Lymphocyte phenotyping of infants with congenital heart disease: comparison of cell preparation techniques

The diagnostic evaluation of infants with suspected DiGeorge syndrome includes peripheral blood lymphocyte phenotype analysis by flow cytometry. Mononuclear cells are typically concentrated from infants' blood samples by Ficoll-Hypaque (FH) density gradient centrifugation prior to monoclonal antibody (Mab) staining. Having observed that lymphocyte percentages in samples prepared by this technique were low more often than anticipated based on the prevalence of the suspected diagnosis, we undertook a prospective study of 55 infants with congenital heart disease comparing FH with a whole-blood (WB) technique. Sixty healthy adult controls were similarly studied. We report the observation that FH-prepared mononuclear cells from blood samples of infants less than 4 months of age yield substantially different phenotypes than WB-prepared samples. The differences are related to red blood cell (RBC) contamination. No such difference was seen with adult samples. Unlike FH-prepared adult samples, contaminating RBCs are indistinguishable from lymphocytes through at least 4 months of age when assessed by the standard cytometric gating parameters of forward and 90° light scatter. The use of a WB ammonium chloride lysis technique is recommended as most appropriate for the preparation of infants' blood samples.