Evaluation of laboratory investigative methods of diagnosing clonal hematological disorders in a resource-poor setting.

Background: The successful treatment of patients with clonal hematological disorders (CHDs) depends largely on making an accurate diagnosis, which is, in turn, is dependent on performing specific diagnostic tests that are necessary.

Objectives: This study assessed the laboratory investigative methods of diagnosing CHDs with regard to the specific required tests (SRTs) that were needed to make a final diagnosis in a center with limited resources.

Methods: This is a descriptive hospital-based retrospective study. For the study, data about laboratory investigation details of adults diagnosed with CHDs from 1995 to 2015 were retrieved. The SRTs were determined and data analyzed using SPSS version 20.

Results: A total of 129 case notes of adults in the age range of 18-80 years, diagnosed with CHDs, were used. Out of the 671 SRTs needed for diagnosis, only 304 (45.3%) were conducted. When an SRT was requested to be done within the treatment facility, the patients were significantly more likely to do it in comparison with when they were requested to get it done from an external referral laboratory. All the patients with aplastic anemia (AA) and paroxysmal nocturnal hemoglobinuria (PNH) had all (100%) their SRTs done while patients with non-Hodgkin's lymphoma (NHL) had the least (15.3%) of their SRTs done. Full blood count (FBC) was the most frequently used (n = 129; 100%) SRT for diagnosis while immunophenotyping (IMPT) was the least (n = 4; 8.3%) used SRT.

Conclusion: Most of our patients had CHD diagnosis without the complete SRT, and this may cast doubt on the accuracy of diagnosis. Therefore, there is a crucial need for availability of more comprehensive laboratory services, especially in government-owned hospitals.