Optimizing limited antibody panels for efficient hematological disorders diagnosis by flow cytometry in...

Flow cytometry (FC) is an expensive method 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, guided by morphological assessment.

This retrospective observational study included 395 patients referred for flow cytometry at the Rehman Medical Institute in Peshawar. Bone marrow or peripheral blood samples were immunophenotyped using a limited panel of flow markers after morphological and cytochemical assessments. The samples were stained with fluorochrome-labeled monoclonal antibodies and analyzed using a Cytoflex flow cytometer. Data were analyzed using R and R studio by calculating frequency and percentage for descriptive statistics while results are presented in graphs, tables, and charts.

Out of 395 cases, an acute leukemia panel was requested for 225 (56.9%) cases, a lymphoproliferative panel for 80 (20.3%) cases, an absolute CD4 count for 80 (20.3%) cases, and proximal nocturnal hemoglobinuria (PNH) clone screening for 10 (2.5%) cases. Of the 225 acute leukemia cases, 160 (71.1%) were newly diagnosed and 65 (28.9%) were follow-up cases. In the follow-up cases, 21 (32.3%) were in remission, 13 (19.3%) were not in remission, and 31 (48.4%) were in relapse. 98% of cases of acute leukemia and lymphoproliferative disorders and 100% of cases of PNH and absolute CD4 count were conclusively diagnosed using our limited flow panels. Our panel achieved 74-82% average cost reductions and 61-68% reductions in turnaround time (TAT) compared with established reference laboratories in Pakistan.

Optimizing a minimal antibody panel in resource-limited settings enhances flow cytometry-based diagnosis, reduces patient financial burden, enables timely and accurate results, and guides treatment decisions to improve patient outcomes.