BCR-ABL Testing by Polymerase Chain Reaction in Patients With Neutrophilia: The William Beaumont Hospital Experience and the Case for Rational Laboratory Test Requests.
Chronic myeloid leukemia (CML) is a myeloproliferative neoplasm resulting from the fusion of the BCR-ABL genes, forming the Philadelphia chromosome. The diagnosis is often suspected when there is leukocytosis with left shift and basophilia. Confirmation of the diagnosis requires a demonstration of BCR-ABL by polymerase chain reaction. Using data from the William Beaumont laboratory data registry, we conducted a retrospective review of all the orders for BCR-ABL tests sent to the clinical pathology laboratory between March 11, 2014 and September 12, 2014. We concluded that the presence of concurrent neutrophilia and basophilia has a sensitivity of 100% (95% CI, 69.15% to 100%) and specificity of 100% (95% CI, 93.15% to 100%) in the initial diagnosis of CML. Our results suggest that the presence of both neutrophilia and basophilia should be used as a threshold for the placement of orders for BCR-ABL in the initial diagnosis of CML in patients with leukocytosis with left shift and provide a basis for a reduction in health care spending. Restricting BCR-ABL tests to this population would save approximately $198 million annually in national health care spending.
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Foluso
F
Ogunleye
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Mohammed
M
Ibrahim
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Emily
E
Allen
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Neil
N
Brennan
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
James
J
Huang
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Zhou
Z
Yu
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Marianne
M
Huben
William Beaumont Hospital, Oakland University William Beaumont School of Medicine, Royal Oak, MI.
Ishmael
I
Jaiyesimi
D001491:Basophils / Q000276:immunology; D016044:Fusion Proteins, bcr-abl / Q000235:genetics*; D006403:Hematologic Tests; D006801:Humans; D007755:Laboratories, Hospital; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000175:diagnosis* / Q000235:genetics; D009504:Neutrophils / Q000276:immunology*; D016133:Polymerase Chain Reaction
D016044:Fusion Proteins, bcr-abl