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Development of an algorithm for the identification of leukemic hematolymphoid neoplasms in Primary Care patients

Authors
  • Quirós, Covadonga1, 1
  • Fonseca, Ariana1, 1
  • Alonso-Álvarez, Sara1, 1
  • Moro-García, Marco Antonio1
  • Alonso-Arias, Rebeca1, 1
  • Morais, Lucía-Rita1, 1
  • Álvarez-Menendez, Francisco V.1, 1
  • Colado, Enrique1, 1, 1
  • 1 Hospital Universitario Central de Asturias, Spain , (Spain)
Type
Published Article
Journal
Diagnosis
Publisher
De Gruyter
Publication Date
Apr 09, 2020
Volume
8
Issue
2
Pages
239–247
Identifiers
DOI: 10.1515/dx-2020-0021
Source
De Gruyter
Keywords
License
Yellow

Abstract

BackgroundDiagnosis of hematolymphoid neoplasm (HLN) requires different technologies which are performed on a patient basis instead of per protocol. We hypothesize that integration of hematimetric and cytological analysis along with multiparametric flow cytometry (MFC) provides a framework to evaluate peripheral blood (PB) samples from Primary Care.MethodsSamples from patients with persistent (>3 months) lymphocytosis (>5 × 109/L) and/or monocytosis (>109/L) or the presence of atypical and/or blast cells upon the smear review were analyzed by MFC concurrent to cytological analysis. MFC studies were carried out following standardized procedures.ResultsIn a 3-year period, smear review and MFC were performed simultaneously in 350 samples, demonstrating HLN in 194 cases (55.4%). In 156 cases, reactive cell populations were found. The combination of age, absolute lymphocyte count (ALC), hemoglobin and platelets provided the best correlation with MFC for the presence of a chronic lymphoproliferative disorder (CLPD) in lymphocytosis [area under the curve (AUC) 0.891, p < 0.05]. A model evaluating the probability of CLPD has been proposed and validated in an independent cohort.ConclusionsA strategy to perform MFC studies following standardized procedures has proven to be useful to evaluate samples from patients in Primary Care centers for HLN diagnosis or reactive conditions, providing a sensitive and rapid clinical orientation and avoiding unnecessary consultations in routine clinical practice. The probability for the presence of CLPD in PB can be calculated and help guide decision-making regarding further testing.

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