Paroxysmal nocturnal hemoglobinuria other diagnostic studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Other Diagnostic Studies
Flow Cytometry
Modern methods include flow cytometry for CD55, CD16, CD59 and other GPI anchored proteins on white andred blood cells. [1] Laboratories favor flow cytometry to evaluate PNH due to its high sensitivity and specificity. Flow cytometry of the peripheral blood, not the bone marrow aspirate, is required to evaluate the presence or absence of GPI linked proteins. The bone marrow biopsy in PNH shows erythroid hyperplasia. In addition, because of the short life of granulocytes, the peripheral blood samples need to reach the lab in an expedited manner. The most commonly used antibodies are CD59 (expressed on all hematocellular lineages), and CD55 but other GPI anchored antigens (CD14, CD16, CD24) can also be studied on leukocytes. Dependent on the predominance of these molecules on the red blood cell surface, they are classified as type I, II or III PNH cells.
PNH type II & III cell populations; definitions. Some patients may have erythrocytes with low but detectable GPI anchored proteins; these cells are designated PNH type II. By contrast, cells that are completely devoid of GPI anchored proteins are referred to as PNH type III. Patients with large populations of PNH type II erythrocytes may have less hemolysis than those with comparable populations of PNH III cells but these patients are still at risk for both hemolysis and thrombosis.