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Bone marrow engraftment analysis after granulocyte transfusion.
Sharon L Swierczynski1, Michael J Hafez, Juliet Philips
1Department of Pathology, Johns Hopkins Medical Institutions, Park Building, Room SB202, 600 North Wolfe St., Baltimore, MD 21287, USA.
The Journal of Molecular Diagnostics : JMD
|July 29, 2005
Summary
White cell transfusions can interfere with bone marrow engraftment testing, leading to inaccurate results. This case highlights the importance of considering recent transfusions when interpreting molecular engraftment analysis after allogeneic stem cell transplantation.
Area of Science:
- Hematology
- Transplantation immunology
- Molecular diagnostics
Background:
- Allogeneic bone marrow transplantation is a curative treatment for acute lymphoblastic leukemia.
- Monitoring engraftment is crucial for assessing transplant success and detecting graft failure or relapse.
- Molecular methods, such as short tandem repeat (STR) analysis, are commonly used to assess chimerism and engraftment.
Observation:
- A pediatric patient undergoing bone marrow transplant for acute lymphoblastic leukemia experienced relapse and received a granulocyte transfusion.
- Bone marrow aspirate collected for engraftment analysis shortly after transfusion showed inconsistent STR results with unexpected alleles.
- Morphological and flow cytometric analyses revealed peripheral blood contamination in the bone marrow specimen.
Findings:
- The unexpected alleles in the engraftment analysis were identified as originating from the donor of the transfused granulocytes.
- Peripheral blood contamination and the presence of donor-derived cells from transfusion masked true engraftment status.
- This artifactual finding led to potential misinterpretation of graft loss or residual disease.
Implications:
- White cell transfusions, particularly granulocyte transfusions, can cause false-positive results in molecular engraftment monitoring.
- Careful consideration of recent transfusions is essential when interpreting bone marrow engraftment data.
- Using multiple microsatellite loci and correlating with flow cytometry can improve the accuracy of engraftment assessment and mitigate transfusion-related artifacts.