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Somasundaram V, Soni S, Chopra A, Rai S, Mahapatra M, Kumar R, Pati H. Value of Quantitative assessment of Myeloid Nuclear Differentiation Antigen expression and other flow cytometric parameters in the diagnosis of Myelodysplastic syndrome. Int J Lab Hematol 2016; 38:141-50. [DOI: 10.1111/ijlh.12458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/17/2015] [Indexed: 11/30/2022]
Affiliation(s)
- V. Somasundaram
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - S. Soni
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - A. Chopra
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - S. Rai
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - M. Mahapatra
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - R. Kumar
- Department of Laboratory Oncology; IRCH; All India Institute of Medical Sciences; New Delhi India
| | - H. Pati
- Department of Haematology; IRCH; All India Institute of Medical Sciences; New Delhi India
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Refractory thrombocytopenia and neutropenia: a diagnostic challenge. Mediterr J Hematol Infect Dis 2015; 7:e2015018. [PMID: 25745545 PMCID: PMC4344166 DOI: 10.4084/mjhid.2015.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Accepted: 01/28/2015] [Indexed: 11/27/2022] Open
Abstract
The 2008 WHO classification identified refractory cytopenia with unilineage dysplasia (RCUD) as a composite entity encompassing refractory anemia, refractory thrombocytopenia (RT), and refractory neutropenia (RN), characterized by 10% or more dysplastic cells in the bone marrow respective lineage. The diagnosis of RT and RN is complicated by several factors. Diagnosing RT first requires exclusion of familial thrombocytopenia, chronic auto-immune thrombocytopenia, concomitant medications, viral infections, or hypersplenism. Diagnosis of RN should also be made after ruling out differential diagnoses such as ethnic or familial neutropenia, as well as acquired, drug-induced, infection-related or malignancy-related neutropenia. An accurate quantification of dysplasia should be performed in order to distinguish RT or RN from the provisional entity named idiopathic cytopenia of unknown significance (ICUS). Cytogenetic analysis, and possibly in the future somatic mutation analysis (of genes most frequently mutated in MDS), and flow cytometry analysis aberrant antigen expression on myeloid cells may help in this differential diagnosis. Importantly, we and others found that, while isolated neutropenia and thrombocytopenia are not rare in MDS, those patients can generally be classified (according to WHO 2008 classification) as refractory cytopenia with multilineage dysplasia or refractory anemia with excess blasts, while RT and RN (according to WHO 2008) are quite rare. These results suggest in particular that identification of RT and RN as distinct entities could be reconsidered in future WHO classification updates.
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Porwit A, van de Loosdrecht AA, Bettelheim P, Brodersen LE, Burbury K, Cremers E, Della Porta MG, Ireland R, Johansson U, Matarraz S, Ogata K, Orfao A, Preijers F, Psarra K, Subirá D, Valent P, van der Velden VHJ, Wells D, Westers TM, Kern W, Béné MC. Revisiting guidelines for integration of flow cytometry results in the WHO classification of myelodysplastic syndromes-proposal from the International/European LeukemiaNet Working Group for Flow Cytometry in MDS. Leukemia 2014; 28:1793-8. [PMID: 24919805 DOI: 10.1038/leu.2014.191] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Revised: 04/06/2014] [Accepted: 05/02/2014] [Indexed: 12/22/2022]
Abstract
Definite progress has been made in the exploration of myelodysplastic syndromes (MDS) by flow cytometry (FCM) since the publication of the World Health Organization 2008 classification of myeloid neoplasms. An international working party initiated within the European LeukemiaNet and extended to include members from Australia, Canada, Japan, Taiwan and the United States has, through several workshops, developed and subsequently published consensus recommendations. The latter deal with preanalytical precautions, and propose small and large panels, which allow evaluating immunophenotypic anomalies and calculating myelodysplasia scores. The current paper provides guidelines that strongly recommend the integration of FCM data with other diagnostic tools in the diagnostic work-up of MDS.
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Affiliation(s)
- A Porwit
- Department of Pathobiology and Laboratory Medicine, University of Toronto, University Health Network, Toronto General Hospital, Toronto, Ontario, Canada
| | - A A van de Loosdrecht
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - P Bettelheim
- First Medical Department, Elisabethinen Hospital, Linz, Austria
| | | | - K Burbury
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, East Melbourne, Melbourne, Victoria, Australia
| | - E Cremers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Della Porta
- Department of Hematology and Oncology, Fondazione IRCCS Policlinico San Matteo, Pavia, and University of Pavia, Pavia, Italy
| | | | | | - S Matarraz
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - K Ogata
- Metropolitan Research Center for Blood Disorders MRC JAPAN, Midorigaoka, Chofu, Tokyo, Japan
| | - A Orfao
- Servicio Central de Citometría, Centro de Investigación del Cáncer, Instituto de Biologia Celular y Molecular del Cáncer CSIC/USAL/IBSAL) and Department of Medicine, Universidad de Salamanca, Salamanca, Spain
| | - F Preijers
- Department of Hematology, St Radboud University Medical Center, Nijmegen, The Netherlands
| | - K Psarra
- Department of Immunology-Histocompatibility, Evangelismos Hospital, Athens, Greece
| | - D Subirá
- Department of Hematology, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - P Valent
- Department of Internal Medicine I, Division of Hematology and Hemostaseology and Ludwig Boltzmann Cluster Oncology, Medical University of Vienna, Vienna, Austria
| | - V H J van der Velden
- Department of Immunology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - D Wells
- HematoLogics, Inc., Seattle, WA, USA
| | - T M Westers
- Department of Hematology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - W Kern
- MLL Munich Leukemia Laboratory, Munich, Germany
| | - M C Béné
- Service d'Hématologie Biologique, CHU de Nantes, Nantes, France
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