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The presence of F cells with a fetal phenotype in adults with hemoglobinopathies limits the utility of flow cytometry for quantitation of fetomaternal hemorrhage
Author(s) -
Othman Jad,
Orellana Daniel,
Chen Lin Selina,
Russell Megan,
Khoo TehLiane
Publication year - 2018
Publication title -
cytometry part b: clinical cytometry
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.646
H-Index - 61
eISSN - 1552-4957
pISSN - 1552-4949
DOI - 10.1002/cyto.b.21598
Subject(s) - flow cytometry , cytometry , population , cord blood , fetus , fetal hemoglobin , medicine , immunology , andrology , cell , umbilical cord , pathology , microbiology and biotechnology , biology , pregnancy , biochemistry , genetics , environmental health
Background Detection and quantitation of fetomaternal hemorrhage (FMH) can be difficult in patients with pre‐existing elevations of HbF, such as those with hemoglobinopathies. The aim of this study was to evaluate the utility of dual‐color flow cytometry with the Fetal Cell Count Kit (FCCK) in differentiating adult and fetal HbF in this population, as compared to flow cytometry (FC) using HbF alone. Methods Peripheral blood was obtained from normal adults and patients with hemoglobinopathies (β‐thalassemia and sickle cell disease), including a small number of pregnant females. Cord blood was used to spike some samples with 5% fetal cells. Analysis by single color (HbF) and dual‐color (HbF and carbonic anhydrase) FC was performed on these samples. Fetal cells were defined as those with high HbF fluorescence on single‐color FC, and those that were HbF + CA− using the FCCK. The quantity of fetal cells detected by each technique was compared. Results Forty‐six adult patients were included. In non‐pregnant adults with hemoglobinopathies, a population of red cells with a fetal cell phenotype were detected by both techniques. The dual‐color method reported lower quantities of these cells. In nineteen samples spiked with cord blood the FCCK consistently underestimated the quantity of fetal cells. Conclusions Patients with β‐thalassemia and sickle cell disease have a population of HbF‐containing cells which are phenotypically similar to fetal cells. Even with dual‐color flow cytometry (FCCK), the detection and quantification of FMH by flow cytometry in this population remains difficult. © 2017 International Clinical Cytometry Society