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Leukemia is a group of hematologic malignancies characterized by the proliferation of abnormal lymphoid or hematopoietic cells in the bone marrow and frequent involvement of peripheral blood and other organs. Leukemia can be classified as acute or chronic based on its rate of progression and specified as one of the many subtypes with other information incorporated according to the WHO classification. Common leukemias include acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, and chronic myeloid leukemia. With the tremendous improvement in instrumentation and reagents during the past several decades, flow cytometry has become a powerful immunophenotyping tool, and plays a critically important role in the diagnosis of various leukemias. Flow cytometry can quickly identify the abnormal cell population, characterize its phenotype, give lineage classification, make the diagnosis, or narrow down the differential list. It can also assess the clonality of a mature B-cell or T-cell population, and determine DNA ploidy, which is also very useful for making diagnosis or predicting prognosis. Correlation with morphology, clinical information, and sometimes cytogenetic/molecular findings is always necessary for accurate interpretation of flow cytometry results. This chapter provides an overview of the principles and the significant roles of flow cytometry in the diagnosis of leukemias.
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