Identification of Unsuspected PNH-Type Cells in Flow Cytometric Immunophenotypic Analysis of Peripheral Blood and Bone Marrow

Abstract

In this report, the flow cytometric expression patterns for CD14 on monocytic cells and CD16 on granulocytic cells in peripheral blood or bone marrow specimens are illustratedfor 15 patients proven to have a paroxysmal nocturnal hemoglobinuria (PNH) phenotype by flow cytometric analysis for CD55 and CD59. The varied clinical manifestations of PNH and its rarity may make it difficult to recognize clinically. As a result, blood or bone marrow samples may be submitted for flow cytometric analysis to exclude bone marrow neoplasia or dysplasia in patients with cytopenias rather than to exclude PNH. This was true in 5 of 15 study cases. Unlike CD55 and CD59, CD14 and/or CD16 are assessed routinely in the flow cytometric analysis of blood and bone marrow samples. Recognition of abnormal patterns of CD14 and CD16 expression might permit the identification of clinically unsuspected PNH by routine flow cytometric analysis.

Dysplasia andPNH‐type cells in bone marrow aspirates of myelodysplastic syndromes

“…Validation of this BM‐method revealed similar results in comparison with PNH‐analysis in PB and in paired blood and BM samples. Our findings demonstrated that PNH assessments can be achieved in BM samples of cytopenic patients, though most reliably in the mature neutrophil compartment because of higher sensitivity as compared to the lower frequent monocyte subset, thereby confirming data from previous reports (Dulau‐Florea et al, 2018; Nakakuma et al, 1995; Olteanu et al, 2006; Thomason et al, 2004; Yang et al, 2013). In our hands, 0.1% was the most reliable cut‐off.…”

Mercaptopurine Treatment in an Adult Man with Orbital and Intracranial Rosai-Dorfman Disease

“…In RDD, the histiocytes typically stain positive for S100 and CD68 and negative for CD1a [18–21]. These features with the absence of eosinophils and Birbeck's granules on electron microscopy make the differential diagnosis with CNS Langerhans Cell Histiocytosis (LCH) possible [18, 22, 23]. Another interesting differential diagnosis is Erdheim-Cester Disease (ECD), which is a rare non-Langerhans histiocytic disorder most commonly characterized by multifocal osteosclerotic lesions of the long bones.…”

The Laboratory Diagnosis of Paroxysmal Nocturnal Hemoglobinuria (PNH): Update 2010

“…21 Thomason and colleagues recommend the addition of CD 14 (monocytes) and CD16 (granulocytes), which are routine FCM markers, to CD 55 and CD 59, and to search for abnormal expression of CD 14 and CD 16 for increased PNH sensitivity. 22 Similarly, Hernandez-Campo and colleagues recommend CD 16/CD 24/CD 55/CD 59/CD 66b/ CD 157 as a neutrophil panel; CD 14/CD 55/CD 157 for monocytes; CD 24/CD 48/CD 52/CD 55 for B cells; CD 48/CD 52/CD 55 for CD 4 (+) T cells; CD 55/CD 59 for eosinophils; and CD 48/CD 55 for CD 8 (+) T cells. If limited to 1 marker: CD 48 for CD 56 (low) NK cells; CD 55 for BOCA 3(-) dendritic cells plus CD 56 (high) NK cells; and CD59 for RBCs.…”