cp unknown n.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
CP Unknown PowerPoint Presentation
Download Presentation
CP Unknown

Loading in 2 Seconds...

play fullscreen
1 / 23

CP Unknown - PowerPoint PPT Presentation


  • 161 Views
  • Uploaded on

CP Unknown. Heme-10/19/2011 Kumaran Mudaliar and Girish Venkataraman Loyola University Medical Center, Pathology. What cells are these?- hematogones. What cells are the purple population? -Plasma cells. Additional plot of same case.

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'CP Unknown' - chacha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
cp unknown

CP Unknown

Heme-10/19/2011

KumaranMudaliar and Girish Venkataraman

Loyola University Medical Center, Pathology

slide2

What cells are these?- hematogones

What cells are the purple population?

-Plasma cells

slide4

Explain the gates in this tube containing CD45, CD19, CD20, kappa and lambda

Primary gate CD19/SSC

Light chain negative cells colored green

and forwarded to show on all plots.

hematogones
Hematogones
  • Hematogones: physiologic precursors of B-cells
  • 70 years ago, distinct ‘lymphoid appearing cells’ in the bone marrow (BM).
  • ‘Hematogones’ (hematogonia, meaning ‘blood-maker’)
  • 662 patients
    • 8% pts had 5% or more of hematogones
      • 24.6% < 16 YO had hematogones
      • 6.3% > 16 YO had hematogones
  • MC in patients: lymphoma, marrow regenerative states, immuno cytopenias, AIDS
problem
Problem
  • At 5% level, they are conspicuous on marrow smear and can be confused with neoplastic lymphoblasts
reference ranges
Reference Ranges?
  • No accepted reference ranges
    • BM examination is not performed in healthy people
3 stages of hematogone maturation
3 stages of Hematogone Maturation
  • Early
    • Usually comprise a small minority, but can become expanded in regenerating marrows
    • No expression of CD 20 /CD34+
  • Intermediate
    • Majority in most marrows
    • -CD34-/CD20 dim/CD10+
  • Late
    • In contrast to mature B cells, Cd34-/CD20+/maintain dim CD10 . Light chain surface+
slide17

Stage 1

Hematogones

CD34+/CD10+

Gated on all CD19+ cells

Stage 2 hematogones

Dimmer CD10, CD20 het

Stg 2 (red) and stg 3 (blue)

Hematogones lack CD34

Stage 3 hematogones

-bright CD20, dim CD10

>90% of B-cells in this case are hematogones

immunophenotype
Immunophenotype
  • CD 10+
  • CD 19+
  • CD 20+ Variable expression
  • CD 38+
  • CD 45+
  • TdT + [subset]
  • CD 34 + [subset]
  • Kappa & Lambda -
differences between hematogones and lymphoblasts
Differences between hematogones and lymphoblasts
  • Both present in CD 45 dim gate
  • Hematogones: low side scatter
    • Consistent, highly reproducible, maturational pattern
    • No aberrant or asynchronous antigen expression
  • B-ALL: relatively higher side scatter
    • Phenotypic abnormalities:
      • Myeloid Markers: 13, 33, 15
      • T-cell: 2, 5, 7
      • Concurrent expression: TdT and cytoplasmicIgM; 34 and 20 ; 34 and surface light chains
      • Loss of antigen expression on blasts: 45 – ; 10 – [B-ALL with MLL abnlties] ; 34 – [E2A-PBX1 fusion]
slide20

Even tho both may express an antigen, difference in expression patterns and levels of specific antigens exist

    • IF TdT: hematogones (coarsely granular / speckled) to blasts (finely granular / even distribution)
    • Also, hematogones have higher #’s of TdT and CD 10 molecules / cell
      • Leads to brighter expression on FC
    • Hematogones have less CD 19 molecules/ cell
      • Hence dimmer expression on FC
bm core biopsies
BM Core Biopsies
  • Hematogones: dispersed throughout marrow
  • Blasts: small clusters (> 5 cells)
issues
Issues
  • Differentiation can be challenging
  • Left Shifted Hematogones
    • Early stages after BM transplantation
  • Anti-CD20 immunotherapy
    • Majority of B-ALL lack CD20 expression .
  • -Phenotypic change
sources
Sources
  • McKenna RW, et al. Immunophenotypic analysis of hematogones (B-lymphocyte precursors) in 662 consecutive bone marrow specimens by 4-color flow cytometry. Blood. 2001 Oct 15;98(8):2498-507