ABSTRACT
BACKGROUND: Atypical lymphocytosis is a common peripheral blood abnormality seen not only in Epstein-Barr virus (EBV)-associated acute infectious mononucleosis but also in other conditions, including other viral infections, cancer, immune reactions, etc. Despite numerous reports of individual immunophenotypic alterations in EBV-positive infectious mononucleosis, a detailed comparative analysis of the immunophenotypic changes of peripheral blood lymphocyte subsets in infectious mononucleosis and other forms of atypical lymphocytosis is lacking. METHODS: Multiparametric flow immunocytometry with 26 monoclonal antibodies was performed on peripheral blood lymphocytes from 97 cases of atypical lymphocytosis and 37 normal controls. Atypical lymphocytosis was defined as absolute lymphocytosis with >10% atypical lymphocytes. Absolute or relative mean values of various lymphocyte subsets from EBV-positive cases, EBV-negative cases, and normal controls were compared with the Student's t-test. RESULTS: Highly significant abnormalities detected in atypical lymphocytosis include increases in CD3+/CD8+, CD3-/CD16/56+, CD3+/gammadelta+, CD8+/CD48-, CD8+/CD57-, CD8+/CD95+, CD4+/CCR5+ CD4+/CD7-, CD4+/CD43-, CD4+/CD48-, and CD4+/CD62L- subsets. In contrast, no change in absolute CD4+ T cell and CD19+ B cell counts is seen. When compared with EBV-negative cases, EBV-positive cases are characterized by younger age, and increased numbers of absolute lymphocytes, atypical lymphocytes, CD8+ cells, NK cells, gammadelta T cells, CD8+/CD45RO+ cells, CD8+/CD57- cells, and CD8+/CD28+ cells. CONCLUSIONS: All forms of atypical lymphocytosis are characterized by a marked increase in activated CD8-positive T cells, a moderate increase in NK cells, and no increase in CD4-positive T cells and B cells. Although morphologically indistinguishable, EBV-associated mononucleosis is characterized by several significant differences in peripheral blood lymphocyte subsets when compared with EBV-negative atypical lymphocytosis, most notably increased numbers of CD57-negative CD8 T cells and gammadelta T cells.
Subject(s)
Immunophenotyping , Infectious Mononucleosis/immunology , Lymphocyte Subsets/immunology , Lymphocytosis/immunology , Animals , Antigens, CD/immunology , B-Lymphocytes/immunology , B-Lymphocytes/virology , CD4-Positive T-Lymphocytes/immunology , CD4-Positive T-Lymphocytes/virology , CD8-Positive T-Lymphocytes/immunology , CD8-Positive T-Lymphocytes/virology , Flow Cytometry , Herpesvirus 4, Human/immunology , Humans , Infectious Mononucleosis/virology , Killer Cells, Natural/immunology , Killer Cells, Natural/virology , Lymphocyte Activation , Lymphocyte Count , Lymphocyte Subsets/virology , Lymphocytosis/virologyABSTRACT
BACKGROUND: Understanding the normal surface maturation pattern of granulocytes is essential for the recognition of abnormal patterns, which in turn may be of diagnostic or pathogenetic significance in disorders such as myelodysplastic syndromes and inherited bone marrow failure disorders. CD87 plays a role in cellular interaction, cell migration, and inflammatory response. Surface expression of this antigen has not been adequately studied on bone marrow granulocytes, and the small number of previous studies has provided conflicting data. METHODS: Bone marrow aspirates from 11 control subjects were studied by flow cytometry and a lysed whole blood technique to compare surface expression of CD87 on marrow granulocytes with those of CD11b, CD16, CD35, and CD10, which are expressed at the myelocyte, metamyelocyte, band, and segmented stage of neutrophilic development, respectively. Four sorting experiments of CD87(+) granulocytes were also performed. RESULTS: Our study showed no statistical difference between surface expression of CD35 and CD87 (P > 0.3), whereas significant differences existed between CD87 and the other antibodies (P < 0.004). Sorting experiments showed that more than 80% of CD87(+) cells were bands and segmented neutrophils. Dual staining for CD87 and CD35 showed that most CD87(+) granulocytes coexpress CD35. CONCLUSIONS: CD87 is expressed on granulocytes at the band and segmented neutrophil stage of development and can be used to study normal and abnormal granulopoiesis.
Subject(s)
Biomarkers , Flow Cytometry , Granulocytes/cytology , Granulocytes/metabolism , Hematopoiesis/immunology , Receptors, Cell Surface/metabolism , Adolescent , Adult , Bone Marrow Cells/cytology , Bone Marrow Cells/metabolism , Cell Differentiation/immunology , Cell Separation , Child , Child, Preschool , Female , Humans , Immunophenotyping , Infant , Male , Middle Aged , Receptors, Urokinase Plasminogen ActivatorABSTRACT
Myelodysplastic syndromes (MDS) are associated with cell maturation defects that can manifest as abnormal surface antigen expression. We describe a patient with refractory anemia with excess blasts, who presented with infection and extensive dysplastic features in peripheral blood granulocytes. The granulocytes expressed CD11b, CD13, CD15, CD33, and CD43. The granulocytes also expressed CD4 antigen. Cytogenetic analysis showed a clonal t(5;12)(q33;p13). The patient improved on antibiotics with partial improvement in the dysplastic features. However, shortly after, the patient experienced paravertebral extramedullary blast transformation followed by a leukemia phase of acute monoblastic leukemia. The patient died a few days later. This is the first report describing anomalous expression of CD4 on granulocytes in MDS. Since the breakpoint on chromosome 12 is near the CD4 gene, which is mapped to 12p12, we hypothesize that dysregulation of the CD4 gene may have occurred resulting in its persistent expression on mature and maturing granulocytes.
