Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
Int J Lab Hematol. 2013 Feb;35(1):77-81. doi: 10.1111/ijlh.12001. Epub 2012 Sep 3.
With proper logistical support and sponsorship, a laboratory in an industrialized nation might be able to act as a reference laboratory for clinicians based in a developing country.
We built on previous experience in the clinical laboratory to see whether a specialized histopathology service (hematopathology) could be provided to a developing country without the expertise or experience to do it in country.
Over an 13-year period, 582 cases from 579 individuals were analyzed. Principal pathologic findings included acute leukemia in 84 cases (14%), dyspoiesis in one or more of the hematopoietic lineages in 65 cases (11%, including three cases with high-grade myelodysplasia), 23 cases (4%) with findings suspicious for a chronic myeloproliferative disorder, 35 cases (6%) with findings suspicious for a lymphoproliferative disorder, and infectious organisms (presumably Leishmania in most instances) in 9 (1%) of cases. Specimens from 45 cases (8%) were unsatisfactory owing to extreme hemodilution and/or specimen degeneration.
With proper support, a medical laboratory in an industrialized nation may serve as a reference facility for a developing nation. The use of existing infrastructure may be remarkably effective to achieve optimal turnaround time. Although the lack of ancillary studies and follow-up biopsies limit the ability to achieve a definitive diagnosis in many cases, this must be viewed in the context of the limited ability to diagnose or manage hematopoietic neoplasia in developing nations.
在适当的后勤支持和赞助下，工业化国家的实验室可能能够充当发展中国家临床医生的参考实验室。
我们借鉴了临床实验室的先前经验，以了解在没有专业知识或经验的情况下，能否在发展中国家提供专门的组织病理学服务（血液病理学）。
在 13 年的时间里，分析了来自 579 个人的 582 个病例。主要的病理发现包括 84 例（14%）急性白血病、65 例（11%，包括 3 例高级别骨髓增生异常）一种或多种造血谱系的发育不良、23 例（4%）疑似慢性骨髓增生性疾病、35 例（6%）疑似淋巴增生性疾病，以及 9 例（1%）疑似感染性生物体（大多数情况下推测为利什曼原虫）。由于极度血液稀释和/或标本退化，45 例（8%）标本不满意。
在适当的支持下，工业化国家的医学实验室可以作为发展中国家的参考设施。利用现有基础设施可能非常有效，可以实现最佳周转时间。尽管缺乏辅助研究和随访活检限制了许多情况下做出明确诊断的能力，但必须考虑到发展中国家诊断或管理造血肿瘤的能力有限。
