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Value-based flow testing of chronic lymphoproliferative disorders: a quality improvement project to develop an
Matthew J Oberley1, Sean Fitzgerald2, David T Yang1
1From the Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles;
Insights
Developing a cost-effective flow cytometry strategy for lymphoproliferative disorders (LPDs) can reduce antibody use. This approach uses patient data to screen for LPDs, focusing on common CD5-positive types.
Area of Science:
- Hematology
- Immunology
- Clinical Pathology
Background:
- Flow cytometry is crucial for diagnosing lymphoproliferative disorders (LPDs).
- Current flow cytometry panels are often extensive, increasing complexity and cost.
- Many LPD diagnoses are straightforward, potentially not requiring comprehensive panels.
Purpose of the Study:
- To develop a cost-effective flow cytometry strategy for LPDs in blood.
- To optimize LPD testing by analyzing retrospective flow study data.
- To reduce unnecessary antibody utilization in LPD diagnostics.
Main Methods:
- Retrospective analysis of flow cytometry studies for suspected LPDs.
- Identification of LPD frequencies, types, and correlations with patient age and absolute lymphocyte count.
- Development of flow-testing algorithms including screening and reflex testing.
Main Results:
- LPD likelihood increases with patient age and absolute lymphocyte count.
- CD5-positive LPDs are the most common type, accounting for 71% of cases.
- A new algorithm was devised, incorporating screening for low-risk patients and targeted CD5-positive LPD detection.
Conclusions:
- The proposed flow cytometry strategy is projected to decrease antibody utilization by 40%.
- This approach offers a more economical method for LPD evaluation.
- Optimized flow cytometry protocols can improve diagnostic efficiency and reduce healthcare costs.
Objectives:
Flow cytometry is essential for the evaluation of lymphoproliferative disorders (LPDs) and their classification. Flow panels routinely incorporate a large array of antibodies, making testing complex and expensive; such panels are likely unnecessary in benign cases or those with straightforward diagnoses. Our aim was to develop a more cost-effective testing strategy based on a retrospective analysis of flow studies for possible LPDs in blood.
Methods:
We identified LPD frequencies and types, as well as associated results with patient age and absolute lymphocyte count.
Results:
We found that the likelihood of LPDs increased with patient age and absolute lymphocyte count and that CD5-positive LPD was the most common LPD diagnosed in our institution (71% of LPDs). Using these data, we devised flow-testing algorithms with a screening test for patients at low risk of disease and a focus on CD5-positive LPD detection, with reflexing as needed.
Conclusions:
We project this approach will result in a 40% decrease in antibody utilization.
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