Korean J Clin Pathol.  1997 Apr;17(2):230-237.

G-Score and the Percentage of Pseudo-Pelgeroid Polymorphoneutrophils in Myelodysplastic Syndrome

• Kim SG

Abstract

BACKGROUND: Myelodysplastic syndrome (MDS) is characterized by signs of maturation disturbances in the both of peripheral blood (PB) and bone marrow (BM). Every hematologist who cares for patients with MDS will occasionally encounter difficulties in establishing the diagnosis, particularly in refractory anemia. Dysplastic features of cells in peripheral blood and bone marrow were studied to evaluate the significance of the degree of neutrophil hypogranulation (G-score) and the percentage of pseudo-pelgeroid polymorphs (PPP) in PB smear.
METHODS
Cytoplasmic hypogranulation and nuclear abnormalites of the pelgeroid type of neutrophils were studied retrospectively on air dried peripheral blood and bone marrow smears stained with Wright reagent, and assayed according to Hast's method. In every cases, 100 neutrophils were analyzed as follows: the degree of hypogranulation was graded in arbiturary unit with the range 0 to 3. Neutrophils containing a single or bilobated nucleus with dense compact chromatin were counted as the pelgeroid type. Common morphological features of MDS were observed on bone marrow smears. A numetric level between 0 and 2 was assyed for two dysplastic features of the three hemoatopoiesis lineages. The score for total degree of bone marrow dysplasia (DysT) ranged between 0 and 12.
RESULTS
There was a good correlation between PB and BM findings, of both C-score (r=0.5503, p<0.01) and PPP (r=0.8701, p<0.001). Patients with a high degree of bone marrow dysplasia had significantly higher PPP (r=0.5853, p<0.005) than those with less pronounced myelodysplasia. Patients with refractory anemia with excess blast (RAEB)/refractory anemia with excess blast in transformation (RAEB-T)/chronic myelomonocytic leukemia (CMML) had higher PPP, but lower G-score than those with refractory anemia (RA)/refractory anemia with ringed sideroblasts (RARS).
CONCLUSIONS
The above results show that quantitative estimation of peripheral blood polymorph dysplasia by G-score and PPP seems to reflect the total degree of bone marrow dysplasia in MDS and may serve as a helpful method to bone marrow evaluation when the diagnosis is difficult.

MeSH Terms

Anemia
Anemia, Refractory
Bone Marrow
Chromatin
Cytoplasm
Diagnosis
Humans
Leukemia
Myelodysplastic Syndromes*
Neutrophils
Retrospective Studies
Chromatin