Diagnostic Features of MDS, continued

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The page below is a sample from the LabCE course Myelodysplastic Neoplasms (MDS). Access the complete course and earn ASCLS P.A.C.E.-approved continuing education credits by subscribing online.

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Diagnostic Features of MDS, continued

  • Bone marrow flow-cytometry:
    • May show normal or increased blast counts. Reactive monoclonal antibodies to blast cell surface markers determine the number of blasts. Examples: CD-34, HLA-DR, and CD-117. Correlation between the blasts counted via differentials and flow cytometry is essential to the MDS evaluation process.
  • Bone marrow biopsy immunohistochemistry stain:
    • CD-34 and CD-117 immunostain can be performed on the core biopsy. When the bone marrow aspirate is suboptimal, the core biopsy H&E stain and the immunostains are valuable in the evaluation process.
    • The number of bone marrow and peripheral blood blasts (normal or increased) determines the subtype and the classification of MDS and the prognosis and risk factors.
  • Blood iron, B12, and folic acid levels to rule out nutritional causes:
    • The anemia, neutropenia, and thrombocytopenia are not due to nutritional factors in cases of MDS. Iron study tests and vitamin B12 and folate levels would be normal12 and folate levels. These tests are performed before evaluating the case as possible MDS.
  • Immunophenotyping:
    • There should be a good correlation between the blasts determined by flow cytometry (antibody to CD-34+ or CD-117+ cells), immunohistochemistry (antibody to CD-34+ or CD-117+ cells), and Wright-Giemsa stained aspirate smears. In some cases, there is discordance between the three methods due to sample quality, bone marrow fibrosis, or hemodilution. Immunohistochemical stains on the biopsy section (antibody to CD34+ or CD-117+ cells) become valuable in staining the blasts and determining the diagnosis.