Phenotypic Analysis of Bone Marrow Lymphocytes From Children With Acute Thrombocytopenic Purpura
Hematogones are benign immature B cells that commonly populate the bone marrow of children. Their presence has been noted to interfere with the flow-cytometric analysis of acute lymphoblastic leukemia (ALL), because their immunophenotype is similar to B-precursor cell lymphoblasts. Immune-mediated thrombocytopenia is a clinical condition characterized by increased platelet destruction due to sensitization of platelets by autoantibodies. The aim of this study was to determine the incidence and clinical impact of bone marrow hematogones in cases of acute immune thrombocytopenic purpura (ITP) among children. This was done by immunophenotyping of bone marrow lymphocytes of ITP cases and controls and follow up of cases. This study was done on 25 cases of ITP, 12 females and 13 males, their age ranged from 2 to 13 years. A control group was included in the study, 15 cases of apparently healthy children with matching age and sex taken from among bone marrow donors. Cases and controls were subjected to bone marrow lymphocyte immunophenotyping with flow-cytometry to verify the presence of hematogones. A statistically significant increase in the percentage of hematogones was demonstrated in their bone marrows. An increased percentage of CD10+ lymphocytes was demonstrated; with a mean of 18+/-15.2%, CD19+ with a mean of 27+/-16.3% and CD34+ with a mean of 3.7+/-3.2%. No correlation was found between the percentage of hematogones and peripheral platelet count or bone marrow lymphocytic count. In conclusion, there is an increase in the bone marrow hematogones in ITP cases in comparison to normal controls. This could be the sequence of an immunological response to the cause which determined the disease, or the regeneration of the stem cell compartment following transient damage.
Available from: Manupriya Nain
- "It was reported that in infants less than 2 years of age, hematogones averaged 9%, by 2 - 5 years the percent dropped to 3.9% and in patients more than 50 years of age, the average was less than 1% . Increased hematogones had also been observed in a variety of clinical conditions like ITP, regenerating marrow of treated ALL, after autologous bone marrow transplantation in acute myeloid leukemia and in viral infections commonly due to CMV or HIV[1,3,6]. These data suggest that a mechanism involving immuno-stimulation of the lymphoid population probably underlies the increased proportion of lymphocytes expressing the immature B phenotype. "
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ABSTRACT: Hematogones are the normal bone marrow constituents of bone marrow in children and their number decreases with age. As hematogones can resemble malignant lymphoblasts by their morphologic features and by expression of an immature B-cell phenotype, an accurate distinction of hematogone-rich lymphoid regeneration from leukemic lymphoblasts is critical for patient care. The increased number of hematogones had been reported in the bone marrow of children recovering from chemotherapy, aplastic conditions, other forms of bone marrow injury, infections like Cytomegalovirus, HIV and immune thrombocytopenia disorders. We describe here a case of one and half month old male infant with bicytopenia and leucocytosis associated with increased hematogones in the bone marrow due to an unknown probable viral infection.
Available from: Antonio Molina-Carballo
- "Exceptionally, hematogones have been observed in the bone marrow extension of patients with cytomegalovirus infection or thrombocytopenia . Although there have been reports of an increase in the percentage of hematogones in patients with immune-mediated thrombocytopenia, there does not seem to be a proven relation between the intensity of the thrombopenia, as assessed by a count of platelets in the peripheral blood, and the percentage of hematogones in the bone marrow . We describe the case of a 3-month infant with active cytomegalovirus infection with hepatitis and pancytopenia, associated with a presence of 13% hematogones in the bone marrow. "
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ABSTRACT: Hematogones are normal B-lymphoid precursors that multiply in the bone marrow of small children and of adults with ferropenic anaemia, neuroblastoma or idiopathic thrombocytopenic purpura. They are not normally found in peripheral blood, and the immunophenotype is virtually indistinguishable from that of B lymphoblasts. We discuss the case of a 3-month infant with an active cytomegalovirus infection, with hepatitis and pancytopenia associated with 13% hematogones in the bone marrow.
Available from: Nejia Braham Jmili
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ABSTRACT: Immunophenotyping has become essential to the diagnosis and the treatment management of acute lymphoblastic leukaemia (ALL). We prospectively studied minimal residual disease (MDR) in patients with B lineage ALL who achieved mCR remission. The initial series of patients consisted on 90 cases with B ALL. Sixty-Six patients had bone marrow samples adequate for MDR studies collected on day 35 of remission induction chemotherapy. Strategy of monitoring MRD is based on flow cytometry using quadruple staining according the leukaemia associated immunophenotype found at diagnosis. Data analysis was done using an EPI XL cytometer (Coulter), acquiring 500 000 events. Of the 66 patients 40 (60, 6%) had MRD 0, 01%. B lymphoblasts of ALL may morphologically resemble to hematogones (B benign lymphocyte precursors) and their immunophentypes have similarities. Different combinations of antibodies are tested to determine which combinations are more suitable to detect B residual leukaemics cells. The results of this present study indicate that: CD10/CD38/CD19/CD45 and CD10/CD34CD19/CD45 are the more specifics and should be used to distinguish B lymphoblasts of lymphoblastic acute leukaemia from normal hematogones.
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