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Evaluation of laboratory investigative methods of diagnosing clonal hematological disorders in a resource-poor
H C Okoye1, C C Efobi2, K Korubo3
1Department of Hematology and Immunology, College of Medicine, University of Nigeria, Ituku/Ozalla Campus, Enugu, Nigeria.
Insights
Accurate diagnosis of clonal hematological disorders (CHDs) requires specific tests, but many patients lack complete testing. This highlights the need for improved laboratory services, especially in public hospitals, to ensure reliable diagnoses.
Area of Science:
- Hematology
- Laboratory Medicine
- Diagnostic Accuracy
Background:
- Accurate diagnosis of clonal hematological disorders (CHDs) is critical for successful patient treatment.
- Diagnosis relies heavily on performing specific diagnostic tests (SRTs).
- Resource-limited settings face challenges in providing comprehensive laboratory investigations.
Purpose of the Study:
- To assess laboratory investigative methods for diagnosing CHDs in a resource-limited center.
- To evaluate the availability and utilization of specific required tests (SRTs) for CHD diagnosis.
- To identify gaps in diagnostic testing for CHDs.
Main Methods:
- Descriptive, hospital-based retrospective study.
- Data retrieved from 129 adult CHD case notes (1995-2015).
- Analysis of conducted SRTs compared to those required for diagnosis.
Main Results:
- Only 45.3% of the 671 required SRTs were performed.
- SRTs performed in-house were more likely to be completed than those referred externally.
- Aplastic anemia (100%) and paroxysmal nocturnal hemoglobinuria (100%) had all SRTs done, while non-Hodgkin's lymphoma had the least (15.3%).
- Full blood count (FBC) was most frequent (100%), immunophenotyping (IMPT) least frequent (8.3%).
Conclusions:
- A significant proportion of CHD diagnoses were made without complete SRTs, potentially affecting accuracy.
- There is a critical need for more comprehensive laboratory services.
- Improving laboratory services is especially important in government-owned hospitals.
Background:
The successful treatment of patients with clonal hematological disorders (CHDs) depends largely on making an accurate diagnosis, which is, in turn, is dependent on performing specific diagnostic tests that are necessary.
Objectives:
This study assessed the laboratory investigative methods of diagnosing CHDs with regard to the specific required tests (SRTs) that were needed to make a final diagnosis in a center with limited resources.
Methods:
This is a descriptive hospital-based retrospective study. For the study, data about laboratory investigation details of adults diagnosed with CHDs from 1995 to 2015 were retrieved. The SRTs were determined and data analyzed using SPSS version 20.
Results:
A total of 129 case notes of adults in the age range of 18-80 years, diagnosed with CHDs, were used. Out of the 671 SRTs needed for diagnosis, only 304 (45.3%) were conducted. When an SRT was requested to be done within the treatment facility, the patients were significantly more likely to do it in comparison with when they were requested to get it done from an external referral laboratory. All the patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) had all (100%) their SRTs done while patients with non-Hodgkin's lymphoma (NHL) had the least (15.3%) of their SRTs done. Full blood count (FBC) was the most frequently used (n = 129; 100%) SRT for diagnosis while immunophenotyping (IMPT) was the least (n = 4; 8.3%) used SRT.
Conclusion:
Most of our patients had CHD diagnosis without the complete SRT, and this may cast doubt on the accuracy of diagnosis. Therefore, there is a crucial need for availability of more comprehensive laboratory services, especially in government-owned hospitals.
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