title: Value-based flow testing of chronic lymphoproliferative disorders: a quality improvement project to develop an algorithm to streamline testing and reduce costs.
abstract: OBJECTIVE
  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.
authors.affiliation: From the Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles;
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Oberley
authors.affiliation: Department of Pathology, University of Texas Medical Branch, Galveston;
authors.forename: Sean
authors.initials: S
authors.lastname: Fitzgerald
authors.affiliation: From the Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles;
authors.forename: David T
authors.initials: DT
authors.lastname: Yang
authors.affiliation: Department of Pathology, St Mary's Hospital, Madison, WI;
authors.forename: Adam
authors.initials: A
authors.lastname: Morgan
authors.affiliation: Flow Cytometry Laboratory, University of Wisconsin Hospital and Clinics, Madison; and.
authors.forename: Joyce
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison. cpleith@wisc.edu.
authors.forename: Catherine
authors.initials: C
authors.lastname: Leith
mesh_terms: D000465:Algorithms; D003362:Cost-Benefit Analysis; D005434:Flow Cytometry / Q000191:economics*; D006801:Humans; D008232:Lymphoproliferative Disorders / Q000175:diagnosis* / Q000191:economics; D058996:Quality Improvement
keywords: Absolute lymphocyte count; Flow cytometry; Lymphoproliferative disorder; Quality improvement; Receiver operating characteristic curve