An evidence-based ordering algorithm for appropriate utilization of peripheral blood flow cytometry for hematologic...

Area of Science:

• Hematology
• Oncology
• Clinical Pathology

Background:

• Peripheral blood flow cytometry (PBFC) is a valuable tool for diagnosing hematolymphoid malignancies.
• However, PBFC is frequently ordered in clinically inappropriate situations, leading to underutilization and reduced diagnostic yield.

Purpose of the Study:

• To develop and validate a clinical algorithm to optimize the utilization of PBFC.
• To improve the diagnostic performance of PBFC by guiding appropriate test ordering.

Main Methods:

• A retrospective review of 250 consecutive PBFC orders was conducted.
• Clinical data, including patient history, blood counts, and leukocyte differentials, were analyzed to identify predictors of malignancy.
• An algorithm was designed based on these predictors and validated on an independent set of 250 cases.

Main Results:

• PBFC yielded positive results infrequently across most indications.
• Circulating blasts, a history of hematolymphoid malignancy, lymphocytosis, or pancytopenia in patients aged 50 and older were highly predictive of positive results.
• The developed algorithm significantly reduced PBFC utilization and increased the proportion of positive cases, with similar findings in the validation set.

Conclusions:

• An evidence-based algorithm incorporating five key clinical factors can substantially improve PBFC test ordering.
• This algorithm effectively reduces unnecessary testing and enhances the diagnostic yield of PBFC for hematolymphoid malignancies.