Flow cytometry evaluation of erythroid dysplasia in patients with myelodysplastic syndrome

• Published in: Leukemia Vol. 20; no. 4; pp. 549 - 555
• Main Authors: Porta, M G Della, Malcovati, L, Invernizzi, R, Travaglino, E, Pascutto, C, Maffioli, M, Gallì, A, Boggi, S, Pietra, D, Vanelli, L, Marseglia, C, Levi, S, Arosio, P, Lazzarino, M, Cazzola, M
• Format: Journal Article
• Language: English
• Published: London Nature Publishing Group UK 01.04.2006; Nature Publishing; Nature Publishing Group
• Subjects: Adult; Aged; Anemia; Antigens, CD - biosynthesis; Antigens, CD34 - metabolism; Apoferritins; Biological and medical sciences; Bone Marrow Cells - pathology; Cancer Research; CD105 antigen; Cohort Studies; Critical Care Medicine; Cytogenetic Analysis - methods; Dysplasia; Endoglin; Erythroblasts; Erythrocytes; Erythroid Cells - metabolism; Erythroid Cells - pathology; Erythroid Precursor Cells - metabolism; Erythroid Precursor Cells - pathology; Female; Ferritin; Ferritins - biosynthesis; Flow cytometry; Flow Cytometry - methods; Fluorescence; Hematologic and hematopoietic diseases; Hematology; Hemopoiesis; Humans; In Vitro Techniques; Intensive; Internal Medicine; Investigative techniques, diagnostic techniques (general aspects); leading-article; Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mitochondria; Mitochondria - chemistry; Myelodysplastic syndrome; Myelodysplastic syndromes; Myelodysplastic Syndromes - classification; Myelodysplastic Syndromes - metabolism; Myelodysplastic Syndromes - pathology; Oncology; Pathology. Cytology. Biochemistry. Spectrometry. Miscellaneous investigative techniques; Pigments; Prospective Studies; Quantitative analysis; Receptors, Cell Surface - biosynthesis; Receptors, Transferrin - biosynthesis; Sensitivity and Specificity; Sideroblastic anemia; Sideroblasts; Tumor Cells, Cultured; erythroid dysplasia; transferrin receptor; ferritin; flow cytometry; myelodysplastic syndrome; immunophenotyping; Human; Flow cytometry; Blood cell; Dysplasia; Immunophenotype; Ferritin; Red blood cell; Malignant hemopathy; Myelodysplastic syndrome; Transferrin receptor
• ISSN: 0887-6924; 1476-5551
• DOI: 10.1038/sj.leu.2404142

Erythroid dysplasia is the pathologic hallmark of myelodysplastic syndromes (MDS). To develop a quantitative flow-cytometry approach to its evaluation, we analyzed the expression of CD71, CD105, cytosolic H-ferritin (HF), cytosolic L-ferritin (LF) and mitochondrial ferritin (MtF) in erythroblasts from 104 MDS patients, 69 pathologic control patients and 19 healthy subjects. Six-parameter, 4-color flow cytometry was employed, and data were expressed as mean fluorescence intensity. Compared with pathologic and healthy controls, MDS patients had higher expression of HF ( P <0.001) and CD105 ( P <0.001), and lower expression of CD71 ( P <0.001). MtF was specifically detected in MDS with ringed sideroblasts, and there was a close relationship between its expression and Prussian blue staining ( r =0.89, P <0.001). In vitro cultures of myelodysplastic hematopoietic progenitors showed that both HF and MtF were expressed at a very early stage of erythroid differentiation, and that MtF expression is specifically related to mitochondrial iron loading. A classification function based on expression levels of HF, CD71 and CD105 allowed us to correctly classify >95% of MDS patients. This flow-cytometry approach provides an accurate quantitative evaluation of erythroid dysplasia and allows a reliable diagnosis of sideroblastic anemia, and may therefore be a useful tool in the work-up of patients with MDS.