCM, morphology blind, was done on bone marrow aspirates of 57 suspected MDS and 31 normal controls. Maturation pattern, quantitative FCM for low-grade MDS that awards FCM score, and expression of selected antigens on erythroid cells and CD34+ blasts were evaluated. FCM results were correlated with clinical and laboratory workup. Patients (n = 57) included proven MDS (n = 14), suspected MDS (n = 13), and non-MDS (n = 30). By pattern-based approach, all proven cases were FCM positive. In suspected MDS, 11 (84.61 %) were positive including morphology-negative cases, and two (15.38 %) were intermediate. In non-MDS cases, 27 of 30 (90 %) were FCM negative, 2 of 30 (6.67 %) intermediate, and 1 of 30 (3.33 %) a hematinic-responsive case, positive. Quantitative parameters that characterized MDS included FCM score of >3, percentage CD34+ B cells, and expression of CD11b, CD15, and CD56 on myeloblasts. CD71 MFI on CD235a+ erythroblasts and CD38 MFI on myeloblasts were significantly lower in MDS. The former was present in FCM-intermediate suspected MDS but not FCM-intermediate non-MDS cases. Used in the overall clinical context, both maturation pattern recognition and quantitative approaches, the latter for low-grade MDS, are sensitive methods of diagnosing MDS, including cases negative by morphology and cytogenetics, especially if combined with evaluation of selected antigens, CD71 on CD235a+ cells and CD38 on CD34+ cells. The value of FCM in morphology-negative cases needs better definition of specificity through more extensive evaluation of secondary dyspoiesis.

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Acknowledgments

The authors would like to thank Mr. Amit Kumar and Mr. Zubair Abdullah for technical and secretarial assistance.

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Authors and Affiliations

  1. Department of Laboratory Oncology, IRCH, All India Institute of Medical Sciences, DII/44, AIIMS Campus, Ansari Nagar, New Delhi, 110029, India

    Anita Chopra, Saroj Singh, Sangita Pandey & Rajive Kumar

  2. Department of Hematology, All India Institute of Medical Sciences, New Delhi, India

    Haraprasad Pati, Manoranjan Mahapatra, Pravas Mishra, Tulika Seth & Suman Kumar

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  1. Anita Chopra
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Correspondence to Rajive Kumar.

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Chopra, A., Pati, H., Mahapatra, M. et al. Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches. Ann Hematol 91, 1351–1362 (2012). https://doi.org/10.1007/s00277-012-1461-y

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  • DOI: https://doi.org/10.1007/s00277-012-1461-y

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