Flow Cytometry vs Manual

[Barb]

Hello, I was dx 5q- in 2006. I have been very stable, never even needing a blood transfusion. All of that changed in the last several weeks. My monos and basos are rising and all my other counts are dropping. I have had a PRBC transfusion, and I just had my first bone marrow biopsy since I was first diagnosed.I will get the results of the BMB on Thursday.

In the meantime I am trying to understand whether flow cytometry or manual smear is most accurate in determining blasts. I have had 2 manual smears read of my peripheral blood by 2 different pathologists. One said 10% blasts and the other said 6%. However, the flow cytometry (blood taken the same day as the 6% reading) said only 1% blasts. The only result from the BMB is the flow cyrometry. It says bone marrow has 1% of CD34+ blasts, with 81% of granulocytes with decreased side scatter.

I have searched the forums and other posters have asked the FC vs manual smear question, but I see no answers. Anyone have any insight?

Decreased side scatter on CD45 seems associated with blasts, if I have any understanding of what I have read.

Any insight would be appreciated.

Barb

[mdsfound]

Dear Barb, Flow cytometry sorts individual cells so that specific proteins on the surface of the cells can be identified. Because immature cells such as blasts have specific surface markers, flow can be useful as an approach for identifying the percentage of marrow blasts in the marrow. Because other types of cells in addition to blasts have abnormal expression of protein markers on their surface, flow may sometimes be an additionally useful method to help when findings of dysplasia are subtle or chromosome abnormalities are not present. I hope this helps.

[Barb]

Mdsfound, thank you for responding. Since my post I have learned that some blasts are CD34-. Even though my marrow only has less than 5% CD34+ blasts, my total blast count is 34%, welcoming me to the world of AML. 5q-, trisomy 8, and amplified MLL gene. I am being transferred to The James Cancer Center at Ohio State U. I meet the new hemo tomorrow.

[helenolin1]

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[jennifer clark]

in recent bone marrow the radiogy report came up with 15 to 19 percent blasts, bordering on AML. Mayo e-consult says 8 percent and said difference could be different technics, counts by morphology and CD34 immunohistochemistry rather than relying on flow cytometry. they suggest a repeat bone marrow. I am clinically stable. difference in number of blasts is so significant for life expectancy. am so confused as to which is more correct. any suggestions?

[Barb]

Jennifer, I wish I had answers for you. Other than the fact that some blasts are CD 34- (and that is the main marker flow cytometry seems to use in PB), I don’t know. I asked the hemo/onco that question Friday. He said he was going to figure out the answer. I’ve now had 3 peripheral smears with 10, 6, and 4% blasts, all different pathologists. The flow cytometry said 1%.

Nonetheless, BMB said 34% blasts, even tho less than 5% were CD34+. I start 7+3 induction Thursday. Oh, I get another BMB Tuesday. They are not waiting on those results to start chemo.

[Author]

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