Detection of the proportion of myeloid progenitor cells and lymphocytes in bone marrow by flow cytometry immunophenotyping can effectively identify aplastic anemia and hypoplastic myelodysplastic syndrome / 中华检验医学杂志

ABSTRACT

Objective:To investigate the flow cytometric characteristics of bone marrow in patients with aplastic anemia (AA) and hypoplastic myelodysplastic syndrome (hypoMDS) and its value in differential diagnosis between AA and hypoMDS.Methods:A total of 618 patients were recruited from Shandong Provincial Hospital affiliated to Shandong First Medical University from January 2017 to December 2021, including 441 patients as controls with abnormal peripheral blood counts but confirmed to have no AA, hypoproliferative MDS, or other hematological tumors, 57 patients with AA, 52 patients with hypoMDS and 68 patients with diluted bone marrow. The proportions of bone marrow myeloid progenitor cell, lymphocyte, neutrophil and erythroid cell in bone marrow were analyzed by flow cytometry immunophenotyping. The differences between the four groups were compared by Kruskal-Wallis one-way ANOVA. The diagnostic efficacy was evaluated by the receiver operating characteristic (ROC) curve.Results:The proportion of myeloid progenitor cells in control group was [0.30%(0.20%, 0.46%)]; the proportion of myeloid progenitor cells in AA group was [0.00 (0.00, 0.04)]%, while the proportion of myeloid progenitor cells in hypoMDS group was [3.10%(1.25%, 6.71%)]. The proportion of myeloid progenitor cells in AA group was lower than that in control group( χ2=302.90, P<0.001), while the proportion of myeloid progenitor cells in the bone marrow of patients with hypoMDS was higher than that in the control group ( χ2=203.88, P<0.001). The area under the ROC curve for identifying AA and hypoMDS by the ratio of myeloid progenitor cells in bone marrow is 0.996, with the sensitivity of 96.2% and the specificity of 100% when the cutoff value is 0.21%. The proportion of bone marrow lymphocytes in control group was [10.39%(7.33%, 14.80%)]; the proportion of bone marrow lymphocytes in AA group was [52.67%(42.20%, 67.68%)], and the proportion of bone marrow lymphocytes in hypoMDS group was [24.68%(15.51%, 35.19%)]. The proportion of bone marrow lymphocytes in AA group or hypoMDS group was higher than that in control group( χ2=298.74, P<0.001; χ2=194.33; P<0.001), and the proportion of bone marrow lymphocytes in AA group is higher than that in hypoMDS group, with a statistically significant difference( χ2=104.41, P=0.002). The area under the ROC curve for identifying AA and hypoMDS by the ratio of bone marrow lymphocyte is 0.882, with the sensitivity of 78.9% and the specificity of 92.3% when the cutoff value is 41.6%. Conculsion:Patients with AA and hypoMDS could be differentiated effectively by the proportions of myeloid progenitor cell and lymphocyte in bone marrow by flow cytometry immunophenotyping.