Effective Test Utilization Recommendations

Do not perform peripheral blood flow cytometry to screen for hematological malignancy in the settings of mature neutrophilia, basophilia, erythrocytosis, thrombocytosis, isolated anemia, or isolated thrombocytopenia

Hematology
The role of peripheral blood flow cytometry for hematologic neoplasia is limited to settings in which either there are morphologically abnormal cells identified on a peripheral blood smear review (blasts, lymphoma cells) or there are clinical and/or laboratory findings that suggest a high pre-test probability for the presence of a disorder amenable to the immunophenotypic detection of neoplastic cells in the blood. The latter includes patients with neutropenia, absolute lymphocytosis, lymphadenopathy, or splenomegaly. The likelihood of flow cytometry of blood producing diagnostic results in the settings enumerated in the recommendation above is extremely low; bone marrow sampling with morphologic analysis (and appropriate ancillary diagnostic testing) may be indicated in those scenarios.

REFERENCES

  1. Davis BH, Holden JT, Bene MC, et al. 2006 Bethesda international consensus recommendations on the flow cytometric immunophenotypic analysis of hematolymphoid neoplasia: medical indications. Cytometry B Clin Cytom. 2007;72:S5-S13.
  2. Oberley MJ, Fitzgerald S, Yang, DT, et al. Value-based flow testing of chronic lymphoproliferative disorders. A quality improvement project to develop an algorithm to streamline testing and reduce costs. Am J Clin Pathol. Sept 2014;142:411-418.
  3. Healey R, Naugler C, de Koning L, et al. A classification tree approach for improving the utilization of flow cytometry testing of blood specimens for B-cell non-Hodgkin lymphoproliferative disorders. Leukemia and Lymphoma 2015; 56(9): 2619-2624.
  4. Andrews JM, Cruser DL, Myers JB, et al. Using peripheral smear review, age and absolute lymphocyte count as predictors of abnormal peripheral blood lymphocytosis diagnosed by flow cytometry. Leukemia and Lymphoma 2008; 49(9):1731-1737.
  5. Lim HY and Hong FS. Maximising yield of peripheral blood flow cytometry for chronic lymphoproliferative disorders. Int J Lab Hem 2018; 1-5.
  6. Paolo Strati P and Shanafelt TD. Monoclonal B-cell lymphocytosis and early-stage chronic lymphocytic leukemia: diagnosis, natural history, and risk stratification. Blood. 2015;126(4):454-462.
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