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Immunohistochemical enumeration of plasma cells: manual or digital?
  1. Jacques AJ Malherbe1,2,
  2. Kathy A Fuller1,
  3. Wendy N Erber1,3
  1. 1 Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia, Australia
  2. 2 Haematology Department, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
  3. 3 Haematology, PathWest Laboratory Medicine, Nedlands, Western Australia, Australia
  1. Correspondence to Professor Wendy N Erber, Pathology and Laboratory Medicine (M504), University of Western Australia, Crawley, WA 6009, Australia; wendy.erber{at}

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Plasma cell enumeration in bone marrow samples is a critical component in the assessment and diagnosis of plasma cell dyscrasias, including multiple myeloma. This can be performed by morphological assessment or flow cytometric analysis of aspirated bone marrow. However, due to the patchy nature of the disease, the bone marrow trephine biopsy gives a better assessment of the overall plasma cell burden. Because of the challenges in cytological identification of plasma cells in H&E-stained sections, this is often aided by immunohistochemistry. CD138, or syndecan-1, is most commonly used for this purpose because of its high specificity for plasma cells. There are several publications detailing methods for quantifying CD138-immunostained plasma cells using both manual and digital enumeration approaches, with the recent paper by Gantana et al in this Journal adding to the field.1–6

In their paper, Gantana et al describe an ‘innovative new method’ that used light microscopy to manually examine and quantify CD138-positive plasma cells in paraffin-embedded bone marrow biopsies.1 They initially performed manual assessments at low (×10) magnification to estimate the plasma cell percentage. From this, they selected three areas (with low, moderate and high plasma cell densities) …

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  • Handling editor Vikram Deshpande.

  • Contributors All authors contributed to the writing and revising of this letter to the editor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.