title: Flow cytometry in myelodysplastic syndrome: analysis of diagnostic utility using maturation pattern-based and quantitative approaches.
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.
authors.affiliation: Department of Laboratory Oncology, IRCH, All India Institute of Medical Sciences, DII/44, AIIMS Campus, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Chopra
authors.forename: Haraprasad
authors.initials: H
authors.lastname: Pati
authors.forename: Manoranjan
authors.initials: M
authors.lastname: Mahapatra
authors.forename: Pravas
authors.initials: P
authors.lastname: Mishra
authors.forename: Tulika
authors.initials: T
authors.lastname: Seth
authors.forename: Suman
authors.initials: S
authors.lastname: Kumar
authors.forename: Saroj
authors.initials: S
authors.lastname: Singh
authors.forename: Sangita
authors.initials: S
authors.lastname: Pandey
authors.forename: Rajive
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015703:Antigens, CD / Q000032:analysis; D001707:Biopsy, Needle; D001855:Bone Marrow Diseases / Q000473:pathology; D001856:Bone Marrow Examination / Q000379:methods*; D002452:Cell Count; D005260:Female; D005434:Flow Cytometry / Q000379:methods*; D006410:Hematopoiesis; D006412:Hematopoietic Stem Cells / Q000737:chemistry / Q000473:pathology*; D006801:Humans; D016130:Immunophenotyping / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009000:Monocytes / Q000737:chemistry / Q000473:pathology*; D009190:Myelodysplastic Syndromes / Q000175:diagnosis* / Q000473:pathology; D022423:Myeloid Cells / Q000737:chemistry / Q000473:pathology*; D011446:Prospective Studies; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D015703:Antigens, CD