Light Scatter	CD45/14	CD5/20

CD11c/22	DR/CD21	CD25/103

CD34/10	CD19/Kappa	CD19/Lambda

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Explaination and interpretation of Flow cytometry results
Explaination of other results seen ( hematology,etc) and facts about this patient's disease

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WBC Differential
Blood – characteristics/hematology
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• The bone marrow light scatter demonstrates at least three distinct populations of cells. The small cells are erythroid precursors by glycophorin A positivity (data not shown). The majority of cells in the bone marrow are of normal lymphocyte size and are normal lymphoid components of the bone marrow and are not remarkable (data not shown). The larger population of cells make up approximately 13% of the total nuleated cells (including erythroid precursors) and is the gate of the presented contour plots. These cells match the characteristics of the large cells seen in the peripheral smear (large and with low granularity). (see light scatter)(see peripheral smear).

 
• The CD45/14 contour plot reveals that the majority of cells within the set light scatter gates are high intensity CD45 positive (a characteristic of lymphocytes. There are no monocytes/promonocytes present (see CD45/14).

 
• The CD5/20 contour plot reveals that all of the cells express CD20 (B cell) and not CD5 (Tcell). Therefore, virtually all of the cells within this gate are B cells (see CD5/20).

 
• The CD11c/22 contour plot reveals that the cells are dual positive for CD11c (CR4 receptor found on Monocytes, NK, activated T/B cells, and Hairy cell leukemia) and CD22 (BL-CAM found on B cells, B-ALL, B-CLL, B-PLL, and Hairy cell leukemia).  Together with the CD5/20 results, the results confirms the B cell nature of the cells and limits the choice to activated B or Hairy cell leukemia (HCL) (see CD11c/22).

 
• The DR/CD21 contour plot confirms strenghtens the case for HCL.  HCL is CD21 negative and DR positive. Activated B would be expected to be positive for both markers which it is not (see DR/CD21).

 
• The CD25/103 contour plot confirms the HCL nature of the cells.  CD103 (integrin aE) is found on HCL, Adult T cell leukemia, and intestinal lymphocytes.  CD25 is the interleukin 2 receptor and most HCLs express this antigen (see CD25/103).

 
• The CD34/10 plot demonstrates no reactivity to CD34 which is the expected result for HCL.  Some of the cells express low intensity CD10 which has been reported in HCL (see CD34/10).

 
• Finally the clonal nature of the cell is demonstrated by the CD19/kappa and CD19/lambda contour plots where all of the cells are CD19/Kappa positive and Lamda negative. (see CD19/Kappa, CD19/lambda).

 
• All of these results when taken together make the diagnosis of HCL. The panel of antibodies choosen was based on the clinical presentation and the hematology results of the abnormal cells in which Hairy cell leukemia was suspected.