Review Article2022-05-01
Diagnostic Hematology

Myelodysplastic Syndromes with Bone Marrow Fibrosis: An Update

Akriti G. Jain , M.D., Ling Zhang , M.D., John M. Bennett , M.D., and Rami Komrokji , M.D.

Ann Lab Med 2022; 42(3): 299-305

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Abstract : Myelodysplastic syndrome (MDS) is a diverse hematological malignancy with a wide spectrum of presentations and implications. Treatment strategies for patients with MDS heavily rely on prognostic scoring systems, such as the revised international prognostic scoring system (IPSS-R). Bone marrow fibrosis (BMF) has been identified as an independent risk factor for poor survival in patients with MDS, irrespective of the IPSS-R risk category. However, BMF is not widely included in scoring systems and is not always considered by clinicians when making treatment decisions for patients. In this review, we discuss the available literature about the presentation and prognosis of patients with MDS and concurrent BMF. The prognostic impact of BMF should be factored in when deciding on transplant candidacy, especially for intermediate-risk patients.

Brief Communication2021-09-01
Diagnostic Hematology

Granulocytic and Monocytic Myeloid-Derived Suppressor Cells are Functionally and Prognostically Different in Patients with Chronic Myeloid Leukemia

Ari Ahn , M.D., Chan-Jeoung Park , M.D., Ph.D., Min-sun Kim , M.D., Young-Uk Cho , M.D., Ph.D., Seongsoo Jang , M.D., Ph.D., Mi Hyun Bae , M.D., Ph.D., Jung-Hee Lee , M.D., Ph.D., Je-Hwan Lee , M.D., Ph.D., Kyung-Nam Koh , M.D., Ph.D., and Ho Joon Im , M.D., Ph.D.

Ann Lab Med 2021; 41(5): 479-484

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Abstract : Myeloid-derived suppressor cells (MDSCs) represent phenotypically heterogeneous populations that suppress tumor-specific T-cell responses. MDSCs are produced from myeloid precursors in emergent states and are increased in several hematologic malignancies. We evaluated the differences in the levels and prognostic significance of MDSCs according to the clinical status of chronic myeloid leukemia (CML). The percentages and numbers of granulocytic (g)MDSCs and monocytic (m)MDSCs in peripheral blood (PB) and bone marrow (BM) aspirates were determined by five-color flow cytometry (HLA-DR/CD11b/CD15/CD33/CD14). The median BM-gMDSC% and PB-gMDSC% of the CML group were lower than those of the complete hematologic response (CHR) and control groups (P

Review Article2022-09-01
Diagnostic Hematology

Unreliable Automated Complete Blood Count Results: Causes, Recognition, and Resolution

Gene Gulati, Ph.D., Guldeep Uppal, M.D., and Jerald Gong, M.D.

Ann Lab Med 2022; 42(5): 515-530

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Abstract : Automated hematology analyzers generate accurate complete blood counts (CBC) results on nearly all specimens. However, every laboratory encounters, at times, some specimens that yield no or inaccurate result(s) for one or more CBC parameters even when the analyzer is functioning properly and the manufacturer’s instructions are followed to the letter. Inaccurate results, which may adversely affect patient care, are clinically unreliable and require the attention of laboratory professionals. Laboratory professionals must recognize unreliable results, determine the possible cause(s), and be acquainted with the ways to obtain reliable results on such specimens. We present a concise overview of the known causes of unreliable automated CBC results, ways to recognize them, and means commonly utilized to obtain reliable results. Some examples of unreliable automated CBC results are also illustrated. Pertinent analyzer-specific information can be found in the manufacturers’ operating manuals.

Letter to the Editor2021-09-01
Diagnostic Hematology

Bone Marrow Findings in Patients With Ewing Sarcoma/Primitive Neuroectodermal Tumor

Kuenyoul Park , M.D., Hyeri Kim , M.D., Ph.D., Kyung-Nam Koh , M.D., Ph.D., Ho Joon Im , M.D., Ph.D., Young-Uk Cho , M.D., Ph.D., Seongsoo Jang , M.D., Ph.D., Eul-Ju Seo , M.D., Ph.D., Chan-Jeoung Park , M.D., Ph.D.

Ann Lab Med 2021; 41(5): 499-501

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Letter to the Editor2021-03-01
Diagnostic Hematology

A Case of IgG4-related Disease With Bone Marrow Involvement: Bone Marrow Findings and Flow Cytometric Immunophenotyping of Plasma Cells

Han Joo Kim , M.D., Eunkyoung You , M.D., Seokchan Hong , M.D., Chan-Jeoung Park , M.D.

Ann Lab Med 2021; 41(2): 243-246

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Letter to the Editor2022-03-01
Diagnostic Hematology

Concomitant Diagnosis of Primary Bone Marrow B-Cell Non-Hodgkin Lymphoma and Essential Thrombocythemia: A Case Report

Hongkyung Kim , M.D., Hye Min Kim , M.D., Jin Ju Kim , M.D., Saeam Shin , M.D., Doh Yu Hwang , M.D., Seung-Tae Lee , M.D., and Jong Rak Choi , M.D.

