Diagnostic utility of flow cytometry in resource-constrained settings- a single center experience

Abstract

Abstract Background:Flow cytometry (FC) is an expensive investigation that is unaffordable for many patients from underprivileged nations. We aimed to reduce the total budget of the test by optimizing a limited antibody panel as guided by morphological assessment. Materials and methods:This single-center, experimentalstudy included 247 patients referred for Flow cytometry at Rehman Medical Institute, Peshawar.There were 162 male (65.4 %) and 85 female patients (34.6%) with a mean age of 38.78±21.55 years. Bone marrow or peripheral blood samples were used for immunophenotyping. After the morphological assessment, a limited panel of flow markers was selected. All samples were stained with fluorochromes labeled monoclonal antibodies, acquired, and analyzed with a flow cytometer (Cytoflex, Beckman-Coulter, USA). Data were statistically analyzed through SPSS-22, and descriptive statistics were applied for all variables. All results were presented in form of graphs, tables, and charts Results:Out of 247 cases, an Acute leukemia panel was requested for 128 cases, a lymphoproliferative panel for 56 cases, T-cell subset analysis for 53 cases, and PNH clone screening for 10 cases. Newly diagnosed cases were 221 while 26 cases were known labeled cases of Acute leukemia for Minimal Residual Disease (MRD) analysis. Among the cases for MRD analysis, 10 cases were in remission, 12 cases relapsed and 04 cases were not in the remission phase. 98% of cases referred for Acute leukemia and Lymphoproliferative disorders, and 100% of cases referred for proximal nocturnal Hemoglobinuria (PNH) and T-cell subset analysis was conclusively diagnosed by our limited flow cytometry panels with low-cost effect. Conclusions:In resource-constrained settings, optimization of a limited antibody panel is extremely facilitating to provide a Flow cytometry-based diagnosis which further guides the treatment decision.