Abstract
Background: Bone marrow examination is an essential diagnostic tool in acute leukemia for the
determination of lineage of blasts by flow cytometry or immunophenotyping. In cases
of dry tap or where facilities of flow cytometry is not available, immunohistochemistry
(IHC) on trephine biopsy sections can be used as a supportive tool to diagnose and
classify acute leukemia. Materials and Methods: The giemsa-stained peripheral smears and bone marrow aspirate/imprints smears were
retrospectively evaluated. IHC was done on trephine biopsy sections using a panel
of antibodies which included CD34, MPO, CD117, Tdt, CD3, CD20, PAX5, and CD10 Results: Of the 29 cases diagnosed by IHC on trephine sections, 25 cases could be accurately
classified based on the expression of myeloid and lymphoid markers. Majority of the
acute lymphoblastic leukemia (ALL) were of B-cell lineage (81.25%), and almost half
of the B-ALL were common acute lymphoblastic leukemia-associated antigen positive.
Conclusion: IHC on trephine biopsy facilitates the confirmation and subtyping of leukemia in
more than 85% cases. A limited panel of antibodies using CD34, MPO, TdT, CD3 CD20,
PAX 5, and CD10 can be used for subtyping of leukemias in trephine biopsy sections,
especially in centers with limited resources. It obviates the need for a repeat bone
marrow procedure where material is not available for flow cytometry.
Keywords
Acute leukemia - immunohistochemistry - trephine biopsy
