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Flow cytometric principles in hematopathology.

By Kussick S.J.

Dr. Kussick authored the chapter "Flow Cytometric Principles in Hematopathology" in Hematopathology, 2nd Edition, ed. by E. Hsi, series ed. J.R. Goldblum. Philadelphia, PA, Saunders, Elsevier, Chapter 23, 2012. This chapter is divided into five major sections. 

The first section, entitled "Technical Concepts and Methods in the Flow Cytometric Evaluation of Hematolymphoid Neoplasms" describes the basic methodology of clinical flow cytometry.  Topics include the components of a flow cytometer, the clinical indications for flow cytometry, specimen requirements, specimen processing, instrument configuration, antibody panel design, spectral compensation, data acquisition, data analysis, data reporting, and quality control. 

The second section, on B-lymphoid neoplasms, describes normal B cell maturation in the bone marrow, and then describes the majority of precursor B-lymphoid neoplasms and mature B-lymphoid neoplasms recognized by the 2008 WHO classification system.  There is a detailed figure demonstrating normal B cell maturation in detail, and additional figures showing precursor B-lymphoblastic leukemia/lymphoma, chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, hairy cell leukemia, and Burkitt lymphoma. 

The third section describes plasma cell neoplasms and displays the flow histograms from two cases with significantly different immunophenotypes. 

The fourth section, on T-lymphoid neoplasms, describes normal T cell maturation in the thymus, and illustrates the immunophenotype of normal peripheral T cells.  The chapter then describes T-lymphoblastic leukemia/lymphoma, followed by the majority of mature T cell neoplasms recognized by the WHO classification system.  The figures depict normal T cells in the thymus and marrow, plus precursor t-lymphoblastic leukemia/lymphoma, T cell prolymphocytic leukemia, angioimmunoblastic T cell lymphoma, anaplastic large cell lymphoma, and aggressive natural killer cell leukemia. 

The fifth and final major section, on myeloid neoplasms, describes both normal and benign/regenerative myeloid maturation in the bone marrow.  This section then describes antigenic abnormalities identified in myelodysplastic syndromes and chronic myeloproliferative neoplasms, followed by descriptions of the typical immunophenotypes of the major cytogenetically defined AMLs.  The final part of this section describes paroxysmal nocturnal hemoglobinuria (PNH).

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