Clinical Biochemistry Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Laboratory Medicine Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Diagnosis (Berl). 2020 Apr 9;8(2):239-247. doi: 10.1515/dx-2020-0021. Print 2021 May 26.
Diagnosis 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.
Samples from patients with persistent (>3 months) lymphocytosis (>5 × 10/L) and/or monocytosis (>10/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.
In 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.
A 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.
血液淋巴肿瘤（HLN）的诊断需要不同的技术，这些技术是针对患者个体进行的，而不是按照方案进行的。我们假设血液学和细胞学分析与多参数流式细胞术（MFC）的结合为评估初级保健患者的外周血（PB）样本提供了一个框架。
对持续（>3 个月）淋巴细胞增多症（>5×10/L）和/或单核细胞增多症（>10/L）患者或涂片检查中出现异型和/或原始细胞的患者的样本进行 MFC 分析，同时进行细胞学分析。MFC 研究按照标准化程序进行。
在 3 年期间，对 350 个样本同时进行了涂片检查和 MFC，在 194 个病例中（55.4%）发现了 HLN。在 156 例中，发现了反应性细胞群。年龄、绝对淋巴细胞计数（ALC）、血红蛋白和血小板的组合与 MFC 对淋巴细胞增多症中慢性淋巴增殖性疾病（CLPD）的存在相关性最好（曲线下面积（AUC）为 0.891，p<0.05）。提出并验证了一个用于评估 PB 中 CLPD 概率的模型。
遵循标准化程序进行 MFC 研究的策略已被证明对评估初级保健中心患者的 HLN 诊断或反应性疾病样本有用，为临床提供了敏感和快速的指导，并避免了常规临床实践中不必要的咨询。可以计算 PB 中 CLPD 存在的概率，并有助于指导进一步检测的决策。
