Acute leukemia detection rate by automated blood count parameters and peripheral smear review

Abstract

Introduction: It is unclear what minimal criteria will identify all new cases of acute leukemia in adults in various settings.

Methods: To determine the adult acute leukemia detection rate of the various criteria, we recorded complete blood count (CBC) test results from consecutive patients with leukemia (130 hospitalized patients and 96 outpatients) and from consecutive patients without leukemia (34,827 hospitalized and 33,695 outpatients).

Results: Basic criteria for a reflex review (hemoglobin, platelets, and a five-part differential) detected 91% of new hospital leukemia patients (118 of 130) compared to 75% (72 of 96) outpatients. No cases were missed if we did reflex testing when there was either one of the basic criteria or an increased proportion of large unstained cells (LUC), but five cases were missed using the blast flag instead of the LUC. Adding the LUC to basic criteria resulted in the detection of all cases of acute leukemia. The cost of detection of one case of acute leukemia was 1029 and 425 peripheral smear reviews in hospital and outpatients, respectively.

Conclusion: We conclude that basic criteria available on most hematology analyzers along with the LUC identify all adult patients with acute leukemia in both hospital and outpatient settings with minimal peripheral smear review rates.

Keywords: ADVIA; Leukemia; adults; automated hematology analyzer; criteria; peripheral blood smear review; reflex.