Background: Aplastic anemia (AA), paroxysmal nocturnal hemoglobinuria (PNH), and myelodysplastic syndrome (MDS) are the common spectrums of acquired bone marrow failure syndromes (BMFs). Accurate and timely diagnosis is a significant clinical challenge because of the overlapping features. The pathogenesis is not fully understood, but several studies have suggested that defective monocyte functions play an important role. We aimed to find whether the different expressions of CD52, CD14 and HLA-DR on CD4+ monocytes would be helpful in the preliminary diagnosis of acquired BMFs.
Methods: This study included 45 patients (21 AA patients, 13 MDS patients, 11 PNH patients). The control group was composed of 33 healthy adults. Flow cytometry was performed to determine the fluorochrome conjugated antibodies, including CD52, CD14 and HLA-DR.
Results: In this study, we found the expression of CD52 on CD4+ monocytes in AA patients was significant lower than MDS [15.90% (2.39 - 25.70) vs. 60.63% (26.0 - 94.98), p < 0.001] and healthy controls [15.90% (2.39 - 25.70) vs. 67.19% (25.5 - 88.4)%, p < 0.001], and a little higher than PNH patients [15.90% (2.39 - 25.70) vs. 4.55% (3.1 - 6.0), p < 0.05]. While comparing the levels of HLA-DR on CD4+ monocytes, AA patients were lower than PNH [40.05% (17.2 - 73.3) vs. 83.14% (80.7 - 94.3), p < 0.001] and MDS patients [40.05% (17.2 - 73.3) vs. 82.37% (69.1 - 91.2), p < 0.001].
Conclusions: According to our knowledge, this is a new clinical diagnostic method that uses surface markers for CD4+ monocytes such as CD52, CD14, and HLA-DR to make differential diagnoses within AA, PNH, and MDS patients in clinical practice. In addition, CD52 in patients shows that CD52 represents the most valuable molecular marker for differential diagnosis of three types of acquired BMFs.