Director: Anand S. Lagoo, MD, PhD

This Laboratory offers state of the art diagnostic services based on multiparameter flow cytometric analysis for patients with leukemia, lymphoma and related hematological disorders. CD4 cell counts for HIV patients are also performed. Last year the laboratory analyzed over 3500 clinical specimens. Special studies can be conducted by prior arrangement. Submitting a specimen: Submit blood, bone marrow, or FNA specimens in heparin tube. Solid tissue samples should be submitted in culture medium. Call the laboratory at 684-2725 to arrange for prepared tubes containing culture medium. Submit specimens directly to the Flow Cytometry Laboratory (Room 4345, Duke South, Purple Zone). Hours of operation: The laboratory accepts samples from 8 am to 5 pm, Monday through Friday, and is closed on holidays recognized by Duke University Medical Center. Contact: Kathy Perkinson, Technical Manager, Molecular Pathology, Department of Pathology, 919-684-5822.

FIG 1. A typical analysis of bone marrow involved by Acute Leukemia (Upper panel) compared to a normal bone marrow (lower panel) from another patient.

Clinical Flow Cytometry:
Peripheral blood, bone marrow, various body fluids, fine needle aspiration samples, and tissue biopsy samples can be analyzed utilizing flow cytometric techniques. Normal and abnormal cells in these samples are characterized based on the presence or absence of certain molecules on the cell surface or inside the cells. The samples are stained with a carefully designed panel of specific antibodies coupled to four different fluorescent dyes. The stained cells pass through two laser beams in the FACScaliber flow cytometry analyzers and the molecular signature of each cell is recorded as the intensity of fluorescence for each of the four colors. Our highly trained and experienced staff of five technologists then perform sophisticated computer analysis of the data acquired on each sample. The final diagnostic interpretation is rendered by a hematopathologist after correlation with morphological findings.

The Flow Cytometry Laboratory is a vital part of our comprehensive approach to the diagnosis of hematological and lymphoid malignancies. A diagnosis is provided based on all available material and additional tests are suggested when necessary. Conversely, when flow cytometric analysis is unlikely to yield useful diagnostic or prognostic information for the patients condition, the submitting clinician is so advised. Samples with very limited number of cells are handled to optimize diagnostic information. Recurrent disease and minimal residual disease can be identified accurately as experts in the laboratory correlate clinical findings and previous flow cytometry results.

FIG 2. An apparently normal appearing bone marrow (left panel) is shown to contain a small monoclonal B-cell population (right panel, green colored dots) indicating involvement by lymphoma.

In 2003 the laboratory performed leukemia / lymphoma phenotype analyses on over 1250 bone marrows, 225 blood samples, 200 tissue biopsies, 150 fine needle aspirations, and 60 body fluid including cerebrospinal fluid (CSF). In addition, over 1600 blood samples were analyzed to enumerate the CD4 cells in HIV patients.