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Am J Clin Pathol. 2014 Sep;142(3):411-8. doi: 10.1309/AJCP0SWZJ6GBDHPF.

Value-based flow testing of chronic lymphoproliferative disorders: a quality improvement project to develop an algorithm to streamline testing and reduce costs.

Author information

  • 1From the Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles;
  • 2Department of Pathology, University of Texas Medical Branch, Galveston;
  • 3Department of Pathology, St Mary's Hospital, Madison, WI;
  • 4Flow Cytometry Laboratory, University of Wisconsin Hospital and Clinics, Madison; and.
  • 5Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison. cpleith@wisc.edu.

Abstract

OBJECTIVES:

Flow cytometry is essential for the evaluation of lymphoproliferative disorders (LPDs) and their classification. Flow panels routinely incorporate a large array of antibodies, making testing complex and expensive; such panels are likely unnecessary in benign cases or those with straightforward diagnoses. Our aim was to develop a more cost-effective testing strategy based on a retrospective analysis of flow studies for possible LPDs in blood.

METHODS:

We identified LPD frequencies and types, as well as associated results with patient age and absolute lymphocyte count.

RESULTS:

We found that the likelihood of LPDs increased with patient age and absolute lymphocyte count and that CD5-positive LPD was the most common LPD diagnosed in our institution (71% of LPDs). Using these data, we devised flow-testing algorithms with a screening test for patients at low risk of disease and a focus on CD5-positive LPD detection, with reflexing as needed.

CONCLUSIONS:

We project this approach will result in a 40% decrease in antibody utilization.

Copyright© by the American Society for Clinical Pathology.

KEYWORDS:

Absolute lymphocyte count; Flow cytometry; Lymphoproliferative disorder; Quality improvement; Receiver operating characteristic curve

[PubMed - indexed for MEDLINE]
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