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Correlation of cyto-morphology with flow cytometric immunophenotyping in acute leukemia's: A comparative study

Ali Ahmed Al-Zaazaai*, Saleh Abu Hadi, Ahmed Kaid Salem, Akram Yahia Al-hag, Nouraldin Aljaber, WAssem Al-Kadasy, Amin Abdulrab

Background: Immunophenotypic characterization of Acute Leukemia's (AL) is an important clinical application of Flow Cytometry (FCA) and has become a powerful tool contributing to the diagnosis and classification of acute leukemia's. Objective: To compare the morphological and cyto-chemical diagnosis of peripheral blood and bone marrow sample with flow cytometric immunophenotypic diagnosis in acute leukemia's. Patients and methods: This study was a cross-sectional prospective study taken from July 2016 to June 2019, at Al- Thawra Teaching Hospital Sana’a. All patients subjected to bone marrow aspiration and peripheral blood smear stained by Leishman's stain. The immunophenotyping flow cytometry with a panel of Monoclonal Antibodies specific to acute leukaemias was used. The cyto- morphological diagnosis was based on French-American-British criteria classification. Results: A total of 200 new cases diagnosed as acute leukemia's, were included of them 118 were males and 82 were females. Based on the morphology, of these 200 cases, 134(67%) were classified as Acute Myeloid Leukemia (AML) and 50 were classified as Acute Lymphocytic Leukemia (ALL). Sixteen cases remained unclassified by morphology. All the 200 cases were classified by flow cytometry, 126(63%) were diagnosed as AML, while 74(37%) of patients were identified as ALL. Of the ALL cases, 40(54.05%) patients were T-ALL and 34(45.95%) were B-ALL. CD13 and CD 117 were the mostly positive marker for AML. While for B-LL, CD20, CD34 and TdT, were positive and for TALL, CD19, TdT and CD10 were positive. Conclusion: Flow cytometric immunophenotyping could precisely delineate different forms of acute leukemia's, provide classification and is especially important for confirming cyto-morphologically undetermined acute leukemia's.