Ann Lab Med 2022; 42(2): 282-285

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Letter to the Editor2021-11-01
Diagnostic Hematology

A Case of Burkitt-Like Lymphoma With 11q Aberration With HIV Infection in East Asia and Literature Review

Jee Ah Kim , M.D., Hyun-Young Kim , M.D., Seok Jin Kim , M.D., Hee-Jin Kim , M.D., and Sun-Hee Kim , M.D.

Ann Lab Med 2021; 41(6): 593-597

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Letter to the Editor2022-03-01
Diagnostic Hematology

Clinical Performance of Monocyte Distribution Width for Early Detection of Sepsis in Emergency Department Patients: A Prospective Study

Shinae Yu , M.D., Sae Am Song , M.D., Ph.D., Kyung Ran Jun , M.D., Ph.D., Ha Young Park , M.D., and Jeong Nyeo Lee , M.D., Ph.D.

Ann Lab Med 2022; 42(2): 286-289

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Original Article2022-07-01
Diagnostic Hematology

Digital Morphology Analyzer Sysmex DI-60 vs. Manual Counting for White Blood Cell Differentials in Leukopenic Samples: A Comparative Assessment of Risk and Turnaround Time

Minjeong Nam , M.D., Ph.D., Sumi Yoon , M.D., Mina Hur , M.D., Ph.D., Gun Hyuk Lee , M.D., Hanah Kim , M.D., Ph.D., Mikyoung Park , M.D., Ph.D., and Hyeong Nyeon Kim , M.D.

Ann Lab Med 2022; 42(4): 398-405

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Abstract : Background: Digital morphology (DM) analyzers are increasingly being used for white blood cell (WBC) differentials. We assessed the laboratory efficiency of the Sysmex DI-60 system (DI-60; Sysmex, Kobe, Japan) in comparison with manual counting in leukopenic samples. Methods: In total, 40 peripheral blood smear samples were divided into normal, mild leukopenia, moderate leukopenia, and severe leukopenia groups based on WBC count. In each group, the risk and turnaround time (TAT) were compared between DI-60 and manual counting. Risk was determined by failure mode and effect analysis using the risk priority number (RPN) score, and TAT was recorded for the analytical phase. Results: Overall, DI-60 showed a five-fold lower risk (70 vs. 350 RPN) and longer TAT than manual counting. In severe leukopenic samples, DI-60 showed a shorter TAT/slide and a remarkably lower cell count/slide than manual counting. In all samples, the TAT/cell for DI-60 was substantially longer than that for manual counting (DI-60 vs. manual: total, 1.8 vs. 1.0 sec; normal, 1.5 vs. 0.7 sec; mild leukopenia, 1.9 vs. 0.9 sec; moderate leukopenia, 1.8 vs. 1.0 sec; severe leukopenia, 28.8 vs. 19.0 sec). Conclusions: This is the first comparative assessment of risk and TAT between DI-60 and manual counting in leukopenic samples. DI-60 decreases the laboratory risk and improves patient safety, but requires more time to count fewer cells, especially in severe leukopenic samples. DM analyzers should be applied selectively depending on the WBC count to optimize laboratory efficiency.

Brief Communication2022-09-01
Diagnostic Hematology

Clinical and Genomic Profiles of Korean Patients with MECOM Rearrangement and the t(3;21)(q26.2;q22.1) Translocation

Jikyo Lee , M.D., Sung Min Kim , B.S., Soonok Kim , M.T., Jiwon Yun , M.D., Dajeong Jeong , M.D., Young Eun Lee , M.D., Eun-Youn Roh , M.D., Ph.D., and Dong Soon Lee , M.D., Ph.D.

Ann Lab Med 2022; 42(5): 590-596

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Abstract : The translocation (3;21)(q26.2;q22.1) is a unique cytogenetic aberration that characterizes acute myeloid leukemia with myelodysplasia-related changes (AML-MRC) in patients with AML and myelodysplastic syndrome (MDS) or a therapy-related myeloid neoplasm. Using multigene target sequencing and FISH, we investigated the clinical and genomic profiles of patients with t(3;21) over the past 10 years. The frequency of t(3;21) among myeloid malignancies was very low (0.2%). Half of the patients had a history of cancer treatment and the remaining patients had de novo MDS. Twenty-one somatic variants were detected in patients with t(3;21), including in CBL, GATA2, and SF3B1. Recurrent variants in RUNX1 (c.1184A>C, p.Glu395Ala) at the same site were detected in two patients. None of the patients with t(3;21) harbored germline predisposition mutations for myeloid neoplasms. MECOM rearrangement was detected at a higher rate using FISH than using G-banding, suggesting that FISH is preferable for monitoring. Although survival of patients with t(3;21) is reportedly poor, the survival of patients with t(3;21) in this study was not poor when compared with that of other AML patients in Korea.