Laboratory diagnostic review of chronic myeloproliferative neoplasms at a pathology practice in Kenya

Abstract

Myeloproliferative neoplasm is a term used to classify tumours of the haemopoietic and lymphoid systems. Chronic myeloid leukaemia (CML) is the most common subtype. The diagnosis of chronic myeloproliferative neoplasms (CMN) is dependent on laboratory confirmation which includes peripheral blood and bone marrow testing as well as molecular studies. Methods Data was collated from our laboratory information system over a period of 4 years from September 2009 to September 2013. Data was abstracted into frequency tables to obtain summary and descriptive statistics. Results A total of 1455 bone marrow procedures were conducted over the study period. Of these 107 (7%) were CMN. The most common CMN was CML (67%), followed by myelofibrosis (21%). Only 33 (46%) patients with suspected CML had a confirmatory BCR-ABL assay done with 27 positive. JAK 2 mutational analysis was done in 4% of patients. Conclusion As expected CML remains the most common CMN. Comprehensive assessment of all CMN is important for accurate diagnosis and to inform management. Unfortunately, although PCR for BCR-ABL and JAK2 mutation analysis have greatly improved the accuracy of evaluation of CMNs, theses tests are not optimally used. Increased clinician sensitisation is needed to ensure all patients with suspected CMN undergo sufficient laboratory evaluation.