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JMD 2005, Vol. 7, No. 3
Copyright © 2005 American Society for Investigative Pathology & Association for Molecular Pathology

Consultations in Molecular Diagnostics

Bone Marrow Engraftment Analysis after Granulocyte Transfusion

Sharon L. Swierczynski*, Michael J. Hafez*, Juliet Philips*, Meghan A. Higman{dagger}, Karin D. Berg{ddagger} and Kathleen M. Murphy*

From the Departments of Pathology * and Pediatric Oncology, {dagger} The Johns Hopkins Medical Institutions, Baltimore, Maryland; and the Laboratory Corporation of America, {ddagger} Research Triangle Park, North Carolina

Abstract

We present the case of a 6-year-old male who received an allogeneic bone marrow transplant as part of treatment for acute lymphoblastic leukemia. The patient relapsed 5 months after transplantation and received additional chemotherapy. He acquired an angioinvasive fungal infection that required transfusion of granulocytes. Approximately 5 weeks after relapsing (181 days after transplant), a bone marrow specimen was taken for molecular engraftment analysis and flow cytometry to assess graft loss as well as residual disease. The engraftment results generated by the multiple short tandem repeat loci tested were inconsistent, and alleles were present at several loci that were of neither patient nor donor origin. An error in specimen identification was initially considered. Further investigation into the circumstances surrounding procurement of the patient’s bone marrow aspirate revealed that the patient had received a granulocyte transfusion approximately 10 hours before the bone marrow specimen was taken. In addition, morphological and flow cytometric analyses of the same bone marrow aspirate demonstrated a significant degree of peripheral blood contamination. We determined that the unknown alleles in the bone marrow engraftment specimen were derived from the donor of the transfused granulocytes. This case illustrates that white cell transfusion can lead to erroneous bone marrow engraftment results, particularly if only one microsatellite locus is used to monitor engraftment.




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