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(Created page with " ---- '''Appearance:''' Neutrophils forming aggregates on a blood smear (most frequently seen on the edges) and monocytes may be seen within these aggregates. Less commonly aggregates may be comprised of lymphocytes.. ---- '''Images of agglutination:''' <gallery mode="nolines" widths="300px" heights="300px" > File:Agg.jpg|leftt|link= File:Agg2.jpg|leftt|link= File:Agg3.jpg|leftt|link= </gallery> ''An EDTA-dependent phenomenon seen in neutrophils (image 1) and oc...")
 
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'''Appearance:'''  
<span style="color: navy>'''Background to flow cytometric diagnosis'''</span>


Neutrophils forming aggregates on a blood smear (most frequently seen on the edges) and monocytes may be seen within these aggregates. Less commonly aggregates may be comprised of lymphocytes..
Differentiation to plasma cells involves (in mast cases) the loss of typical pan B-cell markers and surface light chains. The expression of CD45 also differs both within and between cases making standard gating strategies difficult to apply. Cells are most often identified through their co-expression of CD138 with a relatively high expression of CD38, together with the absence of typical B-cell features.




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'''Images of agglutination:'''


<gallery mode="nolines" widths="300px" heights="300px" >
<div style="width: 95%; overflow: auto; border: 1px solid navy; font-size:100%">
File:Agg.jpg|leftt|link=
{| class="wikitable" style="color:black; background-color:#ffffff;" cellpadding="5"
File:Agg2.jpg|leftt|link=
!colspan="4" style = "font-size:110%; color: navy; text-align:center; background:#DEE0DE;"|'''Immunophenotype of plasma cells'''
File:Agg3.jpg|leftt|link=
|-
</gallery>
!colspan="4" style = "font-size:90%; background:#DAE8F2"|'''CD45''' expression
 
|-
''An EDTA-dependent phenomenon seen in neutrophils (image 1) and occasionally in lymphocytes (image 2); aggregation most frequently affects platelets (image 3).''
|colspan="4" style = "font-size:90%; color:black;" |There is no consistent pattern of expression of CD45 although it is most often weak, but may be variable and is occasionally strong.
 
|-
 
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Major markers useful in plasma cell identification
----
|-
|colspan="1" style = "font-size:80%; width: 4%; |'''Marker'''
|colspan="1" style = "font-size:80%; width: 8%; |'''Freq'''
|colspan="1" style = "font-size:80%; width: 8%; |'''Level'''
|colspan="1" style = "font-size:80%; width: 80%; |'''Comment'''
|-
|colspan="1" style = "font-size:90%; color:black;" |CD38
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|The relatively strong expression of CD38 is typical of plasma cells
|-
|colspan="1" style = "font-size:90%;" |CD138
|colspan="1" style = "background:#004466;"|
|colspan="1" style = "font-size:80%;"|var
|colspan="1" style = "font-size:84%;"|Expression is expected although the intensity can vary
|-
|colspan="1" style = "width: 4%; font-size:90%; color:black;" |κ/λ
|colspan="1" style = "width: 8%; background:#E6FAFF;"|
|colspan="1" style = "font-size:80%; width: 8%; |
|colspan="1" style = "font-size:80%;"|Surface light chain expression is lost (internal will be detected in permeabilised cells)
|-
|colspan="1" style = "font-size:90%; color:black;" |CD19
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression of CD19 may persist in some cases
|-
!colspan="4" style = "font-size:90%; background:#DAE8F2"|Other relevant markers
|-
|colspan="1" style = "font-size:90%; color:black;" |CD5
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:80%;"|Not detected on plasma cells
|-
|colspan="1" style = "font-size:90%;" |CD10
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%;" |CD11C
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%;" |CD20
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expression retained in some cases
|-
|colspan="1" style = "font-size:90%; color:black;" |CD23
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%; color:black;" |CD25
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%;" |CD43
|colspan="1" style = "background:#006699;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Generally not expressed by LPL
|-
|colspan="1" style = "font-size:90%; color:black;" |CD79b
|colspan="1" style = "background:#66e0ff;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Expressed in some cases
|-
|colspan="1" style = "font-size:90%;" |CD103
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|
|-
|colspan="1" style = "font-size:90%; color:black;" |CD200
|colspan="1" style = "background:#006699;"|
|colspan="1" style = "font-size:80%;"|-
|colspan="1" style = "font-size:84%;"|Detected frequently|-|}
|-
|colspan="1" style = "font-size:90%; color:black;" |FMC7
|colspan="1" style = "background:#E6FAFF;"|
|colspan="1" style = "font-size:80%;"|
|colspan="1" style = "font-size:80%;"|Not expressed
|-
|}
</div>


'''Cause:'''


This occurs mainly in EDTA samples, if in doubt a smear can be made using a finger-prick sample or other anticoagulant.


<span style="color:navy;font-size:80% ">'''Key to table: '''</span>


'''Consider:'''
<span style="font-size:80% ">Key to colour code for expression frequency [[Key_to_marker_expression_table|Click for link]]</span>


A rare phenomenon that occurs i''n vitro'' and has little clinical significance, although may cause falsely low counts on automated counters
<span style="font-size:80% ">Key to expression strength code and use [[Expression strength key|Click for link]]</span>






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Latest revision as of 18:09, 14 July 2023

  • PC.jpg


Background to flow cytometric diagnosis

Differentiation to plasma cells involves (in mast cases) the loss of typical pan B-cell markers and surface light chains. The expression of CD45 also differs both within and between cases making standard gating strategies difficult to apply. Cells are most often identified through their co-expression of CD138 with a relatively high expression of CD38, together with the absence of typical B-cell features.


Immunophenotype of plasma cells
CD45 expression
There is no consistent pattern of expression of CD45 although it is most often weak, but may be variable and is occasionally strong.
Major markers useful in plasma cell identification
Marker Freq Level Comment
CD38 - The relatively strong expression of CD38 is typical of plasma cells
CD138 var Expression is expected although the intensity can vary
κ/λ Surface light chain expression is lost (internal will be detected in permeabilised cells)
CD19 - Expression of CD19 may persist in some cases
Other relevant markers
CD5 - Not detected on plasma cells
CD10 -
CD11C -
CD20 - Expression retained in some cases
CD23 -
CD25 -
CD43 - Generally not expressed by LPL
CD79b - Expressed in some cases
CD103 -
CD200 - Detected frequently|-|}
FMC7 Not expressed


Key to table:

Key to colour code for expression frequency Click for link

Key to expression strength code and use Click for link


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