Cell Count Differentials by Cytomorphology and Next-Generation Flow Cytometry in Bone Marrow Aspirate: An Evidence-Based Approach

Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro-Majadahonda, Hematology Department, Hospital Universitario Puerta de Hierro, 28222 Majadahonda, Spain Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA), 18014 Granada, Spain Registro de Cáncer de Granada, Escuela Andaluza de Salud Pública (EASP), 18080 Granada, Spain Department of Preventive Medicine and Public Health, University of Granada, 18016 Granada, Spain Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre, 28041 Madrid, Spain Immunology Department, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
Despite a lack of evidence, a bone marrow aspirate differential of 500 cells is commonly used in the clinical setting. We aimed to test the performance of 200-cell counts for daily hematological workup. In total, 660 consecutive samples were analyzed recording differentials at 200 and 500 cells. Additionally, immunophenotype results and preanalytical issues were also evaluated. Clinical and statistical differences between both cutoffs and both methods were checked. An independent control group of 122 patients was included. All comparisons between both cutoffs and both methods for all relevant types of cells did not show statistically significant differences. No significant diagnostic discrepancies were demonstrated in the contingency table analysis. This is a real-life study, and some limitations may be pointed out, such as a different sample sizes according to the type of cell in the immunophenotype analysis, the lack of standardization of some preanalytical events, and the relatively small sample size of the control group. The comparisons of differentials by morphology on 200 and 500 cells, as well as by morphology (both cutoffs) and by immunophenotype, are equivalent from the clinical and statistical point of view. The preanalytical issues play a critical role in the assessment of bone marrow aspirate samples.
Fundación para la Investigación Biomédica del Hospital Universitario Puerta de Hierro-Majadahonda
Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP)
Instituto de Investigación Biosanitaria de Granada (Ibs.GRANADA)
Registro de Cáncer de Granada, Escuela Andaluza de Salud Pública (EASP)
Department of Preventive Medicine and Public Health, University of Granada
Hematology Department, Hospital Universitario 12 de Octubre, Instituto de Investigación del Hospital Universitario 12 de Octubre
Immunology Department, Hospital Universitario Virgen de las Nieves
Fac. de Medicina
TRUE
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