To Explore The Characteristics Of Bone Marrow Smear,bone Marrow Biopsy And Immunophenotype Of The Blasts In Patients With Myelodysplastic Syndrome And Their Value In The Diagnosis

Objective1. Using bone marrow smear,to count the percentage of the blasts and observe the dysplasiaof granulocytic line, erythrocytic line and megakaryocytic line of patients withmyelodysplastic syndrome (MDS).2. By using bone marrow biopsy, to observe the localization of immature precursor, thedysplasia of megakaryocytic line and the characteristics of special staining(Gomoristaining and Iron staining ) of patients with MDS.3. Similarities and differences of the characteristics between bone marrow smear and bonemarrow biopsy of patients with MDS were analysed for exploring their diagnostic value.4. To analyse the characteristics of immunophenotype of the blasts in patients withrefractory anemia with excess blasts,type 1(RAEB-1)and refractory anemia with excessblasts, type 2 (RAEB-2) by flow cytometry (FCM) and investigate its diagnosticsignificance. The rate of the blasts which was detected by FCM and bone marrowsmear(BMS) was also compared.Methods1.The morphological characteristics of bone marrow smear and bone marrow biopsy of 64patients with MDS were observed and compared.2.FCM was used to count the percentage of the blasts and detect the expression of itsantigens in 29 cases with MDS.Results1.Using bone marrow smear, the dysplasia of granulocytic line, erythrocytic line andmegakaryocytic line were found in 57 cases (89.1%) , 40 cases (62.5%) and 23cases( 35.9%),respectively.2.The percentage of primitive cells was less than 5% in 29 cases,5%-9% in 18 cases and10%-19% in 17 cases.3.By biopsy,abnormal localization of immature precursor was found in 55 cases(85.9%)and the dysplasia of megakaryocytic line in 39 cases(60.9%).4.Gomori-positive staining in 23 cases (35.9%), including 13 cases of myelofibrosis(20.3%),and iron-positive staining in 39 cases (60.9%). 5.The rate of the blasts which was detected by FCM and BMS was not statisticallysignificant between patients with RAEB-1 and those with RAEB-2 (P>0.05).6.Of 13 cases with RAEB-1,the blasts of 10 cases,12 cases,8 cases,11 cases, 11 cases, 3cases,7 cases,0 case,0 case,3 cases and 2 cases patients had positive expressions ofCD34,HLA-DR,CD117,CD33,CD13,CD15,CD11b,CD3, CD19,CD7 and CD56,separately. There were 12 cases,13 cases,3 cases,12 cases,15 cases,7 cases,5 cases,0case , 1 case , 4 cases and 2 cases patients with RAEB-2 who were positive forCD34 , HLA-DR , CD117, CD33 , CD13 , CD15 , CD11b , CD3 , CD19 , CD7 andCD56 , respectively.However,there was no significant difference in the expression ofantigens of the blasts in the bone marrow between the patients with RAEB-1 andthose with RAEB-2(p>0.05).7.The blasts were positive for CD15(10 cases)and CD11b(12 cases).8.The blasts were positive for CD19(1 case),CD7(7 cases) andCD56(4 cases). None of the29 cases of MDS was positive for CD3.Conclusion1. Bone marrow smear can count exactly the percentage of the blasts and observe carefullythe dysplasia of granulocytic line, erythrocytic line and megakaryocytic line of patientswith MDS.2. Bone marrow biopsy can observe abnormal localization of immature precursor ,thedysplasia of megakaryocytic line and the change of the interstitial,such as the bonemarrow fibrosis and the abnormalities of iron metabolism.3. Combined bone marrow smear and bone marrow biopsy can fully reflect morphologicalchanges of bone marrow in patients with MDS and improve the accuracy of diagnosis.4.Flow cytometry can reveal the characteristics of immunophenotypic abnormalities of theblasts in patients with MDS and provide important information for MDS diagnosis anddifferential diagnosis.