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Ss9

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    Ss9 Ss9 Presentation Transcript

    • CLINICAL PATHOLOGY UPDATE on SURAMADE ISurabaya, 15th Juliy 2011 YETTI HERNANINGSIH, dr., SpPK Clinical Pathology Department Dr. Soetomo Hospital Surabaya
    • (Gorczyca W, Emmons FM, 2008) 2
    • Flow cytometric immunophenotyping is important for the Distinction between ALL and AML, identification of B-cell or T-cell lineage Assessing response to treatment, including the detection of MRD Detection aberrant expression 3
    • SAMPLE STAINING 1.SURFACE ANTIGEN 2.INTRACELLULAR ANTIGEN (TdT, cCD3, cCD22, MPO) 3.DNA CONTENT 4
    • 5
    • 6(Gorczyca W, Emmons FM, 2008)
    • Immunophenotyping of AML(Campana & Behm,2000) 7
    • (Courtesy Sayed DM) 8
    • 9
    • Figure 6.22 Schematic illustration of antigen expression during normal T-cell and NK-cellmaturation. Note that, although the common lymphoid stem cell presumably arises in the bone marrow, most T-cell maturation occurs in the thymus. As with the B cells (Fig. 6.12), T-cell activation occurs after exposure to antigen.(Courtesy Dr. Dan Sabath.) 10 (Tkachuk DC, Hirschmann JV, 2007)
    • (Concise Manual of Hematology and Oncology, 2008) 11
    • (Concise Manual of Hematology and Oncology, 2008) 12
    • Biphenotypic Acute Leukemia If > 2 points is scored for both myeloid and one of the lymphoid lineages the case is classified as biphenotypic 13
    • Undifferentiated Acute Leukemias Rare subgroup of acute leukemias which cannot be further classified using the above mentioned criteria. Usually CD34+, HLA-DR+, CD38+, and CD7+. 14
    • ABERRANTImmature B cell Abberant : co express an antigen of different lineage e.g. CD 65 (myeloid antigen) expressed on an immature B cell (CD19+, CD34+, cyCD22+, cyCD79a+, TdT+) 15
    • How to store and send sample for Immunophenotyping • Bone marrow (BM) aspirate orSpecimen Whole blood (WB) with EDTA • No blood clot or hemolysisStorage and • At room temperature (never be Transport transported on dry ice) • 24 hours, send to lab as soon as Stability possible 16
    • How to store and send sample for ImmunophenotypingHemogram • Should be accompanied (if present)Schedule • Every working day Report • 1 working days issues 17
    • Panel of antibodies recommended by European Group for theImmunoloogical Characterization of aleukemia (EGIL) fordiagnosis and classificatin of acute leukemia (1995) (Courtesy Sayed DM) 18
    • Application of Immunophenotyping at Dr. Soetomo Hospital CD7 FITC/CD33 PE/CD45 PerCPHLA-DR FITC/CD13 PE/CD45 PerCP CD19 FITC/CD10 PE/CD45 PerCP CD3 FITC/CD34 PE/CD45 PerCP CD5 FITC/CD20 PE/CD45 PerCP 19
    • 20
    • 21
    • Positive expression : membran > 20% cytoplasmic >10% 22
    • Dr. SOETOMO HOSPITAL EXPERIENCES 23
    • Mrs.Sh, 44 y.o. 24
    • CD13, CD33, Anti-HLA-DR, CD34  POSITIVE Conclusion: Myeloid Lineage 25
    • Mrs.Sm, 30 y.o. 26
    • CD13, Anti-HLA-DR, CD33, CD10  POSITIVE CML Conclusion: Myeloid Lineage Aberrant Expression CD10 27
    • Mrs.Sl, 27 y.o. 28
    • CD33, CD13, Anti-HLA-DR, CD34, CD3, CD10, CD19  POSITIVE Conclusion:Suspected Biphenotypic (Myeloid + B-Lymphoid) Acute Leukemia with Aberrant expression CD3 29
    • Mrs.M, 60 y.o. 30
    • AML-M5bCD33, CD13, Anti-HLA-DR  POSITIVE Conclusion: Myeloid Lineage 31
    • Mr.Ms, 24 y.o. 32
    • Anti-HLA-DR, CD10, CD19, CD34, CD3, CD20  POSITIVE Conclusion:B-Lymphoid Lineage with Aberrant Expression CD3 CD13: 13.9% 33
    • Mr.My, 51 y.o. 34
    • CD33, CD7, CD13, Anti-HLA-DR, CD34  POSITIVE Conclusion: Myeloid Lineage with Aberrant Expression CD7 35
    • WBC : 10.00 (90.8% Lymphocyte)HGB : 7.2 23 y.o. Mr.Y,PLT : 7 36
    • Anti-HLA-DR, CD10, CD19, CD34, CD20  POSITIVE Conclusion: B-Lymphoid Lineage 37
    • Mr.I, 24 y.o. 38
    • CD33, CD13, Anti-HLA-DR, CD10, CD19, CD34  POSITIVE Conclusion:Suspected Biphenotypic (Myeloid + B-Lymphoid) Acute Leukemia 39
    • References Nguyen D, Diamond L.W, Braylan R.C. 2007. Flow Cytometry in Hematopathology. 2nd ed. Humara Press. New Jersey. Gorczyca W, Emmons F.N. 2008. Atlas of Differential Diagnostic in Neoplastic Hematopathology. 2nd ed. Genzyme Genetics. New York. Tkachuk D.C, Hirschmann J.V. 2007. Wintrobe Atlas of Clinical Hematology. 1st ed. Lippincott Williams & Wilkins. Berger DP, Engelhand m, Henβ H, Mertlesmann (eds.).2008. Concise Manual Hematology and Oncology. Springer. Heidelberg. 40
    • THANK YOU