How I investigate dysgranulopoiesis

Analyzing Blood Cells of High-Risk Myelodysplastic Syndrome Patients Using Interferometric Phase Microscopy and Fluorescent Flow Cytometry

Myelodysplastic syndromes (MDSs) are a group of potentially deadly diseases that affect the morphology and function of neutrophils. Rapid diagnosis of MDS is crucial for the initiation of treatment that can vastly improve disease outcome. In this work, we present a new approach for detecting morphological differences between neutrophils isolated from blood samples of high-risk MDS patients and blood bank donors (BBDs). Using fluorescent flow cytometry, neutrophils were stained with 2',7'-dichlorofluorescin diacetate (DCF), which reacts with reactive oxygen species (ROS), and Hoechst, which binds to DNA. We observed that BBDs possessed two cell clusters (designated H and L), whereas MDS patients possessed a single cluster (L). Later, we used FACS to sort the H and the L cells and used interferometric phase microscopy (IPM) to image the cells without utilizing cell staining. IPM images showed that H cells are characterized by low optical path delay (OPD) in the nucleus relative to the cytoplasm, especially in cell vesicles containing ROS, whereas L cells are characterized by low OPD in the cytoplasm relative to the nucleus and no ROS-containing vesicles. Moreover, L cells present a higher average OPD and dry mass compared to H cells. When examining neutrophils from MDS patients and BBDs by IPM during flow, we identified ~20% of cells as H cells in BBDs in contrast to ~4% in MDS patients. These results indicate that IPM can be utilized for the diagnosis of complex hematological pathologies such as MDS.

Guide to the Diagnosis of Myeloid Neoplasms: A Bone Marrow Pathology Group Approach

OBJECTIVES

The practicing pathologist is challenged by the ever-increasing diagnostic complexity of myeloid neoplasms. This guide is intended to provide a general roadmap from initial case detection, often triggered by complete blood count results with subsequent blood smear review, to final diagnosis.

METHODS

The integration of hematologic, morphologic, immunophenotypic, and genetic features into routine practice is standard of care. The requirement for molecular genetic testing has increased along with the complexity of test types, the utility of different testing modalities in identifying key gene mutations, and the sensitivity and turnaround time for various assays.

RESULTS

Classification systems for myeloid neoplasms have evolved to achieve the goal of providing a pathology diagnosis that enhances patient care, outcome prediction, and treatment options for individual patients and is formulated, endorsed, and adopted by hematologists/oncologists.

CONCLUSIONS

This guide provides diagnostic strategies for all myeloid neoplasm subtypes. Special considerations are provided for each category of testing and neoplasm category, along with classification information, genetic testing requirements, interpretation information, and case reporting recommendations based on the experience of 11 Bone Marrow Pathology Group members.

Differential diagnoses and the mutational landscape of myelodysplastic/myeloproliferative neoplasm with neutrophilia: A case report

Myelodysplastic/myeloproliferative neoplasm with neutrophilia (MDS/MPN-N; previously referred to as atypical chronic myeloid leukemia) is a type of myelodysplastic syndrome/myeloproliferative neoplasm. A molecular genetic precondition for diagnosis is BCR::ABL negativity; further diagnostic criteria include clinicopathological assessments, such as peripheral blood leukocyte counts, the number of neutrophils and their precursors, and the presence of dysgranulopoiesis. The present case report highlights the importance of differential diagnoses with a stringent diagnostic workup according to the 5th Edition of the World Health Organization Classification of Hematolymphoid Tumors. A systematic review of the literature from 2013 to 2022 covering the mutational landscape of MDS/MPN-N was also performed to highlight recent improvements in the molecular genetic diagnostics of this disease.

Combination of NeuX and NeuZ can predict neutrophil dysplasia features of myelodysplastic neoplasms in peripheral blood

INTRODUCTION

The assessment of neutrophil dysplasia features in peripheral blood is very helpful for the early screening and diagnosis of myelodysplastic neoplasms (MDS). Cell population data (CPD) parameters generated by automated hematology analyzers can reflect morphological characteristics of blood cells. This study aimed to investigate the clinical significance of CPD parameters neutrophil (Neu) X, NeuY and NeuZ in assessing neutrophil dysplasia.

METHODS

218 MDS patients were divided into two subgroups according to neutrophil morphology. The differences of neutrophil research parameters between the two MDS subgroups and the control group, consisting of 210 healthy individuals, were compared, the correlation among neutrophil research parameters and the relationship between these parameters and cell morphology in MDS patients were analyzed, and receiver operating characteristic analysis were performed.

RESULTS

The median values of neutrophil research parameters NeuX and NeuZ in MDS with granulocyte dysplasia group were significantly lower than those in MDS without granulocyte dysplasia group and control group (p < 0.001), and they were positively correlated (r = 0.878, p < 0.001). The area under the receiver operating characteristic curve of NeuX and NeuZ was 0.720 (95% CI: 0.643-0.796, p < 0.001) and 0.738 (95% CI: 0.665-0.811, p < 0.001), respectively. In addition, with the decrease of NeuX value, neutrophils gradually show decreased nuclear segment and/or cytoplasmic granules.

CONCLUSIONS

Combining NeuX and NeuZ can predict neutrophil dysplasia features of MDS in peripheral blood, and this can be an easier method to screen for the neutrophil dysplasia cases, as compared with the microscopic examination of peripheral blood and/or bone marrow smears.