title: Use of a United States-based laboratory as a hematopathology reference center for a developing country: logistics and results.
abstract: BACKGROUND
  With proper logistical support and sponsorship, a laboratory in an industrialized nation might be able to act as a reference laboratory for clinicians based in a developing country.
  
  
  METHODS
  We built on previous experience in the clinical laboratory to see whether a specialized histopathology service (hematopathology) could be provided to a developing country without the expertise or experience to do it in country.
  
  
  RESULTS
  Over an 13-year period, 582 cases from 579 individuals were analyzed. Principal pathologic findings included acute leukemia in 84 cases (14%), dyspoiesis in one or more of the hematopoietic lineages in 65 cases (11%, including three cases with high-grade myelodysplasia), 23 cases (4%) with findings suspicious for a chronic myeloproliferative disorder, 35 cases (6%) with findings suspicious for a lymphoproliferative disorder, and infectious organisms (presumably Leishmania in most instances) in 9 (1%) of cases. Specimens from 45 cases (8%) were unsatisfactory owing to extreme hemodilution and/or specimen degeneration.
  
  
  CONCLUSIONS
  With proper support, a medical laboratory in an industrialized nation may serve as a reference facility for a developing nation. The use of existing infrastructure may be remarkably effective to achieve optimal turnaround time. Although the lack of ancillary studies and follow-up biopsies limit the ability to achieve a definitive diagnosis in many cases, this must be viewed in the context of the limited ability to diagnose or manage hematopoietic neoplasia in developing nations.
authors.affiliation: Department of Pathology and Immunology, Washington University School of Medicine, St Louis, MO, USA.
authors.forename: C O
authors.initials: CO
authors.lastname: Deetz
authors.forename: M G
authors.initials: MG
authors.lastname: Scott
authors.forename: J H
authors.initials: JH
authors.lastname: Ladenson
authors.forename: M
authors.initials: M
authors.lastname: Seyoum
authors.forename: A
authors.initials: A
authors.lastname: Hassan
authors.forename: F H
authors.initials: FH
authors.lastname: Kreisel
authors.forename: T T
authors.initials: TT
authors.lastname: Nguyen
authors.forename: J L
authors.initials: JL
authors.lastname: Frater
mesh_terms: D000401:Aircraft; D001853:Bone Marrow / Q000473:pathology; D001856:Bone Marrow Examination / Q000191:economics / Q000592:standards; D019049:Developed Countries; D003906:Developing Countries; D019017:Eritrea; D017048:Health Care Costs; D019337:Hematologic Neoplasms / Q000097:blood / Q000175:diagnosis* / Q000473:pathology; D006403:Hematologic Tests / Q000191:economics / Q000592:standards; D006405:Hematology / Q000191:economics / Q000379:methods / Q000458:organization & administration; D006801:Humans; D055552:Infectious Disease Medicine / Q000191:economics / Q000379:methods / Q000458:organization & administration; D007390:International Agencies; D007391:International Cooperation; D007896:Leishmaniasis / Q000097:blood / Q000175:diagnosis* / Q000469:parasitology / Q000473:pathology; D008495:Medical Oncology / Q000191:economics / Q000379:methods / Q000458:organization & administration; D010338:Pathology, Clinical / Q000191:economics / Q000379:methods / Q000458:organization & administration; D013048:Specimen Handling; D013685:Telecommunications; D013997:Time Factors; D014481:United States; D014837:Voluntary Health Agencies