False-positive flow cytometric platelet glycoprotein IIb/IIIa expression in myeloid leukemias secondary to platelet adherence to blasts.
False-positive flow cytometric platelet glycoprotein IIb/IIIa expression in myeloid leukemias secondary to platelet adherence to blasts.
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DOI：
10.1182/blood.v79.9.2399.bloodjournal7992399
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发表时间：
1992-05
期刊：
影响因子：
20.3
通讯作者：
S. Betz;K. Foucar;D. Head;I. Chen;C. Willman
中科院分区：
文献类型：
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作者：
S. Betz;K. Foucar;D. Head;I. Chen;C. Willman
由于形态学和常规细胞化学特征均不具有特异性，因此急性巨核细胞白血病（AML-M7）的诊断很困难，需要专门的超微结构或免疫学技术。由于超微结构技术是繁琐的，免疫分析表达的几个血小板特异性抗原，如CD41 a（血小板糖蛋白IIb/IIIa），已成为主要的方法来检测巨核细胞分化。在我们对来自西南肿瘤组（SWOG）治疗方案注册患者的1,000多例AML病例的免疫表型进行流式细胞术分析时，我们发现38%的病例表现出CD41a反应性。由于流式细胞术检测的CD41a表达频率大大超过了形态学定义的AML-M7病例的数量，我们推测该反应可能是由粘附于白血病母细胞的血小板引起的。为了研究这一假设，我们对37例成人初发AML进行了流式细胞术和细胞离心涂片免疫荧光研究的并排比较，流式细胞术分析显示了广泛的CD41a表达。我们发现，通过流式细胞术检测的CD41a的表达是继发于粘附血小板或血小板碎片在85%的情况下。这些病例中的许多还表达谱系特异性碳水化合物，LNF III（CD15），其可介导血小板粘附于成熟单核细胞和中性粒细胞。只有15%的CD41a流式细胞术阳性的情况下，表现出真正的弥漫性膜和细胞质阳性的细胞涂片指示巨核细胞分化。应对所有疑似AML-M7病例进行CD 41 a的细胞离心免疫荧光检测。如果仅使用流式细胞术技术，粘附的血小板可能导致该AML亚型的错误诊断。
Because neither morphologic nor routine cytochemical features are pathognomonic, the diagnosis of acute megakaryoblastic leukemia (AML-M7) is difficult, requiring either specialized ultrastructural or immunologic techniques. Because the ultrastructural techniques are cumbersome, immunologic assays for expression of several platelet-specific antigens, such as CD41a (platelet glycoprotein IIb/IIIa), have become the primary method used to detect megakaryoblastic differentiation. In our flow cytometric analysis of the immunophenotypes of over 1,000 cases of AML from patients registered to Southwest Oncology Group (SWOG) Treatment Protocols, we found that 38% of cases demonstrated CD41a reactivity. Because this frequency of CD41a expression by flow cytometry greatly exceeded the number of morphologically defined cases of AML-M7, we postulated that the reaction may be caused by platelets adherent to leukemic blasts. To investigate this hypothesis, we performed a side-by-side comparison of flow cytometric and cytospin immunofluorescence studies on 37 cases of adult de novo AML that demonstrated a wide range of CD41a expression by flow cytometric analyses. We found that the expression of CD41a detected by flow cytometric techniques was secondary to adherent platelets or platelet fragments in 85% of cases. Many of these cases also expressed the lineage-specific carbohydrate, LNF III (CD15), which may mediate platelet adhesion to mature monocytes and neutrophils. Only 15% of the CD41a flow cytometrically positive cases demonstrated true diffuse membrane and cytoplasmic positivity on cytospin slides indicative of megakaryoblastic differentiation. Cytospin immunofluorescence for CD41a should be performed on all cases of suspected AML-M7. If only flow cytometric techniques are used, adherent platelets may result in the erroneous diagnosis of this AML subtype.