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Updated: Aug 6, 2026
Database-guided Flow-cytometry for Evaluation of Bone Marrow Myeloid Cell Maturation
Published on: November 3, 2018
Immunophenotypic analysis of hematogones (B-lymphocyte precursors) in 662 consecutive bone marrow specimens by
R W McKenna1, L T Washington, D B Aquino
1Dept. of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390-9072, USA. mckenna@utsouthwestern.edu
Insights
Bone marrow hematogones (B-lymphocyte precursors) are often mistaken for cancerous lymphoblasts. This study quantifies hematogones, identifies factors influencing their numbers, and confirms flow cytometry reliably distinguishes them from neoplastic cells.
Area of Science:
- Hematology
- Immunophenotyping
- Flow Cytometry
Background:
- Bone marrow hematogones, or B-lymphocyte precursors, share morphological and immunophenotypic similarities with neoplastic lymphoblasts, complicating diagnostic accuracy.
- Distinguishing between normal hematogones and malignant lymphoblasts is critical for accurate diagnosis and treatment of hematologic malignancies.
Purpose of the Study:
- To prospectively quantify bone marrow hematogones across different age groups and clinical conditions.
- To identify factors influencing the relative quantity of hematogones.
- To compare the immunophenotype of hematogones with that of neoplastic lymphoblasts.
Main Methods:
- Prospective analysis of 662 bone marrow specimens using multiparametric flow cytometry with 4-color antibody combinations.
- Quantification of hematogones and assessment of their antigen expression.
- Comparison of immunophenotypes between hematogones and lymphoblasts from precursor B-acute lymphoblastic leukemia (B-ALL) cases.
Main Results:
- Hematogones were identified in 79.8% of specimens, with a significant decline observed with increasing age (P <.001).
- Higher hematogone percentages were associated with density gradient processing (P <.001) and lower marrow involvement by neoplastic cells.
- Increased hematogones were noted in lymphoma, marrow regenerative states, immune cytopenias, and AIDS; lymphoblasts in B-ALL showed maturation arrest and aberrant antigen expression.
Conclusions:
- Four-color flow cytometry with optimized antibody panels reliably distinguishes normal hematogones from neoplastic lymphoblasts.
- Understanding hematogone quantification and immunophenotypic profiles aids in accurate differential diagnosis in hematologic disorders.
- Age and processing methods influence hematogone levels, while their immunophenotype consistently reflects normal B-cell precursor development.
Abstract:
Bone marrow hematogones (B-lymphocyte precursors) may cause problems in diagnosis because of their morphologic and immunophenotypic similarities to neoplastic lymphoblasts. The purposes of this prospective, multiparametric flow cytometry study were to quantify hematogones across age groups and a spectrum of clinical conditions, to identify factors that affect the relative quantity of hematogones, and to compare their immunophenotype with that of neoplastic lymphoblasts. A total of 662 consecutive marrow specimens were analyzed for hematogones using one of two 4-color antibody combinations; hematogones were identified in 528 (79.8%). There was a significant decline in hematogones with increasing age (P <.001), but a broad range was found at all ages and many adults had a relatively high number. Specimens processed by density gradient had a higher mean percent hematogones than those processed by erythrocyte lysis (P <.001). There was a direct decline in hematogones with increasing marrow involvement with neoplastic cells. A total of 8% of the 662 specimens contained 5% or more hematogones: 24.6% of specimens from patients aged less than 16 years and 6.3% from those 16 and older (P <.000 01). Increased hematogones were observed most often in patients with lymphoma, marrow regenerative states, immune cytopenias, and acquired immunodeficiency syndrome. Hematogones always exhibited a typical complex spectrum of antigen expression that defines the normal antigenic evolution of B-cell precursors and lacked aberrant expression. In contrast, lymphoblasts in 49 cases of precursor B-ALL showed maturation arrest and exhibited 1 to 11 immunophenotypic aberrancies. Four-color flow cytometry with optimal combinations of antibodies consistently distinguishes between hematogones and neoplastic lymphoblasts.
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